| 1. |
- Fransson, Helena, et al.
(författare)
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There is a paucity of economic evaluations of prediction methods of caries and periodontitis : A systematic review
- 2021
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Ingår i: Clinical and Experimental Dental Research. - : John Wiley & Sons. - 2057-4347. ; 7:3, s. 385-398
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Direct cost for methods of prediction also named risk assessment in dentistry may be negligible compared with the cost of extensive constructions. On the other hand, as risk assessment is performed daily and for several patients in general dental practice, the costs may be considerable. The objective was to summarize evidence in studies of economic evaluation of prognostic prediction multivariable models and methods of caries and periodontitis and to identify knowledge gaps (PROSPERO registration number: CRD42020149763). Material and methods: Four electronic databases (PubMed, Web of Science, The Cochrane Library, NHS Economic Evaluation Database) and reference lists of included studies were searched. Titles and abstracts were screened by two reviewers in parallel. Full-text studies reporting resources used, costs and cost-effectiveness of prediction models and methods were selected and critically appraised using a protocol based on items from the CHEERS checklist for economic evaluations and the CHARMS checklist for evaluation of prediction studies. Results: From 38 selected studies, six studies on prediction fulfilled the eligibility criteria, four on caries and two on periodontitis. As the economic evaluations differed in method and perspective among the studies, the results could not be generalized. Our systematic review revealed methodological shortcomings regarding the description of predictive models and methods, and particularly of the economic evaluation. Conclusions: The systematic review highlighted a paucity of economic evaluations regarding methods or multivariable models for prediction of caries and periodontitis. Our results indicate that what we currently practice using models and methods to predict caries and periodontitis lacks evidence regarding cost-effectiveness.
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| 2. |
- Andersson, Helena, et al.
(författare)
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Walking football for Health - physiological response to playing and characteristics of the players.
- 2023
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Ingår i: Science and medicine in football. - : Routledge. - 2473-3938 .- 2473-4446. ; , s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Walking Football (WF) is one type of recreational football increasing in popularity, targeting older adults. Further knowledge on the intensity and physical workload of WF, characteristics of the players, the social context, and reasons for playing WF is needed. Thus, the aim of the study was to characterize the individuals that regularly play WF and their experience of WF, and the physiological characteristics of the sport. Sixty-three players from three clubs taking part in organised WF in Sweden were included. The players participated in up to four WF-games and underwent performance tests and answered a questionnaire. The participants mean age was 70.9 years, ranging from 63 to 85 years with 71% (n = 27) of the men and 68% (n = 13) of the women having a BMI > 25. Fifty-one percent (n = 27) of the players had hypertension, and 73% (n = 39) regularly used prescription drugs due to illness. During WF, the players covered on average 2,409 m (2,509 m for men and 2,205 m for women, p = .001). Expressed in percentage of their age-estimated maximal heart rate, mean heart rate represented 80 ± 9 and 80 ± 8% of max for men, and 78 ± 9 and 79 ± 9% of max for women in the first and second halves, respectively, hence WF can be considered a moderate intensity activity for older adults. The main reason for WF participation was to socialize. WF includes a considerable number of accelerations and decelerations, making it more energetically and mechanically demanding than walking.
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| 3. |
- Brodén, Joséphine, et al.
(författare)
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“Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth
- 2023
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Ingår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aims: Reflection on a deeper level is recognized as an important skill to learn for undergraduate students since mastering reflection can be helpful throughout their future careers. The aim with this study was to (i) examine if short structured written reflections could stimulate deep reflection among a group of dental students and (ii) explore specifically how the students reflected on clinical experience in relation to uncertainty when assessing the risk for exacerbation of apical periodontitis in root filled teeth.Methods: Short reflections were written by 52 dental students at Malmö University in 2021. All students first answered some questions associated with the risk for exacerbation of apical periodontitis in a case with a root filled tooth with a diffuse widening of the periodontal ligament space. After this, they were asked to write short reflections following prompts developed specifically to stimulate reflection. For each student, the reflections were analyzed and the level of reflection according to the 4Rs framework (Reporting/responding, Relating, Reasoning, Reconstructing) was assessed. The written content in the reflections were analyzed by a qualitative method, Systematic Text Condensation (STC). Results: Thirteen of the students (25%) reached the deepest level of reflection, Reconstructing. Sixteen students (31%), reached only the most superficial level, Report/respond. Two themes about experience and lack of experience were identified in the reflections: Theme 1 “The meaning of clinical experience” and Theme 2 “Differences and similarities”. The themes were subdivided into nine subgroups and described in more detail the relationship between experience and certainty as perceived by the students.Conclusions: A short reflection exercise stimulated deep reflection in a proportion of, but not all, dental students. The students believed that certainty comes with experience even when there is a lack of scientific evidence.
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| 4. |
- Brodén, Joséphine
(författare)
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Uncertainty in Endodontics : Strategies for Understanding and Management
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dentists often experience uncertainty when deciding on the most effective treatment for a particular patient. There are various sources of uncertainty and different strategies for coping with it, such as reducing or accepting it and learning how to make decisions despite feeling uncertain.The overall objectives of the thesis are to contribute with information that reduces uncertainty regarding the treatment of cariously exposed pulps in young permanent teeth and to improve dental education to ensure that future dental students manage well despite uncertainty.By means of a systematic review and a model analysis, the thesis evaluates the available evidence and cost-effectiveness of a pulp capping procedure compared to a root canal treatment to reduce the uncertainty regarding the cost-effectiveness of treatments for young permanent teeth with vital pulps exposed by caries.The thesis also addresses the acceptance of uncertainty. A reflection exercise was developed and tested in a group of dental students. Prompts from an established model were used to stimulate the students to write reflections during the risk assessment of a root-filled tooth. The effect of the reflections on the student’s awareness of and comfort with uncertainty was explored with a repeated questionnaire. The written reflections were analyzed with a qualitative method to explore how dental students reflected on clinical experience in relation to uncertainty.In the systematic review, the success rate for pulp capping in children and adolescents varied between 64 and 100 percent in the included studies. The model indicated that pulp capping procedures are cost-effective compared to root canal treatment in teeth with pulp exposure due to caries. Fewer teeth were extracted after a pulp capping during the 9 years the patients were followed in the model and the cost for the initial treatment and follow-up treatments during this time period was lower compared to a root canal treatment.The reflection exercise had an effect on the students’ responses to the questions regarding how certain they believed an experienced colleague would feel, and how certain they felt of their capacity to handle the case. Most students did not state that they felt certain about assessing the risk for exacerbation of apical periodontitis in root-filled teeth but felt certain of their own capacity to handle the case, as well as comfortable with their ability to handle the situation and do their best for the patient.Three themes about experience and lack of experience were identified in the reflections: “the meaning of clinical experience”, “assumed differences regarding assessment” and “relating to the same risk factors”.The following conclusions were drawn from the four studies:For children and adolescents with pulp exposure due to caries, pulp capping procedures are cost-effective compared to root canal treatment, but there is a lack of prospective studies concerning root canal treatment. Moreover, the existing studies on pulp capping procedures are of low quality.Most final-year dental students participating in a reflection exercise did not feel certain of their risk assessment of root-filled teeth but still felt certain of their capacity to handle the situation, as well as comfortable with their ability to do the best for the patient. The students believed that clinical experience leads to certainty even when the scientific evidence is lacking and experts who meet students have a great responsibility to be transparent with their own uncertainty.
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| 5. |
- Dawson, Victoria, et al.
(författare)
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Coronal restoration of the root filled tooth - a qualitative analysis of the dentists' decision-making process
- 2021
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 54:4, s. 490-500
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe the decision-making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth. Methodology GDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semistructured in-depth interviews were conducted, focusing on the informant's personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27-64 (mean age 46 years), were included and analysed according to Qualitative Content Analysis. Results A theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven subcategories (manifest content), were identified. The categories were clinical factors, contextual factors and patient's views. Clinical factors underlying the GDPs' decision included the current dental status and the estimated longevity of the intended restoration. In certain cases, contextual factors were also of importance, either supporting the GDPs' decision or modifying it. However, the patient's views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient's economic status and opinions. Conclusions With respect to coronal restoration of a root filled tooth, the GDPs' decision-making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients' views.
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| 6. |
- Dawson, Victoria, et al.
(författare)
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Further interventions after root canal treatment in relation to type of coronal restoration and tooth group : a 10-year follow-up of a Swedish dental register
- 2023
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Ingår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To investigate the frequency of further interventions after root filling during a follow-up of 10 to 11 years, and to compare the outcomes with respect to type of coronal restoration and tooth group.Methods: Data from the Swedish Social Insurance Agency´s register of dental treatments were obtained to identify the teeth registered as root filled in Sweden 2009. Type of coronal restoration within 6 months after root filling, as well as the frequency of further interventions (nonsurgical retreatment, periradicular surgery, extraction, further direct and indirect restoration) were tracked in the data register until December 31, 2019. Descriptive statistics and Chi-square tests were used for statistical analysis.Results: Of the 215 611 teeth root filled in 2009, nonsurgical retreatment, periradicular surgery, and extraction were registered for 3.5%, 1.4% and 20%, respectively. The highest frequency of nonsurgical retreatment was registered for molars (4.2%), and periradicular surgery was most frequent in maxillary canines and incisors (2.3%). The highest frequency of extractions was registered for mandibular molars (25.1%). Directly restored teeth had higher frequency of nonsurgical retreatment (3.9%) and extraction (20.8%), compared to indirectly restored teeth (1.7% and 13.6%, respectively; P < 0.001). Of teeth restored with direct restoration within 6 months after root filling, 41.5% were registered with at least one further direct restoration and 14.7% with an indirect restoration. In the group of indirectly restored teeth, 9.3% and 7.1% underwent further restorative treatment with direct and indirect restoration, respectively. The differences registered between directly and indirectly restored root filled teeth were statistically significant (P < 0.001).Conclusions: The frequencies of nonsurgical retreatment and periradicular surgery were low 10 to 11 years after root filling, despite one in five root filled teeth being registered as extracted. Further interventions were significantly more common for directly restored teeth than for those indirectly restored.
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| 7. |
- Dawson, Victoria S., et al.
(författare)
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Further Interventions after Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations : A 10–11-Year Follow-Up of the Adult Swedish Population
- 2024
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Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554. ; 50:6, s. 766-773
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10–11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction. Methods: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, and unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10–11 years, and further interventions were recorded. Descriptive statistics and chi-square tests were used for statistical analysis. Results: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < .001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10–11 years. Conclusions: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite 1 in 5 root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.
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| 8. |
- Djos, Anna, 1983, et al.
(författare)
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Telomere Maintenance Mechanisms in a Cohort of High-Risk Neuroblastoma Tumors and Its Relation to Genomic Variants in the TERT and ATRX Genes
- 2023
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Ingår i: CANCERS. - 2072-6694. ; 15:24
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Tidskriftsartikel (refereegranskat)abstract
- Tumor cells are hallmarked by their capacity to undergo unlimited cell divisions, commonly accomplished either by mechanisms that activate TERT or through the alternative lengthening of telomeres pathway. Neuroblastoma is a heterogeneous pediatric cancer, and the aim of this study was to characterize telomere maintenance mechanisms in a high-risk neuroblastoma cohort. All tumor samples were profiled with SNP microarrays and, when material was available, subjected to whole genome sequencing (WGS). Telomere length was estimated from WGS data, samples were assayed for the ALT biomarker c-circles, and selected samples were subjected to methylation array analysis. Samples with ATRX aberration in this study were positive for c-circles, whereas samples with either MYCN amplification or TERT re-arrangement were negative for c-circles. Both ATRX aberrations and TERT re-arrangement were enriched in 11q-deleted samples. An association between older age at diagnosis and 1q-deletion was found in the ALT-positive group. TERT was frequently placed in juxtaposition to a previously established gene in neuroblastoma tumorigenesis or cancer in general. Given the importance of high-risk neuroblastoma, means for mitigating active telomere maintenance must be therapeutically explored.
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| 9. |
- Fransson, Helena, et al.
(författare)
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Behandlingar av vital pulpa i tänder med djupa karieslesioner
- 2023
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Ingår i: Tandläkartidningen. - : Sveriges Tandläkarförbund. - 0039-6982. ; 115:2, s. 56-62
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Tidskriftsartikel (refereegranskat)abstract
- Vital pulpabehandling utförs för att bevara pulpans försvarsfunktioner och därmed undvika pulpektomi och rotfyllning som kan vara tekniskt krävande och inte alltid ger önskat resultat. European Society of Endodontology (ESE) har publicerat ett positionsdokument avseende vitalbehandling av tänder med djupa karieslesioner vilket delvis överensstämmer med de nationella riktlinjerna i de nordiska länderna. Det finns svårigheter när det gäller att bedöma pulpans status i tänder med djupa karieslesioner. Så länge karieslesionen inte har nått pulpan rekommenderas behandlingar som utförs för att undvika exponering av pulpan, såsom stegvis exkavering.Å andra sidan, när pulpan exponerats på grund av karies, skiljer sig rekommendationerna något åt mellan ESE och de nationella riktlinjerna i de nordiska länderna. Detta beror troligen på avsaknad av evidens som talar för fördelar av den ena behandlingen framför den andra och på grund av svårigheterna att bedöma vilka exponerade pulpor som är irreversibelt skadade. Minimalinvasiva behandlingsstrategier som använder sig av nyligen utvecklade hydrauliska kalciumsilikatcement visar lovande resultat vid vitalbehandling av pulpa. Vital pulpabehandling vidareutvecklas och förändringar i de kliniska rekommendationerna är att förvänta.
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| 10. |
- Fransson, Helena, et al.
(författare)
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EndoReCo banar väg för ökad kunskap och akademisk meritering
- 2022
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Ingår i: Tandläkartidningen. - : Sveriges tandläkarförbund. - 0039-6982. ; 114:12, s. 46-52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- För att minska kunskapsluckorna inom odontologin krävs samarbete mellan lärosätena. Det ger även möjlighet till akademisk meritering, vilket är angeläget då antalet seniora forskare med behörighet för forskningshandledning i Sverige är färre än någonsin. EndoReCo (Endodontic Research Collaboration) är ett skandinaviskt forskningsnätverk i endodonti som kan ta del av just dessa fördelar.
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