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Introduction
it is generally accepted that the number of
teeth decreases with age and that caries and
periodontal disease are the main causes of
tooth loss, although the relative impact of
these two disease entities may vary in different population groups and geographic
areas. Most of our knowledge of tooth
mortality stems from cross-sectional studies
of populations of different age and socioeconomic circumstances, and longitudinal
studies in which tooth loss can be assessed
564
L D E , ANERUD,
B O Y S E N A N D S M I T H
due to periodontal disease. Published reports on baseline data (Loe, Anerud, Boysen
& Smith 1978a) and on the rate of periodontal destruction (Loe. Anerud, Boysen &
Smith 1978b) have substantiated this notion.
T H E
N A T U R A L
H I S T O R Y
O F
Table 1
Cumulative number of observations in each
age category for all participants and for those
who appeared in all four surveys
(in parenthesis)
Age
1969-1975
and academicians
15-16
17-18
19 20
21-22
23-24
25-26
27-28
29-30
31-32
33-34
35-36
37+
81
127
150
216
232
232
174
147
75
33
14
(21)
(34)
(60)
(97)
(102)
(111)
(98)
(70)
(44)
(22)
( 9)
P E R I O D O N T A L
77
127
162
196
203
199
170
145
85
57
19
19
(34)
(58)
(72)
(95)
(96)
(104)
(91)
(85)
(59)
(38)
(18)
(16)
565
Results
1970-1977
tea laborers
D I S E A S E
Table 2
Number and types of teeth missing in both study populations at baseline in 1969 and 1970
Populatio ns
Norwegiain students aind a'c ademician s
Sri Lankai
individuals
Number
teeth lost
565
480
441
415
Mol
Max
Mand
59
59
86
212
Biciispids
Max
Mand
15B
39
51
Max
Mand
27
28
13
26
566
L O E .
A N E R U D .
B O Y S E N
A N D
S M I T H
Table 3
Average number of teeth present in Norwegian students and aoademicians that participated in
ali vaiid observation groups. 1969-1975
Years
of age
17
18
19
27,41
1969
21
20
22
23
24
25
26
27
28
29
30
31
32
34
33
36
35
37
38
26.90
27,28
27,50
27.29
27-13
26.95
27,17
27,45
26.91
27.43
27.58
27.35
27,13
27.18
26.83
27.33
27.09
27.20
27-61
27.28
26,89
27.19
27.42
27.42
26.60
27,32
27.59
27,52
26.78
27.22
26.86
27.63
216
27,16
232
27,37
232
27.27
174
27.29
147
26.93
75
27.32
33
26.86
14
1970
1971
1973
1975
Crossnctiona
Means
27.41
81
27-17
127
27.17
150
Average number of teeth present in Norwegian students and academicians that participated in
all four surveys. 1969-1975
Years
of age
17
1B
20
19
21
22
23
24
25
26
27
28
29
30
31
32
33
35
34
36
1969
27.38
26.92
27.50
27,68
26.46
26.00
27.23
26.78
1970
21
13
26
37
26
22
13
27.38
27-00
27.54
27.68
27,46
26.77
27-38
26.78
21
13
26
37
26
22
13
27,24
26,85
27.50
27,62
27.35
26.64
27.38
21
13
26
37
26
22
13
27.24
26.92
27.58
27.68
27.38
26.64
27.31
21
13
26
37
1971
\
\
1973
38
\
\
26.78 \
\
1975
37
\
27.11
26
22
13
27.07
26,89
27.09
27.11
70
44
22
\
Crosssectional
Means
27.38
27,20
21
34
60
97
102
111
98
The number and types of teeth lost in Norway during 1969-1975 and in Sri Lanka during 19701977 for those participating in the first and fourth survey
Populations
Number
individuals
Number
teeth lost
Molars
245
228
27
169
17
121
10
16
32
T H E
N A T U R A L
H I S T O R Y
O F P E R I O D O N T A L
D I S E A S E
567
Table 6
Table 7
Birth-
Number o.
",""'1'"
;.,H;..;^...,I.,
'
Six y.a,
,..,1;....
teeth lost
._
individuals
1934-39
T94O
1946
1948
1950
years old in 1969 (born in 1952) and reported back six years later had lost a total
of 3 teeth or an average of 0.09 tooth per
person over the six year period and 20 who
were 19 years old in 1969 (born in 1950)
had lost no teeth in the six years (Table 6).
None of the teeth lost between the age of
Average number of teeth present in Sri Lankan tea laborers that participated in all valid
observation groups. 1970-1977
Yean
of ge
1970
1971
14
15
16
17
18
19
20
21
22
23
27.00
27.70
27.67
27.34
27.16
40
47
69
62
77
24
26
26
27
2B
29
30
31
27.31
25 81
26.71
61
36
34
54
32
33
34
27.65
27,47
27.43
27.22
26.97
26.55
27.06
26.78
26.39
34
40
63
54
65
5T
52
32
31
26.74
26.09
26.70
24.44
29
3d
54
51
68
43
46
27
27
26.66
25.93
26.60
1973
1977
Cron.
tections
Means
25
35
36
37
38
26.11
26.63
26.91
26.88
27.00
24.63
25.63
19
22
33
27
32
27
30
19
19
25.62
26.37
24.63
26.63
85
57
19
19
27.50
27.54
27.44
27.14
27.00
26.80
26.72
26.38
77.5
127
162.5
196.5
203.5
199.5
170.5
145
LOE, A N E R U D , B O Y S EN A N D
SMITH
Average number of teeth present in Sri Lankan tea laborers that partioipated in ail four surveys.
1970-1977
Yean
of age
1970
1971
14
15
17
16
19
18
21
22
23
24
25
29
30
31
27.14
26 60
27.18
26.00
26.87
17
18
28
24
28
25
22
18
16
32
33
34
35
36
37
38
26.81
27.47
27-50
27.50
27.25
27.00
26.52
27,00
25.89
17
18
26
24
28
25
22
18
16
27.24
27.44
27.29
27.12
26.86
26.08
26.91
25.56
26.50
17
18
28
24
28
25
22
18
16
26.65
27.22
26 71
27.08
26.68
26.08
27.09
24.89
26.12
17
18
28
24
28
25
22
18
16
34.5
58
72
95
96 5
1950
' 1952
1954
28
27-33
1942
1944
27
27 75
1977
Birthyear
26
27.78
1973
Crosssect iona
Meant
20
27-00
Nu mbEirof
ind ivid uals
Nur nbe
in se'
SGve n yea
morta hty rate
1.32
1.05
104.5
91
85
59
38
18
16
.,^^ , ,. ,
(169 teeth)
Number of
individuals
T H E
N A T U R A L
H I S T O R Y
O F P E R i O D O N T A L
Discussion
AH eross-seetional studies of tooth mortahty
demonstrate that with increasing age there
is a decrease in rhe number of leelh preseni
(Brekhus 1929, Klein 1943, Belting, Massler
& Schour 1953, Krogh 1958, Sandier &
Stahl 1960, Johnson, Kelly & Van Kirk
I9f>5. KoUchke 1%5, Bay & Oati A%7.
Ltindquist 1967, Sheiham, hiobdeU & Cowell
1969, Johansen 1970, Grey et a). 1970,
Jackson & Murray 1972, Axelson et al.
1975,
Edmuttds &. Crahb 1975). 0T^ the
basis of these reports it appears that in
general the 20 year old western patient has
lost between 3 and 5 teeth; 30 year olds
have on an average lost between 5 and 7
teeth, and at 40 years of age the average
patient has lost approximately 10 teeth. It is
also apparent from this literature that at
approximately 40 years of age some S to 1 fl
per cent of the teetb have been losf due to
periodontal disease. At or before 30 years
less ihan 1 per cent of moat western populations are edentulous (Johnson et al. 1^65,
Grey et al. 1970, Axelson et al. J975, Roder
1975). However, after this age, although
varying greatly for specific populations, the
frequency of edentulousness increases sig-
D I S E A S E
570
L O E .
A N E R U D ,
B O Y S
EN
A N D
S M I T H
T H E
N A T U R A L
H I S T O R Y
O FP E R I O D O N T A L
Acknowledgment
This study was supported by grants from
the Danish Research Council, the Royal
Danish Foreign Ministry (DANIDA) and
the University of Connecticut Research
Foundation. The authors would like to express their gratitude to Professor S. B. Dissanayake, his colleagues, staff and students
at the University of Sri Lanka in Paradeniya, to the staff at the tea plantations and
to the many others in Colombo and Kandy,
without whose wholehearted support this
study could not have been undertaken and
continued.
Thanks are also due to Oslo University
and its Faculty of Dentistry for providing
clinical facilities during the examinations,
to the public school authorities in Oslo and
the university administration for their support during all phases of this work.
References
Axeison, P., Goland, V., Hugoson, A., Koch,
G., Paulander, G., Petterson, S., Rasmussen,
C.-G., Schmidt, G. & Thilander, H. 1975.
TandhalsotiiistSndet hos 1000 personer i aldrama 3 till 70 kr innom Jonkopings kommun.
Tandl. T. 67: 656-667.
Bay, T. & Gad, T. 1967. Causes of tooth mortality in Denmark. J. Periodontal Res. 2: 246.
Belting, C. M.. Massler, M. M. & Schour. J.
1953. Prevalence and incidence of alveolar
bone disease. J. Amer. Dent. Assoc. 49: 190197.
Bjom, A.-L. 1974. Dental health in relation to
age and dental care. Odontol. Revy. 25. Supplement 29: 1-117.
Brekhus, P. J. 1929. Dental disease and its relation to the loss of human teeth. J. Amer.
Dent. Assoc. 16: 2237-2247.
Edmunds, D. H. & Crabb, H. S. M. 1975. Fiveyear review of tooth mortality in a selected
D I S E A S E
571
572
..
LOE, ANERUD,
B O Y S E N A N D S M I T H
Address:
University of Connecticut Health Center
School of Dental Medicine
Earmington, Connecticut 06032, U.S.A.