Dr Mark O'Donnell B.D.S
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Latest research challenges whether many people with tooth loss really need dentures
An Australian study has found that people with tooth loss do not suffer lower quality of life provided they still have a certain number and type of teeth left.
In dentistry terms, these patients are considered to have "shortened dental arches", enabling them to maintain functional use of many teeth. The researchers say there is a cutting off point at which tooth loss interferes with quality of life, but patients only need dentures when they reach that cutting off point.
The study, based on data from more than 2,700 Australians, is to be published in a future issue of the journal Community Dentistry and Oral Epidemiology. It challenges the idea that if people experience tooth loss, they will need dentures, bridges, implants or other corrective processes to replace the missing teeth. Researchers found that it depends on the position of the teeth that have been lost, as well as the number. Most people have 28 adult teeth, plus four wisdom teeth, but it is possible to have significantly fewer teeth as long as they are in the right positions and in the right numbers.
These findings are significant both for patients and for dental health systems. It raises the question of how to allocate resources, especially if many people are currently receiving dentures or other corrective procedures when they may not need to do so. Resources could instead be allocated to the prevention of further tooth loss, diagnostic services and follow-up for the patient, said the researchers.
If a dental implant fails, try again
If a dental implant does not fuse with the jawbone, chances are still good that a second implant will work out, says a study published in the online issue of the journal Clinical Oral Implants Research.
The study was done by researchers at Shanghai Jiao Tong University in China. They focused on people who had early implant failure, which happens when the metal implant and the jawbone do not fuse together.
The 66 people in the study had their failed implants replaced with new implants, and researchers then kept track of them for an average of six years. During that time, three people dropped out of the study. At the end of the study, 91% of the second implants were considered successful.
The authors concluded that early implant failure was not a barrier to placing another implant at the same place. They noted that it is important to wait for tissues and bone to heal before placing the second implant.
Decay or not? Watchful waiting is often helpful
There's a white spot on a tooth, but x-rays don't show decay. What should dentists do?
A study from the National Dental Practice-Based Research Network in the US had dentists keeping an eye on 1,033 questionable spots for 20 months. All of the spots were on chewing surfaces of teeth. The spots were not decay; they were white or stained compared with the rest of the tooth, or they felt rough. Besides monitoring the spots, the dentists gave people instruction on proper brushing and flossing. Sometimes they prescribed fluoride treatment.
After 20 months, 4% of the spots had deteriorated so that dentists decided to place fillings. Another 6% received plastic sealants (coatings that cover the tooth and protect it from further decay). Molars and children's teeth were the most likely to get a filling or sealant. The dentists intend to monitor the other 90% of teeth.
Nearly all US adults and 75% of children have had tooth decay. A previous study by this group of dentists found that 34% of people have at least one questionable spot on the chewing surface of a tooth.
The group published another study earlier in the year that looked at the treatment of questionable spots. In that study, more than half of the spots chosen for fillings did not actually need to be filled. Some had no decay, some had inactive decay, and some had decay limited to the enamel.
The authors suggest that long-term monitoring is a reasonable option for these spots.
The study appears in the November issue of the Journal of the American Dental Association.