Gingival recession: prevalence, extension and severity in adults

The gingival recession was assessed in 380 adult individuals aged more than 20 years and comprised both subjects being treated and looking for treatment at Bauru Dental School. Clinical evaluation was conducted by a single examiner in all teeth and involved analysis of four dental aspects (mesial, buccal, distal and lingual). The gingival recession was regarded as present whenever more than 1mm of root surface was exposed, and its vertical width was measured in millimeters from the cementoenamel junction to the gingival margin. The recessions were further scored following the criteria suggested by Miller in 1985. Gingival recession was observed in at least one dental surface in about 89% of the individuals analyzed. The prevalence, extension and severity of this clinical aspect increased with age. Class I recessions were the most frequent, yet there was a gradual increase of Class III and IV recessions as older subjects were evaluated. The mandibular teeth displayed more surfaces with gingival recession than the maxillary teeth and the mandibular incisors were the most affected teeth. Such high prevalence of gingival recession in adult patients demonstrates that dental professionals should provide attention to the clinical relevance of such alterations, as well as to the diagnosis of the etiologic factors.     

Cross-sectional study of patients fitted with fixed partial dentures with special reference to the caries situation

The caries situation among 30 patients with fixed partial dentures was examined 3 yr after cementation of the constructions. The fit of the crowns on the abutment teeth, the size of the interproximal areas and the relation between the crown margin and the gingival margin were registered. Risk factors for caries development, such as salivary factors, microbiologic factors, oral hygiene and diet were evaluated for each patient. During the 3-yr period 54 caries lesions occurred in 25 patients. Eleven lesions were found on abutment teeth. Two were located on the root surfaces unconnected with the crown margin (greater than 2mm from the gingival margin), three were recurrent lesions, where the crown margin was located above the gingival margin but closer than 2 mm and six were recurrent lesions where the crown margin was located under the gingival margin. No single caries risk factor seemed to be so closely correlated to the number of caries lesions developed that it could be used alone to select of patients at risk. When the sum of the assumed negative factors was used, more caries was found among the patients with three or more factors with negative values in the group as a whole. However, predicting the development of caries in an individual case with a high degree of probability seems to be complicated. Generally speaking there was no indication that caries disease development was caused by the presence of the fixed partial denture per se.     

Cross-sectional study of patients fitted with fixed partial dentures with special reference to the caries situation

Abstract – The caries situation among 30 patients with fixed partial dentures was examined 3 yr after cementation of the constructions. The fit of the crowns on the abutment teeth, the size of the interproximal areas and the relation between the crown margin and the gingival margin were registered. Risk factors for caries development, such as salivary factors, microbiologic factors, oral hygiene and diet were evaluated for each patient. During the 3-yr period 54 caries lesions occurred in 25 patients. Eleven lesions were found on abutment teeth. Two were located on the root surfaces unconnected with the crown margin (>2mm from the gingival margin), three were recurrent lesions, where the crown margin was located above the gingival margin but closer than 2 mm and six were recurrent lesions where the crown margin was located under the gingival margin. No single caries risk factor seemed to be so closely correlated to the number of caries lesions developed that it could be used alone to select of patients at risk. When the sum of the assumed negative factors was used, more caries was found among the patients with three or more factors with negative values in the group as a whole. However, predicting the development of caries in an individual case with a high degree of probability seems to be complicated. Generally speaking there was no indication that caries disease development was caused by the presence of the fixed partial denture per se.     

Root surface caries prevalence and associated factors among adult patients in an acute care hospital.

There have been many studies reporting on the prevalence of root surface caries in elderly populations, but there is little consistency in these reports concerning the associated risk factors. In the present study, intraoral examinations were carried out on adult patients (age range 22 to 91 years, mean age 57.9) on the acute care wards of a teaching hospital. Of the 103 patients examined, 23.3% exhibited carious lesions on root surfaces, these lesions occurring more frequently in males than in females, and more frequently in the 60 years and older age groups. Forty-five per cent of all root lesions recorded were found on the buccal or facial root surfaces of teeth exhibiting root surface caries. Individuals exhibiting root surface caries had more surfaces with gingival recession and loss of attachment greater than or equal to 3mm, more retained roots, higher DMFT values, and less teeth. However, statistically significant relationships were not obtained between root surface caries and a) coronal caries, b) dental plaque, c) calculus, d) bleeding on probing, and e) probing depth greater than or equal to 4mm. Thirty-three strains of Actinomyces viscosus were isolated from plaque samples taken from root surface lesions compared to 21 strains isolated from intact root surfaces.     

Risk factors for and the prevention of root caries in older adults

With the absolute and relative number of elderly people rising in most countries, it is essential that dental practitioners be knowledgeable about the normal changes and disease processes that occur in aging individuals. Especially prevalent in the aging population is root surface caries. Several variables may increase the risk of developing root surface caries. Among these are poor oral hygiene, microbial plaque, periodontal disease, gender (male), coronal caries, dietary habits, xerostomia, low socio-economic status, and infrequent dental visits. While each of these has an effect, plaque seems to have the greatest influence on the susceptibility of teeth to root decay. Improved oral hygiene and regular dental visits, combined with the use of fluoride, may continuously convert active root caries lesions to inactive. In fact, prophylactic programs are more effective in converting active to inactive rather than preventing the development of new lesions. The conscientious dental practitioner must identify his/her older patients at risk for developing root lesions and place a major emphasis on the prevention and treatment thereof.     

Prevalence of root caries in a selected population of older adults in Japan

In this study, the prevalence of root caries in a sample of Japanese elders was investigated along with various aetiological factors. Two hundred and eighty-seven independently living elderly people over the age of 60 years were examined for the prevalence of active, inactive, and filled root lesions as well as the number of teeth. General health, oral status and brushing habits were surveyed, and salivary flow was determined in terms of flow rate and subjective feeling of dry mouth during eating. About 39% of the subjects had one or more decayed roots and 53.3% had at least one decayed or filled lesion. Root caries was seen most frequently on canine teeth followed by the first premolar. The number of decayed or filled lesions increased with increasing number of residual teeth (Kruskal-Wallis test, P = 0.033), however, there was no association between the proportion of teeth with root decay and the number of teeth. For subjects with 20 or more teeth, the number of decayed roots is likely to be lower in subjects who reported brushing frequently (P = 0.058), and higher in subjects with low salivary flow (P = 0.059) or subjective feeling of dry mouth (P = 0.052) (Chi-squared). The presence of decayed lesions is likely to be related to dry mouth (P = 0.057, odds ratio 3.13) and brushing frequency (P = 0.088, odds ratio 1.76) (Multiple logistic regression analysis). The results indicate a high frequency of root surface caries in this Japanese community-dwelling older population. Oral hygiene status and low salivary flow or perceived dry mouth were potential risk factors for disease.     

The Distribution of Root Caries in Community-dwelling Elders in New England

An in-home examination of a probability sample of elders aged 70 and older living in the six New England states was conducted to estimate the prevalence and extent of root caries. Oral examinations were conducted by the visual-tactile method using a portable lamp, explorer, and a mouth mirror. Fifty-two percent of the study participants showed root caries experience and 22 percent had untreated root caries. In contrast to previous studies, this analysis showed that buccal root surfaces were no more likely than proximal surfaces to be affected by root caries. Logistic regression analysis showed that gingival recession and number of teeth were positively associated with root caries, while better oral hygiene maintenance and regular dental visits were negatively associated with root caries lesions (all factors: P <.05). The prevalence of root caries was found to increase with higher numbers of teeth except for a minority subgroup— i.e., those who retained 25 or more teeth. This study provides much-needed data on prevalence and extent of root caries in a probability sample of the oldest old in an entire region of the United States.     

Relationship of removable partial denture use to root caries in an older population.

The pattern and severity of root caries in a selected older population, living in the community and attending a general dental practice in Bexhill, East Sussex, England, is reported. A total of 146 patients were examined to determine the relationship among removable partial dentures, their design, and root caries. Of those patients, 57% wore removable dentures and had a higher prevalence of exposed root surfaces and root caries, particularly on abutment teeth. In addition, root caries lesions on abutment surfaces were found to be larger and more active than those on nonabutment surfaces.     

Predictors of root caries in the elderly

In an attempt to determine the association between overall health status, medication history, and oral hygiene status and root caries, 24 older persons residing independently in the community and 23 residents of a nursing home were interviewed and received oral examinations, using the Oral Hygiene Index and the Root Caries Index. The mean age of this population was 80 yr, with the nursing home subjects somewhat older than community-dwelling subjects. Only six persons had no root surface caries; three subjects had caries on all tooth surfaces with gingival recession. Mandibular teeth, particularly molars and premolars, showed the greatest attack rate. The best predictors of root caries were number of teeth remaining, calculus, plaque, and the use of medications with xerostomic effects. Medications were most predictive of maxillary root caries. The results point to the need to provide interceptive dental therapeutics for high risk geriatric populations such as those using multiple medications and with a poor history of oral care.     

Relationship between root caries and coronal decay

The relationship between caries on root surfaces and untreated coronal lesions was analyzed. A representative sample of 5028 persons was examined, their mean ages being 47.3 years for men and 47.7 for women. Poor dental health on root surfaces was associated with poor dental health in the coronal areas of the teeth. Subjects with root caries had fewer teeth and fewer fillings, more retained roots and more teeth with untreated coronal decay than did people with no root caries. Compared with the subjects without untreated coronal decay, those with from one to three decayed coronal surfaces showed an odds ratio of 4.5 of having caries on root surfaces. This ratio was 10.1 for the subjects who had more than three decayed coronal surfaces. It was concluded that factors related to the occurrence of decay are of a similar type whether caries is situated on root surfaces or in the coronal areas of the teeth, and therefore the prevention of caries in both sites may be accomplished by similar means.     

The oral status of elderly removable partial denture wearers

A random sample of 1019 elderly home dwelling persons participated in this study. There were 809 dentate respondents, 28.6% of whom wore removable partial dentures. They were examined for coronal and root caries, gingival recession, pocket depth and loss of gingival attachment. The removable partial dentures were also evaluated. Abutment teeth were found to be more likely to have caries and periodontal disease than all other teeth. Using a manova statistical procedure, the analysis indicated that the partial denture itself, irrespective of any professionally determined problems with the denture, appears to affect coronal and root caries on the teeth of partial denture wearers. Partial dentures judged to need repair or adjustment were related to periodontal status. The data on adverse effects of partial dentures suggest a need for patient education by the dentist and through public health measures, and good oral self care and regular professional recall for people who wear removable partial dentures.     

Prevalence of root and coronal caries in a noninstitutionalized older population

This paper describes the prevalence of coronal caries and root caries in a sample of 520 people representative of the noninstitutionalized, dentate population older than age 65 in two rural Iowa counties. The subjects were examined in their homes by trained dental examiners. All prevalence rates were age- and gender-adjusted. Both types of caries were prevalent in the population age 65 and older. If projections of increased numbers of older people and increased retention of teeth are reasonably accurate, caries in older populations may become a significantly greater dental problem, and increased prevention and treatment of caries will be needed for these people.     

Three-year Root Caries Incidence and Risk Modeling in Older Adults in North Carolina

Objectives : The purposes of this study were to describe the incidence of root caries and to identify its risk factors in a representative sample of older adults. Methods : Root caries incidence was estimated and multivariate risk assessment models were developed to identify predictors for root caries in a three-year follow-up study of 234 black and 218 white noninstitutionalized adults aged 65 and older residing in North Carolina. Results : During the observation period, 29 percent of blacks developed root caries, compared to 39 percent of whites (P<.05). The mean net DFS increment per person was 0.55±0.13 root surfaces for blacks vs 0.80±0.21 for whites (P>.32). Multivariate logistic regression analysis indicated that blacks wearing a partial denture, having some root fragments, having an average gingival recession ≥2 mm, and being free of P. intermedia were at greater risk for developing new root caries. The model for whites showed that retired people with their most severe gingival recession ≥4 mm, an average probing pocket depth ≥2 mm, and taking antihistamines were more likely to develop new lesions. Conclusions : These findings suggest that older blacks had less risk of root caries than whites, and in both groups indicators of poor periodontal status increased the risk of root caries.     

A cross-sectional study into the prevalence of root caries in periodontal maintenance patients

Abstract. The aim of this cross-sectional study was to investigate cross-sectionally the prevalence and several risk indicators of root caries in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11–22 years ago. These patients were part of a routine 3–6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffering capacity, mutans streptococci counts and Lactobacilli were also scored. From the total of 45 study subjects, 37 patients (82%) showed root lesions (root caries and/or root fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 root lesions per patient (range 0–19) in the present study. 10 patients had active root caries lesions. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibulair sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with >10⁶mutans streptococci/ ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: (1) root caries can be regarded as a complication in periodontal maintenance patients; (2) the individual number of root lesions correlate with individual dental plaque scores; (3) a high number of root lesions is associated with high counts of salivary mutans streptococci; (4) no relation between root caries and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiene instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.     

The oral health and attitudes to dental treatment of a dentate elderly population in Mosgiel, Dunedin.

As part of the Mosgiel Community Study, a longitudinal investigation of the health of the elderly, a dental survey was used to determine the oral health status and treatment needs, both objective and subjective, of a group of dentate older adults. Sixteen percent of the 817 subjects were dentate. Of these, 95 were available for the dental survey, and they were questioned and examined at their homes. The mean age was 77 years, and 55 percent of subjects were male; disproportionately more older males than females had retained some of their natural teeth. Seventy-two percent regularly sought dental treatment, and 39 percent felt they were in need of treatment. Few real barriers to treatment were identified, although a major obstacle preventing many from seeking treatment was their lack of perceived need. However, even the realisation that they required treatment was not sufficient cause for many to seek treatment. All subjects required some form of dental treatment. Eighty-five of the 95 subjects required at least one restoration, and 16 percent advanced restorative treatment. The frequencies of coronal and root surface caries were similar. Oral mucosal pathology was also common. Sixty-five percent of denture wearers required prosthetic treatment. Most subjects needed simple periodontal treatment, but 11 percent required advanced therapy. The main oral health problems of this group related to the simple management of plaque-related disease, and the wearing of dentures. However, 24 percent of people required complex restorative and periodontal treatment, or both.     

Root caries in patients in periodontal follow-up care. Prevalence and risk factors

The aim of this cross-sectional study was to investigate the prevalence and several risk indicators of root cari?s in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffer capacity, S. mutans counts and Lactobacilli were also scored. From the total of 45 subjects, 37 patients (82%) showed root lesions (root caries and/or fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 lesions per patient (range 0-19) in the present study. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with > 106 S. mutans/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: root cari?s can be regarded as a complication in periodontal maintenance patients, that the individual number of root lesions correlate with individual dental plaque score, that a high number of root lesions is associated with counts of salivary S. mutans, and that no relation between root cari?s and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygi?ne instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.     

Oral health status of male prisoners in Italy

OBJECTIVES: To determine the prevalence of dental and root caries, periodontal conditions, and prosthetic status of prison inmates. DESIGN: Cross-sectional survey. SETTING: Penal institutions in the Calabria region (Italy). PARTICIPANTS: A random sample of 544 prisoners. METHODS: Participants underwent a structured interview by trained interviewers and a dental examination. RESULTS: Only 2% had no history of caries. Mean DMFT and DMFS were 9.8 and 37.6 and missing teeth was the most prevalent component of the DMFT. Higher DMFT was found among older prisoners, having regular dental attendance, higher plaque index, and in those with a lower frequency of a tooth brushing habit. Conservative care and extractions were required by 61.9% and 33.3%. The mean plaque and gingival indices were 0.74 and 0.75; 10.5% had healthy periodontal tissues. The highest number of individuals was classified as having a CPI of 2, whereas 5% had at least one sextant with a CPI score of 4. Deep pockets were more likely in older subjects and in those with a lower frequency of a tooth brushing habit. A minimum of oral hygiene instruction was needed by 89.6%. Seven subjects were edentulous and 85.1% had a prosthetic treatment need. CONCLUSIONS: This survey emphasises the need for programmes to improve the oral health of prisoners.     

Oral health status of patients 5-6 years after placement of cobalt-chromium removable partial dentures

This study is a clinical survey of cobalt-chromium (Co-Cr) removable partial denture (RPD) wearers that aimed to investigate the effects of denture wearing on oral tissues. A random sample of patients who had received their dentures 5-6 years previously from a dental teaching hospital in Hong Kong was selected. Those who had been constantly wearing the RPDs were examined by one calibrated examiner under an optimal clinical setting. The patients' dental, periodontal and mucosal status were assessed. A total of 87 patients were examined. Mucosal lesions under the Co-Cr RPDs were uncommon in this study sample. However, there was a high prevalence of plaque, gingivitis and gingival recession, especially in dento-gingival surfaces in close proximity (within 3 mm) to the dentures. Thus, there is a special need for regular oral hygiene reinforcement, scaling and prophylaxis among RPD wearers. Despite a low caries incidence in the study sample, root caries were found to be associated with contact with the RPDs (P < 0.05) but coronal caries were not. It is recommended that coverage of the exposed root surfaces by RPD components should be avoided. Also, topical fluorides should be regularly applied onto exposed root surfaces as a preventive measure.     

Wearing of removable partial dentures in relation to dental caries

Using a representative sample of 5028 dentulous Finnish adults the occurrence of dental caries was studied among removable partial denture (RPD) wearers and non-wearers. Of the subjects wearing no RPD(s) 61.4% had one or more carious teeth, among those wearing a single RPD the figure was 60.5% and among those wearing RPDs in both jaws 62.7%, respectively. When sociodemographic background, other oral status measures than caries and oral health care habits were simultaneously controlled, subjects wearing RPDs in both jaws had slightly increased (P less than 0.05) probability of having one or more carious teeth compared to those with no RPD(s). Subjects with a single RPD did not have a statistically significantly increased probability of having carious teeth. Among those 3075 subjects who had one or more carious teeth the wearing of one or two RPDs did not significantly increase the number of carious teeth. Because the subjects wearing RPDs in both jaws were seen to have a slightly increased risk of having caries, this confirms the view that dentists should emphasize good oral hygiene habits and regular dental attendance among RPD wearers.