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National and international patterns in older adult dentition
Tooth Replacement/Retention National and international patterns in older adult dentition Background.—Dental caries is the most common chronic condition among children and adults in the world. The impact of this disorder affects all aspects of life, especially among elderly persons, whose health and well-being are linked to the number of functioning teeth that they have remaining. The oral health status of older persons may vary between countries, but the data have been limited about this aspect. An international survey was used to determine international variations in tooth loss and tooth replacement in persons age 50 to 90 years. Methods.—The data were drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) and cover 14 European countries and Israel. Collected during 2013, the data provide internationally harmonized yet detailed information that allowed country-specific levels of attainment of oral health goals concerning tooth loss and tooth replacement. A total of 62,763 individuals age 50 to 90 years from Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, the Netherlands, Slovenia, Spain, Sweden, Switzerland, and Israel were surveyed. Participants were asked if they retained all their natural teeth (except wisdom teeth) and, depending on their answer, they were asked about how many natural teeth were missing and to what extent the missing teeth were replaced by artificial teeth (bridge, denture, or implant). These questions yielded estimates of the number of teeth overall.
proportions of persons who were edentulous tended to be similar among the older age groups. Most countries demonstrated a nearly linear decline in the number of natural teeth with increasing age. In Denmark, France, and Germany, the median number of teeth began to decrease more rapidly between ages 60 and 70 years. The spread in the distribution of natural teeth was greater among the older age groups. In most countries about 25% of the population reached edentulism before age 80 years, and 50% were edentulous by age 90 years. When considering the natural plus artificial teeth in these patients, most of the countries demonstrated a mean greater than 24 regardless of age. About 10% of the population had considerably fewer teeth at an early age, but the proportion increased among the elderly. Marked increases were noted in Estonia, Slovenia, and Spain, with some increase also seen in France and Israel. At younger ages, a large spread of the number of teeth present was observed, perhaps indicating inequality of care or access. The mean number of natural teeth varied among the countries, ranging from a low of 14.3 in Estonia to a high of 24.5 in Sweden. The median number of natural teeth also varied, with Estonia having 15.0 and Sweden having 27.0. Number of teeth overall did not vary as widely, with nearly all mean and median numbers above 25 and 27, respectively.
Results.—European country participants accounted for 98.5% of the weighted study population, which can be translated to represent 65% of the population of the European Union (EU-28) age 50 years or older in 2013. A decline in the fraction of the population with a complete set of natural teeth was noted from age 50 years onward, but with increasing age the rate of decline tended to level off. Deviations from the estimates for most countries were noted in Sweden, Denmark, and Switzerland, all of which had consistently higher proportions of people who retained all their natural teeth. Belowaverage rates of keeping all the natural teeth were noted for Estonia and Slovenia. In some countries the deviations were noted for a specific age group, such as larger numbers of younger persons in France and Germany retaining fewer teeth compared to the younger persons in other countries.
Patterns of tooth replacement differed between countries and with the number of missing teeth. When between 1 and 5 teeth were missing, full replacement was common in Austria, Germany, Luxembourg, and Switzerland, but partial replacement was noted in Israel, and no replacement in Denmark, Estonia, Spain, and Sweden. With 6 to 18 teeth missing, the fraction of persons who had any replacement increased, and when more than 18 teeth were missing, full replacement was the common response.
Edentulism was more common for the oldest groups of people. Overall, younger age groups had notably higher numbers of people with remaining natural teeth, but the
The WHO goal for edentulism is a limit of just 15% or fewer of a population at 65 to 74 years having no natural teeth remaining by 2020. The percentage of edentulous
22
Dental Abstracts
The World Health Organization (WHO) goal is for most people to retain at least 20 teeth at age 80 years. This goal was achieved by 25% of the population or fewer in most of the countries surveyed. About 50% of the populations of Sweden, Denmark, and Switzerland met this goal.
persons overall was slightly under the target. However, for Sweden, Switzerland, Denmark, France, and Germany, this goal was already realized in the 2013 data. It was unlikely to be met by Spain, Italy, Luxembourg, and Israel and rather unlikely to be attained in the remaining countries surveyed. Discussion.—Tooth loss and tooth replacement varied considerably across the population of older adults from these European countries and Israel. The average number of natural teeth was lower with older age, which was expected. Disparities were noted between countries, with a low of 15 in Estonia to a high of 27 in Sweden. High proportions of persons who retained a complete natural dentition were noted in Sweden, Denmark, and Switzerland, with low proportions in Estonia and Slovenia. Replacement of missing teeth also varied considerably between countries and depended on the number of teeth that were gone.
Clinical Significance.—These results may help in defining realistic teeth-related oral health goals for persons within specific
countries and worldwide. In addition, they can serve as a reference to indicate progress toward and achievement of goals that have already been established. Further research is needed to identify common patterns with respect to health system characteristics that could influence tooth retention or replacement. These include the organization of care, financial coverage for oral health needs, the availability and distribution of the dental workforce, and governance regarding formulation and use of professional guidelines.
Stock C, J€ urges H, Shen J, et al: A comparison of tooth retention and replacement across 15 countries in the over-50s. Community Dent Oral Epidemiol 44:223-231, 2016 Reprints available from C Stock, Inst of Medical Biometry and Informatics (IMBI), Heidelberg Univ, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany; fax: þ49(0)6221 56 41 95; e-mail: stock@im bi.uni-heidelberg.de
Zika Virus Dental provider precautions Background.—Health care workers may contract diseases that were once confined to areas outside their area of practice by working in or travelling to the tropics or subtropics and being exposed to the disease vectors. In addition, global warming is changing the limits of disease vectors’ habitats, allowing them to spread to areas that used to be too cold to survive. Recently it has been found that mosquitoes, the traditional vector for malaria and many other infectious diseases, have the ability to transmit a new pathogen—Zika virus (ZIKV). This arbovirus is becoming a threat to global health because travelers can bring the infection home with them. ZIKV Facts.—The Zika virus was first isolated from Aedes mosquitoes from Africa, with Ae. aegypti the only vector known outside of Africa. However, Ae. albopictus has also been suspected to transmit the arbovirus. The virus is detected in the blood of Zika victims and may be transmitted via blood donation, although this has been rare. It is also found in semen, urine, and saliva, and both sexual transmission and person-to-person transmission have occurred. No airborne or breastfeeding transmission has been documented. Current areas where Zika is known to be a threat include Africa, French Polynesia, Brazil and other South American
countries and territories. In fact, ZIKV disease has reached pandemic levels throughout Latin America, with Brazil having the highest number of cases, currently estimated to be between 497,593 and 1,482,701 cases, and Colombia having the next greatest number. The three dozen or so cases in the United States and those reported in Europe have all involved travelers to areas where Zika virus is already widespread. The illness caused by ZIKV is similar to mild dengue infection, with fever, maculopapular rash, arthralgia, and conjunctivitis. It begins 3 to 15 days after exposure to the virus and lasts 3 or 4 days to a week. Zika infection is generally mild or asymptomatic. Only rarely do adults die, and these deaths are usually caused by neurological complications such as Guillain-Barre syndrome (GBS). The outbreak in Brazil brought attention to reports of poor pregnancy outcomes, ranging from abortions to birth defects such as microcephaly. The association between ZIKV and microcephaly remains controversial, but concerns have been raised by the surge of microcephaly in areas where there are ZIKV disease outbreaks.
Volume 62
Issue 1
2017
23
proportions of persons who were edentulous tended to be similar among the older age groups. Most countries demonstrated a nearly linear decline in the number of natural teeth with increasing age. In Denmark, France, and Germany, the median number of teeth began to decrease more rapidly between ages 60 and 70 years. The spread in the distribution of natural teeth was greater among the older age groups. In most countries about 25% of the population reached edentulism before age 80 years, and 50% were edentulous by age 90 years. When considering the natural plus artificial teeth in these patients, most of the countries demonstrated a mean greater than 24 regardless of age. About 10% of the population had considerably fewer teeth at an early age, but the proportion increased among the elderly. Marked increases were noted in Estonia, Slovenia, and Spain, with some increase also seen in France and Israel. At younger ages, a large spread of the number of teeth present was observed, perhaps indicating inequality of care or access. The mean number of natural teeth varied among the countries, ranging from a low of 14.3 in Estonia to a high of 24.5 in Sweden. The median number of natural teeth also varied, with Estonia having 15.0 and Sweden having 27.0. Number of teeth overall did not vary as widely, with nearly all mean and median numbers above 25 and 27, respectively.
Results.—European country participants accounted for 98.5% of the weighted study population, which can be translated to represent 65% of the population of the European Union (EU-28) age 50 years or older in 2013. A decline in the fraction of the population with a complete set of natural teeth was noted from age 50 years onward, but with increasing age the rate of decline tended to level off. Deviations from the estimates for most countries were noted in Sweden, Denmark, and Switzerland, all of which had consistently higher proportions of people who retained all their natural teeth. Belowaverage rates of keeping all the natural teeth were noted for Estonia and Slovenia. In some countries the deviations were noted for a specific age group, such as larger numbers of younger persons in France and Germany retaining fewer teeth compared to the younger persons in other countries.
Patterns of tooth replacement differed between countries and with the number of missing teeth. When between 1 and 5 teeth were missing, full replacement was common in Austria, Germany, Luxembourg, and Switzerland, but partial replacement was noted in Israel, and no replacement in Denmark, Estonia, Spain, and Sweden. With 6 to 18 teeth missing, the fraction of persons who had any replacement increased, and when more than 18 teeth were missing, full replacement was the common response.
Edentulism was more common for the oldest groups of people. Overall, younger age groups had notably higher numbers of people with remaining natural teeth, but the
The WHO goal for edentulism is a limit of just 15% or fewer of a population at 65 to 74 years having no natural teeth remaining by 2020. The percentage of edentulous
22
Dental Abstracts
The World Health Organization (WHO) goal is for most people to retain at least 20 teeth at age 80 years. This goal was achieved by 25% of the population or fewer in most of the countries surveyed. About 50% of the populations of Sweden, Denmark, and Switzerland met this goal.
persons overall was slightly under the target. However, for Sweden, Switzerland, Denmark, France, and Germany, this goal was already realized in the 2013 data. It was unlikely to be met by Spain, Italy, Luxembourg, and Israel and rather unlikely to be attained in the remaining countries surveyed. Discussion.—Tooth loss and tooth replacement varied considerably across the population of older adults from these European countries and Israel. The average number of natural teeth was lower with older age, which was expected. Disparities were noted between countries, with a low of 15 in Estonia to a high of 27 in Sweden. High proportions of persons who retained a complete natural dentition were noted in Sweden, Denmark, and Switzerland, with low proportions in Estonia and Slovenia. Replacement of missing teeth also varied considerably between countries and depended on the number of teeth that were gone.
Clinical Significance.—These results may help in defining realistic teeth-related oral health goals for persons within specific
countries and worldwide. In addition, they can serve as a reference to indicate progress toward and achievement of goals that have already been established. Further research is needed to identify common patterns with respect to health system characteristics that could influence tooth retention or replacement. These include the organization of care, financial coverage for oral health needs, the availability and distribution of the dental workforce, and governance regarding formulation and use of professional guidelines.
Stock C, J€ urges H, Shen J, et al: A comparison of tooth retention and replacement across 15 countries in the over-50s. Community Dent Oral Epidemiol 44:223-231, 2016 Reprints available from C Stock, Inst of Medical Biometry and Informatics (IMBI), Heidelberg Univ, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany; fax: þ49(0)6221 56 41 95; e-mail: stock@im bi.uni-heidelberg.de
Zika Virus Dental provider precautions Background.—Health care workers may contract diseases that were once confined to areas outside their area of practice by working in or travelling to the tropics or subtropics and being exposed to the disease vectors. In addition, global warming is changing the limits of disease vectors’ habitats, allowing them to spread to areas that used to be too cold to survive. Recently it has been found that mosquitoes, the traditional vector for malaria and many other infectious diseases, have the ability to transmit a new pathogen—Zika virus (ZIKV). This arbovirus is becoming a threat to global health because travelers can bring the infection home with them. ZIKV Facts.—The Zika virus was first isolated from Aedes mosquitoes from Africa, with Ae. aegypti the only vector known outside of Africa. However, Ae. albopictus has also been suspected to transmit the arbovirus. The virus is detected in the blood of Zika victims and may be transmitted via blood donation, although this has been rare. It is also found in semen, urine, and saliva, and both sexual transmission and person-to-person transmission have occurred. No airborne or breastfeeding transmission has been documented. Current areas where Zika is known to be a threat include Africa, French Polynesia, Brazil and other South American
countries and territories. In fact, ZIKV disease has reached pandemic levels throughout Latin America, with Brazil having the highest number of cases, currently estimated to be between 497,593 and 1,482,701 cases, and Colombia having the next greatest number. The three dozen or so cases in the United States and those reported in Europe have all involved travelers to areas where Zika virus is already widespread. The illness caused by ZIKV is similar to mild dengue infection, with fever, maculopapular rash, arthralgia, and conjunctivitis. It begins 3 to 15 days after exposure to the virus and lasts 3 or 4 days to a week. Zika infection is generally mild or asymptomatic. Only rarely do adults die, and these deaths are usually caused by neurological complications such as Guillain-Barre syndrome (GBS). The outbreak in Brazil brought attention to reports of poor pregnancy outcomes, ranging from abortions to birth defects such as microcephaly. The association between ZIKV and microcephaly remains controversial, but concerns have been raised by the surge of microcephaly in areas where there are ZIKV disease outbreaks.
Volume 62
Issue 1
2017
23