Tooth loss can be disabling and handicapping. It has a profound impact on the lives of some people, even those who are apparently coping well with dentures. The profession needs to consider how it can prepare people for the effects of tooth loss.

Canonical Wnt signaling is controlled intracellularly by the level of β-catenin protein, which is dependent on Axin scaffolding of a complex that phosphorylates β-catenin to target it for ubiquitylation and proteasomal degradation. This function of Axin is counteracted through relocalization of Axin protein to the Wnt receptor complex to allow for ligand-activated Wnt signaling. AXIN1 and AXIN2 protein levels are regulated by tankyrase-mediated poly(ADP-ribosyl)ation (PARsylation), which destabilizes Axin and promotes signaling. Mechanistically, how tankyrase limits Axin protein accumulation, and how tankyrase levels and activity are regulated for this function, are currently under investigation. By RNAi screening, we identified the RNF146 RING-type ubiquitin E3 ligase as a positive regulator of Wnt signaling that operates with tankyrase to maintain low steady-state levels of Axin proteins. RNF146 also destabilizes tankyrases TNKS1 and TNKS2 proteins and, in a reciprocal relationship, tankyrase activity reduces RNF146 protein levels. We show that RNF146, tankyrase, and Axin form a protein complex, and that RNF146 mediates ubiquitylation of all three proteins to target them for proteasomal degradation. RNF146 is a cytoplasmic protein that also prevents tankyrase protein aggregation at a centrosomal location. Tankyrase auto-PARsylation and PARsylation of Axin is known to lead to proteasome-mediated degradation of these proteins, and we demonstrate that, through ubiquitylation, RNF146 mediates this process to regulate Wnt signaling.

RESEARCH prostheticsAim To establish how widespread the emotional effects of tooth loss are. Method A questionnaire, distributed to 100 edentulous people undergoing routine prosthetic care in the Department of Prosthetic Dentistry at Guy's, King's and St Thomas' Dental Institute (GKT), was used to explore the emotional effects of tooth loss. Results Ninety four people completed the questionnaire of whom 42 stated that they had experienced difficulties in accepting the loss of their teeth. In comparison with people who had no difficulties in accepting the situation, these people were: more likely to feel less confident about themselves; more likely to feel inhibited in carrying out everyday activities; and less able to accept the inevitable change in facial shape which occurs following the loss of teeth. Additionally, they took longer to come to terms with their tooth loss (All these differences were statistically significant). Just over three-quarters of the people who were unprepared for the loss of their teeth, felt that an explanation from the dentist prior to dental extractions would have helped. Conclusion The impact that tooth loss can have on people and their lives should not be underestimated. In this study it affected 45% of the participants.I t is well established that people with dentofacial abnormalities experience social consequences including greater degrees of social avoidance and being perceived as possessing negative personality characteristics. 1 Even minor facial abnormalities can result in social stigma. 2 Visible disfigurements are recognised as having a profound effect on individuals 3 and, according to French, hidden impairments (such as total tooth loss) can cause an equal amount of stress. 4 Indeed, people with facial disfigurement are among those people who are covered by the 1995 Disability Discrimination Act. 5 While Bergendal acknowledged total tooth loss as a serious life event, 6 and the impact of dental ill health on daily living is well recognised, 7-10 it is only recently that attention has been paid to the emotional effects of tooth loss. A qualitative study into the emotional effects of total tooth loss revealed a wide range of reactions. 11 The main themes identified in relation to tooth loss were: bereavement; loss of self confidence; concerns about appearance and self image; tooth loss as a taboo subject which could not be discussed with other people; keeping tooth loss secret; the need for prosthodontic privacy; behaviour change; premature ageing; and a lack of preparation for the loss of teeth. A further qualitative study among people with partial tooth loss uncovered a similar pattern of emotional reactions. A feeling of having lost part of one's self was an additional finding in the partially dentate group. 12 The researchers were surprised at the depth of feeling that existed among the participants of these two studies, particularly, as they were all coping apparently well with dentures. The subjective view was that these feelings were experienced by a significant prop...

RESEARCH prostheticsAim To establish how widespread the emotional effects of tooth loss are. Method A questionnaire, distributed to 100 edentulous people undergoing routine prosthetic care in the Department of Prosthetic Dentistry at Guy's, King's and St Thomas' Dental Institute (GKT), was used to explore the emotional effects of tooth loss. Results Ninety four people completed the questionnaire of whom 42 stated that they had experienced difficulties in accepting the loss of their teeth. In comparison with people who had no difficulties in accepting the situation, these people were: more likely to feel less confident about themselves; more likely to feel inhibited in carrying out everyday activities; and less able to accept the inevitable change in facial shape which occurs following the loss of teeth. Additionally, they took longer to come to terms with their tooth loss (All these differences were statistically significant). Just over three-quarters of the people who were unprepared for the loss of their teeth, felt that an explanation from the dentist prior to dental extractions would have helped. Conclusion The impact that tooth loss can have on people and their lives should not be underestimated. In this study it affected 45% of the participants. It is well established that people with dentofacial abnormalities experience social consequences including greater degrees of social avoidance and being perceived as possessing negative personality characteristics. 1 Even minor facial abnormalities can result in social stigma. 2 Visible disfigurements are recognised as having a profound effect on individuals 3 and, according to French, hidden impairments (such as total tooth loss) can cause an equal amount of stress. 4 Indeed, people with facial disfigurement are among those people who are covered by the 1995 Disability Discrimination Act. 5 While Bergendal acknowledged total tooth loss as a serious life event, 6 and the impact of dental ill health on daily living is well recognised, 7-10 it is only recently that attention has been paid to the emotional effects of tooth loss. A qualitative study into the emotional effects of total tooth loss revealed a wide range of reactions. 11 The main themes identified in relation to tooth loss were: bereavement; loss of self confidence; concerns about appearance and self image; tooth loss as a taboo subject which could not be discussed with other people; keeping tooth loss secret; the need for prosthodontic privacy; behaviour change; premature ageing; and a lack of preparation for the loss of teeth. A further qualitative study among people with partial tooth loss uncovered a similar pattern of emotional reactions. A feeling of having lost part of one's self was an additional finding in the partially dentate group. 12 The researchers were surprised at the depth of feeling that existed among the participants of these two studies, particularly, as they were all coping apparently well with dentures. The subjective view was that these feelings were experienced by a significant prop...