Obesity and Dental Decay: Inference on the Role of Dietary Sugar

Objective

To evaluate the relationship of children’s obesity and dental decay.

Methods

We measured parameters related to obesity and dental decay in 8,275 4^th and 5^th grade Kuwaiti children (average age = 11.36 years) in a cross-sectional study. First to determine body weight, height, age for computation of BMI . Second, to determine numbers of teeth, numbers of fillings and numbers of untreated decayed teeth to determine extent and severity of dental disease. From these measurements, we computed measures of dental decay in children from four body weight categories; obese, overweight, normal healthy weight and underweight children.

Results

The percentage of children with decayed or filled teeth varied inversely with the body weight category. The percentage of decayed or filled teeth decreased from 15.61% (n=193) in underweight children, to 13.03% (n=4,094) in normal healthy weight children, to 9.73% (n=1,786) in overweight children to 7.87% (n=2,202) in obese children. Differences between all groups were statistically significant. Male children in this population had more dental decay than female children but the reduction of tooth decay as a function of BMI was greater in male children.

Conclusions

The finding of an inverse obesity-dental decay relationship contradicts the obesity-sugar and the obesity-dental decay relationship hypotheses. Sugar is well recognized as necessary and sufficient for dental decay. Sugar is also hypothesized to be a leading co-factor in obesity. If the later hypothesis is true, one would expect dental decay to increase with obesity. This was not found. The reasons for this inverse relationship are not currently clear.     

Edentulism and dental caries in Victorian nursing homes

doi: 10.1111/j.1741‐2358.2011.00510.x Edentulism and dental caries in Victorian nursing homes Objectives: The aim of this project was to investigate edentulism and dental caries in nursing home residents in Victoria, Australia. Background: The Australian population is ageing with a growing number of people living in nursing homes. These residents are at increased risk for dental caries, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Materials and methods: Clinical dental examinations were conducted at 31 nursing homes in Melbourne and regional Victoria between May 2005 and June 2006. A total of 510 residents were examined out of 1345 eligible participants. Socio‐demographic and medical history was collected via questionnaire. Results: Just over half of the residents were dentate (53.9%), and dentate residents had a mean of 14.4 teeth present and 2.66 untreated decayed teeth. Residents who required total assistance with oral hygiene had more decayed teeth and fewer filled teeth than residents who did not require assistance. Conclusions: Nursing home residents in Victoria are retaining an increasing number of natural teeth and have more tooth surfaces at risk for dental caries. Untreated dental caries was a significant problem for residents, particularly for those who are dependent on others for their daily oral hygiene care.     

Dental health of elderly confederate veterans: evidence from the Texas State Cemetery

Analysis of the skeletal remains of 50 Confederate veterans provided a unique opportunity to explore the dental health of a geriatric sample. These men, who died between 1907-1932, had an average age at death of 76.7 years. Ninety percent were institutionalized at the Confederate Home for Men (Austin, TX) prior to their deaths. This elderly sample was assessed in terms of caries, antemortem tooth loss (AMTL), abscesses, and linear enamel hypoplasias. On a per tooth basis, the AMTL rate was 57.2%. Of 39 dentate men, 33 (84.6%) had dental caries, and 24.4% (121 of 496) of teeth were carious. Ten (25.0%) of the dentate men had hypoplastic teeth. At least one abscess was seen in 14 (28%) of 50 individuals. Results from this geriatric institutionalized sample are compared to contemporaneous historical samples. Disparities in dental health among these groups may be due to differences in average age at death, and these comparisons allow a better understanding of dental changes that occur with age. The sample is also compared to modern elderly samples: modern groups have higher caries rates, possibly because they retained more teeth. This finding may be due in part to diets in the United States becoming increasingly cariogenic over time. In addition, dental care has moved from the reactive practices seen in the nineteenth and early twentieth centuries (such as tooth extractions) to modern proactive solutions dedicated to preserving and restoring teeth (such as tooth brushing, fluoride treatments, and dental fillings).     

Oral health among institutionalised elderly in Zagreb, Croatia

Objective: A survey of dental health status was conducted in the institutionalised elderly in Zagreb, Croatia in order to assess the dental and oral health of the elderly population. Participants: In 139 institutionalised elderly from a single nursing home in Zagreb, dental and oral status was registered according to World Health Organization criteria. There were 108 (77.7%) female and 31 (22.3%) male subjects aged 58–99 years. Results: The results showed that 45.3% of the interviewed persons were totally edentulous in both jaws. A significant increase in prevalence of edentulousness with the increasing age was recorded. The mean decayed, missing and filled teeth number was 27. The average number of teeth with caries was 1.03 per person, the number of the teeth extracted was 6.9 per person and teeth with fillings 0.74 per person. The average number of teeth with root caries was 0.17. Approximately 9 teeth per person were in need of treatment. Filled teeth were found 25.9% of subjects and decayed teeth in 30.9%. The mean number of remaining sound teeth, decayed teeth and residual roots in the elderly decreased with increasing age. Complete periodontal treatment was required in 5.8% of the participants and no significant differences between genders in periodontal status could be noticed. Conclusion: The results of this study suggest poor dental health in this group of the institutionalised elderly and the necessity of improving and implementing some special features in the dental health services programs for the institutionalised elderly.     

Predictors of caries in old age

This study measured the incidence of dental caries for one year and identified factors associated with the risk of caries in a sample of 156 elderly subjects. The subjects were examined at baseline and after one year to record the number of missing, filled and decayed teeth, to measure oral hygiene and flow of saliva, and to estimate the numbers of Streptococcus mutans and Lactobacilli cultured from samples of saliva. All subjects were interviewed on both occasions for information on their use of medications and dental services and on their ingestion of sugar. At baseline the elders had a mean of 19 natural teeth with 5 decayed surfaces (DS), 38 filled surfaces and a mean Plaque Index (PI) of 1. The independent group, on average, had more teeth and fillings but a lower PI and less caries. At the end of the year more than two-thirds (71%) of the 98 institutionalised subjects and over half (59%) of the 58 independent subjects had at least one new decayed/filled surface (DFS). The mean net DFS increment per subject was 4.6 and 2.0 respectively. Regression analyses on multivariate models identified caries at baseline, residence in long term care facilities, high numbers of Lactobacilli, poor oral hygiene and frequent sugar consumption as the variables contributing most significantly to the risk of caries in old age.     

Evolving Teeth Within a Stable Masticatory Apparatus in Orkney Mice

Mice from the Orkney archipelago exhibit an important diversity regarding molar shape. While on some islands mice display a usual dental pattern, teeth from other islands display additional cusplets and unusual phenotypes that may constitute case studies for evaluating the potential functional relevance of dental changes. We developed a multifaceted approach combining 2D and 3D geometric morphometrics, dental topography, dental wear, biomechanics, estimations of masticatory muscles force, and in vivo bite force on wild-derived lab descendants exemplifying the two extreme dental morphologies. The two strains differed in the geometry of the upper and lower tooth rows, and in the topography of the upper row only. Surprisingly, the most unusual tooth morphology appeared as the least complex because tooth simplification overwhelmed the signal provided by the occurrence of additional cusplets. No difference in bite force nor muscle force was evidenced, showing that the important change in dental morphology was accommodated without major changes in the rest of the masticatory apparatus. The evolution of unusual dental phenotypes was possibly fueled by drift and inbreeding in small and isolated populations on remote islands of the archipelago. No functional counter-selection impeded this diversification, since the unusual dental phenotypes did not disrupt occlusion and mastication.     

Amounts of Sr and Ca Eluted from Deciduous Enamel to Artificial Saliva Related to Dental Caries

This study was performed to elucidate the relationship between dental caries and the levels of Sr and Ca eluted from enamel, and to examine whether these elements are useful as factors to assess caries risk. The available 103 (Sr) and 108 (Ca) samples were obtained among 111 collected deciduous teeth. The healthy regions of enamel were decalcified in artificial saliva at pH 6.2 and 5.5. The eluted levels of these elements from enamel were determined using atomic absorption spectrophotometry. Sr and Ca levels were not affected by the sex nor tooth type. Sr levels of the caries-experienced tooth (CE) group were 2.6-fold (pH 6.2) and 2.2-fold (pH 5.5) higher than those of the sound tooth (ST) group, respectively. Furthermore, the Sr levels were significantly higher in the teeth with treated than in those with untreated caries. Only at pH 6.2 was a significant difference found in Ca levels between the ST and CE groups. In the ST group, at pH 5.5, both the Sr and Ca levels significantly increased when the children had six or more carious teeth. The Sr and Ca elution levels were significantly inhibited in the teeth receiving fluoride application every 3 or 4 months compared to those that were not. These findings indicate that Sr can be an indicator of the acid resistance of teeth, and a useful factor to assess future caries risk.     

Effect of undernutrition on deciduous tooth emergence among Rajput children of Shimla District of Himachal Pradesh, India

This article examines the influence of nutritional status on the emergence of deciduous dentition in a cross-sectional sample of 510 rural Rajput children from the Jubbal and Kotkhai Tehsils, Shimla District, Himachal Pradesh, India. The nutritional status of each child was evaluated using Z-scores of height/supine length-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). The effects of sex and side on deciduous dental emergence were not statistically significant. Partial correlation indicates that the number of emerged teeth (T) was more strongly correlated with height than with other anthropometric variables. In most age groups, the stunted boys and girls (HAZ <-2) had fewer emerged teeth than nonstunted age peers (HAZ >-2). The mean T in underweight children was also less than that of the normal children, with a few exceptions. The stunted children have a significantly greater likelihood of delayed emergence of deciduous dentition. Measures of linear growth status are more closely related to dental development than measures of growth in mass. The findings indicate that even moderate undernutrition can delay deciduous tooth emergence.     

Dental caries in disabled children

The aim of the study was to evaluate oral health conditions and dental caries status in disabled and healthy children. Two groups of randomly selected children 3-17 years old were examined. The first group comprised 80 children with disabilities (cerebral palsy, mental retardation, Down syndrome, autism and hearing-speaking disorders) and the second (control) group included 80 healthy children. Examined children were selected from several institutions which take care of disabled persons, kindergardens and four elementary schools. Clinical examination was performed by using a mirror and a probe and revealed the presence of dental caries, missing (extracted) and filled teeth. All clinically detected cavitations were registered as dental caries. The degree of oral hygiene was evaluated according to the OHI-S index values, which was determined by marking the plaque with 1% eozine solution. The values of OHI-S index ranged from 3.8-4.53 in disabled children and 2.73-2.84 in healthy children. In disabled children, the average dft values were 3.42 in deciduous teeth and 5.24 in mixed dentition. In healthy children, the average dft values were 1.43 in deciduous teeth and 5.1 in mixed dentition. The average DMFT index in disabled children was 1.41 for mixed and 6.39 for permanent dentitions. In healthy children, the average DMFT values were 1.23 in mixed and 4.76 in permanent dentitions. In general, the results revealed significantly poor level of oral hygiene and quite high level of caries prevalence in both disabled and healthy children, accentuating the need to reorganize preventive care measurements and improve dental care, particularly in disabled children in Croatia.     

Assessment of some elements in human permanent healthy teeth,their dependence on number of metallic amalgam fillings,and interelements relationships

In this study, 60 human permanent healthy teeth (without filling) were collected postmortem and analyzed using flame atomic absorption spectrometry (FAAS), cold vapor atomic absorption spectrometry (CVAAS), hydride generation atomic absorption spectrometry (HGAAS), and electrothermal atomic absorption spectrometry (ETAAS) for the determination of Ca, Hg, Se, Cu, and Ag. The concentration of these elements was assessed in carious and noncarious teeth, different tooth groups, with age and with number of amalgam fillings. A negative correlation was found between Ca and the number of amalgam fillings, and significant negative correlations were found between Ca and three other metals (Hg, Ag, and Cu) that indicate the possibility of substitutions of Ca by three other metals. Significant positive correlations were found among the number of amalgam fillings and Hg, Ag, Cu and Se showed metal concentration in permanent healthy teeth were affected by the presence of the number of amalgam filling. In addition, significant positive correlations between Hg and Ag, Hg and Cu, and Ag and Cu proved the suspicion that the Hg content in permanent healthy teeth was mainly found because of the influence of amalgam filling, not from other sources. Moreover, the significant positive correlation between Hg−Se and Ag−Se showed the formation of mercuric selenide and silver selenide complexes as part of a natural mechanism of detoxification. Consequently, the permanent healthy teeth would be considered as a bioindicator for the accumulation of long-term exposure of Hg and Ag.     

Salivary levels of mutans streptococci associated with restorations: a case-control study

Our aim was to estimate whether restorative therapy with amalgam and composite resin could decrease salivary mutans streptococcal level, thus also decreasing the risk for other caries development. We selected a case group of 93 children with detectable salivary mutans levels (i.e., at least 1x10(4) cfu/ml), and a control group (n=93 subjects) with undetectable levels. Children had the same age (12 years), no extracted teeth, crowns, temporary fillings, and restorations other than amalgam and composite resin, and the two groups had similar gender distribution. We clinically examined children and recorded active caries, restorations and oral hygiene level by means of gingival bleeding on probing; we also investigated sucrose intake at breakfast. The case group had statistically significant higher prevalence of restorations (36.6% vs. 18.3%), active caries (44.1% vs. 12.9%), and bad oral hygiene (84.9% vs. 68.8%) than the control group. However, the logistic regression analysis showed that presence of active caries was the only significant variable associated with mutans streptococci (OR=4.0; p=0.0002), while the effects of sucrose intake and of restorations were marginally significant. This apparent contrast between statistical analyses was due to the concomitant presence, in children with detectable mutans streptococci level, of restorations and decayed teeth at the same time, and, on the basis of the multivariate analysis, presence of mutans streptococci in these children was explained by the presence of active caries, more than restorations.     

Structural analysis of dental fear in children with and without dental trauma experience

The aim of the study was to evaluate dental fear in children with and without dental injuries in a randomly selected children in Croatia (59 girls and 88 boys). Children were divided into three groups depending on dental trauma experience. They were also divided into two age groups: 5-8 and 9-12 years. Only dental trauma to the permanent teeth was included in the study. The CFSS-DS, CDAS and CMFQ were used for evaluation of dental anxiety and the ISP Hollingshead Index of Social Position was calculated for evaluation of social status. The mean values of CDAS, CFSS-DS and CMFQ tests revealed that the anxiety level decreases with increasing experience of dental injury. The analysis of variance performed for CDAS showed a significant difference between children with and without dental trauma (p = 0,010). Regarding the groups, the analysis of variance for CMFQ (p = 0,021) and CFSS-DS (p = 0,001) showed a significant difference, as well as regarding age (CMFQ; p = 0,001 and CFSS-DS; p = 0,016). Cronbach's alpha coefficients revealed the highest reliability for CFSS-DS (alpha = 0,910). Pearson's correlation coefficients revealed significant correlations between the anxiety scores, age and ISP values for children without dental trauma, and between the anxiety scores and age for children with repeated dental trauma. The results of the ISP Hollingshead Index exhibited the highest frequency in children with dental injuries who belonged to the families with poor social background (ISP = 44-60). No significant difference was obtained between children with and without dental injuries depending on either gender or the ISP value.     

Whole-body imaging of the distribution of mercury released from dental fillings into monkey tissues

The fate of mercury (Hg) released from dental "silver" amalgam tooth fillings into human mouth air is uncertain. A previous report about sheep revealed uptake routes and distribution of amalgam Hg among body tissues. The present investigation demonstrates the bodily distribution of amalgam Hg in a monkey whose dentition, diet, feeding regimen, and chewing pattern closely resemble those of humans. When amalgam fillings, which normally contain 50% Hg, are made with a tracer of radioactive 203Hg and then placed into monkey teeth, the isotope appears in high concentration in various organs and tissues within 4 wk. Whole-body images of the monkey revealed that the highest levels of Hg were located in the kidney, gastrointestinal tract, and jaw. The dental profession's advocacy of silver amalgam as a stable tooth restorative material is not supported by these findings.     

步氏巨猿牙齿大小上的变异性和南方古猿类食性假说

步氏巨猿牙齿大小上的变异性表明,在柳城巨猿洞局部地区的堆积中可能有少量时代稍晚的巨猿牙齿标本。晚期步氏巨猿与早期的相比,后部齿显著增大而前部齿则无显著差异。从步氏巨猿牙齿在大小上的演化趋势来看,南非南方古猿类中的纤细类与粗壮类之间在齿列比例上的不同不一定意味着其食性上有大的差异,纤细类与粗壮类也未必有“属”这一分类级别上的差异。     

Dental "silver" tooth fillings: a source of mercury exposure revealed by whole-body image scan and tissue analysis

Mercury (Hg) vapor is released from dental "silver" tooth fillings into human mouth air after chewing, but its possible uptake routes and distribution among body tissues are unknown. This investigation demonstrates that when radioactive 203Hg is mixed with dental Hg/silver fillings (amalgam) and placed in teeth of adult sheep, the isotope will appear in various organs and tissues within 29 days. Evidence of Hg uptake, as determined by whole-body scanning and measurement of isotope in specific tissues, revealed three uptake sites: lung, gastrointestinal, and jaw tissue absorption. Once absorbed, high concentrations of dental amalgam Hg rapidly localize in kidneys and liver. Results are discussed in view of potential health consequences from long-term exposure to Hg from this dental material.     

Oral health status and temporomandibular disorders in multiple sclerosis patients

Multiple sclerosis (MS) is an inflammatory disease of unknown etiology involving the central nervous system. Certain clinical manifestations affect the oro-facial region. Three in particular should be of interest to the dentist: trigeminal neuralgia, sensory neuropathy of the trigeminal nerve and facial palsy. The aim of this study was to determine the oral health status, the frequency of subjective symptoms and temporomandibular disorders (TMD) subtype according to Research diagnostic criteria for temporomandibular disorders (RDC/TMD) among MS patients. Examinees in this study were 50 patients suffering from MS, who were at least once treated during their disease in the Clinic Hospital Center, Rijeka, Clinic for Neurology. All examinees had to meet the diagnostic criteria for clinically and laboratory confirmed MS, according to Poser. The results show the difference in mean DMFT (decayed, missing, filled teeth) between MS and the control group. The number of decayed and missing teeth was higher, but the number of filled teeth was significantly lower in MS group. Eighty-two per cent of the subjects with MS had a least one symptom of dysfunction compared with 24% of the subjects in the healthy control group. In the present study, pain, the pain during mouth opening, the difficulty with mouth opening and temporomandibular joint (TMJ) sounds were more commonly reported in the MS group than in the control group. This study shows a statistically significant excess of dental caries and temporomandibular disorders among MS patients compared with the control group. These results suggest that MS is a possible etiological factor in temporomandibular disorders.     

Measurements of tooth wear among Australian Aborigines: I. Serial loss of the enamel crown

The dental casts made from Aboriginal children during the course of a longitudinal growth study in Central Australia provided material for analyzing tooth wear under known environmental conditions. The wear facets produced on the occlusal surfaces were clearly preserved on the dental stone casts and recorded the progress of enamel attrition from ages 6 to 18. These casts were photographed and traced by electronic planimetric methods that automatically recorded the location and size of wear facets on the first and second permanent molars. These areas of worn tooth surface were compared to the total tooth surface. The worn surface was regressed on age to calculate wear rates of each tooth. Discriminant analyses were also performed to determine the significance of dental attrition differences between the sexes at each age group. The total wear on each tooth was highly correlated with age as expected but females wore their teeth at a significantly higher rate than males. The mandibular molars wore more rapidly than maxillary teeth in both sexes. The discriminant analysis successfully grouped 91% of the cases according to age and sex. Pattern of wear, the location, and size of wear facets also differed between age groups and sex. The questions of why there is a difference between male and female wear or why there is greater wear on one arch or arch region have no ready answers. The differing rates and pattern of dental wear do suggest that arch shape and growth rates may be the answer though it has yet to be tested. However, the occlusal surface wear is useful for age estimation in a population and provides a record of shifting masticatory forces during growth.     

A comparative study of tooth and dental arch dimensions in Jewish children of different ethnic descent. I. Kurds and Yemenites

Dental casts of 99 Kurdish and 98 Yemenite Jewish children evenly distributed between the sexes, aged 12 years, were measured for mesio-distal and buccolingual tooth dimensions, and arch depth and width. Dental dimensions showed significant differences between the two groups in certain permanent teeth in mesiodistal length, while in the buccolingual diameter the differences did not reach statistical significance. Dental arch form in Kurdish children was more rounded due to significantly bigger arch width, while arch depth was not significantly different from Yemenites. Intragroup sex differences were found in both groups with reference to arch dimensions, while in the dental parameters they were more strongly expressed in Kurdish children.     

整体铸造支架式可摘局部义齿添加人工牙的临床修理效果

目的：探讨整体铸造支架式可摘局部义齿添加人工牙的修理体会。方法：对240例佩戴整体铸造支架式可摘局部义齿的患者进行义齿添加人工牙修理,比较修理前后视觉模拟（VAS）评分、咀嚼功能及1年后人工牙的磨耗程度。结果：修复后VAS评分明显低于修复前,两者比较差异有统计学意义（P〈0.05）,但牙槽骨吸收距离未见明显差异（P〉0.05）。经过修复后义齿的固位稳定及咀嚼情况较修复前明显好转,在随访1年后,人工牙大多有轻到中度的磨耗,磨耗后出现23例颌位垂直距离缩短及2例下颌前移及偏移。结论：设计合理的支架连接体,并且尽量作添加人工牙和卡环的修理,可以延长义齿的使用寿命。     

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark

doi: 10.1111/j.1741‐2358.2011.00486.x
A cross‐sectional study of oral health and oral health‐related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral‐health‐related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health‐care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross‐sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health‐care programme. Clinical data and data from interviews comprising social factors, life‐style, dental visit habits, oral hygiene practices and self‐perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results: Sixty‐eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1–9 teeth and tooth mobility. Conclusion: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.