Swedish dental journal最新文献

The study aimed to examine possible time trends in the prevalence of clinical signs indicative of temporomandibular disorder (TMD) in an adult population, to analyse possible associations between TMD signs and associated factors and to estimate the need for TMD treatment. Three independent, stratified and randomly selected samples of around 100 individuals in the age groups of 20, 30, 40, 50, 60 and 70 years participated in the Jönköping studies in 1983,1993 and 2003. The study material consisted of 1,693 subjects who, after answering a questionnaire and being interviewed about the presence of TMD symptoms, were clinically examined in terms of the presence of TMD signs according to the Clinical Dysfunction Index (Di) by Helkimo. Associations between clinical signs and the Di as dependent variables and each of the independent variables of age group, gender, reported bruxism, trauma, self-perceived healthiness and the year of investigation were analysed in binary logistic regression models. Estimates of the need for TMD treatment were based on the presence of a combination of severe symptoms and clinical signs. The prevalence of severely impaired jaw movement capacity, relating to horizontal movements, had increased in 2003. The prevalence of muscle pain and temporomandibular joint pain upon posterior palpation was found to vary statistically significantly between 1993 and 2003. Gender differences were noted in these changes overtime. Female gender, advancing age, awareness of bruxism, self-perceived health impairment and the wearing of complete dentures were associated with TMD signs and a higher degree of clinical dysfunction. The estimated need for TMD treatment increased from 5% in 1983 to 8% in 2003 and was higher in women than in men. In conclusion, the results indicate that the prevalence of some TMD signs and of estimated treatment need increased during the period 1983-2003.

The aim of this study was to investigate changes in knowledge of periodontal disease among patients referred to periodontal specialist clinics. A further aim was to investigate the patients' self- perceived oral health before the treatment. Patients referred to five specialist clinics in periodontology for comprehensive periodontal treatment were consecutive sampled. The study was based on a questionnaire in a before and after design. The first questionnaire was sent to the patients before visiting the specialist clinic and the second was sent after six months. Four questions were analysed, two to measure knowledge about periodontitis and two to measure the patients self- perceived oral health. The first questionnaire was sent by post to 273 patients with a response rate of 31%. The second questionnaire was sent to 85 patients with a response rate of 73%. The results of the study showed a statistically significant improvement of correct answers on the knowledge questions after six months was found for scaling (p = 0.006), X-ray examination (p = 0.001) and increased space between the teeth (p = 0.001). The most frequent self-perceived trouble from the mouth was bleeding gum (70%) and sensitive teeth (51%). In conclusion knowledge of periodontitis improved after visiting the specialist clinic of periodontology. Many of the patients experienced some problems of the mouth.

Aims: To investigate how different default settings for connector design of two different CAD/CAM systems, i.e. to compare how different radii of curvature in the embrasure area of the connector affect the fracture strength and the fracture mode of 3-unit and 4-unit all-ceramic FDPs made from Y-TZP and to investigate how the number of pontics affect the fracture strength of Y-TZP.

Material and methods: 32 all-ceramic three (3Z) and four (4Z)-unit, Y-TZP, FDP cores were made and divided in 4 groups, with 8 FDP in each group. The groups 3Z:1 and 4Z:1 were generated with a mechanical scanner, Procera Forte and the FDPs in group 3Z:2 and 4Z:2 were generated with an optical scanner, NobelProcera Scanner. The connector dimensions were set to 3 mm x 3 mm and core was set to 0.7 mm. The design of radius of the gingival and occlusal embrasures in the connector areas was set according to default settings and the manufacturer's recommendations. All the FDP cores were subjected to heat treatment, thermocycled for 5,000 cycles, preloaded for 10,000 cycles to simulate ageing and finally loaded to fracture.

Results: Regarding connector design a significant difference was found between group 3Z:1 and 3Z:2 (P<0.05), and group 4Z:1 (50% of the FDPs fractured during preloading 30-300N) and 4Z:2 (P<0.05). An extra pontic decreased the fracture strength up to 45%.

Conclusions: The default settings of the two different CAD/CAM systems had a great impact on the fracture strength. It is important that a CAD/CAM system is equipped with possibilities to design a connector that fulfils the clinical demands of mechanical function and longevity. The most crucial factor for the load-bearing capacity isthe design of the radius of the gingival embrasures. Increasing the number of pontics from three to four decreases the load-bearing capacity nearly twice.

The aim of the study was to reduce everyday and dental treatment pain items included in the extended Children's Pain Inventory (CPI), used in a prior study on Swedish children and adolescents. Another aim was to, by means of exploratory factor analysis (EFA), expose hitherto undiscovered dimensions of the CPI pain variables and thus to improve the psychometric properties of CPI. As some pain items are relevant merely to some individuals, a new and more useful questionnaire construction would enhance the internal validity of the instrument in observational surveys. EFA was applied on the extended CPI instrument. 368 children, 8-19 years old, had answered a questionnaire comprising 10 dental and 28 everyday pain variables. These pain items were analysed using a series of sequentially implemented EFA. Interpretations and decisions on the final number of the extracted factors was based on accepted principles; Kaiser's Eigenvalue >1 criterion, inspection of the scree plot and the interpretability of the items loading. The factors were orthogonally rotated using the Varimax method to maximize the amount of variance. Of all tested EFA models in the analysis, a two, three, four, and five factor model surfaced. The interpretability of the factors and their items loading were stepwise examined; the items were modulated and the factors re-evaluated. A four factor pain model emerged as the most interpretable, explaining 79% of the total variance depicting Eigenvalues > 1.014. The factors were named indicating the profile of the content: Factor I cutting trauma to skin/mucosal pain, Factor II head/neck pain, Factor III tenderness/blunt trauma pain, Factor IV oral/dental treatment pain.

Unlabelled: The objective was to investigate diagnostic performance on approximal caries detection among Swedish and Chinese dental students using analogue and digital radiographs in vitro. Additionally, to compare the diagnostic accuracy of two image modalities for approximal caries detection. 46 extracted premolars and molars were mounted in blocks and exposed with two intra-oral systems, one CCD based digital radiographs and one with conventional films. 10 Swedish and 10 Chinese senior dental students diagnosed the approximal sites of the teeth exposed with the digital and analogue images. A 5 point diagnosis confidence scale was applied for caries registration for all the observers. Subsequently, the teeth were sectioned and histo-pathologically analyzed in order to obtain a gold standard. The data were analyzed in terms of receiver operating characteristic (ROC) curves for evaluation of diagnostic accuracy of the two radiographic methods and for the two groups of students for enamel and dentinal caries detection, respectively. The area under the ROC curve was significantly higher for dentinal caries detection compared with enamel caries detection for both Chinese and Swedish students and for both imaging modalities (p<0.001). The present results indicated that the students' ability for enamel caries detection on approximal surfaces was poor. Neither between the two student groups (p=0.15-0.64) nor between the two image modalities (p=0.34-0.91) a statistically significant difference in detecting approximal caries was found.

Conclusions: The two different intra-oral x-ray systems were equally accurate. Chinese and Swedish students showed similar outcomes in their performance for approximal caries detection.

The aim of this study was to generate new knowledge of considerations and factors having impacted the patients' choice of payment system and their views on oral health. Moreover, their later attitudes to the prepaid risk-related payment system, having been enrolled or not, were explored. A qualitative design was chosen and data was collected through semi-structured interviews.Twenty patients in the Public Dental Service (PDS) in western Sweden were strategically sampled with reference to gender, age (older/younger adults), residence (rural/urban), and choice of payment system:fee-for-service or capitation plan.The interview guide covered areas concerning the payment systems, patient considerations before choosing system, views of their own oral health and experiences of received dental care within the chosen system.The analysis was performed according to basic principles of qualitative content analysis. The results revealed two themes expressing the latent content. In the theme "The individual's relation to the PDS", expectations of the care, feelings of safety and aspects of responsibility emerged.The theme"Health-related attitudes and perceptions" revealed that views on health and self-assessment of oral health influenced the patients' considerations. Moreover, the perceived influence on oral health and risk thinking emerged as important factors in this theme. The conclusion was that the individual's relation to the PDS together with his/her health-related attitudes and perceptions were the main factors impacting the choice of payment system in the PDS. A health promotion perspective should be applied, empowering the patients to develop their risk awareness and their own resources.

Dental literature, as well as dental laboratories, has described problems with ceramic veneering of titanium, while clinical and in vitro studies have reported good results. The objective of this study was to investigate the effect of firing temperature, thermo cycling, and veneering methods on bond strength between porcelain and titanium. Eighty titanium specimens were prepared with one of two methods: a bonding agent firing or an oxidation firing. During veneering, half of the specimens in each group were fired at 30 degrees C above and half at the manufacturer's recommended temperature. In the bonding agent group and in the oxidation group, half of each firing group was thermocycled. Bond strength was calculated in a three-point bending test. Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) analyses of the titanium and the porcelain fracture surfaces of one specimen from each subgroup was used in order to study the composition of the interface between titanium and porcelain surfaces after fracture. No significant difference in bond strength was found when firing at a higher temperature compared with firing at the recommended temperature. An oxidation firing before veneering yielded significantly higher bond strength in a three-point bending test than when firing with a bonding agent. SEM and EDS analyses indicated a higher frequency of titanium oxide fractures in the oxidation than in the bonding agent group.The main finding is that firing at 30 degrees C above the recommended temperature does not significantly affect bond strength between titanium and porcelain. SEM and EDS analysis indicate that fractures occur in the titanium oxide layer by oxidation firing and in the interface between titanium oxide layer and veneering material by bonding agent firing.This finding might indicate that three- point bending test is not a relevant method for determining bond strength in this case, since the firing methods might influence the ductility of the samples.

This study comprises a survey of Swedish dentists'treatment preferences in cases of carious exposure of the dental pulp in adults.The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines.Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included.The final study sample comprised 412 participants.The dentists were presented with two case scenarios. In Case 1 a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14.The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.

Unlabelled: The purpose of the study was to assess (i) the degree of overeruption of molars lacking opposed teeth and (ii) the inclination of molars with a mesial edentulous space and alsoto study (iii) changes during a 12 year period. The subject sample originated from the prospective population study of women in Gothenburg, Sweden where scanned panoramic radiographs taken with an interval of 12 years were analysed. Tipping as well as overeruption were scored on the two images according to a five-level scale. Sixty-seven subjects fulfilled the inclusion criteria at baseline and were referred to as "the non-extraction group". Further 35 subjects had lost the opposed and/or the adjacent tooth/teeth during the 12-year follow-up period: "the extraction-group". These groups were studied separately and a comparison between these groups was performed. The prevalence of molars tipped more than 15 degrees at baseline was 17.1% in the upper jaw and 44.3 % in the lower jaw, in the non-extraction group. At baseline overeruption was seen in 25 % of the unopposed upper molars and none of lower molars in the non-extraction group. The prevalence of tipping and overeruption was statistical significant less in the extraction group (P<0.01), than in the non-extraction group at baseline, but at follow-up no statistical significant group differences existed.

In conclusion: The prevalence of tipped molars facing a mesial edentulous space and overerupted unopposed molars increased in adults during the 12-year period but the changes were small. Overeruption and tipping is most pronounced immediately after extractions.

Unlabelled: The aim of this retrospective study was to assess the frequency of postoperative bleeding in patients on warfarin after tooth removal followed by a complete soft tissue closure of the surgical site. A total of 124 consecutive patients, 69 males and 55 females with a mean age of 71 years (range 28-95 years) were included in this study. Inclusion criteria were patients on warfarin with an INR

Conclusion: According to the protocol of this study (local hemostatic, primary closure, sutures and tranexamic acid) the risk of postoperative bleeding after tooth removal in patients on continued warfarin medication is low.