Is there an association between periodontal disease and root caries? A systematic review and meta-analysis.

Some periodontal diseases can be associated with cariogenic bacterial growth due to various oral health imbalances. This fact may be linked to a greater development of root caries. Thus, this systematic review analyzed the evidence on the association between periodontal disease and root caries. An electronic search was performed in five databases (Cochrane Library, LILACS, MedLine via PubMed, Scopus, and Web of Science) and two additional sources (Google Scholar and Open Grey) to partially capture the grey literature. The PECO strategy was used to identify prospective or retrospective observational studies assessing root caries in patients with periodontal disease without language or year publication restrictions. Two reviewers extracted data and evaluated the individual risk of bias in the eligible studies. Random effects meta-analyses were performed to calculate the Odds Ratio (OR). The risk of bias was assessed by the NIH tool, and the certainty of evidence was classified according to the GRADE tool. There were 1,725 studies retrieved, of which four met the eligibility criteria. All of them were evaluated for the control statements for possible confounders, bias consideration, and confounding factors because they had multivariate analysis. Adults with periodontal disease had a greater chance of presenting root caries than adults without, with OR 1.38 [CI 1.25, 1.53]. The certainty of evidence was classified as very low. Within the limits presented in this review, there was an association between periodontal disease and root caries, highlighted in the qualitative synthesis and the meta-analysis results.

Can hyperglycemia be associated with caries activity and root caries in adults?

AIMS: A previous meta-analysis showed that individuals with Type 2 diabetes mellitus (T2D) have a greater chance of developing both coronal caries and root caries than systemically healthy ones, which can be influenced by hyperglycemia per se. This study aimed to associate blood and salivary glucose levels with caries. METHODS: This research is a subset of a cross-sectional study. N = 39 individuals underwent a dental examination and salivary glucose, fasting blood glucose (FBG) and glycated hemoglobin (A1c) measurements. RESULTS: The prevalence of active coronal caries was 10.2%, and that of root caries was 20.5%. A1c and FBG averages were higher in individuals with root caries (9.75 ± 1.71 and 186.3 ± 62.5) than without (7.01 ± 2.23 and 115.1 ± 48.6; p < 0.05). Individuals with T2D showed weak correlation of salivary glucose and number of active coronal caries. Significant correlations were observed between salivary and blood glucose. There was relevance of A1c (0.53; CI=0.124-0.941; p = 0.01) and FBG (0.019; CI=0.006-0.033; p = 0.006) toward the increased number of root caries lesions, even after adjustment for salivary flow and age. CONCLUSION: Blood glucose levels are associated with an increased number of root caries in adults with or without T2D. In individuals with T2D, salivary glucose was correlated with active coronal caries. Additional studies are needed to support this association.

Association between Root Caries and Depressive Symptoms among Elders in Carlos Barbosa, RS, Brazil.

The aim of this study was to evaluate the association between depressive symptoms and root caries among independent-living older persons. All community-dwelling older adults (not hospitalized and not bedridden) living in Carlos Barbosa, RS, Brazil, were invited to participate, and 785 completed the study protocol (standardized questionnaire assessing socio-demographic information and health behavior, Geriatric Depression Scale [GDS] - brief version, and oral examination [DMFT-Root index, Visible Plaque Index and stimulated salivary flow]). Out of them, 390 participants with at least one natural tooth were included in the present analysis. The outcome of interest was the ratio between the number of decayed roots and the number of roots at risk. The association between independent variables (depression and socioeconomic aspects) and the outcome was assessed using negative binomial regression models. RESULTS: The final, fully adjusted model revealed that age (ß=0.03, p=0.001), female sex (ß=-0.23, p=0.08), living in a rural area (ß=0.25, p=0.008), tooth brushing frequency (ß=0.43, p=0.025) and stimulated salivary flow (ß=-0.012, p<0.0001) were significantly associated with the presence of root caries. In addition, the interaction between male sex and the presence of depression symptoms (ß=-0.99, p=0.012) was also independently and significantly associated with root caries. The interaction between male sex and depression symptoms was associated with root caries, suggesting that psychological mechanisms may be involved indirectly in the development of root caries in older adults.

Association between Root Caries and Depressive Symptoms among Elders in Carlos Barbosa, RS, Brazil

Abstract The aim of this study was to evaluate the association between depressive symptoms and root caries among independent-living older persons. All community-dwelling older adults (not hospitalized and not bedridden) living in Carlos Barbosa, RS, Brazil, were invited to participate, and 785 completed the study protocol (standardized questionnaire assessing socio-demographic information and health behavior, Geriatric Depression Scale [GDS] - brief version, and oral examination [DMFT-Root index, Visible Plaque Index and stimulated salivary flow]). Out of them, 390 participants with at least one natural tooth were included in the present analysis. The outcome of interest was the ratio between the number of decayed roots and the number of roots at risk. The association between independent variables (depression and socioeconomic aspects) and the outcome was assessed using negative binomial regression models. Results: The final, fully adjusted model revealed that age (β=0.03, p=0.001), female sex (β=-0.23, p=0.08), living in a rural area (β=0.25, p=0.008), tooth brushing frequency (β=0.43, p=0.025) and stimulated salivary flow (β=-0.012, p<0.0001) were significantly associated with the presence of root caries. In addition, the interaction between male sex and the presence of depression symptoms (β=-0.99, p=0.012) was also independently and significantly associated with root caries. The interaction between male sex and depression symptoms was associated with root caries, suggesting that psychological mechanisms may be involved indirectly in the development of root caries in older adults.

Resumo O objetivo deste estudo foi avaliar a associação entre sintomas depressivos e cáries radiculares entre idosos independentes. Todos os idosos moradores da comunidade (não hospitalizados e não acamados) residentes em Carlos Barbosa, RS, foram convidados a participar, e 785 completaram o protocolo do estudo (questionário padronizado de avaliação sociodemográfica e comportamento de saúde, Escala de Depressão Geriátrica [GDS ] - versão resumida e exame oral [Índice de CPOD-Raiz, índice de placa visível e fluxo salivar estimulado]). Destes, 390 participantes com pelo menos um dente natural foram incluídos na presente análise. O desfecho foi a razão entre o número de raízes em decomposição e o número de raízes em risco. A associação entre variáveis independentes (depressão e aspectos socioeconômicos) e o desfecho foram avaliados utilizando modelos de regressão binomial negativa. O modelo final totalmente ajustado revelou que a idade (b=0,03, p=0,001), sexo feminino (b=-0,23, p=0,08), vivendo em área rural (b=0,25, p=0,008), frequência de escovação (b=0,43, p=0,025) e o fluxo salivar estimulado (b=-0,012, p<0,0001) foram significativamente associados à presença de cárie radicular. Além disso, a interação entre sexo masculino e a presença de sintomas de depressão (b=-0,99, p=0,012) também foi independente e significativamente associada com cáries radiculares. A interação entre sexo masculino e sintomas de depressão foi associada com cárie radicular, sugerindo que mecanismos psicológicos podem estar envolvidos indiretamente no desenvolvimento de cáries radiculares em adultos mais velhos.

Cáries Radiculares na Terceira Idade: contribuição ao estudo1 / Radicular Caries in the Third Age: contribution to the study

Revisão de literatura sobre a prevalente cárie radicular na população idosa e fatores relacionados a esta doença. Pode-se concluir que os idosos, principalmente os institucionalizados, tem alto risco para desenvolver cáries radiculares; que o consumo exagerado de carboidratos, diminuição do fluxo salivar e falta de informação preventiva contribuem muito para aumentar os níveis de...

Indicators for root caries in Danish persons with recently diagnosed Alzheimer's disease.

OBJECTIVE: To identify indicators of root caries among persons with newly diagnosed Alzheimer's disease (AD). BACKGROUND: Few studies have investigated dental caries in older adults with AD. Previously we found that persons with AD had significantly more root caries compared to persons with dementia other than AD. METHODS: Participants were recruited from two university hospital clinics in Copenhagen, Denmark. A team of neurologists/geriatricians carried out the diagnostic screening. The study included an interview, oral examination and medical records. RESULTS: We evaluated potential indicators of root decay across subjects with 3+ decayed surfaces vs. <3 decayed surfaces. Variables associated with increased odds of root caries were age over 80 years, 2+ decayed coronal surfaces and 5+ filled root surfaces. Among the social variables, living with someone was associated with a nearly 70% reduction in the odds of having 3+ surfaces of untreated caries. DISCUSSION: Root caries is highly prevalent among individuals with new AD and there is still a strong need for active assessment of and attention to oral problems in persons with AD. Our findings document that recently diagnosed AD cases with multiple coronal caries lesions are at elevated risk of having more root caries. Also persons 81+ years and those with multiple root fillings are more likely to have numerous untreated root lesions.

Tooth loss in periodontally treated patients: a long-term study of periodontal disease and root caries.

AIM: To study periodontal conditions, root caries, number of lost teeth and causes for tooth loss during 11-14 years after active periodontal treatment. MATERIAL AND METHODS: Sixty-four patients participated in the follow-up study. Reasons for tooth loss were identified through previous case books, radiographs and clinical photos. To identify factors contributing to tooth loss, a logistic multilevel regression analysis was used. RESULTS: The number of lost teeth was 211. The main reason was periodontal disease (n = 153). Due to root caries and endodontic complications, 28 and 17 teeth, respectively, were lost. Thirteen teeth were lost for other reasons. The number of teeth (p = 0.05) and prevalence of probing pocket depths, 4-6 mm (p = 0.01) at baseline, smoking (p = 0.01) and the number of visits at dental hygienists (p = 0.03) during maintenance, significantly contributed to explain the variation in tooth loss. CONCLUSION: Previously treated patients at a specialist clinic for periodontology continued to lose teeth in spite of maintenance treatments at general practitioners and dental hygienists. The main reason for tooth loss was periodontal disease. Tooth loss was significantly more prevalent among smokers than non-smokers. Tooth-related risk factors were smoking, low numbers of teeth and prevalence of periodontal pockets, 4-6 mm.

The comparison of root caries experience between HIV-positive patients and HIV-negative individuals in a selected Iranian population.

OBJECTIVES: Human immunodeficiency virus (HIV) infection is a concerning problem in dentistry and HIV-infected patients may experience root caries due to different risk factors. The aim of this study was to find the prevalence of root caries in a selected Iranian HIV-positive population. METHODS: One hundred and seven IV drug users, based on ELISA and Western Blot test, were divided into two groups: group 1: HIV-positive patients and group 2: HIV-negative individuals. According to the T-CD4(+) cell count, subjects in group 1 were placed in two subgroups: Moderate immunodeficiency (200 mm(-3) < T-CD4(+) cells <500 mm(-3)) and Severe immunodeficiency patients (T-CD4(+) cells <200 mm(-3)). Teeth were examined by an examiner under suitable light to detect any changes in colour, texture or contour. The values of DMFT, DMFS, decayed root surfaces and total decayed surfaces were calculated. Data were analysed by independent t-test and chi-squared test. RESULTS: The mean DMFT, DMFS and decayed root caries in group 1 and 2 had no significant difference. The mean value of total decayed surfaces of HIV+ patients was significantly higher compared with HIV- individuals (P = 0.03). The comparison of all parameters between two subdivisions of group 1 showed no significant difference. CONCLUSIONS: The results indicate that HIV+ patients experienced more dental caries, but not more root caries than healthy ones. Along with decreasing T-CD4(+) cell count, tooth caries' prevalence did not increase. CLINICAL RELEVANCE: Based on our findings, root caries prevalence is almost the same in HIV-positive and negative individuals; however, it is necessary to decrease tooth caries by continual monitoring and periodic dental examination.

Relationship between root caries and cardiac dysrhythmia.

BACKGROUND: Cardiac dysrhythmia are frequently found in the elderly population because of conduction system disease and ageing. Recent reports have suggested that dental caries and periodontal disease are predictors of coronary heart events. However, this hypothesis remains largely unproven. OBJECTIVE: This study investigated the relationship between root caries and cardiac dysrhythmia in an elderly population. SUBJECTS AND METHODS: Among 600 subjects, 233 who were dentate at baseline underwent a baseline examination and subsequent annual investigations, including an oral examination and a 12-lead electrocardiogram, for a 4-year period. Analysis of covariance (ancova) was used to assess the number of sites with root caries between subjects with mean C-reactive protein (CRP) serum level of <3.0 mg/l and those with the mean CRP serum level ≥3.0 mg/l. Logistic regression analysis was performed to assess relationship between root caries and cardiac dysrhythmia. RESULTS: A high mean CRP serum level group had a significantly higher number of sites with root caries than a low CRP group (p < 0.001). Number of sites with root caries events was significantly associated with cardiac dysrhythmia among non-smokers (odds ratio, 5.84; p = 0.040). These results suggest that root caries is related to the incidence of dysrhythmias in non-smokers. CONCLUSIONS: We conclude that non-smoking elders with root caries lesions are at an elevated risk for dysrhythmias.

Classification of dental surface defects in areas of gingival recession.

BACKGROUND: A clinical classification of surface defects in gingival recession area is proposed. METHODS: Two factors were evaluated to set up a classification system: presence (A) or absence (B) of cemento-enamel junction (CEJ) and presence (+) or absence (-) of dental surface discrepancy caused by abrasion (step). Four classes (A+, A-, B+, and B-) were identified on the basis of these variables. To validate the classification three different calibrated examiners applied the proposed classification system to 46 gingival recessions and kappa statistics were performed. The classification was used on 1,010 gingival recessions from 353 patients to examine the distribution of the four classes. RESULTS: The kappa statistics for intrarater agreement ranged from 0.74 to 0.95 (almost perfect agreement), whereas interrater agreement ranged from 0.26 to 0.59 (moderate agreement). Out of 1,010 exposed root surfaces associated with gingival recession, 144 showed an identifiable CEJ associated with a root surface defect (Class A+, 14%); 469 an identifiable CEJ without any associated step (Class A-, 46%); 244 an unidentifiable CEJ with a step (Class B+, 24%); and 153 an unidentifiable CEJ without any associated step (Class B-, 15%). CONCLUSION: The proposed classification describes the dental surface defects that are of paramount importance in diagnosing gingival recession areas.

Root coverage in an HIV-positive individual: combined use of a lateral sliding flap and resin-modified glass ionomer for the management of an isolated severe recession defect.

BACKGROUND: Gingival recession is a frequent clinical finding in the general population. Exposed root surfaces are more likely to develop root sensitivity and root caries and pose esthetic concerns for the patient. Most root coverage procedures have been described on non-restored root surfaces. Limited data are available that describe root coverage procedures on restored root surfaces. To our knowledge, this is the first case report in which a severe recession defect and its associated carious lesion were managed using the combination of a lateral sliding flap and a resin-modified glass ionomer restoration in an HIV-positive individual. METHODS: A 53-year-old male patient with a 25-year history of HIV infection presented for comprehensive care. The facial surface of tooth #22 had a fractured composite restoration, recurrent decay, and a Miller Class III recession defect. The lesion was restored with resin-modified glass ionomer and root coverage was obtained by a lateral sliding flap mobilized from the adjacent edentulous ridge. After 8 weeks, surgical access was used to correct a previously undetected void in the restoration. RESULTS: Uneventful healing was observed at the 1-, 4-, 8-, 10-, 12-, and 24-week postoperative visits. Root coverage of 5 mm along with a 2-mm band of keratinized tissue was obtained at 24 weeks. The gingiva displayed no signs of inflammation and was tightly adapted to the root surface with minimal probing depths circumferentially. CONCLUSION: Successful root coverage was obtained on a resin-modified glass ionomer-restored surface in an HIV-positive individual.

Fresh-socket implants in periapical infected sites in humans.

BACKGROUND: The aim of the present study is to compare the outcome of the immediate placement of implants when used in the replacement of teeth with and without chronic periapical lesions. METHODS: Thirty patients requiring a single-tooth extraction of a monoradicular or premolar tooth were selected. The control group (CG) included 15 patients without periapical lesions but with root caries and root fractures. The test group (TG) included 15 patients with periapical lesions, periapical radiolucencies, and no signs of pain, fistulas, or suppuration. Thirty teeth were extracted, and implants were immediately positioned in fresh sockets and loaded after 3 months in both groups. Clinical parameters (probing depth [PD], modified plaque index, modified bleeding index [mBI], marginal gingiva level [MGL], and keratinized mucosa [KM]) and marginal bone levels were evaluated at baseline and 12 and 24 months after implant placement. Comparisons between CG and TG values over time were performed by the Student two-tailed t test. RESULTS: At the 24-month follow-up, a survival rate of 100% was reported for all implants. The mean bone loss was 0.82 +/- 0.52 mm for the CG and 0.86 +/- 0.54 for the TG. Plaque accumulation was 0.74 +/- 0.29 for the CG and 0.69 +/- 0.29 for the TG. The mBI was 0.77 +/- 0.33 for the CG and 0.72 +/- 0.36 for the TG. The soft tissue profile MGL and KM remained stable for up to 24 months for the CG and TG. The mean PD was 2.05 +/- 0.66 mm for the CG and 1.99 +/- 0.57 mm for the TG. Differences that were not statistically significant were reported between the CG and TG over time and between time points. CONCLUSION: At the 24-month follow-up, endosseous implants placed immediately in extraction sites affected by periapical infection rendered an equally favorable soft and hard tissue integration of the implants, revealing a predictable outcome.

Hyposalivation, xerostomia and oral health status of HIV-infected subjects in Thailand before HAART era.

BACKGROUND: The aims of this study were to determine hyposalivation, xerostomia, and oral health status of HIV-subjects in Thailand before highly active antiretroviral therapy era. METHODS: Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in 135 subjects (56 HIV-subjects, mean age: 34.5 years, and 79 non-HIV controls, mean age: 29.5 years). Presence of oral candidiasis, cervical root caries, and number of existing teeth were recorded. Microbiological investigation of oral Candida was conducted using oral rinse technique. Risk factors associated with hyposalivation and xerostomia were analysed. RESULTS: The unstimulated flow rates in HIV-subjects and non-HIV controls were 0.19 and 0.33 ml/min (P = 0.0024). For stimulated flow rates, the corresponding figures were 1.45 and 1.62 ml/min (P = 0.31). The unstimulated flow rate was significantly higher in the asymptomatic HIV-subjects: 0.17 ml/min, when compared with the symptomatic/AIDS group 0.11 ml/min (P = 0.003). No significant difference between the groups could be found with respect to stimulated flow rate. Hyposalivation was significantly associated with the colony forming unit of Candida. Smoking and alcohol consumption were significantly associated with hyposalivation, but not xerostomia. The following factors were significantly associated with both hyposalivation and xerostomia; sex, stage of HIV infection, risk group of HIV infection, systemic disease, and medication use. CONCLUSIONS: Salivary flow rate of HIV-subjects in Thailand was affected by HIV infection. The rate was significantly decreased with advanced stage of the disease. Various factors including medication use were associated with hyposalivation and xerostomia among the subjects.

[Elderly people and removable partial dentures]. / Ouderen en partiële gebitsprothesen.

The most frequently reported disadvantages of removable partial dentures are the more demanding daily oral hygiene self-care, especially for people who already experience difficulties in self-care, and the possible harmful influence on the remaining dentition. These disadvantages can be expressed in an extreme form in (frail) elderly people. The elderly show relatively large amounts of oral plaque, (root) caries, and periodontal disease. Considerations which may or may not indicate a partial denture for a (frail) elderly person are: the expressed problem and demand for treatment, the general health condition ofthe patient, oral mucosal health, the condition of the opposing jaw, the possible contribution to function and/or aesthetics, the possibilities of oral self-care and/or volunteer aid, the patient's personal adaptability, and possible hazards. Extreme care in subsequent, decisions should be the rule. Key concepts are: explicit demand for treatment, appropriateness, safety, and oral self-care/volunteer aid.

Repair of furcal perforation with mineral trioxide aggregate: long-term follow-up of 2 cases.

Previous studies have demonstrated the efficacy of mineral trioxide aggregate (MTA) in repair of furcal perforation. In this article, the use of MTA in treating 2 cases of furcal perforation (accidental and caries-related) and subsequent long-term follow-up are described.

[Results of the use of whole ceramic prosthetic constructions from zirconium oxide for recovery of the teeth with deep subgingival defects].

30 patients (13 men and 17 women) with deep subgingival defects were selected for treatment, their mean age was equal to 39.7+/-3.2 years; for their teeth recovery 38 stump inlays from zirconium oxide were made. The patients were distributed in 3 groups depending upon the material used for inlay fixation; for 2 years in the dynamic regime (after 6, 12 and 24 months) clinical evaluations were done of the quality of tooth recovery. Medium-term results of the quality of tooth recovery clinical evaluations by inlays from zirconium oxide have shown that this method is perspective for teeth recovery with deep subgingival defects. Such qualities of metal-free ceramics as practicality, biocompatibility, stability and excellent aesthetic characteristics have provided high quality of the treatment. At the same time stability and longevity of the prosthetic constructions were formed not only by mechanic characteristics of the used materials but also by such fixating cements properties as the degree of edge protection and resorption resistance. Adhesive inlay fixation with the use of such cements as Panavia F and Fuji plus have demonstrated stabile joint with perfect edge conformity.

Periodontics: 6. The management of gingival recession.

UNLABELLED: Gingival recession is a common condition affecting the dentition. This paper describes the aetiology of gingival recession and discusses the appropriate management of this condition. CLINICAL RELEVANCE: Careful examination to detect gingival recession, or the factors that may place the patient at risk for recession, are important for prevention.

Longitudinal relationship between root caries and serum albumin.

Serum albumin levels are a practical marker of general health status in the elderly and have been used to determine the severity of an underlying disease and the risk for death. This longitudinal study evaluated the relationship between serum albumin levels and root caries. A total of 266 persons with at least 1 tooth at baseline underwent a baseline examination and then annual investigations for 6 years. Multiple linear regression analysis was used to assess the relationship between changes in serum albumin levels and the number of root caries lesions over 6 years, after adjustment for confounding factors. Change in the number of root caries lesions was significantly associated with change in serum albumin concentrations. The standardized coefficient was -0.148 (p = 0.024). We can confirm that serum albumin concentration correlates with root caries events. From these data, we conclude that persons with hypoalbuminemia are at high risk for root caries.