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Eriksson, L. B., Gordh, T., Karlsten, R., LoMartire, R., Thor, A. & Tegelberg, Å. (2023). Intravenous S-ketamine's analgesic efficacy in third molar surgery: A randomized placebo-controlled double-blind clinical trial. British Journal of Pain
Open this publication in new window or tab >>Intravenous S-ketamine's analgesic efficacy in third molar surgery: A randomized placebo-controlled double-blind clinical trial
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2023 (English)In: British Journal of Pain, ISSN 2049-4637Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background

In most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred.

Methods

The study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline).

Results

A primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group.

Conclusions

Pre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
S-Ketamine pain, pain, postoperative pain, pain management, intravenous, sedation, oral surgery
National Category
Dentistry Surgery Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-518450 (URN)10.1177/20494637231222327 (DOI)001125533900001 ()
Available from: 2023-12-19 Created: 2023-12-19 Last updated: 2024-02-01Bibliographically approved
Tegelberg, Å., Nohlert, E., List, T. & Isacsson, G. (2023). Oral appliance influence on jaw function in obstructive sleep apnea. American Journal of Orthodontics and Dentofacial Orthopedics, 164(5), 682-689
Open this publication in new window or tab >>Oral appliance influence on jaw function in obstructive sleep apnea
2023 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 164, no 5, p. 682-689Article in journal (Refereed) Published
Abstract [en]

Introduction: Oral appliance (OA) therapy in obstructive sleep apnea (OSA) could be a risk factor for normal jaw function, given the prolonged effect of an OA in keeping the mandible in a protruded position away from a normal position. This study aimed to assess changes in symptoms and clinical findings related to jaw function after 1 year of treating OSA with an OA. Methods: In this follow-up clinical trial, 302 patients with OSA were assigned to treatment with either monobloc or bibloc OA. Baseline and 1-year follow-up assessment included using the Jaw Functional Limitation Scale, self-reported symptoms and signs related to jaw function. The clinical examination of jaw function included mandibular mobility, dental occlusion, and tenderness in the temporomandibular joints and masticatory muscles. Descriptive analyses of variables are presented for the per-protocol population. To evaluate differences between the baseline and the 1-year follow-up, paired Student t tests and the McNemar change test was used. Results: One-hundred and ninety-two patients completed the 1-year follow-up (male 73%, mean aged 55 6 11 years). There was no change in the Jaw Functional Limitation Scale score at the follow-up (nonsignificant). The patients described no change in symptoms at the follow-up, except for improvements in morning headache (P \0.001) and increased frequency of difficulties in opening the mouth or chewing on awakening (P = 0.002). Subjectively reported changes in dental occlusion during biting/chewing increased significantly at the follow-up (P = 0.009). Conclusions: No changes in measurements of jaw mobility, dental occlusion, or pain on palpation of the tempo-romandibular joints or masticatory muscles were seen at the follow-up. Thus, using an OA in treating OSA had limited influence on jaw functions and related symptoms. Moreover, the risk of developing pain and functional impairment in the masticatory system was infrequent, indicating that this treatment is safe and can be recommended. (Am J Orthod Dentofacial Orthop 2023;164:682-9)

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-516914 (URN)10.1016/j.ajodo.2023.04.018 (DOI)001102708900001 ()37318425 (PubMedID)
Available from: 2023-12-15 Created: 2023-12-15 Last updated: 2023-12-15Bibliographically approved
Hedberg, P., Nohlert, E. & Tegelberg, Å. (2021). Effects of oral appliance treatment on inflammatory biomarkers in obstructive sleep apnea: A randomised controlled trial. Journal of Sleep Research, 30(4), Article ID e13253.
Open this publication in new window or tab >>Effects of oral appliance treatment on inflammatory biomarkers in obstructive sleep apnea: A randomised controlled trial
2021 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 30, no 4, article id e13253Article in journal (Refereed) Published
Abstract [en]

Obstructive sleep apnea (OSA) may lead to increased circulating concentrations of inflammatory biomarkers and treatment may change these. We aimed to assess the effect of oral appliance (OA) therapy on inflammatory biomarkers in a randomised controlled pilot trial. A total of 71 patients with OSA and systemic hypertension were randomly allocated to an active, mandible protruded (OAa) or a passive, mandible non-protruded device (OAp) treatment. Serum concentrations of the inflammatory biomarkers white blood cells, high-sensitivity C-reactive protein, interleukin 6, interleukin 10, and tumour necrosis factor-alpha were measured at baseline and after 3 months of OA treatment. The differences between treatment groups in biomarker concentration change during the treatment were presented as the Vargha and Delaney effect size and evaluated with the Wilcoxon-Mann-Whitney test. This effect size expresses the probability of a higher value in a random participant from one group compared with a random patient from the other group, and a value of 0.5 means stochastically equal groups. After 3 months of treatment, there was a significant reduction of the apnea-hypopnea index in the OAa group compared with the OAp group (effect size 0.258, 95% confidence interval 0.146-0.386, p < .001). There were no significant differences between the groups in any of the inflammatory markers' concentration changes during the treatment period (effect sizes between 0.488 and 0.524; all p values >=.737). Thus, OA treatment for 3 months did not affect circulating concentrations of some common inflammatory markers in patients with OSA and systemic hypertension.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2021
Keywords
C&#8208, reactive protein, inflammation, interleukins, mandibular advancement device, obstructive sleep apnea
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-454359 (URN)10.1111/jsr.13253 (DOI)000596790100001 ()33300239 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2021-09-28 Created: 2021-09-28 Last updated: 2024-01-15Bibliographically approved
Flink, H., Tegelberg, Å., Arnetz, J. E. & Birkhed, D. (2020). Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults. Acta Odontologica Scandinavica, 78(3), 229-235
Open this publication in new window or tab >>Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults
2020 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 78, no 3, p. 229-235Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25-50 years of age (mean age 39.96.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p<.001). The CA group reported worse oral health (p<.001) and general health (p<.01), more xerostomia (p<.001) and lower salivary flow rate (p<.01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p<.01). There were no differences between groups in quality of life.Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Dental caries, general health, oral health, xerostomia, hyposalivation
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-421804 (URN)10.1080/00016357.2019.1690677 (DOI)000496636700001 ()31729277 (PubMedID)
Available from: 2020-10-12 Created: 2020-10-12 Last updated: 2023-11-13Bibliographically approved
Feldman, I., Helgason, A. R., Johansson, P., Tegelberg, Å. & Nohlert, E. (2019). Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up. BMJ Open, 9, Article ID e030934.
Open this publication in new window or tab >>Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up
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2019 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 9, article id e030934Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up.

Design and outcome measures: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (Euro) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio.

Setting: The study was conducted in dental clinics in Sweden.

Participants: 294 smokers aged 19-71 years were included in the study.

Interventions: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT).

Results: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to Euro918 and Euro3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden.

Conclusion: CEA favours the more costly HIT if decision makers are willing to spend at least Euro4000/QALY for tobacco cessation treatment.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2019
Keywords
smoking cessation, cost-effectivenes, long-term sustainability
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-402227 (URN)10.1136/bmjopen-2019-030934 (DOI)000502537200371 ()31420398 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-1399
Available from: 2020-01-17 Created: 2020-01-17 Last updated: 2023-11-13Bibliographically approved
Adern, B., Minston, A., Nohlert, E. & Tegelberg, Å. (2018). Self-reportance of temporomandibular disorders in adult patients attending general dental practice in Sweden from 2011 to 2013. Acta Odontologica Scandinavica, 76(7), 530-534
Open this publication in new window or tab >>Self-reportance of temporomandibular disorders in adult patients attending general dental practice in Sweden from 2011 to 2013
2018 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 7, p. 530-534Article in journal (Refereed) Published
Abstract [en]

Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) and acceptance or nonacceptance of such disorders in adult patients attending all public dental health services in the County of Sormland, Sweden, during a 3-year period, 2011-2013.

Methods: Two questions were asked about TMD and the voluntary mouth-opening capacity was measured. The results were registered in a score 0-3. The registration was completed with a question about each patient's acceptance or nonacceptance of their condition.

Results: More than 73,000 registrations of the TMD condition were performed in general dental clinics from 2011 to 2013. The mean prevalence of a TMD score of 1-3 was 5% and was consistent over these years. Seventy percent of these patients were women. The peak prevalence of TMD was registered in patients aged 30-45years (38%), and the frequency declined in older age groups. Reduced voluntary mouth-opening capacity (<= 35 mm) was found in less than 2% of the participants. About one-fifth of the patients with a TMD-score of 1-3 did not accept their condition and wanted professional care. The frequency of nonacceptance of the condition increased with the severity of symptom score: 15%, 27%, and 49% for scores 1, 2, and 3, respectively.

Conclusions: This study shows that the prevalence of self-reported TMD in adult patients was consistent from 2011 to 2013 and should be considered as a public health issue in Sweden. Patients with more severe TMD pain symptoms wanted care more frequent. The annual clinical calibrations should be continued to achieve an acceptable level of registration.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Acceptance, general dentistry, implementation, pain, prevalence, TMD
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-363639 (URN)10.1080/00016357.2018.1487076 (DOI)000445863000013 ()29932779 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2023-11-13Bibliographically approved
Eriksson, L. B. & Tegelberg, Å. (2015). Safety of adjunct pre-emptive intravenous tramadol with midazolam sedation for third molar surgery. Oral and Maxillofacial Surgery, 19(4), 353-359
Open this publication in new window or tab >>Safety of adjunct pre-emptive intravenous tramadol with midazolam sedation for third molar surgery
2015 (English)In: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 19, no 4, p. 353-359Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

The purpose of this study was to evaluate patient safety, in terms of adverse events, alterations in blood pressure or oxygen saturation (SpO2) in two routine sedation procedures, with and without intravenous analgesia.

METHODS:

Patients referred for surgical removal of mandibular third molars were treated in a randomized, controlled, single-blinded procedure. Eighty-seven men and women, aged 18 to 44 years, were allotted to either of two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S) or to a control group (C), given no sedation.

RESULTS:

Tramadol at 1 mg/kg body weight resulted in a higher frequency of oxygen desaturation (SpO2 < 90 %) than a placebo (p = 0.002) but had no effect on mean SpO2 at the end point or at the end of surgery. In both the test groups, there was a significant decrease in diastolic blood pressure (p < 0.001) from baseline to the end of surgery.

CONCLUSION:

The results confirm that pre-emptive intravenous tramadol, administered at 1 mg/kg body weight as an adjunct to midazolam sedation for third molar surgery, offers a safe method. But, it should be noted that our previous study shows that it is not a particularly effective analgesic. Further testing is therefore warranted, using other doses or other drugs, to find a better intravenous protocol for postoperative analgesia, with maximum effect and minimal risk, in outpatient oral and maxillofacial surgery procedures.

National Category
Anesthesiology and Intensive Care Dentistry
Identifiers
urn:nbn:se:uu:diva-286569 (URN)10.1007/s10006-015-0502-9 (DOI)000218366700004 ()25925999 (PubMedID)
Available from: 2016-04-21 Created: 2016-04-21 Last updated: 2023-11-13Bibliographically approved
Tegelberg, Å., Wenneberg, B. & List, T. (2007). General practice dentists' knowledge of temporomandibular disorders in children and adolescents. European journal of dental education, 11(4), 216-221
Open this publication in new window or tab >>General practice dentists' knowledge of temporomandibular disorders in children and adolescents
2007 (English)In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 11, no 4, p. 216-221Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of the study was to map general practice dentists' (GPDs) knowledge of temporomandibular disorders (TMD) in children and adolescents. Materials and methods: A questionnaire was mailed to 286 Swedish dentists in the Public Dental Service and 17 TMD specialists with documented research experience. The questionnaire contained 37 statements on aetiology, diagnostics, classification, chronic pain and pain behaviour, treatment, and prognosis. Each statement was judged on a 0-10 point scale with the endpoint definitions agree or disagree. Results: The overall response rate to the questionnaire was 87%. In 28 of all 37 statements, the TMD specialists endorsed a consensus, i.e. > 75% of the specialists had the same opinion about the statement. TMD specialists differed most in opinion in the domain diagnostics and classification. In 65% of the statements, differences in knowledge between GPDs and TMD specialists were non-significant. The greatest number of significant between-group differences was found in the domain treatment and prognosis. Most of these statements were related to morphological factors. Conclusion: There is a high degree of consensus in TMD knowledge amongst the TMD specialists and a high degree of agreement in knowledge between GPDs and TMD specialists. In some areas, however, TMD specialists still need to reach a consensus which is founded on evidence-based TMD knowledge in children and adolescents and that can be used in undergraduate teaching. It is therefore important to develope and strengthen the undergraduate dental teaching in TMD and orofacial pain.

Keywords
adolescent, children, education, questionnaire, temporomanclibular disorders
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-16032 (URN)10.1111/j.1600-0579.2007.00458.x (DOI)000253385200005 ()17935561 (PubMedID)
Available from: 2008-04-08 Created: 2008-04-08 Last updated: 2023-11-13Bibliographically approved
Tegelberg, Å., Wårdh, I., Nohlert, E., Andersson, J.-E. & Axelsson, S. (2006). Att förstå vetenskap - tandläkares kunskaper om evidensbaserad vård. Läkartidningen, 10, 52-58
Open this publication in new window or tab >>Att förstå vetenskap - tandläkares kunskaper om evidensbaserad vård
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2006 (Swedish)In: Läkartidningen, Vol. 10, p. 52-58Article in journal (Other scientific) Published
Identifiers
urn:nbn:se:uu:diva-10485 (URN)
Available from: 2007-03-27 Created: 2007-03-27 Last updated: 2023-11-13
Klobas, L., Axelsson, S. & Tegelberg, Å. (2006). Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders. Acta Odontologica Scandinavica, 64(6), 341-347
Open this publication in new window or tab >>Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders
2006 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, no 6, p. 341-347Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to investigate the effect of a specific therapeutic jaw exercise on the temporomandibular disorders of patients with chronic whiplash-associated disorders. MATERIAL AND METHODS: Ninety-four consecutive patients with whiplash-related conditions were referred to and accepted for a treatment period at a center for functional evaluation and rehabilitation during 2001-2002. The patients followed a program of physical therapy, occupational therapy, and pain management. At the start of their stay, they were examined by a physician specialized in rehabilitation medicine and also by a dentist who performed a functional examination of the stomatognathic system. Of the 93 patients who accepted participation in the study, 55 were diagnosed with temporomandibular disorders and chronic whiplash-associated disorders in accordance with the inclusion criteria. They were randomized into a jaw exercise group (n = 25), who performed specific therapeutic jaw exercises, and a control group (n = 30). Both groups undertook the whiplash rehabilitation program at the center. RESULTS: There were no inter- or intra-group differences in symptoms and signs of temporomandibular disorders at baseline, nor at the 3-week and 6-month follow-ups, except for an increase of maximum active mouth-opening capacity in the control group. CONCLUSIONS: In conclusion, the therapeutic jaw exercises, in addition to the regular whiplash rehabilitation program, did not reduce symptoms and signs of temporomandibular disorders in patients with chronic whiplash-associated disorders.

Keywords
exercise movement techniques, randomized clinical trial, temporomandibular joint disorders, whiplash injuries
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-10458 (URN)10.1080/00016350600825310 (DOI)000242333500003 ()17123910 (PubMedID)
Available from: 2007-03-26 Created: 2007-03-26 Last updated: 2023-11-13Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-2812-5409

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