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1.
  • Bernson, Jenny M, et al. (author)
  • Adaptive coping strategies among adults with dental fear. Further development of a new version of the Dental Coping Strategy Questionnaire
  • 2012
  • In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 70:5, s. 414-420
  • Journal article (peer-reviewed)abstract
    • Objective. The aim of this study was to further develop and investigate a newly constructed 15-item questionnaire on strategies for coping with dental treatment, used by fearful adult patients undergoing regular dental care and those with phobic avoidance. Materials and Methods. The dental coping strategy questionnaire (DCSQ-15) was distributed to 77 individuals with dental phobic avoidance and 94 fearful patients undergoing regular dental care. Previous analyses of a 20-item coping questionnaire (DCSQ-20) revealed that 2 of 4 identified factors predicted regularity or phobic avoidance of dental care. However, one of these factors was considered related to catastrophizing thoughts and not to coping strategies and it was therefore removed in the present study. Results. The reduced 15-item questionnaire was analyzed to identify its factor structure and a 5-factor solution was found. The five factors were labeled (i) ‘self-efficacy’, (ii) ‘self-distraction’, (iii) ‘distancing’, (iv) ‘praying’ and (v) ‘optimism’. The factors of ‘praying’ and ‘optimism’ correlated significantly with dental anxiety and were assessed significantly higher and lower respectively, among individuals with phobic avoidance. A logistic regression analysis revealed that ‘optimism’, together with gender and dental anxiety, was predictive of the regularity or phobic avoidance of dental care.
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2.
  • Bernson, Jenny M, et al. (author)
  • Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns
  • 2013
  • In: European Journal of Oral Sciences. - : Wiley. - 0909-8836 .- 1600-0722. ; 121:3, s. 270-276
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: To describe the differences in characteristics and outcome between two consecutive series of patients admitted to hospital with chest pain in a 20-year perspective. Particular emphasis is placed on changes in outcome in relation to the initial electrocardiogram (ECG). SUBJECTS: In the two periods, 1986-1987 and 2008, all patients with chest pain admitted to the study hospitals in Gothenburg, Sweden, were included. RESULTS: Five thousand and sixteen patients were registered in a period of 21 months in 1986-1987 and 2287 patients were registered during 3 months in 2008. In a comparison of the two time periods, the age of chest pain patients was not significantly different (mean age 60.1 ± 17.8 years in 1986-1987 and 59.8 ± 19.1 years in 2008, p=0.50). There was a lower prevalence of previous angina pectoris, congestive heart failure and current smoking in the second period, whereas a history of acute myocardial infarction, hypertension and diabetes mellitus had become more prevalent. The use of cardio-protective drugs increased and ECG changes indicating acute myocardial ischemia on admission to hospital decreased. Length of hospitalisation was reduced from a median of 5 days to 3 days (p<0.0001). A significant decrease in 30-day and 1-year mortality was found (3.8% in 1986-1987 vs 2.0% in 2008 and 9.9% vs 6.3% respectively, p<0.0001 for both comparisons). CONCLUSIONS: During a period of 20 years, the characteristics and outcome of patients admitted to hospital with chest pain changed. The most important changes were a lower prevalence of ECG signs indicating acute myocardial ischemia on admission, shorter hospitalisation time and a lower 30-day and 1-year mortality.
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3.
  • Bernson, Jenny M, et al. (author)
  • 'Making dental care possible - a mutual affair'. A grounded theory relating to adult patients with dental fear and regular dental treatment
  • 2011
  • In: European Journal of Oral Sciences. - Copenhagen : Munksgaard Forlag. - 0909-8836 .- 1600-0722. ; 119:5, s. 373-380
  • Journal article (peer-reviewed)abstract
    • Dental fear is a common and widespread problem, which can cause severe stress. Even so, most patients with dental fear undergo regular dental treatment in spite of their fear and many enjoy good oral health. The aim of this study was to obtain a deeper understanding of how patients with dental fear manage to undergo dental treatment. Fourteen patients with dental fear, who undergo regular dental care, were interviewed. Qualitative analysis of the transcribed interviews was performed according to the principles of grounded theory. A conceptual framework was generated, and the main concern was identified as 'making dental care possible - a mutual affair'. Four additional categories explained how patients handled their dental fear and how dental care became possible. The strategies were labelled 'taking part in a mental wrestling match', 'trust-filled interaction with dental staff', 'striving for control' and 'seeking and/or receiving social support'. The results showed that making dental care possible for patients with dental fear is a mutual challenge that requires interplay between dental staff and patients, involving verbal and non-verbal communication reflecting respect, attention, and empathy. Moreover, a balance between nearness and distance and between professional and personal treatment is required.
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4.
  • Elfström, Magnus, et al. (author)
  • Validation of the Swedish version of the clinical outcomes in routine evaluation outcome measure (CORE-OM)
  • 2013
  • In: Clinical Psychology and Psychotherapy. - : Wiley. - 1063-3995 .- 1099-0879. ; 20:5, s. 447-455
  • Journal article (peer-reviewed)abstract
    • The purpose of this study was to perform an initial validation of a Swedish translation of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). The CORE-OM is a broad self-report instrument of psychological problems, designed as an outcome measure for evaluating the effects of psychological therapy. Participants included a non-clinical group of 229 university students and a clinical group of 619 persons from four primary care sites. The Swedish CORE-OM showed excellent acceptability, high internal consistency and test-retest reliability, as well as acceptable convergent validity. There was strong differentiation of the clinical and non-clinical samples, with the clinical group scoring significantly more psychological problems than the non-clinical group. Sensitivity to change was demonstrated in psychological treatments in primary care. Overall, the psychometric characteristics of the Swedish CORE-OM were very similar to the original UK data. Nevertheless, the validity of the Swedish version needs to be examined more in detail, in larger and more diverse samples. Our results so far, however, provide support for using the Swedish CORE-OM as a psychological problems measure. To our knowledge, there are few other relatively short measures in Swedish that are free to reprint that meet the demands for psychometric properties and utility in primary care settings in which patients typically present a broad range of psychological problems.
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5.
  • Abrahamsson H, Kajsa, et al. (author)
  • Evaluation of the Dental Hygienist Beliefs Survey : test-retest assessment in a group of general dental patients
  • 2012
  • In: International Journal of Dental Hygienie. - 1601-5037. ; 10:1, s. 30-35
  • Journal article (peer-reviewed)abstract
    • Objective:  To evaluate the Dental Hygienist Beliefs Survey (DHBS) and the test–retest reliability of DHBS in a group of general dental patients. Material and methods:  The DHBS, which is a questionnaire constructed to assess patients’ specific attitudes towards dental hygienists (DHs), was distributed together with the Dental Anxiety Scale adapted to specifically assess fear of DH treatment (DHAS). It was hypothesized that DHBS would correlate with DHAS and gender. The questionnaires were consecutively distributed to 80 patients at their first visit and after a clinical examination performed by a DH student. Retest assessments of DHBS were conducted approximately two weeks later in conjunction with the next visit at the DH student and before treatment (scaling session). The final study sample included 77 adult general dental patients in treatment at an education clinic for DH students. Results:  The results verified a statistically significant correlation between DHBS and DHAS. The DHBS sum of scores showed high internal consistency with Cronbach’s a coefficient of 0.88 and 0.91 at the first and second assessments, respectively, and the test–retest reliability of the DHBS was acceptable with intraclass correlation coefficient of 0.76. No statistically significant association was found between DHBS and gender. Conclusion:  The results suggest that the DHBS is a reliable and stable scale to use to assess patients’ specific attitudes towards DHs. Moreover, DH beliefs are associated with fear of DH treatment.
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6.
  • Abrahamsson, Kajsa H., 1956, et al. (author)
  • Evaluation of the Dental Hygienist Beliefs Survey; test-retest assessment in a group of general dental patients.
  • 2012
  • In: International journal of dental hygiene. - : Wiley. - 1601-5037 .- 1601-5029. ; 10:1, s. 30-35
  • Journal article (peer-reviewed)abstract
    • To cite this article: Int J Dent Hygiene DOI: 10.1111/j.1601-5037.2011.00521.x Abrahamsson KH, Andersson P, Krok L, Hakeberg M. Evaluation of the Dental Hygienist Beliefs Survey; test-retest assessment in a group of general dental patients. Abstract: Objective: To evaluate the Dental Hygienist Beliefs Survey (DHBS) and the test-retest reliability of DHBS in a group of general dental patients. Material and methods: The DHBS, which is a questionnaire constructed to assess patients' specific attitudes towards dental hygienists (DHs), was distributed together with the Dental Anxiety Scale adapted to specifically assess fear of DH treatment (DHAS). It was hypothesized that DHBS would correlate with DHAS and gender. The questionnaires were consecutively distributed to 80 patients at their first visit and after a clinical examination performed by a DH student. Retest assessments of DHBS were conducted approximately two weeks later in conjunction with the next visit at the DH student and before treatment (scaling session). The final study sample included 77 adult general dental patients in treatment at an education clinic for DH students. Results: The results verified a statistically significant correlation between DHBS and DHAS. The DHBS sum of scores showed high internal consistency with Cronbach's a coefficient of 0.88 and 0.91 at the first and second assessments, respectively, and the test-retest reliability of the DHBS was acceptable with intraclass correlation coefficient of 0.76. No statistically significant association was found between DHBS and gender. Conclusion: The results suggest that the DHBS is a reliable and stable scale to use to assess patients' specific attitudes towards DHs. Moreover, DH beliefs are associated with fear of DH treatment.
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7.
  • Andersson, P, et al. (author)
  • Clinical correlates of oral impacts on daily performances.
  • 2010
  • In: International journal of dental hygiene. - : Wiley. - 1601-5037 .- 1601-5029. ; 8:3, s. 219-26
  • Journal article (peer-reviewed)abstract
    • The aim of this study was to investigate the associations between oral health measures and oral health-related quality of life as captured by OIDP (oral impacts on daily performances).
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8.
  • Andersson, Pia, 1955-, et al. (author)
  • Psychometric properties of the Dental Hygienist Anxiety Scale in a group of general dental patients
  • 2013
  • In: Acta Odontologica Scandinavica. - 0001-6357 .- 1502-3850. ; 71:3-4, s. 877-882
  • Journal article (peer-reviewed)abstract
    • Objective.  The aim of the present study was to evaluate the psychometric properties of the Dental Hygienist Anxiety Scale (DHAS) in a sample of adult general dental patients.  Materials and methods.  The DHAS is a questionnaire adapted to assess fear and anxiety of dental hygienist (DH) treatment. The DHAS contains four items and the sum of scores range from 4 (no anxiety) to 20 (extreme fear). A convenient sample of 80 patients in treatment at two DH programs in Sweden were consecutively included in the study. The DHAS was distributed together with questions regarding self-perceived oral health and experience of dental care at the first visit after a clinical examination performed by a DH. Re-test assessments of DHAS were conducted ∼ 2 weeks later in conjunction with the next visit to the DH before treatment (scaling session).  Results.  The results verified a significant positive correlation between the average DHAS sum of scores and global fear of DH and dentist treatment, perceived pain during the last DH treatment and female gender. The DHAS sum of scores had a high internal consistency, Cronbach's  coefficient of 0.89 and 0.87 at the first and at the second assessment, respectively. The test-re-test reliability of the DHAS sum of scores was acceptable, with an intra-class coefficient of 0.82 and Kappa coefficients between 0.49-0.78 for the four single items in the DHAS. Conclusions.  These results suggest that the DHAS has acceptable psychometric proprieties and is a valid and reliable scale to assess anxiety in DH treatment.
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9.
  • Andersson, Pia, et al. (author)
  • Psychometric properties of the Dental Hygienist Anxiety Scale in a group of general dental patients.
  • 2013
  • In: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 71:3-4, s. 877-882
  • Journal article (peer-reviewed)abstract
    • Abstract Objective. The aim of the present study was to evaluate the psychometric properties of the Dental Hygienist Anxiety Scale (DHAS) in a sample of adult general dental patients. Materials and methods. The DHAS is a questionnaire adapted to assess fear and anxiety of dental hygienist (DH) treatment. The DHAS contains four items and the sum of scores range from 4 (no anxiety) to 20 (extreme fear). A convenient sample of 80 patients in treatment at two DH programs in Sweden were consecutively included in the study. The DHAS was distributed together with questions regarding self-perceived oral health and experience of dental care at the first visit after a clinical examination performed by a DH. Re-test assessments of DHAS were conducted ∼ 2 weeks later in conjunction with the next visit to the DH before treatment (scaling session). Results. The results verified a significant positive correlation between the average DHAS sum of scores and global fear of DH and dentist treatment, perceived pain during the last DH treatment and female gender. The DHAS sum of scores had a high internal consistency, Cronbach's coefficient of 0.89 and 0.87 at the first and at the second assessment, respectively. The test-re-test reliability of the DHAS sum of scores was acceptable, with an intra-class coefficient of 0.82 and Kappa coefficients between 0.49-0.78 for the four single items in the DHAS. Conclusions. These results suggest that the DHAS has acceptable psychometric proprieties and is a valid and reliable scale to assess anxiety in DH treatment.
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10.
  • Andås, Charlotte Andren, et al. (author)
  • A new dental insurance scheme - effects on the treatment provided and costs
  • 2014
  • In: Swedish Dental Journal. - 0347-9994. ; 38:2, s. 57-66
  • Journal article (peer-reviewed)abstract
    • The aim of this study was to investigate whether the revenues cover the costs in a pilot capitation plan, a dental insurance scheme, and to compare this capitation plan (CP) with the original fee-for-service system (FFS), in terms of the amount and type of dental care provided. Data was collected longitudinally over a period of three years from 1,650 CP patients in five risk groups at a test clinic, and from 1,609 (from the test clinic) and 3,434 (from a matched control clinic) FFS patients, in Goteborg, Sweden. The care investigated was the number of total treatments provided and the number of examinations by dentists and dental hygienists, together with preventive, restorative and emergency treatments. The economic outcome was positive from the administrator's perspective, in all risk groups for the three-year period. The amount and type of care provided differed between the payment models, as CP patients received more preventive treatments, less restorative treatments, and more examinations by dental hygienists than the FFS patients. Emergency treatment was performed more often on CP patients, and the difference was due to a higher frequency of such treatments among women in the CP group. The difference between clinics concerning certain treatment measures was sometimes greater than the difference between payment models. The results from this study indicate a net positive economic outcome for the pilot CP system over three years. The payment model and the clinic affiliation had impact on what type and amount of dental care the patients received. This might suggest that the risk of skewed selection and its consequences as well as the influence of clinic-specific practice need further investigation, to ensure economic sustainability in a longer perspective.
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11.
  • Andås, Charlotte Andren, et al. (author)
  • Who chooses prepaid dental care? A baseline report of a prospective observational study
  • 2014
  • In: Bmc Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 146:14
  • Journal article (peer-reviewed)abstract
    • Background: An optional capitation prepayment system has been implemented in Swedish dental care, supplementary to the traditional fee-for-service scheme within the Public Dental Service. The implementation of a new system may have a variety of preferred and adverse effects, arguably dependent on the individual patient's attitudes, health beliefs and course of action. The aim of this study was to describe potential differences regarding socioeconomic and lifestyle factors, perceived oral health and attitudes towards oral health between patients in the two payment systems. Methods: Questionnaire data were consecutively collected from 13,719 patients, who regularly attended 20 strategically selected clinics within the PDS in Region Vastra Gotaland, before they were offered the choice between the traditional and the new payment system. Results: Capitation patients were more often female and well educated. They had healthier habits, were more motivated to follow self-care advice, more often judged their oral health to be very good and considered oral health to be very significant for their wellbeing. The results were statistically significant and described a gradient. Conclusions: The more explicitly affirmative the answer, the more likely the patient was to choose the prepayment scheme. There appears to be a pattern of differences with respect to important individual views on oral health between patients choosing a capitation system or a fee-for-service system. These differences may be important when assessing outcomes in the new payment system and in public dental care.
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12.
  • Bergenholtz, Gunnar, 1939, et al. (author)
  • Treatment of pulps in teeth affected by deep caries - A systematic review of the literature.
  • 2013
  • In: Singapore dental journal. - : World Scientific Pub Co Pte Lt. - 0377-5291. ; 34:1, s. 1-12
  • Journal article (peer-reviewed)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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13.
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14.
  • Bratel, John, 1953, et al. (author)
  • Anamnestic findings from patients with recurrent aphthous stomatitis
  • 2014
  • In: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 38:3, s. 143-149
  • Journal article (peer-reviewed)abstract
    • Recurrent aphthous stomatitis (RAS) is a common oral disorder with a prevalence varying between 5% and 66%. RAS appears in three forms; minor, major and herpetiform. The aetiology is unknown.The aim of this study was to evaluate associations between specific anamnestic information and different types of recurrent aphthous stomatitis (RAS). A group of 177 patients (mean age=42.8 years; SD=14.3; range 17-79 years) participated. Data were collected from a structured interview, consisting of 22 questions. Information about i) health status and medication, ii) predisposing factors, iii) RAS experience, iv) previous treatment methods and v) brand of toothpaste was collected. Sixty-eight per cent of the patients were healthy and 44% of the patients were not taking any medication. Forty-one per cent of the patients did not have any apprehension of the reason for their RAS, while stress (15.8%) was the most common apprehended aetiological factor. Sixty-two per cent had one to three minor ulcers at one time. Forty-eight per cent reported having had a major aphthous ulcer at least once.The most frequent symptom reported was pain (53.7%), followed by a smarting sensation (18.6%) and tenderness (4%). The most common treatment for RAS was Zendium™ toothpaste/mouthrinse (28%), followed by corticosteroids (25%). Fifty-four per cent of the patients experienced no relief from the treatment. When toothpaste habits were investigated, Zendium™ was used by 32% of the patients and toothpaste containing sodium-lauryl-sulfatase was used by 32%. There was no positive correlation between the use of Zendium™ toothpaste and the relief of symptoms or the size, number or frequency of the aphthous ulcers. Sixty-four per cent of the patients had never smoked, while 7% were smokers. No positive correlation was found when age, gender, allergy, medication and smoking were correlated to the frequency, number and size of the aphthous ulcers. In conclusion, we found that the aetiology behind RAS is still unclear and probably multifactorial. Standard treatment methods like Zendium™ should perhaps be questioned and this study did not find any support for smoking as a "protective" factor, i.e. having less likelihood of experiencing major problems from RAS.
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15.
  • Bratel, John, 1953, et al. (author)
  • Treatment of oral infections prior to heart valve surgery does not improve long-term survival
  • 2011
  • In: Swedish Dental Journal. - 0039-6745. ; 35:2, s. 49-55
  • Journal article (peer-reviewed)abstract
    • The objective was to evaluate the importance of preoperative elimination of oral infections and oral health for survival after heart valve surgery In a group of patients (n=149; treatment group, GP group), oral health was examined and dental treatment was performed 3-6 months prior to heart valve surgery. In a second group (n=103; control group, SP group), oral health was examined postoperatively, but patients did not receive dental treatment prior to surgery. Sixteen years after heart valve surgery was performed, morbidity endpoint data were obtained. Differences in survival between the two groups and the influence of differences in oral health were analyzed. Fewer patients survived in the study group (37%) compared with the control group (45%). Mean survival was 122.9 months in the GP group compared with 143.3 months in the SP group, including time to death and those alive at the endpoint (p=0.018). A positive relationship was found between the number of teeth and survival, with RR = 0.98 (95% CI 0962-0.996 (p=0.016)).The deaths from heart valve disease were 18% in the GP group and 7% in the SP group (chi2=3.65, df=1, p=0.56). At the long-term follow-up,the results of the present study show,that it was not possible to demonstrate that dental treatment before heart valve surgery improved survival. Therefore, the need for extensive dental treatment prior to heart valve surgery may be reconsidered.
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16.
  • Carlsson, Sven G., 1935, et al. (author)
  • Dental anxiety - a joint interest for dentists and psychologists.
  • 2013
  • In: European journal of oral sciences. - : Wiley. - 1600-0722 .- 0909-8836. ; 121:3 Pt 2, s. 221-224
  • Journal article (peer-reviewed)abstract
    • This introductory article to the Symposium on Behavioral and Community Dentistry aims to describe the development of research and clinical work on dental anxiety, and includes a discussion of the historical background and the evolution since the 1970s. In view of its pioneering activities in this regard, special focus is placed on research and development at the Institute of Odontology of the University of Gothenburg, Sweden.
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17.
  • Carlsson, Viktor, 1980, et al. (author)
  • Attention deficit hyperactivity disorder and dental anxiety in adults: relationship with oral health.
  • 2013
  • In: European journal of oral sciences. - : Wiley. - 1600-0722 .- 0909-8836. ; 121:3 Pt 2, s. 258-63
  • Journal article (peer-reviewed)abstract
    • The aim of the present study was to investigate the presence of attention deficit hyperactivity disorder (ADHD) in adult patients with severe dental anxiety. Specifically, we analysed the relationship among ADHD, oral health, and dental anxiety. The World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was administered to a consecutive sample of patients referred to a dental fear research and treatment clinic. Patients completed questionnaires measuring dental anxiety (Dental Fear Survey) and self-rated oral health, and underwent a full radiographic examination. Of the total sample (n=110), 16% scored above the established ASRS cut-off point, which is indicative of having ADHD. The ADHD group showed a higher level of dental anxiety and poorer self-rated oral health. There were also indications of poorer clinical oral health in the ADHD group, but these results did not reach statistical significance. In conclusion, the results of this study indicate an increased prevalence of ADHD in highly dentally anxious adults and the need to pay special attention to these patients because of greater treatment needs and increased dental anxiety.
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18.
  • Carlsson, Viktor, 1980, et al. (author)
  • Orofacial esthetics and dental anxiety: Associations with oral and psychological health
  • 2014
  • In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 72:8, s. 707-713
  • Journal article (peer-reviewed)abstract
    • Objective. Severe dental anxiety (DA) is associated with both oral health and psychosocial consequences in what has been described as a vicious circle of DA. The aim of this study was to investigate self-rated orofacial esthetics in patients with DA and its relationship to psychological and oral health. Materials and methods. A consecutive sample of 152 adult patients who were referred or self-referred to a specialized dental anxiety clinic filled out the Orofacial Esthetic Scale (OES) as well as measurements on DA, self-rated oral health and general anxiety and depression. Clinical measures of dental status were also obtained. Results. Compared with the general population, patients with DA had lower ratings of satisfaction on all aspects of their orofacial esthetics, which included the teeth, gingiva, mouth and face, as well as a global orofacial assessment. Furthermore, the perception of the orofacial appearance was related both to dental status and self-rated oral health, as well as to general anxiety and depression. The level of dissatisfaction with the orofacial appearance was similar for both genders, but women reported more regular dental care and better dental status. Conclusions. The results of this study clearly show less satisfaction with dental and facial appearance in patients with DA, and that the self-rating of orofacial esthetics is related to both oral and psychological health. The OES can be used to assess orofacial esthetics in patients with DA.
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19.
  • Frisk, Fredrik, 1971, et al. (author)
  • Pulp exposures in adults--choice of treatment among Swedish dentists.
  • 2013
  • In: Swedish dental journal. - : Sveriges tandläkarförbund. - 0347-9994. ; 37:3, s. 153-60
  • Journal article (peer-reviewed)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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20.
  • Hakeberg, Magnus, 1954, et al. (author)
  • Symptoms, Clinical Characteristics and Consequences
  • 2013
  • In: Cognitive Behavioral Therapy for Dental Phobia and Anxiety. Eds. L.-G. Öst and E. Skaret. - Oxford : Wiley. - 9781119960713 ; , s. 1-19
  • Book chapter (peer-reviewed)abstract
    • Description The first book to describe evidence-based treatment of dental phobia using brief CBT, based on the pioneering single-session treatment for specific phobias developed by Lars-Göran Öst. Brings together research, experience and techniques from clinical psychology and dentistry to describe evidence-based treatment of dental phobia in clinical and dental contexts Chapters describe epidemiology, diagnosis and differential diagnosis, symptoms, clinical characteristics and consequences, and aetiology of dental phobia Also covers related issues including intra-oral injection phobia, dental treatment of fearful children, and the use of medication to supplement psychological treatment of fear
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21.
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22.
  • Hallberg, Lillemor R-M, 1942, et al. (author)
  • Facing a moral dilemma--introducing a dental care insurance within the public dental service.
  • 2012
  • In: Swedish dental journal. - : Swedish dental journal. - 0347-9994. ; 36:3, s. 149-56
  • Journal article (peer-reviewed)abstract
    • Through the reform entitled "Dental care insurance-dental care at a fixed price", patients are offered a dental insurance, a capitation plan, that ensures that they can visit the dentist regularly during a period of three years at a fixed price per month (Frisktandvård).This insurance may be offered to all patients. The aim of this study was to generate a theory explaining the main concern for the staff at the public dental service when they have to introduce and advocate dental care insurance to patients. Interview data from 17 persons, representing different professions within the public dental service, were collected and analyzed simultaneously in line with guidelines for grounded theory. The results indicated that dentists/dental hygienists experienced several difficult standpoints concerning the implementation of the dental insurance, somewhat of a moral dilemma. The staff generally had a "cautiously positive attitude" to the forthcoming dental care insurance, but had perceptions how and when the patients should be offered the insurance and what that may mean to the clinic.The respondents reflected about the economic aspects for the clinic and how the oral health may be affected over time for the patients.
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23.
  • Hassani-Nejad, Azar, et al. (author)
  • Mandibular trabecular bone as fracture indicator in 80-year-old men and women.
  • 2013
  • In: European journal of oral sciences. - : Wiley. - 1600-0722 .- 0909-8836. ; 121:6, s. 525-31
  • Journal article (peer-reviewed)abstract
    • The objective of the present study was to compare assessments of the mandibular bone as fracture risk indicators for 277 men and women. The mandibular trabecular bone was evaluated in periapical radiographs, using a visual index, as dense, mixed dense and sparse, or sparse. Bone texture was analysed using a computer-based method in which the number of transitions from trabeculae to intertrabecular spaces was calculated. The sum of the sizes and intensities of the spaces between the trabeculae was calculated using Jaw-X software. Women had a statistically significantly greater number of fractures and a higher frequency of sparse mandibular bone. The OR for having suffered a fracture with visually sparse trabecular bone was highest for the male group (OR = 5.55) and lowest for the female group (OR = 3.35). For bone texture as an indicator of previous fracture, the OR was significant for the female group (OR = 2.61) but not for the male group, whereas the Jaw-X calculations did not differentiate between fractured and non-fractured groups. In conclusion, all bone-quality assessments showed that women had a higher incidence of sparse trabecular bone than did men. Only the methods of visual assessment and trabecular texture were significantly correlated with previous bone fractures.
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24.
  • He, Tailun, 1969, et al. (author)
  • Effects of masticatory muscle training on maximum bite force and muscular endurance
  • 2013
  • In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 71:3-4, s. 863-869
  • Journal article (peer-reviewed)abstract
    • Objective. This study evaluates the effects of chewing training on strength and endurance of the masticatory muscles. Materials and methods. Of the 49 healthy young adults included in the study, nine served as controls for a baseline measurement of bite force. The 40 participants who actively trained their masticatory muscles were randomly divided into a ‘continuous training group' (CTG) and an ‘intermittent training group' (ITG). The participants performed oral motor training by clenching silicon tubes (Chewy Tubes™) according to a designed protocol. The muscular strength was studied in terms of maximum bite force. Muscular endurance was evaluated by measuring the duration for which the participants held 50% of their maximum bite force value. Results. Both the maximum bite force and the muscular endurance capacity increased after intensive training for both groups. After 2 months, the ITG stopped training for 1 month. At this point, a significant difference was identified both in the mean bite force values and the mean muscular endurance duration: the ITG exhibited lower values. For both groups, the highest values were attained after 3 months of training. The maximum bite force values and the muscular endurance duration were observed to follow similar patterns. The effects attained decreased rapidly in both groups when the training stopped. Conclusions. For both the continuous and intermittent training groups, 4 months of chewing exercises strengthened masticatory muscles, but such effects diminished gradually for both groups when the exercises stopped.
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25.
  • Hägglin, Catharina, 1955, et al. (author)
  • On the dynamics of dental fear: dental or mental?
  • 2013
  • In: European Journal of Oral Sciences. - : Wiley. - 0909-8836. ; 121:3, s. 235-239
  • Journal article (peer-reviewed)abstract
    • This study explored possible predictors of change over time in dental fear. In a population-based sample of 664 women, 38–54 yr of age at first assessment, a self-rating of dental fear was recorded on two occasions, 6 yr apart. Whilst the majority of the women maintained their level of fear, two subgroups reported changes at follow up. Of the 99 subjects indicating high fear at baseline, 54 recorded no or minimal fear at follow up and, among the 565 recording minimal fear at baseline, 27 reported increased fear at follow up. We used psychological and odontological findings at baseline to compare the four subgroups with altered or maintained fear ratings at follow up. The women reporting reduced fear at follow up differed significantly in the psychological variables from those reporting unchanged fear; there were no significant differences between these groups in any of the odontological variables. The group indicating increased fear at follow up did not differ from those with a maintained fearlessness in any of the baseline measurements. The results are discussed in terms of a systems-oriented understanding of the development of dental fear.
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26.
  • Jonasson, Grethe, 1945, et al. (author)
  • A prospective study of mandibular trabecular bone to predict fracture incidence in women: A low-cost screening tool in the dental clinic
  • 2011
  • In: Bone. - : Elsevier BV. - 8756-3282. ; 49:4, s. 873-879
  • Journal article (peer-reviewed)abstract
    • Bone structure is the key to the understanding of fracture risk. The hypothesis tested in this prospective study is that dense mandibular trabeculation predicts low fracture risk, whereas sparse trabeculation is predictive of high fracture risk. Out of 731 women from the Prospective Population Study of Women in Gothenburg with dental examinations at baseline 1968, 222 had their first fracture in the follow-up period until 2006. Mandibular trabeculation was defined as dense, mixed dense plus sparse, and sparse based on panoramic radiographs from 1968 and/or 1980. Time to fracture was ascertained and used as the dependent variable in three Cox proportional hazards regression analyses. The first analysis covered 12 years of follow-up with self-reported endpoints; the second covered 26 years of follow-up with hospital verified endpoints; and the third combined the two follow-up periods, totaling 38 years. Mandibular trabeculation was the main independent variable predicting incident fractures, with age, physical activity, alcohol consumption and body mass index as covariates. The Kaplan–Meier curve indicated a graded association between trabecular density and fracture risk. During the whole period covered, the hazard ratio of future fracture for sparse trabeculation compared to mixed trabeculation was 2.9 (95% CI: 2.2–3.8, p < 0.0001), and for dense versus mixed trabeculation was 0.21 (95% CI: 0.1–0.4, p < 0.0001). The trabecular pattern was a highly significant predictor of future fracture risk. Our findings imply that dentists, using ordinary dental radiographs, can identify women at high risk for future fractures at 38–54 years of age, often long before the first fracture occurs.
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27.
  • Jonasson, Grethe, 1945, et al. (author)
  • Mandibular bone changes in 24years and skeletal fracture prediction.
  • 2013
  • In: Clinical Oral Investigations. - : Springer Science and Business Media LLC. - 1432-6981 .- 1436-3771. ; 17:2, s. 565-572
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction. MATERIALS AND METHODS: From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense. RESULTS: Visually, the mandibular compact and trabecular bone transformed gradually during the 24years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78%) than the non-sparse group (27-31%), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993. CONCLUSION: Dental radiographs contain enough information to identify women most at risk of future fracture. CLINICAL RELEVANCE: When observing sparse mandibular trabeculation, dentists can identify 40-69% of women at risk for future fractures, depending on participant age at examination.
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28.
  • Krekmanova, Larisa, 1959, et al. (author)
  • Common experiences of pain in children and adolescents - an Exploratory Factor Analysis of a questionnaire
  • 2013
  • In: Swedish Dental Journal. - 0347-9994. ; 37:1, s. 31-38
  • Journal article (peer-reviewed)abstract
    • The aim of the study was to reduce everyday and dental treatment pain items included in the extended Children's Pain Inventory (CPI), used in a prior study on Swedish children and adolescents. Another aim was to, by means of exploratory factor analysis (EFA), expose hitherto undiscovered dimensions of the CPI pain variables and thus to improve the psychometric properties of CPI. As some pain items are relevant merely to some individuals, a new and more useful questionnaire construction would enhance the internal validity of the instrument in observational surveys. EFA was applied on the extended CPI instrument. 368 children, 8-19 years old, had answered a questionnaire comprising 10 dental and 28 everyday pain variables. These pain items were analysed using a series of sequentially implemented EFA. Interpretations and decisions on the final number of the extracted factors was based on accepted principles; Kaiser's Eigenvalue >1 criterion, inspection of the scree plot and the interpretability of the items loading. The factors were orthogonally rotated using the Varimax method to maximize the amount of variance. Of all tested EFA models in the analysis, a two, three, four, and five factor model surfaced. The interpretability of the factors and their items loading were stepwise examined; the items were modulated and the factors re-evaluated. A four factor pain model emerged as the most interpretable, explaining 79 % of the total variance depicting Eigenvalues >1.014. The factors were named indicating the profile of the content: Factor I cutting trauma to skin/mucosal pain, Factor II head/neck pain, Factor III tenderness/blunt trauma pain, Factor IV oral/dental treatment pain.
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29.
  • Larsson, Pernilla, et al. (author)
  • General population norms of the Swedish short forms of Oral Health Impact Profile
  • 2014
  • In: Journal of Oral Rehabilitation. - : Wiley. - 0305-182X .- 1365-2842. ; 41:4, s. 275-281
  • Journal article (peer-reviewed)abstract
    • We reported the development and psychometric evaluation of a Swedish 14-item and a five-item short form of the Oral Health Impact Profile. The 14-item version was derived from the English-language short form developed by Slade in1997. The five-item version was derived from the German-language short form developed by John etal. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N=1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N=1309) were on average 50 center dot 1 +/- 17 center dot 4years old, and 54% were women. Short form summary scores correlated highly with the 49-item OHIP-S (r >= 0 center dot 97 for OHIP-S14, r >= 0 center dot 92 for OHIP-S5) and with self-report of oral health (r >= 0 center dot 41). Reliability, measured with Cronbach's alpha (0 center dot 91 for OHIP-S14, 0 center dot 77 for OHIP-S5), was sufficient. In the general population, 50% of the subjects had >= 2 OHIP-S14 score points and 10% had >= 11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had >= 2 OHIP-S14 score points, and 10% had >= 11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP-S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14-item and 5-item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies.
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30.
  • Lindmark, Ulrika, et al. (author)
  • Kan känsla av sammanhang ha betydelse för beteende, kunskap och attityder relaterat till oral hälsa?
  • 2010
  • In: Tandhygienisttidningen. - 1102-6146. ; 30:2, s. 55-
  • Journal article (other academic/artistic)abstract
    • Syfte: Att studera sambandet mellan känsla av sammanhang (KASAM), oralt hälsorelaterat beteende, kunskap om och attityd till oral hälsa i en vuxen svensk befolkning. Metod: En tvärsnittsstudie där ett stratifierat urval av 910 individer, i åldrarna 20, 30, 40, 50, 60, 70 och 80 år erbjöds att delta i studien. I undersökningen användes den svenska kortversionen (13 frågor) av Antonovsky’s livsfrågeformulär som mäter känslan av sammanhang samt ett frågeformulär gällande oralt hälsorelaterat beteende, kunskap om samt attityder till oral hälsa. Dessutom ingick frågor gällande sociodemografiska faktorer. Totalt var det 589 individer som samtyckte att delta i studien. Resultat: Totalt var det 525 individer, 261 men och 264 kvinnor, som besvarade alla 13 frågorna i SOC frågeformuläret, vilket utgjorde det slutliga materialet vid analyserna. Bivariata analyser visade på samband mellan högre KASAM medel poäng och beteende såsom färre söta drycker och färre antal mellanmål/ dag, jämfört med individer med lägre KASAM medel poäng. Individer med högre KASAM hade också en mer positive attityd såsom påståenden om att vara nöjd med tandvården, betydelsen av att ha egna tänder när man blir äldre, nöjd med egna tänder, anser sig ha bra tänder samt ingen känsla av obehag att uppsöka tandvården. Individer med högre KASAM poäng hade även ett signifikant samband med kunskap om karies. Dessa samband, förutom variabeln söta drycker, kvarstod efter kontrollering för alla sociodemografiska faktorerna (kön, ålder, civilstånd, inkomst, utbildning och yrkesnivå). Stark KASAM och god kunskap om karies var statistiskt signifikant, efter kontrollering för ålder och kön. Sammanfattning: KASAM hade ett statistiskt signifikant samband med oralt hälsoorelaterat beteende, attityder till oral hälsa samt kunskap om karies. I arbetet med oralt hälsofrämjande arbete, skulle KASAM kunna vara ett verktyg för att främja en större förståelse för individers beteende, attityder till och kunskap om oral hälsa och  möjliggöra för tandvårdspersonal att använda denna kunskap i kommunikation med individer och grupper.
  •  
31.
  •  
32.
  • Lindmark, Ulrika, 1965-, et al. (author)
  • Sense of coherence and its relationship with oral health-related behaviour and knowledge of and attitudes towards oral health
  • 2011
  • In: Community Dentistry and Oral Epidemiology. - : John Wiley & Sons. - 0301-5661 .- 1600-0528. ; 39:6, s. 542-553
  • Journal article (peer-reviewed)abstract
    • Objective:  To investigate the relationship between sense of coherence (SOC), oral health–related behaviour, knowledge of and attitudes towards oral health in an adult Swedish population.Methods:  A cross-sectional design with a stratified random sample of 910 individuals aged 20, 30, 40, 50, 60, 70 and 80 years were invited to the study, from Jönköping, Sweden. The investigation used the Swedish short version of the SOC questionnaire comprising 13 items and self-reported questions about oral health habits and knowledge of and attitudes towards oral health. In addition, a self-report questionnaire to elicit demographic information was included.Results:  A total of 525 individuals, 261 men and 264 women, answered all the 13-item SOC questions, which constituted the final number of the participants. After adjustment for all the sociodemographic factors included in the analysis, individuals with a stronger SOC had twice as high a chance of having healthier behaviour, including a lower frequency of snacks and drinks between meals, as well as a more positive attitude, such as the importance of having one’s own teeth as one gets older, satisfaction with their own teeth, perceiving their teeth as good and no feeling of dental fear, compared with individuals with a poorer SOC. Moreover, SOC and a good knowledge of caries were significantly associated after adjustment for age and gender.Conclusions:  SOC was significantly associated with several oral health–related behaviours, attitudes towards oral health and knowledge of dental caries. When working with oral health promotion, SOC could be a way for promoting a better understanding of the behaviour and attitudes of individuals and for enabling dental personals to use that knowledge for the guidance of the individual.
  •  
33.
  • Lindmark, Ulrika, et al. (author)
  • Sense of coherence and oral health status in an adult Swedish population
  • 2010
  • In: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 69, s. 12-20
  • Journal article (peer-reviewed)abstract
    • Objective. To investigate sense of coherence in relation to oral health status in an adult Swedish population in order to better understand the determinants of positive oral health-promoting behavior and differences in oral health.Material and methods. A stratified random sample of 910 individuals from Jönköping, Sweden aged 20, 30, 40, 50, 60, 70 and 80 years was obtained. The investigation used the Swedish short version of the Sense of Coherence (SOC) questionnaire comprising 13 items and a self-report questionnaire to elicit demographic information. In addition, a clinical and radiographic oral examination was performed.Results. A total of 525 individuals, 261 men and 264 women, consented to participate in the study. Bivariate analysis revealed that higher mean SOC scores were statistically significantly associated with more decayed and filled surfaces (DFS) and filled surfaces (FS), fewer decayed surfaces (DS), fewer teeth with calculus and periodontal health. Multivariate analysis showed that higher SOC scores represented a predictor of fewer occurrences of a periodontal probing pocket depth of ‡4 mm and a lower risk of plaque in different regression models.Conclusions. Higher SOC scores may be a protective determinant of plaque and periodontal disease, indicating an association between SOC and oral health.
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34.
  • Lindmark, Ulrika, et al. (author)
  • Sense of Coherence (SOC) and Oral Health among Swedish Adults – A Population Study
  • 2010
  • Conference paper (peer-reviewed)abstract
    • Objectives: Research are suggested studying the complex causal processes to understand and explain people’s behaviour and actions in their living context, which both can be promoting or unfavourable for oral health. A way to measure health related behaviour is with sense of coherence (SOC), which estimate a person’s degree of an inside strength and attitude to the world around, and by that maintaining health. A person with high level of SOC have been seen to have an adaptive health behaviour. The aim was to investigate a person’s ability to maintaining health, in terms of Sense of coherence in relation to oral health. Method: A stratified random sample of 910 individuals from Jönkping, Sweden, aged 20,30,40,50,60,70 and 80 years old, was used. The investigation contained the Swedish short version of The orientation to life questionnaire (SOC) with 13-items and a self-reported questionnaire about demographic information, oral health related behaviour and attitudes to oral health. These questionnaires were distributed in addition to the clinical and radiographical examination. Results: A total of 525 individuals participated in the study, 261 men and 264 women. Mean SOC scores increased with age, and the youngest group (20-year-olds) had a significantly lower SOC score compared to the other age groups. Bivariate results showed that individuals with higher SOC scores had statistically significant relationships with oral clinical status such as more decayed filled surfaces (DFS), less caries severity, less teeth with calculus and a higher degree of periodontal health. SOC was also significantly associated with gingivitis and dental plaque, after controlling for socioeconomic and demographic factors. Conclusions: Younger individuals had lower SOC scores compared to elderly individuals. Some statistical associations were found between SOC scores and oral health with regard to several important oral clinical variables and higher SOC scores may indicate a protective determinant for gingivitis and plaque. 
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35.
  • Lindskog Stokland, Birgitta, 1959, et al. (author)
  • Changes in molar position with missing opposed and/or adjacent tooth: a 12-year study in women
  • 2012
  • In: Journal of Oral Rehabilitation. - 0305-182X. ; 39:2, s. 136-43
  • Journal article (peer-reviewed)abstract
    • Summary The aim of this study was to radiographically analyse long-term changes in (i) overeruption of unopposed molars and (ii) tipping of molars with a mesial edentulous space, and whether there is an interaction between the two events. A further aim was to analyse if loss of alveolar bone height might influence overeruption and tipping. The sample consisted of panoramic radiographs taken at an interval of 12years of 292 subjects from a prospective population study of women. The panoramic radiographs were scanned and analysed. Changes in tipping, overeruption and alveolar bone height of molars and control teeth were measured. The results showed that unopposed molars were more commonly found in the upper jaw and that unopposed molars showed 4·9 times higher risk of overeruption of ≥2mm (95% CI 1·5-15·3) than opposed molars during the 12-year observation period. The average overeruption for the unopposed molars was 4·5% (s.d. 7·6), which corresponds to approximately 0·9mm. The degree of overeruption increased with decreased bone support. Molars with a mesial edentulous space were most prevalent in the lower jaw, but neither an edentulous space nor alveolar bone level/bone level change were found to have a significant effect on tipping of the molars. The average mesial tipping was 0·8° (s.d. 5·6). In conclusion, unopposed molars showed a significantly increased risk for overeruption. Molars facing a mesial edentulous space showed a low risk for mesial tipping, but a significant interaction between overeruption and tipping was identified.
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36.
  • Lindskog Stokland, Birgitta, 1959, et al. (author)
  • Molar position associated with a missing opposed and/or adjacent tooth: a follow up study in women
  • 2013
  • In: Swedish Dental Journal. - 0347-9994. ; 37:2, s. 97-105
  • Journal article (peer-reviewed)abstract
    • The purpose of the study was to assess (i) the degree of overeruption of molars lacking opposed teeth and (ii) the inclination of molars with a mesial edentulous space and also to study (iii) changes during a 12 year period. The subject sample originated from the prospective population study of women in Gothenburg, Sweden where scanned panoramic radiographs taken with an interval of 12 years were analysed. Tipping as well as overeruption were scored on the two images according to a five-level scale. Sixty-seven subjects fulfilled the inclusion criteria at baseline and were referred to as "the non-extraction group". Further 35 subjects had lost the opposed and/or the adjacent tooth/teeth during the 12-year follow-up period: "the extraction-group". These groups were studied separately and a comparison between these groups was performed. The prevalence of molars tipped more than 15 degrees at baseline was 17.1 % in the upper jaw and 44.3 % in the lower jaw, in the non-extraction group. At baseline overeruption was seen in 25 % of the unopposed upper molars and none of lower molars in the non-extraction group. The prevalence of tipping and overeruption was statistical significant less in the extraction group (P<0.01), than in the non-extraction group at baseline, but at follow-up no statistical significant group differences existed. -The prevalence of tipped molars facing a mesial edentulous space and overerupted unopposed molars increased in adults during the 12-year period but the changes were small. -Overeruption and tipping is most pronounced immediately after extractions.
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37.
  • Mejare, I. A., et al. (author)
  • Diagnosis of the condition of the dental pulp: a systematic review
  • 2012
  • In: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:7, s. 597-613
  • Journal article (peer-reviewed)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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38.
  • Petersson, Arne, et al. (author)
  • Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review
  • 2012
  • In: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:9, s. 783-801
  • Journal article (peer-reviewed)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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39.
  • Rythén, Marianne, et al. (author)
  • Risk indicators for poor oral health in adolescents born extremely preterm.
  • 2012
  • In: Swedish dental journal. - 0347-9994. ; 36:3, s. 115-24
  • Journal article (peer-reviewed)abstract
    • Children born extremely preterm often suffer from medical complications that have been shown to affect their oral health as toddlers and school children.The aim of this study was to investigate oral health and possible risk indicators for poor oral health in adolescents born extremely preterm compared with a control group and relate the findings to medical diagnoses at the clinical examination. Also in the same groups, compare the frequency of mineralization disturbances and its relation to postnatal morbidity and treatments. The medical records postnatally,was noted in 45 extremely preterm infants with a gestational age (GA) of <29 weeks, at 12 - 16 years of age and in age and gender matched fullterm controls with 37-43 weeks GA. A dental clinical examination was performed including a salivary examination. Medical diagnoses were noted at the time of the survey. Data from the patient dental records at 3, 6, and 9 years of age was compiled. The findings were related to gestational age, birth weight, neonatal and postnatal medical diagnoses treatments and medical diagnoses at the clinical examination. The result showed that the prevalence of plaque, gingivitis and the occurrence of Streptococcus mutans were higher among adolescents born extremely preterm compared to matched controls, and the saliva secretion was lower in the extremely preterm infants. The frequency of caries did not differ between the groups. Mineralization disturbances were more frequent in the primary dentition and more severe in the permanent dentition among the children born extremely preterm. No association between dental pathology, neonatal and postnatal morbidity and treatments was found. In conclusion, adolescents born extremely preterm have an increased number of risk indicators for a poorer oral outcome compared with the controls and more severe mineralization disturbances. These findings may imply an increased vulnerability for poorer oral health later in life.
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40.
  • Sahlstrand, Pia, et al. (author)
  • Timing of mineralization of homologues permanent teeth - an evaluation of the dental maturation in panoramic radiographs.
  • 2013
  • In: Swedish Dental Journal. - 0347-9994. ; 37:3, s. 111-119
  • Journal article (peer-reviewed)abstract
    • Clinically the condition Molar Incisor Hypomineralization (MIH), varies considerably between individuals, where any number of molars, from one to all four permanent first molars, may be affected with different degrees of hypomineralized enamel within the same dentition. An explanation to these variations could be that the start of the enamel mineralization differs between homologues teeth. The aim of this study was to compare the dental development between homologues teeth in digital panoramic radiographs (PRs), from children aged 7 to 11 years, using the Gleiser and Hunt method on second and third molars and to calculate the crown/root ratio for the mandibular premolars. 77 PRs, from individuals between 7.3 and 11.0 years of age, were studied. Differences in developmental stages between homologues teeth (second and third molars) were studied. In 72 of these PRs, the crown/root ratio of mandibular premolars was also compared. In 31 of the PRs, a difference in development was found between the right and left maxillary second molar. In 22 PRs, a difference in development between the right and left mandibular second molar was found. In 17 of the PRs, a difference in development was found between the right and left maxillary third molars. In 26 PRs, a difference in-between the right and left mandibular third molar was found. In 72 PRs, the crown/root ratio of mandibular premolars was measured and differences were found. All these differences were significant. A possible explanation to the variations in expressivity of MIH may be a result of differences in the start of mineralization between homologues teeth.
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41.
  • Schatz, Jean-Paul, et al. (author)
  • Prevalence of traumatic injuries to permanent dentition and its association with overjet in a Swiss child population.
  • 2013
  • In: Dental traumatology : official publication of International Association for Dental Traumatology. - : Wiley. - 1600-9657. ; 29:2, s. 110-114
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: Dental trauma is a very common issue in dentistry and its occurrence has been related to many factors. The aim of this study was to evaluate the prevalence of traumatic dental injuries in the permanent dentition among Swiss children and its association with overjet. MATERIAL AND METHODS: A sample of 1900 children aged 6-13years was prospectively evaluated to determine the number and types of injuries, the influence of overjet on the risk of suffering trauma and the relationships between trauma, age, gender and life conditions. RESULTS: The observed prevalence of trauma was higher for boys, with a slight risk increase with age and a peak frequency at the age of 10years. Most of the injuries (91.2%) involved the upper front teeth; 87.2% of all injuries were hard tissue injuries (enamel or dentin fractures), and 12.8% only subluxation and luxation injuries. Children with an overjet of 6mm or more had a four times higher risk of suffering trauma, compared with those with less overjet. CONCLUSION: This cross-sectional study confirmed most of the results from earlier studies dealing with epidemiological factors of dental injuries to the permanent dentition. Of all the variables analysed, overjet stood out as the most significant risk factor: an increased overjet of 6mm or more had a major impact on the risk of trauma, which would speak in favour of early orthodontic correction of an increased overjet to reduce the prevalence of dental trauma.
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42.
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43.
  • Stenebrand, Agneta, et al. (author)
  • Dental anxiety and symptoms of general anxiety and depression in 15-year-olds.
  • 2013
  • In: International journal of dental hygiene. - : Wiley. - 1601-5037 .- 1601-5029. ; 11:2, s. 99-104
  • Journal article (peer-reviewed)abstract
    • To cite this article: Int J Dent Hygiene DOI: 10.1111/j.1601-5037.2012.00551.x Stenebrand A, Wide Boman U, Hakeberg M. Dental anxiety and symptoms of general anxiety and depression in 15-year-olds. Abstract: Objectives: The objective of the study was to analyse the relationship between dental anxiety and symptoms of general anxiety and depression among 15-year-old individuals. Methods: The sample analysed included 221 randomly selected 15-year-old individuals living in the city of Jönköping, Sweden. One questionnaire captured sociodemography and dental history, while dental anxiety was assessed by the Dental Fear Survey (DFS) and symptoms of general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Results: About 6% of the adolescents were classified as dentally anxious. Symptoms of general anxiety and depression were significantly correlated with dental anxiety in both the bivariate and multivariate analyses. The latter analyses were adjusted for gender and previous painful experiences of dental care. Individuals with high dental anxiety showed general anxiety scores on a clinical level (mean=9.8, SD=4.3). Conclusions: Symptoms of general anxiety and depression were shown to be significantly correlated with dental anxiety among 15-year-old individuals.
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44.
  • Stenebrand, Agneta, et al. (author)
  • Dental anxiety and temperament in 15-year olds
  • 2010
  • Conference paper (peer-reviewed)abstract
    • Objectives: Dental anxiety has a major impact on oral health and general quality of life. Previously, some studies have shown an association between dental anxiety and temperament among children and adults. However, there is a lack of cohort studies which have investigated a possible relationship in adolescents. The aim of the present study was to analyse the prevalence of dental anxiety and its association with temperament (EASI - emotionality, activity, sociability, impulsivity), sociodemographic factors and previous painful and unpleasant experiences of dental care among 15-year old individuals. Methods: The sample included 263 randomly selected 15-year old individuals living in the municipality of Jönköping, Sweden. The school, parental and adolescent consent was acquired. Because no sensitive nor clinical procedures were performed on the 15-year olds, no ethic approval was necessary. Three self-reported questionnaires were used, one included items of sociodemography, while the others dealt with dental anxiety assessed by the Dental Fear Survey (DFS) and temperament assessed by an adapted version of “The EAS Temperament Survey for Children” now composed of 25 items, which has been modified for adults, the EASI temperament survey. SPSS 16.0 was used for statistical analysis with T-test, Mann-Whitney U-test, Chi-square test, Fisher’s exact test, Pearson correlation and Hierarchical multiple regression. Results: The results showed that 6.5 % of the adolescents were classified as dentally anxious and with girls proportionally more fearful than boys. The three temperaments activity, impulsivity and emotionality were significantly correlated with dental anxiety. A hierarchical multiple regression analysis showed that pain at the last dental appointment or previous pain experiences during dental care treatment were the strongest predictors regarding dental anxiety in 15-year olds. The temperament dimensions activity and impulsivity had also statistically significant correlations to dental anxiety in this regression analysis. Conclusions: Although some of the temperament dimensions are correlated with dental anxiety, this study showed that previous pain experiences during dental care treatment is a strong predictor for high dental anxiety in 15-year olds.
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45.
  • Stenebrand, Agneta, 1965-, et al. (author)
  • Dental anxiety and temperament in 15-year olds
  • 2013
  • In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 71:1, s. 15-21
  • Journal article (peer-reviewed)abstract
    • Objective: The aim of the present study was to analyse the prevalence of dental anxiety and its association with temperament, sociodemographic factors and previous painful and unpleasant experiences of dental care among 15-year old individuals. Material and methods: The sample included 263 randomly selected 15-year old individuals living in the municipality of Jönköping, Sweden. The school, parental and adolescent consent was acquired. Three self-reported questionnaires were used, one included items of sociodemography, while the others dealt with dental anxiety assessed by the Dental Fear Survey (DFS) and temperament assessed by an adapted version of The EAS Temperament Survey for Children modified for adults, the EASI temperament survey. Results: The results showed that 6.5 % of the  adolescents were classified as dentally anxious and with girls proportionally more fearful than boys. The three temperaments activity, impulsivity and emotionality were significantly correlated with dental anxiety. A hierarchical multiple linear regression analysis showed that pain at the last dental appointment or previous pain experiences during dental care treatment were the strongest predictors regarding dental anxiety in 15-year olds. The temperament dimensions activity and impulsivity were also significantly predictive of dental anxiety. Conclusions: Although some of the temperament dimensions are correlated with dental anxiety, which may emphasize an important finding with regard to personality, this study showed that previous pain experiences during dental care treatment is a strong predictor for high dental anxiety in 15-year olds.
  •  
46.
  • Stenebrand, Agneta, et al. (author)
  • General fearfulness, attitudes to dental care, and dental anxiety in adolescents.
  • 2013
  • In: European journal of oral sciences. - : Wiley. - 1600-0722 .- 0909-8836. ; 121:3 Pt 2, s. 252-7
  • Journal article (peer-reviewed)abstract
    • The etiology of dental anxiety (DA) may involve a spectrum of factors related to past dental experiences, general and specific fears, and other personality factors, but is relatively unexplored in adolescents. The aim of this study was to examine how general fearfulness and attitudes to dental care/personnel were related to DA in 15-yr-old subjects. The sample included 263 randomly selected 15-yr-old adolescents living in the municipality of Jönköping in southern Sweden. Four questionnaires were used: one general questionnaire regarding background data and three psychometric instruments dealing with DA, general fearfulness, and dental beliefs. Of all participants, 6.5% were classified as having DA. Dental anxiety was moderately to strongly correlated both with attitudes to dental care/personnel and with general fearfulness and indicated the strongest impact for individuals with both high general fearfulness and high dental beliefs in relation to DA. The linear multiple regression analysis showed that the best predictors of DA were general fearfulness and dental beliefs. This suggests that both individual vulnerability in terms of generalized fear and apprehensions about dental staff, which is linked to experiences of dentistry, appear to be important factors for DA and may be considered as risk factors for DA in adolescents.
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47.
  • Stenebrand, Agneta, et al. (author)
  • TANDVÅRDSRÄDSLA OCH TEMPERAMENT HOS 15-ÅRINGAR
  • 2010
  • Conference paper (other academic/artistic)abstract
    • Syfte: Syftet med föreliggande studie var att bland 15-åringar undersöka prevalens av tandvårdsrädsla och dess samband med temperament (EASI), bakgrundsfaktorer samt tidigare smärtsamma erfarenheter i tandvårdssituationen.   Metod: Urvalet bestod av 263 slumpmässigt utvalda 15-åringar boende i Jönköpings kommun. Tre självrapporterande frågeformulär användes varav ett gällande bakgrundsfaktorer. Grad av tandvårdsrädsla mättes med Dental Fear Survey (DFS) medan temperament mättes med hjälp av en bearbetad version av ”The EAS Temperament Survey for Children”, nu bestående av 25 delfrågor, vilken blivit modifierad för vuxna, EASI temperament survey.   Statistiska analyser: Data analyserades med SPSS 16,0 gällande frekvenser, medelvärden,  standardavvikelser, medianer, samband samt skillnader.   Resultat: Resultatet visade att 6,5 % av ungdomarna klassificerades som tandvårdsrädda med en övervägande andel flickor. De tre temperamenten aktivitet, impulsivitet och emotionalitet var signifikant korrelerade till tandvårdsrädsla. En hierarkisk multipel regression visade emellertid att smärta vid senaste tandläkarbesöket samt om det under uppväxten förekommit smärtsamma eller obehagliga tandbehandlingar var de tydligaste prediktorerna avseende tandvårdsrädsla hos 15-åriga ungdomar. Även dimensionerna aktivitet och impulsivitet i temperament korrelerade signifikant till tandvårdsrädsla i denna regressionsanalys.   Slutsats: Fastän några av dimensionerna i temperament korrelerar med tandvårdsrädsla, visade denna studie, att tidigare smärtsamma erfarenheter i tandvårdssituationen är en stark prediktor gällande hög nivå av tandvårdsrädsla bland 15-åringar.     Studien har inte genomförts med stöd eller forskningsanslag.
  •  
48.
  • Stenman, Ulrika, et al. (author)
  • Oral health-related quality of life - associations with oral health and conditions in Swedish 70-year-old individuals.
  • 2012
  • In: Gerodontology. - : Wiley. - 1741-2358 .- 0734-0664. ; 29:2
  • Journal article (peer-reviewed)abstract
    • Objective: The aim of this study was to evaluate oral health–related quality of life (OHRQoL) in relation to different chronic oral conditions and perception of oral health among elderly individuals. Background: Health-related quality of life is important to assess and understand the impact of different diseases and conditions on individuals’ well-being. Material and methods: Randomly selected 70-year-old individuals (N = 561) were included in this analysis. They were clinically examined and answered a questionnaire. Variables used were perceived oral health, satisfaction with appearance of teeth, problems with chewing and dry mouth, burning mouth syndrome, dental anxiety and dental visiting habits. To measure the participants′ perception of the impact of oral conditions on their well-being, the Oral Health Impact Profile (OHIP-14) was used. Results: The OHIP-14 distribution of sum of scores showed a floor effect but revealed acceptable psychometric properties with regard to reliability and validity. Multivariable logistic regression revealed three highly predictive variables for individuals with high OHIP-14 scores: using dentures, having chewing problems and being dissatisfied with appearance of teeth. Conclusion: Use of dentures, having chewing problems and being dissatisfied with appearance of teeth are associated with high OHIP-14 sums, indicating strong influence on OHRQoL.
  •  
49.
  • Wennström, Anette, 1975, et al. (author)
  • Oral health, sense of coherence and dental anxiety among middle-aged women.
  • 2013
  • In: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 71:1, s. 256-62
  • Journal article (peer-reviewed)abstract
    • Abstract Aims. The specific aims of this investigation were to analyze the relationship between sense of coherence (SOC), dental anxiety (DA) and oral health status among middle-aged women, measured both subjectively and objectively and adjusted for socioeconomic status (SES). Materials and methods. Randomly selected women, 38 (n = 206) and 50 (n = 287) years of age, were included in a cross-sectional health examination. The participants underwent a series of examination stages, including a clinical and dental radiographic examination. The women responded to questionnaires concerning SES, oral health, DA and SOC. Results. The number of teeth was significantly related to SOC, where more missing teeth revealed a lower SOC level among 50-year-olds. The variables of caries, apical periodontitis and filled surfaces were not statistically significantly associated with SOC. However, the self-reported measure of oral health was associated with SOC in both age groups. High DA was significantly related to self-perceived poor oral health regardless of age. Individuals with high DA also had fewer teeth, more filled surfaces and more approximal caries. The multivariate models showed that higher SOC levels were associated with better oral health, as estimated by objective or subjective measures, while the inverse results were seen for DA. Thus, individuals reporting high DA were more likely to have fewer teeth and poor perceived oral health, taking SES into account. Conclusions. Sense of coherence and dental anxiety are psychological aspects with respect to health- and risk-factors of oral health.
  •  
50.
  • Wennström, Anette, 1975, et al. (author)
  • Trends in tooth loss in relation to socio-economic status among Swedish women, aged 38 and 50 years: repeated cross-sectional surveys 1968-2004
  • 2013
  • In: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 13:63
  • Journal article (peer-reviewed)abstract
    • Background: Oral diseases are a health problem worldwide. Differences in oral health status may vary with geographical locations, but also within the same country and between groups with different social backgrounds. The specific aims were to describe secular trends in oral health status regarding number of remaining teeth and also to describe differences in socio-economic status, among 38- and 50-year-old women, over a 36-year period. Methods: Cross-sectional health surveys were performed at four occasions; 1968/69 (n=746), 1980/81 (n=532), 1992/93 (n=165) and 2004/05 (n=500), including randomly selected women aged 38 and 50 years. The number of teeth was determined using panoramic radiographs and self-reported measures of marital status, social class, educational level, and income were recorded. Results: The mean number of teeth among women has increased significantly. The educational level has increased while fewer women are married/cohabiting over time. There has been a shift in the social group the women belong to, where proportionally more women were categorized in a higher social group in 2004/05 than in 1968/69. Moreover, there is a significant relationship between fewer teeth and a lower social group, and among the 50-year-old women, this was irrespective of examination year. However, multivariate analyses showed that the risk to be edentulous or not, or to have fewer remaining teeth was significantly higher for women of lower social group, or living alone, in all studies over the 36 year-period. This was independent of age group, even though the risk diminished over the study period. Conclusions: Cohort comparisons of women aged 38 and 50 years during 36 years showed that dental status improved, with (i) a decreasing prevalence of edentulism and, (ii) an increasing number of remaining teeth in dentate individuals over time. Differences due to social group and education were still present, with more remaining teeth in the women in the higher social group. A time trend analysis indicated that in the later examination years the individuals had fewer teeth lost, irrespective of age, marital status and, social group.
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