Tooth wear among psychiatric patients: prevalence, distribution, and associated factors

PURPOSE: The purpose of this study was to evaluate the prevalence, distribution, and associated factors of tooth wear among psychiatric patients. MATERIALS AND METHODS: Tooth wear was evaluated using the tooth wear index with scores ranging from 0 to 4. The presence of predisposing factors was recorded in 143 psychiatric patients attending the outpatient clinic at the Prince Rashed Hospital in northern Jordan. RESULTS: The prevalence of a tooth wear score of 3 in at least one tooth was 90.9%. Patients in the age group 16 to 25 had the lowest prevalence (78.6%) of tooth wear. Increasing age was found to be a significant risk factor for the prevalence of tooth wear (P < .005). The occlusal/incisal surfaces were the most affected by wear, with mandibular teeth being more affected than maxillary teeth, followed by the palatal surface of the maxillary anterior teeth and then the buccal/labial surface of the mandibular teeth. The factors found to be associated with tooth wear were age, retirement and unemployment, masseter muscle pain, depression, and anxiety. CONCLUSION: Patients' psychiatric condition and prescribed medication may be considered factors that influence tooth wear.     

Tooth wear, a proposal for an evaluation system

The present-day terminology and definitions of tooth wear are not unambiguous. For diagnosing tooth wear, however, it is essential that they are unambiguous. In this article a proposal is presented for a tooth wear evaluation system with simplified definitions. This system consists ofa number of modules and can be used for various aspects of the diagnostic procedure. It can be used for the quantification of tooth wear, both for periodic screening and for the monitoring of tooth wear in individual patients. The scoring of occlusal/incisal tooth wear as well as of non-occlusal/non-incisal tooth wear is possible. The evaluative system is also suitable for determining which type of tooth wear, such as attrition, abrasion and erosion, is most likely to have caused any observed loss of hard tooth tissue.     

Immunohistochemical detection of uPA, uPAR, PAI-1, and maspin in ameloblastic tumors

BACKGROUND: To evaluate the roles of extracellular matrix (ECM)-degrading serine proteinase in progression of odontogenic tumors, expression of urokinase-type plasminogen activator (uPA), uPA receptor (uPAR), plasminogen activator inhibitor-1 (PAI-1), and maspin was analyzed in ameloblastic tumors as well as in tooth germs. METHODS: Tissue specimens of 10 tooth germs, 45 ameloblastomas, and 5 malignant ameloblastic tumors were examined immunohistochemically with the use of antibodies against uPA, uPAR, PAI-1, and maspin. RESULTS: Immunohistochemical reactivity for uPA, uPAR, PAI-1, and maspin was detected in normal and neoplastic odontogenic tissues: uPA was recognized predominantly in mesenchymal cells, uPAR was evident in epithelial cells, PAI-1 was found in both epithelial and mesenchymal cells, and maspin was expressed only in epithelial cells. The levels of uPA and uPAR immunoreactivity in ameloblastic tumors were slightly higher than the levels in tooth germs, while PAI-1 reactivity in ameloblastomas tended to be lower than that in tooth germs. The level of maspin immunoreactivity in ameloblastomas was significantly higher than that in tooth germs, and ameloblastic carcinoma showed decreased maspin reactivity. CONCLUSION: Expression of uPA, uPAR, PAI-1, and maspin in tooth germs and ameloblastic tumors suggests that interactions among these molecules contribute to ECM degradation and cell migration during tooth development and tumor progression. Altered expression of the serine proteinase and its associated molecules in ameloblastic tumors may be involved in oncogenesis of odontogenic epithelium.     

Tooth Color Measurement Using Chroma Meter: Techniques, Advantages, and Disadvantages

Tooth whitening has become a popular and routine dental procedure, and its efficacy and safety have been well documented. However, the measurement of tooth color, particularly in the evaluation of the efficacy of a system intended to enhance tooth whiteness, remains a challenge. One of the instruments used for assessing tooth color in clinical whitening studies is the Minolta Chroma Meter CR-321 (Minolta Corporation USA, Ramsey, NJ, USA). This article describes the instrument and discusses various measuring procedures and the Chroma Meter's advantages, limitations, and disadvantages. The available information indicates that, although Minolta Chroma Meter CR-321 provides quantitative and objective measurements of tooth color, it can be tedious to use with a custom alignment device. The Chroma Meter data are inconsistent with the commonly used visual instruments such as Vitapan Classical Shade Guide (Vita Zahnfabrik, Bad Säckingen, Germany), although in many cases the general trends are similar. It is also questionable whether the small area measured adequately represents the color of the whole tooth. A more critical challenge is the lack of methods for interpreting the Chroma Meter data regarding tooth color change in studies evaluating the efficacy of whitening systems. Consequently, at present the Chroma Meter data alone do not appear to be adequate for determining tooth color change in whitening research, although the quantitative measurements may be useful as supplemental or supportive data. Research is needed to develop and improve the instrument and technique for quantitative measurement of tooth color and interpretation of the data for evaluating tooth color change.
CLINICAL SIGNIFICANCE
This paper will help readers to understand the advantages and limitations of the Minolta Chroma Meter used for evaluating the efficacy of tooth-whitening systems so that proper judgment can be made in the interpretation of the results of clinical studies.     

Cognitive, Affective, and Behavioral Responses Associated with Mechanical Tooth Movement

The cognitive, affective, and behavioral responses to mechanical tooth movement were separated into those associated with the discomfort of the procedure and those related to changes in physical appearance. The influence of psychosocial variables such as age, ethnicity, gender, and personality-related adaptation to these changes was described. The importance of distinguishing between the longer time for adjustment to tooth movement and relatively short time available for adjustment to plastic or orthognathic surgery was also noted. Some speculation was also offered on the role of biochemical mediators associated with tooth movement on mood and behavior. Methods of behavioral or pharmacological intervention for anticipating and managing patient responses to mechanical tooth movement were provided.     

Analysis of dental anomalies in the Siberian mole, Talpa altaica (Insectivora, Talpidae)

We re-examined tooth variation in specimens of the Siberian mole, Talpa altaica, from the collection of the Siberian Zoological Museum and discuss the mechanisms of dental evolution. The number of teeth counted in 1789 specimens ranged from 34 to 47, and supernumerary, absent, and connate teeth were observed. The most frequent tooth anomaly was an absent tooth in the premolar region (200 maxillary first premolars and 190 mandibular third premolars), which does not support Fujita and Kirino's terminal reduction hypothesis in the mandible [Fujita T, Kirino T. Ha No Kaibougaku. 21st ed. Tokyo: Kanehara Publishers Inc.; 1976 (in Japanese)]. Supernumerary teeth were found in premolar rows and in the incisor and molar regions. An maxillary fourth molar, positioned distal to the normal third molar, was thought to result from a genetically programmed atavistic event during the natal stages. Connate teeth were observed only in the premolar rows and were thought to have developed with the fusion of two independent tooth germs. Connate premolars appeared to result from an expression of an incomplete division of tooth germ at an early developmental stage or a reunion of independent tooth germs, based on the morphological similarity of the normal and supernumerary premolars. These extraordinarily frequent tooth anomalies of T. altaica are of much interest both in terms of tooth development and classification.     

Severity, distribution, and correlates of occlusal tooth wear in a sample of Mexican-American and European-American adults

PURPOSE: The objective of this study was to determine the severity, distribution, and correlates of tooth wear in a sample of Mexican-American and European-American adults drawn from a community-based longitudinal aging study on oral health. MATERIALS AND METHODS: The maxillary teeth of 71 subjects enrolled in a longitudinal aging study were assessed using a previously introduced five-point (0 to 4) ordinal scoring system in which each tooth is given a score describing the severity of wear. The tooth wear scores were compared with data concerning demographic factors, functional/parafunctional habits, soft drink consumption, and bite force measurements to determine specific correlates of tooth wear. RESULTS: The mean wear score for all teeth was 1.50 on the five-point scale. There was a significant difference between the mean wear score of anterior teeth (1.85) and posterior teeth (1.17). Bivariate analyses detected a moderate degree of correlation between maxillary tooth wear and age and bite force. Maxillary tooth wear was significantly greater in males and in subjects with reported teeth clenching/grinding. Multivariate analyses revealed that age, gender, bite force, self-reported teeth clenching/grinding, and number of daily meals/snacks had significant correlations with maxillary tooth wear. CONCLUSION: The overall severity of maxillary tooth wear in this sample of Mexican-American and European-American adults was low, with anterior teeth having a greater degree of wear than posterior teeth. Age, gender, bite force, teeth clenching/grinding, and number of daily meals/snacks are potential factors that may have contributed to tooth wear in the study sample.     

Immunohistochemical detection of phosphorylated JNK, p38 MAPK, and ERK5 in ameloblastic tumors

BACKGROUND: To evaluate roles of mitogen-activated protein kinases (MAPKs) in oncogenesis and cytodifferentiation of odontogenic tumors, expression of phosphorylated JNK (p-JNK), p38 MAPK (p-p38 MAPK), and ERK5 (p-ERK5) was analyzed in ameloblastic tumors as well as in tooth germs. METHODS: Ten tooth germs, 47 ameloblastomas, and 5 malignant ameloblastic tumors were examined immunohistochemically with the antibodies against p-JNK, p-p38 MAPK, and p-ERK5. RESULTS: Immunoreactivity for p-JNK was detected in epithelial or neoplastic cells detached from the basement membrane in 7 tooth germs and 7 ameloblastomas, and the expression levels of p-JNK in ameloblastic tumors were significantly lower than that in tooth germs. Expression of p-p38 MAPK was found in epithelial or neoplastic cells in tooth germs and ameloblastic tumors except for two ameloblastomas, and increased expression was found in keratinizing cells of acanthomatous ameloblastomas. The expression level of p-p38 MAPK in ameloblastomas was significantly higher than the levels in tooth germs and malignant ameloblastic tumors. Immunoreactivity for p-ERK5 was found predominantly in epithelial or neoplastic cells near the basement membrane in tooth germs and ameloblastic tumors. The expression levels of p-ERK5 in ameloblastic tumors were slightly higher than that in tooth germs, and plexiform ameloblastomas showed significantly higher p-ERK5 expression than follicular ameloblastomas. CONCLUSION: Expression of p-JNK, p-p38 MAPK, and p-ERK5 in tooth germs and ameloblastic tumors suggests that these MAPK signaling pathways contribute to cell proliferation, differentiation, or apoptosis in both normal and neoplastic odontogenic tissues. Altered expression of these phosphorylated MAPKs in ameloblastic tumors may be involved in oncogenesis and tumor cell differentiation.     

Diabetes, periodontal diseases, dental caries, and tooth loss: a review of the literature

Diabetes mellitus, is a common chronic disease, and its prevalence in the United States, particularly type 2 diabetes, is increasing. Complications associated with diabetes impose a heavy burden on many people, especially among certain minority populations. Periodontal diseases, dental caries, and tooth loss also are common conditions in the United States, but their prevalence is generally decreasing. Nevertheless, among important subgroups of the population, particularly certain minority and economically disadvantaged groups, there is a disproportionately higher burden of periodontal diseases, dental caries, and tooth loss. This article reviews the post-1960 English-language literature on the relationship between diabetes and oral health, specifically focusing on periodontal disease, dental caries, and tooth loss. Substantial evidence exists to support the role of diabetes and poorer glycemic control as important risk factors for periodontal disease. Additionally, the evidence provides support for viewing the relationship between diabetes and periodontal diseases as bidirectional. However, additional research is necessary to firmly establish that treating periodontal infections can contribute to glycemic control management and possibly to the reduction of type 2 diabetes complications. The literature does not describe a consistent relationship between type 2 diabetes and dental caries. It reports increased, decreased, and similar caries experiences between those with and without diabetes. This review suggests that currently there is insufficient evidence to determine whether a relationship between diabetes and risk for coronal or root caries exists. Most of the reviewed studies reported greater tooth loss in people with diabetes. However, the differences were slight and not significant in several of the reports. Furthermore, this review of the association between diabetes and tooth loss reveals that valid population-based evidence generalizable to the US population is sparse. Further investigations of the association of diabetes with dental caries and tooth loss are warranted. If adverse effects of diabetes on dental caries and/or tooth loss are substantiated, the results of such studies would help design intervention studies to prevent or reduce the occurrence of dental caries and tooth loss in people with diabetes. These results also may affect existing clinical practice protocols and promote new public policy related to diabetes.     

Tooth size, spacing, and crowding in relation to eruption or impaction of third molars

A study was conducted for the purpose of comparing mesiodistal tooth diameters, sum of tooth widths, and the degree of spacing or crowding in the dentitions of two groups of young adults. The subjects in the first group had complete dentitions including third molars (M3s). In the second group, all M3s had been extracted for failure to erupt. Tooth size and consequently the sum of mesiodistal tooth widths were found to be greater in the extraction group than in the group with complete dentitions. The relationship between tooth size and M3 impaction was most pronounced in female subjects. The sum of mesiodistal tooth widths is apparently one factor of importance in the cause of M3 impaction in women. The results suggest that tooth size in girls could be used at preadolescent age as one predictive variable for third molar eruption. The sexual dimorphism demonstrated regarding the relationship between tooth size and M3 impaction implies that studies in the field of M3 development and eruption should be performed on male and female subjects separately. The dental arches in the extraction group tended to be more crowded than in the group with complete dentitions. However, the differences were small and significant only as they related to the upper arches in males.     

Evaluation of the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil

Abstract –  Tooth avulsion is common in children, and emergency management in these cases is critical. This management can be made, not only by a dentist but by people who are present where the accident occurs. Consequently, knowledge of tooth avulsion is fundamental for school professionals working with children. The purpose of the present study was to evaluate the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil. For that purpose a questionnaire, including questions regarding emergency procedures for tooth avulsion, was answered by 117 teachers. The results demonstrated that 75.2% of school professionals knew the importance of emergency management and 60.6% would look for a dentist for treatment of the cases; 18.8% would reimplant the tooth and 7.6% would keep it in milk. This study showed the lack of knowledge of teachers on tooth avulsion; educational campaigns are necessary to improve the emergency management of tooth avulsion.     

Smoking, tooth brushing and oral cleanliness among 15-year-olds in Tehran, Iran

PURPOSE: To assess smoking, tooth brushing and oral cleanliness and their relationships among 15-year-olds in Tehran, Iran. MATERIALS AND METHODS: A cross-sectional study based on World Health Organization criteria and the methods of the Second International Collaborative Study was carried out in autumn 2004 among 15-year-olds (n=502) in Tehran. Data were based on a self-administered questionnaire and a clinical dental examination. RESULTS: Smokers comprised 5% of the boys and 2% of the girls (p = 0.02). Smoking was more common among students of less-educated parents (50% vs. 30%, p < 0.05). Of all students, 26% reported twice-daily tooth brushing; those of higher socio-economic backgrounds and girls did so more frequently. Of the smokers, 11% reported no tooth brushing compared to 6% of the non-smokers. Oral cleanliness was good for 13%, moderate for 32%, and poor for 55%; the rates associated positively with female gender (p = 0.002), having higher-educated parents (p = 0.03), and reporting a higher frequency of tooth brushing (p < 0.001). Those students reporting twice-daily tooth brushing had less dental plaque and gingival bleeding (p < or = 0.01) on both anterior and posterior teeth. In multivariable analyses, the best predictors for a good level of oral cleanliness were female gender (OR = 2.0) or twice-daily tooth brushing (OR = 1.7). CONCLUSION: Oral cleanliness and tooth brushing among 15-year-olds were at poor levels, particularly among boys. Such poor levels call for intensive attempts to enhance rates of twice-daily tooth brushing and to improve its quality. For this age group, anti-smoking purposes should be combined into school-based oral health promotion programmes as well.     

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邻牙、对颌牙及颞下颌关节损伤是牙拔除术中较为严重的并发症,一旦发生,易引发医患矛盾。本文针对邻牙、对颌牙以及颞下颌关节损伤的原因、临床表现、处理和预防进行阐述,为口腔外科医生的临床操作提供参考。     

Immunohistochemical detection of MT1-MMP, RECK, and EMMPRIN in ameloblastic tumors

BACKGROUND: To evaluate the roles of matrix-degrading proteinase regulators in progression of odontogenic tumors, expression of membrane-bound matrix metalloproteinase (MMP) MT1-MMP, MMP inhibitor RECK and MMP inducer EMMPRIN was analyzed in ameloblastic tumors as well as in tooth germs. METHODS: Tissue specimens of 11 tooth germs, 40 ameloblastomas, and five malignant ameloblastic tumors were examined immunohistochemically with the use of antibodies against MT1-MMP, RECK, and EMMPRIN. RESULTS: Immunohistochemical reactivity for MT1-MMP, RECK and EMMPRIN was detected predominantly in odontogenic epithelial cells near the basement membrane in tooth germs and benign and malignant ameloblastic tumors. The level of immunoreactivity for MT1-MMP was slightly higher in benign and malignant ameloblastic tumors than in tooth germs. RECK expression was lower in ameloblastomas than in tooth germs. Follicular ameloblastomas showed significantly lower expression of RECK than plexiform ameloblastomas, and immunoreactivity for RECK in acanthomatous ameloblastomas was slightly lower than that in other cellular variants. CONCLUSION: Expression of MT1-MMP, RECK and EMMPRIN in tooth germs and ameloblastic tumors suggests that these normal and neoplastic epithelial components control MMP-dependent extracellular matrix (ECM) degradation during tooth development and tumor progression via epithelial-mesenchymal interactions.     

Opg, Rank, and Rankl in tooth development: co-ordination of odontogenesis and osteogenesis

Osteoprotegerin (OPG), receptor activator of nuclear factor-kappaB (RANK), and RANK ligand (RANKL) are mediators of various cellular interactions, including bone metabolism. We analyzed expression of these three genes during murine odontogenesis from epithelial thickening to cytodifferentiation stages. Opg showed expression in the thickening and bud epithelium. Expression of Opg and Rank was observed in both the internal and the external enamel epithelium as well as in the dental papilla mesenchyme. Although Rankl expression was not detected in tooth epithelium or mesenchyme, it was expressed in pre-osteogenic mesenchymal cells close to developing tooth germs. All three genes were detected in developing dentary bone at P0. The addition of exogenous OPG to explant cultures of tooth primordia produced a delay in tooth development that resulted in reduced mineralization. We propose that the spatiotemporal expression of these molecules in early tooth and bone primordia cells has a role in co-ordinating bone and tooth development.     

Investigated reports of tooth fractures cases from November, 1986 to September, 1988

Researching the actual condition of tooth fractures, clinical records and X-ray photographs of 2717 patients, visited P.D.I. Dental Clinic from November, 1986 to September, 1988 were investigated statistically. 174 cases were tooth fractures in 2717 patients. The frequency rate of tooth fractures at an early age was low, increased from the latter half of the 30s and was highest at the latter half of the 50s accounted for over 10%, and decreased from the 60s. In the upper anterior teeth, the crown fractures caused by traumatic factors, at an early age showed a high proportion, and in the lower anterior the tooth fractures were rare. In the posterior the root fractures of non-vital teeth attributed to dental treatment at the middle and advanced age indicated a high proportion. In the case of tooth restored with metalcore and bridge, the proportion of the root fractures were high, the metalcore, was used in 63%, and in the bridge in 27% of the root fractures.     

The House Shrew,Suncus murinus,as a Model Organism to Investigate Mammalian Basal Condition of Tooth Development

Mammalian dentition is characterized by regional differentiation into incisors, canines, premolars and molars in each jaw quadrant (heterodonty), and tooth replacement once during the lifetime (diphyodonty). Despite their significance in various research fields, little is known about the developmental mechanisms regulating tooth type (class) determination and diphyodont tooth replacement. The mouse, the most popular laboratory animal, is not appropriate for the investigation of heterodonty and diphyodonty, because of its highly specialized dentition. The house shrew, Suncus murinus, has been suggested to be a potentially excellent model organism to study the mammalian basal condition of tooth development. Using three-dimensional (3-D) reconstructions of dental epithelium from serial histological sections, and Sonic hedgehog (Shh) expression patterns, we have precisely located the tooth-forming regions of all tooth types in the developing jaws of the house shrew. The incisor region in the upper jaw is found to extend across the boundary between the frontonasal and maxillary processes. The molar-forming region is later added distal to the first demarcated tooth-forming regions by secondary extension of the dental lamina. Furthermore, we have elucidated the replacement pattern of the deciduous dentition by succession and addition (accession) of the permanent teeth in the house shrew. On the basis of new knowledge on tooth development in the house shrew, we discuss the developmental mechanisms regulating tooth type determination and diphyodont tooth replacement, and consider future prospects in the field.     

Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis

When a dentist replants an avulsed tooth, the repair process sometimes results in the cementum of the root and the alveolar bone fusing together, with the replanted tooth becoming ankylosed. When this occurs, the usual process of tooth movement with bone deposition and bone resorption at the periodontium cannot function. If dental ankylosis occurs in the maxillary incisor of a growing child, the ankylosed tooth also cannot move vertically with the subsequent vertical growth of the alveolar process. This results in the ankylosed tooth leaving the plane of occlusion and often becoming esthetically objectionable. This report describes a 12-year-old female with a central incisor that was replanted 5 years earlier, became ankylosed, and left the occlusal plane following subsequent normal vertical growth of the alveolar process. When growth was judged near completion, the tooth was moved back to the occlusal plane using a combination of orthodontics, surgical block osteotomy, and distraction osteogenesis to reposition the tooth at the proper vertical position in the arch. This approach had the advantage of bringing both the incisal edge and the gingival margin of the clinical crown to the proper height in the arch relative to their antimeres. Previous treatment procedures for ankylosed teeth have often involved the extraction of the affected tooth. When this is done, a vertical defect in the alveolar process results that often requires additional bone surgery to reconstruct the vertical height of the alveolar process. If the tooth is then replaced, the replacement tooth must reach from the final occlusal plane to the deficient ridge. This results in an excessively long clinical crown with a gingival height that does not match the adjacent teeth.     

Incidence of, and reasons for, tooth mortality among mentally retarded adults during a 10-year period

The aim of the study was to investigate the reasons for, and incidence of, tooth mortality over a 10-year period in mentally retarded adults receiving regular dental care. The number of teeth present in 115 individuals (mean age in 1984 was 41.0, range 19-83 years) was registered in 1984 and 1994. The reasons for tooth mortality, medication utilization, frequency of dental care visits and cooperation during dental treatment were registered and related to tooth loss. The average incidence of tooth mortality was 3.72 teeth during the 10-year period. The mean number of dental care visits per year was 6.6. Most of the 428 teeth (58%) were lost due to periodontal disease. The preventive dental care given was not sufficient to arrest oral diseases. The data indicate, however, that achievement of cooperation in dental care situations not only makes dental treatment possible, but also leads to a decreased incidence of tooth mortality.     

Restorative Treatments Received by Children Covered by a Universal, Publicly Financed, Dental Insurance Plan

Objectives : This study sought to identify risk markers associated with the provision of new restorations in children and to investigate whether the carious status of a tooth surface is associated with the restorative decisions of dentists. Methods : A total of 911 schoolchildren in grades one, two, and three were randomly selected from the island of Montreal, Quebec, Canada. Dental examinations were carried out in 1990, 1991, and 1992. Tooth surfaces of first permanent molars were classified as sound, noncavitated, and cavitated. The carious status of a tooth was matched with restorative decisions reported to the insurance board. Results : The presence of a carious cavity was a strong risk marker for placement of new restorations (odds ratios ≥4.11). After one year, less than 2 percent of sound tooth surfaces of first permanent molars were restored and about 21 percent of noncavitated tooth surfaces were restored. When new class I restorations placed in maxillary first permanent molars within 3–6 months after the baseline examination were evaluated, we found that between 73 percent and 86 percent of these new restorations were placed in sound or noncavitated tooth surfaces. A similar trend also was observed in mandibular first permanent molars. Poor agreement between epidemiologic diagnosis and restorative decisions was found. The restorative profile of dentists was a significant risk marker for placement of new restorations. Conclusion : The majority of new restorations in first permanent molars were placed in sound and noncavitated tooth surfaces because of the ubiquitous prevalence of these tooth surfaces and the validity problems of current caries diagnosis methods.