Swedish dental journal. Supplement最新文献

The aim of the thesis was to study orthodontic tooth movement in relation to edentulous areas and infrabony pockets as well as the physiological movement of teeth facing an edentulous area. A dog model was used in Studies I and II. Teeth were orthodontically moved into and out from inflamed, infrabony periodontal pockets (Study I) and into areas of reduced bone height (Study II). Clinical, radiographic and histometric analyses were made with respect to changes in tooth-supporting tissues. Study III involved clinical, radiographic and 3D model assessments of changes in periodontal conditions and alveolar ridge dimensions in adult patients subjected to tooth movement into areas with reduced ridge dimensions. In Study IV, panoramic radiographs of 292 subjects, taken at an interval of 12 years, were analyzed with regard to changes in the elongation of unopposed molars and tipping of molars facing a mesial edentulous space. In the animal study orthodontic bodily movement of teeth with inflamed, infrabony pockets caused an enhanced rate of progression of the periodontal lesion (Study 1), particularly when the tooth movement was directed towards the infrabony defect. Teeth with healthy periodontium that were orthodontically moved into areas of markedly reduced bone height maintained their periodontal tissue support (Study II). Corresponding orthodontic tooth movement in humans (Study III) resulted in minor dimensional alterations of the periodontal tissues and an increased bucco-lingual width of the alveolar ridge in the area into which the tooth had been moved, whereas a decreased width of the newly established edentulous area was noted. All teeth that were moved showed lateral root resorption at the level of the bone crest on the pressure side, but signs of repair were noticed 1-year post-treatment. In the 12-year radiographic study (Study IV) unopposed molars showed a significant increase in elongation over the 12 years of follow-up. The degree of elongation increased with decreased bone support. Neither edentulous space nor alveolar bone level were found to have a significant effect on tipping. In the presence of both conditions, unopposed molars and molars facing a mesial edentulous space, an increase in elongation was associated with tipping.

Unlabelled: The minor salivary glands are of great importance for maintenance of homeostasis in the oral cavity. These glands continuously secrete substances which lubricate and protect the oral tissues, contributing to comfort and health. The minor salivary glands contribute approximately 7-8 per cent of the total volume of saliva. Flow rate and composition seem to vary according to anatomical location. Current knowledge about the minor salivary glands is derived primarily from studies on adults. The overall aim of this thesis was to study age-related changes in minor gland saliva, from childhood to adulthood. By increasing the knowledge of minor gland secretion, we hopefully better understand how different mucosal locations are lubricated and protected in individuals of different ages and various health statuses. The project comprises four papers. In Paper I, the flow rate and numerical density of the labial and buccal minor glands of pre-school children, adolescents and adults were investigated. Saliva was collected on filter paper discs and the flow rate was measured by the Periotron-method. The numerical density was assessed by PAS-staining.

Key findings: The flow rate of the buccal glands was significantly lower in children than in adults and the number of labial glands was significantly higher in children than in the other age-groups. In Paper II, the composition of minor gland saliva of the three age groups (Paper I) was analysed (by ELISA-technique), with reference to the mucins MUC5B and MUC7, representing some of the major components of innate salivary immunity.

Key findings: Children did not differ from adolescents and adults with respect to MUC5B content in labial gland saliva, but had less MUC7 than the adults. In the buccal gland saliva, detectable amounts of the mucins were found in only a few of the participants. In Paper III, the content of the adaptive immune component (salivary IgA) in minor gland saliva of pre-school children, adolescents and adults was measured by the ELISA technique. The salivary IgA-concentration in whole saliva of the three age-groups was also estimated.

Key findings: The IgA-concentration was significantly lower in the labial glands and the whole saliva of the children than in the adults. In Paper IV, age-dependent differences of other innate components were studied in pre-school children, adolescents and adults, by analysing the amount of glycoprotein 340 (gp-340) in minor gland and whole saliva, using the ELISA technique. The content of sialic acid, a common terminal structure of glycoproteins, was analysed using the ELLA technique.

Key findings: With respect to minor gland saliva, no differences were disclosed among pre-school children, adolescents and adults. However, the gp-340 content of whole saliva was significantly higher in the children than in the adults. The above investigations of

Insufficient regeneration of missing bone and soft-tissue may present aesthetic or functional problems in patients indicated for dental implant surgery. Several techniques such as bone grafts, bone substitutes and guided tissue regeneration (GTR) have been described to rebuild a compromised alveolar ridge. Adequate soft-tissue coverage of grafted bone and titanium-mesh is important to avoid exposure which may result in loss of the bone graft. The general aim of this thesis was to evaluate use of an osmotic tissue expander for expanding intra-oral soft tissue--creating a surplus of soft tissue-- in preparation for onlay bone grafting. An experimental rabbit model was used in studies (I), (II) and (III). In (I) an osmotic soft-tissue expander was placed bilaterally on the lateral wall of the mandible via an extra-oral approach. After two weeks of expansion the rabbits were killed and specimens were collected for histology. No inflammatory reaction and no resorbtion of the cortical bone occured. The periosteum was expanded and new bone formation was seen in the edges of the expander. In (II) and (III) the expander was placed under the periosteum in the same way as in (I): bilaterally in 13 rabbits in (II) and unilaterally in 11 rabbits in (III). After two weeks of expansion the expander was identified and removed. In (II) particulated bone was placed at the recipient site protected by a titanium mesh in one site and a bio-resorbable mesh on the other site. In (III), DBBM particles and bone particles collected from the lateral border of the mandible separated by a collagen membrane was placed at the recipient site. The graft was protected by a pre-bent titanium mesh covered by a collagen membrane. After a healing period of 3 months specimens were collected for histological and SEM examination. New bone was growing in direct contact with the titanium mesh and bio resorbable mesh. The newly formed bone had the same calcium content as the mature bone in the base of the mandible. In the clinical study (IV) 20 patients were consecutively recruited and randomised into two groups. The experimental group (ten patients) had an osmotic soft tissue expander implanted. After two weeks of expansion the expander was removed and a particulated bone graft protected by a titanium mesh and a collagen membrane was fixed to the recipient site. Titanium implants were installed after a healing period of 6 months. The patients in the reference group had a bone block grafted from the anterior ramus fixated to the recipient site with one or two titanium mini screws. Implants were installed after a healing period of 6 months. A three dimensional optical measuring device was used to measure alterations in the soft tissue profile before each surgical procedure. The three-dimensional changes were then analysed on a PC. The results from the clinical study in patients confirmed the results from the experimental rabbit studies. The osmotic tissue expander expanded the soft ti

Among researchers and in the general population, awareness of the impact of health and health care on the quality of human life is increasing. An important medical and dental research area that addresses this issue is health measurement scales and psychometrics. Such instruments have numerous uses, such as to screen psychosocial aspects in individual patient care, assess perceived health or disease in population surveys, measure outcome in clinical trials, and gather data for cost-utility analyses. Assessing and improving oral health-related quality of life (OHRQoL), orofacial function, and orofacial aesthetics are three major goals in dental care. The overall aim of this thesis was to describe how three assessment tools were developed-using current scientific methodology-to measure these concepts in the Swedish culture. This thesis comprises five studies. In article I, recommended guidelines were used to translate the Oral Health Impact Profile (OHIP), an OHRQoL instrument, into Swedish. A group of 145 consecutive patients comprising five diagnostic groups participated in reliability and validity evaluations of OHIP-S, the Swedish OHIP version. Data supported excellent reliability and acceptable validity. In article II, the Jaw Functional Limitation Scale (JFLS) was developed, and reliability and validity were assessed in 132 consecutive patients from five diagnostic groups. An expert panel identified 52 functional limitation items. Rasch methodology reduced the number of items to 20 and assessed model fit. Three constructs were identified-mastication, vertical jaw mobility, and emotional and verbal expression-and good reliability and validity were found. The JFLS-20 is an organ-specific instrument for assessing functional status of the masticatory system while the shorter JFLS-8 assesses global functional limitation. Article III describes development of the Orofacial Aesthetic Scale (OAS), in particular its conceptual framework, measurement model, and method of questionnaire item generation. Interview and questionnaire data from 17 prosthodontic patients created an initial 28-item pool. After focus group reduction and pilot testing, a final 8-item instrument was generated. Exploratory factor analysis investigated OAS dimensionality, and item analysis was performed in 119 subjects. Forward and backward translations and reconciliation produced an English version of the instrument. Exploratory factor analysis supported OAS unidimensionality. In article IV, psychometric properties of the OAS were evaluated in 119 patients from four groups: aesthetically compromised, functional disability, and two age- and gender-matched control groups. Various methods of testing reliability and validity supported good score reliability and validity. In article V, the OAS was part of a mail survey to a national sample of 3000 persons and normative values were derived. Survey respondents totaled 1406, and missing data were analyzed. There was a significant diff

The general aim of this thesis was to broaden our knowledge of the signs and symptoms, genetics, and outcomes of dental implant treatment in individuals with oligodontia or ectodermal dysplasia. Article I is a population-based study in three Swedish counties of 162 individuals with oligodontia, which was a prevalence of 0.09%. The intent was to explore ways for dentists to assess symptoms from other ectodermal structures than teeth through a clinical interview and chair-side analyses. Thirty per cent had low salivary secretion rates while only 11% with no known syndrome reported symptoms from hair, nails, or sweat glands. These are, together with teeth, the ectodermal structures on which it is proposed that a clinical diagnosis of ectodermal dysplasia (ED) be based. Article II screened 93 probands with oligodontia for mutations in six genes known to cause oligodontia and hypohidrotic ED. Sequence alterations predicted to be damaging or potentially damaging were revealed in the AXIN2, MSX1, PAX9, and EDARADD genes in 14 (15%) of the probands. All mutations but one were novel. For the first time, EDARADD mutations were shown to cause isolated oligodontia. No individual who had reported ectodermal symptoms from hair, nails, or sweat glands had a mutation. Article III assessed orofacial function in individuals with different types of EDs using the Nordic Orofacial Test-Screening (NOT-S) protocol. Individuals with ED scored significantly higher in orofacial dysfunction than a healthy reference sample, especially in the Chewing and swallowing, Dryness of the mouth, and Speech domains. Article IV surveyed treatment outcome of dental implants in Swedish children up to age 16 years. In a 20-year period, only 26 patients were treated, 5 of whom had hypohidrotic ED and anodontia of the mandible. Individuals with ED had 64% failed implants compared to 6% among subjects with teeth missing due to trauma or agenesis. The main conclusions of this thesis were that (i) a check of whether one or more permanent incisors are missing will identify 65% of individuals with oligodontia and 84% of individuals missing nine teeth or more, (ii) evaluation of salivary secretion is indicated in children with oligodontia, (iii) a majority of individuals with oligodontia did not report other abnormal ectodermal organ function besides teeth, (iv) no clinical indicator discriminated between individuals with and without mutations in the tested genes, and more unidentified genes are involved in tooth morphogenesis, (v) EDARADD mutations are associated with isolated oligodontia, (vi) evaluation of orofacial function is indicated in individuals with ED, and many individuals with ED would benefit from orofacial skills training, (vii) dental implant placement is a rare treatment modality in children, (viii) individuals with hypohidrotic ED seem to present special challenges due to structural as well as direct effects of the mutations on bone, which seem to compromise osseointegrat

Diagnostic radiology has undergone profound changes in the last 30 years. New technologies are available to the dental field, cone beam computed tomography (CBCT) as one of the most important. CBCT is a catch-all term for a technology comprising a variety of machines differing in many respects: patient positioning, volume size (FOV), radiation quality, image capturing and reconstruction, image resolution and radiation dose. When new technology is introduced one must make sure that diagnostic accuracy is better or at least as good as the one it can be expected to replace. The CBCT brand tested was two versions of Accuitomo (Morita, Japan): 3D Accuitomo with an image intensifier as detector, FOV 3 cm x 4 cm and 3D Accuitomo FPD with a flat panel detector, FOVs 4 cm x 4 cm and 6 cm x 6 cm. The 3D Accuitomo was compared with intra-oral radiography for endodontic diagnosis in 35 patients with 46 teeth analyzed, of which 41 were endodontically treated. Three observers assessed the images by consensus. The result showed that CBCT imaging was superior with a higher number of teeth diagnosed with periapical lesions (42 vs 32 teeth). When evaluating 3D Accuitomo examinations in the posterior mandible in 30 patients, visibility of marginal bone crest and mandibular canal, important anatomic structures for implant planning, was high with good observer agreement among seven observers. Radiographic techniques have to be evaluated concerning radiation dose, which requires well-defined and easy-to-use methods. Two methods: CT dose index (CTDI), prevailing method for CT units, and dose-area product (DAP) were evaluated for calculating effective dose (E) for both units. An asymmetric dose distribution was revealed when a clinical situation was simulated. Hence, the CTDI method was not applicable for these units with small FOVs. Based on DAP values from 90 patient examinations effective dose was estimated for three diagnostic tasks: implant planning in posterior mandible and examinations of impacted lower third molars and retained upper cuspids. It varied between 11-77 microSv. Radiation dose should be evaluated together with image quality. Images of a skull phantom were obtained with both units varying tube voltage, tube current, degree of rotation and FOVs. Seven observers assessed subjective image quality using a six-point rating scale for two diagnostic tasks: periapical diagnosis and implant planning in the posterior part of the jaws. Intra-observer agreement was good and inter-observer agreement moderate. Periapical diagnosis was found to, regardless of jaw, require higher exposure parameters compared to implant planning. Implant planning in the lower jaw required higher exposure parameters compared to upper jaw. Substantial dose reduction could be made without loss of diagnostic information by using a rotation of 180 degrees, in particular implant planning in upper jaw. CBCT with small FOVs was found to be well-suited for periapical diagnosis and impla

The primary aim of this thesis was to study dental fear, personal characteristics and psychosocial concomitants in relation to dental behaviour management problems (DBMP) and dental attendance. The study sample consisted of children (8-12 yrs) and adolescents (13-19 yrs) referred to the Specialized Paediatric Dental Clinic because of DBMP. They were compared to a reference group of same aged dental patients in ordinary dental care. A methodological study explored the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) in terms of agreement between self and parental ratings and age- and gender-differentiated cut-off scores as compared to the commonly used. Baseline data on children's and adolescents' dental fear, psychosocial situation and everyday life, and personal characteristics were analysed according to a variable-based approach using logistic regression analyses and tree-based modelling of group differences. From the frequency of missed or/and cancelled appointments or interruption of dental treatment the group of referred children was separated into two groups (non-attendees vs. attendees). The differences between the groups were analysed using logistic regression analyses and tree-based modelling. It was found that children and adolescents referred because of DBMP differ in several ways from children and adolescents in ordinary dental care. These differences concerns dental fear, emotional and behavioural problems and temperamental aspects, as well as psychosocial concomitants. The results indicated an overall more negative and complex picture for the children and adolescents referred because of DBMP. The occurrence of single-parent families, child-parent separations, and professional support actions were clearly more frequent among patients referred because of DBMP. Dental fear was the only variable with consistent discriminatory capacity for DBMP through all age and gender subgroups. Aspects of anxiety, temperament, and behavioural symptoms contributed to the prediction of DBMP, but differently for different subgroups and at different levels of dental fear. A non-attending behaviour within the DBMP group was predicted by family factors and a temperamental profile indicating an out-going and somewhat impulsive personal profile. The results indicate further need to establish and validate age and gender differentiated cut-off scores and that self-rating on the CFSS-DS should complement parental ratings, since DF was the single best predictor of DBMP at clearly lower scores than commonly used. Avoidance may be seen as the extreme of DBMP, varying from irregular dental attendance to dropping out entirely from dental treatment. Therefore deeper knowledge and understanding of DBMP, will help the dental staff to meet and treat children and adolescents according to their individual need and act for the prevention of DBMP and irregular dental attendance.

Temporomandibular disorders (TMD) with orofacial pain with or without reduced jaw function, are frequent conditions in the general population. Different factors such as tooth clenching and grinding, sometimes due to enhanced psychosocial stress, and trauma to the jaws may be important as etiologic factors. Signs and symptoms of TMD are a common cause for general practitioners to use different intraoral appliances as pain and bite-force reducing devices and for improvement of a reduced jaw function. Intraoral appliances are often used parallel to other treatment modalities. Before treatment start a thorough history taking and clinical examination is necessary for a relevant diagnosis. Sometimes the diagnostic process has to be complemented with proper radiographic imaging in order to support the diagnostic process. The overall aim of this thesis was to compare magnetic resonance imaging (MRI) findings of the TMJ on the clinically assessed diagnoses and to evaluate short- and long-term treatment outcome of a resilient intraoral appliance, in patients with TMD pain. A further aim was to study Sense of Coherence as an influencing factor on treatment outcome, on these patients. In article I the aim was to compare findings on MRI in TMD pain patients with clinical diagnoses of myofascial pain or arthralgia/osteoarthritis in combination with myofascial pain according to the Research Diagnostic Criteria for TMD (RDC/TMD). The temporomandibular joints of 60 consecutive patients, 19 with myofascial pain and 41 patients with arthralgia/osteoarthritis in combination with myofascial pain were examined clinically and with MRI. The most common MRI findings were disc displacements with or without reduction and structural bone changes. These findings were found in both pain groups, however, disc displacements were found significantly more often in patients with arthralgia/osteoarthritis in combination with myofascial pain. Joint fluid was found in both pain groups. The clinical diagnoses for subdivision into myogenous only or combined arthrogenous and myogenous pain groups were not confirmed by MRI findings. In article II the short-term efficacy of a resilient appliance compared to a non-occluding control appliance was studied in a randomised, controlled trial with 80 recruited TMD pain patients. They were randomly allocated to one of two groups: treatment with a resilient appliance or treatment with a hard, palatal, nonoccluding appliance. After 6 and 10 weeks of treatment, characteristic pain intensity (CPI) decreased in both groups. There was no statistically significant difference found between the resilient appliance and the non-occluding control appliance in reducing TMD pain in a short-term perspective. In article III possible factors of importance for treatment outcome were studied as well as the association between Sense of Coherence and grade of depression, and grade of non-specific physical symptoms and general health, in the TMD pain patients. A

Background: Myotonic Dystrophy type 1 (DM1) is a hereditary neuromuscular multisystem disease with varying clinical expressions and severity. The prevalence worldwide is 5-20/100 000. It is characterized by progressive muscular waste and myotonia. Facial weakness is one of the earliest and most constant features. Muscular weakness has been shown to have an impact on oral health in various ways. The molecular basis for DM1 is an unstable trinucleotide (CTG) expansion on chromosome 19. The severity of the disease and time of onset is roughly correlated to the length of the CTG expansion.

Aim: The overall aim of this thesis is to shed light on oral health with focus on periodontal disease and caries in adults and children with DM1. Specific aims are: 1) To assess oral health and motoric ability in adults with DM. 2) To explore caries related factors including oral sugar clearance. 3) To assess oral health and dental care in children with DM1 and to evaluate the changes observed longitudinally over a four year period. SUBJECTS AND METHODS In all, 27 adults, ages 35-64 years and 56 children, ages 2.7-18 years, and age and gender matched control persons were examined. Thirty-six of the children with DM and 33 of the control children were examined on two occasions about four years apart. Plaque, gingivitis caries and number of teeth were recorded. In the adult patients, finger force, oral muscular coordination ability, salivary secretion rate and oral sugar clearance were determined. In children, the ability to cooperate during dental treatment was estimated. Questionnaires concerning eating habits and dental care were also used.

Result: The adult and children DM1 patients had significantly more caries, plaque and gingivitis and had lost more permanent teeth than the control patients. This was particularly evident for the boys with DM1. Motoric ability, salivary secretion and oral sugar clearance showed less favorable mean values for the adult DM group than for the control group. A negative correlation was found between plaque index and finger force. The children with DM1 had a lower ability to cooperate than the controls and general sedation was often needed during dental treatment.

Conclusions: Adults and children with DM1 have more plaque, gingivitis and caries and have lost more teeth than age and gender-matched control persons. This may be explained by lower motoric ability, lower salivary secretion and slower oral sugar clearance and, in children, more cooperation problems. The differences between the groups remained or increased for children with DM1 over the four years in the longitudinal study. For these reasons, intensified prophylactic care, including easy home-care methods, is essential for patients with DM1 to firstly improve their oral health and secondly accustom DM1 children to the dental clinic and the treatment there.

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20-year-old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self-perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to "Index of Orthodontic Treatment Need--Dental Health Component" (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 per cent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory "Being under the pressure of social norms" was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjust