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A total of 146 patients were examined to determine the relationship among removable partial dentures, their design, and Root Caries. Root Caries lesions on abutment surfaces were f ound to be larger and more active than those on nonabutment teeth. The prevalence of Root Caries has been shown to increase with age.
A total of 146 patients were examined to determine the relationship among removable partial dentures, their design, and Root Caries. Root Caries lesions on abutment surfaces were f ound to be larger and more active than those on nonabutment teeth. The prevalence of Root Caries has been shown to increase with age.
A total of 146 patients were examined to determine the relationship among removable partial dentures, their design, and Root Caries. Root Caries lesions on abutment surfaces were f ound to be larger and more active than those on nonabutment teeth. The prevalence of Root Caries has been shown to increase with age.
Root Caries in an Older Population Paul S, Wright, PhD, BDS, FDSRCS' Paul H. Hellyer, MSc, BDS" David Beighton, PhD'" Robin Heath, PhD, BDS, fDSRCS" Edward lynch, BA, BDentSc, FDSRCS" The London Hospital Medical College The pattern and severity of root caries in a selected older popul at i on, living in the communi t y and attending a general dental practice in Bexhill, East Sussex, England, is repotted. A total of 146 patients were examined to determine the relationship among removable partial dentures, their design, and root caries. Of those patients, 57% wore removable dentures and had a higher prevalence of exposed root surfaces and root caries, particularly on abutment teeth. In addi ti on, root caries lesions on abutment surfaces were f ound t o be larger and more active than those on nonabutment surfaces, int] Prosthodont ]992;5:39-46. R oot caries may be defined as dental caries that is either totally confined to the anatomic tooth root or, while involving the undermining of enamel at the cementoenamel junction, appears to have been initiated on the root,' The prevalence of root caries has been shown to increase with age^-" and the prevalence of root caries in a selected older population, living in the community and attending a general dental practice in Bexhill, East Sussex, England, has recently been reported,^ In this pop- ulation, those having removable partial dentures (RPDs) demonstrated a higher prevalence of exposed root surfaces and of root caries. Earlier studies of the effect of RPDs on the remaining natural teeth demonstrated an increased prevalence of dental caries in the absence of ade- quate oral hygiene,'' Later, careful oral mainte- Department of Prosthetic Dentistry. The London Hospital Medicai College, Turner Street, London El 2AD. England. "Department of Prosthetic Dentistry. '"Hunterlan Dental Research Unit. ''"Department of Conservative Dentistry. Presented to The British Society for tbe Study of Prosthetic Dentistry Annuai Conference, Durbsm, 1991. Supported by the Soutb East Tbames Regionai Health Author- ity (LORS Project 88/05). nance was shown to prevent the detrimental effects associated with RPDs,' More recently, in a study of 58-year-old men in Finland, those using RPDs demonstrated less dental caries than those without a prosthesis, in spite of the rather high levels of dental plaque and calculus in both groups,^ None of these studies, however, differ- entiated between coronal or root caries. The investigation of the selected older popula- tion in this study was designed to include infor- mation about the relationship of RPDs to the remaining teeth. The purpose was to analyze the data acquired to determine both the pattern and severity of root caries in removable partial denture wearers as well as the relationship of these param- eters to removable partial denture design. Materials and Methods A total of 146 persons (49 males, 97 females) ranging in age from 56 to 88 years, with a mean of 69,3 years, were examined. All subjects lived inde- pendently in the community and had a minimum of 12 teeth. Plaque was removed and the teeth were dried prior to examination. Each root sur- facemesial, distal, buccal, and lingualwas recorded as either exposed, if the cementoenamel junction was clearly visible above the gingival mar- gin, or absent. Each exposed root was then coded as either sound or decayed. Root caries was k/olume 5, Number ! , 1992 39 The International Journal of PrOilhodontics ut RPD Use and Root Ca Wright et al IB 17 16 IE 14 13 12 11 21 23 2i 5 26 27 2 i 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Mandibular Teeth MESIAL 0 DISTAL BUCCAL 0 PALATALf LINGUAL Fig 1 Abutment surfaces con- tacted by ttie denture. defined as an area of exposed root, at or below tbe cementoenamel junction, where the colour and/or texture of the root differed from the norm. The individual characteristics of each root caries lesion were recorded. The colour (yeliow, light brown, dark brown, or black) was assessed against a colour guide prepared from photographs of root caries. The depth of cavitation, the vertical and horizontal dimensions, and the distance of the iower border of the lesion from the gingival margin were recorded to the nearest millimetre, using a periodontal probe. Texture was recorded as either bard (as hard as surrounding tooth tissue), soft (if tbe lesion had the spongy texture of actively car- ious dentine), or leathery (if the lesion was not obviously soft, but displayed resistance to with- drawal on probing witb an Ash no. 6 probe). The presence or absence of removable partial dentures in each arch was recorded and the relationship of the prosthesis to each tooth surface was noted. Surfaces of the teeth were classified as abutment surfaces if eitber the denture base or a clasp cov- ered tbat surface. Means and standard deviations of values were calculated and compared using the appropriate t test. Cross tabulations of variables were examined using the cbi-square test of independence. Results There was a range of 12 to 29 teeth with a mean of 20.16 ( 4,45) teeth per person. Of the? 11,816 tooth surfaces examined, 415 were recorded as having root caries. The International lournal of Prosthodontii 40 5, Number 1, 1992 Wright Et al Relationship of RPD Use and Root Caries Fig 2 Exposed root surfaces present on abutment teeth. 18 17 16 15 ia 13 12 11 J1 2 2 2 3 2 i 25 6 27 21 Maxillary Teeth Mandibular Teeth DISTAL D BUCCAL PALATAL/LINGUAL Removable partial dentures were worn by 81 persons (55.5%) and maxillary complete dentures were worn by 2 persons (1.4%). A total of 52 (35.6%) persons wore one denture and 31 (21.2%) wore both maxillary and mandibular prostheses. The majority of the dentures (87) were fabricated using polyimethyl methacrylate), with or without stainless steel clasps; 16 RPDs were fabricated using cobalt-chromium plates; and 9 RPDs utilised cobalt-chronnium bar designs. Denture wearers generally had fewer teeth than non-denture wearers. Mandibular anterior teeth were present in similar numbers in both groups but mandibuiar posterior teetb and all maxillary teeth were more frequently absent in the denture wear- ers. Tbe number of exposed root surfaces present, expressed as a percentage of tbe number of retained tooth surfaces by tootb, clearly demon- strated tbe greater prevalence of exposed root sur- faces in those using RPDs. The most common abutment surface contacted by the denture was tbe lingual or palatal surface (Fig 1), Facial abutment surfaces, contacted by clasps, were mainly the maxillary posterior teeth and mandibuiar canines and premolars. Because only those surfaces associated with the denture were recorded, some surfaces are not represented (eg, facial surfaces of incisor teeth). The promi- nence of the maxillary canines in Fig 1 is accen- tuated by the number of RPDs that contact three or four surfaces of these teeth. The pattern of exposed root surfaces on abutment teeth (Fig 2) is closely related to tbe pattern of abutment surfaces present. 5, Number 1, 1992 41 The International Journal of Proithodontics Reladonsliip of RPO Use and Root Cari Wright et al 18 IT 16 15 14 13 IS 11 !1 22 13 2i 5 26 27 2 Mandibular Teeth MESIAL 0 DISTAL D BUCCAL PALATALfLIKGLIAL Fig 3 Root caries in denture wearers. Table 1 Exposed Root Surfaces and Root Caries Expressed as a Percentage of all Root Surfaces, Exposed and Unexposed, by Person Non- denture Denture % wearers wearers Denture wearers Nonabutments Abutments Exposed root surfaces Root 27.0 (15.9) 2.1 (2.4) 48.0 (24.5) 5.6 (4.9) Standard deviation in perenttieses. " P < .0001. 44.3 (25.6) 4.1 (4.3) 50.3 (25.9) 8.7 (9.2) The InlernlionaL Journal o Pro^thodontk 42 Volume 5, Number I , 1992 Relalionship of RPD Use and Root Caries Fig 4 Root caries in non- denture wearers. 18 17 t6 IS 14 13 1J 11 21 22 23 2S 26 27 2 Removable partial denture wearers may also be compared to non-denture wearers by calculating the mean of the percentage of all root surfaces that are exposed in each individual for each group. Those having RPDs had almost twice as many root surfaces exposed. This difference was highly sig- nificant (Table 1 ), Comparisons between abutment surfaces and nonabutment surfaces show a smaller btit still significant difference, with abutnnent sur- faces more likely to show gingival recession. The differences in the percentage frequency of root caries were even more dramatic. Root caries was 2.6 times as likely to be present in denture wearers as in non-denture wearers. Among den- ture wearers, root caries was twice as likely to occur on abutment surfaces as on nonabutment surfaces; nearly 9% of the abutment surfaces demonstrated root caries. The pattems of the occurrence of root caries were compared between those having RPDs and those without. Those having RPDs experienced a higher prevalence of mesial, distal, and lingual root caries than did non-denture wearers, whose root caries was predominantly buccal or palatal on the maxillary posterior teeth (Figs 3 and 4), The pat- terns of lesions on abutment surfaces and of exposed root surfaces were similar. Characteristics of the root caries lesions were 5, Nun^ber 1, 1992 43 The International lournal of Pmsthodontii Rel.iliorship of RPD Use and Root Caries Table 2 Carious lesions (mm) <2 Totals Vertical Dimension of Lesion Non- denture wearers 91 27 118 Denture wearers Nonabutments 106 52 160 Abutments 66 52 118 Totals 265 131 396 Table 3 Carious lesions (mm <2 Totals Horizontal Non- denture wearers 44 73 117 Dimension of Lesion Denture wearers Nonabutments 35 125 160 Abutments 16 102 118 Totals 95 300 395 Table 4 Distance from Lower Border of Lesion to Gingival Margin Distance (mm) <3 Totals Non- denture wearers 117 7 124 Denture wearers Nonabutments 146 22 168 Abutments 97 21 118 Totals 360 50 410 Table 5 Texture of Root Canes Texture Inactive (hard) Active (soft or leathery) Totals Non- denture wearers 87 37 124 Denture wearers Nonabutments 97 76 173 Abutments 58 60 118 Totals 242 173 415 compared between those without RPDs and those with RPDs, In denture wearers, the abutment sur- faces had lesions with greater vertical and hori- zontal dimensions than did the nonabutment surfaces. Lesions on the nonabutment surfaces in denture wearers were, in turn, larger than those in non-denture wearers. These differences were emphasised by di vi di ng the lesions into two groups, the smaller lesions measuring < 2 mm and the larger measuring >: 2 mm (Tables 2 and 3), Similarly, the distances from the lower border of the lesion to the gingival margin progressively increased from root surfaces in non-denture wear- ers, to nonabutment surfaces in those having RPDs, to abutment surfaces. More of the lesions in the latter two groups measured at least 3 mm from the gingival margin (Table 4). A greater proportion of lesions in the denture wearer groups were leathery or soft. If these lesions are regarded as active lesions and hard lesions are Tlie International lournai of Prostliodorlii 1 Volun Wright et al Relationship of RPD Use and Root Caries considered to be inactive, then the differences are even more apparent (Table 5). More than half of tbe lesions on abutment surfaces were active while only one third of lesions in non-denture wearers were active. No significant relationship could be shown between the colour of tbe lesion or the depth of cavitation and the various groups studied. Discussion The study sample in this report was chosen because of a particular interest in patients attending general dental practice in a seaside town, with a large retirement population, in England. It is not a random sample of an elderly population. In partic- ular, the selection of persons with a minimum of 12 retained teeth strongly influenced the pattern of tooth loss demonstrated. Nevertheless, consid- erations of the characteristics of the sample suggest that it is very similar to other samples obtained by random sampling of dentate persons in defined geographic areas,^ The design of tbe dentures worn by most of the persons in this study was representative of a partial denture design commonly used in general dental practice. The oral and denture hygiene measures recommended to these patients were not specially modified or monitored for the study. These data indicate that denture wearers are more likely to have exposed root surfaces and root caries than persons without dentures. How- ever, whether this represents an effect of the pres- ence of tbe dentures or a fundamental difference between the two groups of persons is not estab- lished. The need for a denture indicates a greater level of tooth loss, which may indicate a lower level of dental motivation or even a greater sus- ceptibility to root caries caused by some unde- fined factors. The effect of denture wearing in accentuating the accumulation of plaque is, bow- ever, well known, ^" In this population, denture wearers harboured significantly higher salivary levels of mutans streptococci, lactobacilii, and yeasts.'^ The increase in the percentage of exposed root surfaces on abutment surfaces might be expected where the dentures are predominantly mucosa supported. The assumption that exposure of the root surface is necessary for the development of root caries has not been proven and the root car- ies pattern is not closely related to recession,^ except for abutment surfaces. However, tbe increased prevalence of root caries on abutment surfaces is difficult to attribute to any cause other than to the presence of tbe denture. No previous studies have examined the prevalence of root car- ies specifically related to denture wearing. In general, root caries lesions were clearly larg- est on the abutment surfaces and more of those lesions tended to be active. These findings would support the hypothesis that covering the surface of an exposed root with a denture significantly increases the risk of root caries. The tendency of lesions to be further from the gingival margin on the abutment surfaces may be related to either tbe denture's covering that sur- face up to its maximum height of contour or the progressive nature of the gingival recession on these surfaces. Eurther study is planned on this aspect. Conclusions 1. Those using removable dentures have a greater prevalence of exposed root surfaces and root caries, 2. Abutment surfaces are more likely to have exposed roots than nonabutment surfaces when a removable partial denture is present and they are twice as likely to have root caries, 3. In denture wearers, root caries lesions on abutment surfaces are generally larger and are more likely to be active than those on non- abutment surfaces. Likewise, lesions on non- abutment surfaces in denture wearers are generally larger and are more likely to be active than those in persons who do not wear dentures. References 1. Hellyer Ph), Lynch E: Root caries-diagnosis, epidemiol- ogy, aetiology and prediction, in Tay WM, Rear S (eds|: Genersi Dental treatment. London, Kluwer Publishing, 1989;4,1.8:1-18, 2. Kalz RV, Hazen SP, Chilton N, Mumma RD: Prevalence and intra-oral distrihution of root caries in an adult pop- ulation. Caries Res 1982;16:265-a71. 3. Miller A|, Brunelle |A, Carlos |P, Brown L|, Loe H: Oral Heaith of United States Adults, publication No, 87/2868, Bethe5ds, National Institute for Dental Research, 1987, 4. Vehkdlahli M: Occurrence of root caries and factors relat- ing to it, Proc Finn Denf Soc1987;83:l-99, 5. Hellyer PH, Beighton D, Heath MR, Lynch E: Root caries in older people attending a general dental practice in East Sussex. rDenf/1990;169:201-206. 6. Carlsson GE, Hedegard B, Kolvumaa KK; The current place of removable partial dentures in restorative den- tistry. Dent Clin Nortfi Am 1970;14:553-569. 7. Bergman B, Hugoion A, Olsson CO: Caries and peri- odontai status in patients fitted with removable partial dentures, ; Clin Pefio<ontoM977;4:134-146, 5, Number 1, 1992 45 The Internationa i of Prosthodontics Relationship of RPD Use and Root Carit 8. Lappaiainen R, Koskenranla-Wuorinen P, Markkanen H: Periodonial and cariologital 5latus in relation to different combinations of removable dentures in eiderly men. Ger- Oont/es19e7;3;122-l24, 9. Brill N, Tryde G, Stoltze K, Ei Ghamrawy EA: Ecologie changes in the oral cavity caused by removable partial dentures.; Prosthet Dent 1977;3B: 138-148, 10. Addy M, Bates IF: The effect of partial dentures and chior- hexidine gluconate gel on plaque accumulation in the Wright et al absence of oral hygiene. ; Clin Periodontol 1977;4:4I -47. 11. Stipho HDK, Murphy WM, Adams D: Effect of oral prostheses on plaque accumul at i on. Br Dent I 1978;145:47-S0. 12. Beighton D, HellyerPH, Lynch E, Heath MR: Salivary lev- els of mtitans streptococci, lactobaalli. yeasts and root carie5 prevalence in non-institutionalised elderly dental patients. Community Dent Oral Epidemiol 1991 ;19:302- 307. Literature ADstracts . Assessing Neck Extension-Flexion as a Basis for Temporomandibuiar Joint Dysfunction Extension-flexion injury of the muscles of the neck is a commoniy encountered consequence ot motor vehicle accidents. Often, temporomandibuiar joint syndromes and myotascial pain are subsequentiy reported with the extension-fiexion motion cited as the causative event. Tfie article assesses the proposed mechanism of injury, points out misconceptions in the previously publisfied physical and biochemicai analyses, and compares the magnitude and direction of actual forces in extension-flexion events to those that would be expected to occur in routine nontraumatic events. The authors state that normal physiologic activity of mastication possesses a greater potential to produce traumatic injury to the temporomandibuiar joints, whether caused by mechanical force at the joint or induced by myospasm, than does mild-to-moderate extension-flex i on motion of the cervical spine. Howard HP, Benedict JV, Haddin JH, Smith HL. J OraJ MaiiHofac Surg 1991 ;49:1210-1213. Reterences: 6. Reprints: Df Hicfiara P. Howara, Biodynamic Research Corporation. 9901 I H 10 West, Suite 1000, San Antonio, Texas 78239.Jon D. Wagner, MD. DOS. University o New Mexico Medical Center. Albuquerque, Wew Mexico Repairs Wifh Visible Ligfit-Curing Denture Base Materials The strength of Traid VLC resin, used as a repair material, was examined. The results were compared to a uto polymerizing acrylic resin. Sixty rectanguiar plates, fabricated from either Triad VLC or a heat- activated denture base resin, were tractured and then were repaired with either Triad VLC or autopoiymerizing acrylic resin. The highest mean transverse bending strength and mean fracture toughness were obtained for heat-activated acrylic resin samples repaired with autopolymerizing acryiic resin. The lowest strengths were found with Triad sampies that were repaired with Thad. it is proposed that the low strength of the Triad repair specimens can be attributed to the high viscosity and poor adhesive properties ot the material compared to autopoiymerizing acryiic resin. Andreopouloa AG, Polyzois GL. Oemetriou PP. QuiVilessence ynn991;22(9 703-706. Reterences: 19. Reprints; Dr G.L Poiyzois, 15 Msandrou Street, 1152B Atliens, Greece.-EsWer J. Penn, DOS, Department o Veterans Affairs, Veterans Administration Medical Center, Maniiattan, New York atonal Journal of Prostliodortic 46 5, Number I , 7992