Knowledge, experiences and attitudes of dental and health care personnel in Sweden towards infant dental enucleation.

PURPOSE: To examine self-rated knowledge of clinical experiences and attitudes towards the practice of infant dental enucleation among dental and health care personnel in Sweden. METHODS: A questionnaire survey was performed among 776 licensed dental and health care personnel working in emergency departments, midwifery, child health centres, school health services and public dental health services in 10 Swedish cities. The response rate was 56.2% (n = 436). RESULTS: Fewer than a fifth of the respondents reported self-rated knowledge of the practice. Approximately 13% of personnel encountering children professionally believed they had seen subjected patients in their clinical practice. Personnel with self-rated knowledge and clinical experience worked mostly in dental care. Additionally, the personnel had diverging attitudes regarding agreement and disagreement concerning professional responsibility for patients subjected to or at risk of infant dental enucleation. CONCLUSIONS: The study indicated there is need for increased knowledge about the practice and for clarification of obligatory responsibilities among dental and health care personnel regarding management and prevention of cases of infant dental enucleation.

Dental status and self-assessed chewing ability in 70- and 80-year-old subjects in Sweden.

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.

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 Sweden.

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.

Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects.

The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio-economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50- and 60-year-old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50- and 60-year-old subjects in two Swedish counties, Orebro and Ostergötland (n = 17,138; n50 = 8878; n60 = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72.8% (n = 12,468). The reported responses to questions regarding 'pain in the TMJ region' and 'difficulty to open the mouth wide' were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue-collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio-economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.

Explanatory models for clinical and subjective indicators of periodontal disease in an adult population.

BACKGROUND: The aim of this study was to analyze indicators of periodontal disease using: (1) community periodontal index of treatment needs (CPITN), (2) subjectively reported change of front teeth position, and 3) subjectively reported gingival bleeding. METHOD: These 3 indicators were used in models with explanatory variables from 4 domains: (A) socio-economic attributes, (B) general health and health-related lifestyle, (C) dental attitudes and behaviors, and (D) dental status expressed as (number of teeth and DFT) for the clinically-determined dependent variables. In 1992, the study was carried out cross-sectionally in all 50-year olds in 2 Swedish counties using a questionnaire (n=6343) and clinical investigation of a 20 % sub-sample (n= 1040). RESULTS: Multiple and logistic regression analysis showed that explanatory patterns varied for the clinical and subjective indicators. Use of tobacco had strong effects in all models as did high care utilization. There were few associations with socio-economic attributes. The 2 subjective indicators "changed front position" and "gingival bleeding" associated with attitudes, behaviors and subjective health. Number of teeth and DFT covaried with clinical indicators. CONCLUSIONS: The main conclusions from this study are: (1) that it is possible to find multivariate models with acceptable goodness of fit for prediction of occurrence of periodontal indicators, and (2) that the lack of relation between social attributes and the disease gives arguments for a biological provenance of periodontitis.

Explanatory models for clinically determined and symptom-reported caries indicators in an adult population.

The aim of the present study was to analyze possible indicators of: (i) relative number of decayed and filled teeth, (ii) relative number of decayed teeth, (iii) subjectively reported toothache, and (iv) sensitive teeth, and to find explanatory models for these phenomena. Independent variables from three domains were used: (i) socio-economic factors, (ii) general health and health-related lifestyle, and (iii) dental attitudes and behaviors. The study basis was validated questionnaires from all 50-year-olds in 2 Swedish counties (n = 8888), response rate 71% (n = 6343). For a 20% subsample (58% participation) the DFT and DT were determined by calibrated dentists. Analyses were done with logistic and multiple regression. The variables born outside Sweden, gender, education, shift work, satisfaction with dental care, fear and care utilization were associated with DFT/number of teeth. For DT/number of teeth, the direction of association was reversed for the variables born outside Sweden and gender. Social class, education, general health, and use of tobacco were further covariates. Good oral hygiene gave a lower ratio of DT. For the logistic regression model of toothache, residence in cities and satisfaction with dental care had lower probability for toothache reports, while born outside Sweden, mouth dryness, use of pharmaceuticals, tobacco, fear, and high utilization increased this probability. In general, the association pattern was as could be expected: immigrants, working class, low education, smoking, dissatisfaction with dental treatment and low utilization all appeared as risk factors for both the clinically determined caries indicators, but not necessarily for subjective symptom reports. Only fear of dental treatment showed a consistent positive association with all the indicators.

Proximal caries prevalence in 19-year-olds living in Sweden. A radiographic study in four counties.

A random sample of all 19-year-olds in four counties in the middle of Sweden in 1994 constituted the group studied. The material consisted of posterior bitewing radiographs from 511 19-year-old patients. The purpose was to study the prevalence and distribution of initial and manifest caries. It was found that on the manifest caries level 56% of the subjects were 'free from caries', in good correspondence with the official epidemiological data from the Swedish National Board of Health and Welfare, but only 27% when initial caries was added. Initial caries lesions constituted 90% of all lesions. The distribution of caries was highly skewed on the manifest caries level whereas initial caries had a broader distribution. Thus, on the surface level 75% of the individuals had 16% of all manifest caries and restorations, and 33% of all initial caries. A high correlation was found between initial and manifest caries, besides increasing with the number of initial lesions. Thus, only 2.5% of individuals without initial caries had manifest caries, compared to 54% of individuals with more than eight affected surfaces. A correlation was also found between the prevalence of manifest caries and restoration. The prevalence of initial caries and its obvious significance for further caries development should be a reason for finding new strategies in caries prevention on a population basis.

Attitudes to and experience of dental care among 50-year-olds in two Swedish counties.

The aim of this study was to investigate attitudes to and experiences of dental care in a population, born 1942. The following items were studied: opinions of general and oral health, attitudes to and experiences of dental care, dental care habits, experiences of latest visit to a dentist, tobacco habits and use of various dental hygiene articles. A cross-sectional mail questionnaire was sent in 1992 to all 50-year-olds in two Swedish counties, Orebro and Ostergotland, totally 8888 persons; the response rate was 71%. Of the population 89%, indicated good health. Satisfaction with dental care was high, 94%. 26% stated attendance to a dentist twice or more per year, and 64% at least once a year. As to expenses, 78% paid less than 1000 SEK the last year. Concerning the latest visit, 38% reported painless treatment, 37% no inconvenience, and 55% good care. The duration of the latest visit included on an average 27 min in travel time, 7 min in waiting time and 27 min in treatment time. Information about oral hygiene was given to 29% and about cost for treatment to 47% of the interviewed. There were 28% daily smokers. Snuff was daily used by 10% of the males. Toothbrushing twice a day with fluoride toothpaste seemed to be the standard oral hygiene procedure and was reported by 80% of the respondents.

On oral disease, illness and impairment among 50-year-olds in two Swedish counties.

There were three general aims of the thesis. To investigate 1) the fulfillment of the judiciary Swedish goal of good dental care on equal conditions in an adult population born 1942 in two Swedish counties in 1992. Both selfrated oral health and clinical observations indicated good oral health in the study population. Full social equality of dental care was not attained, but the social gradient was modest. 2) To find models for risk prediction on population level for oral health, expressed as number of remaining teeth, as caries and as periodontitis. Relatively efficient such models were constructed, with the lowest efficiency for periodontitis indicators. Oral health and disease were found to be qualitatively different. Still, use of tobacco was a consistent risk factor for both poor health and presence of disease. 3) To investigate if questionnaires can be used to monitor oral health, disease and illness. It was found that this is the case on population level, but also that questionnaire surveys cannot wholly replace clinical studies, especially regarding periodontal disease. For number of remaining teeth and frequency of removable dentures, the questionnaire methodology is appropriate for monitoring in this type of population, which has been utilized by setting the present study as a baseline for ongoing longitudinal studies relying on survey methodology.

Explanatory models for oral health expressed as number of remaining teeth in an adult population.

OBJECTIVE: To develop explanatory models for oral health expressed as the number of remaining teeth. METHOD: Socio-economic attributes, health factors, dental attitudes and behaviours were used as explanatory variables in a logistic regression. Cross-sectional validated questionnaire data from all 50-year-old residents in two Swedish counties were collected from 8,888 persons, a response rate of 71.4% (n = 6,343). Adjusted number of teeth and three dichotomies of edentulousness and remaining teeth in various combinations were used as the dependent variables. RESULTS: Social class was unrelated to edentulousness, while individual and health factors were covariants. Individuals with < or = 8 teeth had a social class and education gradient, while those with > or = 25 teeth had class and education gradients as well as a relation to dental care utilisation. There were only three variables showing a consistent and stable relation to the various dependent variables, these were use of tobacco, having only junior high school education and satisfaction with dental care. The multiple and logistic regression models revealed different results. CONCLUSIONS: The main conclusions from this study were, first, that there were different mechanisms for different states of the dentition, interpreted as signs of disease and signs of health, corresponding to the ideas of patho- and salutogenesis, and secondly, that number of teeth present is not usable as a continuous variable, since it does not reflect the same mechanisms across the whole scale.

Oral disease, impairment, and illness: congruence between clinical and questionnaire findings.

In 1992 a questionnaire was sent to 50-year-olds in two Swedish counties. These self-report data were compared with clinical observations with regard to number of teeth, removable dentures, caries, and periodontitis. Complete information from both data sources was obtained for 1041 persons. The relevant questionnaire item explained 71% of the missing tooth variance. An agreement of 0.91 (Cohen's kappa) was obtained for removable dentures. A question about problems in opening the mouth differentiated clearly with regard to measured mouth opening ability. Toothache and tooth sensitivity were reported with 95% probability when having 22 decayed teeth and with 46% when there were no decayed teeth (58% correctly predicted). Two teeth with pockets > or = 6 mm gave 5% probability and 22 such teeth gave 39% probability of reporting migration of front teeth. The main conclusion from this study is that there is good correspondence between subjective self-reports and clinical findings, especially for those conditions that are relatively easy for the patient to observe, such as the number of teeth and the presence of dentures. Thus questionnaire data can be used for information and screening about some well-defined oral conditions.

Equality in satisfaction, perceived need, and utilization of dental care in a 50-year old Swedish population.

Satisfaction with dental care, perceived need for dental care, and dental care utilization were analyzed as to equality in geographical, socio-economic, and gender distributions. The study base was a cross-sectional mail questionnaire sent in 1992 to all 50-year old persons (totally 8890) in Orebro and Ostergötland counties in Sweden. Measures of the variables were all based on self-assessments. The response rate was 71.3%. The results showed no large inequalities as to satisfaction, except the aspect travel time for rural residents. They also had higher perceived need for dental care. For utilization of dental care, workers were relatively fewer among "high" consumers. Controlling for socio-economic group, there were twice as many men than women among "low" consumers. In conclusion, there was relative equality in the dental care delivery in this 50-year old Swedish population, with some remaining social differences, primarily socio-economically contingent.

A longitudinal study of dental health in a group of Swedish teenagers/young adults from the age of 14 to 25.

87 participants were followed from the ages of 14 to 25. Data concerning dental caries, gingival status, pocket depth, subgingival calculus, loss of attachment, and regularity of dental care were recorded. During the 11-yr-study-period 16% of the participants did not develop any carious lesions at all, and the average increase in DMFS-value was 0.6 per year. At age 25, about 75% of the subjects had never experienced any manifest carious lesions in incisors or cuspids or on any buccal and lingual surfaces, and 30% had never needed any proximal restorations. Over the study period, gingival inflammation changed from being merely a result of poor oral hygiene to being an indication of initial periodontal disease, and at age 25, 11% showed evidence of loss of marginal bone. The Dental Health was better in females than in males. In general, this sex differences increased in age, and at the age of 19 it had become clinically significant. The good habit of regular dental care reinforced during these 19 years of life was continued by 91% at 25, and no difference could be seen between the care rendered by the Public Dental Health Care system and by Private General Practitioners.

Marginal bone loss in the primary dentition of patients with juvenile periodontitis.

118 patients with juvenile periodontitis (JP), diagnosed when the patients were 13-19 years old, were studied retrospectively with respect to radiographic marginal bone loss in the primary dentition, experienced when the patients were 5-12 years old. 168 other 13-19 year old patients without any signs of bone loss in the permanent teeth were used as a reference group. The JP patients were classified into 2 groups according to the number of sites with bone loss in the permanent dentition: JP group I having 1 site with bone loss (n = 45) and JP group II having > or = 2 sites with bone loss (n = 73). It was found that 35 patients (52%) of JP group II displayed 1 or more sites with bone loss in the primary dentition during the age of 5-12 years. The corresponding numbers for JP group I and the reference group were 9 (20%) and 8 (5%) respectively. These findings indicate that juvenile periodontitis, at least in some individuals, may have its onset already in the primary dentition.

Periodontitis in the primary dentition associated with Actinobacillus actinomycetemcomitans infection and leukocyte dysfunction. A 3 1/2 year follow-up.

2 siblings, aged 5 years (girl) and 7 years (boy), with periodontitis in the primary dentition were studied. Actinobacillus actinomycetemcomitans was isolated from the gingival pockets of both children. The titers of IgG antibodies against A. actinomycetemcomitans were elevated, and the polymorphonuclear leukocytes had a decreased capacity to ingest IgG-coated latex particles. Other functions of the polymorphonuclear leukocytes were normal. After antibiotic therapy and for the 7-year-old boy, debridement of the gingival pockets A. actinomycetemcomitans was no longer detectable in the gingival pockets, and the phagocytic capacity of the polymorphonuclear leukocytes was normalized. After 2 1/2 years, A. actinomycetemcomitans was found again in the gingival pockets of the boy, and once more his polymorphonuclear leukocytes had a decreased capacity to ingest IgG-coated latex particles. The antibiotic therapy was repeated and 6 months later, the number of A. actinomycetemcomitans was very low and the phagocytic capacity of the polymorphonuclear leukocytes was back to normal. This case report suggests that A. actinomycetemcomitans may be involved in the etiology of periodontitis in the primary dentition, possibly by triggering a phagocytic dysfunction of polymorphonuclear leukocytes.

A retrospective radiographic study of alveolar bone loss in the primary dentition in patients with localized juvenile periodontitis.

Lately, it has been questioned whether localized juvenile periodontitis (LJP) is restricted to the permanent dentition, or if it sometimes might have a prepubertal onset, involving the primary dentition. To clarify this question, 17 patients with LJP, together with 17 non-LJP matched controls, were retrospectively examined for radiographic signs of alveolar bone destruction in their primary dentitions. All LJP subjects but one showed localized marginal bone loss, whereas no bone loss was observed among the controls. The results suggest that at least some cases of LJP start in the primary dentition prior to the involvement of the permanent teeth.

Salivary lactobacillus counts as a diagnostic and didactic tool in caries prevention.

The usefulness of salivary lactobacillus counts in regular dental care was investigated in 236 13 1/2-yr-old Swedish children for 2 1/2 yr. The average individual preventive care was at least as extensive as the restorative care and the dental health of these children must be considered good with a mean DFS-value of 6.8 at baseline. Nevertheless, it proved possible to reduce caries increment by more than 50%, simply by replacing one NaF-rinsing in school once every 6 months by a saliva sampling session together with subsequent presentation and information of an inoculated and incubated Dentocult dip-slide. The way of determining salivary lactobacillus counts in schoolchildren, as performed in this study, could easily be adopted as a routine part of general care. It proved to be useful for early diagnosis of caries and motivation to home care, and as a supplement to clinical examination it would be a valuable aid in the early selection of high-risk cases as well as identification of low-risk cases, who do not require extensive prevention.

A longitudinal study of dental health and treatment need in Swedish teenagers.

Ninety-seven teenagers were followed from the age of 14 1/2 to 19 yr. During that time they were given regular dental care by the Public Dental Service. Data concerning dental caries, gingival status, probing pocket depths, subgingival calculus, defective fillings, loss of attachment and additional preventive care were recorded. The prevalence and increment of caries were low and at 19 one-third of the subjects had still needed no proximal restorative care at all. However, in 26% of the 19-yr-olds subgingival calculus was diagnosed radiographically and during the study period gingival inflammation changed from being merely a result of poor oral hygiene to an indication of initial periodontal disease. There was a sex difference in dental health, which increased with age and was of clinical importance at 19. In spite of a good caries situation, most of the subjects were in need of individual care due to an initial periodontal problem. Furthermore, the change to a treatment strategy based on prevention requires regular check-ups, and an extension of intervals between dental examinations could not be justified in this study, especially as it seemed to be difficult for the regular dentist to predict future disease on a clinical basis.

Denture stomatitis in nursing home patients.

All 352 patients in two nursing-homes in Orebro were examined. In one of the homes microbiological tests could be done on the patients with full upper dentures. The samples were taken both from the denture and the oral mucosa. Candida albicans, Yeast, Staph. aureus, B-hemolytic streptococci and Klebsiella/Enterobacter were controlled. In samples from the oral mucosa a correlation was found between stomatitis, Candida albicans and Staph. aureus (P less than 0.01). A weak correlation was also found between stomatitis and Klebsiella/Enterobacter (0.01 less than P less than 0.05). In samples from the dentures there were only a weaker correlation between Stomatitis, Candida albicans and Staph. aureus (0.1 less than P less than 0.05).

Nursing - home patients in Orebro. Oral status and aspects of dental care.

An epidemiological study of oral status in two nursing-homes in Orebro was performed. Totally 352 patients were examined. In one of the nursing-home stomatitis occurred more frequent among younger than older denture wearers greater than 75 years old (P less than 0.05). In the other home there was a correlation between denture hygiene and stomatitis (P less than 0,01). The estimated need of treatment from different types of dental personal was calculated for one of the homes. 17.6% of the patients needed treatment by a dentist. For the other patients the dentist was only necessary for planning and leading treatment performed by other nursing personal.