Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-62 From Set 97): ----------------------------------------------------------------------------- 1 ("99351665" or "98132732" or "97321740" or "93139336").ui. 4 2 Reproducibility of results/ 53323 3 exp risk/ 227197 4 Models, statistical/ 9724 5 Prevalence/ 44755 6 Discriminant analysis/ 2577 7 Forecasting/ 28594 8 exp Cohort studies/ 367539 9 Evaluation studies/ 99787 10 Risk-taking/ 3751 11 exp Health behavior/ 26393 12 reproducib:.mp. 87122 13 risk:.mp. 414044 14 forecast:.mp. 30078 15 False negative reactions/ or False positive reactions/ 19370 16 (sensitivity or specificity).ti,ab. 279532 17 (predictive adj value$1).mp. 20072 18 (predictive adj validit:).mp. 880 19 (likelihood adj ratio:).mp. 1434 20 (false adj (negative$1 or positive$1)).ti,ab. 23142 21 (randomized controlled trial or controlled clinical 183793 trial).pt. 22 double blind method/ or single blind method/ 65359 23 practice guideline.pt. 4699 24 consensus development conference$.pt. 2783 25 random$.ti,ab. 193352 26 random allocation/ 40827 27 (single blind$3 or double blind$3 or triple blind$3).ti,ab. 56757 28 exp "sensitivity and specificity"/ 89544 29 or/15-28 670432 30 or/2-14 959966 31 exp Tooth demineralization/ 22628 32 demineralization.mp. 1620 33 caries.mp. 15295 34 caires.mp. 1 35 craies.mp. 0 36 careis.mp. 4 37 carise.mp. 0 38 (teeth adj3 cavit:).mp. 422 39 (tooth adj3 cavit:).mp. 217 40 (dental adj3 cavit:).mp. 276 41 (dentin adj3 cavit:).mp. 254 42 (enamel adj3 cavit:).mp. 182 43 (teeth adj3 decay:).mp. 374 44 (tooth adj3 decay:).mp. 321 45 (dental adj3 decay:).mp. 250 46 (dentin adj3 decay:).mp. 12 47 (enamel adj3 decay:).mp. 20 48 (active adj decay).mp. 9 49 (rampant adj3 decay:).mp. 14 50 (recurrent adj3 decay:).mp. 30 51 (white adj spot:).mp. 509 52 carious.mp. 2077 53 cariology.ti,ab. 56 54 (non-cavitated adj3 lesion:).mp. 15 55 (noncavitated adj3 lesion:).mp. 2 56 Tooth remineralization/ 478 57 (dental adj3 fissure:).mp. 99 58 (tooth adj3 fissure:).mp. 50 59 (teeth adj3 fissure:).mp. 98 60 caries-free.mp. 603 61 cariesfree.mp. 17 62 Cariogenic agents/ 728 63 precavit:.mp. 8 64 (filled adj3 teeth).mp. 510 65 (filled adj3 tooth).mp. 117 66 (oral adj fissure:).mp. 6 67 (tooth adj3 remineraliz:).mp. 28 68 (teeth adj3 remineraliz:).mp. 24 69 dft.mp. 413 70 dfs.mp. 1258 71 dmf:.mp. 6397 72 cariogeni:.mp. 1787 73 or/31-72 32256 74 73 and 30 5368 75 74 and 29 1059 76 75 or 1 1059 77 limit 76 to (human and english language and yr=1980-2000) 970 78 limit 77 to (preschool child < 2 to 5 years > or child < 6 459 to 12 years > or adolescence < 13 to 18 years >) 79 exp Tooth, deciduous/ 5992 80 Dentition, primary/ 369 81 Dentition, mixed/ 1066 82 ((primary or deciduous or mixed) adj5 (tooth or teeth or 5759 dent: or odont:)).mp. 83 or/79-82 9322 84 77 and 83 87 85 78 or 84 466 86 from 85 keep 1-300 300 87 from 85 keep 310-466 157 88 from 85 keep 301-466 166 89 77 not 85 504 90 "Root caries"/ 297 91 ("root" adj3 (carie: or lesion:)).mp. 1180 92 exp Tooth root/ 7047 93 ((tooth or teeth or enamel or dentin) adj5 ("root" or apex 3443 or apices)).mp. 94 ((amelocemental or cemental or cementum) adj5 (carie: or 74 lesion:)).mp. 95 Dental cementum/ 1911 96 or/90-95 11043 97 89 and 96 62 98 from 97 keep 1-62 62 *************************** <1> UI - 20244915 AU - Yeung AL AU - Lo EC AU - Chow TW AU - Clark RK IN - Faculty of Dentistry, University of Hong Kong. TI - Oral health status of patients 5-6 years after placement of cobalt-chromium removable partial dentures. SO - Journal of Oral Rehabilitation 2000 Mar;27(3):183-9 AB - 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. <2> UI - 20205077 AU - Simons D AU - Baker P AU - Jones B AU - Kidd EA AU - Beighton D IN - West Herts Community Dental Services, Principal Health Centre, Civic Close, St Albans. TI - An evaluation of an oral health training programme for carers of the elderly in residential homes. SO - British Dental Journal 2000 Feb 26;188(4):206-10 AB - OBJECTIVE: The objectives of this study were: to evaluate carers' knowledge of oral health; to provide a high quality, consistent, oral health training programme for carers in residential homes; to evaluate the quality of this programme by examining both carers' changes in knowledge and any changes in carers' behaviour as reported by residents and to assess any changes in the oral health of the elderly residents after one year. DESIGN: A cross-sectional, multi-centre study using a carer training programme, evaluated by both a questionnaire conducted with carers and residents and oral examination of residents. SETTING: In August 1996, 20 (20%) of the residential/nursing homes, in West Hertfordshire were chosen at random and all managers contacted and offered an oral examination for all their residents. Ten (10%) of the homes were also offered an oral health training programme for their carers. Eighteen homes accepted the oral examination for all consenting residents and 7 of the 10 homes offered accepted the carer training. SUBJECTS: Thirty-nine carers from 7 of the residential homes attended an oral health training course and 213 elderly residents in the 18 homes were examined both at baseline and after 12 months. RESULTS: Carers' baseline knowledge about oral health was poor; the oral health training programme was enjoyed and their knowledge gain after one week was high. However, the elderly residents perceived no change in the oral care given by carers either after one week or after one year and there was no measurable improvement in the oral health of residents after carer training, except for an increase in filled coronal surfaces. Few of the carers originally trained were still working in the same residential homes after one year. CONCLUSION: Although the carer training programme was well received, no changes in oral health practice resulted. Barriers to practice of oral care by carers remained and training, even when including practical skills, evaluation by peers and a high knowledge gain, failed to reduce these barriers. <3> UI - 20152119 AU - Papas A AU - Russell D AU - Singh M AU - Stack K AU - Kent R AU - Triol C AU - Winston A IN - Tufts University School of Dental Medicine, Boston, USA. apapas@infonet.tufts.edu TI - Double blind clinical trial of a remineralizing dentifrice in the prevention of caries in a radiation therapy population. SO - Gerodontology 1999 Jul;16(1):2-10 AB - OBJECTIVES: The purpose of this study is to determine the efficacy and safety of a specially formulated remineralizing toothpaste in controlling caries in a group of high risk, head and neck radiation patients. DESIGN: The study compares the performance of the remineralizing toothpaste with a leading conventional fluoride dentifrice using double-blind randomization. TEST PRODUCTS: The products compared both contain equivalent quantities of fluoride (1150 ppm). The remineralizing toothpaste also delivers soluble calcium and phosphate ions, the essential components of teeth. SUBJECTS: On completion, 50 subjects who received > 50 Gy of radiation to the head and neck. MEASUREMENTS: Examinations include coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over one year. RESULTS: At this point subjects are enrolled in the study at various phases. However, the current average for the net increment per month per subject is -0.12 (+/- 1.30) for coronal caries and 0.06 (+/- 0.73) for root caries in subjects using the remineralizing toothpaste and 0.53 (+/- 1.62) for coronal caries and 0.45 (+/- 0.98) for root caries in subjects using the conventional fluoride dentifrice. Non-parametric analysis of rank scores for net root surface increments/month was statistically significant (p = 0.02), suggesting lower net root surface increment/month for the remineralizing toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. CONCLUSIONS: The results to date indicate that the remineralizing toothpaste is significantly superior to the conventional fluoride dentifrice in preventing root caries in high risk patients. <4> UI - 20168987 AU - Walls AW AU - Silver PT AU - Steele JG IN - Restorative Dentistry, The Dental School, The University of Newcastle upon Tyne, United Kingdom. a.w.g.walls@ncl.ac.uk TI - Impact of treatment provision on the epidemiological recording of root caries. SO - European Journal of Oral Sciences 2000 Feb;108(1):3-8 AB - The estimation of root caries prevalence and the identification of risk factors for decay depend upon the successful identification of carious lesions in epidemiological studies. Root surface restorations can either be placed to manage decay or cervical wear/sensitivity. The handling of data for restorations during epidemiological surveys is critical to the accurate assessment of caries prevalence. The objective of this study was to determine the relative frequency of dentists' placing root surface restorations according to their reason for placement. Data for 696 restorations were recorded from 35 dentists. Forty-five % of restorations were placed because of decay compared with 55% for cervical wear/sensitivity. There were no significant differences in proportion of placement of restoration with age of the patient or between regular and irregular attenders of different ages. Using these data a correction factor was developed for inclusion in the Root Caries Index (RCI) to make allowance for the proportion of restorations placed because of wear/sensitivity. When this correction factor was introduced into an existing data-set for root caries, the RCI was reduced for all groups. This reduction was greatest in regular attenders. When these data were analysed without making allowance for treatment effects, there was a significant difference in RCI between regular and irregular attenders. When the correction factor was applied to these data, this difference was eliminated. <5> UI - 99160133 AU - Albandar JM AU - Kingman A IN - National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA. Jasim.Albandar@odont.uib.no TI - Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. SO - Journal of Periodontology 1999 Jan;70(1):30-43 AB - BACKGROUND: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used. RESULTS: We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces. CONCLUSIONS: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population. <6> UI - 98441571 AU - Ravald N AU - List T IN - Specialist Centre Oral Rehabilitation, Linkoping, Sweden. TI - Caries and periodontal conditions in patients with primary Sjogren's syndrome. SO - Swedish Dental Journal 1998;22(3):97-103 AB - The present investigation was designed to study caries and periodontal conditions in a selected group of patients with primary Sjogren's syndrome (1oSS). Twenty-one patients, 20 females and 1 male aged 44-75 years (mean 64 years), with recently diagnosed 1oSS constituted the study population. As a control group, 21 patients matched according to sex and age were randomly selected from patients at one clinic in the Public Dental Service. Clinical examinations including registrations of dental caries, restorations, and periodontal conditions were performed. Unstimulated and stimulated salivary secretion rates were recorded. The 1oSS group had a mean number of 16.4 +/- 8.9 and the control group 17.1 +/- 8.4 natural teeth. The 1oSS patients had significantly more DF crown surfaces (63 +/- 25.8 vs 43 +/- 21.3) and more inactive root caries (4.4 +/- 5.4 vs 0.5 +/- 0.9) than did the control patients. No significant differences were found between the groups in the periodontal conditions. The mean value of the unstimulated salivary secretion rate was 0.09 +/- 0.16 ml/15 min in the 1oSS group and 3.33 +/- 2.81 ml/15 min in the control group. The stimulated secretion rate was 0.16 +/- 0.15 ml/min and 1.47 +/- 0.64 ml/min respectively. This study confirms results from other studies that patients with 1oSS face a high risk of developing both coronal and root caries due to xerostomia. The periodontal conditions are similar to those found in patient groups in general dentistry. <7> UI - 99012584 AU - Niu W AU - Eto JN AU - Kimura Y AU - Takeda FH AU - Matsumoto K IN - Department of Endodontics, Faculty of Dentistry, Dalian Medical University, China. TI - A study on microleakage after resin filling of Class V cavities prepared by Er:YAG laser. SO - Journal of Clinical Laser Medicine & Surgery 1998 Aug;16(4):227-31 AB - OBJECTIVE: The aims of this study were to investigate microleakage after composite resin filling to class V cavities prepared by Er:YAG laser and to compare the results with those obtained by a conventional method using an air turbine in vitro. SUMMARY BACKGROUND DATA: There has been no report of the microleakage study on class V cavities prepared by Er:YAG laser. METHODS: Forty-eight human extracted single root teeth were used in this study. Teeth were divided into three groups of sixteen each and class V cavities of the same size were prepared by Er:YAG laser for two groups and by air turbine for one group (control). For one group prepared by Er:YAG laser and the control group, the teeth were treated with 30% phosphoric acid. After the cavities were filled with the composite resin, the teeth except the areas of cavities and margins were covered by nail varnish and dye penetration was performed under the 0.6% Rhodamine B at 36 degrees C for 48 hrs. The teeth were sectioned at a thickness of 2 mm transversally and the slices were evaluated by stereoscopy and scanning electron microscopy (SEM). RESULTS: Microleakage at the cavity margins was observed in all three groups using the dye penetration method, but there was no significant difference among the three groups. SEM results showed similar results with the dye penetration method. CONCLUSION: These results suggest that microleakage at the cavities prepared by Er:YAG laser is at the same level as for prepared by air turbine using dye penetration and SEM methods. <8> UI - 99012592 AU - Cortes O AU - Garcia C AU - Perez L AU - Perez D IN - Dental School, University of Murcia, Spain. TI - Marginal microleakage around enamel and cementum surfaces of two compomers. SO - Journal of Clinical Pediatric Dentistry 1998 Summer;22(4):307-10 AB - The purpose of this study was to evaluate the marginal microleakage of two compomers, placed in enamel and cementum. The buccal and lingual surfaces of twenty human premolar teeth were used. Materials used were Dyract and Compoglass. Teeth were randomly divided into 4 groups of 5 teeth each. Materials were handled according to the instructions of the manufacturer. Class V cavities were prepared with enamel and cementum margins. The groups with etched surfaces was done using 37% phosphoric acid. Two percent fuchsin was used for microleakage study. Results were evaluated using an analysis of ANOVA. These showed that microleakage in enamel was significantly less than in cementum. No significant differences in microleakage were seen between the two materials or between etched and unetched surfaces. <9> UI - 98439243 AU - Meyerowitz C AU - Watson GE 2nd IN - Eastman Department of Dentistry, University of Rochester, N.Y. 14642, USA. TI - The efficacy of an intraoral fluoride-releasing system in irradiated head and neck cancer patients: a preliminary study. SO - Journal of the American Dental Association 1998 Sep;129(9):1252-9 AB - This study compared the anticaries effectiveness of an intraoral fluoride-releasing system, or IFRS, with a standard regimen of daily application of a 1.1 percent neutral sodium fluoride gel in custom trays. Caries protection in subjects in the IFRS group was comparable to that in subjects in the 1.1 percent neutral sodium fluoride group. The subjects all had head or neck cancer and had received radiation therapy, but no more recently than three months before taking part in the study. Overall, IFRS devices were well-tolerated and patient satisfaction was high. The IFRS appears to offer several advantages over the daily application of fluoride gels in custom trays. <10> UI - 98332258 AU - Powell LV AU - Leroux BG AU - Persson RE AU - Kiyak HA IN - Department of Restorative Dentistry, University of Washington, Seattle 98195, USA. lvpowell@u.washington.edu TI - Factors associated with caries incidence in an elderly population. SO - Community Dentistry & Oral Epidemiology 1998 Jun;26(3):170-6 AB - The purpose of this paper was to identify baseline factors associated with future caries development in older adults (age 60+) during a 3-year study period. Poisson regression analysis was used to determine the association between potential risk factors and disease incidence. The significant factors associated with high coronal caries incidence rates were high baseline root DMFS (P<0.001), high counts of mutans streptococci and lactobacilli (P=0.036), male gender (P=0.007), and Asian ethnicity (P=0.002). These factors had small to moderate effects on incidence rates, with relative risk values of approximately 1.2 to 2. The significant factors associated with higher disease incidence on root surfaces were baseline coronal DMFS (marginally significant, P=0.078), high bacterial counts (P=0.002), and Asian ethnicity (P=0.009). The predictive value of the models was low for both coronal and root caries. This result may be because this population had a higher than usual caries incidence rate, making discrimination among these caries-active individuals difficult. The current study affirmed the value of baseline DMFS and salivary variables to modeling caries incidence and introduced ethnicity as a variable useful for the study of dental caries in older adults. <11> UI - 98237091 AU - Fure S IN - Department of Cariology, Faculty of Odontology, Goteborg University, Sweden. fure@odontologi.gu.se TI - Five-year incidence of caries, salivary and microbial conditions in 60-, 70- and 80-year-old Swedish individuals. SO - Caries Research 1998;32(3):166-74 AB - The 5-year incidence of dental caries in a random sample of 60-, 70- and 80-year-old inhabitants of Goteborg was related to salivary and microbial conditions. 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. The study revealed that 27% of the participants had not developed any carious lesions during the 5-year period and that the incidence of coronal and root caries increased with age. In the 60-year-olds, 2.5% of the susceptible coronal and root surfaces, respectively, had decayed, while the corresponding figures for the 80-year-olds were 8.8% for coronal surfaces and 9.8% for root surfaces. In all, 18% had an unstimulated saliva secretion rate of below 0.1 ml/min and 14% had a stimulated secretion rate of <0.7 ml/min, with a mean rate which decreased with increasing age from 2.0 to 1.6 and 1.3 ml/min (p = 0.02). The overall salivary counts of lactobacilli and mutans streptococci, particularly the subspecies of Streptococcus sobrinus, had increased during the period. In the respective age groups of 60, 70 and 80 years, 15, 39 and 39% had a mutans streptococci count of > or = 10(6) CFU/ml in saliva and the corresponding figures for > or = 10(5) lactobacilli counts were 22, 31 and 43%. In the stepwise regression analysis, it was found that age, salivary levels of mutans streptococci and lactobacilli and number of teeth were the best predictors of the incidence of root caries. In conclusion, these observations indicate that there is an increased risk of dental caries with age owing to unfavourable microbial and salivary conditions. <12> UI - 99459661 AU - Duke ES AU - Trevino DF IN - University of Texas Health Science Center, School of Dentistry, San Antonio 78284, USA. TI - A resin-modified glass ionomer restorative: three-year clinical results. SO - Journal Indiana Dental Association 1998 Fall;77(3):13-6, 25 AB - Resin modified glass ionomer (RMGI) restorative materials have gained popularity in recent years. Their use is most often indicated in Class III and Class V cavities in adults and in numerous applications in children. This popularity in use has taken place in the absence of scientific knowledge of the RMGI materials. Lacking are adequate clinical trials to validate the proposed indications. The purpose of this study was to examine a representative RMGI in cervical abrasions and root caries in adults. Patients were recalled up to three years to evaluate standard clinical criteria. Results found the RMGI to be inferior to conventional composite resin in similar applications. The most noted deficiencies were in color stability and anatomic form, or wear of the RMGI. The results of this prospective clinical trial would suggest a limited longevity for RMGI compared to traditional restorative materials. This study also reinforces the need for evidence of clinical performance prior to making decisions regarding material selections. <13> UI - 98157021 AU - Lehane RJ AU - Murray PA AU - Deasy MJ IN - Department of Periodontics, University of Medicine & Dentistry of New Jersey, New Jersey Dental School, Newark 07103-2425, USA. TI - Effect of an enzymatic rinse on salivary levels of Streptococcus mutans and lactobacilli in periodontally treated patients. SO - Periodontal Clinical Investigations 1997 Fall;19(2):17-21 AB - Root surface caries is prevalent in patients with both treated and untreated periodontal disease. The major etiologic factor has been identified as microbial plaque. In periodontally treated patients, significantly higher root caries prevalence and incidence have been found in patients with high levels of Streptococcus mutans and Lactobacilli in saliva. Reducing the levels of S. mutans and Lactobacilli in saliva may lower the risk of root caries development. The purpose of this investigation was to determine the effect of an oral enzymatic rinse on the salivary counts of S. mutans and Lactobacilli in periodontally treated patients. Fifteen adult subjects participated in a double-blind, cross-over designed clinical trial. Each subject had previously undergone comprehensive periodontal therapy and had been maintained on a regular program of supportive periodontal therapy. Paraffin-stimulated whole saliva was collected from each participant. Each subject was then randomly given either the enzymatic rinse product or a control rinse and instructed to rinse with one tablespoonful twice a day for 2 weeks, after which saliva samples were taken. After a washout period, salivary samples were again taken, and the subjects received the alternate rinse product. Two weeks later, final salivary samples were taken. The salivary samples were serially diluted and incubated aerobically on selective culture media. S. mutans and Lactobacilli were counted on the basis of colonial morphology. Pretreatment and posttreatment salivary counts of S. mutans and Lactobacilli were analyzed using the Wilcoxon matched-pairs signed-rank test at the 5% level of significance. Analysis of data revealed that neither the test nor the control rinse significantly lowered salivary counts of either species in the sample population. <14> UI - 98091651 AU - Slade GD AU - Gansky SA AU - Spencer AJ IN - Department of Dental Ecology, University of North Carolina, Chapel Hill 27599-7450, USA. TI - Two-year incidence of tooth loss among South Australians aged 60+ years. SO - Community Dentistry & Oral Epidemiology 1997 Dec;25(6):429-37 AB - Tooth loss diminishes oral function and quality of life, and national health targets aim to reduce population levels of tooth loss. OBJECTIVES: The purpose of this study was to determine tooth loss incidence and predictors of tooth loss among older adults in South Australia. METHODS: Data were obtained from a cohort study of a stratified random sample of community-dwelling dentate people aged 60+ years. Interviews and oral examinations were conducted among 911 individuals at baseline and among 693 of them (76.1%) 2 years later. Incidence rates and relative risks were calculated for population subgroups and multivariate logistic regression was used to construct risk prediction models. A method was developed to calculate 95% confidence intervals (95% CI) for relative risks (RR) from logistic regression models using a Taylor series approximation. RESULTS: Some 19.5% (95% CI = 15.4-23.6%) of people lost one or more teeth during the 2 years. Men, people with a recent extraction, people who brushed their teeth infrequently, smokers and people born outside Australia had significantly (P < 0.05) greater risk of tooth loss. Baseline clinical predictors of tooth loss included more missing teeth, retained roots, decayed root surfaces, periodontal pockets and periodontal recession. In a multivariate model that controlled for baseline clinical predictors, former smokers (RR = 2.55, 95% CI = 1.48-4.40) and current smokers (RR = 2.06, 95% CI = 0.92-4.62) had similarly elevated risks of tooth loss compared with non-smokers. CONCLUSIONS: The findings from this population suggest that a history of smoking contributes to tooth loss through mechanisms in addition to clinical disease processes alone. <15> UI - 98120161 AU - Locker D AU - Jokovic A AU - Payne B IN - Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Life circumstances, lifestyles and oral health among older Canadians. SO - Community Dental Health 1997 Dec;14(4):214-20 AB - OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question. <16> UI - 97385915 AU - Slade GD AU - Spencer AJ IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, USA. TI - Distribution of coronal and root caries experience among persons aged 60+ in South Australia. SO - Australian Dental Journal 1997 Jun;42(3):178-84 AB - This report provides epidemiological data describing caries experience among the population of non-institutionalized older adults in Adelaide and Mt Gambier. Subjects were selected in a stratified random sample of persons aged 60+ who were listed on the South Australian Electoral Database. Oral examinations were conducted by four calibrated dentists among 853 dentate persons aged 60 years and over. There was an average of 14.7 missing teeth, 8.3 filled teeth and 0.3 decayed teeth, and a further 0.2 teeth were present as retained roots. The mean number of missing teeth was higher (p < 0.05) in older compared with younger age groups, and in Mt Gambier compared with Adelaide. The mean DFS of 22.1 was significantly higher (p < 0.05) among younger persons, females and in Adelaide. Root surface caries affected an average of 3.1 surfaces, and was greater (p < 0.05) among persons aged 70-79 years, males and Adelaide residents. However, when root caries was expressed as an attack rate per 100 exposed surfaces, differences were statistically significant only among age groups. Analysis of specific teeth revealed that no more than 40 per cent of molars were retained, and between 30 and 58 per cent of retained molars had coronal fillings. <17> UI - 97338940 AU - Beck JD AU - Drake CW IN - Department of Dental Ecology, University of North Carolina, Chapel Hill 27599, USA. TI - Do root lesions tend to develop in the same people who develop coronal lesions?. SO - Journal of Public Health Dentistry 1997 Spring;57(2):82-8 AB - OBJECTIVES: The three purposes of this study are to: (1) describe the relationship between the prevalence of coronal caries and root caries; (2) describe the relationship between the three-year incidence of coronal caries and root caries; and (3) if the two conditions are associated, develop a multiple regression model that identifies characteristics distinguishing people who had increments of both root caries and coronal caries from people who had increments of either coronal caries or root caries, or who had no new caries. METHODS: Dental examinations and interviews were conducted in the homes of a randomly selected, stratified sample of people over the age of 65 years in five North Carolina counties. The relationships between coronal and root D and DF were analyzed through contingency table analyses, and ordinal logistic regression was used to identify characteristics that differentiated people who had both coronal and root D over the three years from people who had either coronal or root D and people who had no new disease. RESULTS: Evidence of root and coronal caries in whites was much more likely to be in the form of fillings, while for blacks, it was more likely to be in the form of untreated decay. Prevalence rates of coronal and root D and DF were significantly associated for both blacks and whites. Incidence rates based on DF indicated that root and coronal caries were not associated in whites, but were associated in blacks. People more likely to experience both types of caries had more gingival recession at baseline, greater average attachment loss over the three years, and lactobacilli at baseline. In addition, the presence of Porphymonas gingivalis at three years was important for whites. CONCLUSIONS: It appears that coronal and root caries do tend to appear together in the same individuals, but fillings attenuate that relationship. The impact of dental treatment on the epidemiology of dental caries appears to be considerable and calls into question whether the F component of the caries index is related to disease as defined by epidemiologic criteria. <18> UI - 97243848 AU - Pitts NB IN - Dental Health Services Research Unit, Dental School, University of Dundee, Scotland, UK. TI - Diagnostic tools and measurements--impact on appropriate care. [Review] [98 refs] SO - Community Dentistry & Oral Epidemiology 1997 Feb;25(1):24-35 AB - The diagnosis of primary coronal caries should be seen as a complex process, comprising both detection and measurement phases, which enables clinicians, researchers and epidemiologists to make informed decisions about the management and prognosis of the disease process. The different diagnostic thresholds employed for measurements of caries experience can be viewed as an iceberg, a metaphor which demonstrates the ambiguity of the term "caries free" and which can also represent the differing management options appropriate for the care of different types of active and inactive lesions: NAC (No Active Care). PCA (Preventive Care Advised) and OCA (Operative Care Advised). There are considerable methodological difficulties in drawing valid comparisons between studies using incompatible criteria and simulations. However, it is apparent that no caries diagnostic tool in current clinical use fulfils all of the ideal criteria for measurements needed to plan and monitor appropriate care. Systems providing reliable serial measurements with which to assess future caries risk and present caries activity are urgently required as diagnostic tasks are becoming both more difficult and more important from the standpoint of long-term oral health. Existing diagnostic tools frequently rely on subjective judgements and provide only semi-quantitative measures insensitive to smaller lesions. In the future tools are needed which are objective, quantitative and which can provide acceptable compromises between sensitivity and specificity for a wide range of applications for individual patient care as well as for research and survey use. Key problem areas with existing tools include confusion in terminology and between caries assessments made by clinicians and epidemiologists as well as the lack of valid measurements relating to the activity of primary root caries and secondary caries. Deficiencies with current tools impact on the care of individuals by allowing false negative diagnoses of hidden occlusal dentine lesions and approximal cavities on the one hand, whilst generating some false positive diagnoses on sound surfaces leading to inappropriate decisions to restore on the other. At the population level, current conventional tools significantly underestimate overall caries experience. In future the adoption of more accurate and reliable methods would facilitate more effective preventive care and promote more appropriate restorative treatment decisions. Research in this area should focus for the next five years on diagnostic technologies which: 1) inform valid prospective caries risk assessments for different age groups, 2) can help to determine present caries activity and monitor lesion behaviour over time and 3) help identify methods which can implement existing and new research knowledge about diagnostic tools into clinical and research practice. [References: 98] <19> UI - 97114185 AU - Drake CW AU - Beck JD AU - Lawrence HP AU - Koch GG IN - Department of Diagnostic Sciences, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. TI - Three-year coronal caries incidence and risk factors in North Carolina elderly. SO - Caries Research 1997;31(1):1-7 AB - The data presented in this paper are from the Piedmont 65+ Dental Study (1988-1991), designed to assess the levels of coronal and root caries, periodontal disease, tooth loss, and a variety of dental health-related needs among a representative sample of 234 black and 218 white noninstitutionalized older adults in North Carolina. Of the 452 subjects followed for 3 years, 45% of blacks and 59% of the whites developed new coronal caries when caries was defined as decayed and filled surfaces, decayed root fragments, and crowned surface (p = 0.022). The annualized rate of caries increment for blacks and whites was 0.8 and 1.6 surfaces per 100 at risk (p < 0.001), respectively. The mean 3-year net increment per subject, excluding newly crowned surfaces, was 1.6 and 2.1 (p = 0.025), respectively. Whites had more newly filled and crowned surfaces, whereas blacks had more newly decayed surfaces and more decayed root fragments. Logistic regression models using baseline explanatory variables showed factors related to coronal caries differed between blacks and whites. For blacks, having more teeth, higher concentration of lactobacilli in stimulated saliva, more decayed and filled root surfaces, and smoking were related to the development of new coronal DFS (mostly D). For whites, having more coronal surfaces at risk and having more physical health problems but not seeking medical care in the past 6 months were related to the development of new coronal DFS (mostly F). The study showed the caries attack rate to be higher for whites than blacks, mainly as a result of more crown restorations, whereas blacks appeared to be at greater risk for incident lesions. Thus, in order to obtain more realistic figures for caries risk groups, coronal caries increment can and should be presented including and excluding crowns, since the utilization of dental services is likely to differ between groups of older adults. <20> UI - 99459728 AU - Steele JG AU - Walls AW AU - Murray JJ IN - Department of Restorative Dentistry, Dental School, Newcastle upon Tyne, UK. TI - Partial dentures as an independent indicator of root caries risk in a group of older adults. SO - Gerodontology 1997;14(2):67-74 AB - OBJECTIVES: To estimate the independent association between the wearing of removable partial dentures (RPD) and the presence of root caries in a population of older adults. DESIGN: Multivariate logistic regression modeling of root caries prevalence using different measures of root caries as dependent variables. The model included measures of disease history as indicators of historical risk. SETTING: Data collected in the field from three areas of England. SUBJECTS: Random sample of adults aged 60 years and over, drawn from lists of patients registered with general medical practitioners. INTERVENTION: Field measurements of a range of oral health variables including oral disease, disease history, oral status and various social and demographic measures. MAIN OUTCOME MEASURES: The presence of root caries, unsound and sound root restorations. RESULTS: Of the five different models of root caries prevalence which were used, RPDs featured as an independent risk indicator for root surface caries in the three which were related to the presence of untreated disease. The odds ratios for the contribution made by RPDs were all over 1.6, and when considered alone was in excess of 2 in one model. These models were generally well fitting. RPDs did not feature as a risk indicator in the two models which related only to the presence of root surface restorations. CONCLUSIONS: In this study, where RPDs were present, the odds of untreated disease being present increased substantially. <21> UI - 97237892 AU - Makinen KK AU - Pemberton D AU - Makinen PL AU - Chen CY AU - Cole J AU - Hujoel PP AU - Lopatin D AU - Lambert P IN - Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor 48109, USA. TI - Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--an exploratory study. SO - Special Care in Dentistry 1996 May-Jun;16(3):104-15 AB - An exploratory study investigated the root caries incidence in Department of Veterans Affairs patients with exposed root surfaces. For a period of six to 30 months, the subjects were systematically assigned to groups which used chewable dragees or chewing gums that contained either xylitol or sorbitol as bulk sweeteners. The mean treatment time was 1.8 years (standard deviation = 0.8). The consumption levels of both polyols was up to 8.5 g daily, used typically in five episodes during a 16-hour period. The subjects were examined every six months in connection with their standard scheduled visits at the Veterans Affairs Medical Center. The risk for a root-surface lesion in the xylitol group was only 19% of that for a surface in the sorbitol group (relative risk, 0.19; 95% confidence interval, 0.06-0.62; p < or = 0.0065). Simultaneous study in periodontal patients showed that both polyols significantly reduced the gingival index scores, and slightly (but not significantly) reduced the plaque index scores. Collectively, both studies suggest that frequent daily consumption of chewable, saliva-stimulating products containing essentially nonfermentable or slowly fermentable dietary carbohydrate sweeteners (xylitol and sorbitol) may have an oral-health-improving effect in Department of Veterans Affairs Medical Center patients. It is necessary to evaluate if these procedures would be efficacious in larger and expanded patient cohorts. <22> UI - 97159842 AU - Locker D IN - Department of Communicty Dentistry, University of Toronto, Ontario, Canada. TI - Incidence of root caries in an older Canadian population. SO - Community Dentistry & Oral Epidemiology 1996 Dec;24(6):403-7 AB - This paper reports the results of a longitudinal study of Canadians aged 50 years and over which was designed to estimate the three-year incidence of root caries. At baseline, 699 randomly selected dentate subjects were clinically examined and 493 were examined again after three years. Over this period 27.4% had one or more root DFS increments and the mean DFS increment was 0.6 per person. Because DFS increments overstate root caries incidence DS increments were also calculated. Relatively few baseline variables were associated with either DFS or DS increments. In logistic regression analyses, age was the only variable associated with one or more root DFS increments, while age, dental visiting pattern and wearing a partial denture were associated with one or more root DS increments. In both cases, the predictive power of the models was poor but improved marginally when baseline root caries experience was also entered as an independent variable. <23> UI - 97112538 AU - Lawrence HP AU - Beck JD AU - Hunt RJ AU - Koch GG IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. TI - Adjustment of the M-component of the DMFS index for prevalence studies of older adults. SO - Community Dentistry & Oral Epidemiology 1996 Oct;24(5):322-31 AB - Cross-sectional studies of caries in older adults report a substantial number of missing teeth, making it difficult to estimate caries experience accurately. The goal of this study was to improve the method of estimating caries experience as expressed by the DMFS index in population groups with missing teeth. The adjustment was demonstrated with reference to the Piedmont 65+ Dental Study conducted on a random sample of 363 community-dwelling older adults in North Carolina who were followed for 5 years. These older dentate adults had a mean (+/-SE) of 11.7 +/- 0.5 teeth missing at baseline, 56.1 +/- 2.5 missing surfaces and a DMFS of 86.7 +/- 2.0. A predicted caries prevalence was determined from the DFS at 5 yrs plus the 5-yr DFS incidence and the baseline DFS of teeth lost during the study period. Then a formula was developed that would estimate the predicted caries prevalence as a function of the observed 5-yr DMFS. This formula provided a good estimation of caries prevalence at 5 yrs (DMFSadj) when compared with the predicted prevalence (paired t-test, p > 0.05), while prevalence was underestimated by the DFS and greatly overestimated by the traditional DMFS index. Subgroup analyses by race, sex, and periodontal status also indicated that the DMFSadj resulted in patterns of estimates similar to the predicted prevalence, while the DFS and the DMFS were likely to result in different findings. The DMFS from the time of tooth eruption also was adjusted using this formula. The resulting analyses of subgroup differences in caries were not different from the previous estimates based on the 5-yr historical data, indicating that the adjustment of all M surfaces avoids the biases inherent in the traditional DMFS and DFS indices. This study showed that predicted caries prevalence could be estimated by adjusting the M component of the DMFS. It appears that this adjustment formula can be used without obvious bias, but additional studies are needed to provide adjustment figures for populations with different caries prevalences. <24> UI - 96415166 AU - Odor TM AU - Ford TR AU - McDonald F IN - Department of Conservative Dental Surgery, United Medical School, Guy's Hospital, London, UK. TI - Effect of probe design and bandwidth on laser Doppler readings from vital and root-filled teeth. SO - Medical Engineering & Physics 1996 Jul;18(5):359-64 AB - Laser Doppler flowmetry has been shown to be useful in assessing blood flow in teeth. This study investigated the effect of probe design and bandwidth on laser Doppler readings from vital and root-filled teeth using an 810 nm light source, and established the sensitivity and specificity of each probe/bandwidth combination. Readings were taken from 20 human subjects with a root-filled tooth and a vital contralateral tooth using each of the probes with 0.125 mm, 0.375 mm and 0.5 mm fibre separations and three bandwidths (3.1 kHz, 14.9 kHz and 20 kHz). Ten pairs of traces from each group were examined by 10 trained observers who indicated whether the traces had come from a vital or root-filled tooth. The sensitivity and specificity of each combination were calculated from the accuracy of their replies. This was repeated for five observers but with additional information from Fourier analysis. Median readings from vital teeth were higher than those from root-filled teeth for all combinations. This difference was only significant at the 95% confidence level for the 0.5 mm probe with the two lower bandwidths. The 0.125 mm fibre separation probe showed good specificity. The other two probes had better sensitivity but poor specificity. The best specificity and sensitivity was shown by the 0.5 mm probe/3.1 kHz bandwidth combination. All sensitivities and specificities increased when additional information from Fourier analysis was available, but the 0.5 mm probe/3.1 kHz combination still had the best sensitivity and specificity. <25> UI - 96376522 AU - Liu RS AU - Chu LS AU - Yen SH AU - Chang CP AU - Chou KL AU - Wu LC AU - Chang CW AU - Lui MT AU - Chen KY AU - Yeh SH IN - National PET/Cyclotron Center and Department of Nuclear Medicine, Taipei Veterans General Hospital, National Yang-Ming University Medical School, Taipei, Taiwan. TI - Detection of anaerobic odontogenic infections by fluorine-18 fluoromisonidazole. SO - European Journal of Nuclear Medicine 1996 Oct;23(10):1384-7 AB - Odontogenic infections are a potential risk for patients who receive cervicofacial radiotherapy and should be treated before irradiation. Anaerobic microbial infections are the most common causes. This study assessed the value of the hypoxic imaging agent fluorine-18 fluoromisonidazole (FMISO) in detecting anaerobic odontogenic infections. Positron emission tomography (PET) imaging was performed at 2 h after injection of 370 MBq (10 mCi) of FMISO in 26 nasopharyngeal carcinoma patients and six controls with healthy teeth. Tomograms were interpreted visually to identify hypoxic foci in the jaw. All patients received thorough dental examinations as a pre-radiotherapy work-up. Fifty-one sites of periodontitis, 15 periodontal abscesses, 14 sites of dental caries with root canal infection, 23 sites of dental caries without root canal infection, and seven necrotic pulps were found by dental examination. Anaerobic pathogens were isolated from 12 patients. Increased uptake of FMISO was found at 45 out of 51 sites of periodontitis, all 15 sites of periodontal abscess, all 14 sites of dental caries with root canal infection, all seven sites of necrotic pulp and 15 sites of dental caries without obvious evidence of active root canal infection. No abnormal uptake was seen in the healthy teeth of patients or in the six controls. The diagnostic sensitivity, specificity, positive and negative predictive values, and accuracy of FMISO PET scan in detecting odontogenic infections were 93%, 97%, 84%, 99% and 96%, respectively. 18F-fluoride ion bone scan done in three patients showed that 18F-fluoride ion plays no role in the demonstration of anaerobic odontogenic infection. FMISO PET scan is a sensitive method for the detection of anaerobic odontogenic infections, and may play a complementary role in the evaluation of the dental condition of patients with head and neck tumours prior to radiation therapy. <26> UI - 97030654 AU - Slade GD AU - Spencer AJ AU - Locker D AU - Hunt RJ AU - Strauss RP AU - Beck JD IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. TI - Variations in the social impact of oral conditions among older adults in South Australia, Ontario, and North Carolina. SO - Journal of Dental Research 1996 Jul;75(7):1439-50 AB - Previous studies among older adults have demonstrated that oral disease frequently leads to dysfunction, discomfort, and disability. This study aimed to assess variations in the social impact of oral conditions among six strata of people aged 65 years and older: residents of metropolitan Adelaide and rural Mt Gambier, South Australia; residents of metropolitan Toronto-North York and non-metropolitan Simcoe-Sudbury counties, Ontario, Canada; and blacks and whites in the Piedmont region of North Carolina (NC), United States. Subjects were participants in three oral epidemiological studies of random samples of the elderly populations in the six strata. Some 1,642 participants completed a 49-item Oral Health Impact Profile (OHIP) questionnaire which asked about impacts caused by problems with the teeth, mouth, or dentures during the previous 12 months. The percentage of dentate people reporting impacts fairly often or very often was greatest among NC blacks for 41 of the OHIP items. Two summary variables of social impact were used as dependent variables in bivariate and multivariate least-squares regression analyses. Among dentate people, mean levels of social impact were greatest for NC blacks and lowest for NC whites, while people from South Australia and Ontario had intermediate levels of social impact (P < 0.01). Missing teeth, retained root fragments, root-surface decay, periodontal pockets, and problem-motivated dental visits were associated with higher levels of social impact (P < 0.05), although there persisted a two-fold difference in social impact across the six strata after adjustment for those factors Among edentulous people, there was no statistically significant variation in social impact among strata. The findings suggest that there are social and cultural factors influencing oral health and its social impact, and that those factors differ most between dentate blacks and whites in NC. <27> UI - 96273797 AU - Steele JG AU - Walls AW AU - Ayatollahi SM AU - Murray JJ IN - Department of Restorative Dentistry, Dental School, Newcastle upon Tyne, UK. TI - Major clinical findings from a dental survey of elderly people in three different English communities. SO - British Dental Journal 1996 Jan 6;180(1):17-23 AB - A random sample of 2280 subjects aged 60 years or over from three areas of England were examined clinically in order to assess their dental health and needs. Between 33% (south of England) and 57% (north of England) were edentulous. Twenty per cent of all dentate subjects were edentulous in one arch and thus still required a complete denture. Amongst the dentate subjects geographical differences were small, but social class and behavioural differences were large. Dental non-attenders were the group who stood out as having much poorer oral health, averaging six fewer natural teeth than attenders. Nearly 50% of all teeth either had coronal fillings or needed them. Root caries was common, 20-22% of vulnerable teeth were affected and there was an age related increase in disease risk. The mean number of teeth with decayed roots per subject (0.8) was similar to the mean number with decayed coronal surfaces (0.9). Moderate tooth wear and moderate periodontal disease were both widespread. A minority of subjects had a functional dentition of 21 or more teeth. Major changes in the dental status of older adults have taken place in the last 30 years and these will continue, resulting in lower levels of edentulousness but a large need for maintenance of existing restorations. <28> UI - 96243030 AU - Odor TM AU - Pitt Ford TR AU - McDonald F IN - Department of Conservative Dental Surgery, United Medical and Dental Schools, Guy's Hospital, London, England. TI - Effect of wavelength and bandwidth on the clinical reliability of laser Doppler recordings. SO - Endodontics & Dental Traumatology 1996 Feb;12(1):9-15 AB - The aim of this study was to investigate the effect of wavelength and bandwidth on laser Doppler flowmeter signals from vital and root-filled teeth, and to establish their sensitivity and specificity. Twenty human subjects were recruited, each with a vital tooth and the contralateral tooth root filled but not restored apart from the palatal access cavity. Readings were taken from these teeth for 3 min at 20 Hz for each of 3.1 kHz, 14.9 kHz and 22.1 kHz bandwidths using a modified laser Doppler blood flow monitor which permitted simultaneous recording using 810 nm and 633 nm light sources with a probe of four optical fibres with 0.25 mm separation. Ten traces from each combination of variables was examined by 10 trained observers who indicated if the traces came from vital or root-filled teeth judged by the amplitude and regularity of pulsatility of the trace. From the accuracy of their replies, sensitivity and specificity were calculated. Median flux values were higher for vital teeth than for root-filled teeth and for the 810 nm wavelength than for the 633 nm wavelength. Flux values increased with wider bandwidth using the 810 nm light source. With the 633 nm light source, the highest flux values were recorded using the 3.1 kHz bandwidth. Using the Mann-Whitney U test, there was a highly significant difference between readings from vital and root-filled teeth for the 3.1 kHz/810 nm wave length combination (p<0.003) and a significant difference for the 3.1 kHz/633 nm wavelength group (p<0.02). Comparison of other groups showed no significant difference (p>0.05). The 810 nm wavelength showed good sensitivity but poor specificity at 14.9 and 22.1 kHz bandwidths. The 633 nm wavelength showed good specificity, but poor sensitivity, at 14.9 and 22.1 kHz bandwidths. The 3.1 kHz bandwidth showed the best sensitivity and specificity for both wavelengths. Sensitivity and specificity were increased if the results of fast Fourier analysis were considered in addition to observations of flux values and pulsatility of traces. The 810 nm/3.1 kHz combination offered the greatest sensitivity and specificity as a test to distinguish between root-filled and vital teeth. This combination was best when the results of Fourier analysis were considered in addition to visual observations. <29> UI - 98176363 AU - White SC AU - Atchison KA AU - Hewlett ER AU - Flack VF IN - Section of Oral Radiology, UCLA School of Dentistry, USA. TI - Clinical and historical predictors of dental caries on radiographs. SO - Dento-Maxillo-Facial Radiology 1995 May;24(2):121-7 AB - This report evaluates the efficacy of the clinical predictors of caries proposed in the USA FDA guidelines for prescribing dental radiographs. The clinical findings that best associate with the presence of any caries where a history of pain, a defective restoration, unusual calcification, and an abutment tooth for a fixed or removable prosthesis. There is a group of measures of periodontal disease that were also weakly associated with the presence of caries. The best predictors of caries extending into the dentin were the presence of clinically defective restorations, a history of pain, and signs of periodontal disease. Proximal lesions are likely to appear on teeth with defective restorations, unusual calcification or large or deep restorations. The best predictors of radiographic root caries are periodontal findings such as furcation involvement, increased mobility, a history of periodontal therapy and gingival recession. While the specificities for these findings were generally high, the sensitivities and positive predictive values were usually under 50%, and often much lower. Thus these clinical findings cannot successfully be used as exclusive criteria for ordering radiographs for caries detection. Because caries is found fairly frequently, and because we are unable to identify tooth-specific criteria with clinically useful sensitivity and specificity values, these data support the FDA panel recommendation of bitewing examinations for all new patients and at periodic intervals for recall patients. <30> UI - 97095136 AU - Chow LC AU - Takagi S IN - American Dental Association Health Foundation, Paffenbarger Research Center, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA. TI - Remineralization of root lesions with concentrated calcium and phosphate solutions. SO - Dental Materials Journal 1995 Jun;14(1):31-6 AB - Remineralization of enamel lesions in vitro by use of sequential treatments with an alkaline (pH 9) phosphate (1 mol/L) solution and slightly acidic (pH 6) calcium (1 mol/L) solution was reported to be relatively ineffective. An analysis of the diffusion processes that may occur during the remineralization treatments suggested that the driving force for diffusion of Ca into the lesion can be increased by making the calcium solution more alkaline than the phosphate solution. In the present study this modified treatment procedure was evaluated for remineralizing root lesions in vitro. Results show that (1) in the control group there was a slight increase in mineral density in the surface region of the lesion, (2) in the experimental group there were significant (p < 0.05) increase in mineral content in the outer 40 microns of the lesion, and (3) in contrast to the finding reported previously, thick mineral deposits on the surface of the root were not observed. <31> UI - 96345676 AU - Powell LV AU - Johnson GH AU - Gordon GE IN - Department of Restorative Dentistry SM-56, School of Dentistry, University of Washington, Seattle 98195, USA. TI - Factors associated with clinical success of cervical abrasion/erosion restorations. SO - Operative Dentistry 1995 Jan-Feb;20(1):7-13 AB - The purpose of this study was to evaluate the clinical performance of class 5 restorations according to USPHS criteria. Twenty-five patients and 116 abrasion/erosion lesions were restored with either a glass-ionomer cement restoration (Ketac-Fil), a composite resin restoration with a dentin bonding agent (Silux Plus, Scotchbond 2), or a composite resin restoration with a dentin bonding agent and a glass-ionomer liner (Silux Plus, Scotchbond 2, Vitrebond). At 3 years, 24 patients and 110 teeth were evaluated. All restorations were rated clinically acceptable for color match, cavosurface discoloration, surface texture, and caries development. Glass-ionomer cement restorations demonstrated a slightly rougher surface texture than the composite restorations (Friedman Two-way ANOVA, P=0.000). Significant differences were found with retention (Cochran Q test, P=0.012). Percentages retained were: glass ionomer, 97.3% (36/37); composite/dentin bonding agent, 75.7% (28/37); composite/dentin bonding agent/glass-ionomer liner, 100% (36/36). At 3 years class 5 restorations of glass-ionomer cement or composite with a dentin bonding and a glass-ionomer liner demonstrated significantly better retention than restorations of composite with a dentin bonding agent. Increased occlusal function, mobility, and mandibular arch were associated with a decrease in retention rate. <32> UI - 96333154 AU - Katz RV IN - Department of Behavioral Sciences and Community Health MC-3910, School of Dental Medicine, University of Connecticut Health Center, Farmington 06030, USA. TI - The clinical diagnosis of root caries: issues for the clinician and the researcher. [Review] [30 refs] SO - American Journal of Dentistry 1995 Dec;8(6):335-41 AB - This paper, after presenting a brief case for the relevance of root caries to today's practitioner, describes the differing diagnostic needs of clinical practitioners and clinical researchers. The goal is to inform the clinician of the state-of-the-art that exists today for the diagnosis of root caries in both clinical and research settings. Differing definitions for the diagnosis of root caries are presented that are useful, respectively, for the clinician and for the clinical researcher. Reasons for why there are differing definitions for clinicians and researchers are presented. Finally, eight critical issues are presented that will have to be resolved if clinical research on root caries is to improve its rigor: (1) active vs. inactive lesions, (2) supra- vs. sub-gingival lesions, (3) lesions crossing the CEJ, (4) prior clinical treatment: a visibility issue, (5) oral debris: a visibility issue, (6) instruments for tactile clues, (7) radiographs, and (8) diagnostic conventions. [References: 30] <33> UI - 96235617 AU - Beck JD AU - Lawrence HP AU - Koch GG IN - Department of Dental Ecology, University of North Carolina, Chapel Hill 27599-7450, USA. TI - A method for adjusting caries increments for reversals due to examiner misclassification. SO - Community Dentistry & Oral Epidemiology 1995 Dec;23(6):321-30 AB - Two types of reversals occur in longitudinal caries studies, remineralization (true reversals) and reversals due to examiner misclassification (D3 to S; F to S). Since 1966, the standard practice has been to subtract examiner reversals from the crude increment (CCI), resulting in a net caries increment (NCI). The use of the NCI has been based on the assumption that examiners make an equal number of false positive and false negative errors both at baseline and follow-up examination. Consequently, the difference between the two caries prevalence scores would provide an unbiased estimate of caries incidence between examinations. The NCI considers all reversals to be true reversals which is an extreme strategy, particulary when the level of diagnosis is set at lower thresholds. In this study we compromised between the NCI and CCI by creating a simple formula to calculate the caries increment using a prevalence-based adjustment for reversals. The formula is ADJCI = y2(1-(y3/(y3 + y4))), where y2 = S to D or F; y3 = D or F to S; y4 = D to D/F or F to F. The impact of this adjustment is illustrated using data from a random sample of 452 older black and white adults followed over a 3-yr period. The ADJCI was more likely to result in higher caries increments and more observed intergroup differences than the NCI, a finding that has implications for clinical trials. For example, the crude 3-yr coronal DS increment for whites was 0.62, the NCI was 0.26 and the ADJCI was 0.56. There were significant black-white differences for the CCI and ADJCI, but not the NCI. We conclude that the NCI was too severe of an adjustment for reversals for this study population. <34> UI - 96116024 AU - Jansson L AU - Ehnevid H AU - Lindskog S AU - Blomlof L IN - Department of Periodontology, Public Dental Service at Skanstull, Sweden. TI - The influence of endodontic infection on progression of marginal bone loss in periodontitis. SO - Journal of Clinical Periodontology 1995 Oct;22(10):729-34 AB - The purpose of the present investigation was to determine magnitude and rate of proximal radiographic attachment loss in relation to endodontic infection in periodontally involved teeth. The investigation was conducted as a retrospective longitudinal study on a periodontitis-prone randomly selected referral population, including 175 single-rooted, root-filled teeth in 133 patients. An observation period of at least 3 years was required. Periapical conditions of the selected sample at baseline and re-examination were evaluated on radiographs, independently by 3 investigators. Each single-rooted, root-filled tooth of the sample was given a score according to the combined registrations. Radiographic attachment level was measured as the distance between the most coronal point of the alveolar bone and the apex at the mesial and distal sides of the tooth, and expressed as relative radiographic attachment level (RRAL) (radiographic attachment level at baseline/root length) at proximal sites for every tooth. Multiple regression analysis was used to study change in RRAL over time. Teeth in periodontitis-prone patients with progressing periapical pathology indicating a continuous root canal infection were found to lose comparatively more radiographic attachment than teeth with no signs of periapical pathology or teeth with an established periapical destruction which subsided during the observation period. An approximate 3-fold amplification of the rate of marginal proximal radiographic bone loss by endodontic infection in periodontitis-prone patients was found with an average 0.19 mm/year, while 0.06 mm/year was lost for teeth without endodontic infection or subsiding endodontic involvement. <35> UI - 96230280 AU - Mojon P AU - Favre P AU - Chung JP AU - Budtz-Jorgensen E IN - Division of Gerodontology and Removable Prosthodontics, University of Geneva, Switzerland. TI - Examiner agreement on caries detection and plaque accumulation during dental surveys of elders. SO - Gerodontology 1995 Jul;12(1):49-55 AB - Indices used to evaluate plaque accumulation and coronal caries have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of clinical criteria used in coronal and root caries diagnosis and oral hygiene evaluation as applied in elders. Nineteen elderly subjects, 73 years old on average, were examined at a first appointment by two independent examiners. They were re-examined two weeks later. Plaque accumulation was evaluated using the Plaque Index (PI) and coronal and root caries were detected according to the WHO criteria and Fejerskov et al. (1991), respectively. Recurrent caries was recorded as recommended by WHO and by probing at the interface tooth-restoration. Inter- and intra-examiner agreement was evaluated using kappa statistics. The PI score showed good reliability except for examiner b, for whom a simplification of the 4-point scale in 3-point scale improved significantly the reliability. The prevalence of coronal caries was very low and intra- and inter-examiner agreement was poor. Most of the root caries lesions were covered by plaque and the kappa values indicated only poor agreement. Recurrent caries were found with good agreement using WHO criteria but the detection with the probe was not reliable. In conclusion, it seems that examiners should be trained carefully to maximise their reliability and that plaque should be removed to obtain reliable diagnoses of caries. Retraining and calibration may be necessary for surveys continuing over a long period. <36> UI - 95369954 AU - Ahlberg KM AU - Assavanop P AU - Tay WM IN - Department of Conservative Dentistry, The London Medical College Dental Institute, London, United Kingdom. TI - A comparison of the apical dye penetration patterns shown by methylene blue and india ink in root-filled teeth. SO - International Endodontic Journal 1995 Jan;28(1):30-4 AB - This study compared the linear leakage patterns shown by 5% aqueous solution of methylene blue (MB) and India ink (II). One-hundred and twenty-five roots with single canals from extracted human teeth were used. The canals were cleaned and shaped using the step-back technique under copious irrigation. Three groups were arranged to receive root fillings of gutta-percha and one of three proprietary sealers using standard lateral condensation techniques: Sealapex (40 roots), Tubli-Seal (40 roots) and Ketac-Endo (20 roots). The remaining roots were used as controls: positive with gutta-percha and no sealer and negative with the apices sealed with nail varnish. The roots were randomly selected for 7-day immersion in either MB or II, then sectioned longitudinally; dye penetration was assessed using a Wild Leitz stereomicroscope. In all groups MB showed more penetration than II. The results were statistically significant at the P = 0.01 level, with the exception of the positive control groups. Negative controls showed no penetration. It is concluded that MB, which has a low molecular weight penetrated more deeply along root canal fillings than II, which has a large particle size. <37> UI - 95113549 AU - Tidswell HE AU - Saunders EM AU - Saunders WP IN - Department of Adult Dental Care, Glasgow Dental Hospital and School, UK. TI - Assessment of coronal leakage in teeth root filled with gutta-percha and a glass of ionomer root canal sealer. SO - International Endodontic Journal 1994 Jul;27(4):208-12 AB - The effect on coronal leakage of the use of either a single gutta-percha cone or cold lateral condensation of gutta-percha, with a glass ionomer sealer cement was studied. In addition, the effect of the removal of the smear layer was also determined. Eighty-eight single-rooted teeth were prepared chemomechanically using hand files, with the balanced force technique. Lubrication was provided by either Hibiscrub (maintaining the smear layer) or an EDTA-containing paste (to remove the smear layer). Copious irrigation was carried out with 2.2% sodium hypochlorite. The teeth were allocated randomly to four groups of 20 teeth each, the remaining eight teeth served as controls. Two groups of teeth, one with and one without smear layer, were obturated with either a single gutta-percha cone or cold laterally condensed gutta-percha, with Ketac Endo as the sealer. The teeth were stored for 6 weeks, thermocycled, and the extent of coronal leakage determined for each group after immersion in India ink for 90 h. The teeth were demineralized, dehydrated and immersed in methyl salicylate, which rendered them transparent. Linear measurement of maximum dye penetration was recorded. The mean depth (+SD) of leakage for the groups in which the smear layer was left intact was 1.68 mm (+0.38) for the single cone (A1) and 2.29 mm (+1.58) for lateral condensation (B1). When the smear layer was removed the mean depth of leakage for the single cone group (A2) was 2.04 mm (+0.73) and 2.37 mm (+1.70) for the laterally condensed group (B2). There was no significant difference in coronal leakage between the groups (P > 0.05). <38> UI - 95094191 AU - Spak CJ AU - Johnson G AU - Ekstrand J IN - Department of Cariology, School of Dentistry, Karolinska Institute, Huddinge, Sweden. TI - Caries incidence, salivary flow rate and efficacy of fluoride gel treatment in irradiated patients. SO - Caries Research 1994;28(5):388-93 AB - The caries-preventive effect of daily applications of a fluoride gel was studied in 55 patients receiving radiotherapy for tumors of the head and neck. The study was designed as a randomized, double-blind study with two parallel groups. From the start of radiotherapy one group received a 0.42% F gel once a day for 1 year. The other group received a daily application of a 1.23% F gel for 4 weeks followed by the use of the 0.42% F gel daily for 1 year. The results showed that in patients with an unstimulated saliva flow of > 0.1 ml/min daily fluoride gel treatment with a fluoride concentration of 0.42% F was sufficient to inhibit caries almost completely. The use of the 1.23% F gel was not superior to the 0.42% gel treatment program alone. In an attempt to evaluate the salivary flow rate as a diagnostic criterion for increased caries risk, sensitivity and specificity were evaluated. It was found that with an unstimulated saliva flow rate of < 0.1 ml/min the positive predictive value was 80%. The corresponding value for stimulated salivary flow rate of < 0.5 ml/min was 85%. One can therefore predict that 80% of patients with flow rates < 0.1 ml/min will develop at least one carious lesion per year. The corresponding negative predictive value for unstimulated saliva flow > 0.1 ml/min was 75%. That means that 75% of patients using the 0.42% F gel daily and with at least some saliva secretion will not develop any new carious lesions. <39> UI - 94265430 AU - Scheinin A AU - Pienihakkinen K AU - Tiekso J AU - Holmberg S AU - Fukuda M AU - Suzuki A IN - Department of Cariology, University of Turku, Finland. TI - Multifactorial modeling for root caries prediction: 3-year follow-up results. SO - Community Dentistry & Oral Epidemiology 1994 Apr;22(2):126-9 AB - The study was part of a series aiming at the development of caries tests. The initial material (n = 104, age range 47-79 yr, mean 62 yr) was reduced to 96, who were observed for 3 yr. During the follow-up four subjects died, all due to myocardial infarction, and four refused to participate. Thorough oral examinations were conducted at the baseline, 1- and 3-yr registrations; coronal and root surface caries were registered separately according to WHO classification. The tests included salivary mutans streptococci, lactobacilli, candida/yeasts, secretion rate, buffer effect and sucrase activity, and quantitation of visible plaque. The association between prospective root caries increment and several tests was significant. Multifactorial modeling resulted in the combination of Past Root Caries Experience (OR 12.8), Lactobacilli (OR 8.6) and Candida (OR 2.8). At screening, the criterion "two or three positive tests" of these yielded acceptable accuracy (77.1) and a relative risk of 3.3. <40> UI - 94217095 AU - Drake CW AU - Hunt RJ AU - Beck JD AU - Koch GG IN - Department of Diagnostic Sciences, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - Eighteen-month coronal caries incidence in North Carolina older adults. SO - Journal of Public Health Dentistry 1994 Winter;54(1):24-30 AB - In this longitudinal study of a random sample of North Carolinians over the age of 65 and living in their homes, 325 blacks and 280 whites were examined and interviewed 18 months after baseline examinations. Coronal caries incidence was greater among whites than blacks. The increment due to teeth becoming root fragments were similar for both races; however, there were more newly crowned teeth among whites. Newly crowned surfaces were not used as part of the caries increment in logistic regression models to investigate potential risk predictors. For blacks, caries development over the 18-month period was associated with a higher lactobacillus score and more coronal caries at baseline, more previously filled coronal surfaces, and lack of active membership in clubs or other groups. For whites, having no self-reported tooth sensitivity, having a lower socioeconomic index score, taking antihistamine medications at baseline, and having the perception of more problems after the age of 40 than before were all associated with the development of coronal caries. <41> UI - 95229180 AU - Joshi A AU - Papas AS AU - Giunta J IN - Department of Dental Care Administration, Harvard School of Dental Medicine, Boston, USA. TI - Root caries incidence and associated risk factors in middle-aged and older adults. SO - Gerodontology 1993 Dec;10(2):83-9 AB - Data from population-based longitudinal studies required to assess the incidence of root caries and associated risk factors are sparse in the literature. To this end, a group of 130 middle-aged and older adults were examined for root caries at baseline and at a follow-up visit between nine and 24 months (median: 16 months). Dental examinations were conducted by one examiner at a Tufts dental clinic using NIDR defined diagnostic criteria. Fifty percent of subjects in this study population developed one or more new root caries lesions over the follow-up period. Also, an annualised increment of 0.60 (SD: 0.72) decayed and filled surfaces per person was observed for the 45-59 year old group while the 70+ group showed an annualised increment of 1.38 (SD: 1.97) DFS in this study. Multivariate logistic regression analysis identified past root caries experience, high plaque score, and high number of teeth (> = 22) to be positively associated with new root caries (p < 0.05). <42> UI - 94082857 AU - Banting DW IN - Faculty of Dentistry, The University of Western Ontario, London, Canada. TI - Diagnosis and prediction of root caries. [Review] [37 refs] SO - Advances in Dental Research 1993 Aug;7(2):80-6 AB - Diagnosis is the process of recognizing diseases by their characteristic clinical signs and symptoms. Diagnostic ability varies considerably between and among examiners, and, consequently, the accuracy of the diagnosis can be questioned. Root caries is a disease for which there are several clinical signs (location, color, surface texture, and surface cavitation). Unfortunately, these signs are open to broad clinical interpretation. As a result, estimates of disease occurrence (incidence rate) have ranged from 0.87 to 8.20/100 surfaces at risk/year or 0.15 to 0.43 lesions/person/year for adults living independently in the community. When multiple examiners are utilized, interexaminer agreement has been reported to be relatively good but could be further improved by minimizing the effects of several sources of examiner disagreement, including the absence of a global consensus on the signs which indicate the presence of root caries. The use of a diagnostic test can enhance the diagnosis and prediction of root caries, but the development of useful tests is hindered by the lack of an accurate clinical standard of diagnosis. At this time, diagnostic tests for root caries are quite limited and of questionable value. A powerful predictive tool for root caries would result from the combination of risk assessment measures and a valid diagnostic test developed with use of standardized and accurate methods of clinical diagnosis. [References: 37] <43> UI - 94082855 AU - Douglass CW IN - Harvard School of Dental Medicine, Department of Dental Care Administration, Boston, MA 02115. TI - Evaluating diagnostic tests. SO - Advances in Dental Research 1993 Aug;7(2):66-9 AB - The presentations at this conference will discuss new technologies and rapid scientific developments that have resulted in new diagnostic tests for periodontal disease, musculoskeletal imaging, temporomandibular joint dysfunctions, and incipient coronal and root dental caries. However, for many of these claims, there has been insufficient scientific support regarding the sensitivity and specificity of the tests, or their ability to predict the percent of cases in which the disease or condition progresses to the next state of development. Research is needed that will yield the basic diagnostic parameters of new diagnostic tests, i.e., their accuracy, precision, sensitivity, specificity, positive predictive value, and negative predictive value. The purpose and methods for calculating each of these measures are described in this paper. Five questions are then presented that will need to be addressed in future research regarding new diagnostic tests: (1) Does the scientific theory of the test fit with our current body of knowledge? (2) Have the efficacy parameters of the test been reliably determined? (3) How does the test affect clinical decision-making? (4) Does using the test improve the patient's health? and (5) Is the added expense of the test justified by increased effectiveness or by avoiding other health expenditures? <44> UI - 94014062 AU - Jette AM AU - Feldman HA AU - Douglass C IN - New England Research Institute, Watertown, MA 02172. TI - Oral disease and physical disability in community-dwelling older persons. SO - Journal of the American Geriatrics Society 1993 Oct;41(10):1102-8 AB - OBJECTIVE: The aim of this epidemiologic investigation was to determine whether poor oral health in older persons was associated with physical disability. DESIGN: The study was a cross-sectional survey involving in-home interviews and dental examinations of older persons. SETTING: A random sample of 68 cities and towns was selected from the six New England states, with stratification according to population size. PARTICIPANTS: The study sample consisted of 1,156 community-dwelling (non-institutionalized) individuals aged 70 and over, randomly selected from the Medicare beneficiary lists for each city and town. MEASUREMENTS: Oral health was assessed by three dichotomous indices: edentulism (no teeth); current caries, including either coronal or root decay; and periodontal disease, as measured by gingival pocket depth. Physical disability was indicated by the subject's self-report of difficulty in the areas of personal care (eating, bathing, dressing, and using the toilet) and mobility (walking, bed transfer, getting outside). Additional independent variables included age, sex, number of teeth, education, living alone, oral hygiene practices, and time since last dental visit. RESULTS: We found a direct association between specific areas of physical disability and current caries and edentulism. The risk of poor oral health did not increase with advancing age once the related risk factors were controlled for. Those subjects with mobility disabilities were at increased risk of tooth loss; those with personal care limitations were at increased risk of current caries. CONCLUSIONS: Physical disability should be added to the list of known risk factors for oral disease among the older population. Our findings call attention to the need for health care providers to screen for oral health problems among disabled older persons. Further gerontologic research is needed to identify the mechanisms linking physical disability with oral disease in older persons. <45> UI - 93381601 AU - Wallace MC AU - Retief DH AU - Bradley EL IN - Department of Community and Public Health Dentistry, University of Alabama, Birmingham 35294. TI - The 48-month increment of root caries in an urban population of older adults participating in a preventive dental program. SO - Journal of Public Health Dentistry 1993 Summer;53(3):133-7 AB - The purpose of this study was to determine the effect of a 48-month preventive dental program on the incidence of root caries in an urban, geriatric, noninstitutionalized population residing in an optimally fluoridated area. The 466 participants were randomly assigned to one of three groups at baseline. Group A (control): 171 subjects using a placebo mouthrinse daily; group B: 147 subjects receiving semiannual applications of a topical APF gel (1.2% F-) with the daily use of a placebo mouthrinse; group C: 148 subjects using a fluoridated mouthrinse daily, ACT (0.05% F-). At baseline, the numbers of surfaces at risk, and decayed and filled surfaces were recorded. After 48 months, in addition, the number of reversed and new lesions were determined, and the incremental DMFS calculated. The data were analyzed by ANCOVA. The incremental DMFS were: A = 0.91, B = 0.27, C = 0.26. The incremental DMFS in groups B and C were significantly lower than in group A (P < .05). The number of reversed lesions in group C (1.53 +/- 2.03) was significantly greater than in group A (1.11 +/- 1.74) and group B (1.01 +/- 1.86) (P < .05). The number of new lesions in group B (1.36 +/- 2.00) was significantly less than in group A (1.99 +/- 2.65) (P < .05). The daily use of the fluoride mouthrinse significantly increased the number of reversed lesions. <46> UI - 93155818 AU - Drake CW AU - Beck JD IN - Department of Diagnostic Sciences, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - The oral status of elderly removable partial denture wearers. SO - Journal of Oral Rehabilitation 1993 Jan;20(1):53-60 AB - 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. <47> UI - 93171335 AU - Ravald N AU - Birkhed D AU - Hamp SE IN - Department of Periodontology, Public Dental Service, Linkoping, Sweden. TI - Root caries susceptibility in periodontally treated patients. Results after 12 years. SO - Journal of Clinical Periodontology 1993 Feb;20(2):124-9 AB - The aim of the investigation was to study the individual susceptibility to root caries in periodontally treated patients in a long-term follow-up of 12 years. Age, plaque score, salivary counts of lactobacilli and mutans streptococci, salivary secretion rate and buffer effect, oral sugar clearance time and dietary habit index were tested as possible predictors for root caries incidence. During the whole observation period of 12 years, new root caries lesions were recorded in 24 of a total of 27 patients. In 8 of these, the root caries incidence was between 1 and 5, in 7 between 6 and 9 and in 9, 12 or more new DFS. However, the annual mean number of new DFS was rather low. 13 patients with > 5 new DFS% during the 3rd 4-year period (years 9-12) differed significantly from 14 patients with < or = 5 new DFS% in salivary mutans streptococcus counts (p < 0.01), plaque scores (p < 0.001) and new DFS% during the 2nd 4-year period (years 5-8) (p < 0.001). Simultaneously, risk values among the variables tested at the 8-year examination were about 3 x more prevalent in patients that developed > 5 new DFS% in years 9-12 than in those with < or = 5 new DFS%. During the whole 12-year observation period, smokers had significantly more root caries than non-smokers (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) <48> UI - 93105466 AU - Drake CW AU - Beck JD IN - Department of Diagnostic Sciences, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - Models for coronal caries and root fragments in an elderly population. SO - Caries Research 1992;26(5):402-7 AB - A random sample of 809 dentate, home-dwelling people 65 years of age or older participated in a study to determine the prevalence of dental diseases in the elderly. Part of the study investigated the determinants of coronal caries and root fragments in these older adults. Using a wide array of potentially explanatory variables available, logistic regression models were developed to identify relationships between these variables and coronal caries and root fragments. The variables with the most explanatory power in the coronal caries model were the presence of decayed root surfaces, lower salivary flow rate, lack of regular dental care and an interaction variable including race and a perception of financial well-being. When a subsequent model was created that did not include decayed root surfaces or root fragments as potential explanatory variables, an additional variable relating to self-perception of mouth appearance emerged. The strongest variables in the model for root fragments were episodic (vs. regular) dental visits, presence of root caries, lack of replacement for lost teeth, high levels of Streptococcus mutans and number of teeth present in the mouth. <49> UI - 93068661 AU - Hunt RJ AU - Drake CW AU - Beck JD IN - School of Dentistry, University of North Carolina, Chapel Hill. TI - Streptococcus mutans, lactobacilli, and caries experience in older adults. SO - Special Care in Dentistry 1992 Jul-Aug;12(4):149-52 AB - This study investigated salivary levels of Streptococcus mutans, lactobacilli, and caries experience in a random sample of 448 black and 362 white older dentate adults living in North Carolina. Significant proportions of the participants had stimulated salivary flow rates less than 1.0 mL/min, salivary buffering capacity less than 4.0, S. mutans levels of 10(5) cfu/mL or more in stimulated whole saliva, or lactobacilli levels of 10(5) cfu/mL or more. Each of these factor levels could be considered, on a clinical basis, to increase caries risk. In general, people with higher levels of S. mutans or lactobacilli had more untreated coronal and root caries, but not greater total caries experience. <50> UI - 92191525 AU - Scheinin A AU - Pienihakkinen K AU - Tiekso J AU - Holmberg S IN - Department of Cariology, University of Turku, Finland. TI - Multifactorial modeling for root caries prediction. SO - Community Dentistry & Oral Epidemiology 1992 Feb;20(1):35-7 AB - The study was part of a series of investigations aiming at the development of diagnostic caries tests for screening of risk subjects. The material consisted of 100 adult subjects (mean 62 yr, range 47-79 yr), 50 of these under chronic medication. The series of tests included two chairside registrations, i.e. incipient demineralization of exposed root surfaces without cavitation (RD 1) and quantitation of visible plaque (VPT%), three microbiological tests for mutans streptococci, lactobacilli, and candida/yeasts and three tests on stimulated saliva, i.e. secretion rate, buffering capacity and sucrase activity. A thorough clinical examination was conducted at the baseline and 1-yr registration phases, caries being registered at a tooth surface level according to WHO recommendations separately for coronal and root caries. Considerably more root caries than coronal caries developed during the observation period. For coronal caries increment, the predictive value of any of the tests was not significant. For root caries, however, the association between several tests and prospective caries increment was significant. Subsequent multifactorial modeling yielded the highest predictive value to the combination of Past Root Caries Experience (OR 25.0, Visible Plaque (OR 4.2), Candida (OR 8.0) and Lactobacilli (OR 5.8). A positive finding of Past Root Caries (RDFS) or the combination of the other three tests (Can, LB, VPT%) as criteria for selection in screening for root caries produced good accuracy (84.0) and a relative risk of 5.5. <51> UI - 92083570 AU - Ravald N AU - Birkhed D IN - Department of Periodontology, Public Dental Service, Linkoping, Sweden. TI - Factors associated with active and inactive root caries in patients with periodontal disease. SO - Caries Research 1991;25(5):377-84 AB - The aim of this study was to analyze a number of microbial, salivary, and dietary factors in patients with clinically active and inactive root caries. 147 patients, aged 30-78 years, referred for specialist treatment of periodontal disease, were randomly selected. 645 decayed and 539 filled root surfaces were found. Out of the carious lesions, 372 (58%) were recorded as clinically active and 273 (42%) as inactive. 30 patients showed no lesions (group 1), 46 had only fillings or inactive lesions (group 2), and 35 showed 1-2 (group 3) and 36 greater than or equal to 3 active lesions (group 4). The lactobacillus count differed significantly between all groups, except group 1 vs. 2, and the mutans streptococcus count between groups 1 vs. 4 and 2 vs. 3 and 4. Group 4 differed in plaque score from the other groups, and the salivary buffer effect differed between the inactive groups 1 and 2 and the active group 4. By stepwise multiple regression analysis, it was shown that lactobacillus count, plaque index, salivary buffer effect, dietary habit index, and number of exposed root surfaces contributed significantly to the coefficient of determination. <52> UI - 92076759 AU - Powell LV AU - Mancl LA AU - Senft GD IN - Department of Restorative Dentistry, University of Washington, Seattle 98195. TI - Exploration of prediction models for caries risk assessment of the geriatric population. SO - Community Dentistry & Oral Epidemiology 1991 Oct;19(5):291-5 AB - The purpose of this study was to demonstrate a method for establishing a model designed to predict the caries risk of elderly individuals. Twenty-three patients over the age of 65 and living in a semi-independent retirement center were examined; several variables were collected and analyzed for their ability to predict the development of new carious lesions. The analysis was performed using logistic regression where the proportion of new decay was used as the dependent variable. The model for prediction of combined coronal and root caries included the variables flow rate, gender, and root caries index. The proposed method has the advantages of easily collected data, individualized criteria, and the ability to order patients as to the relative risk of developing decay. <53> UI - 92045696 AU - Drake CW AU - Beck JD AU - Graves RC IN - Department of Diagnostic Sciences, University of North Carolina, Chapel Hill 27599-7450. TI - Dental treatment needs in an elderly population. SO - Journal of Public Health Dentistry 1991 Fall;51(4):205-11 AB - A random sample of 1,019 adults 65 years of age and older, living in their own homes, consented to a clinical dental examination and an interview. Eight hundred nine subjects were dentate and 210 were edentulous. Each dentate person was examined for caries and periodontal conditions, as well as a separate determination of restorative and extraction treatment needs. Most people in this study lacked restorative treatment needs of any kind. Blacks required restorative treatment and extractions more often than whites. Carious coronal and root surfaces, pocket depths, number of teeth, as well as educational level and time since last visit to the dentist were related to treatment needs. While clinical findings were related to treatment needs, precise determinations of treatment needs of this elderly population generally could not be based solely on clinical findings. Additional behavioral, social, and health factors appear to play a role in dentists' decisions when determining treatment needs of older persons. <54> UI - 91208900 AU - Hand JS AU - Hunt RJ AU - Kohout FJ IN - Department of Preventive and Community Dentistry, University of Iowa, Iowa City. TI - Five-year incidence of tooth loss in Iowans aged 65 and older. SO - Community Dentistry & Oral Epidemiology 1991 Feb;19(1):48-51 AB - The prevalence of missing teeth has been described for US adults, but little is known about the incidence of tooth loss in any segment of the population. This study investigated the 5-yr incidence of tooth loss in a random sample of Iowans aged 65 yr and older residing in two rural counties. These people had an average of 20 teeth at baseline and approximately 40% lost at least one tooth in the subsequent 5 yr. The incidence of tooth loss was highest for mandibular molars and lowest for mandibular canines. Men were more likely than women to lose teeth. Although we were able to identify a number of statistically significant potential risk factors for tooth loss, the multivariate models that incorporated all these factors were not good predictors of which people were at highest risk for tooth loss. <55> UI - 91123519 AU - Schaeken MJ AU - Keltjens HM AU - Van Der Hoeven JS IN - Institute of Preventive and Community Dentistry, University of Nijmegen, The Netherlands. TI - Effects of fluoride and chlorhexidine on the microflora of dental root surfaces and progression of root-surface caries. SO - Journal of Dental Research 1991 Feb;70(2):150-3 AB - The effects of fluoride and chlorhexidine varnishes on the microflora of dental root surfaces and on the progression of root-surface caries were studied. Forty-four patients, surgically treated for advanced periodontal disease, were distributed at random among three groups. All patients received a standardized preventive treatment. Furthermore, the dentition of the patients in the two experimental groups was treated, at three-month intervals, with chlorhexidine and fluoride varnish, respectively. Patients in the control group received no additional treatment. In the experimental groups, plaque samples were collected from selected sound and carious root surfaces at baseline and at three, six, and nine months after the onset of the study. The presence of root-surface caries was scored at baseline and after one year. In addition, the texture, depth, and color of the root-surface lesions were monitored. Mutans streptococci on root surfaces were suppressed significantly (p less than 0.05) during the whole experimental period in the chlorhexidine varnish group, but not in the fluoride varnish group. A non-significant increase in the number of Actinomyces viscosus/naeslundii was noted after treatment with chlorhexidine and fluoride varnish. The increase in the number of decayed and filled root surfaces after one year was significantly lower in the experimental groups than in the control group. After treatment with chlorhexidine varnish, significantly more initial root-surface lesions had hardened than in the other groups. <56> UI - 91156968 AU - Fure S AU - Zickert I IN - Department of Cariology, Faculty of Odontology, Gothenburg University, Sweden. TI - Root surface caries and associated factors. SO - Scandinavian Journal of Dental Research 1990 Oct;98(5):391-400 AB - The prevalence of root surfaces caries in 208 randomly selected 55, 65, and 75-yr-old Swedes was related to the frequency of coronal caries, the number of remaining teeth and to bacteriologic, salivary, and dietary variables. At least one decayed or filled root surface was found in 89% of the individuals and all of those had also experienced coronal caries. The frequency of root surface caries was positively correlated to the frequency of coronal decay and negatively correlated to the number of remaining teeth and exposed root surfaces. The study shows that the same factors which are associated with enamel caries seem to be of importance in determining the development of root surface caries. The variation in the frequency of root surface caries was best explained by the salivary levels of mutans streptococci and lactobacilli, the percentage of surfaces harboring plaque and the frequency of carbohydrate intake. Other contributory factors were the saliva secretion rate and the buffer capacity. <57> UI - 90352954 AU - Angelillo IF AU - Sagliocco G AU - Hendricks SJ AU - Villari P IN - Institute of Hygiene, Medical School, University of Reggio Calabria, Catanzaro, Italy. TI - Tooth loss and dental caries in institutionalized elderly in Italy. SO - Community Dentistry & Oral Epidemiology 1990 Aug;18(4):216-8 AB - An epidemiological survey of dental health status and needs was conducted in a group of 234 randomly selected institutionalized elderly people in Naples, Italy. The mean age of the patients was 81.4 yr, 71.4% were women and 28.6% men. A total of 140 (59.8%) people were totally edentulous; an additional 13.7% were edentulous in one jaw. A significant increase in prevalence of edentulousness with increasing age was recorded. 44.3% of the edentulous in both jaws wore complete dentures. The mean number of remaining sound teeth, decayed teeth and root remnants in the elderly with maxillary and mandibular natural teeth decreased with increasing age. Of the 94 dentate elderly, 29.8% had no need of dental treatment. Of all dentate patients 68.1% needed one or more dental extractions with a mean need of 3.9 per patient; 37.2% needed restorative treatment for one or more teeth with a mean need per patient of 2.9. Analysis of the results showed poor dental health in this target group and the necessity of improving the dental health services programs for the elderly living in institutions. <58> UI - 90242625 AU - Fure S AU - Zickert I IN - Department of Cariology, Faculty of Odontology, University of Gothenburg, Sweden. TI - Prevalence of root surface caries in 55, 65, and 75-year-old Swedish individuals. SO - Community Dentistry & Oral Epidemiology 1990 Apr;18(2):100-5 AB - 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. <59> UI - 89234832 AU - Locker D AU - Slade GD AU - Leake JL IN - Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Prevalence of and factors associated with root decay in older adults in Canada. SO - Journal of Dental Research 1989 May;68(5):768-72 AB - We collected data on the oral health status and treatment needs of a random sample of persons aged 50 years and over. Data on root decay were obtained from the 183 subjects who were dentate. All remaining teeth were examined for root decay and restorations, whether root surfaces were affected by recession or not. Analysis was undertaken by case and root surface, with separate analyses of decayed (DS), and decayed and filled (DFS) root surfaces. One or more root surfaces with untreated decay were found in 37.2% of subjects, while one or more decayed or filled root surfaces were found in 56.8%. The mean number of decayed surfaces was 1.3 per person, and the mean number of decayed and filled root surfaces was 2.6. Multiple and logistic regression analyses showed that oral health variables were more important predictors of the presence and severity of root decay than demographic, general health, or dental care factors. <60> UI - 89108640 AU - Beck JD AU - Kohout F AU - Hunt RJ IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - Identification of high caries risk adults: attitudes, social factors and diseases. [Review] [27 refs] SO - International Dental Journal 1988 Dec;38(4):231-8 AB - Since agent, host and environmental factors have been associated with caries, the development of multivariate risk assessment models is warranted. This process comprises the identification of risk factors, the development and testing of risk models, assessment and targeting. Work-in-progress by the authors in delineating oral, social/behavioural and medical risk factors for root caries in older adults shows that regression models explain 48 per cent of the variance in root caries scores for males and 47 per cent for females. Discriminant analyses using the risk factors identified in the regressions differentiated between people who did and did not get root caries during an 18-month period. The sensitivity of the predictions for men was 0.75 and the specificity was 0.79. For women, the sensitivity was 0.79 and the specificity was 0.83. These results suggest that it will be possible to develop a clinically useful risk assessment model. Future studies should include data on oral risk factors, such as micro-organisms present, salivary flow and buffering capacity, that can be added to the multivariate model. [References: 27] <61> UI - 89036683 AU - Caffesse RG AU - Kerry GJ AU - Chaves ES AU - McLean TN AU - Morrison EC AU - Lopatin DE AU - Caffesse ER AU - Stults DL IN - University of Michigan School of Dentistry, Department of Periodontics, Ann Arbor 48109. TI - Clinical evaluation of the use of citric acid and autologous fibronectin in periodontal surgery. SO - Journal of Periodontology 1988 Sep;59(9):565-9 AB - This study evaluated the effects of citric acid demineralization and autologous fibronectin application in association with a modified Widman flap in the treatment of periodontitis. The study population comprised 29 patients under treatment for moderate to advanced periodontitis who reached the one-year posttherapy evaluation. After thorough scaling and root planing, a split mouth design was used in which two quadrants were treated by modified Widman flap alone, and the other two randomly assigned quadrants were treated by modified Widman flap combined with citric acid demineralization and autologous fibronectin application. Fibronectin, which had previously been isolated from the patient's own plasma, was applied with a tuberculin syringe on the citric acid demineralized root surfaces and the inner aspect of the flap. After suturing provided good flap adaptation, additional fibronectin was again applied under the flap and external pressure was applied. Patients were clinically evaluated at baseline and at one year. Statistical evaluation of the data using paired t test and Chi-square analysis indicated that both approaches, modified Widman flap alone or in combination with citric acid and fibronectin, significantly reduced probing pocket depth and increased clinical attachment. However, the changes achieved with citric acid and fibronectin were statistically greater than those obtained with the flap alone. Furthermore, the number of sites gaining 2 mm or more of clinical attachment were significantly increased. The results suggest that the use of citric acid and fibronectin holds promise in promoting reattachment after periodontal therapy. <62> UI - 88338849 AU - Hunt RJ AU - Hand JS AU - Kohout FJ AU - Beck JD IN - Department of Preventive/Community Dentistry, College of Dentistry, University of Iowa, Iowa City 52242. TI - Incidence of tooth loss among elderly Iowans. SO - American Journal of Public Health 1988 Oct;78(10):1330-2 AB - This study investigated the 18-month incidence of tooth loss in a random sample of 451 dentate noninstitutionalized Iowans aged 65 and older residing in two rural counties. They had a mean of 19.0 teeth at baseline and lost an average of 0.4 teeth during the subsequent 18 months. Twenty-one per cent of the population lost at least one tooth. Four people had all their teeth extracted. Of the teeth present at baseline, 1.9 per cent subsequently were extracted. The highest incidence of tooth loss occurred among mandibular molars (3.7 per cent), followed by maxillary premolars and canines (3.1 per cent each). The best predictors of tooth loss were previous coronal and root caries.