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Sökning: LAR1:gu > Forskningsöversikt > Dahlén Gunnar 1944

  • Resultat 1-10 av 16
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1.
  • Asikainen, S, et al. (författare)
  • Antibiotika vid parodontala behandlingar
  • 2002
  • Ingår i: Tandläkartidningen. ; 94, s. 26-33
  • Forskningsöversikt (refereegranskat)abstract
    • Inom parodontalvården kan systemisk behandling med lämpligt antibiotikum i vissa situationer vara indicerad som ett tillägg till konventionell behandling, till exempel vid akuta infektioner, snabbt progredierande former av parodontit (inkluderande juvenil parodontit) och hos patienter med komprometterat immunsystem. Denna terapeutiska ansats grundas på uppfattningen att den marginala parodontiten i dess olika former kan anses vara en endogen polymikrobiell opportunistisk infektion där en ekologisk obalans uppstått, varvid vissa så kallade parodontitpatogena bakteriearter kommit att dominera. Eftersom det är näst intill omöjligt att kliniskt diagnostisera en pågående parodontal destruktion kan diagnostiken lämpligen kompletteras med en mikrobiologisk analys. Val av antibiotikum görs på basis av dessa diagnostiska kriterier. Då infektionerna är att betrakta som endogena kan vi inte räkna med att eliminera dessa parodontitpatogener, däremot kan vi med antibiotika hämma deras aktivitet och kontrollera deras tillväxt. För att uppnå en bestående parodontal hälsa krävs att de parodontala vävnaderna efter behandling åter kan anses vara fria från inflammation och uppvisa ett reducerat, men friskt, fäste. Lokal behandling med olika antibiotika finns som behandlingsform men det saknas alltjämt studier som övertygande visar bättre kliniska långtidseffekter när subgingival depuration kombineras med lokal antibiotikabehandling än de resultat som kan uppnås med enbart konserverande parodontal behandling.
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2.
  • Basic, Amina, et al. (författare)
  • Microbial metabolites in the pathogenesis of periodontal diseases: a narrative review
  • 2023
  • Ingår i: Frontiers in Oral Health. - 2673-4842. ; 4
  • Forskningsöversikt (refereegranskat)abstract
    • The purpose of this narrative review is to highlight the importance of microbial metabolites in the pathogenesis of periodontal diseases. These diseases, involving gingivitis and periodontitis are inflammatory conditions initiated and maintained by the polymicrobial dental plaque/biofilm. Gingivitis is a reversible inflammatory condition while periodontitis involves also irreversible destruction of the periodontal tissues including the alveolar bone. The inflammatory response of the host is a natural reaction to the formation of plaque and the continuous release of metabolic waste products. The microorganisms grow in a nutritious and shielded niche in the periodontal pocket, protected from natural cleaning forces such as saliva. It is a paradox that the consequences of the enhanced inflammatory reaction also enable more slow-growing, fastidious, anaerobic bacteria, with often complex metabolic pathways, to colonize and thrive. Based on complex food chains, nutrient networks and bacterial interactions, a diverse microbial community is formed and established in the gingival pocket. This microbiota is dominated by anaerobic, often motile, Gram-negatives with proteolytic metabolism. Although this alternation in bacterial composition often is considered pathologic, it is a natural development that is promoted by ecological factors and not necessarily a true "dysbiosis". Normal commensals are adapting to the gingival crevice when tooth cleaning procedures are absent. The proteolytic metabolism is highly complex and involves a number of metabolic pathways with production of a cascade of metabolites in an unspecific manner. The metabolites involve short chain fatty acids (SCFAs; formic, acetic, propionic, butyric, and valeric acid), amines (indole, scatole, cadaverine, putrescine, spermine, spermidine) and gases (NH3, CO, NO, H2S, H-2). A homeostatic condition is often present between the colonizers and the host response, where continuous metabolic fluctuations are balanced by the inflammatory response. While it is well established that the effect of the dental biofilm on the host response and tissue repair is mediated by microbial metabolites, the mechanisms behind the tissue destruction (loss of clinical attachment and bone) are still poorly understood. Studies addressing the functions of the microbiota, the metabolites, and how they interplay with host tissues and cells, are therefore warranted.
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4.
  • Charalampakis, Georgios, et al. (författare)
  • Rationale for treatment of oral infectious diseases based on a micro-ecological concept
  • 2014
  • Ingår i: Current Trends in Microbiology. - 0972-7736. ; 9
  • Forskningsöversikt (refereegranskat)abstract
    • The most common oral infectious diseases are caries, endodontic infections, periodontitis and peri-implantitis. Early diagnosis and total control of these conditions remain a major challenge for clinicians. In this review, we describe infectious oral diseases and evaluate critically the current treatment strategies using a holistic aetiological approach. We draw attention to the local environment, the micro-ecology, where opportunistic pathogens may survive and thrive. We explain why elimination of bacteria from the disease site is probably not feasible and may not be critical; acceptance of this idea would represent a paradigm shift in understanding these conditions. We demonstrate that a crucial step for long-term success of treatment interventions and shift from disease to health involves a change in the local environment to create conditions in which pathogenic bacteria cannot survive and grow. We argue that measures that do not entail local micro-ecological change at affected sites will fail to prevent the recurrence of infectious oral diseases. Our further hope is that the idea of micro-ecology in dentistry will provide a model and pedagogical tool that will help clinicians, in their quest to counter oral diseases of infectious origin, to evaluate treatment approaches in dental care.
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6.
  • Dahlén, Gunnar, 1944, et al. (författare)
  • Allmänt om orala infektioner
  • 2002
  • Ingår i: Tandläkartidn. ; 94, s. 12-17
  • Forskningsöversikt (refereegranskat)abstract
    • Exogena infektioner är oftast ytliga i munhålan. Behandlingen inriktas i dessa fall på att avlägsna predisponerande förhållanden och/eller eliminera den mikrobiella faktorn. Behandling med antibiotika är indicerad. Endogena infektioner i munhålan är opportunistiska infektioner. Sådana infektioner orsakas av normalt icke patogena mikroorganismer som kan bli patogena, antingen genom att de invaderar sterila vävnader eller genom en mikrobiell ekologisk obalans. Djupa opportunistiska infektioner är oftast endogena och dessutom polymikrobiella. Antibiotika används för att hindra spridning och komplikationer men på grund av låg koncentration i infektionshärden måste behandlingen kompletteras med incision och mekanisk rensning. Ytliga endogena opportunistiska infektioner är orsakade av en mikrobiell ekologisk obalans. Behandlingen går ut på att avlägsna de predisponerande faktorerna, reducera mängden mikroorganismer samt återställa den mikrobiella homeostasen (balansen). Opportunistiska infektioner vid nedsatt värdresistens är en speciell form av infektion där den ekologiska obalansen kan leda till spridning och komplikationer. I dessa fall kan det vara indicerat att behandla infektionen med ett lämpligt antibiotikum.
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7.
  • Dahlén, Gunnar, 1944 (författare)
  • Bacterial infections of the oral mucosa.
  • 2009
  • Ingår i: Periodontology 2000. - : Wiley. - 1600-0757 .- 0906-6713. ; 49, s. 13-38
  • Forskningsöversikt (refereegranskat)
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8.
  • Dahlén, Gunnar, 1944 (författare)
  • Biofilms in Dental Unit Water Lines.
  • 2021
  • Ingår i: Monographs in oral science. - : S. Karger AG. - 1662-3843. ; 29, s. 12-18
  • Forskningsöversikt (refereegranskat)abstract
    • Biofilm formation has become a significant problem in dental unit water lines (DUWLs). The formation of biofilms and microbial growth in DUWLs leads to an unacceptably high number of microorganisms in the water used for spraying, cooling, and ultrasonication procedures. These procedures form aerosols which can be inhaled by the patients, and consequently dentistry constitutes an area of specific concern for patient safety. In particular, older and immunocompromised patients are at risk of serious respiratory tract infections if the water contains pathogens such as Legionella pneumophila and Pseudomonas spp. In the EU it is recommended that the water in DUWLs should not exceed 200 colony-forming units (CFU) of heterotrophic bacteria (bacteria living on organic material) per milliliter of water to be acceptable in dental work. A number of efficient products are available on the market that can be applied onto dental units. New dental units are nowadays equipped with "inbuilt" systems. Such measures have resulted in an acceptable standard of water in 95% of the 1,200 dental units in the Public Dental Health Service of the Västra Götalands region of Sweden that were followed yearly for 4 years. For the majority of the remaining DUWLs with an unacceptable standard this is due to neglect or inappropriate routines for water-cleaning procedures. It is the ability to follow instructions rather than the cleaning procedure itself that is decisive if clinics and dental units are to have an appropriate standard of water in their systems.
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9.
  • Dahlén, Gunnar, 1944, et al. (författare)
  • Current concepts and an alternative perspective on periodontal disease.
  • 2020
  • Ingår i: BMC oral health. - : Springer Science and Business Media LLC. - 1472-6831. ; 20:1
  • Forskningsöversikt (refereegranskat)abstract
    • Epidemiological data from countries worldwide show a consistent pattern implying that a fraction of around 10% of those over 40-50 years in all populations will exhibit severe periodontitis with the potential risk of losing teeth during their life-time. The subgingival microbiota shows striking similarities between populations irrespective of disease severity and can only marginally explain the clinical pattern. It is also difficult to explain this pattern by genetic and acquired risk factors such as systemic disease (e.g. diabetes) or habits (e.g. smoking) even if they may have a confounding effect on the disease.Inflammation of the gingiva appears to be a normal and physiological response to the presence of commensal bacteria along the gingival crevice and in the dental biofilm. Over many years of exposure to the dental biofilm, the chronic inflammation in the gingiva gradually results in a loss of attachment and bone loss. Numerous laboratory and clinical studies have provided insight into the potential role of determinants that are associated with periodontitis. However, it has been difficult to relate the findings to the pattern of the distribution of the disease observed in epidemiological studies. We propose a simple and parsimonious model that considers all the multitude of potential determinants as creating effectively random noise within the dental biofilm to which the tissues react by accumulating the effects of this noise.We suggest that such a model can explain many of the epidemiological features of periodontal breakdown over time, and we discuss its clinical implications.
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10.
  • Dahlén, Gunnar, 1944 (författare)
  • Microbiology and treatment of dental abscesses and periodontal-endodontic lesions
  • 2002
  • Ingår i: Periodontology 2000. - : Wiley. - 0906-6713. ; 28, s. 206-239
  • Forskningsöversikt (refereegranskat)abstract
    • Dental or dento-alveolar abscesses are abscesses of dental origin, the majority being periapical with an endodontic origin or periodontal with a periodontal pocket origin. Dental abscesses also include pericoronitis, and abscesses caused by trauma and surgical infections. The incidence of serious odontogenic infections has decreased dramatically over the last half century due to preventive dental care and availability of more effective antibiotics. Dental abscesses still occur and they may lead to serious consequences by spreading, involving the bone or various spatia, which, could lead to life-threatening conditions. Periapical and periodontal abscesses may advance and merge into perio-endo lesions. A majority of dental abscesses are caused by the resident oral microflora, which enters normally sterile tissues. Mechanical removal of necrotic infected tissues and surgical drainage are the most important treatment steps. Antibiotics are indicated in case of general symptoms and to limit the spread of the infection. This paper was initiated to review present knowledge of the dental abscess concerning its pathology, microbiology and treatment.
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