The Impact of Tooth Retention on Health and Quality of Life in Older Adults

America is aging rapidly, and older adults (age ≥65 y) are retaining more of their natural teeth, a trend expected to continue. Although much is known about the impact of complete tooth loss on overall health and well-being, less is known about the effect of partial tooth loss. We conducted a systematic review to advance our understanding of the impact of retaining ≥20 teeth on health and quality of life (QoL) in older adults using two tooth retention concepts – shortened dental arch (SDA) and functional dentition (FD). We searched seven scientific databases from 1981–2019 for publications on tooth retention and outcomes and impact on health and QoL. Ninety-six studies were included in this review. Most were assessed with low risk of bias (n=74) and of good quality (n=73) using the revised Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Tooth retention was defined as FD in 82 studies, SDA in 10 studies, and four studies used both. Most were cross-sectional and only seven were from the US. We found an increasing trend among published studies in using FD and SDA to describe natural dentition retention (50 articles in 2015-19 vs one in 1995-99). In general, having <20 teeth was associated with increased likelihood for functional dependence, onset of disability, declines in higher-level functioning, and lower QoL. New information is needed to facilitate clinical decision-making, care-giving, and to help health providers better meet the future oral health needs of an aging US population.

Hyperdentia in adult patient in the ENT practice

According to the literature, such dentition anomaly as supernumerary teeth is more common in the practice of a dentist than of an otorhinolaryngologist. Clinical manifestations of this pathology in adults are less frequent than in children. Periodically, there appear descriptions of individual cases of hyperdentia, in which the tooth is located in the nasal cavity, paranasal sinuses, orbit. It is not always possible to find such a tooth on examination, therefore, additional research methods help to determine the location and pathological process in more detail. We present our clinical observation of tooth retention and ectopia in the nasal cavity and upper jaw. The diagnosis was confirmed by the data of endoscopic examination and computed tomography of the paranasal sinuses. The ectopic tooth was found before the development of pronounced local inflammation. The tooth was removed from the nasal cavity using endoscopic techniques, no communication between the nasal cavity and the oral cavity was found. The postoperative period was uneventful. On examination two weeks after the operation, no pathological changes in the nasal cavity, paranasal sinuses were found, as well as defects in the mucous membrane and bone part of the nasal cavity floor.

Health Behaviors and Tooth Retention among Older Adults in China: Findings from the 4th Chinese National Oral Health Survey

Background This study aimed to examine the association between oral health behaviors and tooth retention among Chinese older adults. Methods Data were used from the 4th Chinese National Oral Health Survey, a nationally representative sample. The sample included 9054 older adults aged 55 to 74. A chi-square test was used for univariate analysis. Multivariate Logistic regression was used to explore the association between health behaviors and the number of remaining teeth. Results The average number of remaining teeth in the sample was 24.4 ± 7.8. There was a higher proportion of residents living in urban areas with ≥ 20 teeth than rural residents (83.2% vs 79.4%, χ2 = 20.862, p = 0.000); and a higher proportion of individuals with high education levels with ≥ 20 teeth compared to those with low education levels (χ2 = 148.168, P = 0.000). Logistic regression models showed that older adults who used toothpicks (OR = 3.37, 95% CI: 2.94–3.85), dental floss (OR = 1.93, 95%CI: 1.05–3.53), toothpaste (OR = 3.89, 95%CI: 3.14–4.83); and never smoked (OR = 1.43 95%CI: 1.20–1.70) were more likely to retain 20 or more natural teeth; whereas older adults who had a dental visit were less likely to retain 20 or more natural teeth (OR = 0.45, 95% CI: 0.39-052). Conclusion This study did not find the association between frequency of tooth brushing and tooth retention. This study demonstrates that improvement of oral hygiene and preventive dental care are key for good oral health.

Unusual case report of an adenomatoid odontogenic tumor in the mandible: 3-years of follow-up

This case report showed an AOT in a 12-year-old female patient referred for orthodontic-surgical of both impacted right mandibular canine and lateral incisor. Cone beam computed tomography revealed a well-defined mixed hyperdense/hypodense lesion, involving the crown of the mandibular lateral incisor. The surgery consisted in surgical exposure of the mandibular right canine and lateral incisor, bonding of the lateral incisor for orthodontic traction and curettage of the mandibular lesion. Histopathological examination revealed several columnar epithelial cells with minimal stromal connective tissue, lobular pattern and rosettes and duct-like structures, confirming the diagnosis of AOT. After, the patient was referred for orthodontic traction of the impacted teeth. At 1 and 3-year postoperatively, follow-ups examinations showed extensive bone repair, resolution of the tooth-retention and absence of recurrence. Although AOT is an uncommon lesion in the mandible, it should be considered in the differential diagnosis of the mixed profile lesions in this region.

Nonsurgical Treatment Outcomes and Prognostic Factors for Cases with Lesions of Endodontic Origin in a Private Practice

Aim: The prognosis of the healing of an apical lesion is extremely important for the treatment decision for tooth retention or implantation. In several studies, the presence of an apical lesion was shown to be a significant factor in both primary treatment and non-surgical retreatment. The aim of the present study was the retrospective investigation of the prognosis of the healing of bony apical lesions of teeth, which were treated endodontically. The evaluation contained various clinical parameters that can influence the success of the root canal treatment. Materials and Method: 62 teeth were treated in 52 patients during the study period. The treatment was carried out by a specialist in endodontics with the aid of the dental surgical microscope and a two-stage procedure. Two certified examiners assessed the radiological results after three to 72 months. Preoperative and postoperative information related to potential prognostic factors was evaluated. Results: Results of the 62 apical lesions, 82.3% (examiner 1) - 88.75% (examiner 2) were classified as healed. Of all the prognostic factors analyzed, none showed a significant influence on the treatment success. The success rate of the present study was in the range of comparable studies. Conclusions: The apical lesion can be treated with relatively high success rates if general micro-endodontic procedures are followed.

Example of managing a patient with a complex retention (analysis of a clinical case)

Tooth retention is a fairly common orthodontic anomaly. Of all the retained teeth, canines are most commonly involved. There are several approaches to treating retention, including displacement and removal. When choosing treatment strategies, localization of the retained tooth is of great importance. In this report, we sought to present an example of the removal of one of such difficult-retained teeth.

Tooth Retention and Health Behaviors: Findings From the 4th Chinese National Oral Health Survey

This study aimed to investigate the association between tooth retention and health behaviors among Chinese older adults. Data was used from the Chinese 4th National Oral Health Survey, a national representative sample. The sample included 9054 older adults age 55-74. The control variables included age, gender, residence, region, education level, occupation, periodontal health, self-reported oral health, and self-reported general health. Logistic regression models shows that older adults who used tooth picks (OR=3.37, 95% CI: 2.94-3.85), dental floss (OR=1.93, 95%CI: 1.05-3.53), and toothpaste (OR=3.89, 95%CI: 3.14-4.83), and never smoked (OR=1.43 95%CI: 1.20-1.70) were more likely to retain more than 20 natural teeth; while having dental visit had the opposite association (OR = 0.45, 95% CI: 0.39-052). Unexpectedly, this study did not find frequency of toothbrushing was associated with tooth retention. This study suggest that improving oral hygiene and preventive dental care are key for good oral health. .

Cost-effectiveness of Artificial Intelligence for Proximal Caries Detection

Artificial intelligence (AI) can assist dentists in image assessment, for example, caries detection. The wider health and cost impact of employing AI for dental diagnostics has not yet been evaluated. We compared the cost-effectiveness of proximal caries detection on bitewing radiographs with versus without AI. U-Net, a fully convolutional neural network, had been trained, validated, and tested on 3,293, 252, and 141 bitewing radiographs, respectively, on which 4 experienced dentists had marked carious lesions (reference test). Lesions were stratified for initial lesions (E1/E2/D1, presumed noncavitated, receiving caries infiltration if detected) and advanced lesions (D2/D3, presumed cavitated, receiving restorative care if detected). A Markov model was used to simulate the consequences of true- and false-positive and true- and false-negative detections, as well as the subsequent decisions over the lifetime of patients. A German mixed-payers perspective was adopted. Our health outcome was tooth retention years. Costs were measured in 2020 euro. Monte-Carlo microsimulations and univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability at different willingness-to-pay thresholds were quantified. AI showed an accuracy of 0.80; dentists’ mean accuracy was significantly lower at 0.71 (minimum–maximum: 0.61–0.78, P < 0.05). AI was significantly more sensitive than dentists (0.75 vs. 0.36 [0.19–0.65]; P = 0.006), while its specificity was not significantly lower (0.83 vs. 0.91 [0.69–0.98]; P > 0.05). In the base-case scenario, AI was more effective (tooth retention for a mean 64 [2.5%–97.5%: 61–65] y) and less costly (298 [244–367] euro) than assessment without AI (62 [59–64] y; 322 [257–394] euro). The ICER was −13.9 euro/y (i.e., AI saved money at higher effectiveness). In the majority (>77%) of all cases, AI was less costly and more effective. Applying AI for caries detection is likely to be cost-effective, mainly as fewer lesions remain undetected. Notably, this cost-effectiveness requires dentists to manage detected early lesions nonrestoratively.