This document summarizes factors that affect tooth mortality and risk of tooth loss. It discusses several landmark studies that show supportive periodontal therapy can significantly reduce tooth loss. Common reasons for extraction include severe caries, periodontal disease, trauma, and failed root canals. Factors like furcation involvement, residual periodontal support, and mobility also impact tooth loss risk. Studies found greater loss of attachment and smoking increased risk, while regular supportive care lowered it.

1. Supportive periodontal therapy
Tooth mortality
DR RAMYA GANESH
SENIOR LECTURER
MALABAR DENTAL COLLEGE AND RESEARCH CENTRE

2. Contents
• Introduction
• Common reasons for extraction
• Landmark studies
• Factors affecting tooth mortality
• Risk factors affecting tooth mortality
• Conclusion
• References

3. Introduction
Reversal of
periodontal disease
and reduction in
tooth loss

4. Common causes of tooth loss!!
Prostheses Third molars Trauma
Failed root
canal
treatment
Orthodontic
treatment
Grade III
mobile teeth
Severe
caries
other

5. Tooth position within
dental arch
Furcation involvement
Iatrogenic factors
Residual periodontal
support
Mobility
Factors affecting tooth mortality

6. Tooth position within dental arch
Early clinical surveys have associated the prevalence
and severity of periodontal diseases with
malocclusion and irregularities of tooth position.
Ditto and hall 1954 ; Bilimora 1963; beagre and
james 1962; Geiger 1962,gould and picton 1962
Ingervall et al 1977
Buckley 1980
Griffith and addy 1981
Horup et al 1987

7. Furcation involvement
Multirooted teeth appear to be at high risk for
tooth loss during maintainence phase.
Kalkwarf and Reinhardt 1988 ; Hirschfield and
Wassermann 1978; McFall 1982
Clark et al
Burton et al
Wassermann et al

8. Iatrogenic factors
Overhanging margins and ill fitting crown margins – plaque
retention ….increased prevalence of periodontal lesions.
Lang et al 1983
Kirkstrom et al 1995

9. Residual periodontal support
Teeth with healthy periodontal support can function
either individually or as abutments for many years
without further loss of attachment.
Nyman and Lindhe 1979
Nyman and Ericcsson 1982
Teeth…… treated periodontally …….abutment in fixed
bridgework …….amount of residual periodontal support.
Bragger et al 1990

10. Mobility
2 factors contribute to tooth mobility:
- Unidirectional or multidirectional traumatic forces
- Height of periodontal supporting structures.
Persson et al1980,
Baume et al 1981

11. Risk factors for tooth loss

12. Ageing increased the risk of tooth loss in periodontally compromised
pts.
- Page and beck et al
- Burt et al
Ageing

13. Studies associate greater periodontal attachment loss with a
higher rate of tooth loss
- Burt et al
- Bauma et al
Loss of attachment

14. Smoking may increase the risk for loss of tooth and reduction bone height
even if the standard of oral hygiene is maintained . [Bergstorm et al ]
Study was done among 9,032 men and 14,344 women which included current cigarette smokers, and past
cigarette smokers and was found that there was an increased tooth loss among current smokers as compared
to past smokers and also the effect of smoking was seen to continue for a period of 5 years after cessation of
smoking. [ Susan et al 2016]
Smoking

15. 51 per cent of lower central incisors presented with >50 per cent loss of
attachment.
Bauma et al
Tooth type

16. STUDIES DONE IN ASSOCIATION OF TOOTH LOSS

17. Lovdal A , Arno A, Schei O in 1961
In 1428 factory workers ….subgingival scaling every 3-6 months
after 5 year
interval
Tooth loss was significantly reduced in all pts

18. Ramford et al 1974
SRP was done in 104 pts comprising a total of 2604 teeth
After 1- 7 years of
treatment 53 teeth
were lost
32 teeth were lost
during 1st and 2nd
years after initiation
of treatment
21 teeth were lost
in a random
pattern over next 6
years
Concluded that loss of
teeth due to advanced
periodontal disease after
treatment was minimal.

19. Lindhe et al 1975
Subjects were 75 pts who had lost 50% or
more of periodontal support
Treatment
No teeth lost ……5 years
14 years…..isolated areas of recurrence
of periodontal disease

20. Ross et al 1978
180 pts who had been treated for chronic destructive periodontal disease
a total of 141 teeth were lost
one in 5 pts lost 3 teeth
10 years of
follow up

21. Loe h et al 1986
Population
First population group consisted of
565 male non dental students and
academicians between 17 and
30+years from oslo Norway
Second group consisted of 480
male tea laborers of sri lankan
population.
-17 year old Norwegian ……27.4 teeth
present out of 28 possible
-No loss of teeth….20s and 30s
-40 years of age……27.1 and the mean
mortality rate was 0.01 teeth per year
-15 year old had 27 teeth present and
the 40 year old had 25.6 teeth.
-The mean mortality rate …..0.1 and 0.3
teeth per year.
-Teeth with deep periodontal lesions
started to exfoliate in Sri Lankans as
they approached 40 years of age.
30 -35 years
follow up

22. 53% of Blacks and 29% of Whites lost at least one tooth. Blacks lost 13% of their
remaining teeth compared with 4% for Whites.
Blacks and whites with tooth loss
Drake et al 1995
Data was collected from 263 Blacks and 228
Whites by dental examinations and interviews
3 year follow
up
Stimulated saliva of blacks
………higher counts of
p.intermedia
Stimulated saliva of
whites……higher counts of
lactobacillus

23. • Hirshfield et al 1978
600 pts of 15 to 53 years with chronic periodontitis were
periodontal treated
Out of 15,666 teeth …..1,110-- periodontal reasons , 666 teeth----- questionable prognosis,
1464 teeth with furcation teeth were lost.
Follow up of 22
years
Downhill
4- 9 teeth lost
Extreme downhill
10 to 23 teeth

24. Relationship between metabolic syndrome and tooth loss
Middle aged adults , 2107
participants
5 year
follow up
Compared to those with no metabolic
components, participants with ≥3
components had an increased risk of tooth
loss Michiko furuta et al 2016

25. Life style correlation and tooth loss
Mid western
population
Tooth loss is found to be more in older age group patients with history of
smoking of more than 5 years along with systemic disease.
Thimothy et al 2013

26. Diabetes and tooth loss
100 diabetic and 100 non diabetic individuals aged 30 to 60 years
Number of mean missing teeth in diabetic individual was
found to be 6.45 % as compared to 1.43 % in control group
Charlotte Rodrigues et al
2015

27. Conclusion
Tooth risk assessment encompasses an estimation of various factors to
evaluate functional stability. Risk assessment at tooth level may be
useful in evaluating the prognosis and furcation of individual teeth and
may indicate the need for specific therapeutic measures during patient
visits. Hence prevention of tooth loss must be ensured by dentist by
advocating SPT and educating and motivating patients to take care of
their oral hygiene.

28. • Textbook of jan Lindhe 6th edition chapter 60 supportive periodontal therapy
• Textbook of clinical periodontology 11th edition chapter 79 results of periodontal therapy
• Ong, G., 1998. Periodontal disease and tooth loss. International dental journal, 48(S3),
pp.233-238.
• Bailit, H.L., Braun, R., Maryniuk, G.A. and Camp, P., 1987. Is periodontal disease the primary
cause of tooth extraction in adults?. The Journal of the American Dental Association, 114(1),
pp.40-45.
• Renvert, S. and Persson, G.R., 2004. Supportive periodontal therapy. Periodontology
2000, 36(1), pp.179-195.
• Axelsson, P., Nyström, B. and Lindhe, J., 2004. The long‐term effect of a plaque control
program on tooth mortality, caries and periodontal disease in adults. Journal of clinical
periodontology, 31(9), pp.749-757.
References