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  • 1.
    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.

  • 2.
    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.

  • 3.
    Carlsson, Gunnar E
    et al.
    Department of Prosthetic Dentistry/Dental Materials Science, University of Gothenburg, Göteborg, Sweden.
    Johansson, Anders
    Department of Oral Sciences—Prosthodontics, Faculty of Dentistry, University of Bergen, Norway.
    Johansson, Ann-Katrin
    Department of Oral Sciences—Cariology, Faculty of Dentistry, University of Bergen, Norway.
    Ordell, Sven
    Östergötland County Council, Linköping, Sweden.
    Ekbäck, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro County Council, Örebro, Sweden.
    Unell, Lennart
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Attitudes toward dental appearance in 50- and 60-Year-old subjects living in Sweden2008In: Journal of Esthetic and Restorative Dentistry, ISSN 1496-4155, E-ISSN 1708-8240, Vol. 20, no 1, p. 46-55Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Attitudes toward the importance of general appearance have varied much, not only over time but also among groups of individuals of different age and other characteristics. Whether the situation is similar regarding dental appearance does not seem to have been studied.

    PURPOSE: The aim was to study the differences in attitudes toward dental appearance between two large samples of 50- and 60-year-old subjects.

    MATERIALS AND METHODS: Identical questionnaires were sent to all subjects born in 1942 and 1952 living in two Swedish counties in 2002 (N=17,444; N50=8,881, N60=8,563). The final response rate was 72.2% (N=12,599). In this study, responses to four statements on the importance of dental appearance have been analyzed with respect to gender and age.

    RESULTS: Many of the responses to the four statements differed with gender and age. To the first statement ("To have beautiful and perfect teeth is very important for how you are treated by other people"), 73% agreed at age 60 compared with 64% at age 50 (p < 0.001). Approximately 90% of the subjects agreed with the second statement ("Minor esthetic imperfections of the teeth have no importance, only they function well"). Logistic regression indicated that several variables were significantly associated with the statements. Besides age and gender, education and self-assessed dental problems were most important.

    CONCLUSION: Attitudes toward the importance of dental appearance differed both between genders and age groups in these population samples living in Sweden.

    CLINICAL SIGNIFICANCE: The varying attitudes toward dental appearance in the population must be acknowledged in treatment decisions.

  • 4.
    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.

  • 5.
    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.

  • 6.
    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.

  • 7.
    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.
    Palmetun-Ekbäck, Maria
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    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.

  • 12.
    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.

  • 13.
    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.

  • 14.
    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.

  • 15.
    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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    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)
  • 19.
    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.

  • 20.
    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.

  • 21.
    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.

  • 22.
    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.

  • 23.
    Johansson, Ann-Katrin
    et al.
    Department of Clinical Dentistry – Cariology, Faculty of Medicine and Dentistry, University of Bergen, Bergen.
    Johansson, Anders
    Department of Clinical Dentistry – Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Unell, Lennart
    Örebro County Council, Örebro, Sweden.
    Ekbäck, Gunnar
    Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Östergötland County Council, Linköping; Department of Oral Public Health, Malmö University, Malmö.
    Carlsson, Gunnar E.
    Department of Prosthetic Dentistry, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects2009In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 117, no 1, p. 13-19Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine the changes in prevalence of xerostomia in subjects from 50 to 65 yr of age. Questionnaires were sent to all subjects who were born in 1942 and were living in two Swedish counties in 1992, 1997, 2002, and 2007. The analyses focused on those who answered the questionnaires both in 1992 and in 2007. The response rate was 71.4% (n = 6,346) in 1992 and 73.1% (n = 6,078) in 2007. Of those who answered the questionnaire in 1992, 74.3% (n = 4,714) also responded in 2007. There was an almost linear increase in the prevalence of xerostomia at the four study time-points (i.e. when the subjects were 50, 55, 60, and 65 yr of age). Xerostomia was more prevalent at night than during the day. The pooled prevalence of night-time and daytime xerostomia was 6% at 50 yr of age and 15% at 65 yr of age, and it was higher in women than in men on both occasions. Logistic regression analyses showed that impaired health and smoking were significantly associated with daytime xerostomia but not with night-time xerostomia. Despite the increase in prevalence of xerostomia from 50 to 65 yr of age, there was considerable variation during the observation period. The incidence rate was 13% (507/4,015) and the disappearance rate was 42% (104/250) (dichotomized answers).

  • 24.
    Johansson, Ann-Katrin
    et al.
    Department of Clinical Dentistry – Cariology, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
    Johansson, Anders
    Department of Clinical Dentistry – Prosthodontics, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
    Unell, Lennart
    Örebro County Council, Örebro, Sweden.
    Ekbäck, Gunnar
    Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Östergötland County Council, Linköping, Sweden;.
    Carlsson, Gunnar E
    Department of Prosthetic Dentistry, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Self-reported dry mouth in Swedish population samples aged 50, 65 and 75 years2012In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 29, no 2, p. e107-e115Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Reduced salivary flow may have a negative impact on general well-being, quality of life and oral health.

    OBJECTIVES: To examine xerostomia in 50-, 65- and 75-year-olds, background factors and effect on Oral Impacts on Daily Performances (OIDP).

    METHODS: In 1992, a questionnaire was sent to all 50-year-old persons (n = 8888) in two Swedish counties. In 2007, the same questionnaire was sent to all 65-year-olds (n = 8313) in the two counties and to all 75-year-olds (n = 5195). Response rate was for the 50, 65 and 75 year olds 71.4, 73.1 and 71.9%, respectively.

    RESULTS: Xerostomia was higher in women than in men in all age groups. There was higher prevalence of xerostomia with increasing age in both sexes and it was more frequent at night than during daytime. 'Often mouth dryness' was 2.6-3.4 times more prevalent in those who reported an impact from OIDP. The highest odd ratios were for daytime xerostomia and for the variables burning mouth (17.1), not feeling healthy (4.5), daily smoking (4.4), and medication (4.1).

    CONCLUSIONS: The dramatic increase of xerostomia between age 50 and 75, especially amongst women, needs to be considered in the management of this age group.

  • 25.
    Ståhlnacke, Katri
    et al.
    Örebro University, School of Medical Sciences. Community Dental Office, Örebro County Council, Örebro, Sweden .
    Unell, Lennart
    Community Dental Office, Örebro County Council, Örebro, Sweden .
    Söderfeldt, Björn
    Dept of Oral Public Health, Malmö University, Malmö, Sweden.
    Ekbäck, Gunnar
    Community Dental Office, Örebro County Council, Örebro, Sweden .
    Ordell, Sven
    Östergötlands County Council, Linköping, Sweden .
    Self-perceived oral health among 65 and 75 year olds in two Swedish counties2010In: Swedish Dental Journal, ISSN 0347-9994, Vol. 34, no 2, p. 107-119Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate self-perceived oral health in two elderly populations, age's 65 and 75 years, and its relation to background factors, socioeconomic, individual, and dental health service system factors. Another purpose was to investigate if there were any differences in these respects, between the two age groups, born in 1932 or 1942.

    In two counties in Sweden, Orebro and Ostergötland, all persons born in 1942 have been surveyed by mail every fifth year since 1992. In the year 2007 all persons born in 1932 were also surveyed using the same questionnaire. Those born in 1932 consisted of 3735 persons and those born in 1942 6078 persons. From an outline of a general model of inequalities in oral health data were analyzed with descriptive statistics and contingency tables with chi2 analysis. Multivariable analysis was performed by using multiple regression analysis.

    Factors related to self-perceived oral health were age group, social network, ethnicity, education, general health,tobacco habits, oral hygiene routines, dental visit habits and cost for care.

    The self-perceived oral health was overall rather high, especially in view of the studied ages, although it was worse for those of age 75. Socio-economic factors, dental health service system as well as individual lifestyle factors affected self-perceived oral health. To have a satisfying dental appearance, in the aspect of howyou are judged by other people, was important for these age groups. This presents a challenge for dental health planners especially since the proportion of older age groups are growing.

  • 26.
    Unell, Lennart
    et al.
    Örebro University Hospital. Post Graduate Dental Education Centre, Örebro County Council, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Johansson, A.
    Department of Clinical Dentistry - Prosthodontics, 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. Department of Dentistry.
    Ordell, S.
    Dental Commissioning Unit, Linköping University, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Carlsson, G. E.
    Department of Prosthetic Dentistry/Dental Materials Science, University of Gothenburg, Göteborg, Sweden.
    Dental status and self-assessed chewing ability in 70-and 80-year-old subjects in Sweden2015In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 42, no 9, p. 693-700Article in journal (Refereed)
    Abstract [en]

    The objective was to compare two cohorts of elderly people, 70 and 80 years old, with respect to dental status and self-assessed chewing ability. The hypotheses were as follows: (i) dental status is associated with self-assessed chewing ability; (ii) chewing ability is poorer among the 80-than the 70-year-old subjects. Identical questionnaires were in 2012 sent to all subjects born in 1942 and 1932, living in two Swedish counties. The response rate was 70.1% resulting in samples of 5697 70- and 2922 80-year-old subjects. Answers to questions on self-assessed chewing ability, dental status and some other factors have been analysed. Dental status varied but was in general good; 72% of the 70- and 60% of the 80-year-old subjects reported that they had all or only few missing teeth. Rate of edentulism was 3% and 7%, respectively. Removable partial dentures were reported by 6% and 10%, respectively, implant treatment by 13% in both cohorts. Self-assessed chewing ability was mostly good and correlated with the number of teeth (Spearman rho = 0.46). A majority of the edentulous subjects assessed their chewing ability as very or fairly good. Logistic regression showed that self-assessed chewing ability was significantly associated with a number of dental variables but also with general health. In conclusion, dental status was relatively good at both ages but somewhat poorer in the older cohort. Dental status, some other dental variables and being healthy were in both age groups significantly associated with self-assessed chewing ability.

  • 27.
    Unell, Lennart
    et al.
    Department of Oral Public Health, Malmö University, Malmö, Sweden; Post Graduate Dental Education Centre, Örebro County Council, Örebro, Sweden .
    Johansson, Anders
    Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Department of Oral Public Health, Malmö University, Malmö, Sweden; Dental Commissioning Unit, Östergötland County Council, Sweden.
    Carlsson, Gunnar E
    Department of Prosthetic Dentistry, University of Gothenburg, Gothenburg, Sweden.
    Prevalence of troublesome symptoms related to temporomandibular disorders and awareness of bruxism in 65- and 75-year-old subjects2012In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 29, no 2, p. e772-e779Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the prevalence of three troublesome temporomandibular disorder (TMD) symptoms and awareness of bruxism in two cohorts of subjects aged 65 and 75 years.

    BACKGROUND: Epidemiological studies have demonstrated varying prevalence of TMD symptoms. The results concerning elderly people are inconclusive.

    MATERIAL AND METHODS: In 2007 identical questionnaires were sent to all subjects born in 1942 and 1932 living in two Swedish counties. The response rate was 73.1% for the 65- and 71.9% for the 75-year-old subjects, totally 9093 subjects.

    RESULTS: The great majority reported no or only a few TMD problems. Less than 4% considered their TMD symptoms to be rather great or severe. The mean prevalence of TMD-related symptoms and bruxism was greater in women than in men in both age groups. The 75-year-old women reported a marked lower prevalence of TMD symptoms and bruxism than the 65-year-old women, whereas the age differences were small among the men. Self-reported bruxism was associated with a higher prevalence of TMD symptoms.

    CONCLUSIONS: The great majority of the subjects did not report any troublesome TMD related symptoms. However, 5.4% of the 65-year-old women and 3.8% of the 75-year-old women considered their symptoms severe or rather severe.

  • 28.
    Åstrøm, A. N.
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Gulcan, F.
    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, S.
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Long-term healthy lifestyle patterns and tooth loss studied in a Swedish cohort of middle-aged and older people2015In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 13, no 4, p. 292-300Article in journal (Refereed)
    Abstract [en]

    The promotion of a healthy lifestyle has become an issue of public health importance in the context of ageing populations and increasing prevalence of chronic diseases.

    Objective: (i) To estimate changes in use of fluoridated tooth paste, use of tooth picks, smoking and alcohol consumption and (ii) to examine whether experience with incident or prevalent tooth loss predict healthy lifestyle transitions from age 50 to 70.

    Method: In 1992, 6346 individuals born in 1942 agreed to participate in a prospective cohort study and 3585 completed follow-up questionnaires in 1997, 2002, 2007 and 2012. Statistical analyses were conducted by chi-square statistics, Cochran's Q and logistic regression.

    Results: In total, 15.7% and 74.0% reported incident (tooth loss only in 2012) and prevalent tooth loss (tooth loss in 1992 and 2012). Significant differences occurred between the 1992 and 2012 prevalence of using toothpicks (from 48.3% to 69.1%), smoking (from 26.9% to 10.1%) and alcohol consumption (from 41.5% to 50.5%), 29% and 15.6% increased use of toothpicks and alcohol consumption, whereas 15.5% stopped daily smoking. Increased use of fluoridated tooth paste, smoking cessation and failure to increase use of toothpicks was associated with prevalent tooth loss between age 50 and 70.

    Conclusion: This study revealed positive and negative trends in oral health behaviours over a 20-year period in persons aged 50 at baseline. Mixed support was obtained for the assumption that oral health promoting lifestyle transitions follow experience with tooth loss. Older people with tooth loss experience could benefit from targeted counselling aimed at coping with oral diseases.

  • 29.
    Åstrøm, Anne Nordrehaug
    et al.
    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 County Council, Örebro, Sweden.
    Lie, Stein A
    Department of Clinical Dentistry-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ordell, Sven
    Dental Comissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Life-course social influences on tooth loss and oral attitudes among older people: evidence from a prospective cohort study2015In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 123, no 1, p. 30-38Article in journal (Refereed)
    Abstract [en]

    This study examined the relationship of trajectories in social condition with oral attitudes and major tooth loss, using the social mobility and accumulation life-course models in a cohort. Whether social-condition inequalities remained stable or changed from 65 yr of age to 70 yr of age was investigated. In 1992, 6,346 inhabitants born in 1942 and residing in two Swedish counties agreed to participate in a prospective survey. Of the participants in 1992, 3,585 (47.6% men) completed questionnaires in 1997, 2002, 2007, and 2012. In line with the social-mobility model, the prevalence of negative oral attitudes and major tooth loss in participants at 65 and 70 yr of age showed a consistent gradient according to social-condition trajectory, whereby it was lowest among those who were persistently high and highest among those who were persistently low, with the upwardly and downwardly mobile categories being intermediate. A linear graded association between the number of periods with disadvantaged social condition and oral health supported the accumulation model. Both the social mobility and accumulation life-course models were supported. Social-condition differentials in negative oral attitudes and tooth loss seem to remain stable or to narrow weakly after the usual age of retirement.

  • 30.
    Åstrøm, Anne Nordrehaug
    et al.
    Institute of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Institute of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway; Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Factor structure of a conceptual model of oral health tested among 65-year olds in Norway and Sweden2010In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 38, no 2, p. 110-119Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: No studies have tested oral health-related quality of life models in dentate older adults across different populations.

    OBJECTIVES: To test the factor structure of oral health outcomes within Gilbert's conceptual model among 65-year olds in Sweden and Norway. It was hypothesized that responses to 14 observed indicators could be explained by three correlated factors, symptom status, functional limitations and oral disadvantages, that each observed oral health indicator would associate more strongly with the factor it is supposed to measure than with competing factors and that the proposed 3-factor structure would possess satisfactory cross-national stability with 65-year olds in Norway and Sweden.

    METHODS: In 2007, 6078 Swedish- and 4062 Norwegian adults borne in 1942 completed mailed questionnaires including oral symptoms, functional limitations and the eight item Oral Impacts on Daily Performances inventory.

    RESULTS: Model generation analysis was restricted to the Norwegian study group and the model achieved was tested without modifications in Swedish 65-year olds. A modified 3-factor solution with cross-loadings, improved the fit to the data compared with a 2-factor- and the initially proposed 3-factor model among the Norwegian [comparative fit index (CFI) = 0.97] and Swedish (CFI = 0.98) participants. All factor loadings for the modified 3-factor model were in the expected direction and were statistically significant at CR > 1. Multiple group confirmatory factor analyses, with Norwegian and Swedish data simultaneously revealed acceptable fit for the unconstrained model (CFI = 0.97), whereas unconstrained and constrained models were statistically significant different in nested model comparison.

    CONCLUSIONS: Within construct validity of Gilbert's model was supported with Norwegian and Swedish 65-year olds, indicating that the 14-item questionnaire reflected three constructs; symptom status, functional limitation and oral disadvantage. Measurement invariance was confirmed at the level of factor structure, suggesting that the 3-factor model is comparable to some extent across 65-year olds in Norway and Sweden.

  • 31.
    Åstrøm, Anne Nordrehaug
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Gulcan, Ferda
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Changes in oral health-related quality of life (OHRQoL) related to long-term utilization of dental care among older people2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 8, p. 559-566Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine whether long-term utilization of dental care, treatment with fillings and crowns and persistent tooth loss between age 50 and 65 years associate with subsequent changes in OHRQoL from age 65 to 70 years.

    METHOD: In 1992, a census of 50-year-olds received invitation to participate in a questionnaire survey. Of 6346 respondents, 3585 completed follow-ups in 1997, 2002, 2007 and 2012. OHRQoL was measured using the Oral Impacts on Daily Performances (OIDP) inventory.

    RESULTS: Around 70.4%, 11.2% and 18.4% confirmed respectively, no change, worsening, and improvement in OIDP scores between age 65 and 70 years. Compared to those being permanent non-routine dental attenders, ORs of improving and worsening of OIDP were respectively, 0.4 and 0.6 if being a permanent routine dental attender. ORs for improving OIDP was 1.6 if reporting persistent specialist attendance and 2.5 if having received crowns and fillings. Participants with permanent tooth loss were most likely to both worsen and improve OIDP.

    CONCLUSION: Long-term routine dental attendance and permanent tooth loss occurred as predictors simultaneously for improvement and worsening of OIDP. Accumulation of advantages and disadvantages throughout the life-course increases and decreases the probability of improvement and worsening in OIDP among older people in Sweden.

  • 32.
    Åstrøm, Anne Nordrehaug
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Östergötland, Sweden.
    Nasir, Elwalid
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Long-term routine dental attendance: influence on tooth loss and oral health-related quality of life in Swedish older adults2014In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 42, no 5, p. 460-469Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Few studies have investigated the effect of long-term routine dental attendance on oral health between middle-aged and older adults, using a prospective cohort design. This study aimed to assess routine dental attendance (attending dentist in the previous 12 months for dental checkups) from age 50 to 65 years. Moreover, this study examined whether long-term routine dental attendance contributes to oral health-related quality of life, OHRQoL, and major tooth loss independent of social factors and the type of treatment sector utilized. Whether oral health impacts of long-term routine attendance varied with type of treatment sector utilized was also investigated.

    METHOD: In 1992, a census of the 1942 cohort in two counties of Sweden participated in a longitudinal questionnaire survey conducted at age 50 and again after 5, 10, and 15 years. Information was collected on a wide range of health- and oral health-related aspects. Of the 6346 subjects who completed the 1992 survey, 4143 (65%) completed postal follow-ups in 1997, 2002, and 2007.

    RESULTS: Routine dental attendance decreased from 69.1% at age 50-64.2% at age 65. Adjusted logistic regression analyses revealed that individuals reporting long-term routine attendance (routine attendance in both 1992 and 2007) were 0.3 (95% CI 0.2-0.5) times less likely than their counterparts who were nonroutine attenders to report oral impacts. According to generalized estimating equations (GEE), individuals who reported long-term routine attendance were 0.6 (95% CI 0.4-0.7) times less likely than nonroutine attenders to have major tooth loss across the survey years. The effect of long-term routine attendance on OHRQoL was stronger in public than in private dental healthcare attenders.

    CONCLUSION: Routine attendance decreased from age 50-65 years. Long-term routine attendance had positive impact on major tooth loss and OHRQoL supporting the principle of encouraging annual dental attendance for preventive checkups among older people.

  • 33.
    Åstrøm, Anne Nordrehaug
    et al.
    Institute of Clinical Dentistry-Community Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden.
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Social inequality in oral health-related quality-of-life, OHRQoL, at early older age: evidence from a prospective cohort study2011In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 69, no 6, p. 334-342Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aimed to assess the long-term effect of socio-behavioral characteristics on oral impacts on daily performances (OIDP) at age 65 and the influence on OIDP at age 65 of changes in socio-behavioral characteristics between age 50 and 65.

    METHODS: In 1992, all 50-year-olds in two counties of Sweden were invited to participate in a longitudinal survey. A total of 6346 responded and, of those, 4143 completed follow-ups at ages 55, 60 and 65 years.

    RESULTS: At age 65, 26.9% had oral impacts. Subjects being immigrants, being unmarried, reporting economic barriers, bad general health, bad quality dental care, less than annual dental attendance, limited social network and smoking at age 50 experienced oral impacts at age 65 more frequently than their counterparts in the opposite groups. Compared to the stable advantaged groups, stable disadvantaged groups regarding marital status, health status, smoking and reported quality of care had increased ORs for oral impacts. Compared to the stable advantaged groups, those who experienced deterioration with respect to health status, dental attendance and quality of oral health care and those who quitted smoking had increased ORs for oral impacts.

    CONCLUSIONS: Disadvantaged socio-behavioral condition at age 50 had a long lasting detrimental effect on OHRQoL at age 65. Deterioration in socio-behavioral circumstances was associated with increased oral impacts. Early protection against the effect of socio-behavioral adversity by imposing economic barriers, ensure provision of high quality care and by promotion of healthy lifestyles seems to have the potential to reduce oral impacts at older ages.

  • 34.
    Åstrøm, Anne Nordrehaug
    et al.
    Faculty of Medicine and Dentistry, Institute of Clinical Odontology-Community Dentistry, University of Bergen, Bergen, Norway; Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit Östergötland County Council, Linköping, Sweden.
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Socio-behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort2011In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 39, no 4, p. 300-310Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Using a prospective cohort design, this study assessed loss of natural teeth between ages 50 and 65. Guided by a conceptual framework grouping variables according to the life-course stage at which they would be expected to operate, this study assessed the impacts of socio-behavioral and disease-related factors on tooth loss between ages 50 and 65.

    METHODS: In 1992, all 50-year-olds in two counties of Sweden were invited to participate in a longitudinal questionnaire survey. Of the total population of 8,888 subjects, 6,346 responded (71.4%). Of the 6346 subjects who completed the 1992 questionnaire, 4,143 (65%) completed postal follow-ups at ages 55, 60 and 65.

    RESULTS: For the total sample, the prevalence of having lost at least some teeth increased from 76% at age 50-85.5% at age 65. A total of 14% women and 13% men changed from having all teeth in 1992 to having tooth loss in 2007. Stepwise logistic regression analyses focused on predictors of tooth loss between 1992 and 2007. The following life-stage predictors achieved or approached statistical significance with respect to overall tooth loss; country of birth and education (early life and young adult life stage), marital status, dental care avoidance because of high cost, smoking and reporting consistent pain (middle-age and early-old-age life stage).

    CONCLUSION: Fewer substantial proportions of the 1942 cohort experienced tooth loss between ages 50 and 65. Tooth loss was highly prevalent from age 50 and increased moderately with increasing age. Oral disease-related factors and socio-behavioral characteristics such as refraining from dental care because of financial limitations, acting at earlier and later life-course stages were major risk factors for having tooth loss. Early primary prevention of smoking and increased equitable access to dental care might improve tooth retention throughout the transition from middle age to early-older age.

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