Trend-analysis of dental hard-tissue conditions as function of tooth age

doi:10.1016/j.jdent.2018.05.011

Journal of Dentistry

Volume 74, July 2018, Pages 107-112

https://doi.org/10.1016/j.jdent.2018.05.011 Get rights and content

Abstract

Objective

This retrospective in-vitro study investigated tooth age effect on dental hard-tissue conditions.

Methods

Unidentified extracted premolars (n = 1500) were collected and their individual age was estimated (10–100 (±10) years old (yo)) using established dental forensic methods Dental caries, fluorosis and tooth wear (TW) were assessed using the International Caries Detection and Assessment System (ICDAS; 0–5 for crown and 0–2 for root), Thylstrup-Fejerskov (TFI; 0–9) and Basic Erosive Wear Examination (BEWE; 0–3) indices, respectively. Staining and color were assessed using the modified-Lobene (MLI) (0–3) and VITA shade (B1-C4) indices, respectively. Relationships between indices and age were tested using regression models.

Results

Starting at age ∼10yo, presence of caries increased from 35% to 90% at ∼50yo (coronal), and from 0% to 35% at ∼80yo (root). Caries severity increased from ICDAS 0.5 to 2 at ∼40yo and from ICDAS 0 to 0.5 at ∼60yo for coronal and root caries, respectively. Presence of TW increased from 25% (occlusal) and 15% (smooth-surfaces) to 100% at ∼80yo. TW severity increased from BEWE 0.5 to 2 at ∼50yo (occlusal) and ∼0.3 to 1.5 at ∼50yo (smooth-surfaces). Percentage and severity of fluorosis decreased from 70% to 10% at ∼80yo, and from TFI 1 to 0 at ∼90yo, respectively. Percentage of extrinsic staining increased from 0% to 85% at ∼80yo and its severity increased from MLI 0 to 2 at ∼70yo. Color changed from A3 to B3 at ∼50yo (crown), and from C2 to A4 at ∼85yo (root).

Conclusions

Aging is proportionally related to the severity of caries, TW, staining, and inversely to dental fluorosis. Teeth become darker with age.

Introduction

Population aging is a global trend, and the percentage of older individuals (65+) is expected to more than double over the next half century [1]. Aging is defined as the cumulative and progressive change that occurs with time, causing deterioration in structural integrity, as well as increase in disease susceptibility and debilitated function [2].

Besides improvement in dental health awareness and preventive measures, age may also impact propensity for dental diseases. Tooth aging is related to several behavioral (environmental) and biological (tooth) factors. Teeth suffer different mechanical and chemical insults throughout a person’s life. The accumulation of these experiences may affect the properties and behavior of dental hard tissues. Several microstructural changes have been correlated with age, including increase in mineral content, decrease in organic bridging ligaments at enamel rods and dentin tubular occlusion [3], [4]. These changes are likely to impact enamel and dentin mechanical, physical and chemical properties. Increase in brittleness and decrease in fracture toughness with age cause an overall reduction on the mechanical strength of enamel and dentin [4]. Other properties, including solubility, ion exchange and tooth color may also alter with age. Consequently, the susceptibility to demineralization (as in dental caries and erosion), rate of remineralization, and tooth shade may change as well. Moreover, behavioral aspects such as diet and oral hygiene may significantly impact the presence of those diseases and conditions as well as tooth appearance, including abraded fluorotic enamel and tendency to retain more extrinsic staining.

Despite the importance of this topic, scarce data are available in literature to allow deeper understandings of the age impact on dental hard-tissue conditions. Major limitations of longitudinal clinical studies, such as time and costs, prohibit conducting a comprehensive evaluation of their prevalence and severity. Meta-analyses from previous clinical studies are limited, due to lack of robust retrospective data of different ages. Considering these circumstances, we propose that a systematic laboratory approach using extracted teeth with estimated ages can be valuable. Tooth aging manifests a highly predictable developmental sequence of morphological and biochemical changes, which allows the forensic identification of an individual’s age using mathematical models [5], [6].

We hypothesized that individual’s susceptibility to dental hard-tissue diseases and conditions change throughout life, suggesting a need for age-specific clinical preventive and therapeutic protocols. In the current study, we started exploring this hypothesis by evaluating the occurrence of clinically common dental problems in a large set of extracted human premolars, with a broad age range. Our unique experimental approach consisted of using established forensic methods to estimate tooth age, and established clinical indexes to assess dental pathologies and conditions, as well as staining and color.

Section snippets

Teeth collection

A sample of 1500 extracted human premolars were randomly selected from an existing pool (approximately 18,000 premolars) at the Oral Health Research Institute (OHRI), Indiana University School of Dentistry (Indiana University IRB # NSO 911-07). This tooth-bank was compiled through teeth collection from dental practice clinics across the USA over several years. Upon receipt at OHRI, teeth were sorted, gently cleaned from tissue remnants and kept in 0.1% thymol, at 4 °C. Patient metadata (e.g.,

Results

Our sample showed similar distributions for maxillary (50.6%) and mandibular (49.4%) premolars. Although the sample represented a wide age range (9–101yo), the distribution was unbalanced at the highest end, with fewer teeth ≥ 80yo. This should be considered when interpreting and comparing data obtained from those ages. ICC revealed excellent intra-examiner agreement for average translucency (0.92), and inter-examiner agreement for TFI (0.97) and staining intensity (0.90). Acceptable

Discussion

Time, costs and ethical concerns limit the study of age’s effect on dental hard-tissue pathologies and conditions in a clinical setting. Our in-vitro approach, based on the age-estimation of unidentified extracted teeth using forensic methods, allowed us to investigate a relatively large number of teeth under very controlled conditions. We selected premolars for practical reasons since they are extracted at a wide age-range due to orthodontics, prosthodontics, and periodontal disease progress.

Conclusion

Within the limitations of our study, we concluded that the presence and severity of dental caries, tooth wear, and extrinsic staining increased with age, while of enamel fluorosis decreased. Tooth also showed to be darker with age.

Declaration of interest

The authors of this paper have no interest to declare.

Acknowledgements

Dr. Algarni received a scholarship from Taibah University, Al Madina Al Munawarah, KSA. This research was part of her thesis to be submitted in partial fulfillment of the PhD degree in Dental Sciences at Indiana University School of Dentistry (IUSD). This project was supported by the Erosive Tooth Wear Research Program of the IUSD. The authors are thankful to Mr. Aied Algarni for constructing the SQL database and website software used in this study.

References (40)

C. Lopez-Otin et al.
The hallmarks of aging
Cell
(2013)
B. He et al.
Mineral densities and elemental content in different layers of healthy human enamel with varying teeth age
Arch. Oral Biol.
(2011)
G. Gustafson
Age determination from teeth
J. Am. Dent. Assoc.
(1950)
N.X. West et al.
Prevalence of dentine hypersensitivity and study of associated factors: a European population-based cross-sectional study
J. Dent.
(2013)
H. Aboshi et al.
Age estimation using microfocus X-ray computed tomography of lower premolars
Forensic Sci. Int.
(2010)
Q. Zheng et al.
Spatial distribution of the human enamel fracture toughness with aging
J. Mech. Behav. Biomed. Mater.
(2013)
Y. Kitasako et al.
Age-specific prevalence of erosive tooth wear by acidic diet and gastroesophageal reflux in Japan
J. Dent.
(2015)
J.R. Mayoral et al.
In vivo spectrophotometric evaluation of pure enamel and enamel-dentine complex in relationship with different age groups
J. Dent.
(2013)
J. Miura et al.
Accumulation of advanced glycation end-products in human dentine
Arch. Oral Biol.
(2014)
World Population Ageing. 1950–2050: United Nations; Population Division....

M. Yahyazadehfar et al.

On the mechanics of fatigue and fracture in teeth

Appl. Mech. Rev.

(2014)

G. Johanson

Age determination from human teeth

Odont Revg

(1971)

International Caries Detection and Assessment System, ICCMS™ Guide for Practitioners and Educators

(2014)

H.M. Liversidge et al.

Developing permanent tooth length as an estimate of age

J. Forensic Sci.

(1999)

G. Bang et al.

Determination of age in humans from root dentin transparency

Acta Odontol. Scand.

(1970)

A. Thylstrup et al.

Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes

Community Dent. Oral Epidemiol.

(1978)

D. Bartlett et al.

Basic erosive wear examination (bewe): A new scoring system for scientific and clinical needs

Clin. Oral Investig.

(2008)

L.M. Macpherson et al.

Comparison of a conventional and modified tooth stain index

J. Clin. Periodontol.

(2000)

H. Soomer et al.

Reliability and validity of eight dental age estimation methods for adults

J. Forensic Sci.

(2003)

A.B. Acharya et al.

Effectiveness of Bang and Ramm's formulae in age assessment of Indians from dentin translucency length

Int. J. Legal Med.

(2009)

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View full text

Trend-analysis of dental hard-tissue conditions as function of tooth age

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Teeth collection

Results

Discussion

Conclusion

Declaration of interest

Acknowledgements

Cell

Arch. Oral Biol.

J. Am. Dent. Assoc.

J. Dent.

Forensic Sci. Int.

J. Mech. Behav. Biomed. Mater.

J. Dent.

J. Dent.

Arch. Oral Biol.

On the mechanics of fatigue and fracture in teeth

Appl. Mech. Rev.

Age determination from human teeth

Odont Revg

International Caries Detection and Assessment System, ICCMS™ Guide for Practitioners and Educators

Developing permanent tooth length as an estimate of age

J. Forensic Sci.

Determination of age in humans from root dentin transparency

Acta Odontol. Scand.

Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes

Community Dent. Oral Epidemiol.

Basic erosive wear examination (bewe): A new scoring system for scientific and clinical needs

Clin. Oral Investig.

Comparison of a conventional and modified tooth stain index

J. Clin. Periodontol.

Reliability and validity of eight dental age estimation methods for adults

J. Forensic Sci.

Effectiveness of Bang and Ramm's formulae in age assessment of Indians from dentin translucency length

Int. J. Legal Med.