From the earliest times, humans have shown concern for oral diseases and how to repair their effe... more From the earliest times, humans have shown concern for oral diseases and how to repair their effects. Archaeological findings show signs of dental caries in several ancient cultures, with the earliest evidence of any dental intervention found in a pair of 13,000-year-old teeth in Italy. By the middle of the twentieth century, dentistry had become well established as a technical expertise where the dentist could perform delicate operative procedures in the oral cavity. The focus shifted from the surgical to the restorative, which allowed restoring damaged teeth, with the aim of keeping the teeth functioning in the mouth. While modern oral health care has benefited enormously from advances such as fluoridation, the oral health professions still face significant challenges, such as the major inequalities in oral health, both within and between countries in terms of disease severity and prevalence. Looking to the future, there are key trends which will greatly influence how oral health care is conceptualised and organised, how oral health care personnel are trained and how they will deliver health services to the population. These trends are: the pervasive use of communication and information technologies, world globalisation and migratory movements, the ageing of the world population and climate change.
Dental caries (tooth decay) is one of the most highly prevalent disease around the world affectin... more Dental caries (tooth decay) is one of the most highly prevalent disease around the world affecting a significant proportion of the population. Dental caries may take place on any tooth surface in the oral cavity where dental plaque is allowed to develop over a period of time. Understanding its causes and progression allows the dental team to prevent and manage it so that patients can maintain healthy teeth for life. The fourth edition of Essentials of Dental Caries provides readers with an up-to-date, clinically relevant guide to dental caries. Written in an accessible style, the authors explain the biological and socioeconomic background of lesion development and progress. Current methods of clinical diagnosis and evidence based management are outlined in clearly laid out and highly illustrated chapters. This book is essential reading for students and practitioners of dentistry, dental therapy, dental hygiene, and oral health educators.
It is now well-established that a linear relationship exists between fluoride dose and enamel flu... more It is now well-established that a linear relationship exists between fluoride dose and enamel fluorosis in human populations. With increasing severity, the subsurface enamel all along the tooth becomes increasingly porous (hypomineralized), and the lesion extends toward the inner enamel. In dentin, hypomineralization results in an enhancement of the incremental lines. After eruption, the more severe forms are subject to extensive mechanical breakdown of the surface. The continuum of fluoride-induced changes can best be classified by the TF index, which reflects, on an ordinal scale, the histopathological features and increases in enamel fluoride concentrations. Human and animal studies have shown that it is possible to develop dental fluorosis by exposure during enamel maturation alone. It is less apparent whether an effect of fluoride on the stage of enamel matrix secretion, alone, is able to produce changes in enamel similar to those described as dental fluorosis in man. The clini...
Twenty-eight young, healthy adults completed an experimental gingivitis study in which blood and ... more Twenty-eight young, healthy adults completed an experimental gingivitis study in which blood and clinical recordings were obtained at baseline; after a 4-week period of thorough oral hygiene; after a subsequent 3-week period of plaque accumulation; and after another 2 weeks of thorough oral hygiene. Serum immunoglobulin G antibodies against whole cells of Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Streptococcus sanguis were determined using enzyme-linked immunosorbent assay. Mean serum immunoglobulin G antibody levels to P. intermedia, F. nucleatum and S. sanguis remained essentially constant during the experiment, whereas the immunoglobulin G antibodies to P. gingivalis declined during the initial period of oral hygiene and the subsequent period of plaque accumulation to an average of 84.5% of the baseline value. This reduction could be attributed to the people who developed marked gingival inflammation during the period of plaque accumulation, indicating that the systemic host response may be associated with local tissue responses to variations in oral hygiene. These people were, however, also characterized by higher initial serum immunoglobulin G responses to P. gingivalis than people who developed less pronounced gingival inflammation during the experiment. The variability and individuality noted in the host response to potential pathogens have important implications for attempts to use such measures for establishing a diagnosis or prognosis for the individual patient.
The prevalence of Actinobacillus actinomycetemcomitans isolates was examined in a rural populatio... more The prevalence of Actinobacillus actinomycetemcomitans isolates was examined in a rural population of southern Thailand. Sixty individuals aged 30-39 and 50-59 years were randomly selected from a group of 363 persons, living in four villages, who had been clinically examined previously. A subgingival plaque sample was taken with a curette from the mesial aspect of the two upper and lower first molars. Each sample was dispersed in 3.3 ml of VMGA III transport medium and spread onto Trypticase Soy Broth with Bacitracin and Vancomycin (TSBV)-agar plates on the same day. After incubation in 10% CO2 for 5 days the plates were examined for typical A. actinomycetemcomitans colonies which were tested for catalase activity. Each strain was further tested for biochemical characteristics, serotyped against serotype-specific antisera a-e and ribotyped after DNA digestion using the restriction endonucleases HindIII and EcoRI. For 53 (88%) of the 60 individuals, A. actinomycetemcomitans was present in at least one subgingival sample, which is considerably higher than the prevalence in Western European adults. In 11 individuals, two or three different strains were found. Serotypes a and c were the most prevalent, and serotype b was found only once among 46 tested isolates. Eleven ribotypes were found among the 46 strains. While the same ribotype could be found among individuals of the same village, no ribotype of A. actinomycetemcomitans was unique for individuals of any one village. The study demonstrated a high prevalence of A. actinomycetemcomitans among adults of the rural population of southern Thailand and indicates that this species is present as part of the resident oral flora in this population.
The "checkerboard" Dna-Dna hybridization technology was used to study the epide... more The "checkerboard" Dna-Dna hybridization technology was used to study the epidemiology of 18 microbial species associated with various states of periodontal health and disease, in a sample of 148 Chinese subjects never exposed to systematic dental therapeutic intervention, aged 30 to 39 and 50 to 59 years. Our aims were to: 1) describe the prevalence of these microorganisms; 2) correlate the microbiological and clinical profiles of the subjects; and 3) examine the association between the microbiological variables and the longitudinal changes of periodontal status that occurred over a preceding 10-year period. A maximum of 14 subgingival samples were obtained from each subject-1,864 in all. The frequency of occurrence of the 18 species examined was high in this Chinese population, on both the subject and the tooth site level. However, all species were not found equally capable of reaching high numbers in the subgingival samples and, as a rule, colonized heavily only limited proportions of tooth sites within each mouth. There was a profound increase of certain species such as Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus in deep pockets or progressing sites. Multivariate techniques using the subgingival profile could effectively discriminate between deep/shallow pockets and progressing/ stable tooth sites. The microbiological variables showed an enhanced discriminating potential when classifications were performed on the individual subject level. Colonization by P. gingivalis, B. forsythus, Campylobacter rectus, and T. denticola at levels exceeding certain thresholds entailed a significantly increased probability (odds ratios > 4) for an individual subject to harbor deep pockets or progressing tooth sites.
Salivary levels of mutans streptococci (S. mutans and S. sobrinus) and lactobacilli were determin... more Salivary levels of mutans streptococci (S. mutans and S. sobrinus) and lactobacilli were determined in a random sample of rural Kenyans between 15 and 19 years of age (n = 149). It is possible for the natural history of dental caries in this population to be studied since it is characterized by a limited access to conventional dental treatment. Using a short set of biochemical tests, we identified from seven to ten presumptive mutans streptococcus colonies-cultured from the saliva of each individual-to differentiate between S. mutans and S. sobrinus. No colonies resembling S. rattus (S. mutans serotype b) were isolated. Lactobacilli were identified as Gram-positive, catalase-negative rods. The mean D1-4MFS and D3-4MFS were 7.03 ± 6.43 and 1.46 ± 3.44, respectively. The mean mutans streptococcus and lactobacillus levels were 8. 7 x 104 and 6. 7 x 104, respectively. The salivary mutans streptococcus and lactobacillus levels were significantly correlated (p<0.01). Of the subjects, 6...
This study investigates the relationship between CPITN findings and the prevalence and severity o... more This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15-65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN score &lt; or = 1 did not have attachment loss &gt; or = 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment loss &gt; or = 4 mm and over 50% of the 50+ year-olds with CPITN score 3 had attachment loss &gt; or = 6 mm. Less than 20% of the 15-29 year-olds with CPITN score 3 had attachment loss &gt; or = 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment loss &gt; or = 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levels &lt; or = 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.
If an etiological relationship exists between destructive periodontal disease and putative period... more If an etiological relationship exists between destructive periodontal disease and putative periodontopathogens, they would be expected to have a very low prevalence in periodontally healthy elderly persons. To test this hypothesis, 2 subgroups of elderly, rural Chinese (a periodontally &quot;best&quot; and a &quot;worst&quot; group, each comprising 15 persons) were identified in 1990 from a cohort aged 55-69 years, examined in 1984. Assessment of changes in periodontal status over the 6-year period were possible by comparing detailed clinical recordings performed by the same examinator. Subgingival microbial samples were taken at the mesial aspects of an upper central incisor and a lower canine and examined for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia group, Prevotella melaninogenica group, Capnocytophaga, Selenomonas, Campylobacter rectus as well as predominant Streptococcus and Actinomyces species. During the 6 years prior to microbiological sampling, persons in the &quot;best&quot; group had lost an average of 1.21 +/- 0.48 mm attachment, while persons in the &quot;worst&quot; group had lost an average of 1.60 +/- 0.94 mm. The latter group had lost 53.3 teeth, predominantly for periodontal reasons, in contrast to 1.8 teeth lost in the &quot;best&quot; group. &quot;Best&quot; persons did not differ from &quot;worst&quot; persons with respect to the occurrence of the putative periopathogens, total viable count, and total streptococcal and Actinomyces recovery. Similarly, sites which had experienced an attachment loss &gt; or = 2 mm during the 6-year period did not differ microbiologically from sites with less attachment loss. It is concluded that subgingival microbial characterization does not allow for a distinction between elderly individuals with markedly different periodontal disease experiences.
The aim of the study was to assess the occurrence of some putative periodonto-pathogens in &q... more The aim of the study was to assess the occurrence of some putative periodonto-pathogens in &quot;test&quot; and &quot;control&quot; sites in &quot;diseased&quot; and &quot;non-diseased&quot; persons, respectively, from an adult rural Kenyan population exhibiting poor oral hygiene and widespread loss of attachment (LA). 14 persons (less than 35 years) were assigned to a &quot;diseased&quot; category on the basis of at least 4 sites with LA greater than or equal to 4 mm; at least 5 mm LA and a pocket greater than or equal to 4 mm interproximally in a lower incisor (&quot;test&quot; site): and less than 2 mm LA and no pocket greater than or equal to 4 mm distal to a lower canine or mesial to a lower first premolar (&quot;control&quot; site). Age-matched &quot;non-diseased&quot; persons were identified on the basis of no sites with LA greater than 2 mm and no pockets greater than or equal to 4 mm associated with LA. Paperpoint samples from test and control sites as well as a scraping sample from the dorsum of tongue were examined for presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides intermedius, B. melaninogenicus group, Capnocytophaga, Selenomonas spp., and Wolinella recta. P. gingivalis was found in 79% of test sites and 36% of control sites in &quot;diseased&quot; persons, and in 18% and 35% of test and control sites, respectively, in &quot;non-diseased&quot; persons. &quot;No other bacterial group discriminated significantly between test and control sites or between diseased and non-diseased subjects. The surprisingly high occurrence of P. gingivalis in non-diseased subjects, both subgingivally and on tongue, indicates that deep periodontal pockets are not prerequisite ecological environments for P. gingivalis establishment.
A total of 170 adults aged 30-69 yr from the Zanzibar and Pemba Islands (Tanzania) were examined ... more A total of 170 adults aged 30-69 yr from the Zanzibar and Pemba Islands (Tanzania) were examined for tooth loss, dental caries and loss of periodontal attachment. The cause of tooth loss was recorded from information given by the examinee to a Kiswahili-English interpreter. Dental caries were recorded according to the depth of the lesion, i.e. involving enamel, dentin or pulp, respectively. Loss of attachment was measured as the distance in mm from the CEJ to the bottom of the pocket. The most severely affected surface determined the state of the tooth. The mean number of teeth present ranged from 29.5 in the youngest to 23.9 in the oldest age group. The mean number of teeth missing due to dental caries ranged between 2.1 and 7.0 teeth, and exceeded by far tooth loss due to periodontal breakdown which was only observed in the two oldest age groups. In all age groups the molars were the teeth most frequently missing and also the teeth most frequently affected by dental caries. Although a substantial number of the teeth in the older age groups demonstrated an extensive loss of attachment only a few teeth, mainly mandibular incisors, were lost due to periodontal breakdown within the age range examined.
From the earliest times, humans have shown concern for oral diseases and how to repair their effe... more From the earliest times, humans have shown concern for oral diseases and how to repair their effects. Archaeological findings show signs of dental caries in several ancient cultures, with the earliest evidence of any dental intervention found in a pair of 13,000-year-old teeth in Italy. By the middle of the twentieth century, dentistry had become well established as a technical expertise where the dentist could perform delicate operative procedures in the oral cavity. The focus shifted from the surgical to the restorative, which allowed restoring damaged teeth, with the aim of keeping the teeth functioning in the mouth. While modern oral health care has benefited enormously from advances such as fluoridation, the oral health professions still face significant challenges, such as the major inequalities in oral health, both within and between countries in terms of disease severity and prevalence. Looking to the future, there are key trends which will greatly influence how oral health care is conceptualised and organised, how oral health care personnel are trained and how they will deliver health services to the population. These trends are: the pervasive use of communication and information technologies, world globalisation and migratory movements, the ageing of the world population and climate change.
Dental caries (tooth decay) is one of the most highly prevalent disease around the world affectin... more Dental caries (tooth decay) is one of the most highly prevalent disease around the world affecting a significant proportion of the population. Dental caries may take place on any tooth surface in the oral cavity where dental plaque is allowed to develop over a period of time. Understanding its causes and progression allows the dental team to prevent and manage it so that patients can maintain healthy teeth for life. The fourth edition of Essentials of Dental Caries provides readers with an up-to-date, clinically relevant guide to dental caries. Written in an accessible style, the authors explain the biological and socioeconomic background of lesion development and progress. Current methods of clinical diagnosis and evidence based management are outlined in clearly laid out and highly illustrated chapters. This book is essential reading for students and practitioners of dentistry, dental therapy, dental hygiene, and oral health educators.
It is now well-established that a linear relationship exists between fluoride dose and enamel flu... more It is now well-established that a linear relationship exists between fluoride dose and enamel fluorosis in human populations. With increasing severity, the subsurface enamel all along the tooth becomes increasingly porous (hypomineralized), and the lesion extends toward the inner enamel. In dentin, hypomineralization results in an enhancement of the incremental lines. After eruption, the more severe forms are subject to extensive mechanical breakdown of the surface. The continuum of fluoride-induced changes can best be classified by the TF index, which reflects, on an ordinal scale, the histopathological features and increases in enamel fluoride concentrations. Human and animal studies have shown that it is possible to develop dental fluorosis by exposure during enamel maturation alone. It is less apparent whether an effect of fluoride on the stage of enamel matrix secretion, alone, is able to produce changes in enamel similar to those described as dental fluorosis in man. The clini...
Twenty-eight young, healthy adults completed an experimental gingivitis study in which blood and ... more Twenty-eight young, healthy adults completed an experimental gingivitis study in which blood and clinical recordings were obtained at baseline; after a 4-week period of thorough oral hygiene; after a subsequent 3-week period of plaque accumulation; and after another 2 weeks of thorough oral hygiene. Serum immunoglobulin G antibodies against whole cells of Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Streptococcus sanguis were determined using enzyme-linked immunosorbent assay. Mean serum immunoglobulin G antibody levels to P. intermedia, F. nucleatum and S. sanguis remained essentially constant during the experiment, whereas the immunoglobulin G antibodies to P. gingivalis declined during the initial period of oral hygiene and the subsequent period of plaque accumulation to an average of 84.5% of the baseline value. This reduction could be attributed to the people who developed marked gingival inflammation during the period of plaque accumulation, indicating that the systemic host response may be associated with local tissue responses to variations in oral hygiene. These people were, however, also characterized by higher initial serum immunoglobulin G responses to P. gingivalis than people who developed less pronounced gingival inflammation during the experiment. The variability and individuality noted in the host response to potential pathogens have important implications for attempts to use such measures for establishing a diagnosis or prognosis for the individual patient.
The prevalence of Actinobacillus actinomycetemcomitans isolates was examined in a rural populatio... more The prevalence of Actinobacillus actinomycetemcomitans isolates was examined in a rural population of southern Thailand. Sixty individuals aged 30-39 and 50-59 years were randomly selected from a group of 363 persons, living in four villages, who had been clinically examined previously. A subgingival plaque sample was taken with a curette from the mesial aspect of the two upper and lower first molars. Each sample was dispersed in 3.3 ml of VMGA III transport medium and spread onto Trypticase Soy Broth with Bacitracin and Vancomycin (TSBV)-agar plates on the same day. After incubation in 10% CO2 for 5 days the plates were examined for typical A. actinomycetemcomitans colonies which were tested for catalase activity. Each strain was further tested for biochemical characteristics, serotyped against serotype-specific antisera a-e and ribotyped after DNA digestion using the restriction endonucleases HindIII and EcoRI. For 53 (88%) of the 60 individuals, A. actinomycetemcomitans was present in at least one subgingival sample, which is considerably higher than the prevalence in Western European adults. In 11 individuals, two or three different strains were found. Serotypes a and c were the most prevalent, and serotype b was found only once among 46 tested isolates. Eleven ribotypes were found among the 46 strains. While the same ribotype could be found among individuals of the same village, no ribotype of A. actinomycetemcomitans was unique for individuals of any one village. The study demonstrated a high prevalence of A. actinomycetemcomitans among adults of the rural population of southern Thailand and indicates that this species is present as part of the resident oral flora in this population.
The &quot;checkerboard&quot; Dna-Dna hybridization technology was used to study the epide... more The &quot;checkerboard&quot; Dna-Dna hybridization technology was used to study the epidemiology of 18 microbial species associated with various states of periodontal health and disease, in a sample of 148 Chinese subjects never exposed to systematic dental therapeutic intervention, aged 30 to 39 and 50 to 59 years. Our aims were to: 1) describe the prevalence of these microorganisms; 2) correlate the microbiological and clinical profiles of the subjects; and 3) examine the association between the microbiological variables and the longitudinal changes of periodontal status that occurred over a preceding 10-year period. A maximum of 14 subgingival samples were obtained from each subject-1,864 in all. The frequency of occurrence of the 18 species examined was high in this Chinese population, on both the subject and the tooth site level. However, all species were not found equally capable of reaching high numbers in the subgingival samples and, as a rule, colonized heavily only limited proportions of tooth sites within each mouth. There was a profound increase of certain species such as Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus in deep pockets or progressing sites. Multivariate techniques using the subgingival profile could effectively discriminate between deep/shallow pockets and progressing/ stable tooth sites. The microbiological variables showed an enhanced discriminating potential when classifications were performed on the individual subject level. Colonization by P. gingivalis, B. forsythus, Campylobacter rectus, and T. denticola at levels exceeding certain thresholds entailed a significantly increased probability (odds ratios &gt; 4) for an individual subject to harbor deep pockets or progressing tooth sites.
Salivary levels of mutans streptococci (S. mutans and S. sobrinus) and lactobacilli were determin... more Salivary levels of mutans streptococci (S. mutans and S. sobrinus) and lactobacilli were determined in a random sample of rural Kenyans between 15 and 19 years of age (n = 149). It is possible for the natural history of dental caries in this population to be studied since it is characterized by a limited access to conventional dental treatment. Using a short set of biochemical tests, we identified from seven to ten presumptive mutans streptococcus colonies-cultured from the saliva of each individual-to differentiate between S. mutans and S. sobrinus. No colonies resembling S. rattus (S. mutans serotype b) were isolated. Lactobacilli were identified as Gram-positive, catalase-negative rods. The mean D1-4MFS and D3-4MFS were 7.03 ± 6.43 and 1.46 ± 3.44, respectively. The mean mutans streptococcus and lactobacillus levels were 8. 7 x 104 and 6. 7 x 104, respectively. The salivary mutans streptococcus and lactobacillus levels were significantly correlated (p<0.01). Of the subjects, 6...
This study investigates the relationship between CPITN findings and the prevalence and severity o... more This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15-65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN score &lt; or = 1 did not have attachment loss &gt; or = 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment loss &gt; or = 4 mm and over 50% of the 50+ year-olds with CPITN score 3 had attachment loss &gt; or = 6 mm. Less than 20% of the 15-29 year-olds with CPITN score 3 had attachment loss &gt; or = 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment loss &gt; or = 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levels &lt; or = 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.
If an etiological relationship exists between destructive periodontal disease and putative period... more If an etiological relationship exists between destructive periodontal disease and putative periodontopathogens, they would be expected to have a very low prevalence in periodontally healthy elderly persons. To test this hypothesis, 2 subgroups of elderly, rural Chinese (a periodontally &quot;best&quot; and a &quot;worst&quot; group, each comprising 15 persons) were identified in 1990 from a cohort aged 55-69 years, examined in 1984. Assessment of changes in periodontal status over the 6-year period were possible by comparing detailed clinical recordings performed by the same examinator. Subgingival microbial samples were taken at the mesial aspects of an upper central incisor and a lower canine and examined for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia group, Prevotella melaninogenica group, Capnocytophaga, Selenomonas, Campylobacter rectus as well as predominant Streptococcus and Actinomyces species. During the 6 years prior to microbiological sampling, persons in the &quot;best&quot; group had lost an average of 1.21 +/- 0.48 mm attachment, while persons in the &quot;worst&quot; group had lost an average of 1.60 +/- 0.94 mm. The latter group had lost 53.3 teeth, predominantly for periodontal reasons, in contrast to 1.8 teeth lost in the &quot;best&quot; group. &quot;Best&quot; persons did not differ from &quot;worst&quot; persons with respect to the occurrence of the putative periopathogens, total viable count, and total streptococcal and Actinomyces recovery. Similarly, sites which had experienced an attachment loss &gt; or = 2 mm during the 6-year period did not differ microbiologically from sites with less attachment loss. It is concluded that subgingival microbial characterization does not allow for a distinction between elderly individuals with markedly different periodontal disease experiences.
The aim of the study was to assess the occurrence of some putative periodonto-pathogens in &q... more The aim of the study was to assess the occurrence of some putative periodonto-pathogens in &quot;test&quot; and &quot;control&quot; sites in &quot;diseased&quot; and &quot;non-diseased&quot; persons, respectively, from an adult rural Kenyan population exhibiting poor oral hygiene and widespread loss of attachment (LA). 14 persons (less than 35 years) were assigned to a &quot;diseased&quot; category on the basis of at least 4 sites with LA greater than or equal to 4 mm; at least 5 mm LA and a pocket greater than or equal to 4 mm interproximally in a lower incisor (&quot;test&quot; site): and less than 2 mm LA and no pocket greater than or equal to 4 mm distal to a lower canine or mesial to a lower first premolar (&quot;control&quot; site). Age-matched &quot;non-diseased&quot; persons were identified on the basis of no sites with LA greater than 2 mm and no pockets greater than or equal to 4 mm associated with LA. Paperpoint samples from test and control sites as well as a scraping sample from the dorsum of tongue were examined for presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides intermedius, B. melaninogenicus group, Capnocytophaga, Selenomonas spp., and Wolinella recta. P. gingivalis was found in 79% of test sites and 36% of control sites in &quot;diseased&quot; persons, and in 18% and 35% of test and control sites, respectively, in &quot;non-diseased&quot; persons. &quot;No other bacterial group discriminated significantly between test and control sites or between diseased and non-diseased subjects. The surprisingly high occurrence of P. gingivalis in non-diseased subjects, both subgingivally and on tongue, indicates that deep periodontal pockets are not prerequisite ecological environments for P. gingivalis establishment.
A total of 170 adults aged 30-69 yr from the Zanzibar and Pemba Islands (Tanzania) were examined ... more A total of 170 adults aged 30-69 yr from the Zanzibar and Pemba Islands (Tanzania) were examined for tooth loss, dental caries and loss of periodontal attachment. The cause of tooth loss was recorded from information given by the examinee to a Kiswahili-English interpreter. Dental caries were recorded according to the depth of the lesion, i.e. involving enamel, dentin or pulp, respectively. Loss of attachment was measured as the distance in mm from the CEJ to the bottom of the pocket. The most severely affected surface determined the state of the tooth. The mean number of teeth present ranged from 29.5 in the youngest to 23.9 in the oldest age group. The mean number of teeth missing due to dental caries ranged between 2.1 and 7.0 teeth, and exceeded by far tooth loss due to periodontal breakdown which was only observed in the two oldest age groups. In all age groups the molars were the teeth most frequently missing and also the teeth most frequently affected by dental caries. Although a substantial number of the teeth in the older age groups demonstrated an extensive loss of attachment only a few teeth, mainly mandibular incisors, were lost due to periodontal breakdown within the age range examined.
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