Do root lesions tend to develop in the same people who develop coronal lesions?

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.

Three-year coronal caries incidence and risk factors in North Carolina elderly.

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.

Eighteen-month incidence of tooth loss among older adults in North Carolina.

This study investigated tooth loss in North Carolina adults 65 years of age or older. A random sample of 335 Blacks and 284 Whites participated in dental examinations and interviews at baseline and again after 18 months. Blacks were more likely than Whites to lose at least one tooth (36% vs 19%), and they lost more teeth on average (1.0 vs 0.4). Several oral disease conditions and symptoms were related to tooth loss, but many other hypothesized factors were not. Risk models were inconclusive in the identification of factors related to risk of tooth loss.

Three-year tooth loss among black and white older adults in North Carolina.

The distribution and determinants of tooth loss in older adults are poorly defined, especially in Blacks, who have been underrepresented in previous studies. This study investigated, epidemiologically, the distribution and predictors of tooth loss in elder Blacks and Whites by following a random sample of older adults in North Carolina for three years. It was hypothesized that Blacks would be at greater risk of tooth loss and would have different risk factors for tooth loss. Data from 263 Blacks and 228 Whites were collected by dental examinations and interviews conducted in the participants' homes. During the three-year follow-up, 53% of Blacks and 29% of Whites lost at least one tooth. Blacks lost 13% of their remaining teeth compared with 4% for Whites. Logistic regression models showed that factors related to tooth loss for Blacks were: more S. mutans in stimulated saliva, deeper periodontal pockets, more P. intermedia in subgingival plaque, high blood pressure, limited help from others, and few symptoms of depression. For Whites, significant factors were: more lactobacilli in stimulated saliva, history of current oral pain at baseline, more alcohol consumption, no history of past use of calcium or xerostomic medications, higher income, lower occupational prestige, and increased numbers of negative life events. This study showed that older Blacks were at greater risk of tooth loss than older Whites. For both races, factors such as oral bacteria, periodontal conditions, oral symptoms, and psychosocial and economic factors are related to increased risk of tooth loss.

Eighteen-month coronal caries incidence in North Carolina older adults.

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.

The distribution and interrelationship of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and BANA scores among older adults.

In a random sample of subgingival dental plaque samples from 375 blacks and 300 whites aged 65 and older, immunofluorescence assays for 3 target pathogens including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia, and BANA enzyme analysis were carried out. Blacks had significantly greater proportions of P. gingivalis and P. intermedia in their subgingival plaque and had significantly higher BANA scores. These assay results were investigated for concordance with each other and with 2 cariogenic salivary bacteria, Streptococcus mutans and lactobacilli. In general for both races, the periodontal pathogens were more likely to occur in combination with each other than with either S. mutans or lactobacilli. P. gingivalis and P. intermedia were more frequently associated with each other than with A. actinomycetemcomitans. There was a significant negative concordance between BANA and A. actinomycetemcomitans in whites and a significant positive concordance between BANA and P. intermedia in blacks.

The oral status of elderly removable partial denture wearers.

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.

Streptococcus mutans, lactobacilli, and caries experience in older adults.

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.

Root caries prevalence in black and white North Carolina adults over age 65.

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.

Models for coronal caries and root fragments in an elderly population.

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.

Dental treatment needs in an elderly population.

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.

Reasons for restoration replacement: differences in practice patterns.

Patients receive varying types and amounts of restorative treatment, depending on the prescribing dentist. The aim of this study was to enhance the understanding of the variation of the restoration replacement practices of dentists. Three dentists in private practice in similar semirural communities with comparable practice demographics were asked to gather data on all restorations they replaced over a period of 1 month. They recorded the tooth number, number of restored surfaces, restorative material being replaced, number of surfaces in the replacement restoration, the replacement restorative material, and the reasons for the replacement restoration. Statistically significant differences were found among the dentists as to the reasons for posterior restoration replacement, replacement materials used, and increase in size of the replacement restorations. Differences were attributed to individual practice philosophies, demonstrating that clinical information was not the sole determining factor as to type of replacement restorations that patients received.

The accuracy of oral self-perceptions in a dentate older population.

A random sample of 1,016 subjects aged 65 and older were interviewed and examined in their own homes. The sample was stratified by race and place of residence. As part of the interview, the 821 dentate subjects were asked to rate their mouth appearance, chewing ability, and mouth health. Most subjects responded positively to these questions. The self-perception of mouth health was most related to the presence of anterior teeth. Perception of chewing ability was most related to the number of anterior teeth present, total number of teeth present, and the need for extractions. Subjects also were asked about their perceived dental needs. A small proportion of subjects thought they needed restorations, periodontal treatment, or teeth replacement. Subjects generally were not able to define the extent of their treatment needs, but their self-perceptions of mouth appearance, chewing ability, and mouth health had some relationship to their oral health.

Dental restoration longevity: survival functions and statistical indices in low and high failure rate groups.

A group of 71 patients was examined to determine the longevity of restorations placed at the University of North Carolina School of Dentistry. Patients with an overall restorations failure rate of equal to or greater than 40 per 1000 restoration-yr were categorized as having a "high failure rate" and those below that were considered "low failure rate". An investigation was made to determine statistical differences between these two groups of patients using survival analysis and various statistical indices. Time of exposure and age of patients for both groups were similar. High rate patients had a greater number of anterior restorations and anterior teeth restored. In addition, the number of restorations per tooth was significantly greater in anterior and posterior teeth of the high failure rate group. No single variable was found to account for the differences in the failure rates in the two groups of patients. A prospective study is needed in order to examine possible causes for restoration failures.

A comparison of restoration longevity in maxillary and mandibular teeth.

This study determined if the survival time of restorations in maxillary and mandibular teeth differed in a group of 71 patients. The 1,232 restorations were placed by a dental school clinic in a 29-year period. There were no significant systematic differences in the survival time of restorations in maxillary and mandibular molars, premolars, and canines. Maxillary and mandibular incisors show significant differences in survival patterns. Of the mandibular restorations available for follow-up, 71% were still intact after 26 years.

Longevity of restorations in a dental school clinic.

The longevity of 1,207 restorations placed by students was studied in 70 adult patients. The overall percentage of restorations lasting ten years or more (P10) was 75.4 percent and survival times were longer than in most previous restoration longevity studies. Cast restorations lasted significantly longer than amalgams, which in turn lasted significantly longer than composites. P10 values were 91.1 percent, 72.0 percent, and 55.9 percent, respectively. Analysis by surfaces involved indicated that single-surface lasted longer than multisurface restorations. The survival of restorations placed in patients aged 60 or more was less favorable (P10 = 56.8 percent) than for younger patients (P10 = 78.3 percent). A subset of the population was identified on the basis of a restoration failure rate of greater than 4.0 X 10(-2) failures/restoration year. This group, comprising 18.6 percent of the population, accounted for 56.1 percent of all restoration failures. The P10 value for this high-risk group was 55.8 percent, as compared with 83.9 percent for the remainder of the population.