Socio-behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort

Astrom AN, Ekback G, Ordell S, Unell L. Socio‐behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort. Community Dent Oral Epidemiol 2011; 39: 300–310. © 2010 John Wiley & Sons A/S Abstract – Objectives: Using a prospective cohort design, this study assessed loss of natural teeth between ages 50 and 65. Guided by a conceptual framework grouping variables according to the life‐course stage at which they would be expected to operate, this study assessed the impacts of socio‐behavioral and disease‐related factors on tooth loss between ages 50 and 65. Methods: In 1992, all 50‐year‐olds in two counties of Sweden were invited to participate in a longitudinal questionnaire survey. Of the total population of 8888 subjects, 6346 responded (71.4%). Of the 6346 subjects who completed the 1992 questionnaire, 4143 (65%) completed postal follow‐ups at ages 55, 60 and 65. Results: For the total sample, the prevalence of having lost at least some teeth increased from 76% at age 50–85.5% at age 65. A total of 14% women and 13% men changed from having all teeth in 1992 to having tooth loss in 2007. Stepwise logistic regression analyses focused on predictors of tooth loss between 1992 and 2007. The following life‐stage predictors achieved or approached statistical significance with respect to overall tooth loss; country of birth and education (early life and young adult life stage), marital status, dental care avoidance because of high cost, smoking and reporting consistent pain (middle‐age and early‐old‐age life stage). Conclusion: Fewer substantial proportions of the 1942 cohort experienced tooth loss between ages 50 and 65. Tooth loss was highly prevalent from age 50 and increased moderately with increasing age. Oral disease‐related factors and socio‐behavioral characteristics such as refraining from dental care because of financial limitations, acting at earlier and later life‐course stages were major risk factors for having tooth loss. Early primary prevention of smoking and increased equitable access to dental care might improve tooth retention throughout the transition from middle age to early‐older age.     

Changes in dental status over 10 years in 80-year-old people: a prospective cohort study

Abstract – Objectives: The aim of the present study was to follow‐up the condition of the teeth over a sufficiently long period. Methods: Dental examinations were a part of a multidisciplinary 10‐year cohort study on the elderly. These examinations were made in 1990 (n = 226), 1995 (n = 90) and 2000 (n = 65) for the entire population born in 1910 and living in Jyväskylä, Finland. The subjects were divided into two categories, dentate (one tooth or more) and edentulous. Results: The results showed that men had more intact teeth and lower DMF scores than women, but the differences diminished during the follow‐up period. The number of remaining and filled teeth of those women who took part in all three phases of the present study was higher than that of those who died during the follow‐up. In men the DMF scores showed the opposite trend. The most significant deterioration during the 10‐year follow‐up was found in the number of teeth and DMF scores in men and in the number of remaining and filled teeth in women. Conclusion: Among men, in particular, significant changes in oral health status could be seen even between 80 and 90 years of age. Hence, regardless of advanced age, a subject should be motivated by the oral health care team to seek regular dental treatment.     

Discrepancies between self-ratings of and satisfaction with oral health in two older adult populations

OBJECTIVES: General health perceptions, usually measured by means of single-item indicators, are commonly included in health and oral health surveys. The aim of the study reported here was to assess the relationship between self-rated oral health and satisfaction with oral health in two studies of older adult populations. METHODS: Participants in Study 1 were aged 50 years and over, the majority of whom had multiple chronic medical conditions and disabilities and lived within a multi-level geriatric care setting. They were recruited when attending a clinic in that setting for their annual dental screening. Participants in Study 2 were somewhat healthier community dwelling individuals, also aged 50 years and older, who took part. They were originally recruited by means of a telephone survey based on random-digit dialing. For Study 1, data were collected by means of personal interviews and a review of dental clinic charts, while for Study 2 personal interviews, clinical examination and self-completed questionnaires were used. Measures included self-rated oral health, satisfaction with oral health, oral health-related quality of life (OHRQoL) and tooth loss. RESULTS: Data were obtained from 225 persons in Study 1 and 541 in Study 2. In both studies there was a significant association between self-ratings of oral health and satisfaction with oral health. However, also in both studies there was a discrepancy between the measures: approximately 10% of those with favourable oral health ratings were dissatisfied while approximately half of those with unfavourable ratings were satisfied. Those with apparently discordant responses had significantly higher scores on OHRQoL measures such as the GOHAI and the OHIP-14 than those with concordant responses. In Study 2, a similar discrepancy between self-rated general health and satisfaction with general health was also observed. CONCLUSIONS: There is degree of discordance between self-ratings of and satisfaction with both oral and general health status in the older adult populations studied here. This may be because of the expectations concerning health in later life. More needs to be known about the frames of reference people use in constructing their responses to questions designed to assess health perceptions.     

Flap extension attained by vertical and periosteal-releasing incisions: a prospective cohort study

Objectives: To evaluate the effect of vertical and periosteal‐releasing incisions (PRI) on the extension of the buccal flap in a trapezoidal flap design. Material and methods: Thirty patients scheduled for implant surgery accompanied by bone augmentation were recruited. The amount of flap extension pulled with a minimal tension of 5 g using a dynamometer was measured before and after the first and the second vertical incisions (VI) and PRI. The results were compared based on gender, surgical site and operator's experience. Results: The first VI extended flap length by 1.1 ± 0.6 mm, 113.4% more compared with the original flap length. The second VI increased flap length by 1.9 ± 1 mm (124.2%), and the PRI significantly extended flap length by 5.5 ± 1.5 mm (171.3%) (P<0.001). The length of the first and the second VI and the amount of flap extension by each incision were compared, and there were no statistically significant differences between gender, surgical site (maxilla vs. mandible) and operator's experience (faculty vs. residents). Conclusion: Vertical and PRI in a trapezoidal flap design can be successfully utilized to attain tension‐free primary closure during implant or periodontal surgeries. However, the PRI appears to be the only determinant key factor that can significantly extend the length of the flaps, while host‐ and operator‐related factors might not have any significant effect on such flap extension. To cite this article:
Park JC, Kim CS, Choi SH, Cho KS, Chai JK, Jung UW. Flap extension attained by vertical and periosteal‐releasing incisions: a prospective cohort study.
Clin. Oral Impl. Res. 23 , 2012; 993–998
doi: 10.1111/j.1600‐0501.2011.02244.x     

Effect of implant therapy on oral health‐related quality of life (OHIP‐49), health status (SF‐36), and satisfaction of patients with several agenetic teeth: Prospective cohort study

Background

Effect of fixed prosthodontics on patients with several agenetic teeth is not well understood.

Purpose

To assess the effect of implant‐based fixed prosthodontics on oral health‐related quality of life (OHRQoL), general health status, and satisfaction regarding dental appearance, ability to chew and speech in patients with several agenetic teeth.

Materials and Methods

For this prospective cohort study, all patients (≥18 years) with several agenetic teeth who were scheduled for treatment with fixed dental implants between September 2013 and July 2015 at our department were approached. Participants received a set of questionnaires before and 1 year after implant placement to assess OHRQoL (OHIP‐NL49), general health status (SF‐36), and satisfaction regarding dental appearance, ability to chew and speech.

Results

About 25 out of 31 eligible patients (10 male, 15 female; median age: 20 [19;23] years; agenetic teeth: 7 [5;10]) were willing to participate. Pre‐ and post‐treatment OHIP‐NL49 sum‐scores were 38 [28;56] and 17 [7;29], respectively (P < .001). Scores of all OHIP‐NL49 subdomains decreased tool, representing an improved OHRQoL (P < .05) as well as that satisfaction regarding dental appearance, ability to chew and speech increased (P < .001). General health status did not change with implant treatment (P > .05).

Conclusions

Treatment with implant‐based fixed prosthodontics improves OHRQoL and satisfaction with dental appearance, ability to chew and speech, while not affecting general health status.     

Predictors of change in satisfaction with chewing ability: a 24-month study of dentate adults

People's satisfaction with chewing ability is not determined entirely by their mechanical chewing function. Instead, it is a complex measure that embraces broad physical, social and psychological components. Using data from the Florida Dental Care Study, a prospective longitudinal study of oral health and dental care, this current study aimed to identify the longitudinal relationships between changes in satisfaction with chewing ability and changes in other dimensions of oral health and oral health-related quality of life (OHRQoL). A multidimensional conceptual model of oral health and OHRQoL was applied to guide the analysis. Most dentate people were satisfied with their chewing ability. However, changes in satisfaction with chewing ability were common: nearly 11-22% of subjects experienced improved satisfaction, depending on the interval; while about 12-18% of subjects experienced deteriorated satisfaction by the end of the interval. Changes in satisfaction with chewing ability were significantly associated with changes in other aspects of oral health and OHRQoL. Onset of certain oral health problems/conditions or constantly having such problems was associated with a lower probability of reporting improvement in satisfaction and a higher probability of experiencing deterioration. In contrast, recovery from certain oral health problems/conditions or not having such problems was associated with a higher probability of improvement and a lower probability of deterioration.     

Oral health condition of French elderly and risk of dementia: a longitudinal cohort study

Arrivé E, Letenneur L, Matharan F, Laporte C, Helmer C, Barberger‐Gateau P, Miquel JL, Dartigues JF. Oral health condition of French elderly and risk of dementia: a longitudinal cohort study. Community Dent Oral Epidemiol 2011. © 2011 John Wiley & Sons A/S Abstract – Objectives: Oral condition could be associated with cognitive impairment, but this is not yet well documented. We therefore hypothesized that people with poor oral condition would be more at risk to develop dementia. The objective of this study thus was to describe the oral condition of French community‐dwelling elderly persons and to assess its relationship with the occurrence of dementia. Methods: Oral examination was conducted on a sample of individuals aged 66–80 years followed‐up prospectively for screening of dementia over 15 years in Gironde, France. Univariate and multivariate analyses of the risk of dementia were performed using a Cox proportional hazard model with delayed entry. Results: Data from 405 individuals were analyzed; 45.4% men; median age at baseline: 70 years [interquartile range (IQR): 68–75]. The median number of decayed, missing, and filled teeth was 18 (IQR: 13–24) and was higher in women (median: 20 versus 17, P = 0.004) and in persons with lower school level (median: 21 versus 17, P = 0.003). Among 348 persons with sextant eligible for periodontal assessment, 2/3 required periodontal care: 5.2% had bleeding observed, 44.8% calculus, 17.8% 4–5 mm pockets, and 2.9%≥6 mm pockets. The incidence of dementia during a median follow‐up of 10 years (IQR: 6.5–13.7) was 19 per 1000 person‐years. The adjusted hazard ratio for a number of missing teeth≥11 (median) on the risk of dementia was 1.13 (95% confidence interval, CI = [0.60–2.12]) in people with higher education (n = 312) and 0.30 (CI = 0.11–0.79) in persons with lower school level (n = 93) (P for modification effect = 0.0002). Conclusions: Having eleven or more missing teeth seemed to be associated with a lower risk of dementia in people with lower education possibly owing to the suppression of source of chronic inflammation.     

Sense of coherence and oral health status in an adult Swedish population

Abstract

Objective . To investigate sense of coherence in relation to oral health status in an adult Swedish population in order to better understand the determinants of positive oral health-promoting behavior and differences in oral health. Material and methods . A stratified random sample of 910 individuals from Jönköping, Sweden aged 20, 30, 40, 50, 60, 70 and 80 years was obtained. The investigation used the Swedish short version of the Sense of Coherence (SOC) questionnaire comprising 13 items and a self-report questionnaire to elicit demographic information. In addition, a clinical and radiographic oral examination was performed. Results. A total of 525 individuals, 261 men and 264 women, consented to participate in the study. Bivariate analysis revealed that higher mean SOC scores were statistically significantly associated with more decayed and filled surfaces (DFS) and filled surfaces (FS), fewer decayed surfaces (DS), fewer teeth with calculus and periodontal health. Multivariate analysis showed that higher SOC scores represented a predictor of fewer occurrences of a periodontal probing pocket depth of ≥4 mm and a lower risk of plaque in different regression models. Conclusions. Higher SOC scores may be a protective determinant of plaque and periodontal disease, indicating an association between SOC and oral health.     

Prevalence of apical periodontitis, crowned teeth and teeth with posts in a Swedish population

Abstract A longitudinal radiological study was carried out of 200 consecutive patients in a Swedish population. The aims of the investigation were to study the prevalences of crowned teeth, pontics and posts on two occasions with an interval of 5–7 years and, furthermore, to study apical periodontitis in connection with teeth with crowns and posts to see if such treatments affected this prevalence. 417 (mean 2.1) teeth were crowned at the first examination and 529 (mean 2.6) at the second. For pontics, the corresponding figures were 93 (mean 0.5) and 141 (mean 0.7). Crowns and pontics were more common in the upper jaw. 59.4% of the endodontically treated teeth had posts at the first examination and 64.4% at the second. 34.5% of the 255 teeth with apical periodontitis found at the first examination and 41.0% of the 268 at the second were in connection with posts. It was concluded that both crowns and pontics were common treatment procedures in the studied population. Crown therapy did not seem to impair the apical status while teeth with posts more often had apical periodontitis than other teeth and, furthermore, teeth with screw posts were lost more frequently than other teeth.