Temporomandibular disorders in an adult population in northern Norway: A cross-sectional study.

OBJECTIVES: The aim of the study was to assess the prevalence of symptoms indicative of temporomandibular disorders (TMD) in an adult population in Troms County in Northern Norway, as well as the associations between TMD and socio-demographic factors, dental status, self-reported general, and oral health as well as oral health related quality of life (OHQoL). METHODS: Data were collected from a structured questionnaire and a clinical examination of a random sample of almost 2000 adults, 20-79-year-old, in Troms County in Northern Norway. RESULTS: Women had a higher prevalence of all self-reported and clinical signs of pain and dysfunction in the temporomandibular complex compared to men. For both genders, sounds from the temporomandibular joint (TMJ) upon clinical examination was the most common symptom, followed by pain to palpation of jaw muscles. Headache was the most common of the self-reported symptoms and sounds from the TMJ the second most common. Young women had a higher prevalence of self-reported headache and jaw- and face pain compared to middle-aged and elderly women. TMD-related symptoms of pain were significantly associated with poor self-reported general health and correlated with OHQoL as assessed by the oral health impact profile 14 questionnaire. CONCLUSION: Being women and having moderate to poor self-reported general health were associated with clinical signs and self-reported symptoms of pain in the jaw, face and head region. Self-reported symptoms of TMD correlated more strongly with OHQoL than clinical signs.

Public Dental Service personnel facing a major health care reform in Finland.

OBJECTIVES: A health care reform will replace the health care and social services centred on public provision with a market-oriented system and enhanced competition between public and private sectors. The aim was to ascertain Public Dental Services (PDS) changes personnel anticipated and how dental services in the new "public" undertakings could be made more cost-efficient. MATERIALS AND METHODS: An electronic questionnaire was sent to the Chief Dentists of a random sample of 12 PDS units in southern and northern Finland for distribution to their personnel; 71.0% responded. RESULTS: Most respondents (64.3%) believed that their PDS unit would not change. However, 45.4% foresaw a merger with another unit. More dentists (51.2%) were aware of market- and competition-oriented organisational forms to be introduced in the public sector than dental hygienists (35.0%) and dental assistants (27.3%; p < 0.01). Only 12.4% thought of moving to the private sector. To increase cost-efficiency in the new system, a majority suggested improvement in preventive care (79.8%) and increased use of dental hygienists (75.7%). A smaller proportion suggested longer opening hours (23.1%), higher patient fees (17.9%) or more paying patients (12.4%). DISCUSSION: Public sector employees had little knowledge and understanding of the coming reform and were badly prepared for competition with the private sector.

Psychological symptoms and self-image of patients with complaints attributed to dental restorative materials.

OBJECTIVES: The aim was to study self-image and the level of psychological symptoms in patients with symptoms attributed to their dental restorative materials. MATERIALS AND METHODS: A questionnaire containing questions regarding dental and medical history was answered by 257 participants, one group with local oral symptoms only (LSO), and one group with multi-symptoms (M-S). A reference group was randomly selected from a research database at the Department of Psychology, Umeå University, Sweden. The self-image was assessed using the Structural Analysis of Social Behavior (SASB). Psychological symptoms such as somatization, depression, and anxiety were assessed using the Symptom Check List 90 (SCL-90) and the Global Severity Index (GSI) was used to determine the level of psychological symptoms. RESULTS: SASB showed that the M-S group and the LSO-group scored significantly higher on the "spontaneous" and "positive self-image" than the reference group. In the SCL-90, the M-S group scored significantly higher than the LSO-group and the references on the somatization subscales. On depression, anxiety, and the GSI scale, the M-S group scored significantly higher than the reference group. CONCLUSIONS: The two subgroups scored significantly higher on the SASB Spontaneous and Positive clusters which indicates that these patients have an excessively positive self-image, are very spontaneous and have an overconfidence in themselves compared to the reference group. In the M-S group there was a clear tendency to somatization, depression, and anxiety and they were more psychologically stressed than the reference group. CLINICAL RELEVANCE: Among the patients with illness attributed to their dental materials, the M-S-patients had a significantly higher level of general psychological distress and somatization than the control group which may lead to mental stress.

Periodontitis Prevalence and Severity in Adults: A Cross-Sectional Study in Norwegian Circumpolar Communities.

BACKGROUND: The aim of this study is to describe the prevalence, severity, and extent of periodontitis in the adult population of circumpolar communities in Norway using data from the Tromstannen-Oral Health in Northern Norway study. METHODS: In this cross-sectional survey, data were collected from a randomized population sample (aged 20 to 79 years) in Northern Norway. Periodontal conditions were assessed for 1,911 dentate adults with a full-mouth periodontal examination. Probing depth (PD) and bleeding on probing were measured at six sites per tooth. Radiographic bone loss (BL) was examined using orthopantomograms. RESULTS: According to the Centers for Disease Control and Prevention/American Academy of Periodontology case definitions, 49.5% of participants had periodontitis, and 9.1% had severe periodontitis. Periodontitis prevalence and severity increased with age. Extent of BL and PD ≥4 mm also increased with age, but more rapidly and to a greater extent for BL. Prevalence of periodontitis was higher among men and varied between urban and rural areas. Periodontitis prevalence was positively associated with smoking, lower levels of education, and income. CONCLUSIONS: This study reveals a high burden of periodontitis among adults living in circumpolar communities in Norway. The results showed sociodemographic disparities regarding periodontitis and highlights the importance of further investigation of factors influencing periodontal health.

Methods and background characteristics of the TOHNN study: a population-based study of oral health conditions in northern Norway.

OBJECTIVES: The aim of the Tromstannen-Oral Health in Northern Norway (TOHNN) study was to investigate oral health and dental-related diseases in an adult population. This article provides an overview of the background of the study and a description of the sample characteristics and methods employed in data collection. STUDY DESIGN: Cross-sectional population-based study including a questionnaire and clinical dental examination. METHODS: A randomly selected sample of 2,909 individuals (20-79 years old) drawn from the population register was invited to participate in the study. The data were collected between October 2013 and November 2014 in Troms County in northern Norway. The questionnaire focused on oral health-related behaviours and attitudes, oral health-related quality of life, sense of coherence, dental anxiety and symptoms from the temporomandibular joint. The dental examinations, including radiographs, were conducted by 11 dental teams in 5 dental offices. The examination comprised of registration of dental caries, full mouth periodontal status, temporomandibular disorders, mucosal lesions and height and weight. The participants were grouped by age (20-34, 35-49, 50-64 and 65-79) and ethnicity (Norwegian, Sámi, other European and other world). RESULTS: From the original sample of 2,909 individuals, 1,986 (68.3%) people participated, of whom 1,019 (51.3%) were women. The highest attendance rate was among women 20-34 years old (80.3%) and the lowest in the oldest age group of women (55.4%). There was no difference in response rate between rural and urban areas. There was a positive correlation between population size and household gross income (p < 0.001) and education level (p < 0.001). The majority of Sámi resided in smaller municipalities. In larger cities, most participants used private dental health care services, whereas, in rural areas, most participants used the public dental health care service. CONCLUSION: The TOHNN study has the potential to generate new knowledge on a wide range of oral health conditions beneficial to the population in Troms County. Due to the high participation rate, generalization both nationally and to the circumpolar area ought to be possible.

Reactions to resin-based dental materials in patients--type, time to onset, duration, and consequence of the reaction.

OBJECTIVE: The aim of the present study was to determine the types of side-effects occurring and for how long they lasted in a group of patients with side-effects assessed to be caused by resin-based materials. METHODS: A total of 618 reports were received by the Swedish National Register of Side-Effects to Dental Materials, among which 36 were on patients with reactions assessed to be caused by resin-based restorative materials. The group examined consisted of 25 women and 11 men, with a mean age of 47.8 +/- 15.6 years. A follow-up was done through a structured telephone interview. RESULTS: The majority of symptoms were intra-oral or a combination of intra-oral and extra-oral symptoms that appeared within the first 24 hr after treatment. The most common adverse effects reported were skin problems, oral ulcers, and burning mouth. Within less than a week, the reactions had disappeared in 50% of the patients. CONCLUSION: Immediate reactions to resin-based materials were more prevalent than delayed allergic reactions, and the mechanism of the immediate reactions is probably non-allergic in most cases. There is a need for developing provocation tests to verify the association between the reaction and the material, and also to identify the offending component.

Replacement of restorations in subjects with symptoms associated with dental restorations; a follow-up study.

The aim of this follow-up study was to assess the long-term development of symptoms and their social consequences among patients referred for diagnosis and treatment of symptoms believed to be related to dental-restorative materials. A questionnaire was sent to 614 such patients containing questions on civil status, present health, changes between baseline and follow-up, current employment situation, and consequences of the problems. The results showed that patients with complex symptoms at baseline had a worse prognosis (i.e. more symptoms remaining) at follow-up than patients with local symptoms only. Replacement of dental materials seemed to have the largest impact on the alleviation of the symptoms reported. Those with remaining complex symptoms had more often stopped working or had decreased their work hours because of their symptoms. Only one-sixth of the patients were symptom-free at the follow-up. Our results indicate a relationship between patients with complex symptoms and social consequences in daily life. Therefore, social factors must be taken into consideration when examining the patients. Dental, medical, and social factors have to be considered simultaneously when examining a patient with symptoms that they relate to dental materials, in order to recommend appropriate care-management programs for this group of patients.

Risks with dental materials.

OBJECTIVES: Dental materials are among the most used substitutes for biological tissue in the human body. The possible health effects of amalgam have been studied extensively and have sometimes been replaced with other less well-examined materials. The aim was to study the hazards of other dental materials than amalgam. METHODS: Toxicological information was collected from the Swedish Dental Materials Register 2003 (DentMr). The material safety data sheets (MSDS) included in the DentMR was examined regarding the given composition of the products, the occurrence of CAS-numbers and risk and safety phrases of the substances. Furthermore, complementary information about risk and safety phrases for substances with missing information in the MSDS was collected by using two easily available databases. RESULTS: There were 482 products that included 377 substances of which 219 could be identified. Only 26% of 219 substances had risk and safety phrases. However, via the Swedish Chemicals Inspectorate Classification Register and the Sigma-Aldrich product register, risk and safety phrases could be found for 37 substances. A literature search indicated that some of the listed substances had possible hazards, e.g. substances with embryotoxic and neurotoxic potential. SIGNIFICANCE: The information about hazards with dental materials seems insufficiently described in MSDS and there might be materials with side effects unknown to both patients and dental personnel. There is a need for stronger regulation of dental materials, at least substances that the patients will be exposed to for decades.

Longevity and quality of FPDs: a retrospective study of restorations 30, 20, and 10 years after insertion.

PURPOSE: The aim of this retrospective study was to investigate the longevity and clinical performance of fixed partial dentures (FPD) 30, 20, and 10 years after insertion. MATERIALS AND METHODS: A total of 289 FPDs were inserted in 1966/67, 1976/77, and 1986/87. For patients with FPDs presumably still in function, an evaluation according to the CDA criteria was made. RESULTS: For 64 of the FPDs (22%), no information was available. Seventy-nine patients with 94 FPDs (33%) were clinically examined, and 44 of the FPDs (15%) were reported to be still in function by the patients' current clinicians. The remaining 87 FPDs (30%) were considered lost to follow-up. These FPDs had either been removed for various reasons--in most cases dental caries, lost retention, or fractured abutment teeth--or the patient could not be contacted. Eighty-four percent of the FPDs inserted in 1966/67 were still in function after 20 years, compared to 64% of those inserted in 1976/77. Apart from an increase in wear and discoloration, the oldest FPDs had excellent marginal fit and anatomic shape. CONCLUSION: The survival rate of 30-year-old FPDs was high; 53% remained in function after 30 years. Based on the CDA criteria, 78% of the restorations were rated satisfactory in all subgroups. The FPDs placed in 1966/67 obtained the highest ratings in color, anatomy, and margin integrity.