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  • 151.
    Stenebrand, Agneta
    Jönköping University, School of Health Science, HHJ. Oral health.
    Dental anxiety among 15-year-olds: Psychosocial factors and oral health2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    AIM: The overall aim of this thesis was to examine the associations between dental anxiety, experiences of dental care, psychosocial factors and oral health among 15-year-olds, and to analyse changes in the prevalence of dental anxiety over time.

    MATERIALS AND METHODS: The thesis was based on two cross-sectional epidemiological studies in Jönköping, Sweden. Papers I, II, and III were based on a random sample of 15-year-old individuals. The total sample consisted of 221 individuals. Six questionnaires were used, one included items of background data, while the others were psychometric instruments measuring dental anxiety, temperament, general anxiety and depression, general fearfulness and attitudes to dental care. Paper IV was based on the Jönköping studies, a series of epidemiological studies from 1973, 1983, 1993, and 2003 in which random samples of 15-year-old individuals were included. The total sample consisted of 405 individuals. Questionnaires including background data and dental anxiety were used and clinical data were collected.

    RESULTS: Of the 15-year-old individuals 6.5% were classified as dentally anxious with girls proportionally more fearful than boys (Papers I-III). Dental anxiety correlated significantly with three of the temperament dimensions; emotionality, activity and impulsivity. Reported pain or unpleasant experiences during dental care treatment were clear predictors concerning dental anxiety (Paper I). Both symptoms of general anxiety and depression were significantly correlated with dental anxiety after controlling for other potential risk factors (Paper II). Dental anxiety was associated with both general fearfulness and with attitudes to dental care, where the strongest predictor of dental anxiety was general fearfulness (Paper III). A trend analysis over the 30-year period showed a gradient of statistically significantly decreasing dental anxiety prevalence, from 38.1% in 1973 to 12.8% in 2003. Over the period the 15-year-old individuals with dental anxiety had significantly higher number of filled tooth-surfaces than those with no dental anxiety, and also more caries in 1973. There were no such differences concerning plaque and gingivitis (Paper IV).

    CONCLUSIONS: Dental anxiety in 15-year-olds correlated with experiences of dental care, psychosocial factors as well as to oral health. Specifically, pain experiences related to dental care, attitudes to dental care and general fearfulness seem to have the strongest impact on dental anxiety. Dental anxiety showed a clear declining change over time. More girls than boys reported dental anxiety. The thesis shows that dental care providers need paying attention on providing a supportive dental care situation, in which the patients should not experience pain. One part may be adequate local anaesthesia during operative dentistry or similar dental treatments. Another part may be a good oral health to prevent negative experiences of dental care. There is a need for the understanding of psychological factors associated with dental care procedures.

  • 152.
    Stenebrand, Agneta
    et al.
    Jönköping University, School of Health Science, HHJ. Oral health.
    Hakeberg, Magnus
    Odontologiska institutionen, Sahlgrenska akademin, Göteborgs universitet.
    TANDVÅRDSRÄDSLA OCH TEMPERAMENT HOS 15-ÅRINGAR2010Conference paper (Other academic)
    Abstract [sv]

    Syfte: Syftet med föreliggande studie var att bland 15-åringar undersöka prevalens av tandvårdsrädsla och dess samband med temperament (EASI), bakgrundsfaktorer samt tidigare smärtsamma erfarenheter i tandvårdssituationen.

     

    Metod: Urvalet bestod av 263 slumpmässigt utvalda 15-åringar boende i Jönköpings kommun. Tre självrapporterande frågeformulär användes varav ett gällande bakgrundsfaktorer. Grad av tandvårdsrädsla mättes med Dental Fear Survey (DFS) medan temperament mättes med hjälp av en bearbetad version av ”The EAS Temperament Survey for Children”, nu bestående av 25 delfrågor, vilken blivit modifierad för vuxna, EASI temperament survey.

     

    Statistiska analyser: Data analyserades med SPSS 16,0 gällande frekvenser, medelvärden,  standardavvikelser, medianer, samband samt skillnader.

     

    Resultat: Resultatet visade att 6,5 % av ungdomarna klassificerades som tandvårdsrädda med en övervägande andel flickor. De tre temperamenten aktivitet, impulsivitet och emotionalitet var signifikant korrelerade till tandvårdsrädsla. En hierarkisk multipel regression visade emellertid att smärta vid senaste tandläkarbesöket samt om det under uppväxten förekommit smärtsamma eller obehagliga tandbehandlingar var de tydligaste prediktorerna avseende tandvårdsrädsla hos 15-åriga ungdomar. Även dimensionerna aktivitet och impulsivitet i temperament korrelerade signifikant till tandvårdsrädsla i denna regressionsanalys.

     

    Slutsats: Fastän några av dimensionerna i temperament korrelerar med tandvårdsrädsla, visade denna studie, att tidigare smärtsamma erfarenheter i tandvårdssituationen är en stark prediktor gällande hög nivå av tandvårdsrädsla bland 15-åringar.

     

     

    Studien har inte genomförts med stöd eller forskningsanslag.

  • 153.
    Stenebrand, Agneta
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Hakeberg, Magnus
    Department of Behavioral and Community Dentistry Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden .
    Nydell Helkimo, Anna
    Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden .
    Koch, Göran
    Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden .
    Wide Boman, Ulla
    Department of Behavioral and Community Dentistry Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden .
    Dental anxiety and oral health in 15-year-olds: a repeated cross-sectional study over 30 years2015In: Community Dental Health, ISSN 0265-539X, Vol. 32, no 4, p. 221-225Article in journal (Refereed)
    Abstract [en]

    Objectives: To report the prevalence of dental anxiety in Swedish 15-year-olds over a 30-year period (1973-2003) and how dental anxiety relates to oral health. Basic research design: The study used a repeated cross-sectional design. Participants: In 1973, 1983, 1993, and 2003, random samples of 96 to 107 15-year-olds were selected from the city of Jönköping, Sweden, 405 overall. Main Outcome Measures: Dental anxiety (DA) and its association with oral health (caries, gingivitis, plaque, fillings) were analysed (α=0.05). Results: The proportions of dentally anxious during the period were 38% (n=37) in 1973, 26% (n=28) in 1983, 18% (n=15) in 1993 and 13% (n=12) in 2003 a clearly decreasing trend with time. The strongest predictor of DA was gender, with girls reporting higher levels of DA. In three of the four examination years, adolescents with DA had more filled permanent surfaces than those without DA. Those with DA had a greater caries experience only in 1973. No associations were found between DA and plaque or gingivitis. Multivariate logistic modelling confirmed that DA decreased over time and that girls had higher levels of DA. Conclusions: This study showed a clear decrease in DA in 15-year-olds over a 30-year period, with a greater proportion of girls being more dentally anxious. The results also indicate a relationship between DA and oral health; the dentally anxious having more filled surfaces and, only in 1973, more decayed tooth surfaces.

  • 154.
    Stenebrand, Agneta
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Wide Boman, Ulla
    Odontologen Göteborg.
    Hakeberg, Magnus
    Odontologen Göteborg.
    General fearfulness, attitudes to dental care, and dental anxiety in adolescents2013In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 121, no 3 Pt 2, p. 252-257Article in journal (Refereed)
    Abstract [en]

    The etiology of dental anxiety (DA) may involve a spectrum of factors related to past dental experiences, general and specific fears, and other personality factors, but is relatively unexplored in adolescents. The aim of this study was to examine how general fearfulness and attitudes to dental care/personnel were related to DA in 15-yr-old subjects. The sample included 263 randomly selected 15-yr-old adolescents living in the municipality of Jönköping in southern Sweden. Four questionnaires were used: one general questionnaire regarding background data and three psychometric instruments dealing with DA, general fearfulness, and dental beliefs. Of all participants, 6.5% were classified as having DA. Dental anxiety was moderately to strongly correlated both with attitudes to dental care/personnel and with general fearfulness and indicated the strongest impact for individuals with both high general fearfulness and high dental beliefs in relation to DA. The linear multiple regression analysis showed that the best predictors of DA were general fearfulness and dental beliefs. This suggests that both individual vulnerability in terms of generalized fear and apprehensions about dental staff, which is linked to experiences of dentistry, appear to be important factors for DA and may be considered as risk factors for DA in adolescents.

  • 155. Stenman, U
    et al.
    Wennstrom, A
    Ahlqwist, M
    Bengtsson, C
    Bjorkelund, C
    Lissner, L
    Hakeberg, Magnus
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Association between periodontal disease and ischemic heart disease among Swedish women: A cross-sectional study2009In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850Article in journal (Refereed)
  • 156.
    Stensson, Malin
    Jönköping University, School of Health Science, HHJ. Oral health.
    Unga astmatiker behöver förebyggande vårdprogram2011In: Tandläkartidningen, ISSN 0039-6982, no 9, p. 60-63Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Majoriteten av de studier som undersökt den orala hälsan hos personer med astma visar att astmatiker löper en ökad risk för orala sjukdomar, särskilt karies. Denna studie understryker vikten av att utveckla förebyggande vårdprogram för unga personer med astma.

  • 157.
    Stensson, Malin
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Koch, G.
    Department of Pediatric Dentistry, Institute for Postgraduate Dental Education, Jönköping.
    Coric, S.
    Department of Pediatric Dentistry, Institute for Postgraduate Dental Education, Jönköping.
    Abrahamsson, T. R.
    Division of Pediatrics, Department of Clinical, Linköping University, Linköping.
    Jenmalm, M. C.
    Division of Inflammation Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Birkhed, D.
    Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wendt, Lill-Kari
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Oral Administration of Lactobacillus reuteri during the First Year of Life Reduces Caries Prevalence in the Primary Dentition at 9 Years of Age2014In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 48, no 2, p. 111-117Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effect on oral health, at age 9 years, of daily oral supplementation with the probiotic Lactobacillus reuteri, strain ATCC 55730, to mothers during the last month of gestation and to children through the first year of life. The study was a single-blind, placebo-controlled, multicenter trial involving 113 children: 60 in the probiotic and 53 in the placebo group. The subjects underwent clinical and radiographic examination of the primary dentition and carious lesions, plaque and gingivitis were recorded. Saliva and plaque were sampled for determination of mutans streptococci (MS) and lactobacilli (LB) in saliva and plaque as well as salivary secretory IgA (SIgA). Forty-nine (82%) children in the probiotic group and 31 (58%) in the placebo group were caries-free (p < 0.01). The prevalence of approximal caries lesions was lower in the probiotic group (0.67 ± 1.61 vs. 1.53 ± 2.64; p < 0.05) and there were fewer sites with gingivitis compared to the placebo group (p < 0.05). There were no significant differences between the groups with respect to frequency of toothbrushing, plaque and dietary habits, but to intake of fluoride supplements (p < 0.05). There were no intergroup differences with respect to L. reuteri, MS, LB or SIgA in saliva. Within the limitation of this study it seems that daily supplementation with L. reuteri from birth and during the first year of life is associated with reduced caries prevalence and gingivitis score in the primary dentition at 9 years of age.

  • 158.
    Stensson, Malin
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Wendt, Lill-Kari
    Koch, Göran
    Oldaeus, Göran
    Birkhed, Dowen
    Oral Health in preschool children with asthma2008In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 18, no 4, p. 243-250Article in journal (Refereed)
  • 159.
    Stensson, Malin
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Wendt, Lill-Kari
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Koch, Göran
    Oldaeus, Göran
    Lingström, Peter
    Birkhed, Dowen
    Caries prevalence, caries-realted factors and plaque pH in adolescents with long-term asthma2010In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 44, no 6, p. 540-546Article in journal (Refereed)
    Abstract [en]

    The aim of the present case-control study was to investigate dental caries, various caries-related factors as well as gingival condition, in 12- to 16-year-olds with long-term asthma (n = 20) and a matched healthy control group (n = 20). Data on dietary and oral hygiene habits, numbers of mutans streptococci and lactobacilli in saliva were also obtained. The plaque pH drop after a sucrose rinse was measured up to 40 min at 2 approximal tooth sites. A lower salivary flow rate was found in the asthma group compared to the control group (p < 0.05). The mean (± SD) of DFS, including manifest and initial caries, was 4.9 ± 5.5 in the asthma and 1.4 ± 2.3 (p < 0.01) in the control group. Only 1 adolescent in the asthma group was caries free compared to 13 in the control group. Concerning pH in plaque, adolescents with asthma had a lower initial value (p < 0.01) and final pH (p < 0.05) than the control group. The Cariogram data showed that 55% of the subjects in the control group had ‘a high chance of avoiding caries’ compared to 10% in the asthma group (p < 0.01). The asthmatic adolescents had higher numbers of sites with gingival bleeding (p < 0.01). To conclude, adolescents with long-term asthma had a higher total DFS and caries risk (according to Cariogram), decreased salivary rate, more gingival bleeding and lower plaque pH than adolescents without asthma.

  • 160.
    Stensson, Malin
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Wendt, Lill-Kari
    Koch, Göran
    Oldaeus, Göran
    Nilsson, Mats
    Birkhed, Dowen
    Oral health in pre-school children with asthma - followed from 3 to 6 years2010In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 20, no 3, p. 165-172Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate caries and its determinants in preschool children with and without asthma, followed from 3 to 6 years. METHODS AND SUBJECTS: Caries, plaque, and gingivitis were examined at 3 and 6 years of age in 64 asthmatic children and 50 matched, healthy control children. Furthermore, at 6 years radiographic examination and saliva sampling were conducted. The parents were interviewed about various oral health-related factors. RESULTS: Initial caries increment between 3 and 6 years of age was statistically significant higher for children with asthma compared with children without asthma (P < 0.05). Asthmatic children had more bleeding gingivitis and a higher consumption of sugary drinks than healthy children at 3 years of age (P < 0.05). At both 3 and 6 years of age, the asthmatic children were more frequently mouth breathers than healthy children, only statistically significant for 6-year olds (P < 0.05). CONCLUSION: Preschool children with asthma at 3 years of age run a higher risk of developing caries lesions until 6 years of age compared with children without asthma. Children with asthma have a higher prevalence of bleeding gingivitis, a higher intake of sugary drinks and are more frequently mouth breathers than preschool children without asthma.

  • 161.
    Stensson, Malin
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Wendt, Lill-Kari
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Koch, Göran
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Oldaeus, Göran
    Paediatric Department, County Hospital, Ryhov, Jönköping, Sweden.
    Ramberg, Per
    Department of Periodontology, Institute of Odontology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Birkhed, Dowen
    Department of Cariology, Institute of Odontology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Oral health in young adults with long-term, controlled asthma2011In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 69, no 3, p. 158-164Article in journal (Refereed)
    Abstract [en]

    Objective. To study oral health in young adults with long-term, controlled asthma. Material and methods. Twenty 18- to 24-year-olds with a mean duration of asthma of 13.5 [standard deviation (SD) 5.4] years and 20 matched healthy controls were included. A clinical examination was performed and the prevalences of caries, erosions, gingival inflammation, cervicular fluid and periodontal pockets and the plaque formation rate were registered. The salivary flow rate and the numbers of mutans Streptococci and Lactobacilli in saliva were determined. Plaque pH was measured after a sucrose rinse for up to 40 min at two approximal sites. The participants were interviewed regarding dietary and oral hygiene habits. Results. The mean (SD) DFS, including manifest and initial caries, was 8.6 (10.6) in the asthma group and 4.0 (5.2) in the control group (P = 0.09). Initial caries lesions were more common in the asthma group than in the control group: 6.0 (8.1) and 1.3 (2.0), respectively (P = 0.02). The asthma group had more gingivitis (P = 0.01) and a lower stimulated salivary secretion rate than the controls (P = 0.01). The asthmatics also had a somewhat, although not statistically significant, lower initial pH value in plaque and a more pronounced pH drop compared with the controls. In the asthma group, 65% reported frequent mouthbreathing, compared with 10% of the controls (P = 0.01). No differences were found in tooth-brushing or dietary habits between the groups. Conclusion. Young adults with long-term, controlled asthma had more initial caries, more gingival inflammation and a lower stimulated salivary secretion rate than individuals without asthma.

  • 162. Stenström, Ulf
    et al.
    Einarson, Susanne
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Jacobsson, Brittmarie
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Wenander, Asa
    Hugoson, Anders
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    The importance of psychological factors in the maintenance of oral health: a study of Swedish university students2009In: Oral health & preventive dentistry, ISSN 1602-1622, Vol. 7, no 3, p. 225-33Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to investigate the predictive value of the traditional multidimensional health locus of control (MHLC) scale, a corresponding dental health locus of control (DHLC) scale and dental health values (DHVs) regarding students' dental health before and after a video programme that presented information about dental diseases and instructions on oral hygiene. MATERIALS AND METHODS: A group of 217 university students participated in this study. Before the video programme was presented, assessments were made of MHLC, DHLC and DHVs. Plaque and gingival indices were obtained in a clinical examination conducted before (plaque index [PLI] 1 and gingival index [GI] 1) and 10 weeks after (PLI 2 and GI 2) the presentation of the programme. RESULTS: The percentage of tooth surfaces exhibiting plaque and of sites involving gingivitis decreased and was statistically significant between baseline and re-examination for both males and females. The females exhibited statistically significant better PLI 1 and GI 1 values and stronger DHVs than males. Also, better GI 1 values were found to be statistically significant and related to stronger DHVs for females. A stronger trust in the dental health personnel regarding the dental health was related to more gingivitis at the initial examination (GI 1). For males, stronger internal DHLC was related to more plaque at the final examination (PLI 2). CONCLUSION: The only psychological scales that showed some relationship to the measures of dental health were DHLC and DHVs. Gender was the strongest related variable to dental health.

  • 163.
    Sundell, Anna Lena
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Paediatric Dentistry, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Marcusson, Agneta
    Dentofacial Orthopaedics, Maxillofacial Unit, Linköping University Hospital, Linköping, Sweden.
    A comparison of orofacial profiles in 5- and 10-year-old Swedish children with and without cleft lip and/or palate2018In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objectives of this study were to assess orofacial profiles in 5- and 10-year-old children with cleft lip and/or palate (CL/P) compared to controls and to estimate a possible association between orofacial dysfunction and caries frequency.

    MATERIALS AND METHODS: A total of 133 children with CL/P (77 5-year-olds and 56 10-year-olds) and 308 controls (142 5-year-olds and 166 10-year-olds) were included in the study. Orofacial function was evaluated with Nordic Orofacial Test-Screening (NOT-S), and caries were scored according to the International Caries Detection and Assessment System (ICDAS).

    RESULTS: The total NOT-S score was higher in children with CL/P compared to controls (mean 3.2 vs 0.9, p < 0.001). The domains frequently scored in CL/P children were speech (82%), face at rest (72%), and facial expression (58%). There was a significantly positive correlation between NOT-S scores and caries frequency.

    CONCLUSIONS: Children with CL/P have impaired orofacial function compared to controls. There seems to be a correlation between orofacial function and caries.

    CLINICAL RELEVANCE: Impaired orofacial function seen in children with CL/P can be one of many risk factors for caries development, and it is suggested to be a part of caries risk assessment.

  • 164.
    Sundell, Anna Lena
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Pediatric Dentistry, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Marcusson, Agneta
    Department of Dentofacial Orthopedics, Maxillofacial Unit, Linköping University, Linköping, Sweden.
    Törnhage, Carl-Johan
    Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden.
    Salivary cortisol rhythms in children with cleft lip and/or palate: A case-control study2018In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 55, no 8, p. 1072-1080Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Knowledge about the stress response in children with cleft lip and/or palate (CL/P) is sparse and the association between the stress response and health-related quality of life (HRQoL) is unknown. Consequently, investigations on the influence of CL/P on the stress response alone and its association with HRQoL are of importance. The purpose was to determine whether salivary cortisol concentration in children with CL/P differs from that in children without clefts (controls) and whether there are any differences in salivary cortisol concentrations between ages, gender, and type of cleft. Furthermore, the final aim was to determine the correlation between salivary cortisol concentration and HRQoL.

    DESIGN: The study used a cross-sectional case-control design.

    PARTICIPANTS: Ninety-one 5- and 10-year-old children with CL/P and 180 age-matched controls.

    MAIN OUTCOME MEASURES: Salivary samples were collected on 2 mornings and 1 evening for each child. Samples were analyzed using a commercial competitive radioimmunoassay and HRQoL was assessed using the KIDSCREEN-52.

    RESULTS: Salivary cortisol concentrations were similar in children with CL/P and controls. There was no difference in salivary cortisol concentrations between children with different types of cleft. There was no correlation between cortisol concentration and HRQoL.

    CONCLUSION: Five- and 10-year-old children with corrected CL/P seemed not to be more stressed than controls, and there were no correlation to HRQoL. The HRQoL levels - were comparable to that of a European norm population.

  • 165.
    Sundell, Anna Lena
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Paediatric Dentistry, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Ullbro, C.
    Department of Clinical Dentistry, The Arctic University of Norway, Tromsø, Norway.
    Dahlén, G.
    Department of Oral Microbiology and Immunology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
    Marcusson, A.
    Dentofacial Orthopedics, Maxillofacial Unit, Linköping University Hospital, Linköping, Sweden.
    Twetman, S.
    Department of Odontology, Section for Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Salivary microbial profiles in 5-year old children with oral clefts: a comparative study2018In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 19, no 1, p. 57-60Article in journal (Refereed)
    Abstract [en]

    Aim: To compare the salivary microbial profile in children with oral clefts to matched non-cleft controls in a cross-sectional study.

    Methods: The cleft group consisted of 80 children aged 5 years and 144 age-matched non-cleft children were recruited as a control group. Stimulated whole saliva samples were collected and analysed with checkerboard DNA–DNA hybridisation using 12 pre-determined bacterial probes. Background data on caries, oral hygiene, dietary habits and fluoride exposure were collected from clinical examinations and questionnaires.

    Results: Children in the cleft group had a significantly higher prevalence of dental caries but only minor differences in the salivary microbial profile were found. In general, the cleft-children displayed a lower prevalence of common commensal species (e.g. Streptococcus, Fusobacterium) when compared with the non-cleft controls. The differences were statistically significant (p < 0.05) but the clinical significance was unclear.

    Conclusions: The profile of the salivary microflora in 5-year-old children with and without oral clefts was basically similar and displayed only marginal differences with respect to commensal bacteria. 

  • 166.
    Sundström, Gerdt
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Johansson, Lennarth
    Socialstyrelsen.
    Framtidens anhörigomsorg: Kommer de anhöriga vilja, kunna, orka ställa upp för de äldre i framtiden?2004Report (Other academic)
    Abstract [sv]

    Föreliggande översikt över och analys av äldres anhörigsituation i dag och i en nära framtid har framför allt inriktats på äldres makar och makor samt relationen mellan de äldre och deras barn. Detta betyder inte att andra relationer är oviktiga eller att de inte är någon hjälp och stöd till äldre personer. Andra anhöriga än de nämnda är viktiga i omsorgspanoramat, men låter sig inte lika enkelt fångas i tillgängliga data. De är trots allt sekundära till partner och barn för många äldre.

    Framställningen utgår från tillgängliga uppgifter om hur många anhöriga som gör en vårdinsats och var de finns. Att fastställa vad anhöriga gör i praktiken är betydligt svårare. I Sverige finns undersökningar som belyser detta från 1954 och fram till 2000. De två senaste undersökningarna av äldres levnadsförhållanden och omsorgsmönster, 1994 och 2000, gör det möjligt att analysera förändringar under en period med kraftigt minskande offentlig omsorg. Det visar sig att anhöriga av alla slag, och särskilt barnen, väsentligt ökade sina omsorgsinsatser för gamla föräldrar/närstående under perioden. Även andra material har använts för att belysa det geografiska avståndet mellan generationerna, makars insatser för varandra m.m. Slutligen har vi med en opinionsundersökning sökt klarlägga erfarenhet av omsorg om gamla föräldrar, hur man ser på att själv hjälpa och balansen mellan vad familjen kan och bör göra och vad som är eller bör vara ett offentligt ansvar.

    Familjen och anhörigas insatser för de äldre har länge försummats i den offentliga debatten, eller tolkats i ideologiska termer och med normativa förtecken om vad man förväntar sig att var och en bör göra för sin nästa. Sedan vuxna barns anhörigansvar för föräldrar togs bort ur sociallagstiftningen 1956 och familjelagstiftningen 1979 var den allmänna meningen att äldreomsorg huvudsakligen var ett offentligt ansvar. Numera erkänns dock vårdande anhörigas insatser och behov av stöd i socialtjänstlagen. Samtidigt har andelen äldre som får hemtjänst eller plats i särskilt boende, i förhållande till befolkningsmängden, minskat. Den internationella forskningen har i stort sett enstämmigt visat att t.ex. allt fler äldre är gifta och att allt fler generationer är i livet samtidigt. I vad mån omsorgen i dag stödjer anhöriga blir en fråga om både indirekt och direkt stöd. Ett relativt generöst pensionssystem som det svenska och stöd till bra egna bostäder för äldre kan ses som ett indirekt stöd till anhöriga. Det kan man även säga om ett rikt utbud av bra hemtjänst och särskilt boende av god kvalitet.

    Ensamboendet bland äldre är nu ca 40 procent. Samtidigt är allt fler gamla, även i hög ålder, gifta och många har varit gifta länge, vilket illustreras av ett snabbt växande antal guldbröllopspar. Det är syskon, barn och andra som försvunnit ut ur äldrehushållen. Många har dock barn som bor i närheten, vilket framgår av både riksundersökningar och lokala analyser av totalbefolkningen. Inget tyder på att kontakterna över generationsgränserna försvagats på senare tid. Ytterst få äldre saknar nära anhöriga och de flesta har någon eller flera av dem i närheten. Fler gamla än tidigare har barn och de blir än fler i framtiden när dagens medelålders grupper blir gamla. Samtidigt finns upplösande tendenser, främst i form av skilsmässor, 10 procent av de äldre är frånskilda.

    De flesta gifta med hälsoproblem har en frisk partner och får i allmänhet den hjälp de behöver av partnern. Det tycks i absoluta tal finnas lika många män som vårdar sin fru, som omvänt. Beräkningar har gjorts av omsorgsvolymer för nyblivna änkor och änklingar, med uppgifter om hur många som behövde hjälp, hur länge samt om de fick hjälp av partnern. Trots att betydligt fler kvinnor än män förlorar sin partner slår kvinnornas större och långvarigare funktionsnedsättningar kraftigt igenom i den totala omsorgsvolymen. Beräkningar visar att männen utför minst lika många ”vårdår för hustrur som hustrurna för män vid livets slut. Omsorgen makar emellan dessförinnan vet vi mindre om, men det finns indikationer på ökad jämställdhet mellan könen på äldre dar. Generellt är äktenskapets omsorgskapacitet förbisedd, både socialpolitiskt och inom forskningen. Gifta och samboende äldre nyttjar mindre offentlig omsorg, speciellt särskilt boende. Detta gäller särskilt män och framförallt i den tidigare ålderdomen. Äldre som bor ensamma och behöver hjälp specialstuderas i rapporten. Här framgår att barn är den enskilt största hjälpargruppen och att deras insatser ökat kraftigt under 1990-talet. Det är särskilt döttrarnas insatser som ökat, medan hemtjänstens minskat.

    Anhöriginsatserna för äldre har ökat. En attitydundersökning bland medelålders och äldre svenskar, ur alla samhällsskikt och miljöer, visar stor beredvillighet att hjälpa gamla föräldrar, i den mån man inte redan gör det. När ingetdera är fallet, förklaras det i allmänhet med att man inte kan, till följd av olika praktiska hinder. Förvärvsarbete är ett betydligt mindre hinder än geografiskt avstånd, både för män och kvinnor.

    Beträffande stöd till anhöriga som vårdar har staten under de senaste åren med extra medel försökt stimulera kommunerna att utveckla detta Resultaten av denna satsning har uppfattats som överlag positiva. De har väsentligt bidragit till att man uppmärksammat de anhörigas situation och deras behov av stöd. I många kommuner har möjligheterna att få hjälp också blivit bättre. Detta ska dock ses mot bakgrund av att i somliga kommuner var anhörigstödet tidigare mycket blygsamt. Därtill finns fortfarande mycket att göra när det gäller kvaliteten och innehållet i de stödinsatser som erbjuds de anhöriga. Inte så sällan tackar anhöriga nej till den hjälp som erbjuds därför att kvaliteten upplevs som undermålig, och att den är för dyr, eller därför att den erbjuds på ett sätt som är svårtillgängligt för de anhöriga. Trots ökad uppmärksamhet på de anhörigas situation finns det ännu inga uppgifter om i vilken utsträckning alla anhöriga som behöver det får offentlig hjälp. Det saknas i allmänhet system för att fortlöpande följa upp effekterna av stödet till anhöriga.

    Ett försök att belysa effekterna av stöd till anhöriga som vårdar närstående i hemmet redovisas i en studie från Varbergs kommun. I Varberg har man under de senaste åren systematiskt byggt upp ett generösare och lättillgängligare stöd till anhöriga. Med tiden har också ett antal anhöriga slutat som vårdare, därför att vårdtagaren antingen avlidit eller flyttat till särskilt boende. Av drygt 70 personer, gick det att nå 50. De intervjuades om sina erfarenheter av att vårda och framför allt om sin uppfattning om den hjälp de fått från kommunen. Studien visar att de anhöriga gav stödet från kommunen ett mycket gott betyg. En majoritet anger att om de inte hade fått detta stöd hade kommunen sannolikt fått gå in med betydligt större insatser, antingen hemtjänst eller särskilt boende.

    Ryggraden i kommunens anhörigstöd har varit kostnadsfri avlösning i hemmet upp till 12 timmar per månad. Avlösningen ges genom en individuellt utformad stödplan, som upprättas av kommunens anhörigombud tillsammans med den anhörige. Stödinsatserna till anhöriga utesluter inte att vårdtagaren även får hjälp från hemtjänsten. Slutsatsen i studien är att man kan vinna mycket med ett generösare stöd till anhöriga. Erfarenheterna från Varberg visar hur detta kan gå till. Ett utbyggt och lättillgängligt stöd av god kvalitet kan förbättra både vårdtagarens och de anhörigas livskvalitet. Samtidigt innebär det att kommunens resurser för vård och omsorg utnyttjas bättre.

    Inför framtidens anhörigomsorg och utökade möjligheter till vård i det egna hemmet hyser många stora förhoppningar om den teknikutvecklingen. Detta har dock vanligen inte diskuteras utifrån de anhörigas perspektiv. Det kan tyckas märkligt, med tanke på den centrala roll de anhöriga spelar för att de äldre ska kunna bo kvar och vårdas i hemmet. Många av de hjälpmedel som utvecklats är naturligtvis ett indirekt stöd för de anhöriga, eftersom de underlättar vården och omsorgen. I den här rapporten återges ett utvecklingsprojekt som haft till syfte att med modern teknik informera, utbilda och göra det lättare för anhöriga att ha kontakt med vårdpersonal och andra i samma situation. Erfarenheterna från projektet visar att man med modern IT-teknik kan underlätta åtskilligt för de anhöriga, framför allt genom att stärka deras sociala nätverk. Ensamhetskänslan bland många vårdande anhöriga kunde avhjälpas, och behovet av att kunna fråga någon till råds eller utbyta erfarenheter kunde tillgodoses. Inför framtiden finns således många spännande möjligheter. Det vore önskvärt att även anhörigas behov av stöd i olika former skulle kunna bidra till utvecklingen. Ofta är emellertid det största hindret att man i den offentliga vården inte ser möjligheterna i teknikutvecklingen och än mindre är beredd att betala för detta.

    I författarnas uppdrag ingick också att försöka fånga utvecklingstendenser när det gäller anhörigstöd i bred mening och om möjligt försöka hitta goda exempel på hur man arbetar med frågan i andra länder. Utan tvivel har frågan om familjens och anhörigas ansvar för vård och omsorg om äldre eller andra hjälpbehövande kommit allt högre upp på den socialpolitiska dagordningen i många länder. Liksom i Sverige försöker man på många håll stärka de anhörigas ställning, förbättra det ekonomiska stödet till familjen och ge ett direktare stöd till familjer som vårdar anförvanter i hemmet. På samma sätt som i Sverige har staten således i flera länder, t.ex. Storbritannien, Nederländerna och Finland, tagit särskilda initiativ för att stärka de anhörigas ställning. Utvecklingen har också drivits på genom att anhöriga i många länder organiserar sig för att gemensamt driva sin sak. Anhörigorganisationerna har också viktiga när det gäller att hjälpa enskilda anhöriga med information, råd och personligt stöd.

    Med tanke på de i allmänhet stora svårigheterna att omsätta erfarenheter från utomnordiska länder på området, kan man dock konstatera att anhörigstödet i många länder har en stark subsidiaritetsprägel. Det betyder att stödet framför allt är av ekonomisk natur, och inriktat på att stärka det vårdande hushållets och familjens ekonomiska situation. Det kan ses både som en ersättning för de vårdinsatser som familjen förväntas stå för, som en kompensation för förlust av förvärvsinkomst och som en möjlighet för familjen att köpa nödvändig hjälp. Det offentliga tar alltså inget ansvar förrän familjens resurser är helt uttömda eller. Detta verkar främmande ur svenskt perspektiv. Samtidigt finns det likheter med dessa system och de system för äldrepeng eller anhörigpeng som ibland framförs i den svenska debatten. Det som mer direkt kan överföras till svenska förhållanden är olika intressanta försök att utveckla samarbetet mellan den offentliga omsorgen och frivilliginsatser till stöd för anhöriga.

    Inför framtiden förefaller det rimligt att förmoda att omsorgen mellan makar eller samboende kommer att vara lika omfattande som i dag.Däremot är det svårare att uttala sig bestämt om potentialen av insatser från barn och andra närstående som inte sammanbor med den hjälpbehövande, trots att vi sett att de ökat kraftigt under 1990-talet. Något man bara kan spekulera om är under vilka villkor denna omsorg ges eller mottas. Om den hittillsvarande utvecklingen fortsätter, och det även i framtiden blir allt svårare att få offentlig vård och omsorg, kan detta åstadkomma stora spänningar mellan generationer och i samhället i stort.

    När det gäller samhällets möjligheter att med olika insatser underlätta för anhöriga som vårdar, pekar erfarenheterna på att mycket kan göras, som är av stort värde men utan större kostnader. Detta kan dock inte tas som intäkt för att lägga ett ännu större vård- och omsorgsansvar på familjen och anhöriga. Det är över huvud taget osäkert om man med insatser från samhällets sida kan påverka familjens och anhörigas benägenhet att vårda. Å andra sidan är det risk för att de anhöriga exploateras, om samhället inte stödjer dem. Samhället kan underlätta för de anhöriga och förebygga att de slits ut. Här finns ett stort socialpolitiskt dilemma. Det är varken möjligt eller önskvärt att ersätta familjens och anhörigas insatser med offentlig omsorg. Det betyder att om anhörigas benägenhet att vårda skulle avta, skulle välfärdssystemet på detta område rämna. Däremot kan samhället befrämja anhörigomsorgen genom att upprätthålla nivån och kvaliteten på den omsorg som riktar sig till vårdtagarna, samtidigt som de anhöriga får ett särskilt stöd.

    Med tanke på anhörigomsorgens omfattning och betydelse för samhället, är det nödvändigt att den får en centralare roll i diskussionen om hur framtida vård- och omsorgsbehov ska tillgodoses och finansieras. Varje lösning måste ta hänsyn till att äldreomsorgen i allt väsentligt under de senaste årtiondena varit ett partnerskap mellan samhället och familjen och att framgångsrika lösningar måste bygga på detta.

  • 167.
    Svensson, Gabriella
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Malmberg, Bo
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Hur står det till med magen …?: En kartläggning av förstoppningsproblematiken på några kommunala äldreboenden2004Report (Other academic)
    Abstract [sv]

    Förstoppning är ett vardagligt problem inom äldreomsorgen. Trots det är det inte så noga undersökt och det kan finnas flera orsaker till detta. Dels är det ett oglamoröst ämne och dels finns det metodologiska svårigheter eftersom det finns en mängd orsaksvariabler till förstoppning. Inte heller inom vårdutbildningar ägnas speciellt mycket tid till förstoppningsproblematiken. Det finns inget som tyder på att det är det normala åldrandet som påverkar att äldre blir mer förstoppade utan det är andra faktorer som tex. sjukdom, läkemedel, kost, vätska och inaktivitet som inverkar. Dessa faktorer är påverkbara i olika grad och det är viktigt att inte bara slentrianmässigt ge de äldre laxermedel. Man bör alltså även med ickefarmakologiska metoder försöka förebygga och motverka förstoppning även om många äldre vårdtagare samtidigt också för längre eller kortare tid måste inta laxermedel.

    I denna undersökning ingick två äldreboenden och urvalet bestod av de vårdtagare som accepterade att delta (65). Ett frågeformulär ifylldes tillsammans med vårdtagarens kontaktperson.

    Resultatet visar att det är svårt att utpeka någon enstaka variabel som en speciell markör för risk för förstoppning. Ungefär hälften av vårdtagarna uppgavs vara förstoppade av och till trots att tre fjärdedelar använde laxermedel på stående ordination. Nästan alla (95%) hade en eller flera diagnoser som förknippas med risk för förstoppning. Äldre vårdtagare speciellt de som bor på äldreboende har ofta många läkemedel. Många av dessa har förstoppning som möjlig biverkan. Drygt 85% av vårdtagarna hade någon medicin på stående ordination som kan ge förstoppning som biverkan. Många vårdtagare fick i sig för lite vätska och fibrer men var ändå inte mer förstoppade än de som åt mer fibrer och drack mera vätska. Detta kan bero på att de använder laxermedel.

    Mer än hälften (57%) var avföringsinkontinenta och tre fjärdedelar var urininkontinenta. Det finns risk att dessa vårdtagare inte får komma till toaletten regelbundet på grund av att de bär blöja. Det var 17% som uppgavs inte dagligen komma till toaletten. Alla utom en vårdtagare hade egen toalett vilket säkert underlättar toalettbesöken dels genom att de inte behöver känna stress att andra vårdtagare behöver komma dit, dels genom att toaletterna lättare kan anpassas till den enskilde vårdtagaren.

    Tre fjärdedelar använde dagligen laxermedel och hälften hade laxermedel vid behov. Det var i stort sett de som redan hade laxermedel på stående ordination som även hade det vid behov. De laxermedel som användes på stående ordination var framför allt osmotiska medel som Movicol och Laktulos vilket kan anses lämpligt till äldre personer. Många använder dessutom katrinplommon och/eller extra fibrer. I vilken form det ges verkar vara avdelningsbundet. Några andra metoder för att förebygga förstoppning hos de enskilda vårdtagarna uppgavs endast i ett fåtal fall.

    Det är viktigt att inte nöja sig med att enbart ge de äldre laxermedel när magen krånglar utan att hela tiden vara steget före och försöka motverka förstoppning på alla plan utifrån den enskilde individens riskfaktorer. Likaså är det viktigt att när det så krävs ge ett för individen lämpligt laxermedel i rätt dosering. Både förstoppningen i sig och effekten av laxermedel kan ge problem som inverkar på livskvaliteten.

  • 168.
    Thorstensson, Helene
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Johansson, Boo
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Why do some people lose teeth across their lifespan whereas others retain a functional dentition into very old age?2010In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 27, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To analyse the importance of caries, periodontitis, and medical and psychosocial factors for risk of becoming edentulous across their lifespan and to examine factors critical for retaining functional dentition into very old age.

    METHODS: From the longitudinal population-based Octogenarian Twin study which analysed psychosocial and health variables, 357 individuals aged 82 + in 1995-1998 were collected. Information about number of teeth, decayed and filled surfaces percentage and periodontal disease experience were drawn from dental records. Reasons for and time of edentulousness were recorded.

    RESULTS: Outcome varied - depending on perspective and factors for losing or retaining teeth. Significant factors for losing teeth varied over the lifespan. Losing teeth early in life was related to lower social class; in middle age, to lower education; and in old age, to poor lifestyle factors and low social class. Caries constituted the main reason for tooth loss (about 55%). This increased substantially in the >80 year age-group (75%). Maintaining a functional dentition into old age was significantly associated with non-smoking, more education, being married and good periodontal health.

    CONCLUSION: It is important to apply life-span and cohort perspectives to oral health and disease. In our sample of persons born before World War I, caries was the main reason for losing all teeth, with substantially increased prevalence by age. Lifestyle factors were significant for losing and for retaining teeth. Periodontal condition had a significant influence on the likelihood of retaining functional dentition, and also when taking psychosocial variables into account.

  • 169.
    Vahlberg, Virpi
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Oral hälsorelaterad livskvalitet hos patienter med dentala implantat: en enkätstudie2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: The purpose of this survey study was to identify how dental implant treatment affects quality of life regarding chewing ability, taste, speech, appearance, oral hygiene habits, and self-confidence.

    Materials and methods: An empirical survey study with quantitative data was performed on three different dental clinics in Stockholm during the time period Feb - April 2012. Questionnaire with a covering letter and stamped envelope was sent to a consecutive sample of 83 patients. Participants, 40 patients, 15 men and 25 women, mean age 66.5 years (34 - 89), voluntarily chose to participate in the study. Analyses of responses were performed in statistical software IBM ® SPSS ® 19.

    Results: The proportion of participants who experienced an improvement in perceived chewing ability was 42,5 %, speech and the taste was perceived not to have changed by 85,0 % after dental implant treatment. Regarding the appearance, 27,5 % said it had improved and 62,5 % that there was no change. There were 22,5 % who felt that their self- confidence had improved, while 75,0 % of participants did not experience a change in self- confidence after dental implant treatment. The majority (85,0 %) of participants did not think their social life had changed after treatment, while 7,5 % of patients reported that it had become better. The result could be noted that 17,5 % of patients found it simpler/ easier to perform oral hygiene while 75,0 % experienced no change in the performance of oral hygiene after dental implant treatment.

    Conclusion: An improvement in oral health- related quality of life for all studied factors could be observed in some patients after dental implant treatment. Most patients experience no change in oral health- related quality of life after dental implant treatment.

  • 170.
    Wahlin, Åsa
    et al.
    The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Papias, Apostolos
    The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Faculty of Odontology, Malmö University, Malmö, Sweden.
    Norderyd, Ola
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Faculty of Odontology, Malmö University, Malmö, Sweden.
    Secular trends over 40 years of periodontal health and disease in individuals aged 20-80 years in Jonkoping, Sweden: Repeated cross-sectional studies2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 9, p. 1016-1024Article in journal (Refereed)
    Abstract [en]

    Aim: To assess trends over 40 years regarding prevalence and severity of periodontitis in a Swedish adult population.

    Materials and methods: Cross-sectional examinations using the same clinical protocol have been repeated every 10years (1973-2013) in a Swedish city with focus on periodontal disease in adults. Periodontal recordings included all teeth, excluding 3rd molars. Periodontal disease experience was classified (no/minor, moderate and severe).

    Results: The no/minor group increased from 43% in 1983 to 60% in 2013. There was a non-significant trend for a decrease of the severe group. Over the 40-year period, the number of teeth increased significantly and at the examination 2013, the severe group accounted for this increase. More than 60% of the study population in 2013 had no periodontal pockets (PD) 6mm. The number of PD 4mm and 6mm were unaltered between 2003 and 2013 in all age groups, except for the 20-year old individuals. This group showed a statistically significant increase of 4mm PD.

    Conclusions: The periodontal health has improved in the population over the 40 years. The number of teeth increased significantly in the population, and in 2013, this increase occurred entirely in the severe group. Finally, there was a trend toward diminished prevalence of severe periodontitis.

  • 171.
    Wirefeldt, Amanda
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Cao, Van
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Patienters upplevelser av tandhygienisters bemötande inom tandvården2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background A way to measure the patients’ experiences regarding treatment is to measure the satisfaction. Treatment includes humanistic view and professional approach. According to the competence description, dental hygienists should treat all people equally with respect. Patient satisfaction can be increased through good care. Aim To investigate patients’ degree of satisfaction from dental hygienists’ in the Public Dental Service, and how patients experienced their professional approach. Method The study was a quantitative cross-sectional study. The sample consisted of people ≥ 18 years old. Five dental clinics were chosen strategically by cluster selection. Descriptive statistics was conducted to map background variables. Age, self-perceived oral health and waiting time were compared with chi-square tests. Results Most of the participants were satisfied with the dental hygienists’ treatment. All participants stated that they were treated in a respectful and considerate manner. Statistically significant difference regarding waiting time was detected. The group where the visit started on time was more satisfied than those who had to wait. Through self-assessment of Humanism Scale showed that dental hygienists’ treatment was based on humanistic approach. Conclusion Most of the participants showed satisfaction with the dental hygienists' treatment and professional approach. Waiting time affected the degree of satisfaction.

  • 172.
    Wohlfahrt, J. C.
    et al.
    Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
    Evensen, B. J.
    Private Practice, Tønsberg, Norway.
    Zeza, B.
    Department of Dental and Maxillofacial Sciences, Section of Periodontology, Sapienza, University of Rome, Rome, Italy.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Pilloni, A.
    Department of Dental and Maxillofacial Sciences, Section of Periodontology, Sapienza, University of Rome, Rome, Italy.
    Roos-Jansåker, A. M.
    Department of Periodontology, Public Dental Health Service, Kristianstad, Sweden.
    Di Tanna, G. L.
    Center for Primary Care and Public Health, Queen Mary University of London, London, UK.
    Aass, A. M.
    Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
    Klepp, M.
    Private Practice, Stavanger, Norway.
    Koldsland, O. C.
    Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
    A novel non-surgical method for mild peri-implantitis- a multicenter consecutive case series2017In: International Journal of Implant Dentistry, ISSN 2198-4034, Vol. 3, no 1Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of the present study was to evaluate the effect on peri-implant mucosal inflammation from the use of a novel instrument made of chitosan in the non-surgical treatment of mild peri-implantitis across several clinical centers.

    MATERIALS AND METHODS:

    In this 6-month multicenter prospective consecutive case series performed in six different periodontal specialist clinics, 63 implants in 63 patients were finally included. The subjects had mild peri-implantitis defined as radiographic bone loss of 1-2 mm, pocket probing depth (PPD) ≥4 mm and a positive bleeding on probing (mBoP) score. The patients were clinically examined at baseline and after 2, 4, 12 and 24 weeks, and radiographs were taken at baseline and at 3 and 6 months. Treatment of the implants with the chitosan brush seated in an oscillating dental drill piece was performed at baseline and at 3 months. Reductions in the clinical parameters (PPD and mBoP) were compared between baseline and the later examination time points.

    RESULTS:

    Significant reductions in both PPD and mBoP were observed at all time points compared with the baseline clinical measurements (p < 0.001). The mean PPD and mBoP at baseline were 5.15 mm (4.97; 5.32) and 1.86 (1.78; 1.93), respectively, whereas the mean PPD and mBoP at 6 months were 4.0 mm (3.91; 4.19) and 0.64 (0.54; 0.75), respectively. Stable reductions in PPD and mBoP were evident up to 6 months after the initial treatment and 3 months after the second treatment. All 63 implants were reported to have stable radiographic levels of osseous support.

    CONCLUSIONS:

    This case series demonstrated that an oscillating chitosan brush is safe to use and seems to have merits in the non-surgical treatment of dental implants with mild peri-implantitis. To measure the effectiveness of the method, a multicenter randomized clinical trial needs to be undertaken.

  • 173.
    Zasčiurinskienė, Eglė
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Orthodontics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Studies on orthodontic treatment in subjects with periodontal disease2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The thesis focuses on periodontal-orthodontic treatment of adult subjects with periodontal disease.

    Aims: The overall aim of this thesis was to explore the effects, risks and benefits of periodontal-orthodontic treatment on periodontal tissues in subjects with periodontal disease.

    Methods: The research was conducted through a systematic literature review (Study 1), a randomised controlled trial (Study 2) and cone beam computed tomography examinations (Studies 3 and 4). The clinical part of the thesis was designed as a randomised controlled trial, which aimed to compare two periodontal treatment timing strategies regarding the effect of orthodontic treatment on periodontal status (Study 2). Fifty subjects with periodontal disease were randomly assigned either to the test (periodontal treatment simultaneous with orthodontic treatment) or control group (periodontal treatment before the start of orthodontic treatment). Initial treatment included oral hygiene instruction, supra- and sub-gingival debridement and was performed for all study patients. Nonsurgical and subsequent surgical periodontal treatment was performed at different time points for the test and control groups. Orthodontic treatment was performed with a straight-wire appliance. Clinical attachment level (CAL) change was chosen as a primary outcome variable. All patients were examined by cone beam computed tomography (CBCT) before and after orthodontic treatment to explore the extent of external apical root resorption (EARR) (Study 3) and changes in alveolar bone levels (ABL) (Study 4).

    Results: The findings in the systematic literature review yielded absence of randomized controlled trials orcontrolled clinical trials on comprehensive orthodontic treatment in subjects with periodontal disease. No difference in CAL change, EARR and ABL was found whether orthodontic treatment was performed simultaneously with (test group patients) or after (control group patients) periodontal treatment. Results yielded a median CAL change (sites CAL ≥4 mm) of 0.4 mm (Q1, Q3: 0.19, 0.61). Gain in clinical attachment level was observed in 22 (88%) patients in both treatment groups. CAL remained unchanged in an average of 3/4 of the sites; CAL gain was observed in an average of 1/4 of the sites. Root lengths were shortened in a median of 80.7% (Q1, Q3: 68.0, 90.0) of orthodontically moved teeth with a mean EARR of 1.2 mm (SD 0.44). EARR of <2 mm was observed in 82% of teeth. ABL levels remained unchanged on a mean of 69.3% (SD 8.8) of surfaces, ABL improved on a mean of 15.6% (SD 7.4) of surfaces, more on the mesial and distal, and ABL decreased on a mean of 15.1% (SD 7.5) of surfaces, more on the buccal and lingual.

    Conclusions: Based on the results of the present research it can be concluded that periodontal-orthodontic treatment under optimal conditions (experienced clinicians and patients with excellent oral hygiene routines overtime), if needed, could be included in the rehabilitation of patients with periodontal disease without deleterious effects. However, there are two important prerequisites: meticulous personal oral hygiene of the patient and optimal sub-gingival control of inflammation before and throughout the combined treatment.

  • 174.
    Zasčiurinskienė, Eglė
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Orthodontics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Basevičienė, Nomeda
    Department of Dental and Oral Pathology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Lindsten, Rune
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Slotte, Christer
    Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Bjerklin, Krister
    Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 2, p. 213-224Article in journal (Refereed)
    Abstract [en]

    Aim: To compare two treatment strategies regarding the effect of orthodontic treatment on periodontal status in patients with plaque-induced periodontitis.

    Subjects and Methods: This was a randomized clinical trial. Fifty periodontal patients were randomly assigned to the test or control groups according to periodontal treatment timing. All patients received supra- and subgingival debridement following baseline examination. Control group patients received cause-related periodontal treatment before the start of orthodontic treatment and which was performed simultaneous to orthodontic treatment for the test group patients.

    Results: No difference between the test and control groups was found regarding change of clinical attachment level (CAL) after periodontal–orthodontic treatment. Fewer sites with initial pocket depth (PD) of 4–6 mm healed after periodontal–orthodontic treatment in the test group (20.5%, IQR = 11.9%) in comparison with controls (30.4%, IQR = 27.1%) (p =.03). Anterior teeth [OR 2.5] and teeth in male patients [OR 1.6] had a greater chance for PD improvement ≥2 mm. Total periodontal–orthodontic treatment duration was significantly longer for the control group (p <.01).

    Conclusions: Both groups showed a gain of CAL and a reduction in sites with PD ≥ 4 mm. Orthodontic treatment, simultaneously to the periodontal treatment, could be used in the routine treatment of patients with plaque-induced periodontitis.

  • 175.
    Zasčiurinskienė, Eglė
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Orthodontics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Lindsten, Rune
    Jönköping University, School of Health and Welfare. Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Slotte, Christer
    Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bjerklin, Krister
    Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Orthodontic treatment in periodontitis-susceptible subjects: a systematic literature review2016In: Clinical and Experimental Dental Research, ISSN 2057-4347, Vol. 2, no 2, p. 162-173Article, review/survey (Refereed)
    Abstract [en]

    The aim is to evaluate the literature for clinical scientific data on possible effects of orthodontic treatment on periodontal status in periodontitis-susceptible subjects. A systematic literature review was performed on studies in English using PubMed, MEDLINE, and Cochrane Library central databases (1965-2014). By manually searching reference lists of selected studies, we identified additional articles; then we searched these publications: Journal of Periodontology, Periodontology 2000, Journal of Clinical Periodontology, American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, International Journal of Periodontics & Restorative Dentistry, and European Journal of Orthodontics. Search terms included randomized clinical trials, controlled clinical trials, prospective and retrospective clinical studies, case series >5 patients, periodontitis, orthodontics, alveolar bone loss, tooth migration, tooth movement, orthodontic extrusion, and orthodontic intrusion. Only studies on orthodontic treatment in periodontally compromised dentitions were included. One randomized controlled clinical trial, one controlled clinical trial, and 12 clinical studies were included. No evidence currently exists from controlled studies and randomized controlled clinical trials, which shows that orthodontic treatment improves or aggravates the status of periodontally compromised dentitions.

  • 176.
    Zasčiurinskienė, Eglė
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Orthodontics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Lund, Henrik
    Department of Oral and Maxillofacial Radiology, Sahlgrenska Academy, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden.
    Lindsten, Rune
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bjerklin, Krister
    Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Outcome of periodontal-orthodontic treatment in periodontitis susceptible patients. Part II: A CBCT study of external apical root resorptionManuscript (preprint) (Other academic)
  • 177.
    Zasčiurinskienė, Eglė
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Orthodontics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Lund, Henrik
    Department of Oral and Maxillofacial Radiology, Sahlgrenska Academy, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden.
    Lindsten, Rune
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bjerklin, Krister
    Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Outcome of periodontal-orthodontic treatment in periodontitis susceptible patients. Part III: A CBCT study of alveolar bone changesManuscript (preprint) (Other academic)
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