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Key-risk teeth
29-03-2010
Key-risk teeth The factors determining future tooth loss are related to age, dental caries, periodontal diseases, iatrogenic root fractures, trauma, orthodontic therapy, and so on. Therefore, it may be argued that it is difficult to analyze the true reasons for tooth loss in the adult, particularly in the elderly. The reasons for tooth loss may vary not only among different age groups but also among different populations and countries, depending on differences in prevalence of dental caries and periodontal diseases as well as the availability of resources for dental care. In Sweden, for example, almost all the teeth lost up to the age of 35 years are premolars, extracted for orthodontic indications (Fig 127) (Axelsson et al, 1990). From the same study, the pattern of remaining teeth (third molars excluded) in randomized samples of 50 and 65 year olds is shown in Figs 128 and 129, respectively. In 50 year olds, almost 100% of the mandibular incisors and about 90% of the first and second molars remain. In 50 year olds it is estimated that about 80% of the tooth loss was attributable to caries directly, or indirectly (endodontic complications, apical periodontitis, or postrelated root fractures). In 1948 to 1953, when these subjects were 10 to 15 years old, caries prevalence and incidence were very high, and school dental care was based on “drilling, filling, billing, and killing the pulp.” Only about 10% of the missing teeth would have been extracted for orthodontic indications, and 10% because of periodontal diseases. In 65 year olds about 75%, 20%, and 5% of the missing teeth are estimated to have been lost because of dental caries, periodontal diseases, and orthodontic therapy, respectively. In other words, dental caries is the major reason for lost teeth in the older adult population. In 65 year olds only 5% and 10% of the mandibular and maxillary first molars, respectively, and about 40% and 60% of the maxillary and mandibular incisors, respectively, remain. Quite simplistically, the risk for tooth loss could be predicted by combining measurement of the buccolingual width of the tooth crown and its distance posteriorly from the lips. The molars (key-risk teeth) are the most posterior teeth. The first molars have the widest approximal surfaces and the mandibular incisors the narrowest. In a toothbrushing population, the posterior teeth therefore require supplementary approximal cleaning and topical application of fluoride.
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Articles for theme “caries”:
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29-03-2010
Individual RiskBy combining etiologic factors, caries prevalence (experience), caries incidence (increment), external and internal modifying risk indicators, risk factors, and prognostic risk factors, as well as preventive factors, caries risk may be evaluated at the individual level, as no risk (C0), low risk (C1), risk (C2), and high risk (C3). As discussed earlier in this chapter, these conditions may vary in different age groups. Therefore, the criteria for C0, C1, C2, and C3 should be defined for at least the following general groups: preschool children (primary teeth), schoolchildren (permanent teeth), adults, and the elderly.
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29-03-2010
Risk GroupsRisk age groupsRecent studies have shown that carious lesions are initiated more frequently at specific ages. This applies particularly to children but also to adults. In children, the key-risk periods for initiation of caries seem to be during eruption of the permanent molars and the period during which the enamel is undergoing secondary maturation. In adults, most root caries develops in the elderly, partly because of the higher prevalence of exposed root surfaces.
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29-03-2010
Prediction of Caries Risk and Risk ProfilesIntroductionFor successful prevention and control of dental caries in both children and adults, some basic principles must be adopted: For example, the higher the risk of developing caries (new carious surfaces) in most of the population, the greater the effect of one single preventive measure. This may be illustrated by the Swedish experience, where 30 to 35 years ago, caries prevalence was extremely high. Almost every child developed several new lesions every year, mainly because of very poor oral hygiene.
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29-03-2010
Tooth-related factorsPhysical characteristics of the teeth may increase the risk for caries: tooth size, tooth morphology, cusp and fissure patterns, enamel structure (defects, opacities, mottling, and roughness of the surface), the morphology of the cementoenamel junction, and exposed root surfaces. In addition, the chemistry of the enamel, dentin, and root cementum may influence caries susceptibility. Studies to date indicate that large teeth in crowded mouths are more likely to develop caries, but this cannot be predicted on an individual basis.
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29-03-2010
Systemic and immunologic factorsOf the chronic systemic diseases, by far the most important risk factor and prognostic risk factor for dental caries is Sjogren’s syndrome, because of its extremely depressive effect on both the salivary secretion rate and the quality of the saliva. Indirectly, reduced SSR is associated with other chronic diseases in which medical management involves regular use of drugs with side effects on the salivary system. Some other general chronic diseases, such as leukemia, acquired immunodeficiency syndrome, diabetes mellitus, and Down’s syndrome, impair the immune system generally or specifically.
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