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Objectives: The aim of the study was to examine whether the removal of carious teeth affected children's growth relative to that of a standard population., Design: Longitudinal prospective observational study., Setting: Manchester Dental Hospital (MDH), U.K., Participants: Five- and six-year-old children who attended for extraction of carious teeth under general anaesthesia., Main Outcome Measure: Change in height, weight and BMI standard deviation scores during the six months after extraction of carious teeth., Methods and Materials: The children's dental caries levels, weight and height were measured prior to extraction using standard criteria and a single trained examiner and they were then re-measured six months later. The body mass index of the children was calculated and all measurements were converted to standard deviation scores (SDS) using the U.K. 1990 growth reference. Changes in growth SDS during the six months subsequent to the extractions were then calculated., Results: Two hundred and eighteen children, mean (range) age 5.9 (5-6) were examined initially, of whom 131 were successfully followed up a mean 7.1 (0.13) months later. The participants had a mean dmft of 7.18 (SD 3.27) at baseline and were not shorter than expected (8.3% <10th percentile), or more underweight (6.9% <10th percentile for weight). At follow up children showed a statistically significant gain in BMI SDS (mean (SD) 0.26 (37) p < 0.001) and a small gain in height SDS (0.05 (0.38) p = 0.05)., Conclusion: This study suggests that the extraction of carious teeth in five and six year old children promotes weight gain and possibly growth.

Objectives: The aim of this survey was to investigate the reasons for extraction of the various tooth types in Scotland. This study replicated one which was undertaken 15 years earlier. A further aim, therefore, was to identify any changes in the frequency of extraction of each tooth type in the 15 years between the two studies., Methods: The names of every fourth dentist on the list of the Scottish Dental Practice Board were obtained. Four hundred and twenty-five general dental practitioners were asked to record permanent tooth extractions for 1 week. Data requested for each extraction were: the patient's age, gender and dental attendance pattern, the type of tooth removed and the reason for the extraction., Results: Three hundred and fifty-two dentists participated (a response rate of 82.8%). There were 25% fewer teeth extracted per patient and 30% fewer per dentist than in the 1984 study. In 1999, more teeth of most types were extracted from regular attenders whereas, in 1984, more teeth of all types were extracted from irregular attenders. Premolars and first and second molars were the tooth types most frequently extracted in both surveys. In 1999 premolars were the teeth most commonly removed below 21 years of age, accounting for 57.5% of extractions in this age range. Molars accounted for 33.8% of extractions in this age range compared with 52% in 1984. Overall, caries was found to be the principal reason for loss of all tooth types apart from lower incisors which were extracted mainly for periodontal reasons. However, below 21 years, 84.5% of premolar extractions were performed for orthodontic purposes., Conclusions: Over the last 15 years, the overall number of extractions has reduced and the proportion of extractions from regular attenders has increased. Proportionately more premolars and fewer molars were extracted from under-21-year-olds. This observation can be explained by an increase in orthodontic extractions or a decline in extractions for caries in this age group. However, when extractions from the population as a whole are considered, caries and its sequelae remains the principal reason for loss of all tooth types other than lower incisors which are extracted mainly for periodontal reasons.

Aims: Although Scotland has the highest proportion of edentulous adults in the UK, the frequency of edentulousness has fallen by 21% during the last 20 years. This study, carried out in 1999, was designed to establish whether the reasons for tooth loss have also changed since 1984 when they were last determined., Methods: The Scottish Dental Practice Board provided the names of every fourth dentist on its list among which 425 general dental practitioners were identified. They were asked to record permanent tooth extractions for 1 week, specifying the age, sex and dental attendance of patients who underwent extractions and the reasons for these extractions. 352 dentists took part: a response rate of 82.8%., Results: The study confirmed that there has been a reduction in the number of extractions between 1984 and 1999: there were 25% fewer teeth extracted per patient and 30% fewer per dentist per week. From 0-20 years of age, orthodontics has replaced caries as the commonest reason for extraction and in all age groups over 20 years, caries has become the commonest reason in contrast to 1984 when periodontal disease was the principal reason in patients over 40 years old., Conclusions: Caries and its sequelae remain the most important cause of tooth loss throughout adult life in Scotland and, therefore, caries prevention and maintenance of restorations are of great importance at all ages.

In a study of tooth extractions in general dental practices in Ontario, Canada, 165 dental practitioners provided information on 6134 patients attending during a reference week. Of these, 11.6 per cent of patients had one or more permanent teeth extracted. Periodontal disease was given as the reason for 35.9 per cent of these extractions and caries for 28.9 per cent. Analysis by tooth type showed that third molars were the most common tooth type extracted. However, there were differences in the types of teeth extracted by age. Posterior teeth were most frequently lost by the younger age groups and anterior teeth by older subjects. There were also differences in the reasons for the loss of different tooth types. A comparison of these results with those of a similar study in Scotland suggests that age and tooth type does not account for the excess of extractions due to periodontal disease in this Canadian population. Differences in practice patterns and attitudes towards the retention of teeth may be contributing factors.

While substantial proportions of the population of Ontario, Canada continue to have teeth extracted, little is known about the reasons for this loss. In this survey of Ontario general dental practitioners, 128 dentists provided information on 6143 patients they saw during a reference week. Approximately one-in-seven of these patients had or were going to have one or more extractions as part of their current course of treatment. The mean number of extractions for patients having at least one tooth taken out was 2.3 (SD = 2.5). Emergency patients were more likely than regular patients to have at least one extraction but, on average, had fewer teeth taken out. Orthodontic considerations were the main reason for tooth loss in childhood, caries continued to be an important cause of tooth loss at all ages and periodontal disease accounted for more teeth lost after 40 years of age than caries. This study differs from almost all others in finding that, overall, more permanent teeth were extracted because of periodontal disease than because of caries. The former accounted for 35.9% of teeth lost and the latter for 28.9%. While this may be due to methodological differences between this and other studies, it is consistent with epidemiological data on periodontal disease in the Ontario population and data showing that Ontarians receive little in the way of periodontal care.

Empowerment of the individual is the central tenet of health promotion philosophy. Application of health state utility methodology to clinical decisions will facilitate this process. The study reported here used health state utilities to examine the preferences of young adults concerning third molar care. Respondents were asked to indicate the strength of their preferences for various outcomes consequent to removing, or not removing these teeth by using standardised visual analogue scales. The results demonstrated that health state utilities for most complications of surgery were lower than, and therefore reduced health more than, those associated with the complications of leaving teeth in place. Therefore dental surgeons should be more circumspect about surgical intervention: this group of potential patients believed that the 'cure' is often worse than the 'disease'. This study illustrates the use of health state utilities, a methodology which allows patients' perspectives to be incorporated into the planning of rational health care.