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  • 1.
    Edman, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Publ Dent Hlth Serv, Ctr Oral Rehabil, Falun, Sweden.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Publ Dent Hlth Serv, Gävleborg, Sweden.
    Nordstrom, Birgitta
    Ctr Publ Dent Serv, Falun, Sweden.
    Öhrn, Kerstin
    Sch Educ Hlth & Social Studies, Falun, Sweden.
    Attitudes to dental care, Sweden 2003-2013, and clinical correlates of oral health-related quality of life in 20132018In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 16, no 2, p. 257-266Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate attitudes to dental care, and to assess possible associations with socio‐economic and clinical variables over a period of ten years, and to investigate the association between OHRQoL assessed by oral impact on daily performance (OIDP), and socio‐economic, dental care habits, smoking and oral status.

    Materials and methods: Cross‐sectional studies performed in the county of Dalarna, Sweden, in 2003, 2008 and 2013. Random samples of 1,107‐1,115 dentate individuals, aged 30‐85 years, who answered a questionnaire and who were radiographically and clinically examined were included.

    Results: The importance of preventive treatment, regular recalls and meeting the same caregiver as on previous visits became less important. In individuals with alveolar bone loss, meeting the same caregiver as on previous visits was important (P<.05). In individuals with manifest caries, information on treatment cost was important, while prevention became less important (P<.05). 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 temporomandibular disorders (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. Oral impact was found to be associated with irregular dental visits and limited economy for dental care, individuals with less than 20 remaining teeth, TMD and manifest caries.

  • 2.
    Edman, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Öhrn, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Nordström, Birgitta
    Public Dental Service, Falun.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    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, Sweden2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 5, p. 385-392Article in journal (Refereed)
    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.

  • 3.
    Engström, Sevek
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Self-estimated oral and general health are related and associated with clinically investigated dental health2011In: Swedish Dental Journal, ISSN 0347-9994, Vol. 35, no 4, p. 169-176Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate whether the self-estimation of oral and general health is correlated and related to clinical parameters for dental health. Furthermore, to investigate the influence of socioeconomic factors on the self-assessment of oral and general health. During 2007 a dental health survey was performed in the Community of Gavle located in central Sweden.1,224 subjects randomized from the general population of Gavle (adult population 75, 000) were invited to participate. Seven hundred and forty-eight individuals answered a questionnaire regarding their health and 373 of these subjects participated in a dental examination. Self-estimated oral and general health was correlated (p<0.0001, r= 0.35) and individuals who perceived their oral health as bad had more decayed surfaces, surfaces with secondary caries,fewer teeth and more bleeding on probing than those with good estimated oral health (p<0.017 for all). In a logistic regression analysis with self-estimated oral health as the dependent variable was related to, the independent variables NT, DFT, self-estimated general health and age were related to self-estimated oral health, but not to income or educational level. However, subjects with low disposable income and low education level had significantly more clinical caries and fewer teeth than subjects with high income or a high educational level. Conclusions: In the present study, self-estimation of oral and general health was correlated and related to some clinical oral parameters. Subjects in the low socioeconomic group had worse dental health and a tendency to underestimate their need of dental care.

  • 4.
    Esberg, Anders
    et al.
    Umea Univ, Dept Odontol, Umea, Sweden.
    Isehed, Catrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Umea Univ, Dept Mol Periodontol, Umea, Sweden;Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Lundberg, Pernilla
    Umea Univ, Dept Mol Periodontol, Umea, Sweden.
    Peri-implant crevicular fluid proteome before and after adjunctive enamel matrix derivative treatment of peri-implantitis2019In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 46, no 6, p. 669-677Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to explore which peri-implant crevicular fluid (PICF) protein pattern is associated with the active peri-implantitis process. Materials and methods Peri-implant crevicular fluid from 25 peri-implantitis sites were subjected to proteomic analysis using liquid chromatography-tandem mass spectrometry before and at 3, 6 and 12 months after treatment, to identify associations between PICF protein pattern and implant loss, bleeding on probing, pocket depth and enamel matrix derivative (EMD) treatment. Results Clustering of subjects based on their 3-12 months PICF proteomic profiles by principal component analysis defined two major clusters. Cluster 2 differentiated from cluster 3 by 52 proteins (R-2 = 90%, Q(2) = 80%) and belonging to cluster 2 was associated with implant loss (p = 0.009) and bleeding on probing (p = 0.001). Cluster 3 was associated with implant survival and EMD treatment (p = 0.044). Conclusion Here, we demonstrate that a specific PICF proteomic profile associates with active peri-implantitis process and implant loss.

  • 5.
    Holmlund, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Cty Hosp Gavle, Dept Periodontol, S-80187 Gavle, Sweden.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Poor Response to Periodontal Treatment May Predict Future Cardiovascular Disease2017In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 96, no 7, p. 768-773Article in journal (Refereed)
    Abstract [en]

    Periodontal disease has been associated with cardiovascular disease (CVD), but whether the response to the treatment of periodontal disease affects this association has not been investigated in any large prospective study. Periodontal data obtained at baseline and 1 y after treatment were available in 5,297 individuals with remaining teeth who were treated at a specialized clinic for periodontal disease. Poor response to treatment was defined as having > 10% sites with probing pocket depth > 4 mm deep and bleeding on probing at >= 20% of the sites 1 y after active treatment. Fatal/nonfatal incidence rate of CVD (composite end point of myocardial infarction, stroke, and heart failure) was obtained from the Swedish cause-of-death and hospital discharge registers. Poisson regression analysis was performed to analyze future risk of CVD. During a median follow-up of 16.8 y (89,719 person-years at risk), those individuals who did not respond well to treatment (13.8% of the sample) had an increased incidence of CVD (n = 870) when compared with responders (23.6 vs. 15.3%, P < 0.001). When adjusting for calendar time, age, sex, educational level, smoking, and baseline values for bleeding on probing, probing pocket depth > 4 mm, and number of teeth, the incidence rate ratio for CVD among poor responders was 1.28 (95% CI, 1.07 to 1.53; P = 0.007) as opposed to good responders. The incidence rate ratio among poor responders increased to 1.39 (95% CI, 1.13 to 1.73; P = 0.002) for those with the most remaining teeth. Individuals who did not respond well to periodontal treatment had an increased risk for future CVD, indicating that successful periodontal treatment might influence progression of subclinical CVD.

  • 6.
    Holmlund, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Number of teeth is related to atherosclerotic plaque in the carotid arteries in an elderly population2012In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 83, no 3, p. 287-291Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Periodontal disease has been associated with cardiovascular disorders with an atherosclerotic background, and number of teeth (NT) has been suggested as a possible risk indicator for cardiovascular disease. The objective of this study is to investigate whether NT was related to the intima-media thickness (IMT) and to atherosclerotic plaque in carotid arteries in an elderly population.

    METHODS:

    In a population-based study including 1,016 participants aged 70 years, the NT was self-reported by 947 of the participants. Carotid artery IMT was evaluated by ultrasound. The occurrence of plaque was also measured. Logistic regression was used to analyze the associations between NT and the number of carotid arteries with plaque.

    RESULTS:

    A significant inverse relationship was found between the NT and the number of carotid arteries with plaque after adjustment for age, sex, smoking, body mass index, waist/hip ratio, blood glucose, triglycerides, cholesterol, C-reactive protein, leukocyte count, blood pressure, and Framingham risk score, with odds ratio of 0.89, 95% confidence interval of 0.82 to 0.98, and P = 0.016. The relationship was fairly linear, suggesting a dose-response relationship. When NT was divided into quintiles using the first one as referent, the relationship persisted for all quintiles except for the second one. However, no relationship to IMT was seen.

    CONCLUSION:

    The present study further emphasizes that tooth loss could be an easily obtained risk indicator for atherosclerosis.

  • 7.
    Isehed, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Umea Univ, Dept Mol Periodontol, Umea, Sweden;Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Svenson, Bjorn
    Orebro Univ, Postgrad Dent Educ Ctr, Orebro, Sweden;Orebro Univ, Sch Hlth & Med Sci, Orebro, Sweden.
    Lundberg, Pernilla
    Umea Univ, Dept Mol Periodontol, Umea, Sweden;Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Surgical treatment of peri-implantitis using enamel matrix derivative, an RCT: 3-and 5-year follow-up2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 6, p. 744-753Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the clinical and radiographic outcomes 3 and 5years after the surgical treatment of peri-implantitis per se or in combination with an enamel matrix derivative (EMD). Materials and Methods: At baseline, 29 patients were randomized to surgical treatment with adjunctive EMD or no EMD. One year after the surgical treatment of peri-implantitis, 25 patients remained eligible for survival analyses at the 3- and 5-year follow-up. The primary outcomes were implant loss and bone level (BL) change measured on radiographs, and the secondary outcomes, bleeding on probing, pus and plaque at each implant were analysed in 18 and 14 patients at the 3- and 5-year follow-up, respectively. Results: After exclusion of four patients who discontinued the study, at the 3-year follow-up, 13 (100%) implants survived in the EMD group, and 10 of 12 (83%) in the non-EMD group. At the 5-year follow-up, 11 of 13 (85%) implants in the EMD group and nine of 12 (75%) in the non-EMD group survived. In multivariate modelling, BL changes and EMD treatment were positively associated with implant survival. Similarly, the same trend was seen in univariate analysis. Conclusions: An exploratory analysis suggests that adjunctive EMD is positively associated with implant survival up to 5 years, but larger studies are needed.

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