Bone loss following periodontal therapy in subjects without frequent periodontal maintenance

The longitudinal effects of periodontal therapy in patients without a frequent periodontal maintenance program have been minimally documented. In this study we used Duckworth's modification of the Schei Ruler Technique to assess the difference in bone level around individual teeth treated for periodontal disease in subjects receiving infrequent posttherapy maintenance (less than or equal to 1 time/year). Crestal bone height differences were evaluated using the initial presenting series of long cone parallel radiographs of 23 subjects with their subsequent posttherapy analogous radiographic series taken 5.4 +/- 2.9 years later. Bone loss was defined as a reduction in the alveolar crest of greater than 50% of the radiographic crown height which corresponds to approximately 4 mm in posterior and 5 mm in anterior teeth. The loss for each tooth was expressed as a per cent of the measured height of the crown after conversion from millimeters using the mean crown-root ratio for each tooth. We found increased alveolar bone loss and tooth loss in subjects examined posttherapy when compared with conditions present when each subject initially presented for periodontal treatment. Our data suggest that molar teeth are more at risk than incisors and cuspids and that a lack of periodontal maintenance care and inadequate plaque control contribute to progressive bone loss following treatment.     

Non-surgical periodontal therapy and tooth loss. A cohort study

BACKGROUND: No reliable evidence is available regarding the effect of periodontal therapy on major disease endpoints such as tooth loss, edentulism, or quality of life. The primary objective of this study was to assess the association between tooth loss and the non-surgical periodontal treatment history of 1,021 members of the Kaiser Permanente Dental Care Program. METHODS: Tooth loss rates were estimated using Poisson regression models, adjusting for some of the potentially confounding variables such as initial disease severity and extent. RESULTS: Continuous non-surgical therapy (one or more non-surgical procedures performed during 3 successive years), as opposed to no therapy during such a 3-year period, reduced the subsequent tooth mortality rate by 58% (relative rate, 0.42; 95% confidence interval, 0.29-0.61). Intermittent non-surgical therapy reduced the tooth mortality rate by 48% (RR = 0.52; 95% confidence interval, 0.34-0.80). As the number of non-surgical procedures increased, tooth loss rates decreased. CONCLUSIONS: These findings suggest that non-surgical periodontal therapy may be associated with a substantial reduction in tooth mortality. Different study designs and populations are needed to confirm these findings.     

Trends in tooth loss due to caries and periodontal disease by tooth type

Although the patterns of dental disease is gradually changing, caries and periodontal disease still account for the most important reason for extractions in most countries. However their relative contributions towards overall tooth mortality figures varies. The aim of this study is to investigate the types of teeth usually associated with extractions due to caries or periodontal disease and its relation to the age at which the tooth was lost. The highest proportion of extractions due to caries occurred between 21 to 30 years of age while that for periodontal disease occurred between 41 to 50 years. For caries, the greatest proportion of extractions involved the posterior teeth. The most frequently extracted teeth due to caries are the molars, in particular the first permanent molar. However, for periodontal disease a slightly greater proportion of anterior teeth were lost than the posteriors. This trend is more marked in the lower jaw than the upper. Overall, extractions related to caries tend to increase posteriorly, while that for periodontal disease tend to increase anteriorly.     

Risk indicators for tooth loss due to periodontal disease

BACKGROUND: Several risk indicators for periodontal disease severity have been identified. The association of these factors with tooth loss for periodontal reasons was investigated in this cross-sectional comparative study. METHODS: All extractions performed in 21 general dental practice clinics (25% of such clinics in Kuwait) over a 30-day period were recorded. Documented information included patient age and gender, medical history findings, dental maintenance history, toothbrushing frequency, types and numbers of extracted teeth, and the reason for the extraction. Reasons were divided into periodontal disease versus other reasons in univariate and binary logistic regression analyses. RESULTS: A total of 1,775 patients had 3,694 teeth extracted. More teeth per patient were lost due to periodontal disease than for other reasons (2.8 +/- 0.2 versus 1.8 +/- 0.1; P <0.001). Factors significantly associated with tooth loss due to periodontal reasons in logistic regression analysis were age >35 years (odds ratio [OR] 3.45; 95% confidence interval [CI] 2.79 to 4.26), male gender (OR 1.42; 95% CI 1.17 to 1.73), never having periodontal maintenance (OR 1.48; 95% CI 1.23 to 1.78), never using a toothbrush (OR 1.81; 95% CI 1.49 to 2.20), current or past smoking (OR 1.56; 95% CI 1.28 to 1.91), anterior tooth type (OR 3.23; 95% CI 2.57 to 4.05), and the presence of either of the following medical conditions: diabetes mellitus (OR 2.64; 95% CI 2.19 to 3.18), hypertension (OR 1.73; 95% CI 1.41 to 2.13), or rheumatoid arthritis (OR 4.19; 95% CI 2.17 to 8.11). CONCLUSION: Tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis, and anterior tooth type.     

Systemic antibiotics and tooth loss in periodontal disease

Systemic antibiotics have been recommended for the treatment of destructive periodontal disease. Our goal was to relate antibiotic use for medical or dental reasons to subsequent tooth loss in a cohort of 12,631 persons with destructive periodontal disease. After adjustment for age, smoking, and other confounders, the dispensing of antibiotics for 1-13 days, 14-20 days, or 21 or more days was not associated with reduced tooth loss [Adjusted rate ratio (RR) = 1.0; 95% Confidence Interval (CI) = 0.8-1.1; RR = 1.2; 95% CI = 0.9-1.4, and RR =1.2, 95% CI =1.0-1.3, respectively]. Numerous subgroup analyses were consistent with these overall null findings, with two exceptions: Longer courses of tetracyclines were associated with reduced tooth loss among persons receiving periodontal care, and penicillin was associated with reduced tooth loss among persons with more severe disease. Long-term, larger randomized trials are needed to provide evidence that antibiotics reduce tooth loss when used in the management of destructive periodontal disease.     

牙周维护治疗的重要性

牙周病是由菌斑微生物所引起的牙周支持组织慢性感染性疾病。菌斑微生物的控制是牙周病重要的治疗手段。由于口腔环境及牙周组织结构的特殊性,牙周系统治疗无法一劳永逸,是一个长期的过程。因此,牙周维护治疗应贯穿整个治疗过程,是牙周系统治疗中必不可少的组成部分,也是牙周疗效得以长期保持的重要手段。文章就牙周系统治疗中牙周维护治疗的重要性做一综述。     

Reduction of tooth loss associated with periodontal treatment

Comparing tooth loss for populations comprising subjects with periodontal disease has been limited by broad and different definitions of disease severity. Numeric scores for periodontal disease severity and risk were used to enhance the precision of comparing tooth loss for two populations. Both populations received routine dental care, but only one received comprehensive periodontal treatment. The analysis provides evidence that adding periodontal treatment to routine dental care is associated with less tooth loss and more patients who do not lose any teeth. Furthermore, it may be possible to nearly eliminate tooth loss associated with periodontal disease.     

The periodontal enigma: eruption versus tooth support

The response of the periodontal ligament is reviewed when single or repeated loads are applied to the tooth, as in mastication. A more nearly elastic recovery is produced with simulated chewing than is indicated by single semi-static applications of force. The resting position of the tooth between loadings changes with the time of day and recent loading history. An unstressed tooth extrudes at a variable rate. Soon after entry into the mouth, extrusion is a progressive feature, which manifests as eruption with consequent structural rearrangement of the periodontium. Rates of extrustion are substantially higher than eruption. Experimental evidence is presented that newly erupted teeth of monkey erupt in a similar manner to rodent incisors. Thus reduction in masticatory loads allows teeth to erupt faster than control teeth. It is concluded that the ligament is well constructed to withstand the large but short-acting forces which occur in mastication and which cause relatively small, long term effects, on the position of the tooth in the alveolus. When unstressed, mechanisms in the ligament of a tooth with a developing or fully formed root, generate a continuous net force in the order of a gram tending to cause extrusion. The position a tooth adopts is determined by the interplay of these opposing sets of greatly differing forces.