Dental status and self-assessed chewing ability in 70- and 80-year-old subjects in Sweden.

The objective was to compare two cohorts of elderly people, 70 and 80 years old, with respect to dental status and self-assessed chewing ability. The hypotheses were as follows: (i) dental status is associated with self-assessed chewing ability; (ii) chewing ability is poorer among the 80- than the 70-year-old subjects. Identical questionnaires were in 2012 sent to all subjects born in 1942 and 1932, living in two Swedish counties. The response rate was 70.1% resulting in samples of 5697 70- and 2922 80-year-old subjects. Answers to questions on self-assessed chewing ability, dental status and some other factors have been analysed. Dental status varied but was in general good; 72% of the 70- and 60% of the 80-year-old subjects reported that they had all or only few missing teeth. Rate of edentulism was 3% and 7%, respectively. Removable partial dentures were reported by 6% and 10%, respectively, implant treatment by 13% in both cohorts. Self-assessed chewing ability was mostly good and correlated with the number of teeth (Spearman rho = 0.46). A majority of the edentulous subjects assessed their chewing ability as very or fairly good. Logistic regression showed that self-assessed chewing ability was significantly associated with a number of dental variables but also with general health. In conclusion, dental status was relatively good at both ages but somewhat poorer in the older cohort. Dental status, some other dental variables and being healthy were in both age groups significantly associated with self-assessed chewing ability.

From brain to bridge: masticatory function and dental implants.

Masticatory function is an important aspect of oral health, and oral rehabilitation should aim to maintain or restore adequate function. The present qualitative review is the joint effort of a group of clinicians and researchers with experiences ranging from basic and clinical oral neuroscience to management of patients with dental implants. The aim is to provide a short summary for the clinician of the many aspects related to masticatory function (including quality of life) and rehabilitation with dental implants. While there are many reviews on the tissue responses to dental implants and technical aspects, the functional aspects have received relatively little focus.

The future of complete dentures in oral rehabilitation. A critical review.

Based on available investigations and current trends in oral rehabilitation published in the dental literature, an attempt is made to describe the possible future role of complete dentures. For edentulous patients, complete dentures have for long been the only prosthodontic treatment option. Whereas a large number of edentulous patients report satisfaction with denture usage, a smaller number are unable to adapt; for such patients, sophistication of clinical and technical processes or quality of denture-supporting tissues, appear to have little influence on patient-perceived outcomes. Since the 1980s, osseointegrated dental implants have dramatically improved the therapeutic possibilities, especially so for maladaptive patients. Those able to access such treatment can expect significant improvements in oral functional status and quality of life. While there is a downward trend in edentulism in several countries, it is region-specific, confirming the overriding influence of socio-economic factors on health status. In most societies, despite ageing populations, the need for complete dentures is not likely to reduce in the near future. Whereas a two- or even a one-implant overdenture for the edentulous mandible is increasingly regarded as a minimum standard of care in many developed countries, its routine prescription for the majority in the world who are disadvantaged is unrealistic; for them, even 'low-tech' therapies like conventional dentures are beyond their reach. Improving the conventional management of edentulous patients is a necessity and requires a keener focus by researchers, educators and clinicians in the developed world on the needs of populations with fewer resources.

Rehabilitation of the worn dentition.

The purpose of this review was to evaluate the literature on the rehabilitation of tooth wear, with some pertinent historical, epidemiological and aetiological aspects of tooth wear provided as background information. In historical skull material, extensive tooth wear, assumed to be the result of coarser diets, was found even in relatively young individuals. Such wear is seldom seen in current populations. Although many of the factors associated with extensive tooth wear in historical material are no longer present or prevalent, new risk factors have emerged. In the young individual, the literature points to a global rise in soft drink consumption as the most significant factor in the development of tooth wear through dental erosion. Among older individuals, lifestyle changes and chronic diseases that are controlled with medications that may, in turn, result in regurgitation and/or dry mouth, are possible reasons amongst others for the widespread clinical impression of an increasing prevalence of tooth wear. The aetiology of tooth wear is multifactorial and the role of bruxism is not known. Clinical controlled trials of restorative and prosthodontic approaches for the range of clinical conditions that wear can give rise to, are limited in number and quality. Equally, the striking lack of evidence regarding the long-term outcomes of treatment methods and materials calls for caution in clinical decision-making. Notwithstanding these observations, clinicians have provided and continue to provide rehabilitative strategies for managing their patients' worn dentitions that range traditionally from extensive prosthodontics to an increasing reliance on adhesive techniques.

Implants and/or teeth: consensus statements and recommendations.

In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

Dental state, prosthodontic treatment and chewing ability - a study of five cohorts of 70-year-old subjects.

The aim was to study the relationship between dental state, prosthetic rehabilitation and chewing ability in 70-year-old subjects examined between 1971 and 2001. Five birth cohorts born in 1901/1902 (I), 1906/1907 (II), 1911/1912(III), 1922 (V), and 1930 (VI) were examined at 70 years of age. The number of participants in the odontological cohorts varied between 386 and 583. The prevalence of total edentulism changed from 51% in cohort I to 7% in cohort VI. The proportion of subjects using removable dentures decreased from 76% to 17%, whereas those with >or=20 teeth increased from 13% to 65%. The prevalence of subjects with fixed partial dentures increased from 26% to 58%. Of the 70-year-old subjects examined in 2001, 5% had implant-supported restorations. The self-assessed chewing ability showed only weak associations with dental state, and there was no significant cohort trend. When all cohorts were pooled together, 80% considered their chewing ability good, 16% less good and 4% poor. Among the edentulous subjects, more individuals complained about poor chewing ability in the last two cohorts than in the first three. It was concluded that there were great differences in dental state between the five cohorts of 70-year-old subjects examined from 1971 to 2001. Edentulism and wearing of removable dentures decreased substantially, whereas the proportion of subjects with fixed partial dentures showed a marked increase. In spite of the improved dental state, the self-assessed chewing ability exhibited only minor variation over time.

Bite force and handgrip force in patients with molecular diagnosis of myotonic dystrophy.

Myotonic dystrophy is a multisystemic disease with varying symptomatology. The aim of this study was to compare the maximal bite force and handgrip force in patients with molecular diagnosis of myotonic dystrophy with those in a group of healthy individuals. It was hypothesized that these forces were reduced in the patients in comparison with the control subjects. The bite and handgrip forces of 37 patients with molecular diagnosis of myotonic dystrophy and 37 control subjects matched regarding age and gender were measured using an electronic dynamometer. The bite and handgrip forces were significantly lower in the myotonic dystrophy patient group when compared with the healthy controls (P < 0.0001). There were no significant force differences between genders, right- or left-hand side of mastication or hands in the myotonic dystrophy patient group whereas such differences were found among the controls. There were moderate but significant correlations between bite and handgrip force in both groups (r = 0.43-0.59; P < 0.01). It was concluded that there were considerable differences between the myotonic dystrophy group and the control subjects regarding both bite force and handgrip force. The weakness of the masticatory and hand muscles may have various negative consequences for oral function and dental health in patients with myotonic dystrophy.

A review of the shortened dental arch concept focusing on the work by the Käyser/Nijmegen group.

The aims of this paper were to review the literature on shortened dental arches with special focus on publications of the Käyser/Nijmegen group, and to evaluate the discussions on the shortened dental arch concept found in the literature. A MEDLINE (PubMed) search was conducted for articles in English published in the dental literature from 1966 to November 2005. The search revealed epidemiological, cross-sectional and longitudinal clinical studies as well as opinion papers, the majority of which were published by the Dutch group. The studies found in general no clinically significant differences between subjects with shortened dental arches of three to five occlusal units and complete dental arches regarding variables such as masticatory ability, signs and symptoms of temporomandibular disorders, migration of remaining teeth, periodontal support, and oral comfort. The findings from cross-sectional studies were corroborated longitudinally. No systematic clinical study with conflicting results was found. The shortened dental arch concept was accepted by a great majority of dentists but not widely practised. The studies reviewed showed that shortened dental arches comprising anterior and premolar teeth in general fulfil the requirements of a functional dentition. It may therefore be concluded that the concept deserves serious consideration in treatment planning for partially edentulous patients. However, with ongoing changes, e.g. in dental health and economy, the concept requires continuing research, evaluation and discussion. Patients' needs and demands vary much and should be individually assessed but the shortened dental arch concept deserves to be included in all treatment planning for partially edentulous patients.

Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects.

The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio-economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50- and 60-year-old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50- and 60-year-old subjects in two Swedish counties, Orebro and Ostergötland (n = 17,138; n50 = 8878; n60 = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72.8% (n = 12,468). The reported responses to questions regarding 'pain in the TMJ region' and 'difficulty to open the mouth wide' were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue-collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio-economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.

[A survey of implant-retained superstructure types in the edentulous mandible in The Netherlands]. / Inventarisatie van het type suprastructuur op implantaten in de edentate onderkaak in Nederland.

Treatment of mandibular edentulousness with endosseous permucosal implants has evolved to a common treatment option during the last decades. In The Netherlands, the relative cheap prosthetic treatment of implant-supported overdentures is considered a qualitatively adequate treatment. The aim of the study described in this article was to survey the treatment of edentulous mandibles by fixed implant-supported prostheses and implant-supported overdentures, and to register the different mesostructures used. All clinics of special dental care and all larger clinics for implant dentistry in The Netherlands received a questionnaire. The data provided showed that more than 90% of patients treated with implants because of mandibular edentulousness, were provided with an overdenture. In 85% of cases a bar-clip mesostructure was used. Cost control was the most important reason to choose an overdenture above a fixed implant-supported prosthesis.

Prediction of demand for treatment of temporomandibular disorders based on a 20-year follow-up study.

The purpose was to test the hypothesis that signs and symptoms characteristic of temporomandibular disorders (TMD) at age 15 would predict demand for treatment during a 20-year follow-up period. Of originally 135 examined 15-year-old subjects, 103 completed a questionnaire and 84 were examined clinically at the 10-year follow-up (at age 25). After 20 years (at age 35), 114 completed a questionnaire and 100 were also examined clinically. During the 20-year follow-up period, 21 subjects received some kind of treatment of TMD. At baseline (age 15), the treated group reported tooth grinding at night more often than the non-treated group (P = 0.0042). At the 10-year follow-up (at age 25), the treated group reported more symptoms of TMD and oral parafunctions than the non-treated group. Among the clinical registrations, there was only one significant difference between the groups: anterior tooth wear was more extensive in the treated group. At the 20-year follow-up (at age 35), the treated group reported significantly more symptoms of TMD and oral parafunctions than the non-treated group. The clinical dysfunction index was also higher in the treated group. Logistic regression revealed tooth grinding at night as a significant predictor of received treatment of TMD. However, the positive predictive value was low whereas the negative predictive value was high (90%). The findings indicate that nocturnal tooth grinding is related to demand for treatment of TMD.

Masticatory ability in 80-year-old subjects and its relation to intake of energy, nutrients and food items.

OBJECTIVE: The aim of the present study was to analyse the relationship between masticatory ability (self-assessed masticatory ability and bite force) and intake of energy, nutrients and food items in a population sample of elderly subjects. DESIGN AND SUBJECTS: From a population sample of 80-year-old people, 160 individuals (74 men and 86 women) took part in an odontological study. MAIN OUTCOME MEASURES: A dental examination including bite force recording, a questionnaire focusing on self-assessed masticatory ability, and a dietary interview. SETTING: Department of Geriatric Medicine, Göteborg University, Sweden. RESULTS: The dental status among the participants varied much (from edentulous in both jaws--22%--to more than 20 natural teeth--30%). The mean maximum bite force was higher in men (165 N) than in women (105 N). Bite force was significantly correlated to the Eichner index and to the number of teeth. One third of the subjects reported no masticatory problem, whereas 18% identified > or = 3 such problems. The intake of energy and nutrients varied much but the means were well above recommended values. The correlations between dental status and bite force on one side and dietary intake on the other side were in general weak and most often statistically non-significant. Impaired general health and reduced dentition were both associated with more masticatory problems. CONCLUSION: The examined sample of 80-year-old subjects had a great variation in dental status, bite force and self-assessed masticatory ability, but these factors had only a minor influence on dietary selection and intake, which on average were well above recommended values.

Prospective 3-year study of cross-arch fixed partial dentures in patients with advanced periodontal disease.

STATEMENT OF PROBLEM: Several choices exist for the treatment of advanced periodontal disease. One is a combined periodontal and prosthetic treatment that includes cross-arch fixed partial dentures (FPDs). However, the outcomes of such therapy have been reported mainly from studies in Scandinavian countries. PURPOSE: The aims of this study were: (1) to longitudinally evaluate, after periodontal and prosthodontic treatment that included cross-arch FPDs, treatment outcomes in Korean patients who suffered from severe periodontitis; and (2) to evaluate the patients' treatment assessments and the FPDs after 3 years. MATERIAL AND METHODS: This survey included 39 Korean patients provided with 50 FPDs. Clinical and radiographic examinations were performed at the time of delivery of the FPDs and at the 3-year follow-up examinations. The prostheses were divided into 3 groups according to design (end abutments, unilateral cantilever, and bilateral cantilevers) and the amount of supporting tissues at the time of insertion. On average, only 26% of the total original periodontal tissue remained at the time of insertion. The FPDs consisted of 11 to 14 units, with a mean of 5 to 7 abutments in the 3 groups. The mean periodontal ligament area of the abutments was 79% of the total ligament area of the replaced teeth. RESULTS: At the 3-year follow-up examination, the FPDs were stable in all patients, who in general displayed good oral hygiene and had healthy periodontal conditions. The change in periodontal ligament area over the 3-year observation period was negligible (1 mm(2) per dental unit) and showed no statistically significant difference in relation to FPD design. Most patients were satisfied with the function of their FPDs with respect to mastication, phonetics, hygiene, esthetics, and chewing comfort. A few patients stated that they were careful with the FPDs and avoided certain foods (for example, raw peanuts and grilled squid) because they felt insecure with the cantilever segments. Most patients reported that they would choose the same treatment again. CONCLUSION: Patients with advanced periodontal disease demonstrated successful outcomes over a 3-year period and reported satisfaction with combined periodontal and restorative treatment that included cross-arch FPDs.

Patient evaluation of treatment with fixed implant-supported partial dentures.

The aim of this study was to analyse the patient evaluation of functional treatment outcome in 40 periodontally compromised patients who received implant-supported prostheses (ISPs) as part of the total treatment. The treatment protocol comprised periodontal treatment, extraction of teeth with poor prognosis, placement of dental titanium implants, and after healing, insertion of fixed ISPs. Five of the patients became edentulous in one jaw after extraction of all teeth and received a complete ISP, whereas 35 patients became partially edentulous after extraction of some teeth, 12 receiving a partial ISP on > or = 3 implants, and 23 one on two implants. The follow-up period was on average 1.8 years after the connection of the prostheses, which provided the patients a dentition with a mean of 12 occluding dental units. The first author (S.-W. Yi) performed all implant treatment. Patients' opinions on oral functions--mastication, phonetics, oral hygiene, chewing comfort and aesthetics--were evaluated by means of a questionnaire both before implant installation and at the last follow-up. A control group of 30 subjects with a healthy dentition of 14 occluding natural pairs of teeth answered the same questionnaire on one occasion. A great majority of the patients were extremely satisfied with the oral function after treatment and experienced the ISPs as 'natural teeth'. There was no significant difference between the three treatment groups and the control group for mastication, phonetics, chewing comfort and aesthetics. Patients with ISPs reported a small but significantly greater difficulty with oral hygiene procedures than the controls with natural teeth. Most patients said that they would undergo the treatment again, if necessary, and recommend it to others. It was concluded that the rehabilitation of the periodontally compromised patients, including ISPs on osseointegrated dental titanium implants, resulted in subjectively improved and satisfactory oral function.