Assessment of the periapical and clinical status of crowned teeth over 25 years.

OBJECTIVES: The purpose of this study was to examine radiographically changes in the periapical status and compare the clinical status of teeth with a vital pulp and root-filled teeth restored with crowns and bridge retainers during 25 years. METHODS: During 1967/68, 114 patients received prosthodontic treatment by senior dental students at the Oslo Dental Faculty. In all, 291 teeth with a vital pulp and 106 root-filled teeth were restored with 158 prostheses. All root-filled teeth were restored with a cast dowel and core. The casts were made in a type-3 gold alloy, and cemented with zinc phosphate cement. Forty-six teeth were restored with crowns and 351 teeth with bridge retainers. Radiographs were taken preoperatively, immediately after cementation, and every fifth year. Two independent observers assessed the periapical status on the radiographs according to the PAI-index. At the 25 years examination, 32 patients (28%) with 101 restored teeth (24%) remained in the study. Survival rates of the prostheses and of the restored teeth were estimated using Kaplan-Meyer non-parametric statistics. RESULTS: The PAI-score of the periapical status deteriorated in 13 vital and four root-filled teeth. The survival rates of the fixed prostheses were not influenced by the pulp vitality of the restored tooth at the baseline. The survival rates of the restored teeth with a vital pulp and of the root-filled teeth were similar. Clinical failures were recorded on approximately one-third of the restored teeth. The main reason for tooth failure was caries (12%), and for the teeth with a vital pulp also pulpal deterioration (10%). Estimates of the proportions of crowned teeth with a vital pulp that will remain free from signs and symptoms of pulpal deterioration were 98% after five years, 92% after 10 years, 87% after 20 years and 83% after 25 years. CONCLUSIONS: The incidence of periapical lesions on radiographs of crowned teeth was low during 25 years observation. Crowned, root-filled teeth with a high quality endodontic treatment and an optimal morphology of the dowel and core have a similar survival rate as crowned teeth with a vital pulp. A high proportion of crowned teeth with a vital pulp will remain free from signs and symptoms of pulpal deterioration over 25 years.

[Dental health and the use of dental services among Norwegian recruits in 1988]. / Tannhelseforhold og besöksvaner hos en gruppe norske rekrutter i 1988.

The aim of the present study was to describe dental health and dental health behaviour among Norwegian recruits. Data were collected by questionnaires and clinical and radiological examinations among 1067 recruits in 1988. 23.7% of all recruits had no decayed teeth. The average DMFT score was 12.1 (SD = 4.69) and the number of decayed surfaces was 4.1 (SD = 5.97), 46.1% of all recruits had visited the dentist during the last year. The clinical findings (except x-ray scores) were compared with findings from similar studies in 1968 and 1978. The results showed that the dental health improved from 1968 to 1988, while the treatment need was similar in 1978 and 1988. There was little change in the regular dental attendance pattern from 1968 to 1988.

Assessment of an additive index for plaque accumulation on complete maxillary dentures.

There appears to be a relation between accumulation of plaque on complete maxillary dentures and denture stomatitis. The present index was introduced to assess the location and amount of plaque in some areas of the fitting surfaces of complete maxillary dentures. Scores were recorded in five defined areas on the denture base. Four ranked scores were used: 0 - no visible plaque, 1-plaque visible only by scraping on the denture base with a blunt instrument, 2-moderate accumulation of visible plaque, and 3-abundance of plaque. By summing up the scores from the five areas, the plaque was recorded on a scale from 0 to 15 points. The inter- and intra-reliability were tested for two examiners using the index on 50 complete maxillary dentures. Expressed in terms of Scott's Pi, inter-examiners agreement was 0.83, and intra-examiner 0.83 and 0.82 for examiners A and B, respectively. A simplification of the index was also presented. In this index the scores 0 and 1 were combined to score 0, -no visible plaque, and score 2 and 3 were combined to score 1, -visible plaque. Using this index, Scott's Pi was calculated to 0.91 for inter-examiner reliability. For the intra-examiners reliability Scott's Pi was calculated to 0.91 for examiner A and 0.89 for examiner B.

Oral status and acceptance of dental services among some elderly persons in Oslo.

Oral conditions were studied clinically and radiographically in a group of people aged 67-94 years. The group comprised 70 persons living in an institution for elderly people and 111 persons living in their homes in the surrounding area. The participants were classified according to sex, age and former occupation. The examination was carried out in a dental office established at the institution. 63% of the participants were dentulous with a mean number of 13 teeth. Almost 50% of the teeth were previously restored and 13% of the teeth were decayed at the examination. 45% had complete maxillary dentures and 39% had complete mandibular dentures. The need for dental treatment according to defined criteria was registered, and treatment-offers were given. Comparisons were made between the treatment suggested and the treatment actually given. Of the total group, 129 persons needed dental treatment. Of these, 65 persons accepted all or part of the treatment suggested. In general, sex was not a good predictor of the need for an acceptance of dental services. However, age was found to be useful as a predictor. Social background was an unreliable predictor of the need for and acceptance of dental services.

The reliability of clinical evaluation of some characteristics in complete prosthetics.

The aim of this investigation was to study intra-assessor reliability and the relationship between individual and simultaneous evaluations when retention and stability of complete prostheses and the condition of the residual ridges were clinically assessed according to defined criteria. Further, inter-assessor reliability and the reliability of simultaneous evaluations were studied by evaluating the condition of the residual ridge on two occasions. Nine patients and three prosthodontists participated. Generally, the reliability levels were low and individual deviations from the simultaneous evaluations were common.

Distribution and evaluation of complete dentures in a population in northern Norway.

The frequency and distribution of complete dentures were studied in a population of 358 persons aged 20--69 living in a community in Northern Norway. Among the 83% who attended the investigation, 49% had a maxillary and 26% a mandibular denture. The occurrence of dentures increased with increasing age and with decreasing income and/or social class, while dentures were almost equally common in both sexes, when differences of age and income were taken into account. Of the participants between 50--69 years 39% had received their first maxillary denture at the age 17--24 years. In the age group 30--49 years the corresponding percentage was 20. Forty-four percent of the participants had maxillary dentures and 33% mandibular dentures which were older than 10 years. According to an index on the clinical evaluation of complete dentures as well as to the denture wearers' own opinion, the insufficiency of the dentures tended to increase with increasing age of the dentures. Sex, age, income and social class, however, were found to have only a minor effect on the age and the condition of the dentures as well as on the denture wearers' degree of satisfaction with their dentures. Persons who had natural mandibular teeth, tended to be less satisfied with their maxillary dentures than persons with complete dentures in both jaws.

Validity of information concerning the use of dental services obtained in interviews.

Two hundred and fifty-two persons out of a population of 358 were interviewed concerning their use of dental services. The validity of the information was tested by comparing the answers from each respondent with the contents of his/her dental treatment record. Replies to a question about the time interval since the last dental visit showed a high degree of validity. The validity of information concerning the type of treatment received at the last course of dental visits showed high validity for a single treatment and low validity when the treatment services were mixed. Responses about the regularity of treatment attendance demonstrated decreasing degree of validity with increasing number of dental visits during the last 5 years. The demographic and socioeconomic characteristics of the respondents showed little relation to the validity of their answers. However, the degree of validity decreased with increasing number of teeth.

The use of dental services in a population in Northern Norway.

The utilization of dental services was studied by means of records from dentist's files, a method which permits gathering of detailed information with high reliability and validity. 53% of the adult population of 358 persons living in a coastal community in Northern Norway had visited a dentist during a period of two years. In the group of 13% who were considered to be regular treatment attenders, number of teeth, sex and socio-economical status were the most influential predictors of utilization. Among the 182 persons with 10 or more remaining teeth, 59% had made preventive and restorative dental visits, and in this group there was a dominating proportion of women, young people and people with high income and/or social class. In contrast, only six persons out of 61 with one to nine remaining teeth had made such visits. People in social class 3 were overrepresented among the 26% of the population who visited a dentist because of extractions or complete denture services. The treatment profile according to age showed that younger people used most of their treatment time on consultations, preventive measures and conservative treatments, while fixed and removable prosthetics constituted a major part of the treatment time among elderly people.

Oral health status in a population in Northern Norway.

Information concerning oral health status was obtained through a clinical and radiographic examination of 297 persons aged 20--69 years out of a population of 358 persons living in a coastal community in Northern Norway. The oral health was generally poor. 71% had one or more remaining teeth and the dentulous persons had a mean number of 18 remaining teeth. The mean number of DMF teeth was 27,3 while the mean number of decayed teeth was 4,9 and filled teeth 12,0 giving a percent of decayed and filled teeth of 27 and 65 respectively. Only every fourth dentulous person had one or more crowns and/or bridge units and 4% of all teeth had been treated endodontically. 41% of the teeth had visible plaque and 56% of the teeth had one or more gingival margins bleeding after gentle probing. One fourth of all teeth had gingival pockets exceeding 3 mm and 17% of all teeth showed a bone loss of 20% or more. The number of remaining teeth decreased with increasing age and decreasing income and/or social class. In general, women, young people and people with a high socioeconomic status had less caries, better oral hygiene and periodontal condition and had received more restorative dental care than the remaining part of the population.

Some self-reported symptoms of temporomandibular joint dysfunction in a population in Northern Norway.

The distribution of a number of self-reported symptoms of temporomandibular joint (TMJ) dysfunction, parafunctions and treatment behaviour was studied by means of a questionnaire answered by 94% of a population group of 358 persons aged 20-69 years in Northern Norway. Nine subjects reported pain from the temporomandibular joint (TMJ) when opening their mouth and/or when chewing, while twenty-one subjects had clicking sounds in the TMJ. Seventeen persons had been grinding their teeth during the previous week. Only seven individuals had ever sought medical or dental advice because of TMJ disorder. Tooth grinding and symptoms of TMJ dysfunction were most common in young people, in people with twenty teeth of more and/or in people from high social classes, whereas differences according to sex and income were small. The low frequency of subjective symptoms of TMJ dysfunction and parafunctions in this population was related to demographical, social, dental and methodological influences.