Pederson scale fails to predict how difficult it will be to extract lower third molars

We report a consecutive series of 105 extractions of impacted lower third molars, in each of which operative difficulty was predicted preoperatively using the Pederson scale (radiographic appearance of the anatomical position of the lower third molar), and postoperative difficulty was scored with a modified version of the Parant scale (operative manoeuvres that were needed for extraction of the third molar). Preoperative classification as "difficult" on the Pederson scale was not an accurate predictor of true difficulty (postoperative classification as "difficult" on the modified Parant scale). There was no significant association between the Pederson score and duration of operation, but high Parant scores were significantly associated with longer operations. We suggest that scales for the prediction of operative difficulty in the extraction of impacted lower third molars should take into account factors other than the anatomical position of the tooth.     

Prevalence of mutans streptococci and lactobacilli in elderly Swedish individuals

The number of Streptococcus mutans, Streptococcus sobrinus, and lactobacilli in stimulated whole saliva was examined in 149 elderly persons. More than 10(6) CFU/ml of mutans streptococci were found in 57% of the subjects and 85% had more than 10(5) lactobacilli per ml of saliva. There was no difference in the prevalence of mutans streptococci between edentulous and dentate subjects whereas significantly more lactobacilli were detected in denture wearers. S. mutans was most frequent and was found in 72% of the subjects. S. sobrinus, which was carried by 44% of the persons, was found proportionally in more subjects with dentures than in dentate individuals. In most persons with S. sobrinus, S. mutans was also present but in 8% of the subjects only S. sobrinus was detected. The subjects with both S. mutans and S. sobrinus had higher salivary levels of mutans streptococci than individuals with only S. mutans or S. sobrinus.     

Prevalence of mutans streptococci and lactobacilli in elderly Swedish individuals

Abstract — The number of Streptococcus mutans, Streptococcus sobrinus, and lactobacilli in stimulated whole saliva was examined in 149 elderly persons. More than 10⁶ CFU/ml of mutans streptococci were found in 57% of the subjects and 85% had more than 10⁵ lactobacilli per ml of saliva. There was no difference in the prevalence of mutans streptococci between edentulous and dentate subjects whereas significantly more lactobacilli were detected in denture wearers, S. mutans was most frequent and was found in 72% of the subjects. S. sobrinus, which was carried by 44% of the persons, was found proportionally in more subjects with dentures than in dentate individuals. In most persons with S. sobrinus, S. mutans was also present but in 8% of the subjects only S. sobrinus was detected. The subjects with both S. mutans and S. sobrinus had higher salivary levels of mutans streptococci than individuals with only S. mutans or S. sobrinus.     

Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban population

BACKGROUND AND OBJECTIVE: Growing experimental evidence implicates chronic inflammation/infection due to periodontal diseases as a risk factor for death. The objective was to evaluate the role of periodontitis in premature death in a prospective study. METHODS: The causes of death in 3273 randomly-selected subjects, aged 30-40 years, from 1985 to 2001 were registered. At baseline, 1676 individuals underwent a clinical oral examination (Group A) and 1597 did not (Group B). Mortality and causes of death from 1985 to 2001 were recorded according to ICD-9-10. RESULTS: In Groups A (clinically examined group) and B, a total of 110 subjects had died: 40 subjects in Group A, and 70 in Group B. In Group A significant differences were present at baseline between survivors and persons who later died, with respect to dental plaque, calculus, gingival inflammation and number of missing molars in subjects with periodontitis (p < 0.001). The multiple logistic regression analysis results of the relationship between being dead (dependent variable) and several independent variables identified periodontitis with any missing molars as a principal independent predictor of death. CONCLUSIONS: Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems.     

Root surface caries in older individuals from Sri Lanka

The aim of the present study was to assess the prevalence and factors associated with root surface caries in older individuals from Sri Lanka. A total of 600 urban subjects aged 60 years and above was selected using a two-stage cluster sampling combined with probability-proportionate-to-size technique. The data were collected by means of an interviewer-administered questionnaire and an oral examination. The mean number of teeth present was 13.4 +/- 8.7. The prevalence of root surface caries was 89.7%. The mean number of root surfaces with decay or fillings and the mean root caries index (RCI) per subject were 3.8 and 25.0%, respectively. In both arches, the molars were the most affected by root caries. A multiple logistic regression analysis showed that betel chewing (OR = 0.36; 95% CI 0.20, 0.65), being >80 years of age (OR = 0.24; CI 0.09, 0.57), number of retained teeth (OR = 0.88; CI 0.83, 0.93) and number of root surfaces with recession (OR = 1.03; CI 1.01, 1.07) were significantly associated with the presence of root surface caries. In conclusion, it was evident from the study that the prevalence of root surface caries was high in this group of older individuals. Chewing betel, age, number of retained teeth and the number of root surfaces with recession emerged as significant predictors of root caries.     

轻，中、重度慢性牙周炎多种等位基因的检测

目的：探讨轻度慢性牙周炎个体和中、重度慢性牙周炎个体携带不同数目牙周炎易感基因的差异。方法：对纳入的慢性牙周炎个体和健康对照组进行牙周临床检查,并抽取外周静脉血,提取基因组DNA,应用限制性内切酶,采用聚合酶链反应限制性片段长度多态性的方法检测HLA-DRB1＊1501、TNF-A-308、IL-1B＋3953、雌激素受体、维生素D受体5种基因的多态性。结果：中、重度慢性牙周炎个体携带3种以上易感等位基因的百分比为56.6%,轻度慢性牙周炎个体携带3种以上易感等位基因的百分比为12.5%,健康对照组携带3种以上易感等位基因的个体百分比为7.5%,经方差分析中、重度慢性牙周炎组与轻度慢性牙周炎组和健康对照组间差异具有统计学意义（P〈0.01）,轻度慢性牙周炎组与健康对照组间差异不具有统计学意义。中、重度慢性牙周炎组携带VDR-TT、ER-XX基因型的个体临床附着丧失重于携带VDR-tt和ER-xx基因型的个体,经t检验二组差异具有显著性（P〈0.01）。结论：多种等位基因的共同携带有助于慢性牙周炎的进展;VDR-TT和ER-XX基因型可能是牙周骨组织丧失的危险因素。     

Signs and symptoms from ectodermal organs in young Swedish individuals with oligodontia

OBJECTIVES: The aim was to assess signs and symptoms from other ectodermal organs in addition to teeth in young individuals with oligodontia and to establish the prevalence of oligodontia. SAMPLE AND METHODS: Children born 1981-94 reported by dental teams in the Public Dental Service to have oligodontia were asked to participate in a clinical study. The examinations comprised a structured interview on symptoms from ectodermal organs, and testing of salivary secretion. RESULTS: One hundred and sixty-two individuals met the inclusion criteria, and 123 individuals (75.9%) participated in the clinical study. Half of the individuals had one to four signs or symptoms from ectodermal organs beside oligodontia. The most common sign was low salivary secretion. Twelve individuals (9.6%) with isolated oligodontia reported impaired function of the sweat glands, hair, or nails. The prevalence of oligodontia was 0.090%. CONCLUSIONS: An early identification of individuals with oligodontia can be made in a majority of cases by checking that all permanent incisors have erupted at the age of 8 years. The validity in asking individuals about normal and abnormal function of ectodermal organs was found to be low. This indicates that there is a strong need to establish routine clinical criteria for dysplasia of ectodermal organs.     

Ten-year incidence of tooth loss and dental caries in elderly Swedish individuals

There has been a significant reduction in edentulism and the elderly retain more teeth into old age. The 10-year incidence of tooth loss, coronal and root caries was studied in a random sample of inhabitants of G?teborg, who were 55, 65 and 75 years old at baseline. Of the 208 persons examined at baseline, 102 (49%) participated in the follow-up examination: 56, 37 and 9, respectively, in the different age groups of 65, 75 and 85 years. In addition, for the purpose of time-trend comparisons, a new random sample of 98 individuals aged 55 years was examined. The mean numbers of remaining teeth were 24, 23, 17 and 14, respectively, in the age groups of 55, 65, 75 and 85. The corresponding mean numbers at baseline were 23, 19 and 17, respectively, in those subjects who were then 55, 65 and 75 years old. Forty-eight percent had lost no teeth during the 10-year period, while 13% had lost more than 2 teeth. The major reason for tooth extraction was dental caries and it was found in 60% of all cases. The incidence of coronal caries decreased, while that of root caries increased with age (p < 0.01). Comparing the same age groups, the frequency of root caries had decreased during the 10-year period. It could be concluded from this study that elderly people were determined to retain their teeth for as long as possible, but dental caries may be a problem among the very old.     

Reasons for and incidence of tooth mortality in a Swedish population

Abstract Longitudinal studies on tooth mortality are rare but the reasons for tooth mortality have been studied by several authors. The aims of this investigation were to study the reasons for and incidence of tooth mortality in an earlier described Swedish population of 200 patients on two occasions with an interval of 5-7 years, and to see if the reasons for extractions were correlated to posts, crowns or endodontic status, respectively. 197 (4.0%) of the 4889 teeth registered at the first examination were lost during the interval. 65 (33%) of the lost teeth were endodontically treated. 44 (68%) of these were registered as having one or more root with a root-filling ending more than 2 mm from the apex and 29 (45%) were judged to have an improper seal. In 93 of the 197 lost teeth it was possible to find the reason for extraction from the patient chart. Based on distribution of selected variables, these 93 teeth seemed to be representative of the whole group of 197. It was concluded that tooth losses were evenly distributed in the different age-groups and that above all molars but also premolars were lost more often than teeth in the frontal region. Furthermore, endodontically treated teeth were lost more often than other teeth and the quality of the root-filling affected the risk for losses while crowned teeth did not run a higher risk of being lost than teeth without crowns. Finally, it was found that caries, including pulpitis and apical periodontitis, was the main reason for tooth extractions.     

Factors associated with perceived oral health status in older individuals

AIM: To assess factors associated with perception of oral health in older individuals. DESIGN: A cross sectional study. SETTING: A densely populated urban area in Sri Lanka. PARTICIPANTS: 585 older adults aged 60 years and above of which 475 were living at home and 110 in institutions. The present analysis is limited to 235 subjects who were subjected to a clinical oral examination. METHOD: The data were collected by means of an interviewer-administered questionnaire and a clinical oral examination. RESULTS: Overall, 48% of the dentate and 42% of the edentate perceived their oral health as poor. The final model of the hierarchical logistic regression analysis for the dentate revealed that presence of retained roots, mobile teeth, >20 missing teeth and perceived need for dental care were significantly associated with poor perceived oral health status. For the edentate, perceived need for dental care, loss of taste sensation and difficulty in eating were significantly associated with poor perceived oral health status. CONCLUSIONS: Factors associated with perceived oral health status differed between the dentate and the edentate. Clinical oral health indicators emerged as significant predictors of perceived oral health status in the dentate although the explanatory power of these indicators on perception of oral health was low.     

Oral symptoms predict mortality: a prospective study in Japan

Several studies have reported positive associations between oral infections and systemic diseases. The purpose of the present study was to evaluate the effects of oral symptoms on mortality from cardiovascular disease (CVD) and pneumonia. Using data from a cohort study in Japan, we analyzed 4,139 individuals aged 40-79 years. The baseline questionnaire included the following items related to oral symptoms: 'sensitive teeth', 'difficulty in chewing tough food substances', 'bleeding gums', and 'mouth feels sticky'. We used the Cox proportional hazard model to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) for mortality, after adjustments for lifestyle, socio-economic factors, and history of diseases. Persons complaining that their 'mouth feels sticky' had a two-fold higher risk of pneumonia (HR = 2.1; 95%CI, 1.2-3.6), while those complaining of 'sensitive teeth' had a lower risk of CVD (HR = 0.4; 95%CI, 0.2-0.9). Some oral symptoms may be predictors of mortality from pneumonia and CVD.     

Prevalence of root surface caries in 55,65, and 75-year-old Swedish individuals

The prevalence and intraoral distribution of decayed and filled root surfaces were evaluated in 55, 65, and 75-yr-old inhabitants of Gothenburg. From randomly selected groups, 88, 72, and 48 dentate persons in the respective age groups participated and as many as 85, 93, and 90% respectively had one or more decayed or filled root surfaces. In the two oldest age groups 32-35% were free from root carious lesions, while 20% had five or more decayed root surfaces. The corresponding figures for the youngest group were 63% and 8%. The prevalence of root surface caries was evaluated using the Root Caries Index (RCI), excluding prosthetic crowns. The mean RCI value increased with age (P less than 0.05, ANOVA on age groups) from 14% to 16% and 22% in the 55, 65, and 75-yr-olds, respectively. The root surfaces of the molars were most frequently affected by caries and fillings, the incisors least frequently. In the maxilla the proximal surfaces were most affected, in the mandible this applied to the buccal surfaces, while the lingual surfaces had the lowest proportion of carious lesions and fillings in both jaws.     

Tooth Loss and Periodontitis in Older Individuals: Results From the Swedish National Study on Aging and Care

Background: Due to the increasing number of older people, there is a need for studies focused on this population. The aims of the present study are to assess oral and systemic conditions in individuals aged 60 to 95 years with access to dental insurance. Methods: Probing depths (PDs), tooth loss, alveolar bone levels, and systemic health were studied among a representative cohort of older individuals. Results: A total of 1,147 individuals in young‐old (aged 60 or 67 years), old (aged 72 or 78 years), and old‐old (aged ≥81 years) age groups were enrolled, including 200 individuals who were edentulous, in this study. Annual dental care was received by 82% of dentate individuals. Systemic diseases were common (diabetes: 5.8%; cardiovascular diseases: 20.7%; obesity: 71.2%; elevated C‐reactive protein [CRP]: 98.4%). Serum CRP values were unrelated to periodontal conditions. Rates of periodontitis, defined as ≥30% of sites with a distance from cemento‐enamel junction to bone of ≥5 mm, were 11.2% in women in the young‐old age group and 44.9% in men in the old‐old age group. Individuals in older age groups had a higher likelihood of periodontitis defined by bone loss and cutoff levels of PD ≥5 mm (odds ratio: 1.8; 95% confidence interval: 1.2 to 2.5; P <0.01). A total of 7% of individuals in the old‐old age group had ≥20 teeth and no periodontitis. Systemic diseases, dental use, or smoking were not explanatory, whereas age and sex were explanatory for periodontitis. Conclusions: The prevalence of periodontitis increased with age. Sex seems to be the dominant explanatory factor for periodontitis in older individuals. Despite frequent dental visits, overall oral health in the oldest age cohort was poor.     

Reasons for and incidence of tooth mortality in a Swedish population.

Longitudinal studies on tooth mortality are rare but the reasons for tooth mortality have been studied by several authors. The aims of this investigation were to study the reasons for and incidence of tooth mortality in an earlier described Swedish population of 200 patients on two occasions with an interval of 5-7 years, and to see if the reasons for extractions were correlated to posts, crowns or endodontic status, respectively. 197 (4.0%) of the 4889 teeth registered at the first examination were lost during the interval. 65 (33%) of the lost teeth were endodontically treated. 44 (68%) of these were registered as having one or more root with a root-filling ending more than 2 mm from the apex and 29 (45%) were judged to have an improper seal. In 93 of the 197 lost teeth it was possible to find the reason for extraction from the patient chart. Based on distribution of selected variables, these 93 teeth seemed to be representative of the whole group of 197. It was concluded that tooth losses were evenly distributed in the different age-groups and that above all molars but also premolars were lost more often than teeth in the frontal region. Furthermore, endodontically treated teeth were lost more often than other teeth and the quality of the root-filling affected the risk for losses while crowned teeth did not run a higher risk of being lost than teeth without crowns. Finally, it was found that caries, including pulpitis and apical periodontitis, was the main reason for tooth extractions.     

Periodontitis in children

In children with a healthy periodontal condition the pocket depth may vary between 1 to 2 mm. In the mixed dentition it may increase up to 3 mm and in the permanent dentition the pocket depth usually decreases again to between 1 and 2 mm. If a pocket of 5 mm or more is diagnosed one should be aware of periodontal breakdown, i.e. periodontitis. Periodontitis is usually defined on the basis of age, localisation and the presence of systemic diseases. Frequent periodontal probing is necessary to detect periodontal breakdown in an early stage and enables subsequent periodontal treatment. Involvement of the parents in the treatment is important. Their major contribution in the treatment is daily careful cleaning of the dentition of the child.