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PubMed2003

Tooth loss and dentures: patients' perspectives.

OBJECTIVE: Despite dramatic improvements in tooth retention around the world, a substantial proportion of older adults have lost natural teeth and many wear removable partial and complete dentures. Problems associated with tooth loss and denture wearing remain important in the context of global ageing. The purpose of this paper is to examine the effects of tooth loss and denture wearing on their day-to-day lives from the patient perspective. DESIGN: Cross-sectional study. SETTING: Greater Boston area, USA. PARTICIPANTS: Community-dwelling older men. METHODS: Brief examination and survey. MAIN OUTCOME MEASURES: Self-reported oral health measures including the single-item self-rating of oral health, the Oral Health Impact Profile (OHIP), the Geriatric Oral Health Assessment Index (GOHAI), Oral-Health-related Quality of Life (OHQOL) and a newly-developed short-form instrument (the DELTA). RESULTS: Men with > or = 25 teeth had better self-rated oral health by all measures. The new, brief DELTA differentiates between dentition/denture groupings as well as or better than existing instruments. Over 80% of men with > or = 25 teeth rated their oral health as excellent, very good or good, compared with 70% of men with no teeth (and dentures) and 54% of men with 1-24 teeth. Avoidance of certain foods discriminates well between dentition groups. To a lesser extent, difficulty with relaxation, pain and distress, and avoidance of going out are associated with tooth loss and/or denture wearing.

Aged↗
PubMed2005

Abrasion of human enamel and dentine caused by toothpastes of differing abrasivity determined using an in situ wear model.

OBJECTIVES: To determine the rates of enamel and dentine wear in situ during tooth brushing with a range of five toothpastes of differing RDA and REA values. METHODS: Enamel/dentine inserts were placed in the buccal aspects of full upper dentures of human volunteers. Enamel wear was determined by change in Knoop indent length and dentine wear was determined from the enamel-dentine step height, measured using optical profilometry. RESULTS: Significant differences between the test products were found for both enamel and dentine (p < 0.05). However for the conventional toothpastes the rate of wear was similar and differences between the products were not generally statistically significant for either enamel or dentine, despite the fact that their RDA values differed by more than a factor of two. The rate of wear was found to decrease throughout the duration of the study. CONCLUSIONS: The study demonstrated that the methodology used is capable of assessing enamel and dentine wear in situ within a relatively short period of time. The data suggest that whilst in vitro tests have value in understanding differences in abrasivity between products, they cannot be used to predict in vivo effects.

Adult↗
PubMed2005

Analysis of dental attrition and mortality in the Medieval village of Tirup, Denmark.

New directions and new questions raised in the study of health in the past justify this reanalysis of the pattern of dental attrition in the Medieval Danish population of Tirup. Dental attrition was scored on all permanent molars from the Tirup skeletal sample. Scores were analyzed by means of logistic regression of the probability of having entered a given stage of wear for a given tooth in a way that is very similar to transition analysis. The primary determinant of dental attrition was age at death. In addition to age, the effects of sex, side, and dating were analyzed. In order to assess the homogeneity of the process of wearing teeth down, a third-order polynomial in age-at-death was also fitted to the transition probabilities. It was found that age is the single most important determinant of dental attrition, and that sex or side did not differentiate the rate of attrition. In several transitions, there was evidence of heterogeneity, indicating both random and systematic interpersonal differences in the rate of attrition and an association between the rate of attrition and age-at-death. It was found that attrition proceeded more quickly after AD 1300 than prior to that date. It is suggested that this was due to a possible general deterioration of living conditions in Northern Europe and an increased reliance on grain for food during the first half of the 14th century. The temporal effect on attrition rate accounts for some but not all the observed heterogeneity wear.

Age Factors↗
PubMed2006

Epidemiological evaluation of the multifactorial aetiology of abfractions.

The purpose of this study was to determine risk indicators for the aetiology of abfractions (cervical wedge-shaped defects) on teeth using dental and medical variables obtained in a population-based sample of the cross-sectional epidemiological 'Study of Health in Pomerania' (SHIP). Medical history, dental, and sociodemographic parameters of 2707 representatively selected subjects 20-59 years of age with more than four natural teeth were checked for associations with the occurrence of abfractions using a two-level logistic regression model on a tooth and a subject level. The estimated prevalence of developing abfractions generally increased with age. The following independent variables were associated with the occurrence of abfractions: buccal recession of the gingiva, odds ratio (OR) = 6.7; occlusal wear facets of scores 1, 2 and 3, OR = 1.5, 1.9, 1.9; tilted teeth, OR = 1.4; inlays, OR = 1.6; toothbrushing behaviour, OR = 1.9 to 2.0 (two and three times a day versus once a day). First premolars had the highest estimated risk for developing abfractions, followed by the second premolars. Maxillary and mandibular teeth behaved similarly in terms of abfractions, with the exception of mandibular canines, which had a much lower estimated risk of incurring abfractions than did maxillary canines. The results of this analysis indicated that abfractions are associated with occlusal factors, like occlusal wear, inlay restorations, altered tooth position and tooth brushing behaviour. This study delivers further evidence for a multifactorial aetiology of abfractions.

Adult↗
PubMed2004

Novel porcelain laminate preparation approach driven by a diagnostic mock-up.

UNLABELLED: One critical step in the porcelain laminate technique is the achievement of sufficient ceramic thickness. At least two different strategies for tooth preparation can be found in the literature: (1) earlier simplified techniques included the use of depth cutters guided by the existing tooth surface-however, that approach did not take into consideration alterations of the tooth owing to aging, wear, or loss of enamel and thus led to greater risks for dentin exposures; (2) more recent and sophisticated methods have integrated an additive diagnostic procedure (ie, wax-up or mock-up) to compensate for tooth aging or severe existing loss of tooth substance. This approach allows for more enamel preservation and, as a consequence, more predictable bonding, biomechanics, and esthetics. The present article illustrates in detail the latest development in tooth preparation for porcelain laminates. This technique combines the time efficiency of earliest methods with the rationale and diagnostic foundations of the more recent techniques. CLINICAL SIGNIFICANCE: Using this new laminate porcelain preparation approach, clinicians should be able to produce not only more accurate preparations, but also higher-quality tooth preparations in a time-efficient fashion.

Composite Resins↗
PubMed2004

The measurement of degradation and wear of three glass ionomers following peroxide bleaching.

OBJECTIVES: To investigate, for three glass ionomer dental materials, the effects of a hydrogen peroxide solution on the elution of key elements, and the effects of a novel 6% hydrogen peroxide tooth whitening gel on subsequent wear rates with a toothpaste slurry. METHODS: Discs specimens of three glass ionomers (ChemFlex, Fuji II and Ketac-Fil) were prepared. One set of discs was exposed to either 6% hydrogen peroxide in phosphate buffer, phosphate buffer, water, a carbonated beverage or 38% orthophosphoric acid for 60 min. The ions eluted from the discs were determined by inductively coupled plasma-optical emmision spectroscopy. A second set of discs were conditioned with either a 6% hydrogen peroxide gel (30 min), water (30 min), a carbonated beverage (2 min) or 38% orthophosphoric acid gel (2 min) followed by a three-body abrasive wear treatment (2 min) with a toothpaste slurry. Changes in height of the samples were measured with a digital comparitor. The conditioning and abrasive cycles were repeated thirteen times. RESULTS: For the elution study, the solutions gave only minor release of sodium except orthophosphoric acid which showed increased elution levels of aluminium, silicon and sodium ions. For the wear study, the orthophosphoric acid gave the highest level of wear whilst for the other treatments there were no statistical significant differences in the level of wear (one-way ANOVA). CONCLUSIONS: A 6% hydrogen peroxide solution did not cause significant dissolution, and a novel 6% hydrogen peroxide tooth whitening gel did not significantly increase the three-body wear rate of any of the materials tested.

Aluminum↗
PubMed1990

Dentin dysplasia type II: absence of type III collagen in dentin.

A three-generation family with dentin dysplasia (DD) Type II is presented. Affected family members share common radiologic features with clinically varied expression of tooth discoloration and occlusal wear. Both the primary and the permanent dentition appear to be affected. No generalized connective tissue involvement is found. The mode of inheritance is autosomal dominant. Histologically, the findings are consistent with DD Type II. In indirect immunofluorescence, the irregular radicular dentin of an affected permanent tooth failed to stain with specific antibodies against Type III collagen and the N-terminal propeptide of Type III procollagen.

Collagen↗
PubMed2003

A solution to the worn tooth conundrum in primate functional anatomy.

Worn teeth are a bane to paleobiologists interested in the diets of human ancestors and other fossil primates. Although worn teeth dominate fossil assemblages, their shapes are usually not used to reconstruct the diets of extinct species. The problem is that traditional studies of primate dental functional anatomy have focused on unworn morphology. This has limited most functional analyses to only a few well-represented fossil species. This paper introduces a method to characterize and compare worn occlusal morphology in primates using laser scanning and geographic information systems technologies. A study of variably worn chimpanzee and gorilla molars indicates that differences between these species in tooth shape remain consistent at given stages of wear. Although cusp slope decreases with wear in both taxa, angularity values remain unchanged. These results indicate that African ape teeth wear in a manner that keeps them mechanically efficient for fracturing specific foods. Studies of changes in tooth shape with wear add a new dimension to dental functional anatomy, and offer a more complete picture of dental-dietary adaptations. Also, given how rare unworn teeth are in the fossil record, the ability to include worn specimens in analyses opens the door to reconstructing the diets of many more extinct primate groups, allowing us to better understand the adaptive radiation of our order.

Analysis of Variance↗
PubMed1989

Dental pathologies in ten free-ranging chimpanzees from Gombe National Park, Tanzania.

The dental remains of ten adult chimpanzees from Gombe National Park, Tanzania, were examined for enamel attrition, caries, abscesses, periodontal disease, and tooth loss. Age was the underlying factor in the development of dental pathology, in that enamel wear was present to some extent in all ten but was uniformly severe only in the three for whom estimated age at death was 39-43 years. In turn, enamel wear appears to have been the direct cause of abscess development, periodontal disease, and tooth loss. Periodontal disease was commonly expressed as alveolar resorption, particularly around the premolars and molars. This involvement was variable in all except the two youngest. Some interesting wear patterns were evident in the form of deep grooves in the upper incisors and dramatic notching of the lower canines. These patterns, and enamel attrition in general, were attributed to normal mastication and to various stripping activities. Only one carious lesion was observed, in a male with an estimated age of 26 years. An accurate assessment of the actual prevalence of caries was obscured by enamel wear and tooth loss in the older individuals.

Age Factors↗
PubMed2003

[Comparative study of friction and wear behavior of different human enamel in vitro].

OBJECTIVE: To investigate the friction and wear behavior of different human enamels. METHODS: 24 enamel samples selected from aged, young permanent and faded deciduous teeth were classified into 3 groups and slid against artificial porcelain teeth in the presence of artificial saliva on an oscillating friction and wear test rig. The wear volume loss, microhardness and toughness of each group of the enamel specimens were measured, the wear scars were observed with a scanning electron microscope, and the elemental compositions of Ca, P, and Si of the wear scar and wear debris were determined with an energy dispersion spectrometer. RESULTS: The wear volume losses of aged, young permanent and deciduous tooth enamels are (2.40 +/- 1.10) x 10(-12) m(3), (3.50 +/- 1.83) x 10(-12) m(3) and (4.86 +/- 2.49) x 10(-12) m(3). The data of aged tooth enamels are statistically greater than that of deciduous tooth enamels (P < 0.05). There is no significant difference between the wear volume loss of aged and young permanent tooth enamels or between the young permanent and deciduous tooth enamels (P > 0.05). However, the friction and wear behavior of each group of enamel specimens is different from each other. CONCLUSIONS: In the present testing condition, the wear scars of each kind of enamel specimens is characterized by ploughing and cracking. The different wear resistance of the three kinds of enamels is attributed to the different microstructure of the enamel, while the hardness and toughness of the enamels are not correlated with the wear resistance.

Adolescent↗
PubMed1998

Clinical morbidity and sequelae of treatment with complete dentures.

Wearing complete dentures may have adverse effects on the health of both the oral and the denture-supporting tissues. This article is a review of selected literature on the sequelae of treatment with complete dentures in the specific areas of residual ridge resorption, mucosal reactions, burning mouth syndrome, temporomandibular disorders, and patient satisfaction. Recent literature found with a Medline search from 1952 to 1996 is included in this review. Residual ridge resorption is an inevitable consequence of tooth loss and denture wearing, with no dominant causative factor having been found. Mucosal reactions have a multifactorial cause, most of which can be easily treated. Most patients are satisfied with their complete dentures. Correlations between anatomic conditions and denture quality and patient satisfaction are weak. Psychologic factors seem to be extremely important in the acceptance of and adaptation to removable dentures. There are still no reliable methods to predict the outcome of complete denture treatment and there are many problems related to treatment with complete dentures. Although the prevalence of an edentulous condition is decreasing, the great number of edentulous people warrants the continuing efforts of basic and clinical research on removable partial dentures. Complete denture prosthodontics will remain an important part of dental education and practice. In addition to clinical and technical skills, insight into patient behavior and psychology and communication techniques are also necessary.

Adaptation, Physiological↗
PubMed1990

[In vivo wear test for posterior composites. 1. Development of wear test predicting composite wear in vivo].

A wear test method based on a new concept was developed for predicting the wear rate of posterior composite restorations in vivo. The concept based on the conclusions derived from our clinical tests on posterior composites that composite restorations would be deteriorated chemically and by repeated compressive stress as well as by abrasion by food passing during mastication. New wear tests were performed on several posterior restorative materials under various conditions to compare the effect of abrasion using the tooth-brush. The results of wear rate using the present test on specimens stored in a 0.1 N-NaOH solution (37 degrees C) for 6 days were parallel to those measured in clinical tests. However, the abrasion test results obtained using a tooth-brush on deteriorated specimens did not match the clinical data. These findings suggested that degradation or aging of specimens and repeated compressive stress are necessary for the wear test to simulate the wear of posterior composites in vivo.

Composite Resins↗
PubMedDate not supplied

Erosion and attrition of human enamel in vitro part I: interaction effects.

OBJECTIVE: The aim of the study in vitro was to measure the interplay of attrition and erosion of human enamel under several different pH conditions. MATERIALS AND METHODS: Cusp and smooth surface enamel specimens were prepared from unerupted human third molar teeth. Cusp and smooth surface specimens opposed each other in a wear machine under a load of 600 g. The machine simulated tooth grinding for 30 min (2280 wear cycles). Six groups of 10 specimens were worn in the following environmental conditions: saline, citric acid at pH values of 3.2, 5.5 or 7.0 and two cycling groups (pH 3.2/saline or saline/pH 3.2). Additionally, 10 smooth surface specimens were exposed to the same fluids without attrition. Tissue loss on smooth surface specimens was determined by profilometry. The worn specimen surfaces were studied by SEM. RESULTS: Attrition depth in saline and pH 7.0 citric acid was 25.5 microm. At pH 3.2 and 5.5 attrition depths were 6.0 and 4.3 microm, respectively. Cycling in saline/citric acid and vice versa produced attrition depths of 9.2 and 7.9 microm, respectively. In the erosion only specimens lesion depths were 3.0, 1.2 and 0 microm at pH 3.2, 5.5 and 7.0 and saline, respectively. Attrition specimens at pH 7.0 and in saline showed very rough surfaces. At low pH enamel surfaces appeared flat and smooth. CONCLUSIONS: Enamel wear in neutral conditions is significantly higher than in acidic conditions (p < 0.05), apparently due to a smoothing effect of erosion on contacting surfaces.

Adolescent↗
PubMed1998

Factors affecting the lifespan of the human dentition in Britain prior to the seventeenth century.

OBJECTIVE: To confirm that compensatory eruption (supereruption) of teeth past a stable periodontium occurs in response to severe occlusal attrition. DESIGN: Regression analysis study from radiographs and direct measurements. SETTING: Archaeological material at the University of Aberdeen. SUBJECTS: 47 individuals > 21 years old and dating from Late Mediaeval times (1300-1600 AD). MAIN OUTCOME MEASURES: Occlusal attrition was recorded on the first permanent mandibular molars. Measurements on radiographs of the teeth from the fixed point of the inferior dental canal were taken to the occlusal surface, the alveolar crest and the tooth apex. Regression analysis was undertaken between these variables and related to attrition (age). RESULTS: Continuous eruption of the permanent human dentition past a stable periodontium does occur in response to tooth height lost by wear, despite the fact that supereruption may lead to the eventual self destruction of the dentition. This mechanism was primarily responsible for the early loss (at 40-45 years of age) of dentitions in Mediaeval times. CONCLUSIONS: Stability of occlusal height appears to be an important function of the dentition and if triggered by severe wear will lead to increasing root exposure and eventual exfoliation of the teeth. It is important not to confuse bone loss due to periodontitis with root exposure due to supereruption of the teeth.

Adult↗
PubMed2003

A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures.

A longitudinal clinical trial involving 103 subjects was undertaken to assess the impact of oral implant therapy on the psychosocial well-being of subjects with complete denture wearing problems. There were four experimental groups: (1) an implant group, where subjects were edentulous/edentate in one jaw and requested and received implants to retain an oral prosthesis (IG); (2) subjects edentulous/edentate in one jaw requesting implants but who received conventional dentures (CDG1); (3) edentulous subjects requesting replacement of their dentures by conventional means (CDG2); (4) dentate subjects requiring routine treatment, who were included for comparison. Data were collected in each group pre- and post-treatment using validated oral specific [the Oral Health Impact Profile (OHIP)], and generic (the SF36) health status measures. Subjects in IG, CDG1 and CDG2 also completed a denture satisfaction scale. IG and CDG1 subjects reported that tooth loss and denture wearing problems had a much greater impact on their quality of life than subjects seeking conventional dentures. Dentate subjects had a much better oral health status compared with denture-wearing subjects. Following treatment, subjects who received implant-retained prostheses (IG) reported a significant improvement in satisfaction and health-related quality of life, as did subjects who requested and received conventional dentures (CDG2). Subjects who requested implants, but received conventional dentures (CDG1), reported little improvement in denture satisfaction and only modest improvement in their quality of life. None of the denture-wearing subjects reported health-related quality of life that was as good as that of dentate subjects. The findings have significant implications in the assessment of outcomes in future clinical trials.

Adult↗
PubMed1985

Occlusal wear. A follow-up study of 18 subjects with extensively worn dentitions.

Eighteen patients with moderate to severe dental wear were re-examined 6-10 years after a treatment period that included use of occlusal splints at night. The splints were used with various intensities for an average of 2 years. The methods of evaluation comprised a questionnaire, clinical examination, comparison of dental casts, salivary analysis, and bite force measurements. The changes in dental wear during the follow-up period were small, the typical finding being an increase of facets but no measurable reduction of tooth length. The results indicate that many variables apart from occlusal parafunctions, such as acid regurgitation and salivary and dietary factors, may contribute to loss of tooth substance diagnosed as dental wear. In most patients, the continuing wear process was slow after long-term treatment with occlusal splints.

Adolescent↗
PubMed1989

An indirect in vivo method for quantification of wear of denture teeth.

A method using a reflex microscope to undertake direct and highly precise three-dimensional measurements of denture casts for the purpose of mapping and determining the volumetric loss of material over a period of time has been developed. The wear that occurred in tooth 46 after clinical use for one year was measured and found to be 7.2 mm3. This technique has proved to be an accurate and objective quantification of what has previously often been a subjective impression.

Denture, Complete↗