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The Occurrence of Retained Roots in Association with Oral Health Among the Adult Population of Finland1
Abstract
In the present study the association between the occurrence of retained roots and several oral status factors was studied using a representative sample of 8,000 Finnish adults 30 yrs of age and over. The overall prevalence rate of dentate subjects with roots was 21%, a rate consistently higher among men. In the age category 65+ yrs, the prevalence rate was 35%. Among subjects with at least one root the average number of roots was 2.7. Those having removable denture(s) and a number of filled teeth showed a decreased probability of having root(s). Among those having root(s) the greater number of roots was associated with increasing age and with increasing number of remaining and decayed teeth.
... In a population study of clinically visible roots alone, a higher occurrence of retained roots in men was reported [2]. However, the sex-difference was not apparent when using linear regression analysis [15]. ...
The aim of this study was to assess the occurrence and nature of retained dental roots and their associations with demographics in the Finnish adult population. From the cross‐sectional nationwide Health 2000 Survey of the Finnish population aged 30 years and older, 6005 participants with clinical oral examination and panoramic radiographs were included. Occurrence and characteristics of all retained dental roots were examined. Statistical analyses included χ2, Kruskal–Wallis and Mann–Whitney U tests, and SAS‐SUDAAN calculations. The mean age of the 6005 participants (46% men and 54% women) was 53 (SD 14.6) years. At least one retained dental root was observed in 13% (n = 754) of the participants. The 1350 retained roots included 461 (34%) roots retained entirely in bone and 889 (66%) partly in bone. The most common location of a retained dental root was the third molar region. Occurrence of retained roots partly in bone was associated with male sex and lower education. Occurrence of retained third molar roots entirely in bone was associated with female sex, younger age, higher education, and living in a city. Among all retained dental roots, the preponderance of third molars emphasized the demanding nature of extracting the third molar in women.
Abstract The association between an employer-provided dental benefit scheme and dental status was studied in male industrial workers in southern Finland in 1994. A total of 325 workers (age 38–65 yrs) with access to subsidized dental care and 174 controls completed a multiple-choice questionnaire followed by clinical examinations. One or more carious teeth was registered in 19% of the subsidized group and 50% of the controls (P<0.001). For subjects with retained roots the proportions were 2% and 15%. respectively (P<0.0()1). Among those with caries the mean number of carious teeth was 2.1 (SD 2.0) in the subsidized group, and 3.2 (SD 3.8) in the control group (P<0.05). The groups did not differ significantly in numbers of teeth or filled teeth. The probability of having one or more carious teeth was negatively associated with access to subsidized dental care, with a recall or check-up as the reason for the last dental visit, and with having had the last dental visit within the past two years. The results showed that the dental benefit scheme resulted in less untreated caries.
The association between an employer-provided dental benefit scheme and dental status was studied in male industrial workers in southern Finland in 1994. A total of 325 workers (age 38-65 yrs) with access to subsidized dental care and 174 controls completed a multiple-choice questionnaire followed by clinical examinations. One or more carious teeth was registered in 19% of the subsidized group and 50% of the controls (P < 0.001). For subjects with retained roots the proportions were 2% and 15%, respectively (P < 0.001). Among those with caries the mean number of carious teeth was 2.1 (SD 2.0) in the subsidized group, and 3.2 (SD 3.8) in the control group (P < 0.05). The groups did not differ significantly in numbers of teeth or filled teeth. The probability of having one or more carious teeth was negatively associated with access to subsidized dental care, with a recall or check-up as the reason for the last dental visit, and with having had the last dental visit within the past two years. The results showed that the dental benefit scheme resulted in less untreated caries.
178 totally or partially edentulous patients attending the clinics of the Faculty of Odontology, Karolinska institute, were examined by panoramic radiography.
In the alveolar processes a total of 84 pathological findings were registered, 0.17 per edentulous mandible and 0.38 per edentulous maxilla. There were 41 retained roots, 16 impacted teeth, 16 sclerotic bone areas, 5 osteolytic areas, 4 cystlike radiolucencies, 1 bone defect and 1 metal fragment. Mucosal hyperplasia in the maxillary sinueses was observed in 37 cases. Soft tissue calcifications around the mandibular rami were observed in 8 patients. None of the pathological findings had caused distinct symptoms. No correlation between the frequency of pathological findings in the jaws and the time the jaw had been edentulous could be determined.
Which, if any, of the following statements are true of multiple linear regression?a It may be used to control confounding in cohort studiesb It can only assess a linear (straight line) relationship between variablesc It gives misleading results when two or more independent variables are highly correlatedd It can be …
Abstract A representative sample (n= 8000) was drawn from the population aged 30 years and over, registered as living in Finland. Periodontal disease status was recorded according to the modified Periodontal Treatment Need System (PTNS). Plaque retentions were examined separately. Of the subjects with four or more teeth 3.4% had a healthy periodontal status, while 10.2% of the jaw quadrants were healthy Plaque retentions were found in 96.6% of the subjects and 90.9% of the jaw segments. Periodontal treatment need was calculated in three ways and was 195± 111 (S. D.) min when the calculation was based on WHO recommendations (1978). Number of teeth, age, sex, caries and filling scores, and education explained about 30% of the treatment need when tested by multiple linear regression analysis.
A comprehensive study of 3,874 routine full-mouth radiographs yielded the following findings concerning retained roots and teeth: 1.1. The incidence of retained roots discovered in routine full-mouth radiographs of all types of patients was close to 20 per cent. Twice as many roots are retained in the maxilla as in the mandible, and over six times as many are retained in posterior areas as in anterior areas.2.2. The incidence of retained roots in edentulous jaws was close to 24 per cent, and the incidence of retained and embedded teeth was 2.6 per cent.3.3. The over-all incidence of radiolucencies associated with retained roots was over 50 per cent.4.4. Of these retained roots, those exposed to the oral cavity were involved with radiolucent areas in 81 per cent of the cases, while roots lying beneath the surface or completely encased in bone had radiolucent areas around them in 20 per cent of the cases.5.5. The size of the retained root had no influence on the incidence of associated radiolucent areas.6.6. There was no difference in the numbers of radiolucencies between roots found in the maxilla and those found in the mandible, but a markedly higher incidence of involvement was noted in anterior areas as compared to posterior areas.7.7. The incidence of retained roots of deciduous teeth which remain in the jaws is extremely small (1.2 per cent).8.8. Retention of deciduous teeth occurred in one out of every sixty-three patients. The most frequently retained deciduous tooth was the maxillary cuspid.The significance of these findings is discussed, and the need for comprehensive radiographic examination of all patients is emphasized.
The jaws of 368 edentulous patients are evaluated radiographically and the findings presented. Patients were selected at random from those attending the Oral Diagnostic Clinic of the Dental School of the University of Athens. Pathological findings consisting of residual roots, impacted teeth, radiopaque and radiolucent areas, foreign bodies, and soft tissue calcification were found in 37.0 percent of the patients examined. These conditions were not identifiable from the history or the clinical examination of the patients; 47 patients had been denture wearers for a period of 1 to 5 years. Analysis of the type, incidence, and location of the pathological conditions found in this study stresses the necessity of radiographic examination of the jaws of all edentulous patients prior to construction of complete dentures.
Thirty-four patients provided with removable partial dentures (RPDs) were reexamined after 3 yr. Caries that had developed during the period were analyzed with regard to the following potential caries risk factors: Lactobacilli, Streptococcus mutans, flow rate and buffer pH of paraffin stimulated saliva, oral hygiene and daily sucrose intake. Of 436 initially intact surfaces 31 (7.1%) had decayed and/or were restored during the 3-yr period. Caries recurred in 26 (6.2%) out of 422 initially restored surfaces during the same period. The development of new or recurrent caries had no correlation to whether or not the surfaces affected were in contact with the RPDs. No single caries risk factor seemed to be sufficiently closely correlated to the number of caries lesions developed to be used alone in the selection of patients at risk. When the sum of assumed negative factors was used a correlation was found for the group as a whole between the number of negative factors and the development of caries. However predicting the development of caries in any individual case seems to be more complicated.
Oral health status and dental treatment needs were investigated in 50 randomly selected patients in the geriatric department of a Danish district hospital. All the participants were examined clinically and radiologically. Oral health status was generally poor. Ten participants required no dental treatment. The remaining 40 participants needed some kind of treatment, mainly prosthetic and surgical. The 40 participants requiring treatment were all asked whether or not they wanted the proposed treatment. Only 18 were interested. The participants were divided into three groups according to their medical status. 28 participants had a poor medical status. It was estimated that these patients once having left the hospital would never be able to visit a dentist on their own initiative, and therefore should be treated institutionally.
Using a representative sample of 5028 dentulous Finnish adults the occurrence of dental caries was studied among removable partial denture (RPD) wearers and non-wearers. Of the subjects wearing no RPD(s) 61.4% had one or more carious teeth, among those wearing a single RPD the figure was 60.5% and among those wearing RPDs in both jaws 62.7%, respectively. When sociodemographic background, other oral status measures than caries and oral health care habits were simultaneously controlled, subjects wearing RPDs in both jaws had slightly increased (P less than 0.05) probability of having one or more carious teeth compared to those with no RPD(s). Subjects with a single RPD did not have a statistically significantly increased probability of having carious teeth. Among those 3075 subjects who had one or more carious teeth the wearing of one or two RPDs did not significantly increase the number of carious teeth. Because the subjects wearing RPDs in both jaws were seen to have a slightly increased risk of having caries, this confirms the view that dentists should emphasize good oral hygiene habits and regular dental attendance among RPD wearers.
The need for an epidemiological method which focuses upon the problems of missing teeth, tooth spaces and prosthetic treatment is emphasized. From the prosthetic viewpoint the distinction between missing teeth and tooth spaces must be made and examples are given to show that up to 20 per cent of missing teeth do not give rise to tooth space. The presentation of the prosthetic parameters per tooth is recommended using the six alternatives: tooth present; tooth missing (open space); tooth missing (closed space); tooth replaced by pontic in fixed bridge, by removable partial denture, or by complete denture. In the presentation of the mean number of existing teeth, fixed bridge pontics should be included as they serve as natural teeth both aesthetically and functionally. Data on removable dentures, or edentulism without denture wearing, should be presented in such a way that comparisons at jaw level as well as at person level can be made. A system for this is described. The method may be used in industrialized countries where there is much prosthetic treatment as well as in developing countries with few health services. Comparisons will still be meaningful.
Panoramic radiographs of 289 patients who were edentulous were investigated for: root fragments, impacted teeth, radio-paque areas, radiolucent areas, foreign bodies, maxillary sinus changes, TMJ changes, and extent of bony atrophy. Comparisons were made with the results of previous studies. Technical and darkroom procedures were analyzed with regard to processing, positioning, and procedural errors.
A 14% frequency of pathologic findings was found. These findings support the conclusions of others2–5 that many edentulous patients have some dental pathosis.
Twenty-seven percent of the radiographs had processing errors and 5% had artifacts resulting from procedural errors. Only 24% of the radiographs were without gross positional errors. The most common error being anterior magnification. Under-or overdevelopment interfered with interpretation in about 10% of the films. Thirty-seven percent had condyles that were either partially or totally missing.
The information available on the rehabilitation with removable dentures among dentate subjects is contradictory. In the present study, the most common type of rehabilitation was a complete maxillary denture with or without a partial one. Nineteen per cent of men and 27% of women belonged to this category. Partial denture(s) without a complete one were worn by 11% of men and 15% of women.
The odds ratio of having partial denture(s) was significantly higher among women, among people with a medium level of income, with a regular dental attendance pattern, and with a shorter distance to the nearest dental clinic. The presence of a complete denture significantly decreased the odds ratio of having a partial denture. The effect of age was non-significant in the two youngest age categories.
The odds ratio of having a single complete denture was significantly higher among women, among people with a medium level of income and with a shorter distance to the nearest dental clinic. The presence of a partial denture and belonging to the oldest age bracket decreased the odds ratio significantly. Regularity of use of dental services had a non-significant effect.
A study of panoramic radiographs made on 114 edentulous patients was described. Six radiographic entities were identified: root fragments, retained teeth, radiolucencies, radiopacities, foreign bodies, and mental foramina at or near the crest of the residual ridge. The percent of positive findings in this study and those of previous studies support the fact that one of three edentulous patients has a potentially complicating condition within the denture base foundation. These investigations stress the necessity of radiographic examination of all edentulous patients prior to treatment with complete dentures. The high incidence of positive findings suggests not only the need for radiographic examinations of all patients, but also the frequency with which the dentist is faced with the necessity of modifying the treatment plan.
This article examines the relationship between differences in dental attendance patterns and variations in dental status. A sample of 336 dentate men and 110 dentate women were selected at random from employees of two industrial plants in N.W. England in 1980. They were given a dental examination and asked about visits to the dentist. Regression analysis showed that while the more frequent the dental visits, the lower the rate of tooth loss and the fewer the number of teeth with active decay, the higher, however, the average number of fillings. There were significant differences, moreover, between manual and non-manual workers, the former being more likely to lose their teeth and the latter to have their teeth filled, at each given age and frequency of dental visit. Though the more frequent dental attenders had the advantage over the less frequent of having, on average, a higher number of functioning teeth, restored or otherwise sound, they also had the disadvantage of having higher levels of treated disease and thus of disease experience. The results suggest that while frequent dental visits help to postpone tooth loss and to maintain dental function, they do not apparently help to prevent the onset of further disease.
Oral health and dental treatment needs were investigated in 216 disadvantaged, rural dwellers aged 20 to 60 years. Oral health was generally poor. One-third of the group was edentulous, while the dentulous persons had an average of 13 remaining teeth. Every second dentulous person had one or more residual roots. DMF teeth averaged 28.1, Gingival Index 1.59, and Oral Hygiene Index 2.87. Two-thirds of the group wore some removable denture, and every second denture was found to have major defects. According to described criteria, 96 % of the group needed some treatment. Prosthetic treatment was the most frequent requirement and applied to 69 % of the group. The estimated total treatment time per individual averaged 255 minutes. The time estimates varied markedly with age and treatment pattern.
The prevalence of retained roots among Finnish adults was evaluated by examining a representative sample of 8000 Finnish adults aged 30 or older. The participation percentage was 89.6. Retained root was recorded when more than half the height of the tooth surfaces had been destroyed by caries. The reproducibility coefficient (kappa) for clinical recordings of retained roots was 0.79 for intraexaminer cases and 0.65 for interexaminer cases. Fifteen percent of the subjects had one or more retained roots. Prevalence was twice as great among males as among females. The mean number of retained roots was 0.4 per subject. Of all teeth in the mouth, 4.4% had only the roots left. On the population level, some 343000 adult Finns were estimated to have at least one retained root.
From a representative sample of 8000 persons aged 30 yr and over, 7190 were examined clinically. Thirty-one percent were edentulous, 23% of the men and 38% of the women. Results of our study were compared with seven other nationwide studies of edentulousness in Finnish adults made during the last decade. For subjects 35-64 yr old the rate of edentulousness was lowest in our clinical study. For those over 64 yr old the rates of edentulousness varied from 54% to 67%. In general, results obtained using interviews or questionnaires gave higher percentages for edentulousness than did the clinical study. Statistical evaluation of the differences in rates found in these studies did not show edentulousness to be either increasing or decreasing in Finland during the 1970's.
Oral health and dental treatment needs were investigated in 50 randomly selected long-term medicine patients admitted to The Glostrup Hospital, University of Copenhagen, Glostrup, Denmark. All the patients were clinically and radiologically examined. Oral health generally was poor. Two-thirds (66%) of the patients were totally edentulous, 24% partially edentulous. Only 10% were dentate with no dentures. The number of remaining teeth per patient averaged 4.7, that of caries destructed teeth 1.4. All 17 patients with remaining teeth had periodontal disease, and 13 of them suffered from caries. Alveolar ridge atrophy, periapical inflammation, root remnants, impacted teeth and oral mucosal lesions were demonstrated in, respectively, 80, 22, 24, 8, and 26% of the group. In total 82% of the patients needed some kind of treatment, mainly prosthetic and oral surgery. The estimated total treatment time per patient averaged 165 min.
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