Eirik Ambjørnsen

Assessment of the periapical and clinical status of crowned teeth over 25 years

OBJECTIVES The purpose of this study was to examine radiographically changes in the periapical status and compare the clinical status of teeth with a vital pulp and root-filled teeth restored with crowns and bridge retainers during 25 years. METHODS During 1967/68, 114 patients received prosthodontic treatment by senior dental students at the Oslo Dental Faculty. In all, 291 teeth with a vital pulp and 106 root-filled teeth were restored with 158 prostheses. All root-filled teeth were restored with a cast dowel and core. The casts were made in a type-3 gold alloy, and cemented with zinc phosphate cement. Forty-six teeth were restored with crowns and 351 teeth with bridge retainers. Radiographs were taken preoperatively, immediately after cementation, and every fifth year. Two independent observers assessed the periapical status on the radiographs according to the PAI-index. At the 25 years examination, 32 patients (28%) with 101 restored teeth (24%) remained in the study. Survival rates of the prostheses and of the restored teeth were estimated using Kaplan-Meyer non-parametric statistics. RESULTS The PAI-score of the periapical status deteriorated in 13 vital and four root-filled teeth. The survival rates of the fixed prostheses were not influenced by the pulp vitality of the restored tooth at the baseline. The survival rates of the restored teeth with a vital pulp and of the root-filled teeth were similar. Clinical failures were recorded on approximately one-third of the restored teeth. The main reason for tooth failure was caries (12%), and for the teeth with a vital pulp also pulpal deterioration (10%). Estimates of the proportions of crowned teeth with a vital pulp that will remain free from signs and symptoms of pulpal deterioration were 98% after five years, 92% after 10 years, 87% after 20 years and 83% after 25 years. CONCLUSIONS The incidence of periapical lesions on radiographs of crowned teeth was low during 25 years observation. Crowned, root-filled teeth with a high quality endodontic treatment and an optimal morphology of the dowel and core have a similar survival rate as crowned teeth with a vital pulp. A high proportion of crowned teeth with a vital pulp will remain free from signs and symptoms of pulpal deterioration over 25 years.

ORAL HEALTH IN INSTITUTIONALIZED ELDERLY PEOPLE IN 1993 COMPARED WITH IN 1980

The dental and periodontal status, oral hygiene, and dental visit habits of 250 residents in long-term care (LTC) facilities for the elderly in a suburban community in Norway were recorded. The findings were compared with the data from an identical examination of the residents in the same LTC facilities in 1980. In 1993 the mean number of remaining teeth per person was 11.7 (CI = 10.3-13.1). The mean number of filled teeth was 5.1 (CI = 4.1-6.0), and the mean number of decayed teeth was 1.8 (CI = 1.4-2.2). The mean number of residual roots per person was 0.8 (CI = 0.5-1.1). Periodontal pockets exceeding 4 mm was recorded on 5% of all teeth. In general, the oral hygiene was poor. Edentulousness had decreased from 80% in 1980 to 54% in 1993, and more remaining and filled teeth and fewer residual roots per person were observed in the 1993 population. The findings show that the objective need for resources to prevent periodontal disease and caries among elderly patients in LTC facilities today is higher than previously.

Oral findings in adults with osteogenesis imperfecta

This paper describes oral findings in an adult population with osteogenesis imperfecta (OI) in Norway (n=94). All participants underwent a structured interview and an oral examination. Panoramic radiographs were analyzed. The findings were compared with data from other Nordic epidemiological studies. Seventeen individuals (19%) had clinical signs of dentinogenesis imperfecta (DI). Persons with OI had twice as many missing teeth as the general population, and the number of endodontically treated teeth was higher than in the general population. All persons in the study had an acceptable state of tooth tissue loss. Almost all (97%) of the participants in the study group visited a dentist or a dental hygienist regularly. The results of the study indicated a low prevalence of clinical DI compared with previous reported studies. Oral health was not as good in the population with OI when compared with the general population, although daily oral health habits were good and dental visits were regular.

Dental caries among the elderly in Norway.

Objectives: To describe the occurrence of decayed teeth (DT), missing teeth (MT), filled teeth (FT), and the total sum score DMFT in elderly Norwegian pensioners, 67 years or more. Basic procedures: A representative sample of 582 elderly Norwegians (12.5% receiving social care) participated in a nationwide study (46% men and 54% women). In all, 394 (68%) still had some of their own teeth. A standardized clinical examination was performed by one of the authors (BMH) using well‐defined criteria. Main findings: Mean DT was 0.46, FT was 8.4, and DMFT was 25.4. Mean number of root remnants was 0.11. Mean DT, FT, DMFT, and root remnants for the dentate participants were 0.67, 12.4, 24.1, and 0.17, respectively. Men had significantly higher DT than women. DT decreased with increasing age. Only small differences were found in the prevalence of dentate individuals with caries between gender, age groups, geographical regions, and residence in areas of varying population density. Conclusion: It seems that caries is a minor problem in the Norwegian elderly population. Age and the number of remaining teeth do not have a decisive role in the development of caries. Further, there are no differences in these respects between geographical areas in Norway.

The effect of verbal information and demonstration on denture hygiene in elderly people

The purpose of the present study was to investigate the effect of two oral hygiene information programs on denture hygiene. The programs were provided individually to healthy elderly denture wearers. Totally, 150 edentulous persons between 67 and 89 years of age were selected and randomly assigned to two experimental groups and one control group. In one test group (INFO) the participants were only given individual verbal information on how to remove denture plaque. The participants of the second test group (DEMO) received individual demonstration of denture cleaning in addition. One hundred and thirty-eight persons completed the study. The percentage plaque covering the maxillary denture base was assessed by a morphometric point-estimator scoring method at the start of the study and after 14 and 180 days. Verbal information resulted only in a short-term effect (14 days), whereas demonstration on how to remove denture plaque gave long-term (180 days) improvement of denture hygiene.

A study of examiner errors associated with measurement of denture plaque

The purpose of the present study was to compare the reproducibility and reliability of different methods of measuring the distribution of plaque on the fitting surface of maxillary dentures. Data from a clinical trial were used to determine the reproducibility of (1) the original Budtz-Jörgensen index, (2) a proposed morphometric method for facilitating the measurements by this index, and (3) the index of Schubert and Schubert. The recordings from previous tests of reproducibility of an additive index were used to estimate reliability by means of a test-retest procedure and the internal consistency method. The morphometric point-estimator scoring method gave the highest intra- and inter-examiner reproducibility for the three-graded scale (Scotts pi, 0.90 and 0.81) and for the five-graded scale (0.86 and 0.80). Reproducibility was markedly reduced when the distribution of denture plaque was assessed by visual examination (Scotts pi, 0.81 and 0.72), especially when using the five-graded scale (0.73 and 0.51). The PH index exhibited an intra-examiner reliability of 0.83 with the three-graded scale and 0.78 with the five-graded scale. The corresponding inter-examiner figures were 0.76 and 0.70. The test-retest method showed that in the areas M1 and M2 the mean amount of plaque was significantly reduced at the second examination, whereas no significant change occurred in areas T1 and T2. The reliability coefficients obtained by the additive index were greater than 0.88. Error variance was 8% and 12% of the total variance for this index but only 3% with the morphometric test method. The internal consistency reliability gave coefficients that were higher than those obtained by the test-retest method.

In vitro abrasion of two acrylic veneers

OBJECTIVES The purpose of this investigation was to compare the degree of abrasion in vitro of two acrylic veneers and dental enamel using a dentifrice with and without fluoride. METHODS Ten specimens of each of the two acrylics and enamel were embedded in resin, and eventually polished to 1 micron with diamond paste. Specimens were brushed in a brushing machine with 10,000 double strokes using a dentifrice (Solidox, A/S Denofa) with and without fluoride. The abrasion was evaluated by the naked eye, by photographs and measured by means of profilometer. RESULTS One of the polymer materials (Dentacolor, Kulzer) showed a significantly higher resistance to abrasion than the other (Biodent, DeTrey), irrespective of fluoride treatment. Brushing with or without fluoride revealed no significant difference in degree of abrasion between the two acrylic materials. Dentacolor showed significantly higher abrasion resistance than enamel, whereas Biodent did not. There was no significant difference in the degree of abrasion of enamel using dentifrice with or without fluoride. SIGNIFICANCE Abrasion of acrylic veneering material differed greatly between brands, but did not seem to be influenced by the fluoride in toothpaste.

Adequacy and effectiveness of a public dental care program for old-age pensioners.

The purpose of the present work was to assess the adequacy and effectiveness of a public dental program for old-age pensioners. The dental care program offered free consultation and treatment at reduced prices to all pensioners (3072) in a municipality near Oslo in 1979. To study treatment need and access to dental care, a random sample of 430 pensioners was drawn from the total population of old-age pensioners; 371 persons were clinically examined. Of the 3072 old-age pensioners 23.7% responded positively and indicated that they were interested in the program, whereas 19.8% accepted, and 14.6% had the treatment carried out. The program adequacy was low and became lower when more restricted criteria for access to dental services were used. The program effectiveness was 18% or 16%, depending on which criteria were used for access. Acceptance of the program was highest among people who were aware of it, had natural teeth, had a dental problem, did not have their own dentist, had limited education, or were among the young pensioners.