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PubMed2002

Periodontal pathology associated with asymptomatic third molars.

PURPOSE: We report the prevalence of periodontal probing depth (PD) as a clinical measure of the extent of periodontitis associated with asymptomatic third molars at the initial examination in a cohort of patients enrolled in an institutional review board-approved longitudinal clinical trial. PATIENTS AND METHODS: Three hundred twenty-nine healthy patients were enrolled during a 30-month period. Full mouth periodontal probing that included third molars was conducted to determine periodontal status. Panoramic radiographs were taken to assess the degree of eruption of the third molars and the angulation of third molars compared with the adjacent second molar. Vertical bitewing radiographs were analyzed to detect alveolar bone levels relative to the cementoenamel junction on the distal of second molars. RESULTS: Twenty-five percent (82 of 329) of all enrolled patients, and 34% (14 of 41) of black patients, had at least one PD equal to or greater than 5 mm on the distal of a second molar or around a third molar. PD equal to or greater than 5 mm was associated with periodontal attachment loss of at least 1 mm in every patient; PD equal to or greater than 5 mm was associated with attachment loss equal to or greater than 2 mm in 80 of 82 patients. A higher proportion of patients 25 years old or older had a PD equal to or greater than 5 mm on the distal of second molars or around third molars compared with patients younger than 25 years (33% vs 17%, P =.002). The distals of second molars and third molars in the mandible were affected more often than in the maxilla (25% vs 5%, P =.0001). CONCLUSIONS: Our data indicating that 25% of patients with retained asymptomatic third molars have considerable periodontal pathology in the third molar region were unexpected. National epidemiologic surveys indicate a much lower rate of periodontitis in the population younger than 35 years.

Adolescent↗

PubMed1995

Radiographic alveolar bone loss from posterior teeth in young adults over a 4-year period.

The objective of this study was to determine alveolar bone loss from premolar and molar teeth in young adults over a 4-year period between the ages of 15-16 years and 19-20 years. Pairs of posterior bitewing radiographs from 382 subjects aged 15-16 years were examined and the height of the alveolar bone adjacent to mesial and distal tooth surfaces recorded. Repeat radiographs of the same individuals taken 4 years later were then examined and the height of the alveolar bone remeasured. Change in bone height over the study period was computed for individual sites. Clinical data for the cohort were also obtained at both examinations and included plaque score, bleeding on probing and probing depth. Of the 3314 sites, 16.7% exhibited bone gain, 4.5% exhibited no change whilst 78.8% demonstrated bone loss. The overall mean bone loss for all sites combined was 0.407 mm. Bone loss than 0.5 mm was found in 36% of sites, bone loss between 0.5 and 0.99 mm in 33% of sites whilst only 0.5% of sites had bone loss greater than 2 mm. Only one site had bone loss greater than 3 mm. Bone loss was affected significantly by subject (p < 0.001) and by site (p < 0.05) but there was no significant effect for tooth type, whether the surface was mesial or distal or between quadrants. There was significantly more bone loss from around maxillary teeth than mandibular (p < 0.05). There were no significant associations between bone loss and plaque score, bleeding on probing, pocket depth, gender or social class.

Adolescent↗

PubMed1984

Relationships between bitewing and periapical radiographs in assessing crestal alveolar bone levels.

Bitewing (BW) and periapical (PA) radiographic techniques are used in clinical and epidemiologic studies to assess crestal alveolar bone levels. Since there appeared to be no basis for choosing one technique over the other, the present study investigated relationships between these techniques by assessing alveolar crest location at the same site. BW and PA radiographs were available from posterior quadrants of 210 subjects. Individual radiographs were projected at a magnification x 5.9 using a Leitz Prado-Universal projector. The distance from the cemento-enamel junction to the alveolar crest (CEJ-CR) was measured for each proximal surface from the distal of the cuspid to the distal of the second molar. Data were arranged according to the proximal surface examined, and BW and PA measurements were compared using paired t tests. In addition, the degree of congruence of the two sets (BW/PA) of CEJ-CR measurements was evaluated through computation of the Pearson Correlation. The data showed significant differences between mean BW and PA measurements for 50% of the tooth surfaces, and this trend was consistent through maxillary and mandibular quadrants, and mesial and distal surfaces. In situations of a significant difference, the BW measurement was greater than the PA 94% of the time. The correlations between the two types of measurements showed low reliability. It was concluded that BW and PA techniques provided significantly different values in assessing crestal alveolar bone levels, and data generated by these techniques should not be used interchangeably on an individual or group basis.

Adult↗

PubMed1983

A method to reduce interproximal overlapping and improve reproducibility of bitewing radiographs for use in clinical trials.

To improve the quality of bitewing radiographs a Bite Registration Technique (BRT) was developed by modifying a commercially available Rinn XCP Instrument. The modification involved using a rubber impression material to register the subject's bite so that the subsequent replacement of the instrument in the mouth was guided by the registration indentations. A total of 240 radiographs were analysed to determine the frequency and severity of the overlapping and the degree of deviation in the horizontal angulation between the subsequent films. Approximately half the films were taken with BRT and the other half were taken with the unaltered Rinn SCP Instrument (without BRT). Two radiographs were taken of each side of the mouth. Only 11.6% of the proximal surfaces had more than half the enamel overlapped 'with BRT' compared with 33% 'without BRT'. In addition, when using the BRT, the initial and the subsequent radiographs of each child were more alike than 'without BRT'. Ninety percent were virtually identical; the mean difference in width of the largest overlap between the two films was 0.11 mm. To check the validity of these findings, 100 radiographs from a previously published clinical trial which used similar aged children and also used a Rinn SCP Instrument (modified), were analysed used the same criteria. The results obtained were similar to the 'without BRT' results; 30% of the proximal surfaces had more than half the enamel overlapped. Improved accuracy allowed a narrower X-ray beam to be used, thus reducing patient irradiation. The use of the Bite Registration Technique is recommended when a high degree of diagnostic accuracy is desired in clinical trials involving primary dentitions.

Child↗

PubMed1994

Efficacy of FDA guidelines for ordering radiographs for caries detection.

This study evaluated the effect on caries diagnosis of using the Food and Drug Administration (FDA) guidelines for ordering radiographs on a sample of new adult patients seeking general dental care at a dental school clinic. These guidelines recommend posterior bitewing views accompanied by supplemental periapical views as indicated by the patient's clinical signs or symptoms. We compared the findings from the use of this protocol to those from a full-mouth set of radiographs made on the same new patient. We examined 490 patients and ordered periapical radiographs in accordance with the FDA guidelines, namely, when there was some clinical sign or symptom suggesting the need for radiographs. A full-mouth set of radiographs was obtained, and both the full and selected sets were evaluated separately. We found that 95% of our patients had one or more carious lesions, with an average of 5.7 carious teeth per patient. Of the 2808 carious teeth detected in the study, 1949 (69%) were found radiographically and 1564 (56%) were found clinically. Indeed, 1244 (44%) of the carious teeth were detected only by radiographic examination. Use of the FDA guidelines resulted in a 43% reduction in the number of radiographs ordered. Reduction in the number of images made on patients resulted in failure to detect 93 lesions (3.3%) located on 88 teeth in 11.4% of the study patients. Most of the missed lesions (2.9%) were radiographically confined to the enamel of anterior maxillary teeth. Only 36 of the missed lesions (1.6% of all radiographic lesions) extended into the dentin. We believe that this number is very small and most likely inconsequential compared with the considerable diversity among dentists regarding radiographic detection of caries, as well as the diversity of opinion regarding the indications for restorative treatment.

Adolescent↗

PubMed2005

Tobacco smoking and vertical periodontal bone loss.

Cigarette smoking is associated with increased prevalence and severity of destructive periodontal disease in terms of periodontal pocketing, periodontal bone loss, and tooth loss. The smoking destructive effect on periodontal bone may be of even "horizontal" and vertical "angular" pattern. The vertical bone loss or the "vertical defect" is a sign of progressive periodontal breakdown that involves the periodontal bone. Water pipe smoking has a sharp rise by the popularity in the recent years by men and women in Middle East countries. The general objective of this thesis was to investigate the relationship between tobacco smoking and vertical periodontal bone loss cross-sectionally and longitudinally. This thesis is based on two study populations, Swedish musicians and a Saudi Arabian population. All participants had a full set of intra-oral radiographs including 16 periapical and 4 bitewing projections that were assessed with regard to presence or absence of vertical defects. In Study I, the number of defects per person increased with age. Vertical defects were more common in the posterior as compared to the anterior region of the dentition and the distribution of defects within the maxilla as well as the mandible typically revealed a right-left hand side symmetry. Cigarette smoking was significantly associated with the prevalence and severity of vertical bone defects (Studies II and III). The relative risk associated with cigarette smoking was 2 to 3-fold increased. The impact of water pipe smoking was of the same magnitude as that of cigarette smoking and the relative risk associated with water pipe smoking was 6-fold increased compared to non-smoking. In addition, the risk of vertical defects increased with increased exposure in cigarette smokers as well as water pipe smokers (Study III). In Study IV, the proportion of vertical defects increased over a 10-year period and the increase over time was significantly associated with smoking. Moreover, the 10-year vertical bone loss was significantly greater in heavy exposure smokers than in light exposure smokers suggesting an exposure-response effect of smoking. Compared to non-smokers the 10-year relative risk was 2.4-fold increased in light exposure smokers and 5.8-fold increased in heavy exposure smokers. In conclusion, the present observations indicate that there is a significant relationship between tobacco smoking and vertical periodontal bone loss. Tobacco smoking should be considered a risk factor for periodontal vertical bone loss.

Adult↗

PubMed2005

Radiographic study of the prevalence of periodontal bone loss in Australian school-aged children attending the Royal Dental Hospital of Melbourne.

OBJECTIVES: To investigate the prevalence of alveolar bone loss around the first permanent molars, and first and second deciduous molars in Australian school-aged children attending the Royal Dental Hospital of Melbourne. METHOD: Nine hundred and ninety-five records were examined for useable bitewing radiographs. From these, radiographs of 542 Australian school children aged 5-12 years were used. The cervical-enamel junction (CEJ) to the alveolar bone crest (ABC) distance was measured using the transparent ruler on the magnifier. Each inter-dental site that was readable was scored as one for the following categories: not available (NA); no bone loss (NBL)- the CEJ-ABC was < or =2 mm; questionable bone loss (QBL): the distance from the CEJ-ABC was >2 and <3 mm; and definite bone loss (DBL): the distance from the CEJ to ABC was > or =3 mm. RESULTS: Seventy-one children (13.0%) were found to have 83 DBL sites, as determined by bone levels >3.0 mm from the CEJ. Seventy children had QBL lesions only, 50 children had DBL only and 21 children had both. The overall prevalence of bone loss was 26%. Second deciduous molars were found to be the most affected teeth with almost 75% lesions being distal. These teeth comprised 50% of the DBL lesions. Children of Asian-Far Eastern origin had a higher percentage of sites with bone loss compared with children of Caucasian origin, being 29.5% and 19.7%, respectively, but lower than that of children of Middle-Eastern origin (35.2%). When the data were analysed with relation to age, there was no relationship between age and prevalence of bone loss. CONCLUSION: In the population studied, there was an overall prevalence of periodontal bone loss of 26% and DBL of 13% in an Australian school-aged group. Calculus was detected infrequently and, where present, was associated with bone loss.

Alveolar Bone Loss↗

PubMed1990

Prediction of efficacy of bitewing radiographs for caries detection.

Although bitewing (BW) radiographs play an indispensable role in the detection of interproximal caries, it is not always clear when they should be made. The present study was designed to test the hypothesis that a person's caries and restorative history may be predictive of his or her caries future. Full-mouth radiographic examinations (FMX) and subsequent BW radiographs from 349 adults (age 20 or more) selected at random were examined. Possible risk factors for caries recorded for each patient included the number and type of carious lesions and the restorative experience of the patient. Linear logistic regression models were evaluated to estimate the efficacy of the possible risk factors as predictors of the presence of caries on the BW radiographs. Of the 349 adults examined, 91 (26%) had one or more new carious lesions at the time of their BW examination. The probability of caries in this population at the time of the BW examination increases both with lengthening interval between the FMX and the BW radiographs and with the number of restorations at the time of FMX. A regression model was adopted that estimates the probability of caries being detected on BW radiographs. We found that to provide the most good for the most patients (minimize cost), the threshold level for ordering follow-up radiographs should be when the probability of detecting caries is 5%. It may be seen that even when a person has no caries or restorations at the time of the FMX there will be a 5% chance that BW radiographs will reveal the presence of caries 1.5 years later. The 5% threshold is reached sooner in the presence of caries or restorations.

Adult↗

PubMedDate not supplied

Progression of proximal caries in the mixed dentition: a 4-year prospective study.

PURPOSE: The purpose of this study was to investigate the survival rate and median survival time of different stages of proximal caries in 196 children aged 6 to 8 years at baseline examination. METHODS: Proximal caries and its progression were diagnosed from bitewing radiographs taken at 1-year intervals over a period of 4 years. The mesial surface of the first permanent molars, the mesial and distal surfaces of the first and second primary molars, and the distal surface of the primary canine were examined. Sound surfaces, caries lesions in the external- and internal-half of the enamel and external-, middle-, and internal-third of the dentin, as well as filled, extracted, and exfoliated teeth were recorded. A life table analysis was performed to estimate the annual and cumulative survival rates and the median survival time of each state of proximal lesions. RESULTS: For the sound mesial surfaces of the first permanent molars, the cumulative survival rate was 76% and the median survival time was over 48 months. The corresponding values for the external-half of the enamel lesions were 41% and 45 months. Regarding the sound mesial and distal surfaces of the primary teeth, the cumulative survival rate was 92% and the median survival time was over 48 months. The corresponding values for the external and internal-half of the enamel lesions were 40% and 31 months, and 29% and 22 months, respectively. The value of the cumulative survival rate for the external-third of dentin lesions was 42%, with a median survival time of 34 months, and the value for the middle-third of the dentin was 38% with a median survival time of 17 months. CONCLUSIONS: The risk of developing carious lesions in the sound proximal surfaces of both primary teeth and first permanent molars is low during the mixed dentition period; the progression of the external-half of enamel lesions of the first permanent molars is low for the first 3 years and becomes faster thereafter; and as the time period that the tooth exposed to cariogenic factors increases, the progression of the proximal caries is faster for all stages of the lesion in the primary teeth.

Child↗

PubMed2006

Clinical reliability of the "furcation arrow" as a diagnostic marker.

BACKGROUND: The radiographic entity known as the "furcation arrow" has long been used in practice even though little is known about its usefulness as a clinical indicator. The definitive study of the furcation arrow suggests that its presence on a radiograph reliably predicts furcation invasion, but this has not been confirmed in an in vivo investigation. The purpose of this study was to evaluate the furcation arrow in a clinical setting, testing the assertion that the furcation arrow image is an accurate predictor of furcation invasion. Specifically, we sought to determine the following. First, what is the prevalence of furcation arrow images in the radiographs of maxillary molars with periodontitis? Second, what is the interexaminer agreement on what constitutes a furcation arrow? Third, how does the presence or absence of a furcation arrow correlate with the true clinical status of the furcation? Fourth, what is the sensitivity and specificity of the furcation arrow as a diagnostic indicator? METHODS: Eighty-nine patients requiring surgical treatment of periodontitis in the maxillary molar regions were included in this study. Before surgery, one of five calibrated examiners viewed periapical and bitewing radiographs of the surgical site and recorded the presence or absence of a furcation arrow at each proximal furcation. Before administering anesthesia, the same examiner recorded a Hamp index value of each proximal furcation, with a second Hamp index taken after flap reflection and debridement. After surgery, each of the four remaining examiners independently reviewed the radiographs for furcation arrows. Descriptive statistical analysis was performed to correlate the appearance of the furcation arrow image to the actual degree of furcation invasion as determined by the intrasurgical Hamp index. RESULTS: A total of 164 maxillary molars were examined, providing 328 interproximal furcations; 111 (33.8%) furcations were determined at surgical debridement to have a furcation invasion of Hamp degree 1 or greater. Of the 111 furcation invasions, 43 (38.7%) were predicted by a furcation arrow image seen by at least three of the five examiners. When comparing the appearance of the radiographic image to the extent of furcation invasion, 20 of 64 (31.3%) Hamp 1 furcation invasions and 23 of 47 (48.9%) Hamp 2 and 3 furcation invasions were predicted by furcation arrows observed by at least three of five examiners. The multirater kappa statistic for interexaminer agreement on the presence or absence of the image was 0.489. The sensitivity of the furcation arrow image as a diagnostic marker was 38.7%, and the specificity was 92.2%; the positive predictive value of the image was 71.7%, and the negative predictive value was 74.6%. Of the 324 furcations used to compare clinical indices, the agreement of preanesthesia and postdebridement Hamp indices was 0% for degree 3, 83.7% for degree 2, and 98.4% for degree 1 furcation lesions. CONCLUSIONS: These data suggest that the furcation arrow has limited usefulness as a diagnostic marker of furcation invasion. The image is difficult to interpret and highly subjective and can correctly predict furcation invasions only approximately 70% of the time when present on the radiograph. In addition, when furcation invasions are truly present, the furcation arrow is seen in <40% of sites.

Furcation Defects↗