| 1. |
- Fellows, Jeffrey L., et al.
(författare)
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Dentist and practice characteristics associated with restorative treatment of enamel caries in permanent teeth : Multiple-regression modeling of observational clinical data from The National Dental PBRN
- 2014
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Ingår i: American Journal of Dentistry. - 0894-8275. ; 27:2, s. 91-99
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Current evidence in dentistry recommends non-surgical treatment to manage enamel caries lesions. However, surveyed practitioners report they would restore enamel lesions that are confined to the enamel. Actual clinical data were used to evaluate patient, dentist, and practice characteristics associated with restoration of enamel caries, while accounting for other factors. Methods: Data from a National Dental Practice-Based Research Network observational study of consecutive restorations placed in previously unrestored permanent tooth surfaces and practice/demographic data from 229 participating network dentists were combined. ANOVA and logistic regression, using generalized estimating equations (GEE) and variable selection within blocks, were used to test the hypothesis that patient, dentist, and practice characteristics were associated with variations in enamel restorations of occlusal and proximal caries compared to dentin lesions, accounting for dentist and patient clustering. Results: Network dentists from five regions placed 6,891 restorations involving occlusal and/or proximal caries lesions. Enamel restorations accounted for 16% of enrolled occlusal caries lesions and 6% of enrolled proximal caries lesions. Enamel occlusal restorations varied significantly (P< 0.05) by patient age and race/ethnicity, dentists' use of caries risk assessment, network region, and practice type. Enamel proximal restorations varied significantly (P< 0.05) by dentist race/ethnicity, network region, and practice type.
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| 2. |
- Flink, Håkan, et al.
(författare)
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Effect of oral iron supplementation on unstimulated salivary flow rate : a randomized, double-blind, placebo-controlled trial
- 2006
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Ingår i: Journal of Oral Pathology & Medicine. - : Wiley. - 0904-2512 .- 1600-0714. ; 35:9, s. 540-547
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Tidskriftsartikel (refereegranskat)abstract
- Background: No treatment is known to permanently increase salivary flow in patients with hyposalivation. The objective of this study was to investigate the effect of iron supplementation on salivary flow rate. Methods: A double-blind, randomized, placebo-controlled trial was carried out on 50 individuals with a low unstimulated whole salivary flow rate and low serum ferritin. Half the individuals received 60 mg iron orally twice a day for 3 months, while the other half received placebo. Results: No statistically significant difference was found between the groups after treatment for the unstimulated flow rate and in the subjective assessments of oral dryness. The serum ferritin values increased significantly in the iron group but not in the placebo group. Conclusions: Oral supplementation with iron for 3 months has no effect on salivary flow rate among individuals with hyposalivation and low serum ferritin values.
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| 3. |
- Flink, Håkan, et al.
(författare)
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Identification of caries-active individuals in longitudinal data a methodological study using a national registry
- 2024
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Ingår i: Acta Odontologica Scandinavica. - : Medical Journals Sweden. - 0001-6357 .- 1502-3850. ; 83, s. 70-75
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe aim was to identify caries active individuals among adults by using a trajectory model of longitudinal data from the Swedish national registry (SKaPa) and comparing them with published data from the Dunedin cohort.Materials and methodsData from two different age groups (30- and 40-year-olds) followed for 10 years were retrieved from SKaPa and were compared with published longitudinal birth-cohort data from the Dunedin study. Using the trajectory model, the subjects were divided into three different trajectories according to their caries development over time (i.e. high, 15%; moderate, 45%; low, 40%).ResultsCaries experience, as measured by mean decayed, missing, and filled surfaces (DMFS) index, revealed significant differences among the three trajectories in both age groups. The patterns were similar to those observed in the Dunedin cohort. The mean increase in DMFS during the 10-year follow-up period from SKaPa was significantly higher for the high trajectories in both age groups compared with the moderate and low trajectories.ConclusionsThe method using three trajectories for presentation of caries experience over time, may be a useful tool to identify subjects with different disease activities. Identification of subjects in the high caries experience trajectory may increase the possibility to explore and evaluate more effective caries prevention for this group in the future.
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| 4. |
- Flink, Håkan, et al.
(författare)
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Identification of Swedish caries active individuals aged 30-90 years using a life course perspective and SKaPa longitudinal national registry data over a 10-year period
- 2024
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Ingår i: Acta Odontologica Scandinavica. - : Medical Journals Sweden. - 0001-6357 .- 1502-3850. ; 83, s. 412-418
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the occurrence of caries disease from a life course perspective using longitudinal data from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa). Material and Methods: Data from seven age cohorts (ages 30-90 years), each followed over 10 years, were retrieved from the SKaPa. Using a three-trajectory model, individuals were divided into three trajectories according to their caries development over time: high (15%), moderate (45%), or low (40%). Caries experience was expressed as the mean decayed, missing, and filled surfaces (DMFS) index. Results: Significant differences were found for all three trajectories and in all age groups over the 10 years. The mean DMFS index increase was significantly larger for the high trajectory group than for the moderate and low trajectory groups across all age cohorts. An increase in caries experience was observed for the older cohorts across all trajectories. Conclusions: A three-trajectory model appears useful for identifying and quantifying caries experiences in longitudinal studies. Increased caries disease occurs over time, especially in the highest trajectory group and among older cohorts. These findings emphasise the need for greater attention and more efficient caries prevention methods.
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| 5. |
- Flink, Håkan, et al.
(författare)
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Patient-reported negative experiences related to caries and its treatment among Swedish adult patients.
- 2017
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Ingår i: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment.METHODS: A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients' dental records. Exploratory factor analysis was conducted on items related to patients' perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared.RESULTS: The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients.CONCLUSIONS: Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.
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| 6. |
- Flink, Håkan, et al.
(författare)
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Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults
- 2008
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Ingår i: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 36:6, s. 523-531
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:Several studies have been conducted on the prevalence of hyposalivation in older adults but no population-based studies in younger adults. Therefore, our aims were to determine the prevalence of very low and low unstimulated (UWSFR) and stimulated (SWSFR) whole salivary flow rates in different age groups between 20 and 69 years, and to analyse the relationship between hyposalivation, subjective oral dryness and predictors of reduced flow rate.METHODS:A randomized and stratified cross-sectional study including 1427 dental patients was conducted. UWSFR and SWSFR were measured, numbers of remaining teeth recorded and a questionnaire answered regarding subjective oral dryness, general diseases, use of drugs, body mass index (BMI) and use of tobacco.RESULTS:The prevalence of very low (<0.1 ml/min) and low (0.10-0.19 ml/min) UWSFR was similar for different age groups up to 50 years, ranging between 10.9-17.8% and 17.3-22.7%, respectively. The prevalence of very low UWSFR was significantly higher for women aged 50-69 years than for younger women. For men, prevalence of very low UWSFR was higher at 60-69 years. The prevalence of very low (<0.7 ml/min) and low (0.70 - 0.99 ml/min) SWSFR was between 0-5.5% and 0.8-8.2%, respectively, for the different age groups 20-69 years. Multiple logistic regression revealed that age above 50 years, female gender, having fewer than 20 teeth, and taking xerogenic drugs significantly increased the risk of very low UWSFR. For very low SWSFR, only having fewer than 20 teeth and taking more than two drugs were significant. In the younger individuals (<50 years) only BMI > 25 for very low UWSFR and diagnosed disease for very low SWSFR were found significant. In this younger subset, female gender combined with having fewer than 27 teeth was significant for low UWSFR.CONCLUSIONS:Hyposalivation is prevalent in younger adults, among whom it is associated with diagnosed disease and high BMI, while after age 50 years it is associated with medication. It is also associated with gender and with fewer remaining teeth.
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| 7. |
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| 8. |
- Flink, Håkan
(författare)
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Studies on the prevalence of reduced salivary flow rate in relation to general health and dental caries, and effect of iron supplementation
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Reduced salivary flow is a condition that affects oral health. Its prevalence is unknown in young and middle-aged adults and there is no known treatment that permanently increases the salivary flow rate. Reduced salivary flow is related to dental caries, the most common oral disease. Reduced salivary flow is often found in individuals with insufficient food intake and thereby insufficient nutrition to the salivary glands. One nutrition related factor that has been proposed to effect salivary flow rate is iron deficiency. Aims: The aims of the thesis were to investigate i) the prevalence of reduced salivary flow rate in different age groups of adults, ii) the relationship between reduced salivary flow rate, general health and dental caries, iii) the influence of time of measurement on reduced salivary flow rate, and iv) if reduced salivary flow rates could be increased by iron supplementation. Material and methods: In Study I saliva was collected from 1427 individuals aged 20-69 years. A questionnaire was answered regarding subjective oral dryness, general diseases, use of drugs, BMI (Body Mass Index) and use of tobacco. In Study II saliva was collected from 48 patients with active caries and 48 caries-inactive patients. A blood sample was analysed for serum ferritin. In Study III the unstimulated salivary flow rate was tested at 7:30 and 11:30 a.m. in 108 individuals, age 15-46 years. The participants were allocated to one of three groups (very low <0.1 mL/min, low 0.1-0.2 mL/min and normal >0.2 mL/min) based on the the unstimulated salivary flow rate at 7:30 a.m. Different aspects of the perception of oral dryness were rated using Visual Analogue Scales. In Study IV a double-blind, randomized controlled trial was carried out on 50 individuals with a low unstimulated whole salivary flow rate and low serum ferritin. Half the individuals received 60 mg of iron orally twice a day for 3 months, while the other half received placebo. Results: In Study I it was found that the prevalence of very low (<0.1 mL/min) and low (0.10-0.19 mL/min) unstimulated salivary flow rate were similar for different age groups up to 50 years, ranging between 10.9-17.8% and 17.3- 22.7%, respectively. Multiple logistic regression revealed that above age 50, female gender, ‘having fewer than 20 teeth’, and taking xerogenic drugs significantly increased the risk of very low unstimulated salivary flow rate. In Study II 32 individuals (67%) in the caries active group had low unstimulated salivary flow rate compared with 13 individuals (27%) in the caries inactive group. There was no difference in serum ferritin levels between the two groups. Study III showed for all groups a statistically significant increase in unstimulated salivary flow rate at 11:30 a.m. compared with 7:30 a.m., all of similar magnitude (0.08-0.09 mL/min). In the group with very low salivary flow rate, 70% at 11:30 a.m. exceeded the 0.1 mL/min limit. There were significant difference in perception of oral dryness between the normal group and both the low and the very low groups. In Study IV no statistically significant difference was found between the groups after treatment for the unstimulated flow rate and in the subjective assessments of oral dryness. Conclusions: The prevalence of reduced salivary flow rates is consistent and prevalent in younger and middle-aged adults (<50 years). Very low salivary flow rates are related to high Body Mass Index (BMI) and diagnosed diseases in younger adults, but to medication in older adults. Reduced salivary flow rate in young adult women is related to caries. The time of measurement of salivary flow rates influences diagnosis of hyposalivation. Iron supplementation does not enhance salivary flow.
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| 9. |
- Flink, Håkan
(författare)
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Unstimulated human whole saliva flow rate in relation to hyposalivation and dental caries
- 2005
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Salivary secretion is influenced by a large number of factors, including the circadian rhythm, making the detection of reduced salivary flow (hyposalivation) difficult. This is important since severely reduced salivary secretion has been associated with an increased risk for dental caries and may be a sign of a general disease, e.g. Sjögren's syndrom. It has been suggested that iron deficiency is related to hyposalivation. Aims: The aims of this thesis were to investigate i) the unstimulated whole saliva flow rate and serum ferritin among individuals with dental caries, ii) time-dependent changes in the unstimulated whole saliva flow rate in subjects with hyposalivation, and iii) the subjects’ perception of salivary gland function. Results: Caries-active women were found to have a significantly lower unstimulated saliva flow rate compared with those with inactive caries, but there were no significant differences in serum ferritin. A significant increase in unstimulated whole saliva flow rate was revealed for individuals with hyposalivation as well as for those with a normal saliva secretion rate, when tested at two time points separated by four hours in the morning. There were significant differences in subjective assessments of oral dryness between individuals with hyposalivation and individuals with normal saliva secretion. Conclusions: It was concluded that a low unstimulated whole saliva flow rate is related to caries activity, thereby strengthening the view that the unstimulated whole saliva flow rate test could be used in the prediction, prevention and treatment of caries. Furthermore, serum ferritin appears not to be related to caries activity, or to the unstimulated whole saliva flow rate. The unstimulated saliva flow rate test should be performed in a narrow time interval early in the morning in order to obtain an accurate diagnosis of hyposalivation. Individuals with salivary gland hypofunction perceive an increase in saliva flow rate more clearly than those with normal unstimulated whole saliva flow rate.
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| 10. |
- Rostedt Punga, Anna, et al.
(författare)
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Cholinergic neuromuscular hyperactivity in patients with myasthenia gravis seropositive for MuSK antibody
- 2006
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Ingår i: Muscle and Nerve. - : Wiley. - 0148-639X .- 1097-4598. ; 34:1, s. 111-115
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Tidskriftsartikel (refereegranskat)abstract
- A 75-year-old man with severe oculobulbar myasthenia gravis (MG) treated with acetylcholine esterase inhibitors (AChEIs) was found to have muscle-specific tyrosine kinase (MuSK) antibodies. Neurophysiological examination displayed extra repetitive discharges after the compound motor action potential (CMAP) at low-frequency stimulation, possibly triggered by AChEI. This indicates an abnormal sensitivity to acetylcholine in patients with MuSK antibodies and may be a useful indicator of the adverse effect of AChEI treatment in these patients. Muscle Nerve, 2006
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| 11. |
- Sikk, K, et al.
(författare)
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Clinical, neuroimaging and neurophysiological features in addicts with manganese-ephedrone exposure
- 2010
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 121:4, s. 237-243
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To identify biomarkers supporting the clinical diagnosis of manganism in patients several years after exposure to manganese (Mn). Methods - Neurophysiological examinations, magnetic resonance imaging (MRI), single-photon emission computed tomography and fluorodeoxyglycose (FDG) positron emission tomography were performed in four former ephedrone addicts with extrapyramidal symptoms. Results - Peripheral nervous system was not affected. No patients had reduced uptake of (123)I Ioflupane in the striatum. MRI signal intensities were slightly changed in the basal ganglia. All patients showed a widespread, but not uniform, pathological pattern of FDG uptake with changes mainly located to the central part of the brain including the basal ganglia and the surrounding white matter. Conclusions - Presynaptic neurons in the nigrostriatal pathway are intact in Mn-induced parkinsonism after prolonged abstinence from ephedrone. The diagnosis is principally based on clinical signs and the history of drug abuse.
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