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

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

The associations of age and dentition status with caries treatment in adult males.

This study explores patterns of treatment for caries in adults. Data were collected as part of the Veterans Administration Dental Longitudinal Study. The 698 subjects received comprehensive dental examinations at three-year intervals for approximately ten years. The subjects were classified into three age groups and three dentition status categories. Total need for treatment was defined as the number of surfaces that initially had caries plus those developing caries over the three subsequent examinations. Analysis of variance was used to determine if there were significant associations between age or dentition status groups and the percent of total need that was treated by extraction, treated by restoration, or remained untreated. Significant associations were noted: (1) between age and the percent of carious surfaces extracted, (2) between dentition status and the percent of carious surfaces restored, and (3) between dentition status and the percent of surfaces extracted. These findings were interpreted to indicate that future cohorts of older patients with greater numbers of teeth are likely to seek operative treatment for diagnosed caries.

Representativeness of the "Ramfjord teeth" for epidemiologic studies of gingivitis and periodontitis.

Data from the Veterans Administration Dental Longitudinal Study of 736 men each examined four times were analyzed to determine how representative the six "Ramfjord Teeth" (RT) were of the rest of the dentition for epidemiologic studies of gingivitis and periodontitis. Correlation coefficients were calculated between scores for gingival inflammation generated by the RT and scores for the teeth in the rest of the mouth; the correlation coefficients between the two scores tended to be high. Sensitivity, specificity and predictive values were calculated for periodontal pathology classified on the basis of the pocket depths of the six RT. Reliance on the RT resulted in systematic underestimation of the prevalence and incidence of deep periodontal pockets. The RT are more than adequately representative of the rest of the dentition for epidemiologic studies of gingivitis, but are inadequate surrogates of the rest of the mouth for epidemiologic studies of periodontitis.

Design and analysis considerations for a longitudinal study of periodontal disease.

Perception and concern for the health changes in our aging population led the Veterans Administration to initiate an interdisciplinary and longitudinal investigation of the aging process, the Veterans Administration Normative Aging Study, in 1963. A cohort of the 2,280 healthy men of this study self-selected to enroll in the dental longitudinal study, an investigation of oral health in these healthy males. In 1968, 1,221 men between the ages of 25 and 75 began with a baseline cycle of 5 general series of examinations, including an interim health history and survey of dietary habits; masticatory performance and taste thresholds; salivary analyses; oral cytologic and radiographic survey and comprehensive clinical data on caries and periodontal status. Design considerations for the Dental Longitudinal Study included prospective planning of specific oral variables to be recorded, and provision of collection techniques to allow for additional analyses based on a wide menu of retrospective data. The volunteer cohort was screened to obtain men who met stringent general health criteria, who represented wide socioeconomic ranges and would likely remain geographically stable. Importantly, enrollment in the parent study was without regard for dental status or oral health. Administrative design considerations included orderly transfer for exam data to machine-readable format by use of optical scan forms designed to register specific oral variables, with security preserved for the primary source records and rapid record retrieval. Additional data collection requiring manual coding was designed to transfer spreadsheets of clinical impressions and diagnoses to computer retrieval protocols. Provisions for recording of exceptional circumstances, i.e., salient oral pathology, were recognized and the optical scan forms modified to index and retrieve such cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The reliability of the iodide permeability test applied to the natural dentition.

The purpose of this study was to assess the reliability of the iodide permeability test when applied to the human dentition. Twenty-two subjects were seen once a week for three weeks. At each visit, consecutive iodide permeability measurements were obtained: four from the right central incisor and four from the left. Results of these trials were examined for the degree of variability from one replication to another within the same day, as well as for the variability from one week to the next. Within-day and between-week reliability of the test results was assessed by two indices: the Hoyt Index, which estimates the reliability of the average of the four replicate measurements per tooth, and the Intraclass correlation, which estimates the reliability of a single measurement. The results indicate that the iodide permeability test produces sufficiently replicable measurements for use in future clinical studies.

Influence of cigarette, pipe, and cigar smoking, removable partial dentures, and age on oral leukoplakia.

Oral leukoplakia, a potentially malignant lesion, has been associated with tobacco smoking, but few studies have investigated the influence of different products on lesion prevalence. In the current study 925 healthy male subjects from the Veterans Administration Dental Longitudinal Study were examined for lesion site and prevalence. The participants were grouped according to smoking status: nonsmokers, smokers of cigarettes, cigars, a pipe, cigars plus a pipe, or cigarettes plus another tobacco product. In addition, the amount of product smoked, presence of a removable partial denture, and age were examined to determine their relation to leukoplakia prevalence. The data indicated that cigar smokers had significantly fewer lesions than the other smoker groups and that persons smoking a pipe or a pipe plus cigars had the highest prevalence. Heavy cigarette smokers had significantly more palatal lesions than light to moderate cigarette smokers. While removable partial dentures did not appear to affect lesion prevalence significantly, older smokers, persons of 50 years and above, had a significantly higher prevalence than persons less than 50 years of age.

Deriving scale values from the analysis of variance.

Subjects' responses to ordered stimuli may be used to derive interstimulus scale values without additional experimental procedures. From the conventional data matrix used for analysis of variance, it is possible to maximize selected ratios of sums of squares in a fashion which is equivalent to factor analysis or the classical discrimination problem. Given the assumption of a linear stimulus/response relationship, the calculations are straightforward and provided valuable additional information.

Aging and mastication: changes in performance and in the swallowing threshold with natural dentition.

Few comprehensive studies of oral function have been conducted on adult populations. A "Longitudinal and Cross-Sectional Study of Oral Health in Healthy Veterans" was activated at the VA Outpatient Clinic in Boston in 1969; it included general oral and dental examinations as well as tests of masticatory performance and the swallowing threshold. The current investigation involved 863 subjects from the "Dental Study" who had either their natural teeth or a fixed replacement for missing teeth. Masticatory performance as measured by the subject's ability to reduce a test portion of cut carrot by a mandatory number of chewing stroked remained constant for persons with complete or partially compromised natural dentition. Swallowing threshold performance as measured by the particle size acceptable for swallowing remained constant for persons with complete dentition. Tooth loss significantly decreased the swallowing threshold performance and increased the particle size which the subject was willing to swallow. Older subjects increased the number of chewing strokes and the time required for this test, an observation not related to performance as measured by final particle size. Only with compromised dentition, however, did this increased effort result in increased performance.

The relative caries-inhibiting effects of a stannous fluoride dentifrice in a silica gel base.

An unsupervised toothbrushing study involving 1,339 children from 5 to 13 years of age conducted for three years compared two stannous fluoride dentifrices, one in a calcium pyrophosphate base and the other in a silica gel base, with a nonfluoride control dentifrice. The test dentifrice, stannous fluoride in a silica gel base, reduced caries to a significant extent when compared with the nonfluoride control dentifrice.The percentage of reductions ranged from 15% to 25% for whole mouth and interproximal surface indexes. There was no significant difference between the two fluoride dentifrices.