Main Cause Of Tooth Loss Research Articles

Epidemiology of Periodontal Disease

Epidemiology is the study of health and disease in populations and of how these states are influenced by biology, heredity, and physical and social environment, as well as personal behavior. Advances in research over recent years have led to a fundamental change in our understanding of the periodontal diseases. As recently as the mid-1960s, the prevailing model for the epidemiology of periodontal diseases included the following precepts: (1) all individuals were considered more or less equally susceptible to severe periodontitis; (2) gingivitis usually progressed to periodontitis with consequent loss of bone support and eventually loss of teeth; (3) susceptibility to periodontitis increased with age and was the main cause of tooth loss after age 35–55. Since the development of this paradigm, advances in the understanding of periodontal diseases have led this disease model to be reevaluated. Current knowledge has shown that periodontitis does not present a linear progression and is not age dependent. Moreover, its distribution and severity are strongly influenced by host susceptibility and risk factors. Several epidemiological studies evaluating destructive periodontal diseases have been pursuing associations in the incessant identification of risk factors for these diseases. Analytical epidemiology seeks to identify the risk factors associated with a disease, to quantify the strength of those associations and to estimate whether an association is causal. An understanding of risk factors can lead to theories of causation and then to treatment protocols for clinicians to use in their daily practice. The essential features of epidemiology as a method of research, when compared to clinical research and case studies, are that (1) groups rather than individuals are the focus of study; (2) persons with and without a particular disease (e.g., periodontal diseases) and with and without the exposure of interest are included, rather than just patients. The study of population groups rather than individuals is to allow for valid estimates while accounting for normal biological variation (e.g., some individuals form dental biofilm readily; others do not). Broadening a study to include those with and without a disease can provide a reference point against which a risk is quantified. Under such background, this special issue was designed to summarize the current status of periodontal epidemiology. Thus, we have invited authors to submit original research articles and analysis that seek to clarify aspects of the epidemiology of periodontal diseases and the relevant related factors. As a result, various interesting and scientifically significant papers have been accepted. This special supplement presents manuscripts reporting information about the prevalence and distribution of periodontitis, as well as their associations with risk factors. In addition several studies reported tooth loss, one of the most visible results of the evolution of periodontitis that causes physiological and psychological impacts on patient's life. These papers represent an exciting and insightful observation into the state of art, as well as emerging future topics, in this important interdisciplinary field. We hope that this special issue would attract a major attention of the peers.

Pattern of Tooth Extraction in Children Attending Tertiary Health Care Centers In Nigeria: A Prospective Study

To identify the causes of tooth extraction in a tertiary pediatric center in an urban centre in Nigeria. Data was collected prospectively from 400 children attending one of the four tertiary dental clinics. The demographic profile, the indications for tooth extraction, and the tooth extracted were noted. Data was compared with result of study conducted 21 years back in the same center, and data from two other tertiary health centers in the region. The prevalence of tooth extraction was 58.8% in the study population. This occurred in significantly more male patients. Tooth loss was commonest amongst the 7-10 age group. Dental caries was the main cause of tooth loss for all age groups. Most patients (66.0%) lost a single tooth. The lower molars were the most frequently lost teeth (47%). Indications for tooth extraction were similar in the region. Dental caries remains the most common cause of tooth extraction. The indications for tooth extraction remain the same but the prevalence of tooth loss per cause of tooth loss had not changed over the last 21 years, and across institutions in Southwestern Nigeria.

Reasons for extraction in a group of Libyan patients

To investigate the pattern and causes of tooth loss in patients among eastern part of Libya. This study carried out at Faculty of Dentistry, Garyounis University, Benghazi, Libya. The out patients undergoing extractions at the Oral Surgery Department were randomly selected for this study between Jan 2007 and March 2008 where a total of 9,570 extractions were performed on 8,514 patients. The incidence and reasons for tooth extraction, their distribution according to age and sex were studied. Males had more teeth extracted than females. Forty patients had one or more systemic illnesses, 34 were on regular medication. The study revealed two major causes of tooth loss: dental caries (55.90%) and periodontal diseases (34.42%). Other important causes were trauma (3.76%), impaction (1.83%), prosthodontic reasons (2.19%), and orthodontic reasons (1.30%) and others which included extraction where the tooth was associated with a tumour, cyst or supernumerary tooth (1.61%). Dental caries was the main causes of tooth loss during the 2nd, 3rd and 4th decades. While periodontal diseases were the prevalent aetiological factor during the 4th, 5th, 6th and 7th decades of life. The posterior teeth most frequently extracted due to dental caries were lower first molars (43.92%). Whereas anterior teeth were more frequently extracted due to periodontal diseases (28%) with the remaining posterior teeth also being extracted (7%).

Allogeneic Periodontal Ligament Stem Cell Therapy for Periodontitis in Swine

Periodontitis is one of the most widespread infectious diseases in humans. It is the main cause of tooth loss and associated with a number of systemic diseases. Until now, there is no appropriate method for functional periodontal tissue regeneration. Here, we establish a novel approach of using allogeneic periodontal ligament stem cells (PDLSCs) sheet to curing periodontitis in a miniature pig periodontitis model. Significant periodontal tissue regeneration was achieved in both the autologous and the allogeneic PDLSCs transplantation group at 12 weeks post-PDLSCs transplantation. Based on clinical assessments, computed tomography (CT) scanning, and histological examination, there was no marked difference between the autologous and allogeneic PDLSCs transplantation groups. In addition, lack of immunological rejections in the animals that received the allogeneic PDLSCs transplantation was observed. Interestingly, we found that human PDLSCs fail to express human leukocyte antigen (HLA)-II DR and costimulatory molecules. PDLSCs were not able to elicit T-cell proliferation and inhibit T-cell proliferation when stimulated with mismatched major histocompatibility complex molecules. Furthermore, we found that prostaglandin E2 (PGE2) plays a crucial role in PDLSCs-mediated immunomodulation and periodontal tissue regeneration in vitro and in vivo. Our study demonstrated that PDLSCs possess low immunogenicity and marked immunosuppression via PGE2-induced T-cell anergy. We developed a standard technological procedure of using allogeneic PDLSCs to cure periodontitis in swine. Stem Cells 2010;28:1829–1838

Role of p38 in nitric oxide synthase and cyclooxygenase expression, and nitric oxide and PGE2 synthesis in human gingival fibroblasts stimulated with lipopolysaccharides

Periodontal disease, a gingival inflammatory disease caused by gram-negative bacteria, is the main cause of tooth loss. Lipopolysaccharides (LPS) present in bacterial cell walls induce human gingival fibroblasts' production of pro-inflammatory cytotoxins such as IL-1β and TNFα. The goal of this study was to determine p38 role in the expression of inducible nitric oxide synthase enzyme (i-NOS) and cyclooxygenase (COX-2), as well as in PGE 2 and nitric oxide synthesis in human gingival fibroblasts challenged with LPS. We found that lipopolysaccharides induced a rapid and significant increase in p38 phosphorylation. After interruption of p38 transduction pathway by pre-treatment with inhibitor SB203580, no response to stimulation with LPS was observed; i-NOS expression and nitric oxide synthesis was completely blocked. However, p38 inhibition only partially blocked COX-2 expression and PGE2 synthesis. We conclude that p38 is critically involved in i-NOS induction, and that it participates in COX-2 expression and in PGE2 synthesis.

Commentary: Is tooth loss good or bad for general health?

Abnet et al. 1 show that tooth loss is associated with increased risk of mortality from upper gastrointestinal cancer, heart diseases, and stroke. In the last decade, those working in oral health research, especially within periodontology, have shown increasing interest in studying the possible link between oral health and systemic health outcomes. The study by Abnet et al. evidently shows the difficulties and limitations in study design faced by proponents of a causal relationship. It is simple to think of a randomized controlled trial to test the hypothesis of a relationship between oral health status and systemic health outcomes (not surrogate endpoints such as inflammatory cytokine levels): patients with advanced periodontal disease are randomly allocated to two groups in which one receives standard treatment and maintenance care and the other receives no treatment. However, this study design would be considered unethical. Furthermore, differences in treatment outcomes between the two groups, such as episodes of stroke, will take many years to manifest, and it can be assumed that the treatment reduces/reverses the risk generated by periodontal diseases. Consequently, the only practical alternative research data must come from large-scale cohort studies, such as that reported by Abnet et al., or from case‐control studies. A persistent problem, however, is the assessment of oral health. Although the pathological mechanism in the connection between oral infection and systemic health is not yet known, it is widely thought that the chronic infection due to periodontal diseases is more likely to cause systemic hazard because periodontal infection is chronic and periodontal pathogens enter the systemic blood circulation. However, diagnosis of periodontal diseases is not straightforward and clinical examination to establish diagnosis is time-consuming. Simple indices to screen and summarize periodontal diseases have been used in epidemiological research, but it is questionable that these indices can reliably represent the underlining disease status. An alternative is to use the number of lost teeth, which seems to be a reliable measure of oral health status. Although we accept that tooth loss is less prone to measurement error, the interpretation of tooth loss remains debatable. For the rural Chinese population, Abnet et al. argue that periodontal disease, not dental caries, is the main cause of tooth loss, and this supposition affects only the biological mechanisms they propose and not the accuracy of the risk estimates they report. This supposition might be true, though there is more than one interpretation of their risk estimates.

口腔健康状態とそしゃく機能および全身的健康状態の関連

How oral health conditions influence masticatory function and health in general was reviewed. The relation of cause and effect, which the number of remaining teeth is the most contributing factor to masticatory function, has been established by many researchers. Regarding the relationship between oral health and health in general, however, scientific information is still limited. Some reports suggested that the elderly with poor oral health have high risk for physical and/or mental health problems. Another report was also found that professional care in house calls by dentists made general health of homebound patients improve. On the other hand, leading oral epidemiologists are investigating the relationship between periodontal disease and heart disease or osteoporosis by the same means. For future research, large-scale interdisciplinary cohort studies should be necessary to clarify these relations. As for oral health, there is no doubt about the importance of preventing dental caries and periodontal diseases, which are considered the main causes of tooth loss.

Reasons for tooth extraction in the western states of Germany

The purpose of this study was to collect information on the main causes of tooth loss in the western states of Germany as perceived by dentists and their patients. Sixty-eight dentists, out of 80 that were selected with a systematic random method for an epidemiological study in the western states of Germany, recorded their reason for tooth extraction. Included in the study were only extractions of permanent teeth during a period of 2 weeks (March 1990), up to a maximum of 20 patients per dentist. Of 926 returned questionnaires, 882 could be evaluated. In all 1215 teeth in 882 patients were extracted. The extraction of third molars was included as a reason, when caries, periodontal reasons and others were not indicated. Caries was the reason given for 20.7% of all extractions; periodontal diseases for 27.3%; caries and periodontal reasons for 18.7%; third molars for 14.7%; prosthetic reasons for 11.2%; orthodontic reasons for 4.1%; trauma for 0.4% and others for 2.9%. While caries is a major reason in all age groups, periodontal diseases and the combination of caries and periodontal reasons are more frequent than all other reasons for the age groups beyond 40 or 45 yr, respectively. The third molar was the most often extracted tooth. The patients were asked for their main reason for tooth extraction. For the patients, pain was the major reason for extraction (47.2%). According to the participating dentists periodontal disease is the most frequent cause of tooth extraction for people over 40 yr of age, while for those below 40 yr of age, caries and third molar extractions are the most frequent reasons.

The role of epidemiology in the study of periodontal diseases.

Models of disease are collections of theory on its etiology and progression, based on research as far as possible but often including some untested hypotheses. As such, these models have to be modified from time to time as new research findings come out and sometimes have to be revised extensively. This is the case with the models for periodontal diseases. In fact, knowledge of the disease process has expanded so rapidlv that it is easy to forget that, as recently as the mid-l960s, a widely accepted model of periodontal disease included the following: All gingivitis progresses to periodontitis with consequent bone loss and tooth loss. 0 Virtually everyone is susceptible to periodontitis that becomes serious enough to threaten the dentition. 0 The severity of periodontitis increases with age. 0 Periodontal disease is the main cause of tooth loss after age 35.

Tooth mortality in an adult rural population in Kenya.

This paper reports on the pattern of tooth loss in a random sample of 1131 adults aged from 15 to 65 years in a rural area of Kenya in which access to formal dental care is minimal. We found that the majority of the population retained most of their dentition in a functional state even up to the age of 65 years: In all age groups, more than 50% had at least 26 teeth present, and more than 90% had at least 16 teeth present. The prevalence of edentulousness was less than 0.3%. The principal cause of tooth loss in all age groups was caries, and this was true for all tooth-types except incisors, for which periodontal disease was the main cause of tooth loss. The cultural practice of removing lower central incisors was observed only in those over 40 years of age. More teeth were lost due to caries among women than among men, while the reverse was true for teeth lost due to periodontal diseases. In view of the fact that most people retain most of their teeth throughout life, it is suggested that the most appropriate strategies for dental health care in this population should be those promoting self care, rather than the introduction of a formal treatment-oriented approach provided by dentists.