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  • 1.
    Abdullahi Ossoble, Rage
    Örebro University, School of Health Sciences.
    Use of and patient satisfaction with removable partial dentures and the impact on oral health related quality of life; a cross-sectional survey study2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Removable partial dentures (PRD) are among the treatment options available for partially edentulous patients. The usage of RPD and patient satisfaction with the prosthesis relates to Oral health related quality of life (OHRQoL).

    Aim: The aim of this study was to evaluate the use of RPDs, satisfaction with the prostheses as well as OHRQoL in patients provided with a RPD in general practice. A further aim was to identify possible factors related to RPD usage, patient satisfaction and OHRQoL.

    Material and method: A cross-sectional survey study, utilizing a questionnaire regarding patient satisfaction with different aspects of the participants RPD, the Swedish version of OHIP-14 questionnaire and the usage of the prosthesis.

    Results: A majority of respondents, (83.6%) reported that they used their prosthesis daily or often. The overall satisfaction rate among respondents was 83.0% with 39.3% stating that they were highly satisfied with the prosthesis and the mean OHIP- 14 score was 8.5, SD 10.2. The chewing ability was reported to be improved by 58.9% but impairment in chewing was reported by 26.8%. Pain from supporting teeth and soft tissue, sociodemographic factors and dissatisfaction with pre-treatment information and personal treatment were associated with not using the RPD.

    Conclusions: In the present study, treatment with RPD was in most patients associated with improvement in chewing and appearance. Insufficient pretreatment information, perception of treatment and pain from supporting tissue was associated with reduced use of and satisfaction with the RPD.

  • 2.
    Arvidsson, Caroline
    Örebro University, School of Health Sciences.
    Barns munhälsorelaterade livskvalitet mätt med CPQ: skalans tillförlitlighet och överenstämmelse mellan barn- och föräldraskattning2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

    Bakgrund: Child Perceptions Questionnaire (CPQ) är ett mätinstrument för mätning av munhälsorelaterad livskvalitet (Oral health-related quality of life; OHRQoL) hos barn. Tidigare studier där instrumentet använts är utförda utanför Norden och då livskvalitet kan upplevas olika beroende på var man bor eller vem man är, är det av stor vikt att värdera hur instrumentet fungerar i en barnpopulation i Sverige.

    Syfte: 1. Värdera mätinstrumentets tillförlitlighet i termer av intern konsistens och test-retest stabilitet. 2. Beskriva överenstämmelsen mellan barns självskattning och föräldrars skattning av barnens munhälsorelaterade livskvalitet mätt med CPQ11-14-ISF:16 och P-CPQ- ISF:16. 3. Analysera om överenstämmelsen varierar med grad av eventuella bettavvikelser.

    Material och metod: Tvåhundrafyrtionio barn med medelålder 11,5 år (SD 0,8) och respektive förälder har deltagit i en tvärsnittsstudie där de har besvarat CPQ11-14-ISF:16 i samband med en klinisk undersökning på ortodontiavdelningen. Förekomst av bettavvikelser registrerades och ortodontiskt behandlingsbehov bedömdes enligt Index of Orthodontic Treatment Need (IOTN).

    Resultat: Mätinstrumentet sågs ha hög reliabilitet för totalskalan. Både barn och föräldraskattningen visade på en god munhälsorelaterad livskvalitet med låga värden på CPQ. Barnens självskattning låg dock högre (CPQ total score) 9,27 än föräldrarnas skattning (P-CPQ total score) 5,15. Överensstämmelsen mellan barn och föräldraskattningen var låg (ICC = 0,22) och påverkades inte av barnets ortodontiska behandlingsbehov.

    Konklusion: Mätinstrumentet ska betraktas som endimensionellt och ger uttryck för tillförlitlighet på totalskalan. Bristen på samstämmighet indikerar att såväl barnens som föräldrarnas skattningar bör beaktas.

  • 3.
    Astrøm, Anne N.
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Örebro University, School of Medical Sciences. Örebro University Hospital. Region Örebro County, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Lie, Stein A.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Gulcan, Ferda
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Dental hygienist attendance and its covariates in an ageing Swedish cohort2017In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 125, no 6, p. 487-494Article in journal (Refereed)
    Abstract [en]

    Delegation of tasks between professional groups is important to make health-care services accessible and effective for ageing people. Focussing on a Swedish 1942 birth cohort and guided by Andersen's Behavioral Model, this study assessed dental hygienist attendance from age 50 to age 70 and identified covariates at the population-averaged and person-specific levels. In 1992, a census of 50-yr-old subjects was invited to participate in a questionnaire survey. Of the 6,346 respondents, 3,585 completed follow-ups in 1997, 2002, 2007, and 2012. Multiple logistic regression analysis was conducted using a marginal model and a random intercept model. Cochran's Q test revealed that significantly more respondents confirmed dental hygienist attendance in 2012 than in 1992 (57.2% in 2012 vs. 26.0% in 1992). Population-averaged ORs for dental hygienist attendance across time were 3.5 at age 70 yr compared with age 50 yr (baseline); 2.0 if being a regular rather than an irregular dental attendee; and 0.7 if being of non-native origin compared with native origin. The corresponding person-specific ORs were 8.9, 3.2, and 0.5. Consistent with Andersen's Behavioral Model, predisposing, enabling, and need-related factors were associated with dental hygienist attendance at population-averaged and person-specific levels. This has implications for promoting dental hygienist attendance among ageing people.

  • 4.
    Barzangi, Jir
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Dental Research Department, Public Dental Health Service.
    Unell, L.
    Dental Research Department, Public Dental Health Service, Örebro, Region Örebro County, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden.
    Skovdahl, K.
    Faculty for Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Health Service, Örebro, Region Örebro County, Sweden.
    Knowledge, experiences and attitudes of dental and health care personnel in Sweden towards infant dental enucleation2018In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 19, no 4, p. 229-237Article in journal (Refereed)
    Abstract [en]

    To examine self-rated knowledge of clinical experiences and attitudes towards the practice of infant dental enucleation among dental and health care personnel in Sweden.

    A questionnaire survey was performed among 776 licensed dental and health care personnel working in emergency departments, midwifery, child health centres, school health services and public dental health services in 10 Swedish cities. The response rate was 56.2% (n = 436).

    Fewer than a fifth of the respondents reported self-rated knowledge of the practice. Approximately 13% of personnel encountering children professionally believed they had seen subjected patients in their clinical practice. Personnel with self-rated knowledge and clinical experience worked mostly in dental care. Additionally, the personnel had diverging attitudes regarding agreement and disagreement concerning professional responsibility for patients subjected to or at risk of infant dental enucleation.

    The study indicated there is need for increased knowledge about the practice and for clarification of obligatory responsibilities among dental and health care personnel regarding management and prevention of cases of infant dental enucleation.

  • 5.
    Barzangi, Jir
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Publ Dent Serv, Västmanland Cty Council, Västerås, Sweden.
    Unell, Lennart
    Örebro University Hospital. Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden.
    Söderfeldt, Björn
    Publ Dent Serv, Postgrad Dent Educ Ctr, Örebro Cty Council, Örebro, Sweden; Fac Odontol, Dept Oral Publ Hlth, Malmö Univ, Malmö, Sweden .
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Publ Dent Serv, Postgrad Dent Educ Ctr, Örebro Cty Council, Örebro, Sweden.
    Infant dental enucleation: A literature review on a traditional remedial practice in East Africa2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 3, p. 168-178Article, review/survey (Refereed)
    Abstract [en]

    Objective. To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa.

    Materials and methods. Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review.

    Results. An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined.

    Conclusions. Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

  • 6.
    Barzangi, Jir
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Publ Dent Serv, Västmanland Cty Council, Västerås, Sweden.
    Unell, Lennart
    Örebro University Hospital. Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden; Publ Dent Serv, Örebro Cty Council, Örebro, Sweden.
    Söderfeldt, Björn
    Publ Dent Serv, Örebro Cty Council, Örebro, Sweden; Fac Odontol, Dept Oral Publ Hlth, Malmö Univ, Malmö, Sweden .
    Bond, Jasmin
    Publ Dent Serv, Örebro Cty Council, Örebro, Sweden.
    Musse, Ifrah Ahmed
    Publ Dent Serv, Örebro Cty Council, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Infant dental enucleation in an East African population in Sweden: a cross-sectional study on dental records2014In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 24, no 3, p. 209-214Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the prevalence of infant dental enucleation (IDE) of primary canines, an East African traditional remedial procedure, in a multiethnic population of children in Sweden.

    Design: A cross-sectional study was conducted of dental records of 1133 patients (mean age 4.6years, SD +/- 1.4) attending one public dental service clinic in Sweden. The clinic was located in an area with a large multiethnic community. All were born within the years 2002-2006 and had received a check-up in one of the years 2007-2009. A registry was made of missing primary canines where no reason could be found. In documented cases, information about ethnic origin was extracted. Statistical grouping was made according to known East African ethnicities.

    Results: At least 36 ethnicities were recorded. Twenty-four (2.1%) patients were missing one or more canines according to the criteria for IDE. Significant difference was seen when comparison was made between patients of known East African ethnicities, of whom 20.8% (21/101) manifested findings consistent with the criteria, and the rest of the population (3/1032; P<0.001).

    Conclusions: Prevalence of cases suggestive of IDE among patients of East African origin points to a need for increased awareness within dental and healthcare communities.

  • 7.
    Bazargani, Farhan
    et al.
    Örebro University Hospital. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Jacobson, Sven
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Lennartsson, Bertil
    Postgraduate Dental Education Center, Örebro, Sweden.
    A comparative evaluation of lingual retainer failure bonded with or without liquid resin: A randomized clinical study with 2-year follow-up2012In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 82, no 1, p. 84-87Article in journal (Refereed)
    Abstract [en]

    Objective: To prospectively evaluate and compare the effect of liquid resin on lingual retainer failure after a 2-year follow-up.

    Materials and Methods: Fifty-two patients (26 males, 26 females) with a mean age of 18.3 +/- 1.3 years at follow-up, were randomized into two groups: the resin group and the nonresin group. The lingual retainers in the resin group were bonded to the enamel surfaces with two-step bonding resin, Optibond FL, and Tetric EvoFlow. The nonresin group followed the same procedure of bonding retainers but without applying the Optibond FL. Retainer failure, calculus accumulation, and discoloration of composite pads adjacent to the retainers during the 2-year observation period were registered, compared, and statistically analyzed with a Fisher's exact test and chi-square test.

    Results: In the resin group, the incidence of retainer failure was 4% and occurred at the composite-wire interface; in the nonresin group, the incidence was 27% and occurred at the enamel-composite interface. The difference between the groups was statistically significant (P =.049). The incidences of calculus accumulation and discoloration adjacent to the composite pads were 27% and 69% (P =.003 and P <.001) higher in the nonresin group, respectively.

    Conclusion: Application of resin in bonding of lingual retainers appears to reduce the incidence of retainer failure as well as the incidence of calculus accumulation and discoloration adjacent to the composite pads. (Angle Orthod. 2012;82:84-87.)

  • 8.
    Bazargani, Farhan
    et al.
    Örebro University Hospital. Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Magnuson, Anders
    Clin Epidemiol & Biostat Unit, Örebro Univ Hosp, Örebro, Sweden.
    Dolati, Ali
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Lennartsson, Bertil
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Palatally displaced maxillary canines: factors influencing duration and cost of treatment2013In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 35, no 3, p. 310-316Article in journal (Refereed)
    Abstract [en]

    The purpose of this retrospective study was to assess the relationship between the initial position of palatally displaced canines (PDCs) on panoramic radiographs and the duration of the orthodontic treatment and further to estimate the costs of the treatment. Data from panoramic radiographs and patient records of 66 consecutive patients (mean age 14.9 +/- 1.7 years) with PDC were analysed. The initial position of the canine, the distance between the canine cusp tip and the occlusal plane, and the inclination of the canine were significantly associated with treatment duration both unadjusted and adjusted for background characteristics. The average estimated cost of the treatment of PDC was euro3200 per case. The total annual cost for treatment of PDC in Sweden may therefore be estimated at euro600 0000. In this study, duration of treatment averaged 17 months for canines displaced in impaction zone 1 or 2, 2.6 [95% confidence interval (CI) -1.0 to 6.2] months longer for those in impaction zone 3, and 7.6 (95% CI 4.1-11.1) months longer for canines displaced in impaction zone 4 or 5. This information makes it easier, through study of the panoramic radiograph, to estimate the duration of treatment and to give patients more precise information about the expected length of their treatment.

  • 9.
    Betancourt, Romeu Aramis
    Örebro University, School of Health Sciences.
    En jämförelse av olika mätmetoder för positionsbestämning av ej erupterade överkäkshörntänder med hjälp av panoramabilden - validerat med CBCT2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien är att undersöka fem olika mätmetoders noggrannhet för bestämning av positionen hos en ej erupterad överkäkshörntand på panoramabilder.

    Då allt fler panoramabilder exponeras på barn och ungdomar kan dessa användas för positionsbestämning av överkäkens hörntänder. Materialet omfattar panoramaröntgenbilder på 70 överkäkshörntänder på 47 barn och ungdomar, 9-19 år gamla. Fem mätmetoder för positionsbestämning av hörntanden med panoramabilden jämförs samt valideras med CBCT "Gold standard". 1. Vinkelmetod (Ang1); 2. Vinkelmetod (Ang2); 3. Canine Incisive Index (CII); 4. Sektormetod; 5. Vertikalmetod.

    Studien visade att de bästa metoderna för positionsbestämning av hörntanden är Ang1 och Ang2, samt CII, med en accuracy på 74 % -72 %, medan sektormetoden hade en accuracy på 64 %. Ingen statistiskt signifikant skillnad förelåg mellan Ang1, Ang2, CII och sektormetoden. Panoramabilden kan användas för bedömning av hörntandens position innan vidare utredning med CBCT görs.

  • 10.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Eskilstuna, Sweden; Department of Orthodontics, Postgraduate Dental Education Centre, Örebro, Sweden .
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Postgraduate Dental Education Centre, Örebro, Sweden; Department of Behavioural and Community Dentistry, Institution of Odontology, University of Gothenburg, Gothenburg, Sweden.
    Homocystinuria and oral health. A report of 14 cases2012In: Swedish Dental Journal, ISSN 0347-9994, Vol. 36, no 2, p. 101-108Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the oral health in Swedish individuals with the diagnosis of homozygote cystathionine beta synthase-deficient homocystinuria (HC), a rare disorder of amino acid metabolism affecting connective tissue, in which the phenotypic abnormalities include dislocation of the optic lens, skeletal abnormalities, thromboembolic events, and sometimes mental retardation. Further aims were to evaluate the oral findings against previous oral observations in a medical case report, such as high narrow palate, mandibular prognathia, crowding and early eruption of teeth. Every hospital in Sweden was contacted, with the inquiry of patients with diagnosis of HC, which resulted in 14 individuals participating in oral clinical examination. The oral findings evaluated against previous medical case reports showed to be partly in accordance with previous observations. Dental health showed to be compromised in a majority of cases. Together with the fact that methionine restriction (low-protein diet) is involved in the treatment of the condition and might result in a diet high in sugars,this points out the role of regular dental checkups and preventive oral care for individuals suffering from HC. In addition, short dental roots were a finding not previously reported in the literature. All the studied cases had central maxillary incisors with short roots, when compared to reference values used.

  • 11.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Lindsten, Rune
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Magnusson, Anders
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Sundell, Anna Lena
    Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Gustafsson, Annika
    Department of Paediatric Dentistry, Postgraduate Dental Education Center, Örebro, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions: a multicentre, randomized, controlled trial2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 6, p. 626-635Article in journal (Refereed)
    Abstract [en]

    Background: Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials.

    Objectives: To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs.

    Trial design: The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio.

    Material and methods: Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery.

    Blinding: It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group.

    Results: Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group.

    Conclusion: There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group.

    Trial registration: Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

  • 12.
    Blomqvist, My
    et al.
    Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Dahllöf, Göran
    Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    A cross-sectional study on oral health and dental care in intellectually able adults with autism spectrum disorder2015In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 15, article id 81Article in journal (Refereed)
    Abstract [en]

    Background: Autism spectrum disorder (ASD) is characterized by impairments in social interaction and communication, restricted patterns of behaviour, and unusual sensory sensitivities. The hypotheses to be tested were that adult patients with ASD have a higher caries prevalence, have more risk factors for caries development, and utilize dental health care to a lesser extent than people recruited from the normal population.

    Methods: Forty-seven adults with ASD, (25 men, 22 women, mean age 33 years) and of normal intelligence and 69 age-and sex-matched typical controls completed a dental examination and questionnaires on oral health, dental hygiene, dietary habits and previous contacts with dental care.

    Results: Except for increased number of buccal gingival recessions, the oral health was comparable in adults with ASD and the control group. The group with ASD had less snacking, but also less frequent brushing of teeth in the mornings. The stimulated saliva secretion was lower in the ASD group, regardless of medication. Frequencies of dental care contacts were equal in both groups. The most common reason for missing a dental appointment was forgetfulness in the ASD group.

    Conclusions: Adults with ASD exhibited more gingival recessions and considerably lower saliva flow compared to healthy controls. Despite equal caries prevalence, the risk for reduced oral health due to decreased salivary flow should be taken into consideration when planning dental care for patients with ASD. Written reminders of dental appointments and written and verbal report on oral health status and oral hygiene instructions are recommended.

  • 13.
    Blomqvist, My
    et al.
    Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Dahllöf, Göran
    Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Bejerot, Susanne
    Department of Clinical Neuroscience, Karolinska Institutet and Northern Stockholm Psychiatry, St. Göran Hospital, Stockholm, Sweden.
    Experiences of dental care and dental anxiety in adults with autism spectrum disorder2014In: Autism Research and Treatment, ISSN 2090-1925, E-ISSN 2090-1933, Vol. 2014, article id 238764Article in journal (Refereed)
    Abstract [en]

    Dental anxiety is associated with previous distressing dental experiences, such as lack of understanding of the dentist intentions, perceptions of uncontrollability and experiences of pain during dental treatment. People with autism spectrum disorder (ASD) are impaired in building flexible predictions and expectations, which is very much needed during a dental visit. The aims of the study were to investigate if people with ASD have more negative dental experiences and a higher level of dental anxiety compared to a matched control group. Forty-seven adults with ASD and of normal intellectual performance, and 69 age- and sex-matched typically developing controls completed questionnaires on previous dental experiences and dental anxiety, the Dental Anxiety Scale, and the Dental Beliefs Survey. The ASD group experienced pain during dental treatments more often than the controls and 22% had repeatedly experienced being forced to dental treatment they were not prepared for, compared to 3% of the controls. A higher level of dental anxiety was reported by the ASD group. Dental treatment and methods for supporting the communication with patients with ASD need to be developed, in order to reduce the negative dental experiences and dental anxiety in people with ASD.

  • 14.
    Branzén, Marie
    et al.
    Specialist Clinic of Orthodontics, Public Dental Health Service, Karlstad, Sweden.
    Eliasson, Alf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Prosthetic Dentistry, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dental Research Department, Public Dental Health Service, Örebro County Council, Örebro, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Implant-Supported Single Crowns Replacing Congenitally Missing Maxillary Lateral Incisors: A 5-Year Follow-Up2015In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 17, no 6, p. 1134-1140Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge of the long-term survival of single implants in cases of congenitally missing lateral incisors in the maxilla is limited.

    Purpose: This retrospective study aimed to evaluate the 5-year survival of implants and implant-supported crowns (ISCs) and to assess the functional and aesthetic outcomes from the professional and patient perspectives.

    Materials and Methods: From a total of 46 patients with congenitally missing upper lateral incisors, 36 patients treated with 54 Branemark (R) (Nobel Biocare AB, Goteborg, Sweden) implants and ISCs participated in the study. A clinical examination, California Dental Association (CDA) evaluation, and patient questionnaire were used to rate and compare the objective and subjective evaluations of the ISCs.

    Results: The survival of implants and ISCs was 100%. The CDA ratings were satisfactory for all ISCs, with 70% being rated excellent. The patient rating was also high for the overall satisfaction item, with 21 being completely satisfied and 14 fairly satisfied. However, 12 patients wished for the replacement of their ISCs. Logistic regression analysis indicated that a less optimal embrasure fill was the most discriminating factor though not statistically significant (p = .082).

    Conclusions: One-third of the patients wished for the replacement of their ISCs. Soft tissue adaptation seems to be an important factor for overall satisfaction.

  • 15.
    Cardemil, Carina
    et al.
    Dept Biomat, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Dept Oral & Maxillofacial Surg, Örebro Univ Hosp, Örebro, Sweden.
    Thomsen, Peter
    Dept Biomat, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; BIOMATCELL VINN Excellence Ctr Biomat & Cell Ther, Gothenburg, Sweden.
    Wexell, Cecilia Larsson
    Dept Biomat, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Dept Oral & Maxillofacial Surg, Sahlgrenska Univ Hosp Mölndal, Gothenburg, Sweden; Inst Odontol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Jaw Bone Samples From Bisphosphonate-Treated Patients: A Pilot Cohort Study2015In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 17, p. E679-E691Article in journal (Refereed)
    Abstract [en]

    Osteonecrosis of the jaw (ONJ) is a severe complication of bisphosphonate treatment. PurposeA detailed characterization of sampled peri-necrotic jawbone from bisphosphonate-treated patients was performed at tissue and cellular level (histological analyses and gene expression). Materials and MethodsAlveolar bone samples were collected from patients with (n=5) and without ONJ (n=5). Healthy patients served as controls (n=10). ResultsThe histological analysis demonstrated low to moderate inflammation, displaying areas of inflammatory infiltrate in the bone marrow. Multinuclear giant cells and osteoclasts were found in both groups. Markers of bone formation (alkaline phosphatase, Col1a1, and osteocalcin), bone resorption (receptor activator of NF-kappaB ligand [RANKL], osteoprotegerin [OPG], tartrate-resistant acid phosphatase, and cathepsin K), inflammation (tumor necrosis factor-alpha, interleukin [IL]-1, and IL-6), angiogenesis (vascular endothelial growth factor A), and apoptosis (Casp3, Casp8, p53, and Smac) were evaluated. Nonparametric statistical tests were used to identify differences between the groups. In patients with ONJ, the expression level of the proinflammatory marker IL-1 was strongly up-regulated compared with controls (p=.040). ConclusionsA down-regulated expression of Casp8 compared with controls was observed (p=.014) in patients treated with bisphosphonates. The RANKL/OPG ratios were similar in the three groups. The results indicate a need to further investigate the molecular mechanisms involved in the course of ONJ related to antiresorptive treatment.

  • 16.
    Carlsson, Gunnar E.
    et al.
    Department of Prosthetic Dentistry and Dental Materials Science, University of Gothenburg, Gothenburg, Sweden.
    Ekbäck, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Johansson, Anders
    Department of Clinical Dentistry-Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden; Linköping University, Linköping, Sweden.
    Unell, Lennart
    Örebro University Hospital. School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Post Graduate Dental Education Centre, Örebro County Council, Örebro, Sweden.
    Is there a trend of decreasing prevalence of TMD-related symptoms with ageing among the elderly?2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 714-720Article in journal (Refereed)
    Abstract [en]

    Objective: Older adults have not been studied as much as younger ones regarding prevalence of TMD-related symptoms. The aim was to assess the prevalence of TMD-related symptoms in two population samples, 70 and 80 years old.

    Materials and methods: Identical questionnaires were in 2012 sent to all subjects born in 1932 and 1942 living in two Swedish counties. The response rate was 70.1%, resulting in samples of 5697 70-and 2922 80-year-old subjects. The questionnaire comprised 53 questions. Answers to questions on problems regarding TMD-related symptoms and awareness of bruxism were analysed.

    Results: Twelve per cent of the women and 7% of the men in the 70-year-old group reported some, rather great or severe problems regarding TMD pain. In the 80-year-olds the prevalence was 8% and 7%, respectively. Subjects who had problems with TMJ sounds reported difficulty to open the jaw wide 6-times and TMJ pain 10-13-times more frequently than subjects without such problems. Changes of taste and awareness of bruxism were the only variables significantly associated with TMD symptoms in both age groups. Number of teeth was not significantly associated with any of the TMD-related symptoms.

    Conclusions: Most of the elderly subjects had no severe problems with TMD-related symptoms, but 12% of the 70-year-old women reported some, rather great or severe problems. The marked gender difference at age 70 had disappeared in the 80-year-old group. The prevalence was lower among the 80-compared with the 70-year-old subjects of both sexes. The results support the comorbidity between TMD-related symptoms and general health problems.

  • 17.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dental Research Department, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Bondemark, Lars
    Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Letters to the Editor2016In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 38, no 2, p. 223-223Article in journal (Refereed)
  • 18.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro County Council, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Postgraduate Dental Education Center, Örebro County Council, Örebro, Sweden.
    Bondemark, Lars
    Faculty of Odontology, Malmö University, Malmö, Sweden.
    The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies2015In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 3, p. 238-247Article, review/survey (Refereed)
    Abstract [en]

    Background: Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life.

    Objectives: To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents.

    Materials and methods: Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low.

    Results: The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL.

    Conclusion: The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

  • 19.
    Dimberg, Lillemor
    et al.
    Dental Research Department, Public Dental Service, Örebro County, Örebro, Sweden; Department of Orthodontics, Eastman Institute, Public Dental Service, Stockholm County Council, Stockholm, Sweden.
    Arvidsson, Caroline
    Department of Orthodontics, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Lennartsson, Bertil
    Dental Research Department, Public Dental Service, Örebro County, Örebro, Sweden.
    Bondemark, Lars
    Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Agreement between children and parents in rating oral health-related quality of life using the Swedish versions of the short-form Child Perceptions Questionnaire 11-14 and Parental Perceptions Questionnaire2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 7, p. 534-540Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: and P-CPQ, and to evaluate the impact on agreement of oral health including malocclusion and background characteristics (dental fear, family situation, gender of informant).

    MATERIAL AND METHODS: and P-CPQ separately in connection with a clinical examination.

    RESULTS: The participants comprised 247 child-parent pairs: 116 (47%) boys, 131 (53%) girls, 166 (67%) mothers and 81 (33%) fathers. The agreement between the child and parental ratings of the children's OHRQoL was low, with an ICC of 0.22 (95% CI: 0.04-0.37) for the total scale.

    CONCLUSIONS: There was a low agreement between children's and parents' answers. For best care, it is advisable to consider perceptions of both children and parents because they can complement each other in estimating the child's OHRQoL.

  • 20.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics, Postgraduate Dental Education Center, Orebro County Council, Örebro, Sweden.
    Lennartsson, Bertil
    Postgraduate Dental Education Center, Örebro County Council and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Postgraduate Dental Education Center.
    Bondemark, Lars
    Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Prevalence and change of malocclusions from primary to early permanent dentition: A longitudinal study2015In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 85, no 5, p. 728-734Article in journal (Refereed)
    Abstract [en]

    Objective: To follow a group of children from primary to early permanent dentition and determine the prevalence, self-correction, and new development of malocclusions; the need for orthodontic treatment; and the possible influences of habits, breathing disturbances, and allergies.

    Materials and Methods: Two hundred and seventy-seven children were followed at 3, 7, and 11.5 years of age. Malocclusions and orthodontic treatment need were determined by clinical examinations. Data on sucking habits, breathing disturbances, allergies, dental trauma, and orthodontic treatments were collected from a questionnaire and dental records.

    Results: Malocclusions were found in 71% of participants at 3 years of age, 56% at 7 years of age, and 71% at 11.5 years of age. Self-correction was noted for anterior open bite, sagittal malocclusions, and posterior crossbite, while deep bite developed. A high number of contact point displacements and spacings contributed to the prevalence of malocclusion rate of 71% at 11.5 years. Severe or extreme orthodontic treatment need was apparent in 22%. Habits, allergies, or breathing disturbances found at 3 years of age had no associations with malocclusions at 11.5 years of age.

    Conclusions: This sample revealed a significant percentage of malocclusions and orthodontic treatment need. A substantial number of self-corrections and establishment of new malocclusions occurred during the transition from primary to early permanent dentition.

  • 21.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Lennartsson, Bertil
    Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden; , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bondemark, Lars
    Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Oral health-related quality-of-life among children in Swedish dental care: The impact from malocclusions or orthodontic treatment need2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, p. 127-133Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe oral health-related quality-of-life (OHRQoL) and the impact of malocclusions or orthodontic treatment need in a cohort of children in Swedish dental care, using the Swedish version of the Child Perceptions Questionnaire-Impact Short Form (CPQ(11-14)-ISF:16).

    Subjects and methods: Two hundred and fifty-seven children (mean age = 11.5 years, SD = 0.8, range = 9.8-13.5 years) completed the CPQ(11-14)-ISF:16 in conjunction with a clinical examination. In addition to malocclusions and orthodontic treatment need (based on the Index of Orthodontic Treatment Need-Dental Health Component), possible confounders (caries, enamel defects, dental trauma, headache and socio-economic markers) were recorded. Children also rated their own dental fear on the Children's Fear Survey Schedule-Dental Sub-scale (CFSS-DS).

    Results: The mean total CPQ(11-14)-ISF:16 score was 9.31. The logistic regression analyses revealed an impact of orthodontic treatment need on OHRQoL (CPQ), but no clear association between higher severity and higher impact on OHRQoL was seen. Dental fear and headache appeared to discriminate for poorer OHRQoL. No impact from caries, enamel defects, dental trauma, or socio-economic markers was revealed.

    Conclusions: This cohort of children reported good self-perceived OHRQoL. Effects on OHRQoL from malocclusions or orthodontic treatment need were limited and inconsistent. Dental fear and headache were found to be more distinct impact factors on OHRQoL than were malocclusions or orthodontic treatment need.

  • 22.
    Dimberg, Lillemor
    et al.
    Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden; Department of Orthodontics, Public Dental Service, Eastman Institute, Stockholm County Council, Stockholm, Sweden.
    Lennartsson, Bertil
    Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Bondemark, Lars
    Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Validity and reliability of the Swedish versions of the short-form Child Perceptions Questionnaire 11-14 and Parental Perceptions Questionnaire2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 8, p. 630-635Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the validity and reliability of the Swedish versions of the short-form Child Perceptions Questionnaire 11-14 (CPQ(11-14)) and Parental Perceptions Questionnaire (P-CPQ) for measuring children's oral health-related quality of life (OHRQoL).

    Material and methods: The sample comprised 247 children and parents. OHRQoL was assessed by asking each child and their accompanying parent to complete the relevant questionnaire. To allow test-retest analysis, 30 children and 32 parents were asked to complete the instrument a second time within 2-4 weeks.

    Results: In terms of construct validity, significant correlations were observed between CPQ scale scores and the global ratings of oral health and overall well-being for both the CPQ(11-14) and the P-CPQ. Regarding internal consistency, Cronbach's alphas for the total scales were 0.81 and 0.77, respectively, indicating good reliability, and internal consistency for the subscales (two or four dimensions) was acceptable. Test-retest reliability was good for the CPQ(11-14) total scale (ICC 0.77) and acceptable for the P-CPQ total scale (ICC 0.63).

    Conclusions: The Swedish versions of the short-form CPQ(11-14) and P-CPQ are both valid and reliable, and can be recommended for use among Swedish children aged 11-14 years for evaluation of OHRQoL.

  • 23.
    Edvinsson, Siv Elisabet
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Child and Youth Habilitation Centre, Örebro County Council, Örebro, Sweden; Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Law, Psychology and Social Work. Örebro University Hospital. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    Inter-rater and intra-rater agreement on the Nordic Orofacial Test-Screening examination in children, adolescents and young adults with cerebral palsy2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 2, p. 120-129Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate inter-rater and intra-rater agreement on the Nordic Orofacial Test-Screening (NOT-S) examination applied to children, adolescents and young adults with cerebral palsy (CP).

    Materials and methods. Using the NOT-S examination, two speech and language pathologists independently assessed video recordings of 48 subjects with CP aged 522 years and representing all CP sub-diagnoses and levels of gross motor function and manual ability. Thirty-one subjects were reassessed. Fifteen out of 17 items in the NOT-S examination domains (1) Face at rest, (2) Nose breathing, (3) Facial expression, (4) Masticatory muscle and jaw function, (5) Oral motor function and (6) Speech were rated using a 'yes' (dysfunction observed)/'no' format, generating an overall score of 0-6.

    Results. Inter-rater agreement: Twelve out of 15 items and five out of six domains showed acceptable unweighted kappa values (kappa = 0.46-1.00). The lowest kappa value was found for domain 4 (kappa = -0.04), although it had high inter-rater agreement (92%). The linear weighted kappa value for the overall NOT-S examination score was 0.65 (95% CI = 0.49-0.82). Intra-rater agreement: All items and domains showed acceptable unweighted kappa values (items 0.58-1.00 and 0.59-1.00, domains 0.81-1.00 and 0.62-0.89) for both raters. The linear weighted kappa value for the overall NOT-S examination score was 0.81 (95% CI = 0.63-0.99) for rater A and 0.54 (95% CI = 0.25-0.82) for rater B.

    Conclusions. The NOT-S examination has acceptable inter-rater and intra-rater agreement when used in young individuals with CP.

  • 24.
    Ekbäck, Gunnar
    et al.
    Dental Department, Örebro County Council, Örebro, Sweden .
    Näslund, Ingmar
    Department of Surgery, Örebro University Hospital, Örebro, Sweden .
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Primary Care and Social Medicine, Charing Cross Hospital, Imperial College, London, United Kingdom .
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden .
    Self-perceived oral health and obesity among 65 years old in two Swedish counties2010In: Swedish Dental Journal, ISSN 0347-9994, Vol. 34, no 4, p. 207-216Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the association between oral health and obesity. The study was conducted in the spring of 2007 as a postal survey of all inhabitants born in 1942 and living in the two Swedish counties of Orebro and Ostergotland. This questionnaire survey has been conducted every five years since 1992 but has been updated continually with additional questions and for the sweep used here, height and weight data were collected. A total of 8,313 individuals received the questionnaire and 6,078 of those responded (73,1%). The outcome variable oral health was measured using one global question and four detailed questions representing different aspects of oral health. The independent variable Body Mass Index (BMI) was calculated using self-reported height and weight. A difference in oral health between various BMI groups was found. The difference was both statistically significant and of clinical importance, particularly among the group with severe obesity who reported poorer self-perceived chewing capacity, lower satisfaction with dental appearance, increased mouth dryness and fewer teeth and lower overall satisfaction with oral health. In view of the increased risk of poor oral health demonstrated in this study for those with severe obesity, it may be of value to increase cooperation between dental care and primary health care for these patients.

  • 25.
    Ekbäck, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Linköping University, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Does different wording of a global oral health question provide different results?2015In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, no 4, p. 250-257Article in journal (Refereed)
    Abstract [en]

    Objective: Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions.

    Background: It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the 'global oral health question' is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is.

    Materials and methods: In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Örebro (T) and Östergötland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression.

    Results: The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR = 5.6 and 5.2), chewing capacity (OR = 6.9 and 4.2), satisfaction with dental appearance (OR = 19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR = 3.5 and 3.9). Conclusion. Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants.

  • 26.
    Ekbäck, Gunnar
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Dentistry, Region Örebro County, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Self-perceived taste disturbance: a 20-year prospective study of a Swedish 1942 birth cohort2017In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 34, no 2, p. 180-186Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to assess the impact of dental care factors, general health factors and socio-economic factors on perceived taste disturbance (PTD) over time and to assess the stability of or change in PTD in a panel of individuals as they progressed from middle age (50 years) to early old age (70 years).

    Materials and methods: Data collection was conducted from a cohort study beginning in 1992, when the participants were 50 years old, and again 5, 10, 15 and 20 years later. Stability and change in PTD were described using cross-tabulation. Perceived taste disturbance over the 20-year survey period was modelled using the generalised estimating equation (GEE).

    Results: The prevalence of PTD during a 5-year period found in this study ranged from 2.4 to 2.9%, the latter in individuals between 60 and 70 years of age. Women generally had PTD more often than men. The longitudinal analysis showed that problems with bad breath (OR = 3.6), blisters (OR = 3.4), burning mouth (OR = 3.4) and self-perceived health (OR = 2.7) were the most important factors explaining PTD.

    Conclusions: This study showed that PTD does not increase between 50 and 70 years of age in ordinary community-living individuals. There were no long-term impacts on PTD over time from socio-economic factors, and over time, there were a limited number of factors contributing to the effect. Bad breath, blisters, burning mouth and self-perceived health are important factors for the dentist to discuss with the patient in the case of PTD.

  • 27.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit Östergötland County Council, Linköping University, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Ekbäck, Maria Palmetun
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Drug and Therapeutic Committee, Örebro County Council, Örebro, Sweden.
    Ekbäck, Gustav
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden; Post Graduate Dental Education Centre, Örebro County Council, Örebro, Sweden.
    Johansson, Ann-Katrin
    Department of Clinical Dentistry – Cariology, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
    Reporting dental caries disease in longitudinal studies - a suggestion2016In: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, no 2, p. 173-179Article in journal (Refereed)
    Abstract [en]

    In general, most infectious and/or lifestyle-related diseases are defined as being present when sufficient signs or symptoms occurs in an individual. The term "sufficient" is a relative concept and a disease can therefore be measured with different degrees of certainty. These symptoms are commonly defined in such a way that it is possible to determine the incidence and prevalence of the disease and also the proportion of individuals that are cured from the disease. If dental caries is an individual disease which can be compared to other diseases regarding incidence and prevalence, it is important to determine for how long an individual must be free from new signs of the disease before being considered cured or free from the disease and to define the "sufficient" signs or symptoms needed for a diagnose. Based on these thoughts, the purpose of this study was to calculate caries incidence and prevalence in a group of adolescents from a definition of dental caries based on ICD-10. This study included all 12 year olds in 1990 who attended a clinical dental examination in 1990-1995 in Orebro County, Orebro, Sweden, yearly during these six years. Dental caries disease at the individual level was defined as Ko2.1 (dentinal caries) according to ICD-bo while freedom of caries was defined as the absence of Ko2.1 during a three-year period. In this study the yearly prevalence was 12%, the three year cumulative incidence was 18% and the incidence rate 13%. Results of this study highlight the poor outcomes in curing caries disease in this age-group, according to the criteria in this study, as only 17% of the children with caries at the outset of the study were free from the disease three years later. Defining both a practical level to measure signs of dental caries, and the period an individual must be free from them to be classified as cured from the disease create new opportunities to compare and communicate the disease of dental caries with other diseases. This way of registration is also of advantage for planning purposes as there the centre of interest must be the individual patient and not the tooth or surface.

  • 28.
    Ekbäck, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Dentistry, Region Örebro County, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Ståhlnacke, Katri
    Dental Public Health, Region Örebro County, Örebro, Sweden.
    Satisfaction with dental care and life-course predictors: A 20-year prospective study of a Swedish 1942 birth cohort?2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 3, p. 194-201Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to assess the impact of care experience, health factors and socioeconomic factors on satisfaction with dental care across time and to assess the stability or change in levels of self-reported satisfaction with dental care in individuals as they progress from middle age to early old age.

    Materials and methods: The present work is based on five separate data collections from a cohort study with 3585 individuals responding in all years of the survey. Data collection was conducted in 1992 when the subjects were 50 years of age and again 5, 10, 15 and 20 years later. Absolute stability in satisfaction with dental care was assessed by calculating the proportion of individuals who maintained their position in the same category from one survey period to another. Changes across time were tested using Cochran's Q test. Satisfaction with dental care across the 20-year survey period was modeled using the generalized estimating equation (GEE).

    Results and conclusion: The result showed that 85% of women and 83% of men remained satisfied with dental care. Binomial GEE revealed no statistical significant change in satisfaction with dental care between 1992-2012. In sum, this study has shown that this age group, born in 1942, was stably satisfied with dental care between age 50 and age 70, despite all changes during this time period. Females are more satisfied than men and the most important factors are the experience of attention during the last visit, satisfaction with dental appearance and good chewing capability.

  • 29.
    Ekbäck, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Dentistry, Örebro County Council, Örebro, Sweden .
    Ordell, Sven
    Department of Oral Public Health, Faculty of Odontology, Malmö University, Malmö, Sweden; Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden .
    Unell, Lennart
    Postgraduate Dental Education Centre, Dental Public Health, Örebro County Council, Örebro, Sweden .
    Can caries in the primary dentition be used to predict caries in the permanent dentition?: an analysis of longitudinal individual data from 3-19 years of age in Sweden2012In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 13, no 6, p. 308-311Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate if active caries disease in the primary dentition can be used as a long-term predictor for active caries disease in the permanent dentition.

    STUDY DESIGN: Population-based longitudinal register study.

    METHODS: This study included all those born in 1987 living in Örebro county who came to the clinic for an examination at all three measuring points in 1990, 1993 and 2006 (n = 1,985, panel). The panel consisted of 77.3% of the baseline group (1990) and represented 60.0% of the three-year-olds in the population in 1990. Caries data were compared at the individual level and were broken down into the components of decayed, filled primary teeth (dft) and decayed surfaces (ds) (at three years and six years) and decayed filled permanent teeth (DFT) and decayed surfaces (DS) (at 19 years). DFT (dft) was used as an indicator of caries experience and DS (ds) as an indicator of active caries disease

    RESULTS: There was a poor correlation between active caries disease at six years of age and active caries disease at 19 years of age. A stronger correlation could be measured between dental caries experience at six years of age (primary dentition) and caries experience at 19 years of age.

    STATISTICS: Bivariate analyses were conducted by cross-tabulation and Chi-squared statistics. Multivariate analyses were conducted using binary multiple logistic regression with categorical data.

    CONCLUSIONS: The correlations between active caries disease in the primary dentition and active caries disease at 19 years of age were very low on an individual level. Using early caries disease as a predictive test for later caries disease showed low sensitivity and low specificity over a long time period.

  • 30.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Persson, Carina
    Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden .
    Caries in five different socio-economic clusters in Orebro county2012In: Community Dental Health, ISSN 0265-539X, Vol. 29, no 3, p. 229-232Article in journal (Refereed)
    Abstract [en]

    AIM: This study assessed the prevalence of socio-demographic clusters in a Swedish county and the relationship of socio-demographic clusters and caries.

    METHODS: All 2-19-year-olds (n = 58,573) who attended a routine check-up in Orebro County in 2005-2007 were involved in this study. Initially, two-stage cluster analyses were used to identify outliers. Secondly, the Ward method which is a hierarchical clustering method was used to conduct the final analysis. Bivariate logistic regression was also used to study the relationship between cluster membership and caries. The smallest study unit used in the initial analysis for geographical area is known as key code area, which is a geographical entity defined by the municipalities themselves. Decayed surface (DS/ds) has been used as a measure of dental caries.

    RESULTS: The county of Orebro clustered in five different socioeconomic clusters. Each cluster was defined by proportion of people over 75 years, native-born, single parents, and those with low incomes and low level of education. Odds ratio (OR) for having DS/ds > 0 in the last dental check-up during 2005-2007 was 1.5 (cluster 1), 1.3 (cluster 2), 1.4 (cluster 3) and 3.8 (cluster 4) compared with the most socioeconomically favoured cluster (cluster 5).

    CONCLUSION: Cluster analysis of socioeconomic data is a useful tool to identify neighbourhoods with different socio-economic conditions.

  • 31.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Persson, Carina
    Örebro University, School of Health Sciences. Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden.
    Lindén-Boström, Margareta
    Örebro University, School of Health Sciences. Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden.
    What factors can be protective for both self-rated oral health and general health?2015In: Swedish Dental Journal, ISSN 0347-9994, Vol. 39, no 2, p. 99-107Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze if the same protective factors are significant for both self-rated health and oral health. It was hypothesized that these factors should be the same.

    The material is based on a population sample of 17 113 women and men aged 18-84years in one county in central Sweden.The response rate was 61%.The data were collected through a postal questionnaire "Life and Health" in 2008.The questionnaire comprised of 149 questions and was divided into a number of areas, e.g. socioeconomic conditions, quality of life, social relations, lifestyle, and health. To analyze the strength of the protective factors whilst taking into account the relationships between the various independent variables, multivariate analyses were conducted using binary multiple logistic regression. The outcome measures with the strongest association to general health is belonging to the age group 18-34 years, positive faith in the future, good sleeping pattern and to be employed/ self-employed/retired.

    The outcomes with the strongest association to oral health are good finances, belonging to the age group 18-34years, to be born in Sweden and positive faith in the future.

    Conclusions.This study shows that, in.general, the same protective factors are significant for both self-rated health and self-rated oral health, making it possible to use the same approach to strengthen both general health and oral health. One important outcome, not often considered, is having positive faith in the future. It is a task for the health care system to strengthen people's faith in the future, partly through a very high quality care when needed, but also through active health promotion that increases the chances of a healthy life, both from a public health perspective as from an oral health perspective.

  • 32.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Persson, Carina
    Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden .
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden .
    How much information is remembered by the patients?: a selective study related to health education on a Swedish public health survey2012In: Swedish Dental Journal, ISSN 0347-9994, Vol. 36, no 3, p. 143-148Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the degree to which patients have perceived that they got questions or advice about eating habits and smoking habits at their last visit at the dental clinic and if this information was differently distributed between different age groups. A further aim was to study whether there were differences in the proportions of questions and advice given to individuals who perceived problems regarding caries and gum bleeding compared to those that did not feel they had problems. The results are based on a postal questionnaire survey,"Life and Health 2008". The study was conducted in a population of women and men aged 18-84 years in 5 counties in Sweden. A total of 68,710 questionnaires were sent out and the response rate was 59.2%. Substantial differences in proportions existed between age groups regarding who received questions and advice related to dental caries and periodontal disease. The differences between age groups regarding information were statistically significant since it was less common that older people got questions and advice than younger.These differences also exist, but less pronounced, between those with disease related problems and those without.Three factors were statistically significantly associated with information. Age, education level and problems with caries or bleeding gums had statistical effect on the prevalence of questions and advice related to eating habits or smoking habits respectively. In conclusion, it is an urgent need of education in methods for dental staff if they want to contribute to changes in life style behaviors for their patients since most patients today don't perceive that they got important disease relevant information at the last dental visit.

  • 33.
    Ekbäck, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Unell, Lennart
    Postgraduate Dental Education Centre, Örebro County Council, Örebro, Sweden; School of Health and Medical Sciences , Örebro University, Örebro, Sweden.
    Johansson, Anders
    Department of Clinical Dentistry, Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Carlsson, Gunnar E
    Department of Prosthetic Dentistry, University of Gothenburg, Göteborg, Sweden.
    Changes in dental status and prevalence of symptoms related to temporomandibular disorders in 50- to 70-year-old subjects: longitudinal and cross-sectional results2013In: Journal of craniomandibular function, ISSN 1868-4149, Vol. 5, no 4, p. 317-331Article in journal (Refereed)
    Abstract [en]

    The aim was to assess changes in prevalence of some reported TMD-related symptoms and dental status in 50-year-old subjects who were followed for 20 years. Identical questionnaires were sent to all subjects born in 1942 and living in two Swedish counties every fifth year, from 1992 to 2012. The response rate varied between 71 to 75%, resulting in five cross-sectional samples varying from 5,697 to 6,513 subjects, and a longitudinal sample of 3,585 subjects participating in all examinations. The great majority (80 to 90%) reported no symptoms related to TMD. Prevalence and symptom severity changed only little over time. Less than 3% considered their TMD symptoms to be severe or rather severe. The mean prevalence of TMD-related symptoms and bruxism was greater in women than in men, whereas gender differences in the number of teeth were extremely small. The longitudinal sample had similar prevalence of TMD-related symptoms and reported bruxism, but had more teeth and better chewing ability than the cross-sectional samples. It was concluded that the prevalence of TMD-related symptoms was low but higher in women than in men, whereas there was no gender difference in dental status. The longitudinal sample had more teeth than the cross-sectional samples but there was no difference regarding TMD-related symptoms.

  • 34.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Åstrøm, Anne Nordrehaug
    Institute of Clinical Odontology-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Klock, Kristin
    Institute of Clinical Odontology-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden; Post Graduate Dental Education Center, Örebro County Council, Örebro, Sweden.
    Oral health of 65-year olds in Sweden and Norway: a global question and ICF, the latest conceptual model from WHO2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, no 4, p. 279-288Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aims of this study were to identify explanatory factors of satisfaction with oral health among Norwegian and Swedish 65 year olds in terms of items from four different domains of ICF and to compare the strengths of the various ICF domains in explaining satisfaction with oral health. Further it was to assess whether the explanatory factors of ICF domains vary between Norway and Sweden.

    MATERIALS AND METHODS: In 2007, standardized questionnaires were mailed to all the residents in certain counties of Sweden and Norway who were born in 1942. Response rates were 73.1% (n = 6078) in Sweden and 56.0% (n = 4062) in Norway.

    RESULTS: In total, 33 questions based on four different ICF domains were chosen to explain satisfaction with oral health. Logistic regression showed that four different ICF domains in terms of body function, body structure, activity/participation and environmental factors explained, respectively, 53%, 31%, 12% and 34% of the explanatory variance in the satisfaction with oral health. In the final analysis, only nine items were statistically significant (p < 0.05).

    CONCLUSION: This study indicates that ICF as a conceptual model could cover a broad spectrum of factors embedded in OHRQoL measured by a global question in Sweden and Norway. Nine items, representing four ICF domains, were important in the final model for explaining satisfaction with oral health.

  • 35.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden; Institute of Clinical Odontology-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Åstrøm, Anne Nordrehaug
    Institute of Clinical Odontology-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Klock, Kristin
    Institute of Clinical Odontology-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ordell, Sven
    Dental Commissioning Unit Östergötland County Council, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden; Post Graduate Dental Education Centre, Örebro County Council, Örebro, Sweden.
    Satisfaction with teeth and life-course predictors: a prospective study of a Swedish 1942 birth cohort2010In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 118, no 1, p. 66-74Article in journal (Refereed)
    Abstract [en]

    This study aimed to assess the stability or change in satisfaction with teeth among Swedish adults between the ages of 50 and 65 yr, and to identify the impact of socio-demographics and of clinical and subjective oral health indicators on participants' satisfaction with teeth during that period. Self-administered standardized questionnaires were used as part of a longitudinal study. In 1992, 1997, 2002, and 2007 all residents (born in 1942) of two Swedish counties were invited to participate in the study. A total of 63% women and 66% men reported being satisfied with their teeth between 50 and 65 yr of age. The corresponding figures, with respect to dissatisfaction, were 7% and 6% respectively. Generalized estimated equation models revealed a decline in the odds of being satisfied with advancing age, which was particularly important in subjects with lower education, tooth loss, and smokers. Consolidation in oral health perceptions starts before age 50, suggesting early intervention before that age. Promotion of a healthy adult lifestyle and improved access to quality oral healthcare might increase the likelihood of people being satisfied with their teeth throughout the third age-period in both genders.

  • 36.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden; .
    Åstrøm, Anne Nordrehaug
    Institute of Odontology-Community Dentistry, Faculty of Dentistry, University of Bergen, Norway.
    Klock, Kristin
    Institute of Odontology-Community Dentistry, Faculty of Dentistry, University of Bergen, Norway.
    Ordell, Sven
    Dental Commisssioning Unit Östergötland County Council; Department of Oral Public Health, Malmö University, Malmö, Sweden .
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden; Post Graduate Dental Education Center, Örebro County Council, Örebro, Sweden .
    Self-perceived oral health among 19-year-olds in two Swedish counties2008In: Swedish Dental Journal, ISSN 0347-9994, Vol. 32, no 2, p. 83-93Article in journal (Refereed)
    Abstract [en]

    The primary purpose of the present study, which focused on a census of 19-year-olds (2006) attending dental clinics in two Swedish counties, was to describe the frequency distribution of clinically- and self-perceived oral health indicators in terms of DSa (Decayed Surfaces approximal), four global dimensions of oral health and one'all-embracing' oral health measure, according to county of residence and gender. A second purpose was to examine to what extent the clinical indicator of oral health and the global dimensions of self-perceived oral health contribute to the explainable variance of the global single-item indicator. Finally, the study examined whether or not the association of clinically- and self-perceived oral health indicators with the single global oral health indicator varied as a function of gender and place of residence. The study base was 46.5% (n=3658) of all children attending for dental checks (n=7866). The questionnaire included thirteen questions, divided into four global dimensions. These were Knowledge, Quality of life, Social and Function. There was also one 'all-embracing' oral health question, one question about gender and finally information about clinically-registered disease. The findings of this study were that females reported more serious problems than males in the Social and Quality of life dimensions and there were differences between counties in knowledge about oral diseases. The group with poor self-reported oral health in the 'all-embracing' oral health question had significantly more problems with all global dimensions, especially Quality of life and Social dimensions. Statistically-significant two-way interactions occurred between county and Knowledge and between county and Quality of life. This study supports the idea of one or several questions concerning self-perceived oral health to be used as a complement to the traditional epidemiological clinical registration of oral diseases.

  • 37.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden; Institute of Clinical Dentistry, Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
    Åstrøm, Anne Nordrehaug
    Institute of Clinical Dentistry, Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
    Klock, Kristin
    Institute of Clinical Dentistry, Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
    Ordell, Sven
    Dental Commissioning Unit Östergötland County Council, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Unell, Lennart
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Oral Public Health, Malmö University, Malmö, Sweden; Post-Graduate Dental Education Centre, Örebro County Council, Örebro, Sweden.
    Variation in subjective oral health indicators of 65-year-olds in Norway and Sweden2009In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 67, no 4, p. 222-232Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Guided by the conceptual framework of Gilbert and co-workers, this study assesses satisfaction with oral health as reported by 65-year-olds in Sweden and Norway, the relationship of socio-demographic factors, clinical and subjective oral health indicators with satisfaction of oral health, and the consistency of those relationships across countries.

    MATERIAL AND METHODS: In 2007, standardized questionnaires were mailed to all the residents in two counties in Sweden and three in Norway who were born in 1942. Response rates were 73.1% (n=6078) in Sweden and 56.0% (n=4062) in Norway.

    RESULTS: Totals of 76.8% of the Swedish and 76.5% of the Norwegian participants reported satisfaction with oral health. Corresponding figures for toothache were 48.1% (Sweden) versus 51.5% (Norway), and for temporomandibular joint symptoms, 10.9% (Sweden) versus 15.1% (Norway). Multiple logistic regression analysis revealed that subjects who perceived they had bad health, smoked daily, had missing teeth, experienced toothache, had problems with chewing, bad breath, and oral impacts were less likely than their counterparts in the opposite groups to be satisfied with their oral health status. The corresponding odds ratios (ORs) ranged from 0.08 (problems chewing) to 0.2 (oral impact). No statistically significant two-way interactions occurred and the model explained 46% of the variance in satisfaction with oral health across the two countries (45% in Sweden and 47% in Norway).

    CONCLUSIONS: The oral condition of 65-year-olds in Norway and Sweden produced impacts in oral symptoms, functional limitations, and problems with daily activities that varied to some extent. Satisfaction with oral health varied by socio-demographic factors and subjective oral health indicators. A full understanding of the oral health and treatment needs of 65-year-olds cannot be captured by clinical measures alone.

  • 38.
    Flink, Håkan
    et al.
    Centre for Clinical Research, Västmanland County, Uppsala University, Uppsala, Sweden; Public Dental Clinic, Public Dental Health, Västmanland County, Sala, Sweden.
    Tegelberg, Åke
    Centre for Clinical Research, Västmanland County, Uppsala University, Uppsala, Sweden; Faculty of Odontology, Malmö University, Malmö, Sweden; Postgraduate Dental Education Center, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Arnetz, Judith E
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing MI, USA.
    Birkhed, Dowen
    ODONT-KONSULT Dowen Birkhed, Malmö, Sweden.
    Patient-reported negative experiences related to caries and its treatment among Swedish adult patients.2017In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, no 1, article id 95Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment.

    METHODS: A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients' dental records. Exploratory factor analysis was conducted on items related to patients' perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared.

    RESULTS: The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients.

    CONCLUSIONS: Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.

  • 39.
    Fägerstad, Anida
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dental fear among children and adolecents in a multicultural population- a cross- sectional study:  2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 40.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health Sciences. Public Dental Service, Örebro County Council, Örebro, Sweden.
    Lundgren, Jesper
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Public Dental Service, Örebro County Council, Örebro, Sweden.
    Dental fear among children and adolescents in a multicultural population: a cross-sectional study2015In: Swedish Dental Journal, ISSN 0347-9994, Vol. 39, no 2, p. 109-120Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore dental fear in a multicultural population of child and adolescent dental patients, with background, gender, age, and socioeconomic status taken into account. A specific aim was to investigate whether the level of DF differed between patients with a non- Swedish background and patients with a Swedish background.

    In conjunction with a routine visit to the dental clinic, 301 patients (8-19 years old) assessed their dental fear on the Children's Fear Survey Schedule - Dental Subscale, using self-ratings. Following an interview protocol, patients' and their parents' country of birth, and parents' education and occupation/employment were registered. An interpreter was present when needed.

    Self-rated dental fear was almost equal among patients coming from a non-Swedish background and patients with a Swedish background. Girls scored higher than boys and younger children scored slightly higher compared to older children, but the pattern of dental fear variation was inconsistent. Socioeconomic status differed between the groups with a non- Swedish vs. a Swedish background, but no impact on dental fear was revealed. When children and adolescents with a non-Swedish vs. a Swedish background were modelled separately, female gender and younger age had an impact on dental fear only in the group with a Swedish background.

    No differences in dental fear were found between children and adolescents from non-Swedish vs. Swedish backgrounds. Dental fear variations according to gender and age were more pronounced in the group with a Swedish background compared to the group with a non-Swedish background. No impact of socioeconomic status could be revealed.

  • 41.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health Sciences. Public Dental Service, Dental research Department, Örebro County Council, Örebro, Sweden.
    Lundgren, Jesper
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Windahl, Jenny
    Örebro University, School of Health Sciences.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Public Dental Service, Dental research Department, Örebro, Sweden.
    Dental avoidance among adolescents: a retrospective case–control study based on dental records in the public dental service in a Swedish county2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to investigate the occurrence of missed dental appointments among 16–19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.

    Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009–2012.

    Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.

    Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents’ individual situation and be observant of early signs of avoidance.

  • 42.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Public Dental Service, Region Örebro County, Örebro, Sweden.
    Windahl, Jenny
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Public Dental Service, Region Örebro County, Örebro, Sweden.
    Understanding avoidance and non-attendance among adolescents in dental care: an integrative review2016In: Community Dental Health, ISSN 0265-539X, Vol. 33, no 3, p. 195-207Article in journal (Refereed)
    Abstract [en]

    Objective: To review articles exploring manifestations of avoidance of or non-attendance to dental care, to identify background and concomitant factors specifically associated with dental avoidance among adolescents.

    Methods: PubMed, CINAHL and PsychINFO were searched using MeSH terms and keywords covering dental avoidance, non-attendance and non-utilization. Searches were limited to peer-reviewed studies in English, published in 1994– 2014. Twenty-one research articles were included. Data were extracted, ordered, coded, categorized, and summarized according to the integrative review method.

    Results: The identified factors formed three common major themes: Environmental, Individual and Situational factors. Only seven studies, all from Sweden or Norway, investigated factors associated with dental avoidance. The remaining 14 studies were geographically widespread. Regarding avoidance, the main focus was found to be on individual and situational factors, while environmental factors were more often investigated for the outcome non-attendance.

    Conclusions: Although a wide variety of environmental, individual and situational factors could be summarized in this review, factors specifically associated with dental avoidance in a context of free dental care still need to be investigated. The possible impacts of cultural background, of tobacco, alcohol or drug use and of psycho-social circumstances deserve further research. Clinical implications of today’s knowledge may be to pay attention to the adolescents’ individual background and everyday life situation, to offer agreed and individualized treatment, taking fears and attitudes into consideration, to avoid painful treatments, and to be alert for early signs of avoidance.

  • 43.
    Ghanei, M.
    et al.
    Public Dental Service, Gothenburg, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Service, Örebro, Sweden.
    Robertson, A.
    Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Procedural pain in routine dental care for children: a part of the Swedish BITA study2018In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 19, no 5, p. 365-372Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the frequency and reported intensity levels of dental treatment pain and discomfort in children, in conjunction with regular dental visits.

    METHODS: The study included 2363 children in four different age cohorts. Data was collected from structured interviews by dental personnel regarding pain experiences or discomfort after treatments, including analgesia, extractions, operative treatments and radiographic examinations.

    RESULTS: One-third of all treatment occasions were experienced as painful and/or causing discomfort. Treatment sessions including analgesia were assessed as painful in 49.7% of occasions, with injection being the most common given reason for pain. Extraction was painful in 62.4% of occasions, with injection as the main reason for pain. Operative treatments were assessed as painful in 38.8% of occasions, with drilling as the most common reason for pain and discomfort. Pain was reported in approximately 19% of all radiographic examinations.

    CONCLUSIONS: Injection was the major reason for pain during treatment, including injection and extraction, while drilling was the most common cause of pain during restorative treatment. Dentists should try to minimise the experience of pain and discomfort by using all available measures to perform pain-free and effective dental injections.

  • 44.
    Gulcan, Ferda
    et al.
    Department of Clinical Dentistry-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway .
    Nasir, Elwalid
    Örebro County Council, Örebro, Sweden .
    Ekbäck, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden; Linköping University, Linköping, Sweden.
    Åstrøm, Anne Nordrehaug
    Department of Clinical Dentistry-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway .
    Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden (vol 14, 59, 2014)2015In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 15, article id 58Article in journal (Refereed)
  • 45.
    Gunnarsson, Mikaela
    Örebro University, School of Health Sciences.
    En prospektiv orsaks- och frekvensstudie av akutbesök vid ortodontikliniken i Region Västmanland2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Under tandregleringsbehandling uppstår akuta besvär som kräver extra vårdbesök. De faktorer

    som dominerar orsaken till akutbesöken är inte känd men innebär en belastning för såväl

    patient som för kliniken och dess personal.

    Syftet med studien var att göra en systematiska kartläggning av det akuta omhändertagandet

    av patienter på regionens tandregleringsklinik i Västerås och Köping med avseende på

    frekvens, tidsåtgång samt parametrar associerade till dessa besök.

    Studien gjordes som en hypotesgenererande prospektiv orsaks- och frekvensstudie av

    akutbesök under två månader vid tandregleringskliniken i Västerås och Köping.

    Variabler identifierades och två datainsamlingsformulär framställdes till receptionen

    respektive behandlarstolarna. Receptionspersonal registrerade dagligen alla besök och

    telefonsamtal, både de ordinarie liksom de akuta. Vid varje akutbehandling registrerade

    behandlaren uppgifter om patienten och besöket.

    En fjärdedel av alla inkomna telefonsamtal till kliniken var kopplade till akuta besvär hos

    patienten. Av den totala kliniska tiden åtgick 10% till akuta omhändertaganden. Flickor var

    mer benägna än pojkar att söka akut tandregleringsvård. Av alla akuta besök utgjordes 53%av

    lossad bondad komponent (brackets, tub eller retainer). 59% av alla lossade tuber var bondade

    i underkäken. Av alla lossade brackets var 45% fästa till andra premolaren. Övriga lossade

    brackets var jämnt fördelat över tandbågarna. Misstanke om påbitning på tandställning förelåg

    i 7% av fallen. Lossade brackets och retainers var inte behandlade med primer i 63%

    respektive 68% av fallen.

    I denna hypotesgenererande studie sågs att majoriteten av akutfallen var bondade

    tandställningskomponenter som lossnat. Vidare diskussioner samt planering av arbetsrutiner

    inomtandregleringsvården i Region Västmanland kommer att ske utifrån resultaten i denna

    studie.

  • 46.
    Gustafsson, Annika
    et al.
    Department of Pedodontics, Postgraduate Dental Education Center, Public Dental Service, Örebro, Sweden; Institute of Odontology, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Broberg, Anders
    Department of Psychology, Göteborg University, Göteborg, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Berggren, Ulf
    Unit of Dental Behavioural Sciences, Institute of Odontology, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Arnrup, Kristina
    Department of Pedodontics, Postgraduate Dental Education Center, Public Dental Service, Örebro, Sweden.
    Dental behaviour management problems: the role of child personal characteristics2010In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 20, no 4, p. 242-253Article in journal (Refereed)
    Abstract [en]

    Aim: This study aimed to investigate the role of dental fear (DF) and other personal characteristics in relation to dental behaviour management problems (DBMP).

    Design: A study group of 230 patients (7.5-19 years old; 118 girls), referred because of DBMP, was compared to a reference group of 248 same-aged patients (142 girls) in ordinary dental care. Patients and their parents independently filled in questionnaires including measures of fear and anxiety, behavioural symptoms, temperamental reactivity, and emotion regulation.

    Results: Study group patients referred because of DBMP differed from the reference group in all investigated aspects of personal characteristics. In the multivariate analyses, DF was the only variable with consistent discriminatory capacity through all age and gender subgroups. Aspects of anxiety, temperament, and behavioural symptoms contributed, but differently for different subgroups and at different levels of dental fear.

    Conclusions: Among older children and adolescents, DF deserves to be re-established as the single most important discriminating variable for DBMP at clearly lower scores than commonly used. Further research should focus on the different patterns of DBMP development, considering various personal characteristics that may trigger, maintain, or exacerbate young patients' vulnerability to DF and DBMP.

  • 47.
    Gülcan, Ferda
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Örebro University, School of Medical Sciences. Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Klock, Kristin S.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Lie, Stein Atle
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Åstrøm, Anne Nordrehaug
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Exploring the association of dental care utilization with oral impacts on daily performances (OIDP): a prospective study of ageing people in Norway and Sweden2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 1, p. 21-29Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To explore the association of dental health care utilization with oral impacts on daily performances (OIDP) across time focusing ageing Norwegian and Swedish adults adjusting for predisposing, enabling, and need related-factors as defined by Andersen's model.

    METHODS: Data were based on Norwegian and Swedish 1942 birth-cohorts conducted in 2007 (age 65) and 2012 (age 70). In Norway, the response rates ranged from 54% to 58%. Corresponding figures in Sweden were from 72% to 73%. Self-administered questionnaires assessed OIDP, dental care utilization and predisposing, enabling and need related factors. Logistic regression with robust variance estimation was used to adjust for clustering in repeated data.

    RESULTS: Significant covariates of OIDP were satisfaction with dental services, dental care avoidance due to financial constraints, frightening experience with dental care during childhood and patient initiated dental visiting. Frequency and regularity of dental attendance were associated with OIDP in the Swedish cohort, only.

    CONCLUSIONS: In spite of country differences in the public co-financing of dental care, dental care utilization indicators were associated with OIDP across time in both cohorts. Encouraging regular and dentist initiated visiting patterns and strengthening beliefs in keeping own teeth could be useful in attempts to reduce poor oral health related quality of life in ageing people.

  • 48.
    Gülcan, Ferda
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway .
    Ekbäck, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Lie, Stein Atle
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway .
    Åstrøm, Anne Nordrehaug
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway .
    Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden2015In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 15, article id 20Article in journal (Refereed)
    Abstract [en]

    Background: A life course perspective recognizes influences of socially patterned exposures on oral health across the life span. This study assessed the influence of early and later life social conditions on tooth loss and oral impacts on daily performances (OIDP) of people aged 65 and 70 years. Whether social inequalities in oral health changed after the usual age of retirement was also examined. In accordance with "the latent effect life course model", it was hypothesized that adverse early-life social conditions increase the risk of subsequent tooth loss and impaired OIDP, independent of later-life social conditions.

    Methods: Data were obtained from two cohorts studies conducted in Sweden and Norway. The 2007 and 2012 waves of the surveys were used for the present study. Early-life social conditions were measured in terms of gender, education and country of birth, and later-life social conditions were assessed by working status, marital status and size of social network. Logistic regression and Generalized Estimating Equations (GEE) were used to analyse the data. Inverse probability weighting (IPW) was used to adjust estimates for missing responses and loss to follow-up.

    Results: Early-life social conditions contributed to tooth loss and OIDP in each survey year and both countries independent of later-life social conditions. Lower education correlated positively with tooth loss, but did not influence OIDP. Foreign country of birth correlated positively with oral impacts in Sweden only. Later-life social conditions were the strongest predictors of tooth loss and OIDP across survey years and countries. GEE revealed significant interactions between social network and survey year, and between marital status and survey year on tooth loss.

    Conclusion: The results confirmed the latent effect life course model in that early and later life social conditions had independent effects on tooth loss and OIDP among the elderly in Norway and Sweden. Between age 65 and 70, inequalities tooth loss related to marital status declined, and inequalities related to social network increased.

  • 49.
    Gülcan, Ferda
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dent Commissioning Unit, Östergötland Cty Council, Linköping Univ, Linköping, Sweden.
    Lie, Stein Atle
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Åstrøm, Anne Nordrehaug
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Social predictors of less frequent dental attendance over time among older people: population-averaged and person-specific estimates2016In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 44, no 3, p. 263-273Article in journal (Refereed)
    Abstract [en]

    Objectives: Longitudinal studies considering social disparities in the utilization of dental services are scarce. Repeated measures should be accounted for by the use of appropriate statistical methods. The purpose of this study was first to describe the patterns of less frequent dental attendance (less than once a year) over time from the age of 65-70 in Norwegian and Swedish 1942 cohorts. Second, this study estimated the influence of predisposing, enabling and need-related social predictors using marginal model with robust variance estimators and random intercept model, RIM, to account for the clustered structure of the repeated observations. Third, the study aimed to compare the estimates of associations between social predictors and less frequent dental attendance derived from marginal and random intercept models.

    Methods: In 2007 and 2012, all residents born in 1942 in selected counties of Norway and Sweden were invited to participate in a questionnaire survey. In Norway, the response rate was 58.0% (n = 4211) in 2007 and 54.5% (n = 3733) in 2012 with a follow-up rate of 70%. The corresponding figures in Sweden were 73.1% (n = 6078) and 72.2% (n = 5697), with a follow-up rate of 80%. Marginal and random intercept models were fitted for population-averaged and person-specific estimates. Design effects were calculated by comparing the results from ordinary logistic regression analyses and the marginal model with robust variance estimators. The proportion of the total variation due to differences between persons was reported using the intraclass correlation coefficient (ICC).

    Results: Less frequent dental attendance declined from 14.5% to 12.2% in Norway and from 13.6% to 12.9% in Sweden. According to marginal and random intercept models, time-invariant (gender, country of birth, education) and time-variant social predictors (working status, social network, marital status, smoking and perceived health) contributed to less frequent dental attendance. A likelihood ratio test confirmed that adjustment for clustered observations was appropriate. The ICC was 0.90 in Norway and 0.85 in Sweden.

    Conclusions: The prevalence of less frequent dental attendance was low and dropped by increasing age from 65 to 70 years. Both at population and at person-specific levels, being advantaged on social aspects protects against less frequent dental attendance after 65 years of age in the Norwegian and Swedish cohorts investigated.

  • 50.
    Gülcan, Ferda
    et al.
    Department of Clinical Dentistry-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Nasir, Elwalid
    Department of Clinical Dentistry-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Åstrøm, Anne Nordrehaug
    Department of Clinical Dentistry-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden2014In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 14, article id 59Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.

    METHODS: In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.

    RESULTS: Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p < 0.05). Stratified analysis revealed that the mean OIDP frequency score worsened in participants who became dissatisfied- and improved in participants who became satisfied with oral health. Compared to participants who maintained all teeth, those who lost teeth were more likely to experience improvement and worsening of OIDP across both countries. The two-way interaction between country and tooth loss was not statistically significant.

    CONCLUSIONS: Changes in OIDP at the individual level were more pronounced than the percentage distribution of OIDP at each point in time would suggest. The OIDP frequency score showed promising evaluative properties in terms of acceptable longitudinal validity, responsiveness and reproducibility among older people in Norway and Sweden. This suggests that the OIDP instrument is able to detect change in the oral health status that occurred over the 5 year period investigated. Norwegian elderly were more likely to report worsening in OIDP than their Swedish counterparts. Disease prevention should be at focus when formulating the health policy for older people.

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