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  • 1.
    Barzangi, Jir
    et al.
    Örebro University, School of Health Sciences. Public Dental Health Service, Västmanland County Council, Västerås, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Helath Service, Region Örebro County, Örebro, Sweden.
    Unell, Lennart
    School of Helath Sciences, Örebro University, Örebro, Sweden; Dental Research Department, Public Dental Helath Service, Region Örebro County, Örebro, Sweden .
    Skovdahl, Kirsti
    Department of Nursing Science, University College of Southeast Norway, Drammen, Norway.
    Experiences and perceptions of infant dental enucleation among Somali immigrants in Sweden: A phenomenographic studyManuscript (preprint) (Other academic)
  • 2.
    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.

  • 3.
    Barzangi, Jir
    et al.
    Örebro University, School of Health Sciences. Public Dental Health Service, Västmanland County Council, Västerås, Sweden.
    Unell, Lennart
    School of Helath Sciences, Örebro University, Örebro, Sweden; Dental Research Department, Public Dental Helath Service, Region Örebro County, Örebro, Sweden .
    Skovdahl, Kirsti
    Department of Nursing Science, University College of Southeast Norway, Drammen, Norway.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Helath Service, Region Örebro County, Örebro, Sweden.
    Knowledge, experiences and attitudes of dental and health care personnel in Sweden towards infant dental enucleationManuscript (preprint) (Other academic)
  • 4.
    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.

  • 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; 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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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)
  • 10.
    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.

  • 11.
    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.

  • 12.
    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.

  • 13.
    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.

  • 14.
    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.

  • 15.
    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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    Gustafsson, Annika
    et al.
    Postgrad Dent Educ Ctr, Dept Pedodont, Publ Dent Hlth Serv, Örebro, Sweden.
    Broberg, Anders G.
    Dept Psychol, Univ Gothenburg, Gothenburg, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Örebro University Hospital, Örebro, Sweden.
    Berggren, Ulf
    Inst Odontol, Sahlgrenska Acad, Unit Dent Behav Sci, Univ Gothenburg, Gothenburg, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences. Postgrad Dent Educ Ctr, Dept Pedodont, Publ Dent Hlth Serv, Örebro, Sweden.
    Possible predictors of discontinuation of specialized dental treatment among children and adolescents with dental behaviour management problems2010In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 118, no 3, p. 270-277Article in journal (Refereed)
    Abstract [en]

    This study aimed to identify potential predictors of non-attendance among children and adolescents with dental behaviour management problems (DBMP). A group of 179 patients, 7.5-19 yr of age, was grouped into 56 'non-attenders' (discontinued treatment, missed appointments, or >= 20% cancellations) and 123 'attenders'. In addition to data from an introductory interview and dental recordings, baseline data from psychometric measures of fear and other personal and parental characteristics were included in logistic regression analyses and tree-based modelling. The non-attenders had higher scores on impulsivity and sociability and lower socio-economic status (SES) than the attenders, and they lived more often in single-parent families. Logistic regression analyses and tree-based modelling point to SES and parental anxiety as important predictors for non-attendance within this group of children and adolescents. To predict, and possibly to prevent, non-attendance among children and adolescents referred for specialized dental care because of DBMP, we must consider their lives and family situations as well as their personal characteristics and oral health status. Further research should focus on whether the observed associations between non-attendance and factors such as personal characteristics, family and psychosocial factors, and previous dental experiences, also hold for those who remain in regular dental care.

  • 19.
    Jönson Ring, Ingrid
    et al.
    Department of Orthodontics, Public Dental Service, Uppsala, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Nevéus, Tryggve
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Markström, Agneta
    Department of Medical Sciences, Lung, Allergy, and Sleep Research, Uppsala University, Uppsala, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Örebro University Hospital. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Bazargani, Farhan
    Department of Orthodontics, Postgraduate Dental Education Centre, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Nocturnal enuresis impaired children's quality of life and friendships2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 5, p. 806-811Article in journal (Refereed)
    Abstract [en]

    Aim: There have not been any continence-specific measurement tools in Swedish that have allowed clinicians to investigate the quality of life (QoL) in children with bladder dysfunction. This study evaluated the QoL in Swedish children with nocturnal enuresis and tested the reliability of a Swedish translation of the Paediatric Incontinence Questionnaire (PinQ).

    Methods: This prospective study comprised 46 children aged 6-18 years with nocturnal enuresis, who completed the PinQ after it was translated into Swedish. It was completed twice by 33 patients and these responses were included in the test re-test evaluation.

    Results: The self-reported mean sum score for the whole group was 26.3 ± 13.37 (range 5-58) and the most affected domains were social relations with peers and self-esteem. The highest individual scores were four, three or two for 71.7%, 17.4%, and 10.9% of the study population, respectively. Cronbach's alpha was 0.87 for the whole questionnaire, indicating good internal consistency. The test re-test stability was excellent, with an intra-class correlation coefficient of 0.76.

    Conclusion: Children with nocturnal enuresis had impaired self-esteem and their impaired QoL affected their relationships with friends. The Swedish version of the PinQ proved to be a reliable tool that will be used in further studies.

  • 20.
    Lopes, David
    et al.
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Robertson, Agneta
    Department of Pediatric Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Jesper
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden; Research and Development Service Odontology, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden.
    Validating the dental subscale of the children's fear survey schedule using Rasch analysis2013In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 121, no 3, p. 277-282Article in journal (Refereed)
    Abstract [en]

    Rasch analysis was used to examine the validity of the Children's Fear Survey Schedule Dental Subscale (CFSS-DS). Data were collected from parents of children in regular dental care (n=240) and from parents of children referred to a specialized pediatric dental clinic (n=200). The Rasch model is a probabilistic model in which estimations are based on the relationship between person ability and item difficulty, and the present study investigated the validity of the CFSS-DS through analysis of person and item fit, dimensionality, ordering of thresholds, local dependency, and differential item functioning. The results show multidimensionality of the original scale, and an adjusted version consisting of six items with good fit to the model is suggested. The adjusted scale makes interval-level analysis possible, and time efficiency and elimination of previously criticized items argue in favor of the adjusted scale.

  • 21.
    Sjögren, Anders
    et al.
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden; Div Orthodont, Dept Dent Med, Karolinska Inst, Huddinge, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences. Dept Paediat Dent, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Jensen, Charlotta
    Dept Paediat Dent, Västerås, Sweden.
    Knutsson, Ia
    Dept Paediat Dent, Västerås, Sweden.
    Huggare, Jan
    Div Orthodont, Dept Dent Med, Karolinska Inst, Huddinge, Sweden.
    Pain and fear in connection to orthodontic extractions of deciduous canines2010In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 20, no 3, p. 193-200Article in journal (Refereed)
    Abstract [en]

    Background. Interceptive extractions of deciduous canines are, from a patient perspective, poorly investigated. Aims. To describe pain, discomfort, and dental fear in connection to extractions of the deciduous canines, indicated as an orthodontic treatment procedure. Design. Thirty-two Swedish children aged 7-9 years had all four deciduous canines extracted over three occasions. The children rated procedural and postoperative pain on visual analogue scales. Acceptance of injections and extractions was assessed by the treating dentists. Analgesic consumption and recovery time for drinking and eating was reported by parents. Dental fear was assessed using the Children's Fear Survey Schedule questionnaire. Results. Procedural pain showed low median levels, although some individuals reported high values. Boys reported significantly more pain at appointments when two (as opposed to one) canines were extracted. Postoperative pain levels were low and use of analgesics sparse. Dental fear paralleled norm values and did not increase from pre- to post-extraction. Conclusions. Pain management routines during extractions of this kind should be revised. Single tooth extractions seem to be preferable to extractions of two canines at the same appointment. Extraction of four deciduous canines should not cause major postoperative inconvenience; these extractions neither triggered nor increased dental fear.

  • 22.
    Unell, Lennart
    et al.
    Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ström, Dan
    Department of Stomatognathic Physiology, The Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Ekman, Kristina
    Department of Stomatognathic Physiology, The Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Johansson, Anders
    Department of Clinical Dentistry-Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Service, Örebro, Sweden.
    Carlsson, Gunnar E.
    Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    A 3-year study of patients with tinnitus and jaw muscle tenderness2018In: Cranio, ISSN 0886-9634, E-ISSN 2151-0903, p. 1-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study evaluated three-year results of treatment with an interocclusal appliance in 89 tinnitus patients with jaw muscle tenderness.

    METHODS: Subjective tinnitus severity was recorded using a visual analog scale (VAS). The number of tender muscles was registered. The patients were followed annually. After three years, 64 patients were examined (72%).

    RESULTS: Tinnitus severity at baseline was high (mean VAS value 68.3). After one year, the VAS values were substantially lower (mean 37.4; p < 0.001). During the following two years, there were no significant changes in VAS values. The mean number of tender muscles decreased from seven to two after one year and remained at this number for up to three years.

    CONCLUSION: In many tinnitus patients with signs of temporomandibular disorders (TMDs), intraoral splint therapy reduced tinnitus severity and jaw muscle symptoms. The favorable results after one year remained for up to three years without significant changes.

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