Carious lesions are distributed nonuniformly across tooth surfaces of the complete dentition, suggesting that the effects of risk factors may be surface-specific. Whether genes differentially affect caries risk across tooth surfaces is unknown. We investigated the role of genetics on two classes of tooth surfaces, pit and fissure surfaces (PFS) and smooth surfaces (SMS), in more than 2,600 subjects from 740 families. Participants were examined for surface-level evidence of dental caries, and caries scores for permanent and/or primary teeth were generated separately for PFS and SMS. Heritability estimates (h2, i.e. the proportion of trait variation due to genes) of PFS and SMS caries scores were obtained using likelihood methods. The genetic correlations between PFS and SMS caries scores were calculated to assess the degree to which traits covary due to common genetic effects. Overall, the heritability of caries scores was similar for PFS (h2 = 19–53%; p < 0.001) and SMS (h2 = 17–42%; p < 0.001). Heritability of caries scores for both PFS and SMS in the primary dentition was greater than in the permanent dentition and total dentition. With one exception, the genetic correlation between PFS and SMS caries scores was not significantly different from 100%, indicating that (mostly) common genes are involved in the risk of caries for both surface types. Genetic correlation for the primary dentition dfs (decay + filled surfaces) was significantly less than 100% (p < 0.001), indicating that genetic factors may exert differential effects on caries risk in PFS versus SMS in the primary dentition.
Dental caries; Genetic correlation; Genetics; Heritability; Permanent dentition; Pit and fissure surfaces; Primary dentition; Smooth surfaces
Purpose. To evaluate the prevalence and reasons for teeth extractions in a sample from a dental clinic in Brazil. Methods. The prevalence of teeth mortality was analyzed by gender, age, tooth type and reasons for extraction on 800 teeth of 439 subjects, whose data was collected in clinical records in a convenience sample. Results. The groups with range from 35 to 44 years, 45 to 54 years and 55 to 64 years revealed significantly greater number of teeth extractions than other age groups (P < 0.0001). The anterior teeth loss increased significantly with aging, while the tooth mortality of premolar and molar were higher in younger people. The caries was the more prevalent reason for tooth mortality among young and adults up to 44 years old, while the periodontal disease was the main reason for extractions from 45 years old until range of 81 years (P < 0.0001). Conclusions. It can be suggested that some reasons for tooth loss were age-dependent, but the caries and the periodontal diseases were the main reasons for tooth mortality in this Brazilian sample.
A supernumerary tooth is that which is present additionally to the normal series and can be found in any region of the dental arch. An impacted tooth is defined as the one which is embedded in the alveolus, so that its eruption is prevented, or the tooth is locked in position by bone or the adjacent teeth. The occurrence of multiple supernumerary teeth in only one patient in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. The occurrence of supernumerary teeth in the lower molar region is rare. A prevalence of less than 2% of cases occurring in this region has been estimated. Their occurrence presents a clinical problem for orthodontists and oral surgeons. The cause, frequency, complications, and surgical operation of impacted teeth are always interesting subjects for study and research. An impacted tooth can result in caries, pulp disease, periapical and periodontal disease, temporomandibular joint disorder, infection of the fascial space, root resorption of the adjacent tooth, and even oral and maxillofacial tumours. The management of impacted wisdom teeth has changed over the past 20 years from removal of nonsymptomatic third molars to simple observation. The aim of this paper is to present a rare case of bilateral multiple impacted supernumerary mandibular third molars.
The objective was to study whether a Kiswahili version of the OIDP (Oral Impacts on Daily Performance) inventory was valid and reliable for use in a population of older adults in urban and rural areas of Tanzania; and to assess the area specific prevalence, intensity and perceived causes of OIDP.
A cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. A two-stage stratified cluster sample design was utilized. Information became available for 511 urban and 520 rural subjects (mean age 62.9 years) who were interviewed and participated in a full mouth clinical examination in their own homes.
The Kiswahili version of the weighted OIDP inventory preserved the overall concept of the original English version. Cronbach's alpha was 0.83 and 0.90 in urban and rural areas, respectively, and the OIDP inventory varied systematically in the expected direction with self-reported oral health measures. The respective prevalence of oral impacts was 51.2% and 62.1% in urban and rural areas. Problems with eating was the performance reported most frequently (42.5% in urban, 55.1% in rural) followed by cleaning teeth (18.2% in urban, 30.6% in rural). More than half of the urban and rural residents with impacts had very little, little and moderate impact intensity. The most frequently reported causes of impacts were toothache and loose teeth.
The Kiswahili OIDP inventory had acceptable psychometric properties among non-institutionalized adults 50 years and above in Tanzania. The impacts affecting their performances were relatively common but not very severe.
Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class). Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene) have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care.
stomatognathic system; elderly; oral disease; general health; xerostomia
The success of endodontic treatment is not only measured by the alleviation of pain and formation of healthy bone, replacing the diseased periapical tissue. Concepts for restoring pulpless teeth have been formed more from clinical observation than valid scientific investigation. Endodontically treated posterior teeth present numerous problems because of coronal destruction from dental caries, fractures, and previous restorations or endodontic techniques. The result is loss of tooth structure and a reduction in the capacity of the tooth to resist a myriad of intraoral forces. A summary of this review article suggests that coronal coverage significantly improves the clinical success rate of endodontically treated posterior teeth.
Dental caries; posterior teeth; pulpless teeth and coronal coverage
The objectives of the present study were to assess the prevalence rate of caries on individual permanent tooth surfaces, and to compare individual tooth surface caries rates among gender and age groups.
Without drying the teeth, examinations were performed with dental mirrors and blunt, sickle-shaped explorers under a dental chair light, according to WHO recommendations.
Caries distribution was higher in the maxillary jaw (62.4%) than in the mandibular jaw (37.6%). Except molars, approximal surfaces of all teeth demonstrated the highest caries rates, ranging from 58.5% to 77.5%. Occlusal fissures on the first and second molars contributed most significantly to caries frequency, from 52.7% to 66.3%. Females (59.1%) showed a higher incidence of caries than males (40.9%). Approximal surfaces of incisors, canines, premolars and occlusal fissure sites in molars showed the highest caries rates in both sexes. Caries were most common among individuals aged 17 to 25 years. Approximal surfaces of incisors, canines, premolars and occlusal surfaces in molars had the highest caries rates in all age groups, except for individuals older than 65 years of age.
Gender and age do not affect the prevalence of caries on teeth sites. In addition, more caries are experienced in younger age groups, and their incidence decreases as age increases.
Age; Dental caries; Gender; Tooth surface
Dental research gives rise to data with potentially complex correlation structure. Assessments of dental caries yields a binary outcome indicating the presence or absence of caries experience for each surface of each tooth in a subject’s mouth. In addition to this nesting, caries outcome exhibit spatial structure among neighboring teeth. We develop a Bayesian multivariate model for spatial binary data using random effects autologistic regression that controls for the correlation within tooth surfaces and spatial correlation among neighboring teeth. Using a sample from a clinical study conducted at the Medical University of South Carolina, we compare this autologistic model with covariates to alternative models to demonstrate the improvement in predictions and also to assess the effects of covariates on caries experience.
autologistic; binary; caries; MCMC; spatial; WinBUGS
Over 90% of adults aged 20 years or older with permanent teeth have suffered from dental caries leading to pain, infection, or even tooth loss. Although caries prevalence has decreased over the past decade, there are still about 23% of dentate adults who have untreated carious lesions in the US. Dental caries is a complex disorder affected by both individual susceptibility and environmental factors. Approximately 35-55% of caries phenotypic variation in the permanent dentition is attributable to genes, though few specific caries genes have been identified. Therefore, we conducted the first genome-wide association study (GWAS) to identify genes affecting susceptibility to caries in adults.
Five independent cohorts were included in this study, totaling more than 7000 participants. For each participant, dental caries was assessed and genetic markers (single nucleotide polymorphisms, SNPs) were genotyped or imputed across the entire genome. Due to the heterogeneity among the five cohorts regarding age, genotyping platform, quality of dental caries assessment, and study design, we first conducted genome-wide association (GWA) analyses on each of the five independent cohorts separately. We then performed three meta-analyses to combine results for: (i) the comparatively younger, Appalachian cohorts (N = 1483) with well-assessed caries phenotype, (ii) the comparatively older, non-Appalachian cohorts (N = 5960) with inferior caries phenotypes, and (iii) all five cohorts (N = 7443). Top ranking genetic loci within and across meta-analyses were scrutinized for biologically plausible roles on caries.
Different sets of genes were nominated across the three meta-analyses, especially between the younger and older age cohorts. In general, we identified several suggestive loci (P-value ≤ 10E-05) within or near genes with plausible biological roles for dental caries, including RPS6KA2 and PTK2B, involved in p38-depenedent MAPK signaling, and RHOU and FZD1, involved in the Wnt signaling cascade. Both of these pathways have been implicated in dental caries. ADMTS3 and ISL1 are involved in tooth development, and TLR2 is involved in immune response to oral pathogens.
As the first GWAS for dental caries in adults, this study nominated several novel caries genes for future study, which may lead to better understanding of cariogenesis, and ultimately, to improved disease predictions, prevention, and/or treatment.
Dental caries; Genetics; Genome wide association; Permanent dentition; Genomics
Tooth decay, which affects 95 percent of Americans, is our most common health problem, costing an estimated +2 billion yearly for treatment. By the time children reach 17 years of age, 94 percent have experienced caries and 36 percent have lost one or more permanent teeth due to caries. Dental disease prevention embodies the spectrum of many activities from the fluoridation of community and school water supplies to the dental health education of the child and adult. At this stage of our knowledge, the most effective and cost-beneficial intervention is fluoridation. Fluoridation can reduce the incidence of dental caries by about 65 percent, reduce the need for multiple surface fillings, crowns and extractions, and significantly increase the number of children who are completely free of cavities. No other public health measure is as effective in building a decay-resistant tooth while being available to all without regard to education or socio-economic background. The number of people served by fluoridated water systems has increased steadily since its introduction. Currently, however, less than half of all Americans have access to fluoridated water. In areas where community water supplies are not fluoridated, school drinking water is seldom fluoridated despite evidence supporting the efficacy of this procedure.
Previous studies have suggested that marginal periodontitis is a risk factor for developing atherosclerosis. The objective of this study was to determine whether caries may also be associated with atherosclerosis.
The computed tomography data sets of 292 consecutive patients, 137 women and 155 men with a mean age of 54.1±17.3 years, were analyzed. Caries were quantified based on the number of decayed surfaces of all the teeth, and periodontitis was quantified on the basis of the horizontal bone loss in the jaw. The presence of chronic apical periodontitis (CAP) was assessed, and the aortic atherosclerotic burden was quantified using a calcium scoring method.
The patients with <1 caries surfaces/tooth had a lower atherosclerotic burden (0.13±0.61 mL) than patients with ≥1 caries surfaces/tooth. The atherosclerotic burden was greater in patients with a higher number of lesions with pulpal involvement and more teeth with chronic apical periodontitis. In the logistical regression models, age (Wald 49.3), number of caries per tooth (Wald 26.4), periodontitis (Wald 8.6), and male gender (Wald 11) were found to be independent risk factors for atherosclerosis. In the linear regression analyses, age and the number of decayed surfaces per tooth were identified as influencing factors associated with a higher atherosclerotic burden, and the number of restorations per tooth was associated with a lower atherosclerotic burden.
Dental caries, pulpal caries, and chronic apical periodontitis are associated positively, while restorations are associated inversely, with aortic atherosclerotic burden. Prospective studies are required to confirm these observations and answer the question of possible causality.
Dental Caries; Atherosclerosis; Risk Factors; Dental Restoration; Computed Tomography; Cardiovascular Diseases
Health political background
Caries is one of the most prevalent diseases worldwide. For (direct) restaurations of carious lesions, tooth-coloured composite materials are increasingly used. The compulsory health insurance pays for composite fillings in front teeth; in posterior teeth, patients have to bear the extra cost.
Amalgam is an alloy of mercury and other metals and has been used in dentistry for more than one hundred and fifty years. Composites consist of a resin matrix and chemically bonded fillers. They have been used for about fifty years in front teeth. Amalgam has a long longevity; the further development of composites has also shown improvements regarding their longevity.
This HTA-report aims to evaluate the longevity (failure rate, median survival time (MST), median age) of direct amalgam fillings in comparison to direct composite fillings in permanent teeth from a medical and economical perspective and discusses the ethical, legal and social aspects of using these filling materials.
The systematic literature search yielded a total of 1,149 abstracts. After a two-step selection process based on defined criteria 25 publications remained to be assessed.
The medical studies report a longer longevity for amalgam fillings than for composite fillings. However, the results of these studies show a large heterogeneity. No publication on the costs or the cost-effectiveness of amalgam and composite fillings exists for Germany. The economic analyses (NL, SWE, GB) report higher costs for composite fillings when longevity is assumed equal (for an observation period of five years) or longer for amalgam compared to composite fillings. These higher costs are due to the higher complexity of placing composite fillings.
Due to different study designs and insufficient documentation of study details, a comparison of different studies on longevity of direct amalgam and composite fillings in posterior teeth is difficult. Apart from the difficulties in conducting a randomized, controlled long-term study comparing the longevity of direct fillings, the fact that composites and adhesives used in a study have often already been replaced by the next generation of the product at the time of study publication presents an additional problem. Not only the filling material, but also patient parameters and local, intraoral factors (e. g. localisation of the filling) as well as the treating dentist have an impact on the longevity of dental fillings. In evaluating economic studies, one has to refer to the heterogeneity of data on longevity in the medical evaluation. The only effect parameter used in the studies is longevity, other aspects (e. g. long-term functionality) are only referred to in discussions. Extensive counselling of patients regarding the selection of the appropriate filling material is important.
Amalgam fillings show a longer longevity than composite fillings. Two out of six systematic reviews conclude that the expected survival time of composite fillings can be comparable to amalgam fillings. However, these conclusions are based on the results of short-term studies which usually overestimate the longevity of filling materials. From an economic standpoint, amalgam is the more economic filling material compared to direct composite fillings in posterior teeth when considering longevity as the only result parameter. Other aspects than longevity need to be considered in individually choosing the appropriate dental filling material. For future studies aiming to compare the longevity of amalgam and composite fillings, a sufficient sample size and study period, preferably in the setting of a private dental practice, should be aimed for. An evaluation of the cost-effectiveness of amalgam and composite fillings should take the functionality of teeth over a longer time period into account, as well as patients’ preferences. The rapid development of composite materials and adhesives make short term revisions of these conclusions necessary.
The risk for caries development in children varies significantly for different age groups, individuals, teeth, and surfaces. Thus from a cost-effectiveness point of view, caries preventive measures must be integrated and based on predicted risk from age group down to individual tooth surfaces. Based on this philosophy and experiences from continuously ongoing research on evaluating and reevaluating separate and integrated caries preventive measures, as well as methods for prediction of caries risk, a needs-related caries preventive program was introduced for all 0–19-year-olds in the county of Värmland, Sweden, in 1979. The goals for the subjects following the program from birth to the age of 19 years were:
1. To have no approximal restorations.
2. To have no occlusal amalgam restorations.
3. To have no approximal loss of periodontal attachment.
4. To motivate and encourage individuals to assume responsibility for their own oral health.
The effect of the program is evaluated once every year on almost 100% of all 3–19-year-olds in a computer-aided epidemiologic program from 1979. Most of the individualized preventive program was carried out by dental hygienists or prophy dental assistants at clinics in the elementary schools. During the 20-year period the percentage of caries-free 3-year-olds increased from 51% to 97%. In 1999 as many as 86% of the 12-year-olds were caries free. Caries incidence was reduced more than 90% in all age groups. More than 90% did not develop any new caries lesions in 1999. As a consequence, caries prevalence was dramatically reduced. In 12- and 19-year-olds, the mean number of Decayed and Filled Surfaces (DFS) per individual was reduced from 6 to 0.3 and from 23 to 2 respectively. In 19-year-olds the mean number of approximal DFS was <1, and only 0.5 had to be filled. The mean number of occlusal DFS was <1. Since 1995 we have not been allowed to use amalgam in 1–19-year-olds in Sweden. As an effect of our high quality plaque program, approximal attachment loss was prevented, and by efficient education in self-care based on self-diagnosis, needs-related self-care habits were established. Thus it can be concluded that nearly 100% of our goals had been achieved.
Parkinson's disease (PD) is a progressive neurodegenerative disorder related to the loss or absence of dopaminergic neurons in the brain. These deficits result in slowness of movement, tremor, rigidity, and dysfunction of behaviour. These symptoms negatively influence the patient's capability to carry out the daily oral hygiene manoeuvres. The aim of this work is to record the oral health condition of PD patients evaluated at the IRCSS Bonino-Puleio in Messina. The oral health of 45 consecutive PD patients (study group) with neurologic diagnosis based on United Kingdom Brain Bank Criteria has been compared with that of another 45 no PD patients of the same age (control group). The evaluation of the general oral condition was recorded underlining tooth loss, active periodontal disease, and presence of untreated caries. The frequency of untreated caries, periodontal diseases, and missing teeth of the study group was significantly higher than in control group. Based on the data results, clinicians should direct high attention to the oral hygiene of patients with PD, above all at the early stages of the caries or periodontal disease, in order to prevent serious evolution of those pathologic dental conditions that may finally result in the tooth extraction event.
Background and aims
The present study evaluated the most common reasons for replacing amalgam restorations in a university clinic.
Materials and methods
A total of 217 restorations which needed to be replaced were clinically and radiographically evaluated in a period of 4 months. The frequencies of reasons for replacing amalgam restorations were calculated: The assessed items included recurrent caries, tooth structure fracture (functional or non-functional cusps), amalgam bulk fracture, amalgam marginal fracture, proximal overhangs, and esthetics. Data were analyzed using Fischer’s exact test.
Both in vital teeth and teeth which had undergone root canal therapy, the most common reason for amalgam replacement was cusp fracture, with the fracture of non-functional cusps being statistically significant. Recurrent caries was the second most common reason for amalgam replacement. In Class I restorations, the most common reasons were recurrent caries and esthetics, with no statistical significance. The most frequent problem in Class II restorations was fracture of non-functional cusps, with a statistical significance in three-surface restorations.
According to the results, failing to reduce undermined cusps and neglectful caries removal are the reasons for majority of amalgam restoration replacements. These issues should be emphasized in the curriculum for dental students and continuing education courses.
Amalgam failures; cusp fracture; restoration replacement
This study aimed to assess chewing ability related to dental status.
Material and methods
One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. Chewing ability was analyzed using multivariable logistic regression including five dental conditions (≥10 teeth in each jaw’; ‘complete anterior regions’; “sufficient premolar regions’ (≥3 posterior occluding pairs (POPs)); ‘sufficient molar regions’ (bilaterally ≥1 POP); and tooth replacement), adjusted for six background variables. Likelihood ratios for chewing problems were assessed at each level of the hierarchical classification system based on these dental conditions.
Seventy-eight to 91 % of subjects reported no or minor chewing problems. The conditions ‘≥10 teeth in each jaw’, and ‘complete anterior regions’ were not associated, whereas ‘sufficient’ premolar regions’ and ‘sufficient molar regions’ were associated with chewing problems (Ors, 0.33–0.58). If classified hierarchically, the condition ‘≥10 teeth in each jaw’ was relevant for chewing problems (likelihood ratios 3.3–3.7). ‘Sufficient premolar region’ and ‘sufficient molar region’ were relevant to reduce the likelihood ratios for having chewing problems (both approximately with a factor 2), both for soft and for hard foods. Subjects with artificial teeth added had similar chance for chewing problems compared to counterparts with natural teeth only. However, if comparing replaced teeth with natural teeth, subjects with tooth replacement showed higher chance for chewing problems.
Chewing ability was strongly associated with dental conditions.
The presence of at least 10 teeth in each jaw had highest impact on chewing ability.
Chewing ability; Occlusal status; Hierarchical dental functional classification system; Chinese adults
To quantify the reasons for placing restorations on non-carious tooth defects (NCTD) by Dental Practice-Based Research Network (DPBRN) dentists, and associated tooth, patient and dentist characteristics.
Data were collected on placement of 1,301 restorations due to NCTD by 178 DPBRN dentists. Information included: (1) main clinical occurrence or reason, other than dental caries, for restoring previously un-restored permanent tooth surfaces, (2) characteristics of patients who received treatment, (3) dentists’ and dental practices’ characteristics, (4) tooth and surfaces restored, and (5) restorative materials employed.
Restorations were most often placed to treat abrasion, abfraction, and erosion (AAE) lesions (46%) and tooth fracture (31%). Patients older than 40 years received restorations mainly due to AAE (p<0.0001). Premolar and anterior teeth were mostly restored due to AAE; molar teeth were mostly restored due to tooth fracture (p<0.0001). Directly placed resin-based composite (RBC) was largely used to restore AAE and tooth fracture (p<0.0001).
AAE and tooth fracture are the main reasons for restoring non-carious tooth surfaces among DPBRN practices. Premolar and anterior teeth of patients older than 40 years are most likely to receive restorations due to AAE; molars are most likely to receive restorations due to tooth fracture. Both types of NCTD are most often restored with RBC.
non-carious tooth defects; abrasion; abfraction; erosion; tooth fracture; resin-based composite; DPBRN
Need perceptions for dental care play a key role as to whether people in general will seek dental care. The aim was to assess the prevalence of perceived need of problem based dental care, dental check-ups and any type of dental care. Guided by the conceptual model of Wilson and Cleary, the relationship of perceived need for dental care with socio-demographic characteristics, clinically defined dental problems and self-reported oral health outcomes was investigated. Partial prosthetic treatment need was estimated using a socio-dental approach.
A cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. Information from interviews and clinical examination became available for 511 urban and 520 rural adults (mean age 62.9 yr).
51.7% (95% CI 46.2, 57.0) urban and 62.5 % (95% CI 53.1, 70.9) rural inhabitants confirmed need for dental check-up, 42.9% (95% CI 36.9, 48.9) urban and 52.7% (95% CI 44.5, 60.6) rural subjects confirmed need for problem oriented care and 38.4% (95% CI 32.4, 44.6) urban versus 49.6% (95% CI 41.8, 57.4) rural residents reported need for any type of dental care. Binary and ordinal multiple logistic regression analyses revealed that adults who reported bad oral health and broken teeth were more likely to perceive need for dental care across the three outcome measures than their counterparts. Socio-demographic factors and clinically defined problems had less impact. Based on a normative and an integrated socio-dental approach respectively 39.5% and 4.7% were in need for partial dentures.
About half of the participants confirmed need for problem oriented care, dental check-ups and any type of dental care. Need perceptions were influenced by perceived oral health, clinically assessed oral problems and socio-demographic characteristics. Need estimates for partial denture was higher when based on clinical examination alone compared to an integrative socio-dental approach.
Using data from the Center for Oral Health Research in Appalachia Study, we examined variability in susceptibility to dental caries among children and adolescents in rural Appalachia. Among 210 participants who were caries-free at the initial visit, age at the baseline visit can be used as a proxy for the degree of caries resistance; probability of caries development at the tooth level decreased as age at the baseline visit increased. Participants who stayed caries-free for a longer period during childhood and adolescence experienced less extensive caries, as measured by the number of carious teeth. However, the probability of becoming caries-positive did not correlate with age at the baseline visit. For children between 1 and 18 years of age, there was not a “threshold age” after which a caries-free child’s risk of caries onset is significantly reduced.
caries resistance; age; caries-free; Bayesian analysis; epidemiology; dental public health
Background and aims
The purpose of this investigation was to assess the placement and replacement of resin-based composite restorations and related factors in a private practice in Greece.
Materials and methods
The study included 1500 subjects, 720 males and 780 females, aged 18 to 52 years old. The clinical examination involved calculation of the number of teeth with primary caries and failed-restored teeth. In addition the relationship between placed and replaced composite restorations and the following aspects was assessed: gender, cavity type, tooth type and evaluation of longevity of the replaced composite restorations. Statistical analysis performed using the chi-square test. A p value less than 5% was considered statistically significant.
The total number of restorations placed were 1940; 1202 of those (62%) were placed for first time while 738 (38%) were replaced. The main reason for the placement of new composite resin restorations was primary caries (60%), while secondary caries was the most frequent reason for the replacement (48%) of those. A statistically significant differ-ence was recorded between males and females regarding the composite restorations placed and replaced (p = 0.00082), the type of cavity of placed restorations (p = 0.00062), and the type of cavity of replaced ones (p = 0.00038). The median lon-gevity of the replaced resin composite restorations was approximately 4 years (47%).
Dental caries, primary and secondary, followed by tooth discoloration and loss of filling were the main rea-sons for placed and replaced composite restorations.
Dental caries; longevity; replacement; resin composite restorations
The majority of what is known of the experience of dental caries among adults is from cross-sectional studies, and there are surprisingly few population-level longitudinal studies of dental caries among adults. Dental examinations were conducted at age 26 and again at age 32 among participants in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Some 901 individuals (88.8%) were dentally examined at both ages. The mean number of remaining teeth and tooth surfaces fell between 26 and 32, reflecting ongoing tooth loss. The overall prevalence of caries rose from 94.9 to 96.8%, while there were greater increases in the proportion with caries-associated tooth loss (from 10.8 to 22.8%). Caries experience was greatest in the molar teeth and upper premolars, and was lowest in the lower anterior teeth. The mean crude caries increment (CCI) was 5.0 surfaces (SD 6.6); 681 (75.5%) experienced 1+ CCI, and the mean CCI among those individuals was 6.6 surfaces (SD 6.9). Substantial dental caries and tooth loss experience occur as people move from the third into the fourth decade of life.
Caries; Tooth loss
Dental caries is the most common chronic disease in children and a major public health concern due to its increasing incidence, serious health and social co-morbidities, and socio-demographic disparities in disease burden. We performed the first genome-wide association scan for dental caries to identify associated genetic loci and nominate candidate genes affecting tooth decay in 1305 US children ages 3-12 yrs. Affection status was defined as 1 or more primary teeth with evidence of decay based on intra-oral examination. No associations met strict criteria for genome-wide significance (p < 10E-7); however, several loci (ACTN2, MTR, and EDARADD, MPPED2, and LPO) with plausible biological roles in dental caries exhibited suggestive evidence for association. Analyses stratified by home fluoride level yielded additional suggestive loci, including TFIP11 in the low-fluoride group, and EPHA7 and ZMPSTE24 in the sufficient-fluoride group. Suggestive loci were tested but not significantly replicated in an independent sample (N = 1695, ages 2-7 yrs) after adjustment for multiple comparisons. This study reinforces the complexity of dental caries, suggesting that numerous loci, mostly having small effects, are involved in cariogenesis. Verification/replication of suggestive loci may highlight biological mechanisms and/or pathways leading to a fuller understanding of the genetic risks for dental caries.
caries; childhood caries; fluoride(s); genetics; genome-wide association study; genomics
Several mechanisms may associate tooth loss and related oral
inflammation with cognitive impairment. The authors studied the relationship
between tooth loss and cognitive function.
The REasons for Geographic And Racial Differences in Stroke study is
a national longitudinal study of more than 30,000 African American and white
adults 45 years or older. Data for tooth loss, cognitive function and
potential confounding variables were available for 9,853 participants at the
time of analysis. The authors used incremental linear regression modeling to
investigate the cross-sectional association between self-reported tooth loss
and cognitive function.
In unadjusted analysis (mean learning followed by recall; α
level of significance of .05), the loss of six to 16 teeth and the loss of
more than 16 teeth were associated with poorer cognitive function compared
with the loss of no teeth. Attenuated associations persisted after the
authors adjusted for demographic and systemic risk factors. The full model,
which was adjusted for socioeconomic status (SES), revealed no association
between tooth loss and cognitive function.
Tooth loss may be associated with cognitive function; however, this
association is mediated by age and SES.
Tooth loss due to periodontal disease may be a marker for low SES,
and the interplay of these factors with advanced age may confer risk of
having poorer cognitive function. Further studies are needed to clarify
Cognitive function; tooth loss
Compomer restorations release fluoride to help prevent future caries. We tested the hypothesis that compomer is associated with fewer future caries compared to amalgam. The 5-year New England Children’s Amalgam Trial recruited 534 children aged 6–10 with ≥2 carious posterior teeth. Children were randomized to receive compomer or amalgam restorations in primary posterior teeth, placed using a fluoride-releasing bonding agent. The association between restorative material and future caries was assessed using survival analysis. Average follow-up of restorations (N=1085 compomer, 954 amalgams) was 2.8 ± 1.4 years in 441 children. No significant difference between materials was found in the rate of new caries on different surfaces of the same tooth. Incident caries on other teeth appeared slightly more quickly after placement of compomer restorations (p=0.007), but the difference was negligible after 5 years. Under the conditions of this trial, we found no preventive benefit to fluoride-releasing compomer compared to amalgam.
compomers; dental amalgam; dental caries; dentition; primary; clinical trial
Compomer restorations release fluoride to help prevent future caries. We tested the hypothesis that compomer is associated with fewer future caries compared with amalgam. The five-year New England Children’s Amalgam Trial recruited 534 children aged 6-10 yrs with ≥ 2 carious posterior teeth. Children were randomized to receive compomer or amalgam restorations in primary posterior teeth, placed with a fluoride-releasing bonding agent. The association between restorative material and future caries was assessed by survival analysis. Average follow-up of restorations (N = 1085 compomer, 954 amalgams) was 2.8 ± 1.4 yrs in 441 children. No significant difference between materials was found in the rate of new caries on different surfaces of the same tooth. Incident caries on other teeth appeared slightly more quickly after placement of compomer restorations (p = 0.007), but the difference was negligible after 5 yrs. Under the conditions of this trial, we found no preventive benefit to fluoride-releasing compomer compared with amalgam.
compomers; dental amalgam; dental caries; dentition; primary; clinical trial