Cohort comparisons of dental status in the adult Swedish population between 1975 and 1981

The aim was to describe and analyze changes in dental status in Sweden over a 6-yr period, and to establish a baseline for a subsequent investigation. Representative samples of the Swedish population in 1975, 1977, and 1981 were investigated by means of interviews. The participation rate varied between 81 and 86% and the number of participants between 11,582 and 14,964. Dental status, based on a question about natural teeth and/or removable denture(s), was analyzed in relation to demographic, socio-economic, social support and life style factors. The prevalence of edentulism in the age group 16-74 years decreased during the observation period from 12.7% to 9.9% in men and from 15.5% to 11.2 in women. Besides age, urbanization, occupation and tobacco smoking had the highest explanatory value for edentulism. The findings are discussed with respect to the increasing life expectancy and possible changes in the need and demand for dental care.     

A method for assessment of quality of life in relation to prosthodontics. Partial edentulism and removable partial dentures

The aim of this study was to evaluate the possible use in prosthodontics of a method for an interview technique allowing maximal individuality within the cultural boundaries. The impact of partial edentulism and removable partial denture (RPD) wearing on quality of life was chosen as the target question. The interview included patient generated selection of five quality of life cues. The current status/intensity of each cue was measured by use of a Visual Analogue Scale (VAS), the relative weight/importance between the cues by a direct-weighting (DW) instrument, and a summarized quality of life score was calculated. One hundred and one participants with partial edentulism with or without RPDs were included in the study. No correlation was found between the VAS- and DW-scores, indicating that different aspects are measured with these two instruments. Sixty to seventy per cent of the participants answered positively to questions about the test method, including self-knowledge, consciousness and identification of needs and wishes. The 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting' turned out to be a useful instrument for assessing patients' priorities, and fulfils in many ways the demands for individualized problem identification, decision-making and treatment planning. The results of the comparison of RPD wearers and non-RPD wearers showed that aesthetics is a major factor and that the overall quality of life between the experienced RPD wearers and non-RPD wearers in this study did not differ significantly.     

Dental conditions in middle-aged and older people in Denmark and Sweden: a comparative study of the influence of socioeconomic and attitudinal factors

In 1998-99 two parallel questionnaire studies were performed in Denmark and Sweden. In Denmark the age group was 45-69 years and in Sweden 55-79 years. One aim was to study the influence of socioeconomic and attitudinal factors on dental status in the two countries. For the comparable age groups 55-69 years there was a striking difference in dental conditions between the countries. In Sweden, 72% had either all teeth remaining, missing teeth replaced by fixed prosthodontics, or only one or two single missing teeth not replaced. The corresponding figure for Denmark was 44%. Among Danes, 34% were wearing removable denture(s) or were edentulous in one jaw or both jaws, compared with 15% among Swedes. In logistic regression models, higher income and longer education were significantly associated with the best dental status categories in Denmark but not in Sweden. In the model with wearing removable denture(s) as the dependent variable, lower income and lower education level showed a significant influence for the Danes. In Sweden, lower income showed a significant influence but education level was insignificant. In both Denmark and Sweden, a positive attitude toward the importance of dental appearance was associated with an increased risk of wearing removable denture(s).     

Dental conditions in middle-aged and older people in Denmark and Sweden: a comparative study of the influence of socioeconomic and attitudinal factors

In 1998-99 two parallel questionnaire studies were performed in Denmark and Sweden. In Denmark the age group was 45-69 years and in Sweden 55-79 years. One aim was to study the influence of socioeconomic and attitudinal factors on dental status in the two countries. For the comparable age groups 55-69 years there was a striking difference in dental conditions between the countries. In Sweden, 72% had either all teeth remaining, missing teeth replaced by fixed prosthodontics, or only one or two single missing teeth not replaced. The corresponding figure for Denmark was 44%. Among Danes, 34% were wearing removable denture(s) or were edentulous in one jaw or both jaws, compared with 15%, among Swedes. In logistic regression models, higher income and longer education were significantly associated with the best dental status categories in Denmark but not in Sweden. In the model with wearing removable denture(s) as the dependent variable, lower income and lower education level showed a significant influence for the Danes. In Sweden, lower income showed a significant influence but education level was insignificant. In both Denmark and Sweden, a positive attitude toward the importance of dental appearance was associated with an increased risk of wearing removable denture(s).     

Length of tooth survival in older adults with complex medical, functional and dental backgrounds

BackgroundTooth loss can be considered a failure of current oral health care strategies. Knowing how soon this failure will occur can help clinicians enhance preventive strategies for preventing tooth loss and minimizing its impact. The authors conducted a study to detail tooth survival patterns in an older cohort.MethodsThe authors conducted a retrospective longitudinal study of 491 participants aged 43 to 102 years. They treated the participants' dental conditions before they entered the study. They also collected participants' sociodemographic, medical, functional, cognitive and dental data when they first arrived at the clinic. The authors used Fisher exact tests, χ² tests and analysis of variance to examine the association between baseline characteristics and tooth survival. They generated Kaplan-Meier estimates and used Cox proportional hazards regression models to detail tooth survival and associated risk factors.ResultsThe authors found that tooth survival patterns differed among participants who had different numbers of carious teeth or retained roots (carious or broken teeth that were missing most of their coronal structures) when they first arrived at the clinic (P N/A .001) and between participants who wore removable prostheses and those who did not (P = .02). Participants' tooth loss at different times differed by sex, number of medications being taken and number of carious teeth or retained roots. The authors found that after they adjusted for other factors, tooth survival was associated with the number of carious teeth or retained roots (P = .01), as well as the interaction between the number of carious teeth or retained roots and use of prostheses (P = .02).ConclusionsCaries and the use of removable prostheses synergistically compromised tooth survival in older patients. Patients who wore prostheses and had multiple active carious teeth or retained roots at arrival had the highest risk of losing teeth soon after their existing conditions were treated.Clinical ImplicationsThese findings highlight the need for preventing tooth loss in older adults who wear removable prostheses and have poor oral health. Knowing the groups at the highest risk of experiencing tooth loss soon after dental treatment is received can help dentists better target and design preventive strategies.     

Emotional effects of tooth loss in community-dwelling elderly people in Hong Kong

PURPOSE: This study investigated the emotional effects of tooth loss among community-dwelling elderly people in Hong Kong and compared the effects among edentulous and partially dentate elderly. MATERIALS AND METHODS: A questionnaire study involved 233 southern Chinese elderly who were recruited and interviewed at social centers for elderly people throughout Hong Kong. Data were analyzed using chi-square or chi-square exact tests. RESULTS: Twenty-two percent of the participants reported difficulty accepting tooth loss, with no difference between the edentulous and partially dentate. However, 95% stated that their confidence was unaffected. For more than half of elderly people, tooth loss had a negative effect on food choice and enjoyment of food, with removable denture wearers having greater restrictions. Avoiding going out, eating in public, and forming close relationships were less-common problems. Twenty-two percent felt unprepared for the effects of tooth loss, and more than half said that better communication with the dentist would have helped. CONCLUSION: The emotional effects of tooth loss were not marked among elderly people, and there were no differences between edentulous and partially dentate individuals. However, significant disability was experienced because of restrictions in daily living activities. Restrictions were more severe in people who had lost enough teeth to necessitate denture wearing.     

The randomized shortened dental arch study: tooth loss over five years

Objectives

The study was designed to provide clinical outcome data for two treatments of the shortened dental arch (SDA).

Material and Methods

In a multicenter randomized controlled clinical trial, patients with complete molar loss in one jaw were provided with either a partial removable dental prosthesis (PRDP) retained with precision attachments or treated according to the SDA concept preserving or restoring a premolar occlusion. No implants were placed. The primary outcome was tooth loss.

Results

Of 152 treated patients, 132 patients reached the 5-year examination. Over 5 years, 38 patients experienced tooth loss. For the primary outcome tooth loss, the Kaplan–Meier survival rates at 5 years were 0.74 (95 % CI 0.64, 0.84) in the PRDP group and 0.74 (95 % CI 0.63, 0.85) in the SDA group. For tooth loss in the study jaw, the survival rates at 5 years were 0.88 (95 % CI 0.80, 0.95) in the PRDP group and 0.84 (95 % CI 0.74, 0.93) in the SDA group. The differences were not significant. No Cox regression models of appropriate fit explaining tooth loss on the patient level could be found.

Conclusions

The overall treatment goals of a sustainable oral rehabilitation and the avoidance of further tooth loss over longer periods were not reliably achievable. The influence of the type of prosthetic treatment on tooth loss might have been overestimated.

Clinical Relevance

Regarding our results, the patient’s view will gain even more importance in the clinical decision between removable and fixed restorations in SDAs.     

圆锥型套筒冠修复体对牙周病修复治疗的临床研究

目的对圆锥型套筒冠修复体修复治疗中重度牙周病的疗效作临床研究。方法对14例中重度牙周病与牙周病伴牙列缺损患者经牙周病综合治疗后采用圆锥型套简冠可摘义齿作修复治疗,在修复前和修复后3月、1a、2a进行定期检查.测定菌斑指数、牙龈指数、牙松动度和咀嚼效能,进行对比分析。结果该治疗方法能有效控制牙周菌斑附着,消除对牙周组织的创伤,有效防止牙周病复发,且降低牙齿松动度,咀嚼效能随修复后时间推延不断提高。结论圆锥型套简冠可摘义齿是中重度牙周病的有效修复治疗方法。     

Trends in socioeconomic disparities in oral health in Brazil and Sweden

Celeste RK, Nadanovsky P, Fritzell J. Trends in socioeconomic disparities in oral health in Brazil and Sweden. Community Dent Oral Epidemiol 2011; 39: 204–212. © 2010 John Wiley & Sons A/S Abstract – Objectives: To describe the dynamics of trends in socioeconomic disparities in oral health in Brazil and Sweden among adults, to assess whether trends follow expected patterns according to the inverse equity hypothesis. Methods: In Sweden, we obtained nationally representative data for the years 1968, 1974, 1981, 1991 and 2000, and in Brazil, for 16 state capitals in 1986 and in 2002. Trends in the prevalence of ‘edentulism’ and of ‘teeth in good conditions’ were described in two groups aged 35–44 with lower and higher economic standards, respectively. Results: There was an annual decline in disparities in ‘edentulism’ of 0.4 percentage points (pp) (95% CI = 0.2–0.7) in Brazil and 0.7pp (95% CI = 0.5–0.9) in Sweden, as a result of improvements in both income groups. Concerning ‘teeth in good conditions’, in Brazil, there was improvement only in the higher income group and absolute disparities have increased (0.5pp annually), while in Sweden, there was a nonsignificant decrease (0.3pp annually) with improvements in both groups. Since 1991 in Sweden and in 2002 in Brazil, our measures of socioeconomic disparities in ‘edentulism’ were not statistically significant. Trends did not differ by sex or dental visit. Conclusions: Despite improvements in both income groups and a decrease in disparities in ‘edentulism’, the poorer group in Brazil has seen no improvement in ‘teeth in good conditions’ and disparities have increased. It appears that Brazil and Sweden reflect different stages of trend for ‘teeth in good conditions’ and the same stages for ‘edentulism’, represented by the inverse equity hypothesis.     

Removable prostheses

Reconstruction of the dentition extensively damaged through tooth surface loss may require the use of removable prostheses. This can be the most appropriate type of treatment when either the teeth are very severely worn or the patient wishes a simpler and more economical approach than a fixed reconstruction.     

Correlates of partial tooth loss and edentulism in the Brazilian elderly

BACKGROUND: In South American older adults the association between tooth loss and demographic, predisposing and enabling factors has not been determined. The purpose of this study was to evaluate the association between partial and complete tooth loss and demographic, predisposing, enabling and need factors, and quality of life variables in the Brazilian older adults. METHODS: In this cross-sectional study, 5349 subjects aged 65-74 years were evaluated using conglomerate random sampling. Data collection included dental examinations and questionnaires evaluating demographic, predisposing, enabling and need factors, and quality of life variables. Multinomial logistic regression was carried out to evaluate correlates of tooth loss. The number of teeth was set as the outcome and categorized as: edentulous, subjects with 1-19 teeth, and subjects with 20 or more teeth. RESULTS: Predisposing factors including age, female gender and schooling were independently associated with edentulism. Female gender was associated with partial tooth loss. The only enabling factor associated with edentulism was car ownership. Need factors were associated with edentulism and partial tooth loss. Edentulous subjects perceived the need for dental treatment less frequently. Quality of life factors were associated with partial tooth loss and edentulism. Subjects with 1-19 teeth and edentulous subjects were more likely to rate their chewing ability as not good. Edentulous subjects were more likely to rate their speech ability and their dental appearance as good. CONCLUSIONS: The results indicate that tooth loss and edentulism were complex phenomena, with intricate predisposing, demographic, enabling and need factors playing a role.     

Predoctoral removable prosthodontics education

As the 21st century is approached, changes are occurring that directly relate to removable prosthodontics at the undergraduate level. Edentulism will continue to decline, although the need for complete dentures will diminish slowly because of the replacement needs for the existing edentulous population. In the short- to medium-term future, partial edentulism will increase in the older population at the expense of total edentulism. Therefore, the need for removable partial dentures will increase, but subsequently will decline. In the long-term, tooth loss, regardless of etiology, will be reduced. However, the replacement of lost teeth is unlikely to disappear completely as a needed dental service. With 73% of dental schools reporting inadequate or marginal numbers of complete denture patients, Meskin and Entwistle have identified a shortage of patients needing removable prostheses. On the other hand, 50% of the schools report a surplus of removable partial denture patients. Dental school curriculum time related to prosthodontics has declined significantly over the past 20 years. However, over the past 10 years it has risen slightly. Techniques that are taught in dental schools are frequently not being used in practice. Yet the practitioner's interest in removable prosthodontics as it relates to new techniques and materials remains high according to a 1988 survey of Academy of General Dentistry members. Removable prosthodontics was rated first in regards to continuing education courses desired by its members. There are two basic objectives stated in the prologue of the Council on Dental Education Directive on Accreditation Standards. First, faculties are ultimately responsible for the quality of care rendered to the patient population by students.(ABSTRACT TRUNCATED AT 250 WORDS)     

影响全口义齿期望值与满意度的因素分析

目的分析影响全口义齿修复前期望值与修复后满意度的相关因素,为口腔修复医师提供一定的参考价值。方法收集临床全口义齿修复患者68例,修复前进行患者的年龄、性别、拔牙时间、拔牙目的、教育程度、有无佩戴活动义齿经验、对义齿了解程度等因素以及患者在外观、语音、咀嚼、固位稳定、舒适度等方面的期望值问卷,并在佩戴义齿1个月、3个月以及1年后进行满意度问卷,运用SPSS 13.0统计软件,采用单因素方差及t-检验方法进行统计学分析。结果 1）女性对咀嚼和舒适度的期望值高于男性,而男性对外观和发音的满意度更高;2）〈55岁组对各方面的期望值偏低,56~65岁组的期望值和满意度均最高,〉66岁组的满意度偏低;3）拔牙时间〉3年组对外观和咀嚼的期望值高于其它两组,但各组的满意度总体无显著差异;4）主动拔牙组对咀嚼的期望值高于被动拔牙组,但后者的各方面满意度高于前者;5）无活动义齿佩戴经验组对外观、咀嚼、固位稳定、舒适度的期望值高于有经验组,但后者对固位稳定的满意度更高;6）文化程度初级及以下组对外观、发音、咀嚼、固位稳定的期望值高于高级及以上组,但后者对咀嚼的满意度更高;7）义齿不了解组对各方面的期望值均显著高于了解组,但满意度中两组无明显差异;8）1个月时患者对语音、咀嚼、固位稳定和舒适度的满意度低于期望值,但3个月时满意度明显提高,到1年时,患者对发音、咀嚼、舒适度的满意度要高于3个月时的满意度。以上差异皆具有统计学意义（P〈0.01）。结论全口义齿的期望值和满意度与其个体因素密切相关,口腔修复医师需要在术前与患者进行良好的沟通,对特殊患者如女性、老年患者、过早缺失牙者、初戴者、文化程度低者、对义齿缺乏了解者等在义齿的功能和修复效果上应做更多的解释。     

Diabetes and Tooth Loss: An analysis of data from the National Health and Nutrition Examination Survey, 2003–2004

BackgroundThe authors conducted an analysis of data from the National Health and Nutrition Examination Survey (NHANES) to understand the association between diabetes and tooth loss in the United States.MethodsThe authors analyzed the oral examination and self-reported diabetes data obtained from the NHANES 2003–2004 cycle and included 2,508 participants representing a civilian, noninstitutionalized U.S. population 50 years and older. The authors calculated the prevalence of edentulism and the number of missing teeth among dentate people, and they used multiple regression analyses to assess the association between diabetes and tooth loss.ResultsThe prevalence of edentulism was 28 percent and 14 percent among people with and without diabetes, respectively. The multiple logistic regression analysis revealed that people with diabetes were more likely to be edentulous than were those without diabetes (adjusted odds ratio = 2.25; 95 percent confidence interval, 1.19–4.21). Among dentate adults, those with diabetes had a higher number of missing teeth than did adults without diabetes (mean [standard error {SE}] = 9.8 [0.67]), mean [SE] = 6.7 [0.29]); P < .01).ConclusionsThese study results revealed that adults with diabetes are at higher risk of experiencing tooth loss and edentulism than are adults without diabetes. One of every five cases of edentulism in the United States is linked to diabetes.Practical ImplicationsAlthough the association between diabetes and periodontal disease is well established, health care professionals also need to recognize the risk of tooth loss and its effect on quality of life among people with diabetes.     

Maxillary Rehabilitation Using a Removable Partial Denture with Attachments in a Cleft Lip and Palate Patient: A Clinical Report

Clefts of the lip and/or palate (CLP) are oral‐facial defects that affect health and overall quality of life. CLP patients often need multidisciplinary treatment to restore oral function and esthetics. This paper describes the oral rehabilitation of a CLP adult patient who had maxillary bone and tooth loss, resulting in decreased occlusal vertical dimension. Functional and cosmetic rehabilitation was achieved using a maxillary removable partial denture (RPD) attached to telescopic crowns. Attachment‐retained RPDs may be a cost‐effective alternative for oral rehabilitation in challenging cases with substantial loss of oral tissues, especially when treatment with fixed dental prostheses and/or dental implants is not possible.     

Edentulism as part of the general health problems of elderly adults*

Though the prevalence of edentulism has decreased over the last decades, there will be a relevant proportion of edentulous individuals in the ageing societies worldwide. The impact of edentulism on daily oral function and social interactions has signifcant plausibility and has been described using multiple dimensions. However, evidence of general health associated with complete tooth loss is limited. To highlight the importance of oral health to general well‐being and its interrelated dependencies this article reviews international literature on the psychological and physiological aspects of edentulism, particularly on Oral Health Related Quality of Life (OHRQoL), nutrition aspects as well as morbidity and mortality.     

Oral stereognosis in edentulous subjects rehabilitated with complete removable dentures

Oral stereognosis was analysed in a group of edentulous subjects rehabilitated with complete removable dentures. Stereognosis was evaluated with and without the denture in place. The results showed that the older subjects had poorer stereognostic ability than the younger ones, whereas the duration of edentulism appeared not to influence this ability. The presence of a correct prosthetic rehabilitation appeared to improve stereognostic ability. Subjects with poorer stereognostic ability appeared more satisfied with their rehabilitation than did those with better stereognostic ability.     

Prosthetic epidemiology

The need for an epidemiological method which focuses upon the problems of missing teeth, tooth spaces and prosthetic treatment is emphasized. From the prosthetic viewpoint the distinction between missing teeth and tooth spaces must be made and examples are given to show that up to 20 per cent of missing teeth do not give rise to tooth space. The presentation of the prosthetic parameters per tooth is recommended using the six alternatives: tooth present; tooth missing (open space); tooth missing (closed space); tooth replaced by pontic in fixed bridge, by removable partial denture, or by complete denture. In the presentation of the mean number of existing teeth, fixed bridge pontics should be included as they serve as natural teeth both aesthetically and functionally. Data on removable dentures, or edentulism without denture wearing, should be presented in such a way that comparisons at jaw level as well as at person level can be made. A system for this is described. The method may be used in industrialized countries where there is much prosthetic treatment as well as in developing countries with few health services. Comparisons will still be meaningful.     

Full-arch implant-retained prosthetics in general dental practice

The loss of all teeth from one or both dental arches is a significant disability affecting self-confidence, communication, masticatory function and aesthetics. Whilst missing teeth cannot be restored to the natural state, the development of a prosthetic dentition has been a goal of dental science throughout the centuries. Contemporary techniques allow for the replacement of missing dentition with fixed or removable solutions, solving many of the problems. Implant dentistry has transformed this area of medicine. This article provides dental practitioners with an overview of this important area of patient care. CLINICAL RELEVANCE: Dental practitioners in clinical practice will frequently see edentulism; a good understanding of the available options for rehabilitation is essential.