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Epidemiological studies of Oral Health, development and influencing factors in the county of Dalarna, Sweden 1983–2013
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Centrum Oral Rehabilitering, Folktandvården Dalarna.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis is to describe the development of oral health and possible associations with socioeconomic and socio-behavioural factors, in an adult population over a period of 30 years. A further aim is to describe attitudes to, and demands of dental care, and the impact of oral conditions on quality of life.

The study sample consisted of 787-1158 individuals, aged between 35-85 years, randomly selected from Dalarna’s population register in 1982, 2002, 2007 and 2012. The studies were carried out in 1983, 2003, 2008 and 2013, and the participants responded to a questionnaire and a clinical examination of oral status.

There has been a substantial improvement in oral status in regard to the mean number of teeth, intact teeth, and less removable dentures over this period of 30 years. The proportion of individuals with alveolar bone loss decreased significantly between 1983 and 2008, but increased significantly between 2008 and 2013. Smoking was the overall strongest factor associated with alveolar bone loss, after adjustment for socioeconomic and socio-behaviour factors, age and number of teeth. Calculus, visible on radiographs, increased significantly between 2003 and 2013. The proportion of individuals with manifest caries declined significantly between 1983 and 2008, but seems to level out between 2008 and 2013. Socioeconomic and socio-behaviour factors were significantly associated with manifest caries. Preventive treatment, meeting the same caregiver as on previous visits, and information about treatment cost was reported to a significantly lower degree as important in 2013, compared with 2003 and 2008, and booking time for treatment was reported as more difficult in 2013, compared with earlier years. Regular recalls was reported as less important in 2013, compared with 2008. A third of the respondents reported oral impact on daily performance and irregular dental visits, limited economy for dental care, less than 20 remaining teeth, manifest caries and temporomandibular disorder were significantly associated with oral impact on daily performance.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1191
Keyword [en]
Periodontal disease, dental caries, epidemiology, edentulousness, removable dentures, smoking, socio-behavioural, socioeconomic, tobacco, oral health related quality of life
National Category
Dentistry
Identifiers
URN: urn:nbn:se:uu:diva-280131ISBN: 978-91-554-9501-5 (print)OAI: oai:DiVA.org:uu-280131DiVA: diva2:910082
Public defence
2016-04-27, Föreläsningssalen, Falu lasarett, Falun, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-05 Created: 2016-03-08 Last updated: 2016-04-12
List of papers
1. Comparison of oral status in an adult population 35-75 year of age in the county of Dalarna, Sweden in 1983 and 2008
Open this publication in new window or tab >>Comparison of oral status in an adult population 35-75 year of age in the county of Dalarna, Sweden in 1983 and 2008
Show others...
2012 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 36, no 2, 61-70 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to study the prevalence and distribution of number of teeth, number of intact and decayed teeth and prevalence and distribution of removable dentures and periodontal disease over 25 years 1983-2008. Two cross-sectional studies (EpiWux) were performed in the County of Dalarna, Sweden in 1983 and 2008. In the 1983 study a random sample of 1012 individuals were invited to participate in this epidemiological and clinical study and 1440 individuals in 2008. A total number of 1695 individuals, stratified into geographical areas (rural and urban areas), in the age groups 35, 50,65 and 75 answered a questionnaire and were also clinically and radiographically examined. The number of edentulous individuals decreased from 15% in 1983 to 3 % in 2008. Number of teeth increased from 22.7 in 1983 to 24.2 in 2008 and decayed surfaces per tooth showed a three-time reduction over this period of time. As a consequence of better oral status the prevalence of complete removable dentures in both jaws decreased from 15 % in 1983 to 2 % in 2008. Individuals with moderate periodontitis decreased from 45 % in 1983 to 16 % in 2008. Conclusion: Covering a period of 25 years the present study can report dramatic improvements in all aspects of dental status that were investigated. This is encouraging for dental care professionals, but will not necessarily lead to less demand for dental care in the future as the population is aging with a substantial increase in number of teeth.

Keyword
Periodontal disease, dental caries, epidemiology, edentulousness, removable dentures
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-213103 (URN)000327048700001 ()22876393 (PubMedID)
Available from: 2013-12-19 Created: 2013-12-18 Last updated: 2017-12-06Bibliographically approved
2. Trends over 30years in the prevalence and severity of alveolar bone loss and the influence of smoking and socio-economic factors: based on epidemiological surveys in Sweden 1983-2013
Open this publication in new window or tab >>Trends over 30years in the prevalence and severity of alveolar bone loss and the influence of smoking and socio-economic factors: based on epidemiological surveys in Sweden 1983-2013
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2015 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 13, no 4, 283-291 p.Article in journal (Refereed) Published
Abstract [en]

ObjectiveEpidemiological studies of the prevalence of periodontitis over an extended time using the same methodology to investigate and classify periodontitis are sparse in the literature. Smoking and socio-economic factors have been proven to increase the risk for periodontal disease. The objective of this study was to investigate 30-year time trends, using the same methodology to classify the prevalence and severity in alveolar bone loss (ABL) and to investigate the influence of tobacco and socio-economic factors. MethodsFour cross-sectional epidemiological studies in an adult population were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008 and 2013. Random samples of 787-1133 individuals aged 35-85 who answered a questionnaire about tobacco use and socio-economic factors were radiographically and clinically examined. A number of teeth, ABL and calculus visible on radiographs were registered. The severity of ABL as detected on radiographs was classified into no bone loss, moderate or severe. ResultsThe prevalence of moderate ABL decreased from 45% in 1983 to 16% in 2008, but increased to 33% in 2013 (P<0.05). The prevalence of severe ABL remained the same from 1983 (7%) to 2013 (6%). Calculus visible on radiographs increased from 22% in 2008 to 32% in 2013 (P<0.05). Socio-economic factors had limited impact on the severity of ABL. ConclusionModerate ABL and calculus visible on radiographs significantly increased between 2008 and 2013. Smoking was the strongest factor associated with ABL overall.

Keyword
epidemiology, periodontal disease, smoking
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-265798 (URN)10.1111/idh.12164 (DOI)000362736400009 ()26215672 (PubMedID)
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01Bibliographically approved
3. Prevalence of dental caries and influencing factors, time trends over a 30-year period in an adult population: Epidemiological studies between 1983 and 2013 in the county of Dalarna, Sweden
Open this publication in new window or tab >>Prevalence of dental caries and influencing factors, time trends over a 30-year period in an adult population: Epidemiological studies between 1983 and 2013 in the county of Dalarna, Sweden
2016 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 5, 385-392 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The aim of this study was to investigate the prevalence of dental caries in an adult population using four different cross-sectional studies over a 30-year period and to assess its possible associations with socio-economic and socio-behavioral factors. Materials and methods. Four cross-sectional epidemiological studies were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008, and 2013. Random samples of 1012–2243 individuals, aged 20–85 years, who answered a questionnaire about socio-economic and socio-behavioral factors, were radiographically and clinically examined. Results. The proportion of individuals with at least one decayed surface (DS) was 58% in 1983 and significantly lower, 34% in 2008 (p<0.05) and 33% in 2013; the mean number of DS was 2.0 in 1983 and 1.1 in 2013 in the age group 35 to 75 (p < 0.05). In the age group 85, the mean number of DS was 1.2 in 2008 and 2.4 in 2013. Adjusted for age and number of teeth, irregular dental visits, limited financial resources for dental care, smoking, education below university, male gender, daily medication, and single living were positively and statistically associated with manifest caries. Conclusion. The declining trend in the prevalence of manifest caries seems to be broken. In the oldest age group mean number of DS was higher in 2013 compared with 2008, indicating a possible beginning of an increase.  This needs special attention as this group increases in the population, retaining natural teeth high up in age. Manifest caries was found to be associated with socio-economic and socio-behavioral factors.

Keyword
Dental caries, epidemiology, socio-behavioral, socio-economic, tobacco
National Category
Dentistry
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-280078 (URN)10.3109/00016357.2016.1163733 (DOI)000377809300012 ()27215270 (PubMedID)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-11-30Bibliographically approved
4. Attitudes and demands of dental care, Sweden 2003-2013, and clinical correlates of oral health-related quality of life in 2013
Open this publication in new window or tab >>Attitudes and demands of dental care, Sweden 2003-2013, and clinical correlates of oral health-related quality of life in 2013
(English)Article in journal (Other academic) Submitted
Abstract [en]

Objective. The aim of the present study was to investigate attitudes to, and demands of dental care, and to assess possible associations with socioeconomic and clinical variables over a period of ten years. A further aim was to investigate the association between OHRQoL assessed by OIDP, and socioeconomic, dental care habits, smoking and oral status. Materials and methods. Three cross-sectional epidemiological studies were performed in the county of Dalarna, Sweden, in 2003, 2008 and 2013. Random samples of 1542–2244 individuals, aged 30-85 years, who answered a questionnaire about socio-economic, socio-behavioral factors, oral health-related quality of life were radiographically and clinically examined. Results. The importance of preventive treatment, regular recalls, meeting the same caregiver as on previous visits, and information on treatment cost have become less important. Difficulty in booking treatment time was reported by 17% in 2013, compared with 11% in 2003 and 12% in 2008 (p<0.05). In individuals with alveolar bone loss, meeting the same caregiver as on previous visits was important (p<0.05). In individuals with temporomandibular disorder (TMD) and manifest caries, information on treatment cost was important, while prevention became less important (p<0.05). Oral impact on daily performance (OIDP) was reported by 31% of the individuals in the study, and frequent impact was reported by 10%. Individuals with manifest caries lesions, less than 20 remaining teeth, and TMD reported OIDP to a significantly higher degree, compared to orally healthy individuals. Conclusion. Attitudes important in maintaining and improving good oral health, such as preventive care and regular recalls to dentistry, became less important during this period of 10 years, and difficulty in booking treatment time was reported more frequently in 2013. Oral impact was found to be associated with irregular dental visits and limited economy for dental care, less than 20 remaining teeth, TMD and manifest caries.

Keyword
Dental caries, epidemiology, socio-behavioral, socioeconomic, tobacco, OHRQoL
National Category
Dentistry
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-280127 (URN)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2016-04-12Bibliographically approved

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