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1.
  • Bergenholtz, Gunnar, 1939, et al. (creator_code:aut_t)
  • Treatment of pulps in teeth affected by deep caries - A systematic review of the literature.
  • 2013
  • record:In_t: Singapore dental journal. - : World Scientific Pub Co Pte Lt. - 0377-5291. ; 34:1, s. 1-12
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • BACKGROUND: This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time.STUDY DESIGN: An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE.RESULTS: No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries.CONCLUSIONS: Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.
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2.
  • Frisk, Fredrik, 1971, et al. (creator_code:aut_t)
  • A 24-year follow-up of root filled teeth and periapical health amongst middle aged and elderly women in Göteborg, Sweden.
  • 2005
  • record:In_t: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 38:4, s. 246-54
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • AIM: To describe the endodontic status amongst middle-aged and elderly women longitudinally and cross-sectionally over 24 years. METHODOLOGY: A random sample of 1462 women 38, 46, 50, 54 and 60 years old, living in Göteborg, Sweden, were sampled in 1968 for medical and dental examinations with a participation rate of 90.1%. The same women were re-examined in 1980 and 1992 together with new 38- and 50-year-old women. The dental examination consisted of questionnaires, clinical and panoramic radiological survey (OPG). The number of teeth, number of root filled teeth (RF) and number of teeth with periapical radiolucencies (PA) were registered. The RF and PA ratios were calculated. Cross-sectional data were analysed by means of anova and longitudinal data by a general linear model for repeated measures. Sample prevalences were compared and statistical inferences were made with the chi-squared test. In all analysis, the confidence interval (CI) regarded mean difference between groups (95% CI). RESULTS: The RF and PA ratio decreased over time as well as the frequency of edentulous subjects. Cross-sectional analysis revealed a minor increase in frequency of RF and PA and loss of teeth with age. Longitudinally, loss of teeth was evident in all cohorts. In addition, there was a trend of lower number of teeth with PA, and the RF ratio increased with age. CONCLUSIONS: The prevalence of periapical disease did not increase with age, probably as a result of root canal treatment and extractions. Data showed that the prevalence of RF teeth and teeth with PA decreased for comparable age cohorts during the 24-year follow-up.
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3.
  • Frisk, Fredrik, 1971, et al. (creator_code:aut_t)
  • Endodontic variables and coronary heart disease.
  • 2003
  • record:In_t: Acta odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 61:5, s. 257-62
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • This cross-sectional study was designed to explore a possible association between endodontic disease variables and coronary heart disease (CHD). Dental infections are hypothesized to be linked to atherosclerosis and could be a cause of vascular changes crucial for the development of CHD. Most studies have focused on periodontal disease. To our knowledge, no one has specifically studied endodontic variables as risk factors for the development of CHD. In 1992-93, a representative sample (n = 1056) of women in Göteborg, Sweden, aged between 38 and 84 years, took part in a combined dental and medical survey. The dependent variable was CHD, i.e. subjects with angina pectoris and/or a history of myocardial infarction (n = 106). The independent variables were number of root-filled teeth (RF), number of teeth with periapical radiolucencies (PA), tooth loss (TL), age, life situation, marital status, smoking, alcohol habits, body mass index, waist-hip ratio, serum cholesterol and triglyceride concentrations, hypertension and diabetes. The multivariate logistic regression analysis did not prove the endodontic variables to be predictive of CHD. Only age and tooth loss were significantly associated with CHD, with OR = 1.07 (CI = 1.03-1.12) and OR = 2.70 (CI = 1.49-4.87), respectively. The bivariate logistic regression analysis showed a positive significant association between subjects with RF = 2 and CHD, but for PA the bivariate analysis did not support an association with CHD. This cross-sectional study did not reveal a significant association between endodontically treated teeth and CHD nor between teeth with periapical disease and CHD.
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4.
  • Frisk, Fredrik, 1971, et al. (creator_code:aut_t)
  • Pulp exposures in adults--choice of treatment among Swedish dentists.
  • 2013
  • record:In_t: Swedish dental journal. - : Sveriges tandläkarförbund. - 0347-9994. ; 37:3, s. 153-60
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • This study comprises a survey of Swedish dentists'treatment preferences in cases of carious exposure of the dental pulp in adults.The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines.Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included.The final study sample comprised 412 participants.The dentists were presented with two case scenarios. In Case 1 a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14.The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.
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5.
  • Frisk, Fredrik, 1971, et al. (creator_code:aut_t)
  • Socio-economic risk indicators for apical periodontitis.
  • 2006
  • record:In_t: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 64:2, s. 123-8
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • OBJECTIVE: The aim of this study was to reveal possible socio-economic risk indicators for apical periodontitis. MATERIAL AND METHODS: In 1992-93 a representative sample of women in Göteborg, Sweden, aged 38-84 years, participated in a medical and dental survey (n=981) which included dental and medical examinations and dental radiographic examination (OP). The dependent variable was apical periodontitis (AP=0, AP>0). The independent variables were age, number of teeth, number of restored teeth, number of root-filled teeth, number of teeth with carious lesions, satisfactory masticatory function, and dental esthetics as crude measures of self-reported dental health, dental anxiety, time elapsed since last visit to a dental office, regular dental visiting habits, smoking, alcohol habits, and marital status. A subjective evaluation of economy, health and life situation (acceptable or poor) was accounted for as socio-economic variables. The oldest age group, women born 1908, and edentulous individuals were omitted, leaving 844 subjects for analysis. Statistical analysis included multivariate logistic regression, chi-squared test, and independent t-test for comparison of group characteristics (AP=0 vs AP>0). RESULTS: For socio-economic variables there was a significant association between acceptable health and apical periodontitis (OR=1.72 (CI=1.09-2.70)). For oral-related variables, root-filled teeth (OR=1.17 (CI=1.10-1.23)) and teeth with carious lesions (OR=1.48 (CI=1.19-1.85)) were predictive of apical periodontitis. CONCLUSIONS: In the present study, socio-economic variables and dental visiting habits did not appear to have obvious implications for periapical health, whereas root-filled teeth and carious lesions were associated with apical periodontitis.
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6.
  • Frisk, Fredrik, 1971, et al. (creator_code:aut_t)
  • Technical quality of root fillings and periapical status in root filled teeth in Jönköping, Sweden.
  • 2008
  • record:In_t: International endodontic journal. - : Wiley. - 1365-2591 .- 0143-2885. ; 41:11, s. 958-68
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • AIM: To study changes in technical quality of root fillings and periapical status in root filled teeth in random samples of 20 to 70 year-olds between 1973 and 2003. METHODOLOGY: Data from dentate subjects aged 20-70 years from examinations conducted in 1973 (n = 498), 1983 (n = 530), 1993 (n = 547) and 2003 (n = 491) were used for the analysis. Length of root fillings were measured on radiographs to the nearest 0.1 mm. Adequate seal was defined as a root filling without lateral and/or apical voids. Periapical status was assessed according to the periapical index. All observations were made by one calibrated observer registered from full mouth radiographic examinations. Teeth with root fillings ending within the canal without lateral or apical voids were considered adequate. The association between root filling quality and periapical status was analysed by means of the Chi-squared test and a multilevel logistic regression analysis. RESULTS: Adequately root filled teeth had a significantly lower frequency of apical periodontitis than inadequately root filled teeth (11.8% vs. 22.8%). The frequency of technically adequate root fillings increased statistically significant from 1973 (23.7%) to 2003 (36.4%) without a concomitant improvement of the periapical status in root filled teeth over time (24.5% vs. 24.6%). CONCLUSIONS: This study reports on an improving technical quality of root fillings over time, without a concomitant improvement of the periapical status in root filled teeth. A larger proportion of treated molars over time may be of importance for the result.
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7.
  • Mejare, I. A., et al. (creator_code:aut_t)
  • Diagnosis of the condition of the dental pulp: a systematic review
  • 2012
  • record:In_t: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:7, s. 597-613
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • Mejare IA, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tran ae us S, Bergenholtz G. Diagnosis of the condition of the dental pulp: a systematic review. International Endodontic Journal, 45, 597613, 2012. Abstract The aim of this systematic review was to appraise the diagnostic accuracy of signs/symptoms and tests used to determine the condition of the pulp in teeth affected by deep caries, trauma or other types of injury. Radiographic methods were not included. The electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to June 2011. The complete search strategy is given in an Appendix S1 (available online as Supporting Information). In addition, hand searches were made. Two reviewers independently assessed abstracts and full-text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 155 articles were read in full text. Of these, 18 studies fulfilled pre-specified inclusion criteria. The quality of included articles was assessed using the QUADAS tool. Based on studies of high or moderate quality, the quality of evidence of each diagnostic method/test was rated in four levels according to GRADE. No study reached high quality; two were of moderate quality. The overall evidence was insufficient to assess the value of toothache or abnormal reaction to heat/cold stimulation for determining the pulp condition. The same applies to methods for establishing pulp status, including electric or thermal pulp testing, or methods for measuring pulpal blood circulation. In general, there are major shortcomings in the design, conduct and reporting of studies in this domain of dental research.
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8.
  • Petersson, Arne, et al. (creator_code:aut_t)
  • Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review
  • 2012
  • record:In_t: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:9, s. 783-801
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • Petersson A, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Mejare I, Portenier I, Sandberg H, Tranaeus S, Bergenholtz G. Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review. International Endodontic Journal, 45, 783801, 2012. Abstract This systematic review evaluates the diagnostic accuracy of radiographic methods employed to indicate presence/absence and changes over time of periapical bone lesions. Also investigated were the leads radiographic images may give about the nature of the process and the condition of the pulp in nonendodontically treated teeth. Electronic literature search included the databases PubMed, Embase and CENTRAL from January 1950 to June 2011. All languages were accepted provided there was an abstract in English. The MeSH terms were Cone beam computed tomography (CBCT), Radiography, panoramic, Periapical diseases, Dental pulp diseases, Sensitivity and specificity, receiver operating characteristics (ROC) curve, Cadaver, Endodontics and Radiography dental. Two reviewers independently assessed abstracts and full text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 181 articles were read in full text. The GRADE approach was used to assess the quality of evidence of each radiographic method based on studies of high or moderate quality. Twenty-six studies fulfilled criteria set for inclusion. None was of high quality; 11 were of moderate quality. There is insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to CBCT. No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.
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