Dental caries experience, tooth loss, and factors associated with unmet needs of Haitian immigrants in New York City

OBJECTIVE: The aim of this study was to characterize the dental caries experience, tooth loss, and unmet need of a group of Haitian immigrant residents of New York City. METHODS: A purposive sample of 523 adults was obtained through community outreach activities during 1997-98. Clinical examinations were performed by calibrated examiners, according to NIDCR criteria. A comprehensive survey also was administered to all the participants. RESULTS: For the whole group, the mean number of missing teeth was 2.64 (SD = 4.12), the mean DMFT = 6.05 (SD = 5.26), the mean DMFS = 18.80 (SD = 21.04), and the mean DFS = 5.58 (SD = 6.17). Seventeen percent of the subjects had all their teeth sound, 59 percent had at least one tooth missing, 60 percent had at least one decayed tooth, and only 38 percent had restorations. Multivariate analyses showed that age, sex, education, dental insurance, frequency of dental visits, and dental floss use were predictors of unmet need. CONCLUSIONS: Although results showed a relatively low caries experience among this group of Haitian immigrants, the unmet need was very high. Furthermore, the tooth loss experience was relatively high for all age groups, further denoting a lack of access to preventive and restorative services.     

Socio-economic and behavioural risk factors for tooth loss from age 18 to 26 among participants in the Dunedin Multidisciplinary Health and Development Study

OBJECTIVE: To determine the risk factors associated with tooth loss between the ages of 18 and 26. METHODS: Dental examinations at ages 18 and 26 were conducted on Study members in the Dunedin Multidisciplinary Health and Development Study, and sociodemographic and dental service use data were collected using a self-report questionnaire. At age 15, an estimate of socio-economic status (SES) for each Study member had been obtained by classifying the occupation of the male parent. A case of tooth loss was defined as an individual who had lost one or more teeth (excluding third molars) due to caries between ages 18 and 26. Logistic regression and Poisson analysis were used to model the occurrence of tooth loss. RESULTS: Among the 821 study members who were examined at both ages, one or more teeth were lost because of caries by 85 (10.3%). After controlling for sex, SES and visiting pattern, baseline caries experience predicted subsequent tooth loss, with the odds increasing by 2.8 for every increase by 1 in the number of decayed surfaces present at age 18. Episodic dental visitors had 3.1 times the odds of their routine visiting counterparts of losing a tooth over the observation period. The number of teeth lost was, on average, 2.3 times higher among episodic dental visitors. CONCLUSIONS: Socio-economic inequalities in tooth loss appear to begin early in the life course, and are modified by individuals' SES and dental visiting patterns.     

Socioeconomic Inequality in Dental Caries Experience Expressed by the Significant Caries Index: Cross-Sectional Results From the RaNCD Cohort Study

IntroductionSocioeconomic inequality in dental caries among Iranian middle-aged adults remains largely unstudied. This study aimed to measure socioeconomic inequality in dental caries experience and to identify determinants of this inequality.Materials and methodsData were obtained from the Ravansar Non-Communicable Diseases (RaNCD) Cohort Study. This cross-sectional analysis included 10,002 adults aged 35–65 years. Caries experience was dichotomised based on the decayed, missing and filled teeth (DMFT) of one-third of the population with the highest caries scores (i.e. significant caries index). Socioeconomic status (SES) was calculated using the principal component analysis. The concentration index (CI) was used to quantify the extent of socioeconomic inequality in dental caries experience. Decomposition analysis was conducted to quantify the contribution of each determinant to the observed inequality.ResultsThe mean DMFT for all individuals was 16.1 (SD 9.1). The CI of having significant dental caries was –0.236 (95% CI: –0.0259, –0.213), indicating that having significant dental caries was more concentrated among low-SES individuals. SES (65.6%), age group (24.7%) and female gender (3.7%) were found to have the largest percentage of contributions to the observed inequality in dental caries.ConclusionThis study indicates pro-rich inequalities in dental caries experience among middle-aged adults in Iran. The findings highlight the importance of early prevention of dental caries experience before it happens. To mitigate inequalities in dental caries experience, policy interventions should focus on females, older age groups, and low-SES individuals.     

The overtime effect of social position on dental caries experience in a group of old-aged Danes born in 1914

OBJECTIVES: The purpose of this study was to analyze the life-course effects of education, occupation, and income at ages 70, 75, 80, and 85 years, respectively, on dental caries experience of 85-year-olds. METHODS: The present study includes follow-up data from a population-based study, which comprised a sample of 176 individuals aged 85 years. Data on social position were collected at ages 70, 75, 80, and 85 years by means of structured personal interviews. Clinical oral health examinations were conducted to obtain data on dental caries at age 85. Dental caries was recorded at tooth surface level and caries experience was expressed by the DMF Index: the decayed tooth surfaces (D component), missing tooth surfaces (M component), and filled tooth surfaces (F component). RESULTS: The participants in the present study demonstrated a high level of dental caries experience; the prevalence rate for active dental caries (D-S) was 80 percent. Older adults with low education, low occupational status, and poor income tended to have more active dental caries compared to their counterparts. In contrast, individuals with high education (F-S = 35.5) and high occupational status (F-S = 36.0) had significantly more filled surfaces than persons with low education (F-S = 24.0) and low occupational status (F-S = 25.6). Individuals with high income at ages 75, 80, and 85 years had more filled surfaces (F-S = 31.9, 33.2, 34.1) compared to persons with low income (F-S = 25.5, 23.5, 22.8). CONCLUSION: The study identified social inequalities across age among the very old individuals in relation to dental caries experience.     

Association between developmental defects of enamel and dental caries in schoolchildren

Despite improvement, dental caries is still the main public oral health problem worldwide and the major cause of pain, tooth loss and chewing difficulties in children and adolescents; and it impacts negatively on oral health-related quality of life. A cross-sectional study of a multistage representative sample of 8–12-year-old Brazilian school children was carried out in order to investigate the association between enamel defects and dental caries. Children's mothers completed a questionnaire about socio-demographic and behavioural characteristics at home. Firth's bias reduced logistic regression models were undertaken to assess the association between the main exposure (enamel defects) and caries experience. The prevalence of any enamel defect was 64.0%; the prevalence of diffuse opacities, demarcated opacities and enamel hypoplasia was 35.0%, 29.5% and 3.7%, respectively. The prevalence of dental caries was 32.4%, with mean DMFT of 0.6 (SD, 1.2). Dental caries experience was more common among children who had enamel hypoplasia in their posterior teeth (OR = 2.79; 95% CI: 1.05, 6.51) than among those with none. In anterior teeth, there was no association. Enamel hypoplasia appears to be an important risk factor for dental caries.     

Incidence of tooth loss and dental caries in 60-, 70- and 80-year-old Swedish individuals

Abstract The retention of natural teeth among the elderly is increasing and, in recent studies, dental caries has been identified as the main reason for teeth being extracted. The 5-year incidence of tooth loss and dental caries and the most crucial dental factors for tooth extraction were studied in a random sample of 60-. 70- and 80-year-old inhabitants of Gothenburg, Of the 208 persons examined at baseline, 148 (71%) participated in the follow-up examination: 69, 51 and 28 respectively in the different age groups. In all. 110 teeth had been extracted during the period in 40% of the participants. Only 9 persons had lost three or more teeth. The mean numbers of remaining teeth were 22, 18 and 15 respectively in the 60-, 70- and 80-year age groups and the mean numbers of teeth lost during the 5-year period increased with age from 0.4 in the 60-year-olds to 0.8 and 1.4 in the 70- and 80-year-olds (P<0.05). The major reason for tooth extraction was dental caries and it was found in 60% of all cases and at a higher rate of 77%i in the oldest age group. Fifty-one per cent had developed new coronal carious lesions and 61% had new root carious lesions, while 27% had not developed caries during the period. The mean 5-year increment in decayed and filled coronal surfaces increased with age from 2.3 in the 60-year-olds to 3.7 and 5.3 in the 70- and 80-year-olds (N.S.). The increment in decayed and filled root surfaces was higher in women than men, 3.4 compared with 1.8 (N.S.), which also increased with age from 1.4 in the 60-year-olds to 2.4 and 5.5 in the 70- and 80-year-olds (P<0.0001). It was concluded from this study that few teeth had been lost during the 5-year period but that dental caries still appeared to be a serious problem among some very elderly people.     

Incidence of, and reasons for, tooth mortality among mentally retarded adults during a 10-year period

The aim of the study was to investigate the reasons for, and incidence of, tooth mortality over a 10-year period in mentally retarded adults receiving regular dental care. The number of teeth present in 115 individuals (mean age in 1984 was 41.0, range 19-83 years) was registered in 1984 and 1994. The reasons for tooth mortality, medication utilization, frequency of dental care visits and cooperation during dental treatment were registered and related to tooth loss. The average incidence of tooth mortality was 3.72 teeth during the 10-year period. The mean number of dental care visits per year was 6.6. Most of the 428 teeth (58%) were lost due to periodontal disease. The preventive dental care given was not sufficient to arrest oral diseases. The data indicate, however, that achievement of cooperation in dental care situations not only makes dental treatment possible, but also leads to a decreased incidence of tooth mortality.     

Tooth loss as related to dental caries and periodontal breakdown in adult Tanzanians

A total of 170 adults aged 30-69 yr from the Zanzibar and Pemba Islands (Tanzania) were examined for tooth loss, dental caries and loss of periodontal attachment. The cause of tooth loss was recorded from information given by the examinee to a Kiswahili-English interpreter. Dental caries were recorded according to the depth of the lesion, i.e. involving enamel, dentin or pulp, respectively. Loss of attachment was measured as the distance in mm from the CEJ to the bottom of the pocket. The most severely affected surface determined the state of the tooth. The mean number of teeth present ranged from 29.5 in the youngest to 23.9 in the oldest age group. The mean number of teeth missing due to dental caries ranged between 2.1 and 7.0 teeth, and exceeded by far tooth loss due to periodontal breakdown which was only observed in the two oldest age groups. In all age groups the molars were the teeth most frequently missing and also the teeth most frequently affected by dental caries. Although a substantial number of the teeth in the older age groups demonstrated an extensive loss of attachment only a few teeth, mainly mandibular incisors, were lost due to periodontal breakdown within the age range examined.     

Dental Caries and Tooth Loss in Adolescents With Early-Onset Periodontitis

The aim of this study was to assess the caries experience and tooth loss over 6 years in subjects with early-onset periodontitis as compared to their matched controls, and to describe the characteristics of teeth lost during this period. A multi-stage probability sample representing 8th to 12th grade U.S. schoolchildren were screened during the 1986/1987 school year to identify subjects with early-onset periodontitis (cases). The examination included measuring the clinical attachment level, presence of caries and dental restorations, and tooth loss. A random sample of controls without earlyonset periodontitis were selected for a follow-up examination and were matched to cases on gender, race, age, and geographic location. A total of 266 subjects, with a mean age of 16 years at baseline, were examined during the 1992/1993 school year and were classified into localized (LJP) and generalized juvenile periodontitis (GJP), incidental attachment loss (IAL), and control groups. Whites had more caries experience than Blacks and Hispanics, but there were no significant differences in tooth loss between the ethnic groups. The LJP and the IAL groups, respectively, had higher and lower overall caries experience than the control group. The LJP group had a significantly higher number of missing teeth at follow-up, and exhibited more extensive tooth mortality during 6 years than the control group. The GJP group also showed more tooth loss than the control group, but the difference was not statistically significant. In the LJP, GJP, IAL, and control groups, respectively, 43%, 32%, 26%, and 18% of the subjects lost teeth over 6 years due to disease. The findings showed differences in caries activity between the early-onset periodontitis groups and a variation by race. The findings suggest that loss of periodontal support was the principal cause for tooth loss in the LJP and GJP groups, and that dental caries was the principal cause for tooth extraction in the IAL and the control groups. J Periodontol 1996;67:960–967.     

Consequences of Success: Do More Teeth Translate into More Disease and Utilization?

Objectives : Increased tooth retention coupled with increased numbers of older adults means that the actual number of teeth at risk to dental disease will increase sharply. Whether this increase in the number of teeth will translate into more disease and utilization in unknown. The purpose of this study was to test this "more teeth, therefore more dental disease" theory using cross-sectional data. Methods : In-home personal interview and oral examination data were obtained on a probability sample of elders aged 70 years and older living in the six New England states using the Medicare beneficiary list as a sampling frame. Data on dental utilization, number of teeth, dental caries, and periodontal disease were included in the current analysis. Results : Analysis of variance on subjects with 1–10 (Group 1), 11–24 (Group 2), and 25–32 (Group 3) teeth show that the extent of bleeding on probing, pocket depth, and loss of attachment all increase as numbers of teeth increase. Similarly, a greater number of restored coronal and root surfaces were found in Group 3 relative to the other two groups. Mean numbers of decayed and filled coronal surfaces were 8.4 in Group 1,33.0 in Group 2, and 50.3 in Group 3. In contrast, unrestored coronal and root surfaces were significantly higher in Group 1 (mean root DS=1.3) than Group 3 (mean root DS=0.3). Utilization patterns of those with successful aging dentitions (Group 3) show that they are visiting dentists more frequently than the compromised group (Group 1). Conclusion : These cross-sectional data obtained from a probability sample of New England elders show that subjects who retained higher numbers of teeth have more periodontal disease and dental caries experience, and visit the dentist more frequently.     

Dental restorations: a risk factor for periodontal attachment loss?

BACKGROUND: Dental caries and restorations in proximal tooth surfaces often impinge upon the periodontal biological width. AIM: This study examines whether these factors may contribute to risk for periodontal attachment loss at these sites. METHODS: The study is based upon data from the Dunedin Multidisciplinary Health and Development Study, a long-standing cohort study. Approximal tooth surfaces of 884 study members were evaluated for restorations and caries at age 26 and again at 32 years, and probing depth and gingival recession were recorded in millimetres at age 32. Attachment loss was computed as the sum of pocket depth and gingival recession. Data were analysed using generalized estimating equations. RESULTS: Where a caries/restorative event had occurred on an inter-proximal tooth surface before age 26, the age-32 attachment loss at the corresponding periodontal site was approximately twice more likely to be >or=3 mm than if the adjacent tooth surface had remained sound to age 32. This was also true where a caries/restorative event had occurred subsequent to age 26. The association remained after controlling for potential confounders, including smoking. CONCLUSIONS: Site-specific periodontal attachment loss due to dental caries or restorative events occurs in adults in their third and fourth decades of life.     

Dental caries. Principal cause of tooth extraction in a sample of US male adults

Comprehensive oral examinations carried out over a period of about 10 years on participants in the Veterans Administration Dental Longitudinal Study were evaluated to identify teeth extracted during this time and to ascertain the apparent reason for these extractions. The study population included 736 dentulous adult males, 49% of whom experienced 1,142 extractions. Caries was judged to be the primary cause of tooth loss, responsible for 33.3% of the teeth extracted. Extractions in preparation for a prosthesis (31.3%) and periodontal disease (18.7%) were the other major causes of tooth loss. Thus, dental caries was the prime cause of tooth extraction in this sample of US male adults, while a second major cause was preparation for a prosthesis which included the extraction of sound teeth and teeth with carious lesions which could have been restored. Periodontal disease was clearly not the major cause of tooth loss and was responsible for only 18.7% of the extractions in this population. The results of this study demonstrate that dental caries is a major problem in adults, leading to greater tooth loss than periodontal disease. A large percentage of the tooth loss in these individuals was clearly preventable. The same emphasis placed upon caries prevention in children should be applied to the adult population.     

Dental caries prevalence in early Polynesians from the Hawaiian Islands

We examined the skeletal remains of 1338 early Hawaiians (preserved in the Bishop Museum, Honolulu) to determine total caries and root surface caries prevalence. Specimens from seven islands were represented in the collection. Estimation of age at death was made by a combination of dental developmental staging for younger individuals and occlusal attrition and/or alveolar bone loss in adults. Museum records were also consulted for age estimation of adults which was primarily based on osteological criteria. The material was divided into six age groups. Predentate infants and edentulous adults were not included. A total of 19,425 teeth was examined. Caries lesions were observed in 462 individuals (34.5%) and 1895 teeth (9.8%). Coronal caries lesions in children and adolescents tended to be small and not particularly destructive of tooth structure. Root surface lesions in young adults were also small but increased progressively in size in the older groups, resulting in pulp exposure and coronal amputation. Although coronal caries was apparently not a significant dental health problem in children and young adults (compared with contemporary Hawaiians), root surface caries was an increasingly important source of tooth morbidity and tooth mortality in the older population groups. This age-related caries pattern was similar for all of the islands.     

Prevalence of total tooth loss, dental caries, and periodontal disease in Mexican-American adults: results from the southwestern HHANES

The Southwestern portion of the Hispanic Health and Nutrition Examination Survey (HHANES) was conducted by the National Center for Health Statistics (NCHS) in 1982 and 1983. The survey population was Mexican-Americans residing in five Southwestern states. This report presents data on the prevalence of total tooth loss, dental caries, and periodontal diseases in 3860 Mexican-American adults aged from 18 to 74. Results show that 4.3% of this group was edentulous. Among the dentate, Mexican-Americans had lower overall DMF scores but higher numbers of untreated decayed teeth than did residents of the same region seen in the NHANES I survey in 1971-1974. Caries of the smooth surfaces in both posterior and anterior teeth was more pronounced in the older than in the younger age groups. Mexican-Americans had more gingivitis but fewer periodontal pockets than did the general population in the Western states during NHANES I. The caries pattern in the Mexican-Americans suggests that caries among adults may remain a problem in the future, with the possibility of increased involvement with the aging, although modest, of smooth tooth surfaces.     

Oral health-related quality of life in a birth cohort of 32-year olds

Abstract – Objectives: To describe oral health‐related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well‐established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services. Methods: A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14‐item Oral Health Impact Profile questionnaire (OHIP‐14). The questionnaire also collected data on each study member’s occupation, self‐rated oral health and reasons for seeing a dental care provider. SES was determined from each individual’s occupation at age 32 years. Results: The mean total OHIP‐14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems ‘fairly often’ or ‘very often’. When the prevalence of impacts ‘fairly/very often’ was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and ‘episodic’ dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts. Conclusions: OHIP‐14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age‐ and sex‐standardized estimates from Australia (18.2%) and the UK (15.9%).     

Caries frequency and distribution in an early medieval Avar population from Austria

Objective:  The aim of this study was to determine frequency and distribution of dental caries in an early medieval Avar population from Central Europe, namely Vienna.
Methods:  The evaluation of caries was carried out in an anthropological sample consisting of the remains of 136 individuals and included 2215 permanent teeth. Age and sex estimations were based on dental development and on skeletal ageing methods. The presence of dental caries was determined according to clinical aspects using a dental probe.
Results:  The frequency of ante mortem tooth loss in the sample was 23.8%; the total caries frequency was calculated as 14.9%. The highest caries rate was recorded in the second mandibular molar (34.6%). The most affected tooth surface was found to be the root with 12.7%, followed by the approximal surface with 8.6%, but only 7.7% of the occlusal surfaces were affected by caries.
Conclusion:  This study revealed that Avars suffered from higher caries rates than most other medieval European populations, but experienced a similar dental caries distribution. Attrition of the occlusal surface resulting from a diet containing abrasive particles with accompanying posteruptive tooth movement is considered the major factor causing this premodern caries pattern.     

Tooth mortality in an adult rural population in Kenya

This paper reports on the pattern of tooth loss in a random sample of 1131 adults aged from 15 to 65 years in a rural area of Kenya in which access to formal dental care is minimal. We found that the majority of the population retained most of their dentition in a functional state even up to the age of 65 years: In all age groups, more than 50% had at least 26 teeth present, and more than 90% had at least 16 teeth present. The prevalence of edentulousness was less than 0.3%. The principal cause of tooth loss in all age groups was caries, and this was true for all tooth-types except incisors, for which periodontal disease was the main cause of tooth loss. The cultural practice of removing lower central incisors was observed only in those over 40 years of age. More teeth were lost due to caries among women than among men, while the reverse was true for teeth lost due to periodontal diseases. In view of the fact that most people retain most of their teeth throughout life, it is suggested that the most appropriate strategies for dental health care in this population should be those promoting self care, rather than the introduction of a formal treatment-oriented approach provided by dentists.     

Dental caries in Quebec adults aged 35 to 44 years

BACKGROUND: The purpose of this study was to assess the prevalence of dental caries in Quebec adults aged 35 to 44. METHODS: A stratified sample was used. The participation rate was 77% for the questionnaire and 44.5% for the oral examination. A total of 2,110 people were examined. The World Health Organization's caries criteria were used. Examiner agreement with gold standard dentist was excellent at the end of the nine-day training session (Kappa index > 0.8). RESULTS: The level of caries experience is very high in Quebec adults aged 35 to 44. Almost half of dental surfaces (65 of 148) have been affected. These surfaces are mostly missing (39.3) or filled (23.9). However, there were 1.8 decayed surfaces in need of treatment per adult, and more than half the people (55.5%) had no untreated decayed surfaces. Almost three-quarters of decayed surfaces were present in only 14% of the people; lower family income and lower education are risk factors. CONCLUSION: Comparison between Quebec and industrialized countries (United States, England and the Netherlands) shows that in adults 35 to 44, the mean number of decayed teeth is low (between 1.0 and 2.2) and the mean number of filled teeth is relatively similar (between 9.6 and 11.1); however, Quebec has a higher percentage than the United States of edentulous people. As well, in dentate adults, there are 1.6 times more missing teeth among Quebecers than among Americans.     

Dental neglect and dental health among 26-year-olds in the Dunedin Multidisciplinary Health and Development Study

OBJECTIVES: To test a modification of a previously-reported six-item dental neglect scale and examine its association with dental health and service-use among young adults. METHODS: Of the 980 26-year-old participants in the Dunedin Multidisciplinary Health and Development Study, 973 completed the scale and 930 underwent dental examination. Sociodemographic and dental service-use data were collected using a self-report questionnaire. RESULTS: Factor analysis showed that five of the original six items loaded on the scale, and responses to those items were summed to give a dental neglect scale score for each participant. Scale scores were normally distributed (mean=13.0; SD=3.6; range 5 to 25), and a median split created higher and lower dental neglect groups. A higher proportion of the higher neglect group group: (i) were male; (ii) rated their dental health and dental appearance as below average; (iii) brushed their teeth infrequently; (iv) had extensive plaque deposits; (v) used dental services only when they had a problem; (vi) had not recently seen a dentist; (vii) had lost at least one permanent tooth because of caries, and (viii) had a greater number of decayed tooth surfaces. CONCLUSIONS: Although further examination of its validity and reliability is indicated, the dental neglect scale appears to hold promise for use in dental health promotion, not only in highlighting population groups or individuals who would benefit from intensive health promotion efforts, but also in the evaluation of health promotion interventions.     

Causes of Tooth Loss in a Veteran Population

Tooth loss in adults over age 35 usually is attributed to periodontal diseases. However, certain adult populations are known to have high caries rates. It is not clear to what extent caries contributes to tooth loss in adults. This pilot study examined the causes of tooth loss in a veteran population residing in an 800-bed, primarily long-term care facility. The study retrospectively reviewed 572 patients' dental records and documented causes for dental extractions. Of the sample population, 168 teeth were extracted in 51 patients who had 860 teeth present before treatment. Mean age of the patients undergoing extractions was 57.7 years, lower than the sample population of 60.1 years. Of the 168 teeth extracted, 105 (63%) were attributed to caries and 33 (20%) were documented as root tips, suggesting the presence of root caries. Fifty-five (33%) were extracted due to periodontal disease and six (4%) were extracted for prosthodontic reasons. Of the maxillary teeth, 67 percent were extracted for caries and 25 percent of periodontal reasons. Caries accounted for 57 percent and periodontal disease accounted for 42 percent of the mandibular teeth extracted. The order in which teeth were most frequently extracted was maxillary anteriors, mandibular anteriors, maxillary and mandibular premolars, and maxillary and mandibular molars. This study supports the recent work of authors who have found caries contributing significantly to tooth loss in adult populations.