| 1. |
- Axelsson, Susanna, et al.
(författare)
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Economic aspects of the detection of occlusal dentine caries.
- 2009
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 67:1, s. 38-43
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the cost of true-positive occlusal dentine caries detection in permanent molars assessed by: (I) visual-tactile examination, (II) visual-tactile examination combined with bitewing radiographs, and (III) selective radiographic examination of patients with lesions detected clinically. A second aim was to analyse the different strategies when the costs of the subsequent restorative care are considered. METHODS: A model analysis was applied owing to the lack of original articles. Sensitivity and specificity were calculated from a systematic review and included in vitro and in vivo studies of medium and high quality. The direct costs for examinations and restorative care were extracted from the costs of the Public Dental Service in Sweden (2006). RESULTS: The diagnostic costs per true-positive finding were dependent on the occurrence of occlusal caries and increased with decreasing prevalence. The strategy by which radiographs were exposed selectively on the basis of findings from visual-tactile examination resulted in higher initial costs compared with the first and second strategies. When the costs of the subsequent restorative care were added, the selective strategy was most beneficial by up to 26% savings per true-positive diagnosis. However, with this selective strategy, more cases of true-positive dentine caries were assumed would remain undetected as compared with the combined strategy with visual-tactile examination and radiographs for all. CONCLUSIONS: The cost for a true-positive caries diagnosis was inversely related to caries occurrence, and different diagnostic strategies may display contrasting outcomes when subsequent restorative care is taken into account.
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| 2. |
- Barzangi, Jir, 1978-
(författare)
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Infant Dental Enucleation in Sweden : Perspectives on a Practice among Residents of Eastern African Origin
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Infant dental enucleation (IDE) is a practice consisting of the removal of deciduous canine tooth buds in infants. Practiced mainly in Eastern Africa, the purpose is to treat or to prevent bodily symptoms and diseases. IDE can cause both general and oral complications. The occurrence of IDE among Eastern African immigrants in a few European countries has been reported. However, knowledge surrounding the practice in Sweden was poor. The overall aim of this work was to explore IDE in the Swedish context. Four studies were conducted. Paper I presents a review of scientific publications. An overview of IDE was gained, and some knowledge gaps were identified. Paper II describes a cross-sectional study to determine the prevalence of IDE in small children. Dental records of 1133 children (mean age 4.6 years, SD 1.4) from a multi-ethnic area were studied. Missing deciduous canines without any registered reason were documented. One or more deciduous canines were missing in 21% of the children with known Eastern African origin (n=101), compared to only three children in the rest of the population (n=1032). Six adults of Somali origin were interviewed to explore their experiences and perceptions of IDE (paper III). These experiences and perceptions were categorised in four essentially different ways: an effective and necessary treatment, a disputed tradition, an option to failure and a desperate measure. Their experiences and perceptions were found to be highly influenced by contexts. In the final study (paper IV), the knowledge, experiences and attitudes among dental and health care personnel were examined. Questionnaires were sent to licensed personnel working in emergency departments, midwifery and child health centres, school health services and public dental health services in ten municipalities. Less than 20% had any knowledge of IDE, while 12.5% of the respondents encountering children had seen at least one patient subjected to IDE. Different attitudes were reported between clinical settings regarding responsibilities and possibilities concerning the management and prevention of IDE. From the findings presented in this thesis, it was concluded that there is a need for initiatives to increase awareness of and knowledge on IDE among dental and health care professionals. Legally obligated responsibilities in these professions regarding IDE need to be clarified, and initiatives should include guidelines regarding both the management of IDE and its prevention in Sweden. Educational programmes should also be produced for residents of Eastern African origin to change their perceptions of IDE, and a culturally sensitive approach should be adopted to ensure that such programmes are effective.
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| 3. |
- Johansson, Elisabeth, 1969-
(författare)
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Effect of ozone on dental caries and on cariogenic microorganisms
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are a number of unanswered questions regarding new caries preventive methods such as ozone treatment as well as novel caries detection methods that monitor and evaluate these preventive methods. This thesis seeks answers to some of these questions.Aims: Paper I investigates the in vitro sealing capacity of a novel ozone delivery system and its re-suction capacity. Paper II studies the in vitro antibacterial effect of ozone on cariogenic bacterial species with and without the presence of saliva and its possible effect on the saliva proteins. Paper III assesses the in vitro validity of laser-induced fluorescence (LF) measurements, visual inspection (colour), and tactile examination (surface texture) on root caries lesions and correlates these with histopathological measurements of lesion depths. In addition, Paper III investigates how inter-device, inter-examiner, and intra-examiner levels influence LF reading agreements and whether lesion colour and surface texture influences LF readings. Paper IV evaluates the in vivo effect of ozone and fluoride varnish treatments on occlusal caries in primary molars.Material and methods: Paper I: Full ozone application cycles, including the re-suction period, and interrupted cycles with displacement of the cup during the delivery cycle were studied using an ozone air analyser. Paper II: Ozone gas was exposed to the bacteria in the solution’s buffer and saliva via a tube connected to the ozone generator for 10, 30, and 60 seconds. Paper III: Calibrated examiners assessed lesion colour and surface texture and performed measurements with two LF devices for three separate one-week intervals. Sections (300µm thick) of 64 out of 93 teeth were obtained and examined under a microscope. Lesion depth was assessed with two references: from the delineated borderline of the original exposed root surface (ref I) or, if loss of surface continuity, the absolute lesion depth (ref II). Paper IV: The split mouth study was conducted in two parts. The participants in part A were children (mean age 4.8 years) with medium-high caries risk. Inclusion criteria were bilateral matched pairs of cavitated or non-cavitated occlusal lesions in primary molars (Ekstrand index score ≤ 3). Children in part B (mean age 4.5 years) with low-medium caries risk had pairs of non-cavitated lesions only (Ekstrand index score ≤ 2a). The assessments and treatments with ozone and fluoride varnish were performed at baseline and at three, six, and nine months. At the 12-month follow-up, only assessments were performed.Results: Paper I: Ozone leakage levels varied between 5.2 and 9.8 µg/m3. Paper II: In the salt buffer, 92%, 73%, and 64% of the initial numbers of A. naeslundii, S. mutans, and L. casei, respectively, were killed after 10 s ozone exposure and approximately 99.9% of the bacteria were dead after a 60 s exposure. After 10 and 30 s but not after 60 s exposure to ozone, S. mutans and L. casei were less efficiently killed in saliva compared to in the salt buffer. Various saliva proteins were degraded by ozone after the 60 s exposure. Paper III: The correlation between LF readings and histological depth was low with values ranging from 0.22 (p ˃ 0.05) to 0.31 (p < 0.05). The LF devices were significantly correlated with discolouration and with a surface texture denoted as hard. A significant correlation was found between colour and histological depth. No significant correlation was found between surface texture and histological depth. The reliability, evaluated as intra-class correlation coefficient, was 0.99 for intra-examiner, 0.97 for inter-examiner, and 0.98 inter-device level. Large differences were found between two consecutive measurements and high measurement errors indicated considerable deviation of individual measurements.Paper IV: In the first 15 pairs of part A, eight lesions treated with ozone and nine treated with fluoride, including all cavitated lesions, progressed to failure, i.e., required operative treatment during the study time. Due to non-acceptable results, the sample collection was discontinued because of ethical reasons. In part B, of 35 pairs, one of the ozone treated lesions failed at 12 months. A small shift towards increased VI scores was recorded for both ozone and fluoride lesions in this second part.Conclusions:- The ozone delivery system can be considered a safe system with low leakage levels in air, also with accidental displacements.- The cariogenic species S. mutans, L. casei, and A. naeslundii were sensitive to ozone gas treatment. The presence of saliva hampered the antibacterial effect of ozone.A low correlation between the LF readings and the histopathological depth of root caries lesions was shown. The LF device was found not to be appropriate for application to root caries diagnosis.- Neither ozone nor fluoride varnish treatments arrested the progression of cavitated occlusal caries lesions. In low and medium caries risk children non-cavitated occlusal lesions remained mainly unchanged during the study period. No difference in the effect of ozone and fluoride varnish treatments on occlusal caries in primary molars was seen.
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| 4. |
- Klingberg, Gunilla, et al.
(författare)
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Ethics in pediatric dentistry
- 2017
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Ingår i: Pediatric dentistry. - : Wiley-Blackwell. - 9781118913499 ; , s. 371-376
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 5. |
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| 6. |
- Oscarson, Nils, et al.
(författare)
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Is caries equally distributed in adults? A population-based cross-sectional study in Norway - the TOHNN-study
- 2017
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 75:8, s. 557-563
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of the study was to examine the prevalence and distribution of dental caries in an adult population and identify factors associated with being caries free.MATERIAL AND METHODS: Data were collected from a randomized population sample in Northern Norway (N = 1932; 988 women; mean age 47.0 years, SD 15.3). The study included a structured questionnaire and a clinical examination. The sum of enamel and dentine caries, DS1-5, formed the main outcome measures for caries prevalence.RESULTS: Mean DMFT was 15.1 (95% CI 14.8, 15.4), mean DFT was 12.0 (CI 11.7, 12.2), and mean DT was 1.1 (CI 1.0, 1.2). The mean value for dentine caries (DS3-5) was 0.8 (CI 0.7, 0.9), and mean DS1-5 was 3.8 (CI 3.6, 4.1). Mean DS1-5 was highest in the youngest age group (mean 6.9, 95% CI 6.3, 7.6) and in rural areas (mean 5.0, CI 4.4, 5.6). The most caries-prone 20% in the youngest age group had 52% of the total number of carious lesions compared with 80% in the two oldest age groups. Tooth brushing twice daily (p = .005), drinking sugar containing soft drink (p =.029), and attending dental services every year (p < .001), were associated with being caries free.CONCLUSION: Dental caries is still a common condition, particularly in the youngest age group. Living in a rural area, low socioeconomic status, less frequent tooth cleaning and sugar containing soft drinks were associated with a higher prevalence of dental caries. The different caries distribution among adults calls for different preventive strategies at both population and individual levels.
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| 7. |
- Twetman, Svante, et al.
(författare)
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Adjunct methods for caries detection: A systematic review of literature.
- 2013
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 71:3-4, s. 388-397
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. To assess the diagnostic accuracy of adjunct methods used to detect and quantify dental caries. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion and exclusion criteria. Abstracts and full text articles were assessed independently by two reviewers. The study characteristics were compiled in tables and quality graded according to the QUADAS tool. The level of evidence for each diagnostic technology (fiber-optic methods, fluorescence methods, electrical methods) was based on studies of high or moderate quality according to the GRADE approach. Results. Twenty-five reports fulfilled the inclusion criteria. One study was of high quality, 10 were graded as moderate, while the remaining 14 reports were of low quality. Electrical methods (ECM) and laser fluorescence (DIAGNOdent) displayed sensitivities and specificities around 70-80% regarding occlusal dentin lesions with a mean Youden's index of 0.52-0.54. The mean accuracy of laser fluorescence for detecting enamel and dentin lesions was 0.68 and 0.91, respectively. The heterogeneity of the published reports hampered the analysis. Conclusions. There was insufficient scientific evidence for diagnostic accuracy regarding fiber-optic methods and quantitative light-induced fluorescence (+OOO). The electrical methods and laser fluorescence could be useful adjuncts to visual-tactile and radiographic examinations, especially on occlusal surfaces in permanent and primary molars, but evidence was graded as limited (++OO). No conclusions could be drawn regarding the cost-effectiveness of the methods. There is an obvious need to standardize study designs for in vitro and in vivo validation of the different methods.
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