Per W. Norheim

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.

Assessment of an additive index for plaque accumulation on complete maxillary dentures

There appears to be a relation between accumulation of plaque on complete maxillary dentures and denture stomatitis. The present index was introduced to assess the location and amount of plaque in some areas of the fitting surfaces of complete maxillary dentures. Scores were recorded in five defined areas on the denture base. Four ranked scores were used: 0 - no visible plaque, 1-plaque visible only by scraping on the denture base with a blunt instrument, 2-moderate accumulation of visible plaque, and 3-abundance of plaque. By summing up the scores from the five areas, the plaque was recorded on a scale from 0 to 15 points. The inter- and intra-reliability were tested for two examiners using the index on 50 complete maxillary dentures. Expressed in terms of Scotts Pi, inter-examiners agreement was 0.83, and intra-examiner 0.83 and 0.82 for examiners A and B, respectively. A simplification of the index was also presented. In this index the scores 0 and 1 were combined to score 0, -no visible plaque, and score 2 and 3 were combined to score 1, -visible plaque. Using this index, Scotts Pi was calculated to 0.91 for inter-examiner reliability. For the intra-examiners reliability Scotts Pi was calculated to 0.91 for examiner A and 0.89 for examiner B.

Oral health status in a population in Northern Norway

Information concerning oral health status was obtained through a clinical and radiographic examination of 297 persons aged 20--69 years out of a population of 358 persons living in a coastal community in Northern Norway. The oral health was generally poor. 71% had one or more remaining teeth and the dentulous persons had a mean number of 18 remaining teeth. The mean number of DMF teeth was 27,3 while the mean number of decayed teeth was 4,9 and filled teeth 12,0 giving a percent of decayed and filled teeth of 27 and 65 respectively. Only every fourth dentulous person had one or more crowns and/or bridge units and 4% of all teeth had been treated endodontically. 41% of the teeth had visible plaque and 56% of the teeth had one or more gingival margins bleeding after gentle probing. One fourth of all teeth had gingival pockets exceeding 3 mm and 17% of all teeth showed a bone loss of 20% or more. The number of remaining teeth decreased with increasing age and decreasing income and/or social class. In general, women, young people and people with a high socioeconomic status had less caries, better oral hygiene and periodontal condition and had received more restorative dental care than the remaining part of the population.

Oral status and acceptance of dental services among some elderly persons in Oslo

Oral conditions were studied clinically and radiographically in a group of people aged 67-94 years. The group comprised 70 persons living in an institution for elderly people and 111 persons living in their homes in the surrounding area. The participants were classified according to sex, age and former occupation. The examination was carried out in a dental office established at the institution. 63% of the participants were dentulous with a mean number of 13 teeth. Almost 50% of the teeth were previously restored and 13% of the teeth were decayed at the examination. 45% had complete maxillary dentures and 39% had complete mandibular dentures. The need for dental treatment according to defined criteria was registered, and treatment-offers were given. Comparisons were made between the treatment suggested and the treatment actually given. Of the total group, 129 persons needed dental treatment. Of these, 65 persons accepted all or part of the treatment suggested. In general, sex was not a good predictor of the need for an acceptance of dental services. However, age was found to be useful as a predictor. Social background was an unreliable predictor of the need for and acceptance of dental services.

The use of dental services in a population in Northern Norway

The utilization of dental services was studied by means of records from dentists files, a method which permits gathering of detailed information with high reliability and validity. 53% of the adult population of 358 persons living in a coastal community in Northern Norway had visited a dentist during a period of two years. In the group of 13% who were considered to be regular treatment attenders, number of teeth, sex and socio-economical status were the most influential predictors of utilization. Among the 182 persons with 10 or more remaining teeth, 59% had made preventive and restorative dental visits, and in this group there was a dominating proportion of women, young people and people with high income and/or social class. In contrast, only six persons out of 61 with one to nine remaining teeth had made such visits. People in social class 3 were overrepresented among the 26% of the population who visited a dentist because of extractions or complete denture services. The treatment profile according to age showed that younger people used most of their treatment time on consultations, preventive measures and conservative treatments, while fixed and removable prosthetics constituted a major part of the treatment time among elderly people.