Aim: The aim of this literature study was to investigate oral health in children and adolescents with Down syndrome.

Method: The study is a general literature study where the searches were carried out in the databases CINAHL, MEDLINE and Dentistry & oral sciences source (DOSS). Scientific articles that responded to the purpose of the study were selected based on inclusion and exclusion criteria and relevant keywords. Results: A total of 22 quantitative studies were reviewed which showed that children and adolescents with Down syndrome had poorer oral hygiene, more oral diseases and malocclusions compared to children and adolescents without Down syndrome. The reported oral diseases/conditions were caries, gingivitis, periodontitis, oral candidosis, malocclusions, attrition, agenesis and dental erosion. Risk factors that can influence the development of oral diseases and malocclusions, for example, oral hygiene habits and oral motor factors. Conclusion: Children and young people with Down syndrome have an increased risk of suffering from oral diseases and malocclusions. Through increased knowledge about the oral health of children and young people with Down syndrome, dental hygienists can work preventively and motivate support and care for this risk group.

Oral health is a multifaceted and changeable part of our overall health and well-being as it contributes to important everyday functions such as eating, talking, and conveying feelings. Our oral health can be affected by a range of determinants, one of which is obstructive sleep apnea [OSA] treated with continuous positive airway pressure [CPAP]. Even though xerostomia has been frequently reported upon, the possible relationship between oral health and CPAP-treated OSA is not clearly understood. The World Dental Federation [FDI] recently proposed a definition and theoretical framework of oral health, intended to be globally applicable and to move dentistry toward a more promotive approach. By using the FDI’s framework as a basis for exploration, studies in a general population can increase the understanding of different aspects of oral health and set the frame of reference for whether and how CPAP-treated OSA can be experienced to affect a person’s oral health.

The overall aim of this thesis was to gain a deeper understanding of how the FDI’s theoretical framework of oral health can be applied in a general population and how oral health is experienced in a specific population of persons with increased risk for adverse oral health.

The FDI’s framework was explored with empirical data from a general population (N=630) and a population of persons with experience of CPAP-treated OSA (N=18). In papers I and II, the FDI framework was tested and evaluated with quantitative methods (principal component analysis and structural equation modeling), using cross-sectional data from the Jönköping studies. In papers III and IV, qualitative methods (directed content analysis and critical incident technique) were used where personal views and experiences were explored using individual semi-structured interviews.

The findings in paper I showed that factors such as dental caries, periodontal disease, experience of xerostomia, and aesthetic satisfaction can be included in the FDI’s component the core elements of oral health. In paper II, driving determinants and moderating factors were found to have direct effects on all core elements of oral health except aesthetic satisfaction. Three of the core elements of oral health (oral health-related quality of life, aesthetic satisfaction, and xerostomia) had direct effects on the latent variable overall health and well-being. Driving determinants and moderating factors had no direct effect on overall health and well-being, and no indirect effects were found. In paper III, the study participants’ views on oral health determinants were described and could be categorized into all the FDI framework dimensions. The component driving determinants could include a range of determinants affecting a person’s oral health such as CPAP treatment, age, the influence of family and social surroundings, interdental cleaning, willingness to change when needed, and relationship with oral healthcare professionals. In paper IV, the study participants described both negative and positive experiences occurring with or without their CPAP. The negative experiences included increased xerostomia, pain or discomfort, tooth wear, and negative feelings. The positive experiences included decreased xerostomia and improved oral health habits due to improved sleep. Many of the difficulties could be managed by easily accessible facilitators. The experiences the study participants described could be included in all the FDI framework components.

In conclusion, the FDI’s framework can be applied in a general population to describe different components of oral health, and is also useful to describe a person’s views and experiences of oral health in a specific population. CPAP treatment could be considered an oral health determinant as it can affect a person’s oral health. Both positive and negative experiences can contribute to CPAP adherence as negative experiences often can be successfully managed.

Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.

BACKGROUND: Oral diseases have been associated with cardiovascular diseases, and persons with continuous positive airway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences for both oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomia is a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our general health and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore what persons with experience of CPAP-treated OSA view as determinants for their oral health.

METHODS: Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data were collected by semi-structured individual interviews. A code book based on the World Dental Federation's [FDI] theoretical framework for oral health was developed and used to analyse the data using directed content analysis. The domains in the framework's component driving determinants were used as pre-determined categories. Using the description of driving determinants as a guide, meaning units were extracted from the interview transcripts through an inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaning units into the pre-determined categories.

FINDINGS: The views on oral health determinants described by the informants were compatible with the five domains in the component driving determinants in the FDI's theoretical framework. Ageing, heredity, and salivation (biological and genetic factors), influences from family and the wider society (social environment), location and re-localisation (physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behaviours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinants by the informants.

CONCLUSION: The study points to a variety of individual oral health-related experiences that oral healthcare professionals could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes for persons undergoing long-term CPAP-treatment.

Aim: To investigate how oral health in adults is affected by asthma and asthma medication treatment.  Method: The study design was a general literature review. A search for scientific articles was performed in the databases DOSS, CINAHL, and MEDLINE. A total of 17 scientific articles were selected for the result of the literature review based on relevant inclusion and exclusion criteria, keywords, and the quality of the review. Results: Asthma and asthma medication had an impact on oral health in adults. Studies showed a higher prevalence of dental caries and pathology of periodontal tissues, dry mouth, erosion damage, and poorer oral hygiene among adults with asthma compared to those without asthma. It was also found that adults with asthma who were undergoing medication treatment had an increased presence of Candida albicans in saliva. Other oral health-related conditions such as certain dermatological diseases and benign tumors were also found to be associated with asthma in adults. Conclusion: Adult individuals with asthma showed a higher prevalence of oral diseases compared to adults without asthma. Side effects as a result of medication treatment were an influencing factor in the occurrence of oral diseases in adult asthmatics.  

Aim: The purpose was to compare high school students’ oral hygiene habits and consumption of sweets and snacks before and during distance education, because of the covid-19-pandemic. With two question statements, which aimed to compare women and men. Method: The method was a quantitative questionnaire study in which 215 high school students in year three who had distance education during the academic year 2020-2021 were invited to participate. Data were analyzed through the Fisher exact test; statistical significance was considered at p≤0.05. Results: A total of 86 students participated. The results showed statistically significant difference when comparing all respondents' toothbrushing frequency (p=0.040), frequency of interdental cleaning (p=0.001) and consumption of sweets and snacks (p=0.001) before and during distance education. By comparison, women's toothbrushing frequency changed more than men's (p=0.026 respectively p=o.411). Conclusion: Both oral hygiene habits and consumption of sweets and snacks have been affected by distance education because of the covid-19-pandemic. Reduced toothbrushing frequency and increased consumption of sweets and snacks contribute to risk of oral diseases.

Background: Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment. Methods: Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR −) based on sensitivity and specificity presented in the studies included. Results: Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR − ranges of 0.78–10.3 and 0.0–1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall. Conclusions: The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models’ usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties. Trial registration: PROSPERO CRD#152,467 April 28, 2020

Aim: The aim was to describe oral health in individuals with Parkinson's disease (PD). Method: The study design was a general literature study where three databases were used to search for scientific articles (DOSS, CINAHL and MEDLINE). After applying inclusion, exclusion criteria, proper keywords and conducting a quality review, a total of 19 scientific articles were selected. Result: Oral hygiene tended to be worse in patients with PD. The results showed that xerostomia and hyposalivation are common in patients with PD. Caries, gingivitis and periodontitis were also shown among patients with PD where, among other things, periodontal measurements were shown to be higher in proportion in these individuals. Other oral conditions that were shown among individuals with PD were drooling, dysphagia, halitosis and angular cheilitis. Conclusion: Oral health was shown to be worse among individuals with PD compared to individuals without PD. The risk of being exposed to oral diseases such as caries, gingivitis and periodontitis was higher among these individuals where both drug intake and impaired motor skills have an effect. 

Aim: The aim was to examine dental healthcare professionals experience, actions and factors when suspecting child maltreatment and to determine barriers that affect the decision to report a concern. Method: A literature study based on 20 scientific articles of a quantitative approach. Data collection was performed using the databases DOSS, CINAHL, MEDLINE, PubMed, and Google Scholar. Inclusion and exclusion criteria were used to limit the sample. The selected articles that answered the purpose of the literature study were published between 2017-2022 and were quality-reviewed to ensure high quality. Results: The majority of dental professionals had experienced suspected cases of child maltreatment. Common actions in case of suspicion were to document injuries, report to the police or clinic manager, question the child and the parents and follow up the observations. The frequency of reports to the child protection authorities was consistently low. Barriers to reporting were concern about negative consequences, uncertainty about the reliability of the suspicion, lack of knowledge, guidelines, and routines. Conclusions: Dental professionals experiences of meeting children who are suspected of being maltreated, clear guidelines and routines, knowledge in the subject area and the subjective perception are factors that influence the tendency to report. Further research is needed to investigate which measures can lead to an increased propensity to report among dental professionals and in such a way enable more children to live a life free of violence.

Title: Evaluation of oral health care education for nursing students. A survey study.

Background: Oral health care has an impact on individuals' well-being, quality of life and general health. Healthcare professionals should have knowledge of oral health risks and health factors as well as treatment of symptoms. Oral health education is crucial to carry out measures required in case of bad oral health and to create an understanding of the importance of cooperation between dental care and health care.

Aim: The purpose of this study was to study whether knowledge in oral health and oral care increases by implementing oral health education in collaboration between the nursing program and the dental hygienist program.

Method: An intervention study was conducted with paper questionnaires. The selection was nursing students in semester two at Jönköping University. Method analysis was conducted with fisher exact test and a qualitative content analysis.

Results: The respondents' knowledge of oral health and oral care increased after oral health education and there was a statistically significant difference in most questions before and after. Based on the respondents' reflections, three categories emerged, Gained new knowledge, Gained an understanding of oral care and the link between oral-general health, Need practical training.

Conclusion: Nursing students' knowledge of oral health and oral care increased after oral health education. The education contributed to future clinical skills and provided insight into interprofessional collaboration.

Stannous fluoride Toothpaste and plaque-induced gingivitis 

-A comparison between stannous fluoride and conventional toothpaste

A literature study

Summary

Aim: The aim of this study was to investigate the effect of a stabilized stannous fluoride toothpaste on gingivitis in the short and long term compared to conventional sodium fluoride toothpaste. Method: A literature study , the searching and collecting  of articles was performed in a systematic way from specific databases CINAHL, DOSS and PubMed. The search and the keywords were based on the purpose of the study and the selection was according to the inclusion and exclusion criteria. A total of 14 original articles were selected, which were quality reviewed and presented. Results: Selected articles were divided into three different subheadings: the effect of stannous fluoride on gingivitis in the short term, the effects of stannous fluoride on gingivitis in the long term and the effect of stannous fluoride on the bacterial flora that plays a role in the occurrence of gingivitis. The results showed more advantages of using a stannous fluoride toothpaste compared to a conventional fluoride toothpaste for patients with gingivitis. The results also showed less active pathogenic bacteria throughout the mouth when using toothpaste containing stannous fluoride. Conclusion: Toothpastes that contain stannous fluoride can have preventive and therapeutic effects against plaque and gingivitis. Above all, it provides more benefits than a regular conventional sodium fluoride toothpaste in the daily oral hygiene routine. However, future studies with larger population should be carried out to ensure the results and be able to pursue the recommendation via the Swedish National Board of Health and Welfare's guidelines.

Aim: To describe 19-24 year old young adults’ perception of oral hygiene and dietary habits during distance education in the course of the covid-19 pandemic. Method: A total of six university students aged between 19-24 years old selected through strategic and convenience selection from various faculties and universities in Sweden were interviewed. The acquired material was processed and analyzed using a phenomenographic approach. Results: The phenomenon that emerged was that distance education due to the covid-19-pandemic led to social distancing. This had an impact on the informants' mental health, which affected their dietary habits in an unhealthy direction, while changes in oral hygiene habits were not perceived to be generally important. The results were described in four categories; perception of created social distancing included perceptions of social distancing due to distance education during the covid-19 pandemic; perceptions of created mental di-sease included perceptions of how mental health was affected by social distancing; perception of social distancing and dietary habits contained perceptions of how dietary habits were affected by mental state due to social distancing; perception of social distancing and oral hygiene habits encompassed perceptions of how oral hygiene habit were influenced by mental state because of social distancing. 

Syfte: Syftet med denna litteraturstudie var att undersöka hur kognitiva och motoriska funktionsnedsättningar kan påverka den orala hälsan och den oral hälsorelaterade livskvalitén hos strokedrabbade individer. Metod: En litteraturstudie genomfördes baserad på 18 vetenskapliga originalartiklar. Sökning efter samtliga artiklar genomfördes i databaserna CINAHL, Medline och DOSS där särskilda inklusion och exklusions kriterier styrde valet av vilka artiklar som skulle användas. Därefter kvalitetsgranskades de utvalda artiklarna. Resultat: Strokerelaterad motoriska funktionsnedsättningar påverkar individens förmåga att sköta munhygienen och att tugga och svälja. Det har även påvisat att strokerelaterade motoriska funktionsnedsättningar hade statistisk signifikant påverkan på parodontal status (p <0,001). Kognitiva funktionsnedsättningar hos strokedrabbade individer visade en statistisk signifikant påverkan på hur ofta strokedrabbade individer borstade tänderna dagligen (p <0,001) samt en statistisk signifikant koppling till parodontit. Både motoriska och kognitiva funktionsnedsättningar uppvisade en påverkan på individens dagliga välbefinnande. Slutsats: Strokerelaterade motoriska och kognitiva funktionsnedsättningar har visats ha en påverkan på oral hälsa och oral hälsorelaterad livskvalité. Dock skulle mer forskning inom detta område vara gynnsam för både allmänheten och tandvårdspersonalen.

Astma och karies är två vanligt förekommande sjukdomar hos barn och ungdomar, och det finns samband mellan sjukdomarna och även mellan astma och dental erosion. En fungerande samverkan mellan barnhälsovården och tandvården är därför viktig så att tandvården tidigt kan sätta in adekvata preventionsstrategier, och vid behov ställa diagnos och behandla eventuell karies och dental erosion.

Aim: The aim was to study how depression affects the oral health of adults. Material and method: The study is a general literature study based on quantitative and qualitative articles. The used databases were "Dentistry and Oral Sciences Source" and "Medline". Results: A total of 15 scientific articles were analyzed, compiled and divided under two headings. The headings consist of internal and external factors that affect and limit oral health. The factors described are oral hygiene, oral diseases and impaired chewing ability linked to depression, as well as low socioeconomic status and the role of the dental care staff linked to depression. Conclusion: Depression affects oral health in a negative way. The impact depends on various factors such as low socio-economic status, problems with various mouth functions and oral diseases that limit depressed patients' ability to maintain good oral health and impair the quality of life. Further research on the subject needs to be applied for broader knowledge in the area.

Summary

Title: Sjogren´s syndrome and oral health: A literature study. 

Background: Sjogren´s syndrome (SS) is a globally prevalent disease affecting 0,5–1% of the population, predominantly middle-aged women. 

Aim: The aim of this literature review was to describe the extra- and intraoral clinical signs detected in patients with Sjogren's syndrome.  

Method: A general literature study was conducted. Articles published between 2012 and 2022 with clearly discernible information about SS consistent with the objective were included.

Results: Studies show that patients with SS can have oral involvement, including oral lichen planus, candida infections and angular cheilitis. Saliva production can be reduced, which causes hyposalivation and increases the risk of dental caries. Swelling of salivary glands, reduced function of the jaw and tooth wear may also occur.  

Conclusion: Among the intraoral signs, hyposalivation, oral candidosis and angular cheilitis were mostly common, and for the extraoral signs swelling of the parotid glands was the most common. There was a large variation in clinical signs and it´s important to continue to explore the relationship between SS and oral involvement to improve the diagnosis and treatment for SS of the disease as it is difficult to diagnose. 

Study Design: Retrospective with follow-up. Objective: This study described the long-term outcomes of patients who received either conservative or surgical treatment for zygomaticomaxillary complex (ZMC) fractures. It accounted for the perspectives of both patients and surgeons, and explored factors associated with patient satisfaction. Methods: Patients with unilateral ZMC fractures 2007-2018 were invited to follow-up clinical examinations and photographic documentation. Patient experiences were recorded using a questionnaire. A review panel assessed computed tomography (CT) scans and photographs. Patient and surgeon perspectives of detecting functional sequelae were assessed, and a correlation matrix was used to evaluate different perspectives of perceiving malar asymmetry. Results: The study sample consisted of 180 patients, of which conservative treatment was given to 43 patients and surgical treatment to 137 patients. Median follow-up time was 72.5 months after trauma. Overall satisfaction was 92.8%, with no significant difference between treatment groups. Patients and surgeons showed marked differences in detecting functional sequelae. Predicted malar asymmetry on CT scans did not correlate to findings on photographs or reports by patients. Conclusions: A predicted sunken cheek on CT imaging does not necessarily lead to long-term visible asymmetry of the malar region. Surgeons should acknowledge different perspectives when predicting and assessing long-term sequelae of ZMC fractures, and seek consensus on when to perform surgical reconstructions.

Aim: The aim of the literature study was to investigate the prevalence of musculoskeletal disorders, which factors cause these, and which body parts affect clinically active dental hygienists. Method: The study design was a literature review based on previous research of 14 scientific articles found in the databases CIHNAL, MEDELINE and DOSS. The articles included in this literature review were between the years 2012–2022. Selected articles are quality reviewed. Results: Musculoskeletal disorders affected an average of 80% of dental hygienists from all studies. The factors where work-related such as working hours, workload and working posture. Individual factors such as gender, age, physical fitness and previous injuries. Psychosocial factors such as stress level, workplace environment and social support. More than half of the dental hygienists experienced problems in several body parts at the same time. The body parts affected were the neck (67%), shoulders (54%), the back (46%), hands/wrists (44%), elbows (20%), the hip (17%), the knees (12%) and the feet (12%) Conclusion: Musculoskeletal disorders are a major problem for dental hygienists. This should be considered in the work for a good working environment. More research and more educational programs in ergonomics are needed to prevent musculoskeletal disorders among dental hygienists who work clinically in the future. 

ObjectivesThe aim of this systematic review is to compare conventional peri-implant flap surgery and reconstructive surgical techniques regarding evidence of remission from peri-implantitis.Material and methodsSearches were made among randomized controlled trials evaluating clinical aspects and the changes in marginal bone level before and after surgical treatment of peri-implantitis, with and without bone substitute.ResultsNine published articles and 442 patients were eligible for inclusion in the study. Reconstructive techniques exhibited a greater extent of defect fill than conventional surgical techniques alone. No significant differences could be found for clinical measures of peri-implant disease (bleeding on probing and reduction of probing depth) from baseline to the 12-month follow-up.ConclusionsWith regards to the clinical measures of disease, our review shows that there are no differences between open flap debridement and regenerative surgery. From an esthetic standpoint, it may however be that regenerative measures may lead to improvement but further publications with this focus will be necessary to verify this.

Objective: The primary aim of this current systematic review and meta-analysis was to evaluate the potential microbiological effect of probiotics on the implant microbiota. The secondary aim was to evaluate if probiotics have any effect as an adjunct to non-surgical peri-implant treatment in reducing peri-implant mucositis and peri-implantitis clinical parameters—bleeding on probing, modified Gingival Index, and pocket depth.

Methods: The research focus questions were constructed in accordance with the Participants, Intervention, Comparison, and Outcomes (PICO) criteria, and a PROSPERO protocol was registered. A comprehensive systematic search in MEDLINE via the PubMed, Scopus, and Web of Science Core Collection databases was conducted. Two independent reviewers screened the reports based on the PICO criteria—inclusion and exclusion criteria.

Results: In total, 467 records were identified, and ultimately, 7 papers were included: 3 papers in the qualitative synthesis of microbiological effect and 4 in the meta-analysis synthesis on pocket depth. The data synthesis showed that probiotics had no detectable effect on the implant microflora, and in the following data synthesis, no clinical peri-implantitis variable showed a significantly beneficial effect from probiotics in the test group compared to the control group.

Conclusion: Within the limitations of this review, the oral implant microflora is not affected by probiotics nor do probiotics add any effect to the conventional non-surgical treatment of peri-implant mucositis and peri-implantitis.

Objectives: When teeth are lost, dental implants contribute to improved oral function and quality of life. Limitations in dental implant placement arising from poor bone anatomy may be circumvented via alveolar ridge preservation (ARP). The aim is to evaluate the long-term impact of ARP on peri-implant health and the relationship with common risk indicators such as smoking and history of periodontitis.

Materials and Methods: One hundred and eight patients were enrolled in this retrospective cohort study with 308 implants. Of these, ∼41% were placed in bone sites that had previously received ARP with deproteinized bovine bone mineral xenograft. Association between baseline variables: ARP, age, gender, number of implants per patient, anatomical site, smoking, and previous history of grade III/IV periodontitis, and outcome variables: mucositis, peri-implantitis, implant loss, full-mouth plaque score (FMPS), full-mouth bleeding score, and marginal bone loss (MBL) was evaluated using both univariate and multivariate models.

Results: After 5 years, the overall survival rate was 93.7%. The occurrence of peri-implantitis was 21.3% and the extent of MBL was ~2.2 mm. Both peri-implantitis occurrence and MBL were comparable between ARP+ and ARP−. Smoking is associated with higher FMPS and MBL.

Conclusions: The findings indicate that peri-implant health can be maintained around dental implants for up to 5 years in ARP+ sites using Bio-Oss®. Smoking is a major risk indicator for peri-implantitis, whereas the association between history of periodontitis and the risk of peri-implantitis, based on this specific, well-maintained cohort and the specific implants used, remains inconclusive.

Aim: The aim of this study was to investigate what methods are available to prevent caries in patients with radiotherapy for cancer of the head and neck area.Method: A general literature study was performed by compiling various quantitative studies published in the databases PubMed and DOSS and which included head and neck cancer patients being treated with radiation.Results: The results showed five different methods for preventing radiation-induced caries as a caries prevention program consisting of several different interventions and the use of various preparations such as tin fluoride, sodium fluoride, calcium phosphate and amifostine. Caries prevention programs consisted of various interventions; however, most programs gave statistically significant results in caries reduction in this patient group. Oral care programs can prevent radiation-induced caries.Conclusion: There are studies in this subject area, more research is needed to be able to guarantee that these patients get the best caries prevention.

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

BACKGROUND: Healthcare professionals' attitudes to and knowledge of oral health are fundamental to providing good oral health care to older adults. One instrument that assesses healthcare professionals' attitudes to and knowledge of oral health in a Swedish context is the "Attitudes to and Knowledge of Oral health" (AKO) questionnaire. Two of the three item-groups of the AKO have previously been validated in a Swedish context. However, it is crucial that all three item-groups are validated, and beneficial to design a shorter, easy-to-use questionnaire for healthcare professionals while maintaining adequate integrity of its reliability and validity. Therefore, the present study aims to develop a short-form version of AKO and to secure its psychometric properties.

METHODS: Psychometric evaluation with Classical Test Theory and Item Response Theory to validate and shorten AKO with 611 healthcare professionals from a population of 1159 working in a municipality in an urban area in western Sweden.

RESULTS: Of the original 16 items in the AKO, 13 were shown to warrant retention in the abbreviated/shortened form. These showed acceptable validity and reliability for assessing healthcare professionals' attitudes to and knowledge of oral health.

CONCLUSION: This validated short-form version of AKO shows acceptable validity and reliability after being reduced to 13 items, structured in a 3-part scale. The items are consistent with the total scale, indicating that the internal consistency is acceptable. Future studies should be performed to evaluate AKO in other groups of healthcare professionals, across cultures, languages, and so on, to investigate its use and strengthen its validity and reliability.

A visit to the dental clinic may be challenging for a child with Downs syndrome due to medical and oral health problems as well as communication problems.

Aim: The aim of the present study was to explore how parents of children with Down syndrome describe their child’s needs in the dental health care setting.

Method: In a online survey concerning parental experiences with dental health care in Sweden, free comments were analysed with content analysis. By answering the survey, parents consented to participate. Ethical approval was obtained by from the Regional Ethics Committee for Human Research at Linköping University, Sweden.

Result: The analyse resulted in five categories: “Need for continuity of care in dental health care”; “Need for dental health care professionals to have knowledge and expertise in caring for children with Down syndrome and other disabilities”; “Need for dental health care professionals to use a caring approach with children with Down syndrome”; “Need for the child with Down syndrome to be prepared to participate in their dental health care visit” “Need for the child with Down syndrome to be given the same rights as typically developing children”.

Conclusion: To support children with Down syndrome in an optimal way, dental health care needs to be tailored to meet the child’s unique needs. When visiting dental health care services, children with Downs syndrome need continuity, and they need to meet professionals who have a caring approach and knowledge and experience of children with Down syndrome.

Objectives: Anterior active rhinomanometry (AAR) is widely used in Swedish routine clinical practice to decide if septoplasty is necessary. The scientific basis for the method needs to be strengthened. Therefore, the aims were to evaluate nasal airway resistance (NAR), paradoxical reactions to pharmacological decongestion, and test-retest characteristics of the Rhino-Comp (R) AAR in healthy subjects.

Methods: A prospective longitudinal design was used. AAR was performed before and after decongestion at baseline and after >= 6 months on 60 healthy volunteers. The relationships between NAR, height, weight, BMI, sex, and allergic rhinitis were evaluated by regression analyses. Descriptive statistics were used to evaluate paradoxical reactions. Test-retest and repeatability characteristics were evaluated with intra-class coefficients (ICC), Cronbach's alpha, and standard error of measurement.

Results: No statistically significant differences were found between genders or nasal cavity sides. NAR was statistically significantly related to height. Short- and long-term test-retest characteristics were good with ICC and Cronbach's alpha > .75. The minimal significant difference in NAR Log10V2 values between the two measurements was 0.11 and 0.09 (long- and short-term). Paradoxical reactions to pharmacological decongestion were rare, mostly weak, and not evidently reproducible.

Conclusion: In this study, we report reference data for healthy subjects, test-retest capabilities, and the minimal relevant difference between two measurements for the Rhino-Comp (R) AAR, information that is vital and necessary for the appropriate use of AAR in clinical practice. An effective method for pharmacological decongestion is described and recommended for future studies and clinical practice. Paradoxical reactions to pharmacological decongestants exist but maybe without clinical significance.

Level of Evidence: NA.

OBJECTIVES: The present study evaluated the association of fear of COVID-19 with dental anxiety, oral health-related quality of life (OHRQoL), and psychological distress (depression, anxiety and stress), as well as exploring the mediating role of dental anxiety in the association of fear of COVID-19 with OHRQoL and psychological distress.

METHODS: A cross-sectional study was conducted among adolescents in high schools of Qazvin city (Iran) from March-June 2021, recruited through a two-stage cluster sampling method. All the adolescents completed a self-administered survey assessing (i) fear of COVID-19, (ii) depression, anxiety and stress, (iii) OHRQoL, and (iv) dental anxiety. Structural equation modelling was used to evaluate all the hypothesised associations, and the model fit was estimated.

RESULTS: A total of 2429 adolescents participated in the study. The conceptual model fitted the data well. Fear of COVID-19 had a direct effect on dental anxiety (B = 0.316; bias-corrected bootstrapping 95% CI = 0.282, 0.349), depression (B = 0.302; bias-corrected bootstrapping 95% CI = 0.259, 0.347), anxiety (B = 0.289; bias-corrected bootstrapping 95% CI = 0.246, 0.334), stress (B = 0.282; bias-corrected bootstrapping 95% CI = 0.237, 0.328), and OHRQoL (B = -0.354; bias-corrected bootstrapping 95% CI = -0.530, -0.183). Also, dental anxiety mediated the association of fear of COVID-19 with depression, anxiety stress, and OHRQoL.

CONCLUSIONS: High levels of fear of COVID-19 were associated with high levels of dental anxiety and poorer OHRQoL. Moreover, fear of COVID-19 was positively associated with anxiety, depression and stress. Increased levels of dental anxiety were also associated with increased anxiety, stress, depression, and poorer OHRQoL.