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Publications Maxillofacial Unit Halmstad
2009-09-17
English
J Clin Periodontol. 2009 Jul;36(7):541-9.
Risk factors for atherosclerosis in cases with severe periodontitis.
Buhlin K, Hultin M, Norderyd O, Persson L, Pockley AG, Rabe P, Klinge B, Gustafsson A.
Department of Periodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden.
[email protected]
AIM: Studies have reported on an association between cardiovascular disease (CVD)
and periodontitis. The purpose of this case-control study was to provide an insight into
this association by determining the plasma levels of some risk markers for CVD in cases
with periodontitis. MATERIALS AND METHODS: Sixty-eight cases with
periodontitis, mean age 53.9 (SD 7.9) years, and 48 randomly selected healthy controls,
mean age 53.1 (SD 7.9) years, were investigated. Fasting blood plasma was analysed for
glucose, lipids, markers systemic inflammation, cytokines and antibodies against heat
shock proteins (Hsp). The associations between periodontitis and the various substances
analysed in plasma were calculated using a multivariate logistic regression model, which
compensated for age, gender, smoking and body mass index. RESULTS: The regression
analyses revealed a significant association between periodontitis and high levels of Creactive protein (CRP) [odds ratio (OR) 4.0, confidence interval (CI) 1.4-11.4] and
fibrinogen (OR 8.7, CI 2.6-28.4), IL-18 (OR 6.5, CI 2.2-19.5), and decreased levels of
IL-4 (OR 0.12, CI 0.0-0.5). The study showed increased levels of antibodies against
Hsp65 (OR 2.8, CI 1-7.6) and 70 (OR 2.9, CI 1.1-7.8) and decreased levels of antibodies
against Hsp60 (OR 0.3, CI 0.1-0.8). CONCLUSIONS: Periodontitis was associated with
increased levels of CRP, glucose, fibrinogen and IL-18, and with decreased levels of IL4.
Gerodontology. 2009 Jun 25. [Epub ahead of print]
Oral health and oral implant status in edentulous patients with implant-supported dental prostheses who are
receiving long-term nursing care.
Isaksson R, Becktor JP, Brown A, Laurizohn C, Isaksson S.
Maxillofacial Unit, Division of Hospital Dentistry, Specialisttandvården, Länssjukhuset, Halmstad, Sweden.
Aim: The aim of this study was to investigate oral health and oral implant status in a
group of edentulous patients receiving long-term residential or nursing care (LTC), all of
whom had implant-supported fixed or removable dental prostheses. Material and
methods: A dental examination was performed on a total of 3310 patients receiving LTC
and from this population 35 edentulous patients in whom dental implants had been
placed formed the cohort for this study. All examinations were performed by a specialist
in hospital dentistry and took place in the patients' own home environment. Oral health
was assessed by means of a protocol which evaluated oral hygiene status, possible oral
mucosal inflammation and oral mucosal friction levels. Any problems with the implantsupported prosthesis, implant mobility or other complications were also assessed. In
addition, patients were asked about any oral symptoms and their usual oral hygiene
procedures. Results: About half of the subjects (17/35) were registered as having
no/mild inflammation with 18 of 35 having moderate/severe inflammation. Twelve of
the 35 patients had good/acceptable oral hygiene and 23 of 35 had poor/bad oral
hygiene. Twenty-one of the 35 patients depended on help from the nursing personnel for
their daily oral hygiene procedures. Obvious problems with food impaction were noted
in 11 patients. A total of 229 implants had been placed in 43 jaws supporting 40 full
arch-fixed prostheses and three implant-borne overdentures. There was no evidence of
mobility or fractures of either the implants or the prostheses. Fifteen implants showed
some exposed screw threads. Pus was exuding from one implant site and general periimplant gingival hyperplasia was noted in two patients. Twenty-four patients were
completely satisfied with the function and appearance of their implant-supported
prostheses. Two patients were totally dissatisfied. Conclusion: This study indicates that
oral implant therapy can be considered as a treatment of choice in elderly patients, even
if oral hygiene is sub-optimal.
Acta Odontol Scand. 2009 Feb;67(1):38-43.
Economic aspects of the detection of occlusal dentine caries.
Norlund A, Axelsson S, Dahlen G, Espelid I, Mejare I, Tranaeus S, Twetman S.
Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden.
OBJECTIVE: To evaluate the cost of true-positive occlusal dentine caries detection in
permanent molars assessed by: (I) visual-tactile examination, (II) visual-tactile
examination combined with bitewing radiographs, and (III) selective radiographic
examination of patients with lesions detected clinically. A second aim was to analyse the
different strategies when the costs of the subsequent restorative care are considered.
METHODS: A model analysis was applied owing to the lack of original articles.
Sensitivity and specificity were calculated from a systematic review and included in
vitro and in vivo studies of medium and high quality. The direct costs for examinations
and restorative care were extracted from the costs of the Public Dental Service in
Sweden (2006). RESULTS: The diagnostic costs per true-positive finding were
dependent on the occurrence of occlusal caries and increased with decreasing
prevalence. The strategy by which radiographs were exposed selectively on the basis of
findings from visual-tactile examination resulted in higher initial costs compared with
the first and second strategies. When the costs of the subsequent restorative care were
added, the selective strategy was most beneficial by up to 26% savings per true-positive
diagnosis. However, with this selective strategy, more cases of true-positive dentine
caries were assumed would remain undetected as compared with the combined strategy
with visual-tactile examination and radiographs for all. CONCLUSIONS: The cost for a
true-positive caries diagnosis was inversely related to caries occurrence, and different
diagnostic strategies may display contrasting outcomes when subsequent restorative care
is taken into account.
Acta Odontol Scand. 2008 Oct;66(5):286-92.
Cost-analysis of school-based fluoride varnish and fluoride rinsing programs.
Sköld UM, Petersson LG, Birkhed D, Norlund A.
Department of Preventive
[email protected]
Dental
Care,
Vastra
Gotaland
Region,
Goteborg,
Sweden.
OBJECTIVE: From a dental care perspective, we analyze whether the prevention of
approximal caries by fluoride varnish treatment (FVT) or by fluoride mouth rinsing
(FMR) could contain costs in an extended period of follow-up after the end of schoolbased prevention programs. MATERIAL AND METHODS: It is assumed in a model
that, after 3 years of prevention with either FVT or FMR according to published studies,
the "natural course" of approximal caries progression would follow for 5 consecutive
years, as described in a Swedish longitudinal study. The outcome and costs of FVT,
FMR and controls were modelled from years 4 to 8. RESULTS: The FVT program had a
better outcome in reducing approximal caries than FMR, and costs were lower. The FVT
was expected to result in cost containment compared to controls 3 years after the end of
the preventive FVT program. The ratio benefits to costs were 1.8: 1 for FVT and 0.9: 1
for FMR. CONCLUSIONS: Prevention of approximal caries by FVT may result in cost
containment, at a benefit cost ratio of 1.8: 1, given that the program can be administered
at school.
J Biomed Mater Res B Appl Biomater. 2008 Nov 5. [Epub ahead of print]
Electron beam-melted, free-form-fabricated titanium alloy implants: Material surface characterization and
early bone response in rabbits.
Thomsen P, Malmström J, Emanuelsson L, René M, Snis A.
Department of Biomaterials, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Göteborg,
Sweden.
Titanium-6aluminum-4vanadium implants (Ti6Al4V) were prepared by free-formfabrication (FFF) and were used either as produced or after machining and compared
with wrought machined Ti6Al4V. Auger electron spectroscopy (AES), depth profiles,
and interferometry were used to analyze the surface properties. The tissue response after
6-weeks in rabbit femur and tibia was evaluated using light microscopy and
histomorphometry. The results revealed that the bulk chemical and mechanical
properties of the reference material and the electron beam-melted (EBM) material were
within the ASTM F136 specifications. The as-produced EBM Ti6Al4V implants had
increased surface roughness, thicker surface oxide and, with the exception of a higher
content of Fe, a similar surface chemical composition compared with machined EBM
Ti6Al4V and machined, wrought Ti6Al4V implants. The two latter implants did not
differ with respect to surface properties. The general tissue response was similar for all
three implant types. Histomorphometry revealed a high degree of bone-to-implant
contact (no statistically significant differences) for all the three implant types. The
present results show that the surface properties of EBM Ti6Al4V display biological
short-term behavior in bone equal to that of conventional wrought titanium alloy. The
opportunity to engineer geometric properties provides new and additional benefits which
justify further studies. (c) 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl
Biomater 2009.
J Mater Sci Mater Med. 2008;19(9):2983-92
Bone ingrowth in zirconia and hydroxyapatite scaffolds with macroporosity.
Malmström J, Adolfsson E, Emanuelsson L, Thomsen P.
Abstract not available.
Caries Res. 2008;42(3):164-70. Epub 2008 Apr 29.
Unrestored dentin caries and deep dentin restorations in Swedish adolescents.
Ridell K, Olsson H, Mejàre I.
Faculty of Odontology, Malmo University, Malmo, Sweden. [email protected]
The objectives of this longitudinal study were to assess: (a) the prevalence of unrestored
dentin caries among 15-year-olds, (b) the proportion of these lesions that had progressed
to deep dentin lesions (inner half of dentin) since the immediately preceding
examination at the age of 14 and (c) the frequency of deep restorations (extending into
the inner half of the dentin). The sample consisted of all 15-year-olds (n = 2,487) born in
1990 and included in the Public Dental Service in Malmo, Sweden. Bitewing
radiographs taken during 2005-2007 and the immediately preceding radiographs were
analysed and scored by two examiners. The main radiographic scores were: sound;
radiolucency in the outer or inner half of dentin; restored surface. The results showed
that 22% of the individuals had 1 or more dentin lesions left unrestored from the time of
the examination at the age of 14 until the next recall examination at the age of 15.
During the observation period (median time 1.2 years), 9% of the unrestored outer
dentin lesions progressed to deep dentin lesions. The majority of these (93%) were in
molars. One or more deep restorations were found in 22% of the 15-year-olds; the
majority involved occlusal surfaces of first molars. In conclusion, unrestored dentin
lesions were common in 15-year-olds. Progression to deep dentin lesions occurred in 9%
of these lesions and was most common in first molars. Occlusal surfaces of first molars
had the highest frequency of deep restorations. (c) 2008 S. Karger AG, Basel
Int J Cancer. 2008 Jul 1;123(1):168-73.
Cancer and mortality among users and nonusers of snus.
Roosaar A, Johansson AL, Sandborgh-Englund G, Axéll T, Nyrén O.
Institute of Odontology, Karolinska Institutet, Stockholm, Sweden. [email protected]
Scandinavian moist snuff (snus) is claimed to be a safer alternative to smoking. We
aimed to quantify cancer incidence among male snus users and to shed light on the net
health outcome by studying their overall mortality. A cohort, comprised of 9,976 men
who participated in a population-based survey, was compiled in 1973-74. Follow-up
until January 31, 2002, was accomplished through record-linkages with nation-wide and
essentially complete registers of demographics, cancer and causes of deaths. Adjusted
relative risks among exposed relative to unexposed men were estimated using Cox
proportional hazards regression. The cohort members contributed more than 220,000
person-years at risk for cancer. A statistically significant increase in the incidence of the
combined category of oral and pharyngeal cancer among daily users of snus (incidence
rate ratio 3.1, 95% confidence interval 1.5-6.6) was found. Overall mortality was also
slightly increased (hazard ratio 1.10, 95% confidence interval 1.01-1.21). Although the
combined previous literature on snus and oral cancer weigh toward no association, this
population-based prospective study provided suggestive evidence of snus-related risks
that cannot be lightly ignored. (c) 2008 Wiley-Liss, Inc.
Swed Dent J. 2008;32:165-9
Treatment of smarting symtoms in the oral mucosa by appliance of lingual acrylic splints.
Axéll T
No abstract available.
Arch Oral Biol. 2008 Sep;53(9):896-902. Epub 2008 Jun 12.
LPS-induced MCP-1 and IL-6 production is not reversed by oestrogen in human periodontal ligament cells.
Jönsson D, Nebel D, Bratthall G, Nilsson BO.
Department of Periodontology, Faculty of Odontology, Malmö University, SE-205 06 Malmö, Sweden.
[email protected]
OBJECTIVE: Periodontal ligament (PDL) cells express oestrogen receptors but the
functional importance of oestrogen in PDL cells exposed to bacterial endotoxins is not
known. Here we investigate if the inflammation promoter lipopolysaccharide (LPS)
affects PDL cell production of interleukin-6 (IL-6), monocyte chemoattractant protein-1
(MCP-1), C-reactive protein (CRP) and/or normal functional PDL cell characteristics
such as collagen synthesis and cell proliferation and if oestrogen modulates the effects of
LPS. METHODS: PDL cells were obtained from periodontal ligament of premolars.
PDL cells were treated with Escherichia coli LPS in the absence or presence of
oestrogen (17beta-oestradiol, E2). Cellular concentration of IL-6, MCP-1 and CRP was
determined by enzyme-linked immunosorbent assay (ELISA). Collagen synthesis was
determined by l-[3H]proline incorporation. Cell proliferation was assessed by DNA
synthesis measurement using [3H]thymidine incorporation. RESULTS: Stimulation with
LPS (500 ng/ml to 10 microg/ml) increased IL-6 production in a concentrationdependent manner. Lower concentration (100 ng/ml) of LPS had no effect. LPS-induced
stimulation of IL-6 was not reversed by a physiologically high concentration (100 nM)
of E2. LPS increased also MCP-1 production which was unaffected by E2. Treatment
with E2 alone had no effect on either IL-6 or MCP-1. Stimulation with LPS had no
effect on CRP. LPS did not affect collagen synthesis and cell proliferation, reflecting
normal physiological properties of PDL cells. CONCLUSIONS: LPS stimulates PDL
cell IL-6 and MCP-1 production but has no effect on the normal physiological properties
of PDL cells. LPS-induced IL-6 and MCP-1 is not reversed by oestrogen suggesting that
oestrogen exerts no anti-inflammatory effect via this mechanism.
Swed Dent J. 2008;32(3):115-23.
What findings do clinicians use to diagnose chronic periodontitis?
Leisnert L, Hallström H, Knutsson K.
Department of Comprehensive Care, Faculty of Odontology, Malmö University, Malmö, Sweden.
[email protected]
The prevalence of chronic periodontitis is around 40% in the adult population and most
patients visiting a dental clinic experience an intervention related to this disease, either
as prophylaxis, e.g. disease information, oral hygiene instruction and polishing, or as
treatment of the disease, per se. Hence, chronic periodontitis is a diagnosis that initiates
time and costs consuming interventions. The findings clinicians use to diagnose chronic
periodontitis are probably also the base for their choice of treatment. The aim of this
study was to examine: What findings dental students, dental hygienist students, dental
teachers, and supervisors in Public Dental Health use to diagnose patients with chronic
periodontitis. If different categories of clinicians use different findings to diagnose
chronic periodontitis. A questionnaire was distributed. Seventy-six clinicians
representing the four categories answered the question: "What findings, or combinations
of findings, do you use when you diagnose chronic periodontitis"? Twenty-five different
findings were identified as findings the clinicians use when they diagnosed chronic
periodontitis. The most frequently reported findings were bleeding, deepened pockets
and loss of marginal bone tissue. Variations between different categories of clinicians
were identified. For example, dental hygienist students used more findings (P < 0.05),
and were also more inclined to use irrelevant findings like calculus, plaque, smoking,
compared to the other categories of clinicians (P < 0.05). The majority of clinicians used
only one finding at a time to diagnose chronic periodontitis, and more seldom combined
findings. Only 12 out of 76 clinicians used a finding that provided soft tissue
inflammation, e.g. bleeding, in combination with a finding that provided loss of
supporting tissue, e.g. marginal bone loss. Few clinicians commented that there should
be a progressive loss of supporting tissue over time. Further research is needed to
investigate if these variations in findings used to diagnose chronic periodontitis indicate
variations in treatment of these patients.
J Periodontol. 2008 Mar;79(3):401-5.
Comparison of different methods of assessing alveolar ridge dimensions prior to dental implant placement.
Chen LC, Lundgren T, Hallström H, Cherel F.
Department of Periodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA.
BACKGROUND: The aim of this study was to compare ridge-mapping measurement
before surgical flap reflection and measurement using images from cone beam
computerized tomography (CBCT) to direct caliper measurement following surgical
exposure of the bone. METHODS: Sixteen subjects with 25 sites for planned implant
placement or ridge augmentation were recruited. An acrylic stent was fabricated for each
subject. The stent provided three buccal/lingual pairs of consistent measurement points
for each implant site located 4, 7, and 10 mm from the summit of the alveolar soft tissue.
Two independent examiners participated. RESULTS: Comparisons of bucco-lingual
ridge width using ridge-mapping versus direct caliper measurements showed that 94%
and 89% of the pairs of measurement deviations were within +/- 1 mm for examiners 1
and 2, respectively. The corresponding comparison of CBCT images versus direct
caliper measurements showed 70% and 55% agreement for examiners 1 and 2,
respectively. CBCT image measurements provided lower levels of agreement than ridgemapping measurements because of the more frequent and larger magnitudes of
deviations compared to direct caliper measurements. CONCLUSIONS: Most often,
ridge mapping provides measurements of the bucco-lingual ridge width consistent with
those obtained by direct caliper measurement following surgical exposure of the bone.
As applied in this study, CBCT was less consistent compared to direct caliper
measurements and did not provide any additional, significant diagnostic information.
Clin Oral Implants Res. 2008 Mar;19(3):219-26.
Short-term clinical results of Nobel Direct implants: a retrospective multicentre analysis.
Sennerby L, Rocci A, Becker W, Jonsson L, Johansson LA, Albrektsson T.
Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University,
Gothenburg, Sweden. [email protected]
PURPOSE: The present retrospective clinical study was undertaken to evaluate the
survival rate and marginal bone conditions around Nobel Direct one-piece implants. The
purpose was also to compare the results with when these implants are used for
immediate/early loading with implants allowed to heal before loading. MATERIAL
AND METHODS: Forty-three consecutive patients previously treated with 117 Nobel
Direct implants at four different centres were evaluated. The implants had been used in
both jaws for treatment after loss of single and multiple teeth. Immediate/early loading
(within 2 weeks) with a provisional crown/bridge was applied to 95 implants, while 22
implants healed unloaded for 6 weeks to 6 months before loading. Calculations of
marginal bone loss were performed in radiographs taken at placement and after an
average of 10.2 months (range 1-18 months) of loading. RESULTS: Six (5.1%) of the
117 implants were removed during the follow up. All failed implants belonged to the
immediate/early loading group giving a failure rate of 6.3% for this group and 0% for
two-stage implants. The failure rate was higher for flapless (7.9%) than for flap surgery
(0%). The marginal bone loss was -2.4 mm (SD 1.5) for all implants, while 37.6%
showed more than 3 mm of loss during the follow up. Bone loss increased with time of
follow up. Implants subjected to immediate/early loading showed more bone loss than
two-stage implants: -2.6 mm (SD 1.5) vs. -1.6 mm (SD 1.1). Moreover, 41.3% of
immediately loaded and 22.7% of two-stage implants presented with more than 3 mm of
bone loss. CONCLUSIONS: This short-term retrospective analysis showed a poor
clinical outcome of Nobel Direct implants. Extensive marginal bone loss (>3 mm) was
found around more than 1/3 of the implants evaluated. Less resorption and no failures
were experienced when implants were allowed to heal from 6 weeks to 6 months before
occlusal loading. Within the limitations of the present study design, data indicate that
immediate loading, the use of this implant for multi-unit constructions and flapless
surgery are risk factors for failure of Nobel Direct implants.
J Oral Maxillofac Surg. 2008 Apr;66(4):780-6.
The use of particulate bone grafts from the mandible for maxillary sinus floor augmentation before placement
of surface-modified implants: results from bone grafting to delivery of the final fixed prosthesis.
Becktor JP, Hallström H, Isaksson S, Sennerby L.
Division of Oral and Maxillofacial Surgery, Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden.
[email protected]
PURPOSE: This prospective study followed 61 patients who were partially dentulous
and considered to have insufficient bone volume for routine implant treatment and
consequently underwent sinus inlay bone grafting. PATIENTS AND METHODS: The
patients were treated with maxillary sinus floor augmentation with particulated
autogenous bone from the mandibular ramus/corpus. After a healing period, dental
implants (n = 180) were installed. RESULTS: Radiographic examination revealed
average residual vertical bone heights of 6.5 mm in the first premolar region, 3.8 mm in
the second premolar region, 3.5 mm in the first molar region, and 2.6 mm in the second
molar region. The average implant lengths were 12 mm in the first premolar region and
11 mm in the second premolar, first, and second molar regions. All patients received a
fixed partial prosthesis. All bone grafts were stable, and the implant survival rate was
98.9%. There were few cases of minor complications postoperatively and no record of
any injured teeth, heavy bruising, bleeding, or swelling in either the donor site or the
recipient site. The present clinical study demonstrated a low failure rate of surfacemodified dental implants when placed into the maxillary sinus an average of 7 months
after augmentation with particulate mandibular bone grafts and followed up to delivery
of the final fixed prosthesis. CONCLUSION: The findings indicate that treatment with
endosseous implants may be as predictable in patients with inadequate bone who
underwent sinus floor augmentation as in patients with adequate bone volume.
J Oral Maxillofac Surg. 2008 Jan;66(1):104-11.
Transverse displacement of the proximal segment after bilateral sagittal osteotomy: a comparison of lag screw
fixation versus miniplates with monocortical screw technique.
Becktor JP, Rebellato J, Sollenius O, Vedtofte P, Isaksson S.
Division of Oral and Maxillofacial Surgery, Maxillofacial Unit, Specialisttandvården, Länssjukhuset,
Halmstad, Sweden. [email protected]
PURPOSE: The purpose of the present study was to compare lag screw fixation versus
miniplates with monocortical screw technique with respect to the amount of transverse
displacement of the proximal segment after bilateral sagittal osteotomy (BSO) for
mandibular advancement surgery. PATIENTS AND METHODS: We conducted a
multicenter, retrospective investigation of 82 patients who underwent a mandibular
advancement with BSO and rigid internal fixation. Forty-five patients from Denmark
and Sweden, the miniplate fixation group, received a rigid fixation consisting of
miniplates with monocortical screws. Thirty-seven patients from the Mayo Clinic, the
lag screw fixation group, received a rigid fixation with lag screw fixation of the
mandible. The transverse displacement and angulation of the proximal segments were
measured on posterior-anterior cephalometric radiographs, using the best-fit method.
RESULTS: After BSO, 44 of 45 patients in the miniplate fixation group showed an
increased transverse intergonion distance with a mean of 5.0 mm and an increase
transverse interramus width with a mean of 2.4 mm. Thirty-six of 37 patients in the lag
screw fixation group had an increased intergonial width with a mean of 5.6 mm, and 35
of 37 patients showed an increased transverse interramus width with a mean of 3.3 mm. t
tests showed that there were no significant differences between the 2 groups with respect
to these 2 variables. CONCLUSIONS: Our results indicate that transverse displacements
of the proximal segments occur after BSO surgery with both miniplate or lag screw
fixation technique. Attention and future studies should focus on possible complications
that transverse displacement of the proximal segment may cause.
Swed Dent J. 2007;31(3):113-20.
Attitudes, awareness and perceptions on evidence based dentistry and scientific publications among dental
professionals in the county of Halland, Sweden: a questionnaire survey.
Rabe P, Holmén A, Sjögren P.
Maxillofacial unit, Halmstad Hospital, Halmstad, Sweden.
The objective was to identify dental professionals' attitudes and awareness on evidence
based dentistry (EBD), and to elucidate perceived barriers and views on how to move
towards EBD. A questionnaire was sent to 290 dental professionals (dental hygienists,
general dentists, specialist dentists) in the county of Halland, Sweden. The questionnaire
consisted of closed questions and free text sections, related to attitudes, awareness and
skills on databases, EBD, and terms related to scientific publications, as well as
perceived barriers towards EBD. A majority of the respondents had a welcoming attitude
towards EBD. The respondents perceived their colleagues less positive towards EBD.
The respondents considered EBD, at least partly, useful in daily dental practice. With the
exception of general dentists in private practice, a vast majority of the dental
professionals thought that EBD would improve the care of their patients. Dental
professionals in the county of Halland, in Sweden, had a welcoming attitude towards
EBD, and indicated an open attitude for learning more about interpretation of evidence
from scientific publications. The most commonly perceived barriers towards EBD, were
'lack of time' and 'poor availability of evidence'.
Int J Oral Maxillofac Implants. 2007 Jul-Aug;22(4):603-8.
Endosseous implants and bone augmentation in the partially dentate maxilla: an analysis of 17 patients with a
follow-up of 29 to 101 months.
Becktor JP, Isaksson S, Sennerby L.
Division of Oral and Maxillofacial Surgery, Maxillofacial Unit, Specialisttandvården, Länssjukhuset,
Halmstad, Sweden. [email protected]
PURPOSE: The aim of this study was to analyze the survival rate of endosseous
implants placed in the partially dentate maxilla treated with sinus inlay block bone
grafts. MATERIALS AND METHODS: Seventeen patients were subjected to bone
augmentation procedures prior to or in conjunction with implant placement. Bone
volumes were regarded as insufficient for implant treatment unless a bone grafting
procedure was performed. The patients were treated with sinus inlay block bone grafts
and endosseous implants in a 1- or 2-stage procedure. A total of 69 implants were placed
in the patients who were followed for 29 to 101 months (mean, 53.1 months). The
retrospective patient group was also prospectively followed using a standardized clinical
and radiographic study design. RESULTS: The implant survival rate was 91.3% (63/69).
All implants were lost during the period from abutment connection to connection of the
definitive prosthesis. All bone grafts were stable. Bone grafts supported 48 implants, of
which 5 failed (10.4%). In the residual bone, 21 implants were placed, of which 1 failed
(4.8%). All patients received a fixed partial prosthesis, which was stable during the
follow-up period. CONCLUSION: The results of this investigation revealed a
satisfactory clinical outcome of implant placement in grafted partially dentate maxillae
after a mean follow-up of 53.1 months.
Clin Implant Dent Relat Res. 2007 Dec;9(4):179-85.
A prospective multicenter study using two different surgical approaches in the mandible with turned
brånemark implants: conventional loading using fixed prostheses.
Becktor JP, Isaksson S, Billström C.
Division of Oral and Maxillofacial Surgery, Maxillofacial Unit, Specialisttandvården, Länssjukhuset,
Halmstad, Sweden and Department of Biomaterials, Institute for Surgical Sciences, University of Göteborg,
Sweden.
Background: The use of a submerged implant system in a nonsubmerged surgical
procedure has been reported to have promising results. At the time this study was
initiated, no prospective, comparative studies with randomization between submerged
and nonsubmerged surgical techniques had been published. Purpose: To evaluate the
submerged and nonsubmerged surgical techniques when treating mandibular edentulism
using a submerged implant system, with regard to implant survival and complications.
Materials and Methods: A total of 77 patients were included and treated at nine clinics in
Sweden and Norway. In total, 404 Brånemark System implants (standard and MkII
implants) were inserted in the edentulous mandible; 198 implants according to the
nonsubmerged protocol and 206 implants according to the traditional submerged
procedure. The follow-up period was up to 36 months after prosthesis insertion. Results:
In the nonsubmerged group, 17 implants out of 198 implants (8.6%) were lost and in the
submerged group, 5 out of 206 implants (2.4%) were lost. All implant failures occurred
before the delivery of the final prosthesis. No major complications were reported during
the implant surgery. However, at the clinical check-up postoperatively and at the
abutment connection surgery, 6 patients in the nonsubmerged group complained of pain
at the implant sites, whereas there were no complaints of pain in the submerged group.
Conclusions: The results of this study suggest that a turned Brånemark implant designed
for a submerged implant placement procedure can be used in a nonsubmerged procedure
and may be as predictable as the conventional submerged approach.
Oral Health Prev Dent. 2007;5(3):223-7.
Effect of dentifrices with antimicrobial agents on mutans streptococci in saliva and approximal dental plaque
in orthodontic patients.
Magnusson K, Petersson LG, Birkhed D.
Department of Preventive and Community Dentistry, Maxillofacial Unit, Central Hospital, Halmstad,
Sweden.
PURPOSE: The aim of the present investigation was to study the effect of daily use of
fluoride dentifrices containing various antimicrobial agents on mutans streptococci (MS)
in saliva and approximal dental plaque. MATERIALS AND METHODS: Fifty-nine
healthy adolescents, 12-14 years old, undergoing orthodontic treatment with fixed
appliances and harbouring high levels of MS in saliva and preferably also in interdental
plaque, were randomly distributed into four groups, using dentifrices with: 1) zinc
lactate (n = 16), 2) amine fluoride-stannous fluoride (n = 13), 3) triclosan (n = 15), and
4) no antimicrobial agent (control; n = 15). Changes of MS scores versus baseline were
determined after 1, 3 and 6 months, using the Dentocult SM Strip mutans test.
RESULTS: At the 6-month sampling occasion, the subjects using dentifrice with either
amine fluoride-stannous fluoride or triclosan showed a tendency to lower MS scores in
interdental plaque (p < 0.05). In saliva and in the 1- and 3-month plaque samples, no
changes of MS were detected in any of the four groups. CONCLUSION: This 6-month
clinical study showed that dentifrices with various antimicrobial agents only result in
small or no changes of the MS scores in saliva and approximal dental plaque in
orthodontic patients.
Acta Odontol Scand. 2007 Aug;65(4):219-23.
Background factors associated with endodontic treatment due to caries in young permanent teeth.
Ridell K, Matsson L, Mejàre I.
Department of Paediatric
[email protected]
Dentistry,
Faculty
of
Odontology,
Malmö
University,
OBJECTIVE: The aim of this retrospective cohort study was to assess the association
between background factors and future endodontic treatment due to caries in young
permanent teeth. MATERIAL AND METHODS: The material comprised all 19-yearolds born in 1979 in a city in Sweden who had experienced endodontic treatment due to
caries in permanent teeth (n=105) and a control group with no endodontic treatment.
From dental records, the following independent variables were derived from age 7 to age
19: immigrant background, caries prevalence (DMFT values) at age 10, occurrence of
dental anxiety, and missed or cancelled appointments before endodontic treatment. The
outcome variable was presence or absence of endodontic treatment due to caries.
Sweden.
Bivariate analysis and a multiple logistic regression model were used to analyse the data.
RESULTS: In the bivariate analyses, all independent variables except cancelled
appointments were statistically significantly associated with future endodontic treatment.
Of these, immigrant background did not remain as a statistically significant factor in the
multiple regression model. The highest odds ratios were 4.3 for >2 DMFT at age 10 and
4.1 for >20% missed appointments. CONCLUSION: In the present sample, with a
relatively high proportion of individuals with an immigrant background, >2 DMFT at
age 10, many missed appointments and dental anxiety were all risk indicators for future
endodontic treatment due to caries up to age 19.
Caries Res. 2007;41(3):177-85.
Detection of approximal caries by clinical and radiographic examination in 9-year-old Swedish children.
Lillehagen M, Grindefjord M, Mejàre I.
Department of Paediatric Dentistry, Eastman Dental Institute, Stockholm, Sweden.
The aims were to determine caries prevalence in 9-year-olds belonging to a low-caries
prevalence population and to assess how accurately some commonly used risk
factors/risk markers (predictors) can identify additional approximal caries as judged
from bitewing examination (BW). One calibrated dentist examined 117 consecutive 9year-olds from the inner city of Stockholm. The predictors were the number of clinically
detected dfs and DFS, visible plaque, salivary mutans streptococci, tooth brushing
habits, consumption of sugary products, parents' education, and (before BW) an overall
clinical judgement by the examiner. Analyses of the data included sensitivity and
specificity and a multiple logistic regression model. When BW was included, the mean
DFS was 0.27 and the mean dfs 1.74. For approximal enamel and dentin lesions, the
average gain from BW was 0.20 lesions for permanent first molars and 1.23 lesions for
primary molars. Altogether, 48% of the children benefited from BW. The best predictors
of additional approximal caries from BW were presence of caries (cavitation/dentin
level) on occlusal surfaces of permanent first molars and the dentist's judgement based
on clinical findings, both with a combined sensitivity and specificity of 134%. The only
statistically significant variables in a logistic regression model were the dentist's
judgement and the child's statement about regular tooth brushing. It is concluded that a
sizeable proportion of 9-year-olds, representing a low-caries prevalence population,
benefited from BW. However, the ability to identify these children from the predictors
was limited. Copyright 2007 S. Karger AG, Basel.
Oral Health Prev Dent. 2007;5(3):229-33.
Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression
assessed by laser fluorescence.
Andersson A, Sköld-Larsson K, Hallgren A, Petersson LG, Twetman S.
Department of Orthodontics, Public Dental Service, Skansgatan 1B, SE-302 46 Halmstad, Sweden.
PURPOSE: To investigate and compare the effects of a dental cream containing
complexes of casein phosphoprotein-amorphous calcium phosphate (CPP-ACP) and
fluoride mouthwashes on the regression of white spot lesions (WSL). MATERIALS
AND METHODS: The study group consisted of 26 healthy adolescents (mean age 14.6
years) exhibiting 60 teeth with 152 visible WSL sites on incisors and canines
immediately after debonding of fixed orthodontic appliances. After bracket removal,
professional tooth cleaning and drying, a visual scoring (0-4) and laser fluorescence (LF)
readings were carried out. The patients were randomly assigned to two different
treatment protocols with the aim of remineralising the lesions: A) daily topical
applications of a dental cream containing CPP-ACP (Topacal) for 3 months followed by
a 3-month period of daily toothbrushing with fluoridated dentifrice, or B) daily 0.05%
sodium fluoride mouthwash combined with fluoridated dentifrice for 6 months. The
registrations were repeated after 1, 3, 6 and 12 months and follow-up data were
compared with baseline with aid of chi-square and paired t-tests. RESULTS: A
significant improvement of the clinical WSL-scores was found over time in both groups,
but there was a statistically significant difference (p < 0.01) concerning the number of
sites that totally disappeared after 12 months in favour of the CPP-ACP regime, 63%
compared with 25% respectively. The clinical registrations were mirrored by a
statistically significant decrease (p < 0.05) in the LF readings at the 6- and 12-month
follow-ups compared with baseline. No significant differences were displayed between
the groups. CONCLUSIONS: Clinical scoring and LF assessment suggested that both
regimens could promote regression of WSL after debonding of fixed orthodontic
appliances. The visual evaluation suggested an aesthetically more favourable outcome of
the amorphous calcium phosphate treatments.
Acta Odontol Scand. 2007 Jun;65(3):149-55.
Photographic assessment of fluorosis in children from naturally fluoridated Kungsbacka and non-fluoridated
Halmstad, Sweden.
Macpherson LM, Conway DI, Gilmour WH, Petersson LG, Stephen KW.
Dental Public Health Unit, University of Glasgow Dental School. Glasgow. UK.
Objectives. To assess levels of fluorosis and fluorosis of esthetic concern in children
from a naturally fluoridated and a non-fluoridated area of Sweden, and to determine the
relative contributions of fluoridated water, parental educational level, and infant oral
health-related behaviors. Methods. A parental questionnaire collected information
concerning child F-supplement and F-dentifrice usage histories, and socio-economic
status. Photographic examination of 1336 subjects (F=791; N-F=545) was undertaken.
Fluorosis was assessed (blind to F-exposure) in a random sample (n=250) of 35 mm
slides by four dental and two lay "jurors" (with 10% random repeat-viewing for interobserver and intra-observer agreement). Four outcomes were assessed on each slide:
fluorosis at any level, fluorosis of esthetic concern, acceptability of appearance, and
treatment needs. Ordinal logistic regression models were used to determine significant
determinants. Results. For presence of fluorosis of esthetic concern, majority jury
agreements (>3 of 6) were seen in only 2.3% (N-F) and 13.4% (F) pupils (p<0.001),
albeit jurors unanimously scored only 13 F and 2 N-F exposed children as having
esthetically unacceptable fluorosed teeth (p<0.001). The over-riding significant factor in
terms of fluorosis of esthetic concern was exposure to water fluoridation in infancy in
both unadjusted and adjusted models. Conclusions. The important factor in relation to
fluorosis of esthetic concern was explained by exposure to fluoridated water in infancy,
and was not explained by age, sex, level of parental education or early childhood oral
health behaviors. However, prevalence of this condition was relatively low. These
findings should inform policies on appropriate total fluoride exposure levels during
infancy.
Am J Dent. 2007 Apr;20(2):93-6.
Remineralization of primary root caries lesions using an amine fluoride rinse and dentifrice twice a day.
Petersson LG, Hakestam U, Baigi A, Lynch E.
Department of Communty and Preventive Dentistry, Dental and Maxillofacial Unit, Central Hospital,
Halmstad, S-301 85, Sweden. [email protected]
PURPOSE: To assess the clinical effect of daily use of a toothpaste and mouthrinse,
both containing amine fluoride, on primary root caries lesions (PRCL) in an adult caries
risk population. METHODS: A clinical trial based on male and female subjects, 55-81
years of age, randomly assigned into two equal groups (Groups A and B). Fifty subjects
allocated to Group A used a fluoride toothpaste twice a day, (Elmex sensitive toothpaste,
1400 ppm F) plus a mouthrinse twice a day with 10 ml of a fluoride solution (Elmex
sensitive rinse containing 250 ppm F). The fluoride used was amine fluoride and
potassium fluoride (AmF/KF, 1:1). Subjects in Group B used the same fluoride
toothpaste plus a placebo mouth rinse solution without fluoride. At baseline, a total of
420 PRCL were clinically recorded as either soft (score 3) or leathery (score 2). Parallel
and blind recordings measuring electric resistance of the selected PRCL were performed
at baseline and after 3, 6, 9 and 12 months using an electrical caries monitor (ECM).
Prevalence of tooth sensitivity and subject's satisfaction was also measured in the two
groups. RESULTS: The clinical results showed statistically significant higher numbers
of reversals of soft (score 3) and leathery (score 2) PRCL in Group A compared to
Group B. After 12 months, the number of soft PRCL (score 3) decreased in Group A
from 74% at baseline to 11% compared with 73% to 46% in Group B. After 12 months,
67% of the PRCL became hard (score 1) in Group A compared to only 7% in Group B
(P < 0.001). Statistically significant higher (P < 0.001) ECM mean (sd) log10 resistance
values were recorded for the subjects in Group A, 2.67 (2.56) kOhm compared to 2.12
(1.88) kOhm in Group B. Tooth sensitivity was substantially reduced after 12 months,
by 56% in Group A compared to 20% in Group B.
Swed Dent J. 2007;31(1):45-52.
Oral status and treatment needs among elderly within municipal long-term care 2002-2004.
Isaksson R, Söderfeldt B.
Maxillo-Facial Unit, Halmstad Hospital, Halmstad, Sweden. [email protected]
A supplementary regulation in the Swedish National Dental Health Care Insurance
stipulates an increased economic support to those, who are dependent permanently due
to disease or handicap. Once enlisted to care, they are entitled to an annual dental
examination and individual prophylactic advice free of charge, and to necessary dental
treatment, offered within the ordinary medical care, regulated and funded by the county
council. A population of persons, > or = 65 years of age and enrolled in municipal longterm care (LTC) in a county in the south of Sweden, was followed regarding changes in
oral status and treatment needs for two years. The number of persons examined the year
2002 was 2416 and the corresponding figure for 2004 was 2846. Totally 1170, i.e.
48.4%, of those examined 2002 were deceased two years after the initial examination.
Only 914, assessed in 2002, were available for assessment with full data at follow up
2004 and the results are based upon assessments in this group. Analyzing the assessed
variables (dental status, oral hygiene status, oral mucosal inflammation, oral mucosal
friction) revealed a change during these two years. Significant impairments were
recognised, regarding mucosal inflammation and mucosal friction. Regarding treatment
needs assessed by a dentist and a dental hygienist, there was a maintained and even
increased need for extensive treatment, both by the dentist and, to a greater extent, by the
dental hygienist. In sum, prevention efforts both from the dental profession and from
other care providers are important to achieve and maintain acceptable oral status.
J Oral Maxillofac Surg. 2007 May;65(5):931-5.
Prospective study of periapically infected teeth treated with periapical surgery including ultrasonic
preparation and retrograde intermediate restorative material root-end fillings.
Walivaara DA, Abrahamsson P, Isaksson S, Blomqvist JE, Samfors KA. Resident, Maxillofacial Unit, Halmstad
Hospital, Halmstad, Sweden.
PURPOSE: The aim of this prospective study was to evaluate the current method of
periapical surgery at the Maxillofacial Unit, Halmstad Hospital, which included
ultrasonic root-end preparation and the use of intermediate restorative material as a rootend filling material. PATIENTS AND METHODS: Fifty-five consecutive patients with
a total of 56 treated teeth, within the close vicinity of the hospital, were included in the
study during a period of 10 months in 2002. Teeth with advanced periodontal bone loss
or presence of root fractures were excluded from the study. RESULTS: All teeth but 1
were followed up after 1 year (12-19 months). Radiological evaluation (complete or
incomplete healing) and clinical examination showed an 80% success rate. Twenty
percent of the patients were stated as failures (uncertain healing and unsatisfactory
healing). The success rate was highest among incisors (100%) and lowest among molars
and premolars (78% and 69%, respectively). CONCLUSION: Compared with other
studies, these findings seemed to be a bit inferior regarding success rate. However, our
study population was not selected for the study purpose but rather represented the true
clinical variety taken care of in our practice.
Br J Oral Maxillofac Surg. 2006 Nov 30;
Description of a technique for evaluation of three-dimensional shape alterations in soft tissue after intra oral
bone reconstruction.
Walivaara DA, Isaksson S, Rosen S.
Maxillofacial Unit, Halmstad Hospital, Sweden.
Equipment from GFMesstechnik, Germany, for three-dimensional (3D) measurements
of topography alterations was tested in an intra oral situation. A patient with previous
loss of tooth 21 due to trauma planned for local bone grafting procedure together with a
titanium mesh and later implant insertion was signed as a trial. Pre- and postoperative
measurements of the buccal contour in maxillary anterior region were performed with
the 3D equipment and the pictures were evaluated in a software programme. The
evaluation showed ability to reproduce numerical volume changes in the buccal soft
tissue in the operated area. The contour changes can be displayed as a diagram change as
well, with possibility to make numerical calculations. We believe this is an excellent
system to use in long-term follow-ups of the soft tissue changes after intra oral
reconstructive procedures. The procedure is a rapid, accurate, and harmless procedure
and can be performed directly on the patient.
Clin Oral Investig. 2006 Sep;10(3):249-52. Epub 2006 May 16.
Inhibition of enamel lesion formation by fluoridated milk assessed by laser fluorescence-an in vitro study.
Engstrom K, Petersson LG, Twetman S.
Pediatric and Preventive Dentistry, Oral and Maxillo-Facial Unit, Lanssjukhuset, Halmstad, 301 85, Sweden.
The aim of this study was to investigate the effect of fluoridated milk on enamel lesion
formation as assessed by laser fluorescence (LF). The material consisted of 18 extracted
premolar teeth that were cut in mesial-distal direction and pairwise assigned to either test
or control samples in an experimental caries model. The teeth were exposed to a low-pH
5% cellulose gel for 4 h, 5 days per week immediately followed by a 4-h period in either
fluoridated (5 ppm, test) or nonfluoridated milk (control). In the meantime, the
specimens were stored in pooled human-stimulated whole saliva in room temperature.
All teeth were examined by visual inspection with a magnifying glass and by LF
readings (DIAGNOdent) at baseline and after 2 and 4 weeks. The baseline LF readings
ranged from 3 to 7 with a mean value of 5.6+/-0.9. The mean values increased with time
in both groups but the increase was more marked in the control teeth, 8.7+/-2.3 vs
12.8+/-3.3 after 4 weeks, this difference being statistically significant (p<0.01). The
visual examination could not distinguish between the test or control samples after 2 and
4 weeks, respectively. The findings indicated that fluoride added to milk may to some
extent counteract enamel lesion formation as assessed by LF in an experimental caries
model.
Int J Cancer. 2006 Feb 9.
A long-term follow-up study on the natural course of snus-induced lesions among Swedish snus users.
Roosaar A, Johansson AL, Sandborgh-Englund G, Nyren O, Axell T.
Institute of Odontology, Karolinska Institutet, Stockholm, Sweden.
Snus-induced lesions (SILs) are mucosal changes that are regularly seen in users of
moist snuff (snus). Their role in oral carcinogenesis remains undefined. Our aim was to
assess the natural course of SILs over several decades. A cohort of 1,115 individuals
with SILs, confirmed in 1973-1974 during a population-based survey was followed for
27-29 years through multiple record linkages with virtually complete population- and
health registers. A sample (n = 267) of the cohort members were invited for
reexamination after 19-22 years. Register-based follow-up through January 2002
revealed a total of 3 incident cases of oral cancer (standardized incidence ratio of 2.3,
95% CI 0.5-6.7), none of which occurred at the site of the original SIL. There was a
strong association noted between the degree of SIL and current snus consumption. The
SILs had disappeared in all 62 individuals who had permanently quitted using snus. In
no case did we observe an important clinical change for the worse among individuals
who had decreased their use or continued unabatedly. While the incidence of oral cancer
in this cohort of individuals with SILs tended to be higher than expected, we conclude
that cancers rarely occur at the site of lesions observed in the distant past. (c) 2006
Wiley-Liss, Inc.
Clin Implant Dent Relat Res. 2005;7(3):159-65.
Evaluation of 31 zygomatic implants and 74 regular dental implants used in 16 patients for prosthetic
reconstruction of the atrophic maxilla with cross-arch fixed bridges.
Becktor JP, Isaksson S, Abrahamsson P, Sennerby L.
Division of Oral and Maxillofacial Surgery, Maxillofacial Unit, Lanssjukhuset, Halmstad, Sweden.
[email protected]
BACKGROUND: The use of a specially designed implant to be anchored in the
zygomatic body has been proposed as an alternative to bone grafting in the prosthetic
rehabilitation of the severely resorbed maxilla. However, few studies have evaluated the
long-term stability and soft tissue conditions of zygomatic implants. PURPOSE: The
aim of this retrospective study was to evaluate the clinical performance of zygomatic
implants when used for prosthetic reconstruction of atrophic maxillae. MATERIALS
AND METHODS: Sixteen patients consecutively treated with 31 zygomatic implants
and 74 additional dental implants from 1998 to 2002 were retrospectively evaluated and
prospectively followed using a standardized clinical and radiographic study design. Data
were collected from the time of implant treatment until the last follow-up RESULTS:
The follow-up period ranged from 9 to 69 months from the day of implant treatment,
with a mean of 46.4 months (3 years, 10 months). Three (9.7%) of the 31 zygomatic
implants were surgically removed because of recurrent sinusitis. Three (4.1%) of the 71
additional dental implants failed to integrate. Poor oral hygiene and gingivitis were seen
at most zygomatic implant sites (10/16). Local infections were observed in 9 of 16
patients. Sinusitis occurred in 6 patients. All patients (16/16) eventually received fixed
bridges, which were stable throughout the observation period. CONCLUSIONS: The
results showed an acceptable outcome with regard to implant and prosthetic survival
rates. However, postoperative complications not related to implant and prosthesis
stability were frequent. Further investigations of the long-term performance of
zygomatic implants and with a focus on soft tissue and maxillary sinus health are
needed.
Oral Health Prev Dent. 2005;3(4):203-7.
Cognitive impairment is associated with poor oral health in individuals in long-term care.
Henriksen BM, Engedal K, Axell T.
Faculty of Dentistry, University of Oslo, Norway.
PURPOSE: The aim of this work was to study oral hygiene and cognition in patients in
long-term care. MATERIALS AND METHODS: A representative sample of individuals
in long-term care aged 67 years and above, from all 19 countries of Norway, was
selected for the study. Trained local dental teams examined 1910 individuals--1358 from
institutions and 552 living at home. Oral hygiene was assessed by means of a combined
plaque and mucosal score (MPS), and cognition by means of a short version of MiniMental State Examination (MMSE-12). RESULTS: Mean age was 84.2 years and the
age range was 67-106 years. Over 70% were cognitively impaired. Cognitive
impairment increased with age and was more prevalent in institutionalised individuals
compared to those living at home. Poor oral status was more prevalent among
individuals with cognitive impairment. CONCLUSION: The results of this study
indicate that a large proportion of individuals in long-term care in Norway show
cognitive impairment. A high proportion of these has a poor oral status. Thus, they carry
a high risk of developing dental caries. Obviously, there is a demand for careful and
close surveillance of oral hygiene and oral health in individuals in long-term care, and
especially of those cognitively impaired.
Oral Dis 2005;11:116-8.
Risk for developing cancer in Sweden after use of snuff.
Axell T.
Abstract not available.
Caries Res. 2005 Nov- Dec;39(6):529-35.
Approximal caries development in adolescents with low to moderate caries risk after different 3-year schoolbased supervised fluoride mouth rinsing programmes.
Moberg Skold U, Birkhed D, Borg E, Petersson LG.
Department of Preventive Dental Care, Vastra Gotaland Region, Goteborg, Sweden.
The aim was to evaluate a 3-year randomised controlled trial of school-based fluoride
mouth rinsing (FMR) on approximal caries development in 13- to 16-year-olds with low
to moderate caries risk. The adolescents used F toothpaste at home and underwent
prophylactic treatment at yearly check-ups at public dental clinics. Out of 788 randomly
selected 13-year-olds, 622 completed the trial, carried out in 1999-2003. Supervised by a
dental nurse, the subjects rinsed with a 0.2% NaF solution at different intervals. Group 1
rinsed their teeth on the first three schooldays every semester; group 2 on the first three
and the last three schooldays every semester; group 3 on three consecutive days once a
month during semesters; group 4 once every fortnight during semesters, and group 5
(control) did not rinse. Radiographic recording of approximal caries was performed.
FMR on the three first and the three last schooldays every semester (group 2) had a
prevented fraction of 59%, with approximal enamel lesions as a diagnostic threshold.
Corresponding figures for groups 1, 3 and 4 were 30, 47 and 41%, respectively. The
control group differed statistically from groups 2-4 for new enamel and dentin lesions
and fillings (p < 0.01). Enamel lesions constituted more than 90% of the new caries
lesions. Caries progression was low for all groups and no significant differences were
found between groups. The main conclusion from this randomised controlled trial is that
school-based FMR, as a supplement to the daily use of F toothpaste, reduces caries
incidence on approximal surfaces in adolescents with low to moderate caries risk.
Copyright 2005 S. Karger AG, Basel.
Acta Odontol Scand, 2005 february;63(1): 56-63
Prevalence of dental fluorosis in children from non-water-fluoridated Halmstad, Sweden: fluoride toothpaste
use in infancy.
Conway DI, MacPherson LM, Stephen KW, Gilmour WH, Petersson LG.
Dental Public Health Unit, Level 8, University of Glasgow Dental Hospital and School, 378 Sauchiehall Street,
Glasgow G2 3JZ, UK. [email protected]
OBJECTIVES: To determine the prevalence and severity of dental fluorosis in children
aged 7-9 years from non-water-fluoridated Halmstad, Sweden, and to relate the results to
their reported fluoride exposure history during infancy. MATERIAL AND METHODS:
In Spring 2002, a questionnaire distributed to a cluster random sample of 1039 parents
enquired into their child's early oral health behaviors and included a "photographic
toothpaste menu". The permanent upper anterior teeth (13-23) were examined clinically
(+10% repeats) using a modified Thylstrup-Fejerskov Index. RESULTS: Complete data
were available for 53% (n=548) of the sampled children. The prevalence offluorosis at
any level was 49% (95% CI: 45-54%), and of fluorosis with esthetic concern (TF score >
or =3) 4% (95% CI: 3-6%). Based on repeat observations, reliability was good (kappa =
0.82). There was no statistically significant increased risk of dental fluorosis prevalence
associated with any of the fluoride exposure risk factors examined, including reported
usage of (1000 ppm) fluoride toothpaste from time of first deciduous tooth eruption.
CONCLUSIONS: While there were low levels of dental fluorosis of esthetic concern,
half the children had some degree of dental fluorosis. The prevalence of dental fluorosis
was not explained by the risk factors, including fluoride toothpaste usage as explored in
this study
Caries Res. 2005 Jul-Aug;39(4):273-9
Effect of school-based fluoride varnish programmes on approximal caries in adolescents from different caries
risk areas.
Moberg Skold U, Petersson LG, Lith A, Birkhed D.
Department of Preventive
[email protected]
Dental
Care,
Vastra
Gotaland
Region,
Goteborg,
The aim was to evaluate, in a 3-year RCT study, school-based fluoride varnish
programme on approximal caries incidence and approximal caries progression in 13- to
16-year-olds in high, medium and low caries risk areas on the Swedish west coast. Seven
hundred and fifty-eight (89%) fulfilled the trial. Using a simple mobile unit, 2 dental
nurses treated the adolescents with F varnish: (1) twice a year at 6-month intervals, (2) 3
times a year within 1 week, (3) 8 times per year during the semesters with 1-month
intervals, and (4) no treatment (control). Radiographic caries recording was performed
blindly by one of the authors. Concerning total approximal caries incidence, control
groups in all areas developed more caries than F varnish groups, with the largest
difference in the high risk area: 3.05 +/- 3.37 new approximal caries lesions (mean +/SD) compared to 0.54 +/- 1.26 for group 3, 0.95 +/- 1.67 for group 1 and 1.40 +/- 1.89
for group 2 (p < 0.001). More than 90% of the new approximal lesions in all the groups
and in all areas consisted of new enamel lesions. Regarding progression of enamel
lesions, there were only significant differences between groups 1-3 and group 4 in the
high caries risk area. Prevented fraction for fluoride varnish treatment twice a year at 6month intervals was 69% in high, 66% in medium and 20% in low risk areas. To
conclude, school-based F varnish treatment every 6 months in 13- to 16-year-olds is
excellent to prevent approximal caries in medium and high caries risk areas. Copyright
2005 S. Karger AG, Basel.
Sweden.
Accta Odontol Scand. 2004 Aug;62(4):223-30.
Caries-preventive effect of sodium fluoride mouthrinses: a systematic review of controlled clinical trials.
Twetman S, Petersson L, Axelsson S, Dahlgren H, Holm AK, Kallestal C, Lagerlof F, Lingstrom P, Mejare I,
Nordenram G, Norlund A, Soder B.
Department of Odontology, Pediatric Dentistry, Faculty of Medicine, Umea University, SE-901 87 Umea, Sweden.
[email protected]
The Swedish Council on Technology Assessment in Health Care launched a project
group in 1999 to systematically review and evaluate the existing literature on different
caries-preventive methods. The aim of this article was to report the findings concerning
the caries-preventive effect of fluoride mouthrinses (FMRs) in various age groups, with
special reference to background fluorides. A systematic search in electronic databases
for literature published between 1966 and August 2003 was conducted with the inclusion
criteria of a randomized or controlled clinical trial, at least 2 years' follow-up, and caries
increment in the permanent dentition (DeltaDMFS/T) as endpoint. Out of 174 articles
originally identified, 62 met the inclusion criteria. These studies were assessed
independently by at least two reviewers and scored A-C according to predetermined
criteria for methodology and performance. The measure of effect was the prevented
fraction (PF) expressed as percent. The level of evidence was based on 25 articles. The
results revealed limited evidence (evidence level 3) for the caries-preventive effect (PF
29%) of daily or weekly sodium fluoride rinses compared with placebo in permanent
teeth of schoolchildren and adolescents with no additional fluoride exposure and for a
caries-preventive effect on root caries in older adults. Inconclusive evidence (evidence
level 4) was found regarding the effect of FMRs in schoolchildren and adolescents
exposed to additional fluoride sources such as daily use of fluoride toothpaste. No firm
support for the use of FMRs was disclosed in a small number of studies designed for
patients at caries risk. Furthermore, no association between the frequency of the rinses
and prevented fraction or saved surfaces per year was found. In conclusion, this
systematic review suggests that sodium fluoride mouthrinses may have an anti-caries
effect in children with limited background of fluoride exposure, while its additional
effect in children with daily use of fluoride toothpaste could be questioned. The need for
further clinical trials to elucidate the effect of FMRs in risk patients and older adults is
emphasized.
Acta Odontol Scand. 2004 Jun;62(3):143-6.
Composition of the salivary microflora during habitual consumption of fluoridated milk.
Engstrom K, Petersson LG, Sjostrom I, Twetman S.
Oral and Maxillo-Facial Unit, Lanssjukhuset, Halmstad, Sweden [email protected]
The aim was to evaluate the effect of habitual consumption of fluoridated milk on the
composition of the salivary microflora. The study group comprised 20 healthy
schoolchildren and young adults with a mean age of 13.6 years and the investigation had
a randomized double-blind crossover design with a washout period of 1 month. After
professional tooth-cleaning at baseline, the subjects were supplied with either fluoridated
(250 mL, 5 ppm F) or non-fluoridated milk for one daily intake during a period of 4
weeks. Salivary samples were collected immediately before tooth-cleaning and after 1,
2, and 4 weeks, respectively. The samples were immediately cultivated for total viable
counts, oral streptococci, mutans streptococci, lactobacilli, and actinomyces spp.
Bacterial counts were logarithmically transformed before statistical evaluation using
ANOVA. No significant alterations of the salivary microflora were found during any of
the milk regimens compared with baseline. There was a slight reduction in the
proportion of mutans streptococci after 2 and 4 weeks during consumption with
fluoridated milk but the difference failed to reach statistical significance. In conclusion,
this study was unable to disclose any significant alteration of the composition of the
salivary microflora following daily intake of fluoridated milk.
Acta Odontol Scand. 2004 Jun;62(3):163-9.
Effect of combined caries-preventive methods: a systematic review of controlled clinical trials.
Axelsson S, Soder B, Nordenram G, Petersson LG, Dahlgren H, Norlund A, Kallestal C, Mejare I, Lingstrom
P, Lagerlof F, Holm AK, Twetman S.
The Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden. [email protected]
The aim of this systematic review was to evaluate the caries-preventive effect of
combined caries-preventive methods, defined as two or more different interventions in
combination, each expected to prevent dental caries. The Medline database was searched
for articles published in the period January 1966 to June 2003. Twenty-four controlled
studies met the inclusion criteria, and their value as evidence was assessed according to
predetermined criteria. The level of evidence for the overall conclusion regarding each
method was graded according to the protocol of the Swedish Council on Technology
Assessment in Health Care. The scientific evidence for the combination of treatments
involving fluoride that had a preventive effect on caries in children and adolescents was
graded as moderate. However, for elderly patients the scientific evidence for the cariespreventive effect of different combinations of treatments was found to be incomplete.
No conclusion could be drawn regarding the evidence for combinations of treatments
being effective for groups at high caries risk, as the results from the identified clinical
studies were conflicting.
Acta Odontol Scand. 2004 Jun;62(3):170-6.
Professional fluoride varnish treatment for caries control: a systematic review of clinical trials.
Petersson LG, Twetman S, Dahlgren H, Norlund A, Holm AK, Nordenram G, Lagerlof F, Soder B, Kallestal
C, Mejare I, Axelsson S, Lingstrom P.
Department of Community and Preventive Dentistry, Oral-Maxillo-facial Unit, Central Hosptial, Halmstad, Sweden.
[email protected]
The aim of this paper was systematically to evaluate the caries-preventive effect of
professional fluoride varnish treatments. A search of the literature for articles published
between 1966 and August 2003 was carried out in electronic databases, reference lists of
articles, and selected textbooks in accordance with the strategy of the Swedish Council
on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized
and controlled clinical trials comparing fluoride varnish with placebo, no active
treatment or other fluoride preventive regimens of at least 2 years' study duration were
included. The trials that met the inclusion criteria were assessed independently and
systematically by at least two reviewers and scored from A to C according to
predetermined criteria for methodology and performance. The main outcome measure
was the preventive fraction expressed as a percentage. The results displayed limited
evidence (evidence level 3) for the caries preventive effect of topical applications of
fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0-69%)
when compared with untreated controls. Inconclusive evidence (evidence level 4) was
found for fluoride varnish treatment in the primary dentition and in adults. This
systematic review reinforces the need for future dinical research of high quality,
incorporating modern concepts of dinical performance and evaluation to assess dental
caries control using professional fluoride varnish.
Gerodontology. 2004 Jun;21(2):85-92.
Remineralisation study of artificial root caries lesions after fluoride treatment. An in vitro study using electric
caries monitor and transversal micro-radiography.
Petersson LG, Kambara M.
Department of Community and Preventive Dentistry, Maxillofacial Unit, Central Hospital, Halmstad, Sweden.
[email protected]
AIMS: To evaluate and compare remineralisation of root caries lesions after in vitro
treatment with various fluoride (F) agents using an Electric Caries Monitor (ECM) and
Transversal Micro-Radiography (TMR). MATERIALS: Permanent human teeth were
extracted and root surface specimens were sectioned, prepared (n = 35), and randomly
allocated into seven different experimental groups (groups 1-7). METHODS: Root
surfaces were demineralised in an acidified gel (pH = 5.0) for 3 weeks followed by
various F treatments and stored in a standardised remineralising solution at 37 degrees C
for 6 weeks. The root surfaces were treated twice daily with different dentifrice slurries
for 2 min, either with a neutral placebo dentifrice without F (group 5); or a neutral
sodium fluoride (NaF) 1400 p.p.m. F dentifrice (group 1); or a neutral 1250 p.p.m. F
dentifrice (group 6); or an acid dentifrice (pH 4.7) with 1400 p.p.m. F containing amine
fluoride (AmF) (groups 3 and 4) or a 1250 p.p.m. (pH 4.7) AmF dentifrice (group 6). In
groups 1, 2, 5, 6, and 7, the root surfaces were additionally rinsed for 2 min with a
neutral non-F placebo solution. In groups 3 and 4, rinsing were performed for 2 min with
an acid (pH 4.7) 250 p.p.m. F solution, containing 125 p.p.m. F as AmF and 125 p.p.m.
F as potassium fluoride (KF), once or twice per day respectively. ECM was used to
measure electrical resistance on root surfaces at baseline and after 3 and 6 weeks
respectively. TMR technique was used to measure and compare root surface lesion
depths and mineral loss. RESULTS: Six weeks daily treatment with a dentifrice slurry
containing AmF followed by rinsing with a combination of equal amounts of AmF and
KF solution twice a day showed a statistical significant higher ECM values compared
with the other groups. TMR data measuring lesion depths and mineral loss reduction
supported the results of the ECM findings. CONCLUSIONS: Daily application of a
dentifrice slurry containing 1400 p.p.m. F as AmF combined with twice daily rinsing
with a 250 p.p.m. F solution containing equal amount of AmF and KF significantly
remineralise primary root caries lesions in vitro. ECM and TMR are valuable
complementary methods in order to analyse the remineralisation processes.
Oral Health Prev Dent 2004;2:13-17
Lactic Acid Formation in Supragingival Dental Plaque after Schoolchildrens Intake of Fluoridated Milk
Engström K, Sjöström I, Petersson LG, Twetman S.
PURPOSE: Milk can be used as vehicle for fluoride administration. The aim of this
study was to investigate the lactic acid formation in dental plaque after daily intake of
fluoridated milk.MATERIALS AND METHODS: The study group consisted of 15
healthy schoolchildren, 6 - 15 years of age, in a double-blind crossover study design.
After a one-week flouride depletion period, 250 ml of fluoridated (5 ppm; total amount
1.25 mg F) standard milk or non-fluoridated control milk was consumed once daily
together with an ordinary meal during 3 days of plaque accumulation with no oral
hygiene. On the fourth day, plaque samples were collected immediately before a final
milk intake and then after 30, 60 and 180 minutes. After a washout period of two weeks,
the whole procedure was repeated with the corresponding fluoridated or non-fluoridated
milk regimen. All samples were suspended and the sucrose-challenged lactic acid
formation rate was determined enzymatically.RESULTS: The results showed a
statistically significant (p < 0.05) increase of the lactic acid levels 30 min after the intake
of the standard (control) milk while no such elevation was evident after the fluoridecontaining milk. No differences were found after 60 and 180 minutes compared with
baseline for any of the milks.CONCLUSION: The findings suggested that fluoride
added milk may counteract the lactic acid formation that follows a non-fluoridated milk
intake.
Int J Oral Maxillofac Implants. 2004 Jan-Feb;19(1):107-15.
Survival analysis of endosseous implants in grafted and nongrafted edentulous maxillae.
Becktor JP, Isaksson S, Sennerby L.
Department of Oral and Maxillofacial Surgery, Centre of Head and Orthopaedic, Copenhagen University Hospital,
Rigshospitalet, Denmark. [email protected]
PURPOSE: The aim of this study was to analyze and compare the survival rates of
endosseous implants placed in the edentulous maxillae of patients in whom bone
augmentation was undertaken prior to or in conjunction with implant placement with
survival rates in patients who did not undergo bone augmentation. MATERIALS AND
METHODS: This study included 2 retrospective patient groups: the graft group, which
included 64 patients with 437 implants, and the nongraft group, which included 118
patients with 683 implants. The patients were treated consecutively between 1990 and
1996. In addition, the retrospective patient groups were also followed prospectively
using a standardized clinical and radiographic study design. RESULTS: The implant
survival rate was 75.1% for the graft group and 84.0% for the nongraft group after a
mean follow-up of 5 to 6 years, a statistically significant difference. However, there was
no difference with regard to the prosthesis survival rate, and after reoperation, more
grafted patients had a fixed prosthesis at the end of the study (87.5% versus 85.3%).
Implant failure appeared to be related to the original jawbone volume in the anterior
regions. In the premolar region, where the inlay graft technique was used, the implant
survival rate for the graft group was comparable to that of the nongraft group. The graft
group had significantly more failures than the nongraft group in the incisor region, but
not in the canine, premolar, or molar regions. DISCUSSION: The majority of implant
failures occurred before loading. Occlusal overload during the healing period may have
been a causative factor. CONCLUSIONS: The overall implant survival rate was lower in
grafted maxillae than in nongrafted maxillae after a mean of 5 to 6 years of follow-up.
Analysis revealed that jawbone volume in the anterior regions at the start of treatment
was directly related to implant survival rates in both groups: the greater the volume, the
higher the survival rate. Moreover, the implant survival rate was similar in grafted
posterior edentulous maxillae of classes V and VI and in nongrafted posterior edentulous
maxillae of classes III and IV.
Acta Odontol Scand 2003;61:321-330.
Caries-preventive effect of fissue sealants: a systematic review.
Mejàre I, Lingström P, Petersson LG, Holm A-K, Twetman S et al.,
The objectives of this study were to evaluate systematically the evidence of the cariespreventive effect of fissue sealing of occlusal tooth surfaces and to examine factors
potentially modifying the effect. The search strategies included electonic databases,
refernce lists of articles, and selected textbooks. Inclusion criteria were randomized or
quasi-randomized clinical trials or controlled clinical trials comparing fissue sealing with
no treatment or another preventive treatment in children up to 14 years of age at the
start; the outcome measure was caries increment; the diagnostic criteria had been
described; and the follow-up time was at least 2 years. Inclusion decisions were taken
and grading of the studies was done independently by two of the authors. The main
measure of effect was relative risk reduction. Thirteen studies using resinbased or glass
ionomer sealant materials were included in the final analysis. The results showed that
most studies were performed during the 1970s and an singel application had been
utilized. The relative caries risk reduction pooled estimate of resin-based sealants on
st
permanent 1 molars was 33% (relative risk = 0.67;CI = 0.55-0.83). The effect depended
on retention of the sealant. In conclusion, the review suggests limited evidence that
st
fissure sealing of 1 permanent molars with resin-based materials has a caries-preventive
nd
effect. The evidence is incomplete for permanent 2 molars, permolars and primary
molars and for glass ionomer cements. Overall, there remains a need for further trials of
high quality, particularly in child populations with a low and a high caries risk,
respectively.
Acta Odontol Scand 2003;61:331-340.
Dietary factors in the prevention of dental caries: a systematic review
Lingström P, Holm A-K, Mejàre I, Twetman S, Petersson LG et al.,
The aim of this study was, systematically, to evaluate the effect of dietary changes in the
prevention of dental caries. A search and analysis strategy was followed, as suggested by
the Swedish Council on Technology Assessment in Health Care (SBU). The search
strategy for articles published in 1966 – 2003 was performed using electronic databases
and reference lists of articles and selected textbooks. Out of 714 articles originally
identified, 18 met the inclusion criteria for a randomized or controlled clinical trial – at
least 2 years´follow-up and caries increment as a primary endpoint. This included the
total or partial substitution of sucrose with sugar substitutes or the addition of protective
foods to chewing gum. No study was found evaluating the effect of information
designed to reduce sugar intake/frequency as a single preventive measure. It is suggested
that the evidence for the use of sorbitol or xylitol in chewing gum, or for the use of
invert sugar, is inconclusive. No caries-preventive effect was found from adding calcium
phosphate or dicalcium phosphate dihydrate to chewing gums. The review clearly
demonstrates the need for well-designed rondomized clinical studies with adequate
control groups and high compliance.
Acta Odontol Scand 2003;61:341-346
Economic evaluation of dental caries prevention: a systematic review
Källestål C, Nordlund A, Petersson LG, Twetman S et al.,
The aim of the present study was to perform a systematic review of economic
evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a
manual search in a number of journals identified 154 references, 74 of which were
included. There were 17 original studies including an economic evaluation, and these
form the basis of the present article. The rest were reviews, model studies and reports
concerning economic practice in dentistry. The results show that the reviewed original
studies on economic evaluations of caries prevention do not provide support for the
economic value of caries prevention. The scarcity of well-conducted studies, as well as
contradictory evidence in the reviewed articles, makes it difficult to judge the healtheconomic effect of the studied caries-prevention methods.
Acta Odontol Scand 2003; 61:347-355
Caries-preventive effect of fluoride toothpaste: a systematic review
Twetman S, Axelsson S, Dahlgren H, Petersson LG, et al.,
National Orofacial Resource Center, Goteborg, Sweden. [email protected]
PURPOSE: The purpose of this follow-up study was to quantify the change in the periimplant mucosal level after treatment of edentulous patients with fixed prostheses on
osseointegrated endosseous implants. MATERIALS AND METHODS: Twenty patients
were included in the study: 10 were treated in the maxilla, and 10 were treated in the
mandible. Both groups had fixed prostheses on osseointegrated Branemark implants.
Peri-implant mucosal level was measured with a calibrated probe after removal of the
prostheses at the 1-year follow-up. These measurements were compared to those made
on the original master casts. RESULTS: A larger mean retraction (-) was observed in the
mandible (-1.6 mm) compared to the maxilla (-0.8 mm), but there was great variation.
The individual values varied from -4.5 to +1.0 mm in the mandible and from -6.0 to +6.0
mm in the maxilla. CONCLUSION: Peri-implant soft tissue recession occurs during the
first year in edentulous jaws after treatment with implant-supported fixed prostheses and
more so in the maxilla than the mandible.
Acta Odontol Scand. 2003 Jun;61(3):184-91.
Prevalence of teeth and dentures among elderly in Norway receiving social care.
Henriksen BM, Ambjornsen E, Laake K, Axell T.
Department of Geriatric Medicine, Ullevaal University Hospital, University of Oslo, Oslo, Norway.
[email protected]
The aim of this study was to estimate the prevalence of teeth and dentures in individuals
aged 67 years and over receiving social care in Norway. A representative sample of
2893 individuals was selected from all 19 counties of Norway. In all, 1910 individuals
(1358 living in institutions, 552 living at home) could be interviewed and examined by
calibrated local dental teams in 1996-97. Overall response rate was 66%. Out of the
examined, 1359 (71%) were women and 551 (29%) were men. The mean age was 85.1
years for women and 82.2 years for men. In all, 19.6% had 'own teeth only', 21.0% 'own
teeth and dentures', 54.0% 'dentures only', and 5.3% 'neither teeth nor dentures'. Previous
findings in a random sample of elderly Norwegians from three regions with markedly
different dental health were confirmed by using polychotomous logistic regression.
Three regions of Norway could be identified with respect to the occurrence of teeth and
dentures: region A (South-East counties of Norway including the capital Oslo), region B
(West-Central counties), and region C (Northern counties). Significant differences
existed between them and non-significant differences within them. A mean number of
12.3 teeth were observed in 773 (40.5%) dentate individuals, 13.4 in region A, 11.4 in
region B, and 9.0 in region C, respectively. In conclusion, there are large geographical
disparities with respect to dental/denture status also in individuals receiving social care
in Norway. When the data were collected (1996-97), the oral health goal for the year
2000 suggested by WHO/FDI aiming at 50% of people aged 65 years and above having
a minimum of 20 remaining functional teeth was not fulfilled for individuals receiving
social care in large parts of Norway.
J Oral Pathol Med. 2003 May;32(5):275-81.
Erythematous and reticular forms of oral lichen planus and oral lichenoid reactions differ in pathological
features related to disease activity.
Karatsaidis A, Schreurs O, Helgeland K, Axell T, Schenck K.
Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway. [email protected]
BACKGROUND: Common clinical forms of oral lichen planus (OLP) and oral
lichenoid reactions (OLR) are erythematous (ERY) or reticular (RET). The purpose of
this study was to find histopathological changes that differ between these forms.
METHODS: Epithelial thickness, epithelial proliferation rate, apoptosis, and HLA-DR
expression were compared among 10 reticular and 12 erythematous lesions, and 11
normal oral mucosa samples (NOM). RESULTS: The epithelium in ERY was thinner
than in NOM, whereas RET showed values between ERY and NOM. Cell proliferation
increased significantly in ERY as compared with RET and NOM, with no difference
between RET and NOM. Relative numbers of epithelial cell nuclei displaying visible
chromatin condensation were reduced in ERY form. CONCLUSIONS: The markedly
increased cell proliferation in ERY supports the notion that this form displays a higher
disease activity as compared to RET. It can therefore be important to study each disease
form separately.
Int J Prosthodont. 2003 Mar-Apr; 16(2): 172-6.
Implant-supported fixed partial prostheses: a retrospective study.
Johansson LA, Ekfeldt A.
Department of Prosthetic Dentistry, Dental and Medical Health Centre, Halmstad, Sweden.
PURPOSE: The purpose of this retrospective study was to present treatment outcome
and patient reactions to rehabilitation with implant-supported fixed partial prostheses.
MATERIALS AND METHODS: Eighty-three patients were consecutively treated with
implant-supported fixed partial prostheses (Branemark system) from 1986 to 1995.
Seventy-six of these 83 patients were examined (66 maxillary and 31 mandibular
prostheses). The mean observation time was 53.9 months. In total, 285 implants were
placed. Eleven implants were lost before loading. The first 41 prostheses were removed
and the implants examined regarding the criteria for "success" and tightness of the screw
joints. Only one implant had lost integration. RESULTS: The survival rate before and
after loading was 96%, which included implants placed in augmented bone.All
prostheses were stable at the time of examination. In prostheses with cantilevers (98
implants), 12% of the gold screws and 17% of the abutment screws showed a "not
acceptable" loosening, compared to none in the prostheses without cantilevers (17
implants). The difference was not statistically significant. The mean marginal bone loss
was 0.4 mm for the first year after prosthesis insertion and less than 0.1 mm per year in
the following years. The most frequent prosthesis design was one pontic supported by
two implants. Prostheses made in gold acrylic and titanium acrylic had more
complications and showed a higher need for repair than metal-ceramic restorations.
Patients reacted very positively to the esthetic results and comfort with eating, and were
overall satisfied with their prostheses. CONCLUSION: Implant-supported fixed partial
prostheses seem to have a very good prognosis and are well-accepted by patients.
Acta Odontol Scand. 2003 Feb;61(1):11-8.
Oral treatment need and oral treatment intention in a population enrolled in long-term care in nursing homes
and home care.
Isaksson R, Soderfeldt B, Nederfors T.
Hospital Dentistry Division, Maxillo-Facial Unit, Central Hospital, Halmstad, Sweden. [email protected]
The aim of the study was to evaluate the realistic oral treatment need in a population in
southern Sweden enrolled in long-term care (LTC), in nursing homes (NH), or home
care (HC), taking into consideration treatment intention. Every third individual enrolled
in LTC was selected after proportionally stratifying a total of 866 subjects according to
gender. Of these, 732 (85%) were available for a simple clinical oral health evaluation in
their own homes. Dental status, oral mucosal status, oral hygiene status, oral mucosal
inflammation, and oral mucosal friction were assessed by observational examinations;
suspected malignancies were also noted. Oral treatment need was expressed in
accordance with the Treatment Need Index (TNI) as no, minor, major, or urgent, while
treatment intention was expressed in accordance with the Treatment Intention Index
(TII) as the aim to relieve, delay, maintain, or improve. The rationale for using the TII is
to offer subjects in this generally frail population oral treatment at an appropriate level,
taking their medical condition into consideration. It was found that 61% of the sample
had a need not just for an oral health evaluation but also for additional dental treatment,
31% to be accomplished by prophylactic and 30% by reparative or emergency measures;
only 1% were estimated to be in urgent need. Furthermore, one manifest and one
suspected oral malignancy were found. The results indicate that realistic oral treatment
need, guided by the examiner's estimation of the appropriate treatment intention, is
modest in this population, but that regular oral screening is mandatory.
Plast Reconstr Surg. 2003 Jan;111(1):373-7.
Patient perception of neurosensory deficit after sagittal split osteotomy in the mandible.
Bothur S, Blomqvist JE.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset Sundsvall-Harnosand, Sweden. [email protected]
Abstract not available.
Spec Care Dentist. 2003;23(2):63-9.
The effect of an oral health education program after three years.
Paulsson G, Soderfeldt B, Nederfors T, Fridlund B.
School of Social and Health Sciences, Halmstad University, Box 823, S-30118 Halmstad, Sweden.
[email protected]
Three years after providing an oral health education program (OHEP) to nursing
personnel, the authors analyzed the effect of the program on knowledge of the
importance of oral health and on perception among the nurses of the possibility to
implement oral care in patient care. The study was based on a cross-sectional survey of
all nursing personnel (N = 2,901) in five municipalities in the Southwestern Sweden, of
whom 950 had attended four one-hour lessons during an OHEP in 1996. The response
rate to the survey questionnaire was 67% (1,930 subjects). Statistical analysis was
performed by means of descriptive and analytical statistics. The program was shown to
have an independent effect on the dependent variables "knowledge of oral health" and
"assessment of implementation possibilities," This study has given further evidence of
the feasibility of an educational program to improve both knowledge and
implementation of oral health care.
Acta Odontol Scand 2002 Oct;60(5):311-4
Fluoride concentration in supragingival dental plaque after a single intake or habitual consumption of
fluoridated milk.
Engstrom K, Petersson LG, Twetman S.
Department of Odontology, Pediatric Dentistry, Umea University, Sweden.
The aim of this study was to evaluate the fluoride concentration in supragingival dental
plaque after single and repeated intakes of fluoridated milk. The study group consisted
of 22 schoolchildren, young adults and adults of both sexes, 8-41 years of age. After a 2week fluoride depletion period and 3 days of plaque accumulation, 200 ml of fluoridated
milk (1g F) was ingested along with a standardized lunch meal. Plaque samples were
collected immediately before the intake and after 30, 120 and 240 min. From the adult
participants (n = 9) additional samples were collected after 12 and 18 h. After a fluoridefree washout period of at least 2 weeks, the whole experimental procedure was repeated
after 4 consecutive daily intakes of fluoridated milk. The fluoride concentration was
determined after micro-diffusion with a fluoride selective electrode. The results showed
a statistically significant 3-fold increase of the plaque fluoride levels up to 4 h after the
intake. At 12 and 18 h after the intake, the recorded levels went gradually back to
baseline. There was no significant difference between the fluoride concentrations in the
supragingival plaque after the single intake compared with the repeated intakes. In
conclusion, the findings support the suggestion that milk is a suitable vehicle for local
fluoride administration into the oral cavity, also when consumed together with a meal.
Clin Oral Implants Res. 2002 Aug; 13(4): 349-58
Microbiological findings and host response in patients with peri-implantitis.
Hultin M, Gustafsson A, Hallstrom H, Johansson LA, Ekfeldt A, Klinge B.
Karolinska Institutet, Institute of Odontology, Department of Periodontology, Huddinge, Sweden.
[email protected]
The aim of the present study was to characterise microbiota and inflammatory host
response around implants and teeth in patients with peri-implantitis. We included 17
partly edentulous patients with a total of 98 implants, of which 45 showed marginal bone
loss of more than three fixture threads after the first year of loading. Nineteen subjects
with stable marginal tissue conditions served as controls. Oral hygiene, gingival
inflammation, and probing pocket depth were evaluated clinically at teeth and implants.
Microbiological and crevicular fluid samples were collected from five categories of
sites: 1) implants with peri-implantitis (PI), 2) stable implants (SI) in patients with both
stable and peri-implantitis implants, 3) control implants (CI) in patients with stable
implants alone, 4) teeth in patients (TP) and 5) controls (TC). Crevicular fluid from teeth
and implants was analysed for elastase activity, lactoferrin and IL-1 beta concentrations.
Elastase activity was higher at PI than at CI in controls. Lactoferrin concentration was
higher at PI than at SI in patients with peri-implantitis. Higher levels of both lactoferrin
and elastase activity were found at PI than at teeth in patients. The concentrations of IL-
1 beta were about the same in the various sites. Microbiological DNA-probe analysis
revealed a putative periodontal microflora at teeth and implants in patients and controls.
Patients with peri-implantitis harboured high levels of periodontal pathogens,
Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella
intermedia, Bacteroides forsythus and Treponema denticola. These findings indicate a
site-specific inflammation rather than a patient-associated specific host response.
Acta Odontol Scand. 2002 Aug;60(4):231-6.
Temperament and acceptance of dental treatment under sedation in preschool children.
Jensen B, Stjernqvist K.
Department of Paediatric Dentistry, Faculty of Odontology, Malmo University, Sweden. [email protected]
The major aim of the study was to investigate whether differences concerning
acceptance of dental treatment and amnesia after rectal sedation with midazolam can be
explained by temperament traits in the child. Fifty children (1.5 4.0 years), consecutively
referred for dental extractions because of dental trauma or caries, were sedated with
midazolam 0.3 mg kg(-1) rectally. Level of sedation (state of mind) was assessed
according to Wilton before and 10 min after administration of the sedative. The
children's acceptance of procedures during the oral examination, the administration of
the sedative, and the dental treatment were assessed according to Holst. Acceptance of
an injection of local anesthesia and tooth extraction was dichotomized as satisfactory (n
= 26) or unsatisfactory (n = 24). The parent assessed temperament using the
Emotionality Activity Sociability (EAS) Scale of Child Temperament. Amnesia was
evaluated by the parent on the following day. The relation between temperament and
outcome variables was analyzed using a multiple logistic regression analysis. Children
regarded as shy by the parent were at significantly greater risk of unsatisfactory
acceptance of the dental treatment (P< 0.05). High scores of negative emotionality were
significantly related to less amnesia (P < 0.05). We conclude that parental ratings of their
child's temperament are valuable in predicting a child's acceptance of dental treatment
under sedation.
Acta Paediatr. 2002;91(8):920-5.
Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under
general anaesthesia.
Jensen B, Matsson L.
Department of Paediatric Dentistry, Malmo University, Sweden. [email protected]
Dental treatment in children who are too young or too apprehensive to cooperate is often
performed under sedation. In Sweden, the tradition has been to administer sedatives
rectally in small children, but oral liquid sedation is now increasingly used. AIM: To
compare the sedative effects of oral and rectal administration of midazolam in children
undergoing dental treatment under general anaesthesia and to assess acceptance of
sedative administration, acceptance of application of the facemask, and amnesia.
METHODS: Fifty children aged 2-7 y were randomly allocated to receive either liquid
oral or rectal sedation, with 25 children in each group. RESULTS: The sedative effect of
rectal administration was higher, but not statistically significantly, than that of oral
administration (p = 0.07). No significant differences in acceptance of sedative
administration, acceptance of mask application or amnesia were found between the
groups. CONCLUSION: Both the oral and the rectal routes can in most cases be
appropriate. However, the better sedative effect of rectal administration of midazolam
makes it a more favourable route in pre-cooperative and non-compliant children.
Oral Oncol. 2002 Sep;38(6):521-6.
Oral leukoplakia: a proposal for uniform reporting.
van der Waal I, Axell T.
Department of Oral & Maxillofacial Surgery/Pathology, Vrije Universiteit medical centre/ACTA, PO Box 7057,
Amsterdam, The Netherlands. [email protected]
Leukoplakia is the most common precancerous lesion of the oral mucosa. In order to
promote uniform reporting of management results, including the event of malignant
transformation, recommendations have been made for the various definitions and
terminologies, including the application of a certainty factor with which the diagnosis of
oral leukoplakia has been established. For reporting purposes there seems to be no
rationale for distinguishing "tobacco-associated" leukoplakias from non-tobacccoassociated, so-called idiopathic leukoplakias. The recommendation has been made to use
a classification and staging system in which the size and the histopathologic findings are
reflected. At present, there seems to be no justification to give a weighting factor to the
oral subsite of leukoplakias.
Oral Dis. 2002;8 Suppl 2:110-4.
Prognostic significance of HIV-associated oral lesions and their relation to therapy.
Birnbaum W, Hodgson TA, Reichart PA, Sherson W, Nittayannanta SW, Axell TE.
Guy's, King's and St Thomas' Dental Institute, London, UK. [email protected]
The oral manifestations of HIV infection have been considered to be of value in
assessing disease progression in the developed world. However, the potential use of oral
lesions as prognostic markers in resource-poor countries has yet to be fully investigated.
There is reasonably compelling evidence in the developed world for an association
between oral lesions and viral load. However, the true nature of this association is less
clear and there are few data available from the developing world. With the introduction
of HAART, a change in prevalence of the oral manifestations of HIV infection has been
observed, including regression of oral candidiasis, Kaposi's sarcoma and oral hairy
leukoplakia. However, oral condylomata and herpes simplex virus infection appear to
persist with HMRT therapy. Further research in partnership with resource-poor countries
is required to document disease progression and the associated oral lesions in both adults
and children.
Clin Oral Implants Res. 2002 Apr;13(2):169-74.
The effects of fixed and removable implant-stabilised prostheses on posterior mandibular residual ridge
resorption.
Wright PS, Glantz PO, Randow K, Watson RM.
The London,Queen Mary's School of Medicine and Dentistry, University of London, UK. [email protected]
This study investigated the change over time in the area of the posterior mandibular
residual ridge in patients wearing either i) mandibular overdentures stabilised by two
implants (Branemark System; Nobel Biocare, Goteborg, Sweden) connected by a bar, or
ii) mandibular fixed cantilever prostheses stabilised on five or six implants. Proportional
measurements were made in order to compare the area of the residual ridge with an area
of bone uninfluenced by resorption. Measurements were made by digitising tracings of
panoramic radiographs that were taken shortly after implant insertion and up to seven
years later. With the use of overdentures, the posterior bone area index reduced by a
mean of 1.1% per annum, while a mean bone area index increase of 1.6% per annum
was demonstrated in association with fixed prostheses. A multiple linear regression
model was fitted to predict the change in posterior area from type of prosthesis, gender,
age, years of edentulism and initial height of the mandible. The model was only
significant for initial height of mandible (P = 0.04) and type of prosthesis (P = 0.0001).
In conclusion, patients rehabilitated with implant-stabilised mandibular overdentures
demonstrated low rates of posterior mandibular residual ridge resorption, while patients
rehabilitated with implant-stabilised mandibular fixed cantilever prostheses
demonstrated bone apposition in the same area.
J Oral Pathol Med. 2002 Feb;31(2):95-8.
Interobserver and intraobserver variability in the clinical assessment of oral lichen planus.
van der Meij EH, Schepman KP, Plonait DR, Axell T, van der Waal I.
Department of Oral and Maxillofacial Surgery/Oral Pathology, Academic Centre for Dentistry Amsterdam
(ACTA)/Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
BACKGROUND: In 1978, a clinical definition of OLP was formulated by the WHO. To
date, the validation results of this clinical definition have not been published. The aim of
this study was to evaluate interobserver and intraobserver variability in the clinical
assessment of oral lichen planus (OLP). METHODS: Four clinicians examined a set of
159 clinical pictures of a white lesion in a group of 60 patients. Each reviewing
examiner was asked to apply the WHO definition of OLP from 1978, and to categorise
each case as either: (i) diagnostic of OLP, (ii) other definable lesion, or (iii) leukoplakia.
After three months, each of the four reviewing clinicians was given the clinical pictures
of 45 randomly retrieved cases from the original 60. Interobserver and intraobserver
variability were assessed by calculation of unweighted kappa statistics. RESULTS:
Interobserver agreement varied from 0.43 (moderate) to 0.77 (substantial), while the
intraobserver agreement varied from 0.62 (substantial) to 0.92 (good). CONCLUSIONS:
Although the clinical WHO definition of OLP seems to be more reproducible than the
histopathological one, there is still a significant amount of subjectivity in using this
definition. A set of clinical and histopathological diagnostic criteria with good
interobserver and intraobserver agreements (kappa values > 0.8) is very important in
enabling reproducible and reliable studies on OLP to be performed.
J Oral Maxillofac Surg. 2002 Apr;60(4):395-403.
Transverse displacement of the proximal segment after bilateral sagittal osteotomy.
Becktor JP, Rebellato J, Becktor KB, Isaksson S, Vickers PD, Keller EE.
Department of General Surgery, Division of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905,
USA. [email protected]
PURPOSE: The aim of the present investigation was to evaluate the transverse
displacement of the proximal segment and ramus rotation after a bilateral sagittal
osteotomy (BSO) with rigid internal fixation (RIF) using bicortical LAG screws.
PATIENTS AND METHODS: We conducted a retrospective review of 37 patients (14
males and 23 females, age range of 14 to 55 years) who underwent a mandibular
advancement with BSO and RIF. Posteroanterior and lateral cephalometric radiographs
were obtained 1 to 8 weeks before and 1 to 4 weeks after surgery. The transverse
displacement and angulation of the proximal segments after surgery were measured on
posteroanterior radiographs, using the best-fit method. The amount of mandibular
advancement was compared with the amount of transverse displacement of the proximal
segments. RESULTS: In the 1 to 4-week postoperative period after a BSO, 36 of 37
subjects showed an increased transverse intergonion distance (5.6 mm) (P <.0001) and
35 of 37 patients showed an increased transverse interramus width (3.3 mm) (P <.0001).
No correlation was found between mandibular advancement and
transverse
displacement of the proximal segment. CONCLUSIONS: The study results indicate that
transverse displacements of the proximal segments occur with BSO and RIF. The
clinical impact on temporomandibular joint symptomatology or surgical relapse with
such displacement was not assessed in the study. Future studies that address these issues
may help to determine whether there is an association between proximal segment
displacement and surgical relapse, temporomandibular dysfunction, or both.
Int J Oral Maxillofac Implants. 2002 Jan-Feb;17(1):69-77.
The influence of mandibular dentition on implant failures in bone-grafted edentulous maxillae.
Becktor JP, Eckert SE, Isaksson S, Keller EE.
Department of General Surgery, Mayo Clinic, Rochester, Minnesota, USA. [email protected]
PURPOSE: To evaluate the influence of mandibular dentition on the performance of
maxillary implants prior to definitive prosthesis attachment in maxillae that have been
reconstructed with autogenous bone grafts. MATERIALS AND METHODS: A
retrospective review of 90 consecutive patients, 31 men and 59 women, with a mean age
of 57.4 years, was conducted. All patients underwent treatment planning to receive
endosseous implants in the edentulous maxilla in conjunction with autogenous bone
grafting. During the time from implant and/or bone graft placement until placement of
the definitive restorations in the maxillae, the mandibular dentitions were recorded and
categorized into 6 groups based upon the presence and distribution of teeth. RESULTS:
Of 643 implants placed, 118 (18.4%) were lost between implant placement and
definitive prosthesis placement. The type of mandibular dentition was significantly
associated with implant failure during this time interval (P < 001). In particular, the
patients with implants opposing unilateral occlusal support showed the highest rate of
implant failure (43.8%, or 28 of 64 implants). Implants that opposed a mandibular
implant-supported fixed prosthesis demonstrated an implant failure rate of 14.3% (10 of
70), and in patients with a removable mandibular denture, the implant failure rate was
6.2% (4 of 65 implants failed). The overall mean patient follow-up was 64.2 months. At
60 months, the cumulative implant failure rate based on the Kaplan-Meier method was
20.2%. DISCUSSION: Unfavorable concentration of forces on the maxilla may
contribute to increased risk of implant failure. CONCLUSION: Effort should be made to
create a favorable occlusion in the mandible, with attention being paid to broad
distribution of occlusal contacts.
Caries Res 2002 Jan-Feb;36(1):40-3
Fluoride concentrations in saliva and dental plaque in young children after intake of fluoridated milk.
Petersson LG, Arvidsson I, Lynch E, Engstrom K, Twetman S.
Medical and Oral Health Centre, Halmstad, Sweden. [email protected]
This study determined fluoride (F) concentrations in whole saliva and dental plaque after
intake of fluoridated milk using a randomised crossover experimental design. Eighteen
healthy children (6-8 years) were subjected to each of four different 3-day drinking
regimens: (a) 200 ml F-free tap water; (b) 200 ml tap water with 1.0 mg F; (c) 200 ml
standard milk, and (d) 200 ml standard milk with 1.0 mg F. A washout period of 7 days
was organised between the different drinking regimens. All children used F-free
toothpaste prior to and during the trial and were instructed to avoid F-rich food and
drinks. F concentration in unstimulated whole saliva was determined at baseline and
after 15 and 120 min and in plaque samples at baseline and after 2 h. The mean baseline
values ranged from 0.01 to 0.02 mg F/l in saliva and between 10.4 and 14.2 mg F/l in
dental plaque. A statistically significant (p < 0.05) increase of F was disclosed in saliva
15 min after drinking F-containing milk and water (0.052 and 0.058 mg F/l,
respectively). After 2 h, the salivary F(-) concentrations were back to baseline values. In
the plaque, however, a statistically significant (p < 0.01) twofold increase was found at 2
h after the intake of fluoridated milk and water, respectively. The results indicate that
consumption of fluoridated milk contributes to a F storing process with significantly
elevated F concentrations in dental plaque up to 2 h after intake. Further studies are
required to determine the 'therapeutic concentration' of F in dental plaque after intake of
fluoridated milk.
Int Dent J 2002 Oct;52(5):337-45
Mouthrinses and dental caries.
FDI Commission. Petersson LG, Netuschil L, Brecx M.
Mouthrinsing for the prevention of dental caries in children and adolescents was
established as a mass prophylactic method in the 1960s and has shown average efficacy
of caries reduction between 20-50%. Commonly, weekly or twice monthly rinsing
procedures using neutral 0.2% NaF solutions have been used in schools or institutions in
areas with low fluoride concentrations in the drinking water. Today, when dental caries
has declined substantially in the western countries, and relatively few individuals are
suffering from caries, the efficiency of large scale mouthrinsing is questioned and more
individual approaches of caries prevention strategies are needed. For this reason
individual caries risk assessments are necessary, utilising diagnostic tools with the aim
of explaining the main causes of the caries disease. Therefore in high risk patients, daily
mouthrinses using 0.05% NaF can be recommended combined with other selective
preventive measures such as sugar restriction, improved oral hygiene, antibacterial
treatments, and so forth. Mouthrinsing solutions have therefore been combined with
antiplaque agents like chlorhexidine and other agents which can improve the caries
preventive effect not only in high caries risk patients, including those with dry mouth
problems and root caries. Other agents than sodium fluoride have been used, such as
stannous and amine fluoride with proven clinical effects. However, although a series of
new formulas of mouthrinses containing fluoride combined with different antiplaque
agents have shown promising antibacterial and antiplaque efficacy, their long-term
clinical effects are sparsely documented. Acute and chronic side effects from established
and recommended mouthrinsing routines are extremely rare but ethanol containing
products should not be recommended to children for long-term use or to individuals with
alcohol problems. Patients with dry mouth problems should avoid mouthrinses
containing high concentration of detergent components which reduce the substantivity of
the agent and worsen the dry mouth effect. For the future, patients, dentists and public
health officials will welcome new and safe, controlled and self-administrated
mouthrinsing procedures with not only high efficacy, but also high effectivity and
efficiency.
Int Dent J 2002 Oct;52(5):346-52
Mouthrinses and periodontal disease.
FDI Commission. Brecx M, Netuschil L, Petersson LG.
It is known that mouthwashes can influence gingivitis; however, their role in the three
different kinds of periodontitis is unclear. Some solutions have demonstrated some effect
on necrotising periodontitis, yet none have been shown to influence early onset
periodontitis. The literature provides us with a wide range of in vitro concentrations of
substances used pure or in various mixtures in mouthwashes. Although only a few
solutions can be used in a curative approach, most mouthwashes represent an essential
tool in prophylaxis and thus also in post-periodontal treatment (maintenance phase).
However, severe qualitative differences exist between the diverse families of
mouthwashes. Many studies have shown that the use of a mouthwash associated with
regular tooth cleaning was more beneficial than the utilisation of mouthrinse alone.
Swed Dent J. 2002;26(1):1-7.
The relation between xerostomia and hyposalivation in subjects with rheumatoid arthritis or fibromyalgia.
Nederfors T, Holmstrom G, Paulsson G, Sahlberg D.
Oral Health Centre, Central Hospital, Halmstad, Sweden. [email protected]
Aim of this study was to evaluate the relation between xerostomia and hyposalivation in
100 subjects with either rheumatoid arthritis or fibromyalgia, and further, to evaluate the
predictive value of xerostomia on hyposalivation. Unstimulated and chewing stimulated
whole saliva was collected in the morning with the subjects in a strict fasting condition
and then about 2 hours later, after intake of a standardised breakfast. All participants
filled in a questionnaire, mainly dealing with xerostomia. Forty subjects demonstrated a
pathological fasting unstimulated whole saliva secretion rate, the corresponding number
for fasting stimulated secretion being 39. For unstimulated, but not for stimulated saliva,
the fasting secretion rate was significantly lower than the non-fasting. Xerostomia was
reported by 74 subjects, this group having significantly lower both unstimulated and
stimulated secretion rates than the non-xerostomic group. On the individual level, the
predictive value of xerostomia on hyposalivation showed high sensitivity but
unsatisfactory specificity. In conclusion, this study underlines the importance of
applying strictly standardised procedures when collecting saliva, and that fasting
unstimulated whole saliva is the diagnostic salivary secretion of choice. Finally,
xerostomia was found to predict hyposalivation on a group, but not on an individual
level.
Swed Dent J Suppl. 2002;(153):1-45.
Benzodiazepine sedation in paediatric dentistry.
Jensen B.
Department of Paediatric Dentistry, Faculty of Odontology, Malmo University, Sweden.
Abstract not available.
Cleft Palate Craniofac J. 2002 Mar;39(2):233-45.
Craniofacial and dental manifestations of Proteus syndrome: a case report.
Becktor KB, Becktor JP, Karnes PS, Keller EE.
Division of Orthodontics, Dental Specialties, Mayo Clinic, Rochester, Minnesota 55905, USA.
The Proteus syndrome is a rare congenital hamartomatous condition that is characterized
by a wide range of malformations, sometimes involving the face. Common
manifestations include partial gigantism, congenital lipomas, and plantar hyperplasia. In
this report we describe the craniofacial clinicopathological development in a girl with
Proteus syndrome from age 6 to 20 years. The patient had pronounced hemifacial
hypertrophy, exostoses in the left parietal region, and enlargement of the inferior
alveolar nerve and mandibular canal in the affected region. The dental development of
the affected left mandible and maxilla was characterized by extremely premature
development and eruption of the primary and permanent teeth and by pronounced
idiopathic root resorptions. The multidisciplinary management of the patient and the
treatment outcome is reported. A review of the Proteus patients in the literature who
exhibited manifestation in the craniofacial region is presented.
Caries Res. 2002 Jan-Feb;36(1):31-5.
Caries incidence in young type 1 diabetes mellitus patients in relation to metabolic control and cariesassociated risk factors.
Twetman S, Johansson I, Birkhed D, Nederfors T.
Paediatric Dentistry and Cariology, Department of Odontology, Umea University, Sweden.
[email protected]
The aim of this study was to evaluate the caries incidence in a group of young patients
with type 1 diabetes mellitus over a 3-year period from the onset of the disease in
relation to metabolic control and to caries-associated risk factors. Sixty-four children
and adolescents (8-15 years of age) had their diabetes treated and monitored according
to a standard medical protocol and received extensive preventive oral health care based
on individual needs. Data on blood glucose and glycosylated haemoglobin (Hb A(Ic))
were collected from the medical records. Whole saliva was collected every 3rd month
and secretion rate, buffer capacity, glucose concentration, mutans streptococci and
lactobacilli counts were determined. Dental examinations, including radiographs, were
carried out once a year. Patients with less good metabolic control (>8.0% Hb A(Ic))
exhibited higher glucose levels in resting saliva (p < 0.05) and a significantly higher
caries incidence (p < 0.05) compared to those with good metabolic control. The most
influential determinants for high caries development during the 3-year follow-up period
were metabolic control (odds ratio, OR = 5.7), poor oral hygiene (OR = 6.5), previous
caries experience (OR = 5.3) and high levels of salivary lactobacilli (OR = 5.0). The
findings suggest that the level of metabolic control and traditional caries risk markers are
important factors for caries development in children and adolescents with type 1
diabetes mellitus. Copyright 2002 S. Karger AG, Basel
Acta Odontol Scand. 2002 Jan;60(1):42-9.
Nursing personnel's views on oral health from a health promotion perspective: a grounded theory analysis.
Paulsson G, Soderfeldt B, Nederfors T, Fridlund B.
School of Social & Health Sciences, Halmstad University, and Oral Health Center, Central Hospital, Sweden.
[email protected]
The aim of this study was to develop a model for how nursing personnel view oral health
in general and the oral health of the care receivers in particular, applying a health
promotion perspective and using grounded theory analysis. Data were collected through
interviews with 17 nursing personnel, selected by strategic sampling. Analysis of the
transcribed interviews showed that there were four strategies, related to staff education,
hospital resources, and leadership motivation. The strategies were grounded in data and
emerged from the interaction between the two main categories: 'the valuation of the
importance of oral health' and 'the behavior towards oral health maintenance'. They were
characterized as the routine, theoretical, practical, and flexible strategies, with the latter
considered ideal. As increased knowledge is one important part in enhancing the nursing
personnel's ability to perform oral hygiene procedures, there is a need for education
among nursing personnel, primarily among those using a routine strategy.
Swed Dent J. 2001;25(1):31-8.
Benzodiazepines in child dental care: a survey of its use among general practitioners and paediatric dentists in
Sweden.
Jensen B, Matsson L.
Department of Paediatric Dentistry, Faculty of Odontology, Malmo University, Sweden. [email protected]
Dental treatment in children too young or too apprehensive to co-operate is often
performed under sedation. The aim of this study was to survey the use of rectal and oral
liquid and tablet benzodiazepine sedation in Swedish child dentistry, and estimation of
treatment success. A questionnaire was sent to 500 randomly selected dentists (GPs)
working in the Public Dental Health Service and all (77) specialists (PDs) working at
paediatric dentistry clinics. Benzodiazepine sedation was used by 73% of the GPs and
97% of the PDs. Seven per cent of the GPs and 87% of the PDs had sedation sessions at
least once a month. Of the GPs, 60% administered the sedation rectally, 7% orally in
liquid form, and 39% orally in tablet form. For PDs, the corresponding figures were
97%, 78%, and 68%. Sixteen per cent of the GPs and 84% of the PDs used midazolam
for rectal sedation. PDs rated rectal sedation better than the GPs (p < 0.001). GPs rated
their experiences of rectal sedation as better the more frequent the use (p = 0.03), as did
PDs concerning oral liquid sedation (p = 0.03). Thus, it seems that a more regular use of
sedation is advantageous in achieving better treatment outcome.
Int J Oral Maxillofac Implants. 2001 Nov-Dec;16(6):864-74.
Growth analysis of a patient with ectodermal dysplasia treated with endosseous implants: a case report.
Becktor KB, Becktor JP, Keller EE.
Division of Orthodontics, Mayo Clinic, Rochester, Minnesota, USA. [email protected]
Congenital absence of multiple teeth and poorly developed alveolar ridges are associated
with ectodermal dysplasia. Affected patients often require dental prosthetic treatment
during their developmental years. Maxillofacial growth and development in a
preadolescent female patient with ectodermal dysplasia following oral rehabilitation
with maxillary and mandibular endosseous dental implants is reported. Four maxillary
and 4 mandibular implants were successfully integrated and restored at 8 years of age.
Growth analysis 12 years later revealed that the implants followed maxillary and
mandibular growth displacement. Minor impaction of the maxillary implants was
observed, and mandibular implants were affected by the mandibular growth rotation,
which led to a change in implant inclination. The treatment outcome is compared to
similar previously reported studies and cases.
J Clin Periodontol. 2001 Oct; 28(10): 923-9.
Comparison of ready-to-use EMDOGAIN-gel and EMDOGAIN in patients with chronic adult periodontitis.
Bratthall G, Lindberg P, Havemose-Poulsen A, Holmstrup P, Bay L, Soderholm G, Norderyd O, Andersson
B, Rickardsson B, Hallstrom H, Kullendorff B, Skold Bell H.
Department of Periodontology, Faculty of Odontology, Malmo University, Sweden. [email protected]
OBJECTIVES: The aim of this multicenter trial was to compare the clinical and
radiographical outcome of a ready-to-use Emdogain-gel (test) with the marketed
Emdogain (control). METHODS: Subjects with bilateral infrabony defects > or =4 mm
deep and > or =2 mm wide according to radiographs were selected. 88 subjects with
probing pocket depth (PPD) > or =6 mm > or =1 month after supervised oral hygiene
and scaling participated. At baseline plaque index, bleeding on probing, PPD and
probing attachment level were recorded and reproducible radiographs for computerbased bone level measurements were taken. In each subject, 1 tooth was randomly
treated with the test and 1 tooth with the control gel. Examinations were repeated 8 and
16 months post-operatively. RESULTS: After 16 months, the mean test PPD was 4.1
mm and the mean control PPD 4.2 mm. The mean gain of attachment was 2.7 mm for
test and 2.9 mm for the control sites, and the radiographic measurements demonstrated a
mean gain of 1 mm for both test and control sites. CONCLUSION: This series of cases
demonstrated a statistically significant reduction of pocket depths and gain of attachment
and bone after 8 and 16 months with no difference between the 2 preparations.
Clin Implant Dent Relat Res. 2001;3(3):142-7.
Marginal bone resorption at different treatment concepts using Branemark dental implants in anterior
mandibles.
Petersson A, Rangert B, Randow K, Ericsson I.
Department of Oral Radiology, Faculty of Odontology, Malmo University, Carl Gustafs vag 34, SE-214 21, Malmo,
Sweden. [email protected]
BACKGROUND: Different implant treatment modalities, one- and two-step surgery,
and one-step surgery combined with early functional loading have successfully been
used in the anterior mandible for rehabilitation of edentulism. However, the marginal
bone remodeling has not been compared among the three different techniques.
PURPOSE: The purpose was to compare the marginal bone level in a short- and longterm perspective study using Branemark dental implants placed according to either a
one- or a two-step surgical procedure or a one-step surgical procedure combined with
early functional loading. MATERIALS AND METHODS: Seven patients were treated
with a split-mouth technique with a one-step surgical technique on one side and a twostep technique on the other side. In this latter group, the fixtures were submerged during
a 3- to 4-month healing period before abutment connection and loading. In 13 patients,
following one-step surgery, the permanent prosthetic suprastructure was connected
within 20 days from implant surgery. All patients were operated on by the same surgeon.
The level of the marginal bone was radiographically measured relative to the fixtureabutment junction and was followed up to 5 years from fixture installation. RESULTS:
After connection of the supraconstruction, the marginal bone resorption was
significantly lower in the early functional loading group compared to the one- and twostep surgical technique groups. However, after 18 months and after 5 years, the marginal
bone was located approximately 1 mm apical to the fixture-abutment level in all three
groups. CONCLUSION: There was no difference in marginal bone resorption in a longterm perspective between one- and two-step surgical procedures and a one-step surgical
procedure with early functional loading of Branemark dental implants.
Clin Oral Implants Res. 2001 Oct; 12(5): 462-7.
A retrospective analysis of factors associated with multiple implant failures in maxillae.
Ekfeldt A, Christiansson U, Eriksson T, Linden U, Lundqvist S, Rundcrantz T, Johansson LA, Nilner K,
Billstrom C.
Department of Prosthetic Dentistry, Center of Medical and Oral Health, Halmstad, Sweden.
[email protected]
This retrospective study was designed to verify the factors that influence implant
failures. Six prosthodontic clinics in Sweden participated in the study, and together they
included a total of 54 patients treated between January 1988 and December 1996. All
patients were completely edentulous in the maxilla, and received either a fixed
prosthesis or an overdenture supported by at least 4 implants (Branemark System). Half
of the patients belonged to the study group, and an inclusion criterion for this group was
that they had lost at least half of their implants. To reduce bias, the patients in the control
group were matched to the study group, i.e. they were selected so that both groups were
as identical as possible. The results of the study indicate that the control group had a
better initial bone support than the study group. Furthermore, the patients in the study
group suffered from circumstances that could induce implant failure, such as bruxism,
personal grief, depression, as well as addictions to cigarettes, alcohol and/or narcotics.
On the study form the clinicians were asked to give their own opinion of the reason for
implant failure. The answers given could easily be grouped into 5 different topics, and
this experience can be useful to improve patient selection. This study suggests that there
are certain factors of importance to consider to prevent a cluster phenomenon of implant
failures i.e. lack of bone support, heavy smoking habits and bruxism.
Clin Oral Investig. 2001 Jun;5(2):118-21.
Effect of an antibacterial varnish on lactic acid production in plaque adjacent to fixed orthodontic appliances.
Skold-Larsson K, Borgstrom MK, Twetman S.
Department of Orthodontics, Medical and Dental Health Centre, Lanssjukhuset, Halmstad, Sweden.
The effect of an antibacterial varnish on lactic acid concentration in suspensions of early
supragingival plaque collected adjacent to fixed orthodontic brackets was evaluated in
25 adolescents using a double-blind split-mouth design with a placebo varnish control.
The test varnish contained 1% chlorhexidine and 1% thymol as active ingredients. Both
varnishes were applied on two occasions within 3 days and plaque was subsequently
collected at 3, 7 and 30 days after the first treatment. The samples were evaluated for
total viable counts (TVC) and the proportion of mutans streptococci. Acid fermentation
in suspensions was induced by glucose and L(+)-lactic acid concentrations were
determined enzymatically after a 30-min incubation period. The test varnish did not
affect TVC but reduced the proportion of mutans streptococci significantly at the 7-day
follow-up (P<0.05). The concentration of lactic acid was reduced by approximately 20%
on the 3- and 7-day follow-ups (P<0.05). The results suggest that the
chlorhexidine/thymol-containing varnish may to some extent reduce the viability and
metabolic activity of susceptible oral bacteria in suspensions of early supragingival
plaque.
Am J Orthod Dentofacial Orthop. 2001 Jun;119(6):654-9.
Treatment of a Class II Division 1 malocclusion with macrodontia of the maxillary central incisors.
Hellekant M, Twetman S, Carlsson L.
Department of Orthodontics, Medical and Dental Health Center, Halmstad, Sweden. [email protected]
Gerodontology. 2001 Jul;18(1):7-14.
Recall of an oral health education programme by nursing personnel in special housing facilities for the
elderly.
Paulsson G, Soderfeldt B, Fridlund B, Nederfors T.
Centre for Health Promotion Research, Halmstad University, Halmstad, Sweden.
[email protected]
OBJECTIVES: To investigate the recall of oral health knowledge and confidence by
nursing personnel in special housing facilities for the elderly, three years after an
education programme. DESIGN: A cross sectional design using a questionnaire.
SAMPLE: All nursing personnel, a total of 2,901 subjects, in five municipalities in
south-western Sweden; of whom 950 had attended the programme. The response rate
was 67% (1930 subjects). INTERVENTION: An oral health education programme
consisting of four one-hour lessons. RESULTS: The oral health education programme
still had an effect on the participants' attitudes towards oral health three years later.
When comparing the trained group (OHEP+) which attended the programme with those
who did not have training (OHEP-), the perceived ability, opportunity and the
knowledge of oral health were significantly better in the former group, p < 0.01 Further,
within the OHEP- group who did not attend the programme there was a significant
difference in the perceived ability, opportunity and the knowledge of oral health between
those with a higher level of health care education, p < 0.01. CONCLUSIONS: The effect
of an oral health education programme on the participants' attitudes towards oral health
persists at least for three years. The data indicate that trainees with a low level of health
care education benefit most.
Acta Odontol Scand. 2001 Apr;59(2):88-92.
Effect of a school-based preventive program with salivary lactobacillus counts as sugar-motivating tool on
caries increment in adolescents.
Nylander A, Kumlin I, Martinsson M, Twetman S.
Public Dental Clinic, Kumla, Sweden.
The caries preventive outcome of a school-based program with salivary; lactobacillus
counts as sugar-motivating tool was evaluated in six cohorts of totally 936 adolescents in
a comprehensive school in Sweden. Students from a neighboring district with similar
socioeconomic structure but with no corresponding dental health-promoting activities
were selected as reference. The program started in the beginning of the 7th grade (13
years) and was terminated at the end of the 9th grade (16 years). Salivary lactobacilli
were evaluated semi-annually with a dip-slide method and used for individual
counseling. Dental caries was scored from the dental records and bitewing radiographs
of each 4th participant at baseline and at 16 and 19 years of age. The number of salivary
lactobacilli decreased significantly (P< 0.05) in all cohorts but one during the program.
There was no significant difference in the increment of caries (DFS) between the
participants from the study and reference schools, either at the end of the program or at
19 years of age. The increment of proximal enamel caries was slightly lower in the study
group compared with the reference group (P< 0.05) at the final registration. Considering
the time and efforts spent, the results did not seem to justify a school-based intervention
with lactobacillus counts as a sugar-motivating tool in an adolescent low-caries
population.
Eur J Oral Sci. 2001 Apr;109(2):71-5.
Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children. A
comparative study of remineralisation by fluoride varnish and professional cleaning.
Tranaeus S, Al-Khateeb S, Bjorkman S, Twetman S, Angmar-Mansson B.
Department of Cariology and Endodontology, Karolinska Institutet, Huddinge, Sweden. [email protected]
The aim of this study was to apply the quantitative light-induced fluorescence (QLF)
method in a randomised controlled study, comparing treatment with fluoride varnish and
professional tooth cleaning for remineralisation of white spot lesions in caries-active
adolescents. In the fluoride varnish group (n = 13; 32 lesions), professional toothcleaning was followed by application of fluoride varnish at the beginning of the study,
after 1 wk, and then once every 6 wk for 6 months. The other group (n = 18; 30 lesions)
underwent professional tooth-cleaning once every 6 wk for 6 months. Enamel
fluorescence was measured at baseline and at each visit. In the fluoride varnish group
there was a significant change over time (baseline: 6 months) for both lesion area: and
average change in fluorescence (decreased lesion area and increased fluorescence
radiance). The corresponding changes in the professional tooth-cleaning group were not
significant. There was a significant difference in average change in fluorescence
between the two test groups. For lesion area, there was no significant difference, but a
tendency towards a difference between the test groups. It was concluded that (a) the
QLF method is a sensitive method, suitable for longitudinal quantification of incipient
caries lesions on smooth surfaces; and (b) that repeated fluoride applications had a
favourable effect on the remineralisation of white spot lesions as measured after 6
months.
Caries Res 2001 Jan-Feb;35(1):41-6
Reversal of primary root caries using dentifrices containing 5,000 and 1,100 ppm fluoride.
Baysan A, Lynch E, Ellwood R, Davies R, Petersson L, Borsboom P.
Department of Adult Oral Health, St. Bartholomew's and the Royal London School of Medicine and Dentistry, UK.
[email protected]
This study compared the ability of two sodium fluoride dentifrices, one containing 5,000
ppm fluoride (Prevident 5000 Plus) and the other 1,100 ppm fluoride (Winterfresh Gel),
to reverse primary root caries lesions (PRCLs). A total of 201 subjects with at least one
PRCL each entered the study and were randomly allocated to use one of the dentifrices.
After 6 months, 186 subjects were included in statistical analyses. At baseline and after 3
and 6 months, the lesions were clinically assessed and their electrical resistance
measured using an electrical caries monitor. After 3 months, 39 (38.2%) of the 102
subjects in the 5,000 ppm F- group and 9 (10.7%) of 84 subjects using the 1,100 ppm Fdentifrice, had one or more PRCLs which had hardened (p = 0.005). Between baseline
and 3 months, the log10 mean +/- SD resistance values of lesions for subjects in the
1,100 ppm F- group had decreased by 0.06+/-0.55, whereas those in the 5,000 ppm Fgroup had increased by 0.40+/-0.64 (p<0.001). After 6 months, 58 (56.9%) of the
subjects in the 5,000 ppm F- group and 24 (28.6%) in the 1,100 ppm F- group had one or
more PRCLs that had become hard (p = 0.002). Between baseline and 6 months, the
log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group
decreased by 0.004+/-0.70, whereas in the 5,000 ppm F- group, they increased by
0.56+/-0.76 (p<0.001). After 3 and 6 months, the distance from the apical border of the
root caries lesions to the gingival margin increased significantly in the 5,000 ppm Fgroup when compared with the 1,100 ppm F- group. The plaque index in the 5,000 ppm
F- group was also significantly reduced when compared with the 1,100 ppm F- group.
The colour of the lesions remained unchanged. It was concluded that the dentifrice
containing 5,000 ppm F- was significantly better at remineralising PRCLs than the one
containing 1,100 ppm F-.
Adv Dent Res. 2000 Dec;14:48-56.
Xerostomia and hyposalivation.
Nederfors T.
Oral Health Centre, Central Hospital, Halmstad, Sweden. [email protected]
Dry mouth must not be considered a trivial problem in the population, since it
constitutes a phenomenon with many aspects relative to oral function as well as quality
of life. Up until today, no global consensus has been reached with regard to the
terminology of dry mouth, creating a substantial problem for research, education,
diagnosis, and therapy. In this report, salivary gland hypofunction has been selected as
the overarching term for subjective symptoms and objective signs of dry mouth. Its
different aspects--xerostomia, hyposalivation, and altered saliva composition--are
reviewed with respect to prevalence, diagnosis, and etiology. It is concluded that these
aspects of salivary gland hypofunction are separate entities, which in many respects are
interrelated, constituting not merely a dental but also a medical and social concern.
Eur J Orthod. 2000 Oct;22(5):537-44.
Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic
surgery.
Egermark I, Blomqvist JE, Cromvik U, Isaksson S.
Department of Orthodontics, Tandregleringskliniken, Kungsbacka, Sweden.
Fifty-two patients with malocclusions underwent orthodontic treatment in combination
with orthognathic surgery involving a Le Fort I and/or sagittal split osteotomy.
Approximately 5 years after surgery, the patients were examined for signs and
symptoms of temporomandibular disorders (TMD). The frequencies were found to be
low in comparison with epidemiological studies in this field. The aesthetic outcome and
chewing ability were improved in most patients (about 80 per cent). Some of the patients
had reported recurrent and daily headaches before treatment. At examination, only two
patients had reported having a headache once or twice a week, while all the others
suffered from headaches less often or had no headache at all. Eighty-three per cent of the
patients reported that they would be prepared to undergo the orthodontic/surgical
treatment again with their present knowledge of the procedure. This study shows that
orthodontic/surgical treatment of malocclusions not only has a beneficial effect on the
aesthetic appearance and chewing ability, but also results in an improvement in signs
and symptoms of TMD, including headaches.
Dent Clin North Am. 2000 Jul;44(3):487-505.
Infant oral health.
Twetman S, Garcia-Godoy F, Goepferd SJ.
Department of Pediatric Dentistry, Malmo University, Sweden. [email protected]
According to the United Nations' Convention on "The Rights of the Child," articles 2
and 24, all children should have the same rights and have right to health and medical
service. Early childhood caries is a lifestyle disease with biologic, behavioral, and social
determinants. An early screening of all children at around 1 year of age is an excellent
opportunity for early detection of risk factors and risk indicators that may increase the
possibilities for its prevention. The caries risk evaluation should form the base for
appropriate recommendations of preventive measures. The preventive care must be
coordinated with an eventual operative care and should be based on education of
prospective and new parents as well as professional and home-based measures. The
various interventions must be developed further and evaluated in prospective studies in
terms of effectiveness and efficiency for this specific age group. This is an urgent task
for dental professionals and all societies with the ambition of providing good dental care
for all young children.
Eur J Oral Sci. 2000 Jun;108(3):255-8.
Decreasing prevalence of salivary lactobacilli in Swedish schoolchildren 1987-1998.
Nylander A, Kumlin I, Martinsson M, Twetman S.
Public Dental Clinic, Kumla, Sweden.
The prevalence and number of salivary lactobacilli was determined in all schoolchildren
starting the 7th grade (12-13 yr; n = 1,578) in comprehensive school located in Kumla,
Sweden between 1987 and 1998. Whole saliva samples were collected and transferred to
dip-slides (Dentocult-LB) and incubated in room temperature for 7 d. Caries data were
collected from the dental records and from bitewing radiographs. Both the number of
lactobacilli and the prevalence of manifest caries and restorations exhibited a decreasing
tendency and were significantly lower in 1998 than in 1987. The mean caries prevalence
(DFS) declined from 5.2 to 1.8. In 1987, 45% of the children harboured high or very
high lactobacilli counts ( > or =10(5) CFU/ml) in their saliva compared to approximately
10-15% at the later examinations. The proportion of children with no detectable counts
varied between 4-29% during the study period, while children with low counts (10(3)10(4) CFU/ml saliva) constituted a clear majority at the recent samplings. With such low
levels in the population, the use of lactobacilli counts as a didactic tool in dietary
counselling must be called into question.
Spec Care Dentist. 2000 May-Jun;20(3):109-13.
Evaluation of an oral health education program for nursing personnel in special housing facilities for the
elderly. Part II: Clinical aspects.
Isaksson R, Paulsson G, Fridlund B, Nederfors T. [email protected]
In Sweden, efforts are being made to create strategies for evaluating realistic dental
treatment needs among the elderly, who are retaining more natural teeth. These
strategies focus on the importance of maintaining adequate oral hygiene. Elderly in longterm-care facilities often depend on nursing personnel for carrying out daily oral hygiene
procedures. Therefore, the nursing personnel's knowledge about and attitudes toward
oral health make oral health education for health care professionals an important
concern. The purpose of this study was to evaluate the clinical oral health outcome in
residents after their caregivers had undergone a one-session, four-hour oral health
education program. The study consisted of an intervention with a pre- and a post-test and
was carried out in three municipalities in the southwestern part of Sweden. A newly
developed oral health screening protocol was carried out for 170 subjects living in longterm-care facilities both before and 3-4 months after nursing personnel had attended an
oral health education program. Following the intervention, a statistically significant
improvement was recorded for changes in oral mucosal color, a modified plaque index
which measured oral hygiene status, and a mucosal index which recorded mucosal
inflammation. This study indicated that a limited, one-session, four-hour oral health
education, offered to caregivers within long-term-care facilities, had a positive impact on
the oral health status of residents.
Caries Res 2000 Mar-Apr;34(2):140-3
Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in cariessusceptible teenagers: a 3-year clinical study.
Petersson LG, Magnusson K, Andersson H, Almquist B, Twetman S.
Department of Preventive and Paediatric Dentistry, Medical and Dental Health Centre, Lanssjukhuset, Sweden.
[email protected]
The aim of this study was to compare the effect of two different dental varnishes on
approximal caries incidence in teenagers with proven caries susceptibility during a 3year period. Two hundred 13- to 14-year-old subjects exhibiting at least two approximal
enamel caries lesions were selected to take part in the study. One hundred and eighty
subjects participated after informed consent and were randomly assigned to two equally
sized groups. One group was treated with a fluoride varnish (FV, Fluor Protector)
containing 0.1% F every 3rd month and the participants of the other group were treated
in the same mode with a chlorhexidine varnish (CV, Cervitec((R))) containing 1%
chlorhexidine and 1% thymol. In total, each subject was treated 12 times during the
experimental period. Approximal caries including enamel lesions (DMFS(appr)) were
recorded from four bitewing radiographs exposed at the start and end of the study. The
mean (SD) caries prevalence at baseline was 2.23.4 in the FV group and 2.54.0 in the
CV group. After 3 years, the average approximal caries incidence was 2.73.1 and 3.13.5
in the FV and CV groups, respectively. The differences at baseline and after 3 years
were not statistically significant. In conclusion, treatments every 3rd month with either a
fluoride- or a chlorhexidine/thymol-containing varnish showed a promising effect with
low approximal caries incidence and progression in teenagers with proven caries
susceptibility.
Clin Oral Investig. 2000 Mar;4(1):9-12.
Acid formation in sucrose-exposed dental plaque in relation to caries incidence in schoolchildren.
Borgstrom MK, Edwardsson S, Svensater G, Twetman S.
Departments of Pediatric Dentistry and Oral Microbiology, Centre for Oral Health Sciences, Carl
Gustavs vag 34, SE-214 21 Malmoo, Sweden. [email protected]
The aim was to investigate the composition and concentration of organic acids produced
by plaque bacteria in vivo and its possible relation to caries development in
schoolchildren. Sucrose-exposed pooled plaque from 25 healthy teenagers was collected
and the levels of Streptococcus mutans and lactobacilli were estimated. The acid anions
were analysed with isotachophoresis. The prevalence and incidence of dental caries
during a 2-year period was recorded. Depending on the amount of plaque collected, the
subjects were divided into a low (n = 12) and a high (n = 13) plaque weight group. The
dominating anions in sucrose exposed plaque were lactate, acetate and propionate. For
the entire study group, no association was found between the total acid concentration
and caries development but for the participants with low plaque weight a positive
relationship (P < 0.01) was disclosed. No correlation was found between the
concentrations of acids and the number of lactobacilli or Streptococcus mutans. The
present results did not suggest that the acidogenicity of sugar-exposed pooled plaque
samples was a suitable indicator of caries activity in teenagers.
Clin Oral Investig. 2000 Mar;4(1):31-4.
Fluoride concentration in plaque in adolescents after topical application of different fluoride varnishes.
Skold-Larsson K, Modeer T, Twetman S.
Department of Orthodontics, Medical and Dental Health Center, Skansgatan 1B, SE-302 46 Halmstad, Sweden.
The aim of the study was to measure the fluoride (F) concentration in plaque after a
single topical application of different fluoride varnishes with contrasting levels of F.
Thirty adolescents (12-17 years) with fixed orthodontic appliances were randomly
assigned to one of three groups: Bifluoride (6% F), Duraphat (2.23% F) and Fluor
Protector (0.1% F). The varnishes were applied after professional cleaning in one upper
quadrant, leaving the opposite quadrant untreated according to the split-mouth
technique. Pooled plaque samples from each quadrant were collected at baseline and 3
days, 7 days and 30 days after the varnish treatment, and fluoride was analysed by
microdiffusion. All fluoride varnishes increased the fluoride concentration in plaque
compared with baseline, and the mean values varied between 23 and 138 ng F/mg after 3
days, depending on varnish F concentration. Compared with the control quadrant,
statistically significant elevations were recorded for Bifluoride after 3 days and 7 days
and Duraphat after 3 days, while no significant differences were revealed in the Fluor
Protector group. The fluoride concentration in plaque was back to baseline levels for all
participants in the Duraphat group after 7 days, while some individuals in the Bifluoride
and Fluor Protector groups still registered slightly increased levels after 30 days. The
results suggest that fluoride varnish treatments resulted in elevated fluoride levels in
plaque adjacent to fixed orthodontic appliances for a period of up to 1 week, although
different patterns was disclosed for the various brands.
Swed Dent J. 2000;24(3):105-16.
Ability to estimate oral health status and treatment need in elderly receiving home nursing--a comparison
between a dental hygienist and a dentist.
Nederfors T, Paulsson G, Isaksson R, Fridlund B.
Oral Health Centre, Central Hospital, Halmstad, Sweden.
The aim of this study was to compare the estimation ability of a dental hygienist to that
of a dentist when, independently, recording the oral health status and treatment need in a
population of elderly, receiving home nursing. Seventy-three persons, enrolled in a
home nursing long-time care programme, were recruited. For the oral examination a
newly developed protocol with comparatively blunt measurement variables was used.
The oral examination protocol was tested for construct validity and for internal
consistency reliability. Statistical analyses were performed using Wilcoxon matched
pairs signed rank sum test for testing differences, while inter-examiner agreement was
estimated by calculating the kappa-values. Comparing the two examiners, good
agreement was demonstrated for all mucosal recordings, colour, form, wounds, blisters,
mucosal index, and for the palatal but not the lingual mucosa. For the latter, the dental
hygienist recorded significantly more changes. The dental hygienist also recorded
significantly higher plaque index values. Also regarding treatment intention and
treatment need, the dental hygienist's estimation was somewhat higher. In conclusion,
when comparing the dental hygienist's and the dentist's ability to estimate oral health
status, treatment intention, and treatment need, some differences were observed, the
dental hygienist tending to register "on the safe side", calling attention to the importance
of inter-examiner calibration. However, for practical purpose the inter-examiner
agreement was acceptable, constituting a promising basis for future out-reach activities.
Eur J Orthod. 2000 Feb;22(1):69-74.
A sella turcica bridge in subjects with severe craniofacial deviations.
Becktor JP, Einersen S, Kjaer I.
Department of Oral and Maxillo-facial Surgery, Lanssjukhuset, Halmstad, Sweden.
In earlier studies, a sella turcica bridge was stated to occur in 1.75 to 6 per cent of the
population. The occurrence of a sella turcica bridge has not previously been studied in a
group of patients with craniofacial deviations treated by surgery. Profile radiographs
from 177 individuals who had undergone combined orthodontic and surgical treatment
at the Copenhagen School of Dentistry were studied. A sella turcica bridge was
registered in those subjects where the radiograph revealed a continuous band of bony
tissue from the anterior cranial fossa to the posterior cranial fossa across the sella
turcica. Two types of sella turcica bridge were identified. A sella turcica bridge occurred
in 18.6 per cent of the subjects.
Acta Odontol Scand. 1999 Oct;57(5):263-6.
Fluoride concentration in whole saliva and separate gland secretions after topical treatment with three
different fluoride varnishes.
Twetman S, Skold-Larsson K, Modeer T.
Department of Pediatric Dentistry, Centre for Oral Health Sciences, Malmo University, Sweden.
[email protected]
Fluoride concentration in whole saliva and in separate gland secretions was determined
after a single application of each of 3 different fluoride varnishes with contrasting levels
of fluoride in a randomized crossover design. The study group comprised 8 healthy
schoolchildren aged 10-12 years treated with A: Bifluorid 12 (6% F); B: Duraphat
(2.26% F); and C: Fluor Protector (0.1% F). Unstimulated and stimulated whole saliva,
as well as stimulated parotid and submandibular-sublingual saliva, were collected at
baseline and 1, 6, 12, and 24h after the varnish treatments. The fluoride concentrations
were determined with an ion-selective electrode. Time- and dose-dependent
concentration curves were obtained in all the collected secretions, A > B > C. In whole
saliva, the fluoride levels were significantly elevated (P<0.01) 1 h after the A and B
varnish applications compared with baseline, while the increase was insignificant for
varnish C. Similar patterns were unveiled in the parotid and submandibular-sublingual
secretions, although the increase in fluoride concentration was modest. The elevated
levels did not exceed 6 h for any of the varnish tested. The results of this study suggest a
correlation between the concentration of fluoride of the varnish and fluoride levels
obtained in saliva after application.
J Nurs Manag. 1999 Sep;7(5):299-306.
Conceptions of oral health among nurse managers. A qualitative analysis.
Paulsson G, Nederfors T, Fridlund B.
Oral and Dental Health Centre, Central Hospital, Halmstad, Sweden.
AIM: The aim of this study was to describe how nurse managers perceive oral health in
general and the oral health of the care-receiver in particular. BACKGROUND: Oral
health and general health are independent and influence each other through biological,
psychological, emotional and developmental factors. To most adults, oral health is a
natural daily routine of hygiene, whereas to people who are dependent on other people's
assistance, it is a procedure carried out by nursing personnel. METHODS: Data were
collected through interviews and analysed according to the phenomenographical method.
FINDINGS: Five categories emerged describing how nurse managers perceive oral
health: maintaining patients' well-being, having knowledge about oral health, behaviour
towards the patient, feeling of being insufficient and creating the necessary conditions.
CONCLUSION: The nurses considered oral health an important and obvious, but
neglected, part of nursing. They expressed the wish to be updated in the knowledge area
concerned, both for themselves and for their personnel. A majority called for standards
for oral care, including documentation, which was considered necessary for the
successful implementation. IMPLICATIONS: A suggestion for further research is to
study whether the creation of national standards may increase its status and quality.
Int J Paediatr Dent. 1999 Jun;9(2):93-8.
Pre- and post-treatment levels of salivary mutans streptococci and lactobacilli in pre-school children.
Twetman S, Fritzon B, Jensen B, Hallberg U, Stahl B.
Department of Paediatric Dentistry, Medical and Dental Center, Halmstad, Sweden.
OBJECTIVES: To examine the effect of operative and restorative treatment of dental
caries on the levels of caries associated microorganisms in saliva and to relate alterations
to the type and extent of treatment. DESIGN: Longitudinal. SETTING: Paediatric
Dentistry Department at a central hospital in Sweden. SUBJECTS AND METHODS:
One hundred and eight pre-school children with severe dental caries scheduled for
treatment under general anaesthesia. Chair-side tests were used to estimate the levels of
salivary mutans streptococci, lactobacilli and buffer capacity before the surgery and at
recall appointments 1 and 6 months after treatment. Caries were assessed according to
WHO guidelines and the number of extracted teeth and filled surfaces during surgery
were recorded. RESULTS: The results demonstrate that the post-treatment levels of
mutans streptococci and lactobacilli were significantly reduced (P < 0.001) compared to
pretreatment levels. Lactobacilli levels were more dramatically reduced than mutans
streptococci. The reduction of mutans streptococci was positively correlated to the
number of extracted teeth (P < 0.01), but not to the number of restored or ground
surfaces. Lactobacilli reduction was not significantly related to the type of treatment.
CONCLUSION: The findings suggest that extensive operative and restorative dental
care effectively reduces the levels of caries associated with microorganisms during a
period of at least 6 months.
Int J Oral Maxillofac Surg. 1999 Jun;28(3):181-7.
Oral implants in combination with bone grafts. A 3-year retrospective multicenter study using the Branemark
implant system.
Lekholm U, Wannfors K, Isaksson S, Adielsson B.
The Branemark Clinic, Public Dental Health and Faculty of Odontology, University of Goteborg, Sweden.
A retrospective, multicenter, Scandinavian study of bone grafting of alveolar processes
of severely atrophic jaws in combination with implant insertion was conducted with 150
patients. Five different grafting techniques were assessed: local or full onlay; inlay;
combination of onlay/inlay grafts; and LeFort I osteotomies. The majority of the patients
were treated using a one-stage approach (n = 125) and all had autogenous bone grafts. A
total of 781 Branemark implants were inserted, of which 624 were placed in bone grafts
and alveolar bone. Twenty-five patients (17%) dropped out during the follow-up period
of three years. Within the remaining patients, 77% of the inserted implants (n = 516)
were still in function at the end of the follow-up period. A further ten implants were kept
mucosa-covered, resulting in an overall implant survival rate of around 80%. Onlays,
inlays and LeFort I osteotomies showed almost the same success rates (76-84%),
whereas the onlay/inlay technique gave rise to less favourable results (60%). Most of the
observed losses (n = 131) took place during healing and the first year of loading. More
implants were lost when they were inserted simultaneously with the grafting (23%) than
when they were placed in a second stage (10%). The latter technique was used mainly in
combination with local onlay grafting (16/25). The failure percentage for implants
inserted in non-grafted bone (11%) was lower than for those inserted in bone grafts and
alveolar bone (25%). The surviving implants of treated and followed patients served, in
88% of the cases (n = 110), to support fixed bridges or overdentures, albeit, in some
instances (n = 23), after additional implant placement. In only 15 patients was it
necessary to fall back on conventional removable prostheses or fixed partial bridges.
Acta Odontol Scand. 1999 Aug;57(4):190-4.
Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a
prospective, randomized, double-blind trial in Swedish children aged 1.5-3.5 years.
Jensen B, Schroder U, Mansson U.
Department of Paediatric Dentistry, Faculty of Odontology, Malmo University, Sweden. [email protected]
The aim of this study was to compare rectal sedation with diazepam and rectal sedation
with midazolam with regard to sedative effect, treatment acceptance, and amnesia.
Ninety children, 1.5-3.5 years of age, consecutively referred for extractions of
traumatized primary incisors were randomly sedated with diazepam (0.7 mg/kg body
weight) or midazolam (0.3 mg/kg body weight). The study design was randomized and
double-blind. The level of sedation (state of mind) was assessed prior to and 10 and 60
min after administration of the drug by use of a behavioral scale (Wilton). The children's
acceptance of procedures was assessed using another behavioral scale (Holst) during
administration of the sedative, application of topical anesthesia, injection of a local
anesthesia, and extraction. Amnesia was evaluated by the parents on the following day,
with the child being asked standardized questions. Parental ratings of the child's and
their own distress during and after treatment were made on a visual analog scale (VAS).
No differences were found between the sedatives concerning level of sedation during
treatment, acceptance of procedures, or amnesia. At discharge, 60 min after
administration of the sedative, the children receiving diazepam were significantly more
agitated (P=0.006). Parental rating on a VAS of the child's discomfort after treatment
was significantly higher in the diazepam group (P=0.006). There was a tendency for
children with poor acceptance of the rectal administration to display a more negative
acceptance of the dental treatment. In conclusion, the present results, in combination
with known pharmacological advantages, indicate that midazolam is preferable in
outpatients when sedation is needed and amnesia is desirable.
Acta Odontol Scand 1999 Jun;57(3):144-8
Interdental caries incidence and progression in relation to mutans streptococci suppression after
chlorhexidine-thymol varnish treatments in schoolchildren.
Twetman S, Petersson LG.
Department of Pediatric Dentistry and Public Dental Health, Medical and Dental Center, Halmstad, Sweden.
[email protected]
The aim of this study was to evaluate interdental caries incidence and progression in
relation to the effect of antibacterial varnish treatments in schoolchildren anticipated at
caries risk. After a screening procedure, 110 healthy children (8-10 years) with moderate
and high counts of salivary mutans streptococci (MS) were invited to join a 2-year
longitudinal study. At baseline, MS were enumerated at all mesial interdental sites of the
first permanent molars with a chair-side technique. The children were then treated 3
times within 2 weeks by interdental spot applications with a 1% chlorhexidine/thymolcontaining varnish (Cervitec). Follow-up samples of saliva and plaque were collected 1,
3, 6, and 12 months after onset of treat. Caries prevalence, incidence and progression of
the selected approximal surfaces were scored from bitewing radiographs exposed at
baseline and after 2 years. Sixty-three children of the same age formed a non-varnishtreated reference group. Reduction of caries incidence and progression was dearly
dependent on the outcome of the antibacterial treatment. A significantly (P< 0.01) higher
progression score was found among children who exhibited a less marked suppression of
interdental MS levels compared with those with high suppression and the children of the
reference group. The results suggest that a suppression of MS in interdental plaque may
be an important event to prevent and arrest approximal caries development in
schoolchildren at risk. Monitoring the effect of antibacterial agents in a site-specific way
could therefore be advocated.
Am J Dent. 1999 Apr;12(2):89-91.
Mutans streptococci suppression by chlorhexidine gel in toddlers.
Twetman S, Grindefjord M.
Department of Pedodontics, Lund University, Malmo, Sweden. svante [email protected]
PURPOSE: The effect of daily toothbrushing with a chlorhexidine gel on the levels of
oral mutants streptococci was evaluated in a group of 37 healthy 1 1/2-year-old children.
MATERIALS AND METHODS: The microbial samplings were performed with a
modified Strip mutans chair-side technique: a sterile cotton pellet on a wooden pin was
rolled along the surfaces of the upper primary incisors and then rolled again on a
specially prepared plastic strip. The strips were thereafter incubated and cultivated in a
selective media. After baseline registrations, the parents were instructed and trained to
brush the teeth of their children with a 1% chlorhexidine gel (Corsodyl), twice daily
during 14-days. Follow-up samplings were obtained 1 and 3 months after termination of
gel treatment. RESULTS: The results revealed a statistically significant (P < 0.01)
reduction of mutans streptococci colonization after 1 month compared with baseline.
After 3 months, a certain reduction was still evident although not statistically significant
from baseline.
Clin Oral Investig. 1999 Mar;3(1):7-10. Related Articles, Links
Salivary mutans streptococci and lactobacilli in 9- and 13-year-old Italian schoolchildren and the relation to
oral health.
Brambilla E, Twetman S, Felloni A, Cagetti MG, Canegallo L, Garcia-Godoy F, Strohmenger L.
Department of Pedodontics, Clinica Odontostomatologica, University of Milan, Italy.
The prevalence and levels of mutans streptococci (MS) and lactobacilli (LB) in saliva
and its possible correlation with dental caries and periodontal conditions was
investigated in 473 Italian schoolchildren, 9 and 13 years of age. A clinical examination
and sampling of stimulated whole saliva was carried out in the school and oral health
was assessed as DMFT and CPITN using the WHO criteria. The saliva samples were
frozen in liquid nitrogen and after thawing, cultivated on selective media. To test the
influence of cryopreservation, fresh samples from 20 subjects were cultivated. Thirtyfive percent of the children were caries-free with a mean DMFT of 1.9 at the age of 13.
The majority exhibited healthy periodontal conditions. Salivary MS and LB were
identified in 52% and 21% of the children, respectively. The prevalence of MS was
higher among the 13-year-olds than the 9-year-olds while no such difference was found
regarding LB. There was a statistically positive relationship (P < 0.01) between the
levels of MS and LB and both were significantly correlated to caries (P < 0.01). The
correlation coefficient of microbial recovery between frozen and unfrozen samples was
0.99. In conclusion, the data provided cross-sectional information of a clear positive
relationship between selected micro-organisms in saliva and caries in 9- and 13-year-old
children in spite of a relatively low prevalence of the disease. The findings are discussed
in a risk selection perspective.
Acta Odontol Scand. 1999 Feb;57(1):23-7.
Effect of an antibacterial dental varnish on the levels of prostanoids, leukotriene B4, and interleukin-1 beta in
gingival crevicular fluid.
Yucel-Lindberg T, Twetman S, Skold-Larsson K, Modeer T.
Department of Pediatric Dentistry, Faculty of Odontology, Karolinska Institutet, Huddinge, Sweden.
[email protected]
The aim of this study was to investigate the effects of a chlorhexidine/thymol-containing
dental varnish on the levels of prostaglandin E2 (PGE2), prostaglandin I2 (PGI2),
leukotriene B4 (LTB4), and interleukin-1 beta (IL-1 beta) in gingival crevicular fluid
(GCF). The material consisted of 15 adolescents undergoing treatment with fixed
orthodontic appliances. Four buccal sites adjacent to bands or brackets and exhibiting a
mild chronic gingival inflammation were selected in the upper quadrants of each patient.
According to a split-mouth technique, the first and second quadrants were randomly
treated with either a varnish (Cervitec) containing 1% chlorhexidine diacetate and
thymol (CHX/thymol) or a placebo varnish without active ingredients. The varnishes
were applied immediately after the baseline registration, and follow-up examinations
were carried out after 3, 8, and 30 days. GCF was sampled with the aid of a paper strip
and the volume was determined using a Periotron 8000. The concentrations of PGE2,
PGI2, LTB4, and IL-1 beta in GCF were assessed using radioimmunoassay and ELISA
techniques. The results unveiled statistically significant reductions of PGE2, PGI2, and
LTB4 levels in GCF following the active varnish treatment when compared to baseline
values. A slight drop in IL-1 beta levels was registered after both active and placebo
varnish applications, but the differences were not significant. The results suggest that
treatment with an antibacterial varnish decreases the levels of inflammatory mediators
PGE2, PGI2, and LTB4 in gingival crevicular fluid and further support the concept that
topical application of a CHX/thymol-containing varnish is beneficial in patients with
chronic gingival inflammation.
Swed Dent J Suppl 1998; 130:7-48.
Aspects of maxillary sinus reconstruction with enosseous implants
Blomqvist, J E
This study of maxillary sinus reconstruction in conjunction with insertion of endosseous
implants included 99 patients. Two separate surgical methods were applied; a one-staged
strategy (n=49) and a two-staged strategy (n=50). The aims were to compare two
different strategies concerning implant and prosthetic construction survival. Differences
in positioning and angulation of the inserted implants between the two separate
strategies were compared. Osteomorphometry and standard histological analysis were
performed to evaluate bone morphology from biopsies taken from the alveolar process at
different time intervals and from the iliac crest. Bone quality was also assessed by
osteometry. Further, influence of patients general medical health status, smoking habits
and long lasting medication on implants survival was investigated. Patients assessment
of function, phonetics and esthetics of the final outcome of the treatment was performed
using a questionnaire. The surgical treatment was performed either as a one-stage or a
two-stage procedure using cortico-cancellous bone grafts harvested from the anterior
iliac crest. In the first method the implants were inserted at the time of bone grafting
while in the second method the implants were inserted during a second operation after a
healing period of 9-12 months. Mean follow-up time was 30 months (range 9-48
months). Implant survival rate for the two separate strategies was 81.5% and 79.5%
respectively. Additionally, differences in implant survival were identified between
implants placed in the sinus inlays for both methods (81% and 84% respectively) and the
anterior adjacent grafted or non-grafted alveolar process (81% and 75% respectively).
Permanent bridge survival was 100% for both methods. The opinion for optimal implant
positioning was in favour of the two-stage strategy. Low bone mineral density (BMD%)
assessed by osteometry displayed a significant negative influence on implant survival.
Histological analysis of serial bone biopsies showed bone revitalization which well
support the planned healing time between bone grafting and implant insertion applied in
this study. Osteomorphometry did not seem to be a useful tool for prognostic evaluation
of future implant survival. Patients assessment of the final outcome of the treatment
concerning estetics, phonetics and function showed a high degree of acceptance with the
final result and which also correlated well with the surgery-prosthodontic
teams´evaluation of the same parameters. In conclusion, this investigation showed a rate
of implant and bridge survival which well matched other studies on grafted and nongrafted materials. Bone quality measurements by osteometry proved to be a useful tool
for prognostic evaluation of increased risk of implant failure in patients with decreased
bone mineral density. The 99 patients treated seemed to be most satisfied with the
prosthetic rehabilitation accomplished after treatment with a one- or two- stage surgical
strategy.
Plast Reconstr Surg. 1998 Aug;102(2):325-33.
Sensibility following sagittal split osteotomy in the mandible: a prospective clinical study.
Blomqvist JE, Alberius P, Isaksson S.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
Bilateral sagittal split osteotomy may be associated with postoperative sensory
deficiency in the area innervated by the inferior alveolar nerve. The aim of this study
was to assess the neurosensory response of the inferior alveolar nerve after such surgery.
Fifty consecutive patients receiving mandibular setback or advancement were
investigated. Four different neurosensory tests were used: light touch, pin prick, static
two-point discrimination, and vibration thresholds. These tests were performed
preoperatively, 2 days, as well as 3 months and 12 months postoperatively. The
methodologic error was found negligible. The pin prick and light touch tests as well as
vibratory thresholds often disclosed a short period of decreased local sensibility, whereas
static two-point discrimination displayed a slightly more extended postoperative sensory
reduction. The patients did not experience any practical problems or essential drawbacks
postoperatively. The only variable significantly associated with neurosensory
disturbance was age. In conclusion, bilateral sagittal split osteotomy, when properly
performed, must be considered a safe and reliable surgical technique, even from a
neurosensory point of view.
Int J Oral Maxillofac Implants. 1998 Nov-Dec;13(6):758-66.
Two-stage maxillary sinus reconstruction with endosseous implants: a prospective study.
Blomqvist JE, Alberius P, Isaksson S.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
The aim of this prospective study was to evaluate the results of 2-stage maxillary sinus
reconstruction using titanium implants placed into iliac corticocancellous bone blocks
previously grafted to the floor of sinuses. Fifty consecutive patients received 314
Branemark implants of varying lengths; 202 implants were placed in the grafted bone
and 112 were placed in the adjacent anterior maxillary alveolar process, which had
received buccal onlay bone grafts. Follow-up time was 9 to 48 months after implant
placement, which was accomplished 5 months after bone grafting. Eighty-four percent
of the implants were integrated into the grafted sinuses and 75% were integrated into the
anterior graft. Six patients (12%) lost implants in strategic positions, leading to
secondary implant placement prior to fabrication of fixed prostheses. Thirty-eight
patients (76%) received fixed prostheses. Only 5 individuals (10%) attained permanent
implant-anchored overdentures. One patient lost all implants. The total implant survival
rate (80.9%) and the survival rate of the fixed prostheses (100%) compare favorably
with other reports.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Sep;86(3):268-74.
Importance of bone graft quality for implant integration after maxillary sinus reconstruction.
Blomqvist JE, Alberius P, Isaksson S, Linde A, Obrant K.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad.
OBJECTIVE: The aim of this study was to determine whether bone quality, as assessed
by osteometry and histologic parameters, can be used to predict implant integration in
conjunction with maxillary sinus reconstruction. STUDY DESIGN: Twelve patients
with severely atrophied maxillary alveolar processes were treated through use of a twostage surgical reconstructive strategy with implant placement 4 months after bone
grafting. Bone biopsy specimens taken from the iliac crest peroperatively and from the
sinus inlay sites 1, 2, 4, 6, or 12 months postoperatively were analyzed by light
microscopy and osteomorphometry. Bone mineral content was measured by osteometry.
RESULTS: Osteometric and osteomorphometric data (trabecular bone volume [%],
assessment of chromatin staining, and an osteocyte index) registered for the biopsy
specimens were not statistically correlated with implant failure. CONCLUSIONS:
Prognostic evaluation of implant survival is difficult. The tested methods did not
contribute to the improvement of guidelines for the clinical handling of these patients.
J Oral Maxillofac Surg. 1998 Sep;56(9):1029-33; discussion 1033-4.
Stability of Le Fort I osteotomy with advancement: a comparison of single maxillary surgery and a two-jaw
procedure.
Bothur S, Blomqvist JE, Isaksson S.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
PURPOSE: This study compared single maxillary surgery and a two-jaw procedure in
patients who underwent one-piece Le Fort I advancement without bone grafting.
PATIENTS AND METHODS: Fifty-three patients had Le Fort I osteotomy performed
using a standard technique. Twenty-two patients had maxillary surgery alone, and 31
patients additionally had a bilateral sagittal split ramus osteotomy performed. Both rigid
and nonrigid fixation were used. The postoperative movement of the maxilla was
investigated, comparing cephalograms taken preoperatively, 2 to 3 days postoperatively,
and at least 6 months postoperatively. A computer program was used to superimpose the
three radiographs. RESULTS: No difference in postoperative stability was found when
the two surgical procedures were compared, and no correlation between magnitude of
advancement and degree of relapse could be identified (P > .05). Nonrigid fixation in
patients receiving only maxillary surgery resulted in greater postoperative forward
movement of the maxilla (P = .022). CONCLUSION: This study indicates that
postoperative stability of the maxilla in a two-jaw procedure is equivalent to that of
single maxillary surgery. Nonrigid fixation in single maxillary surgery reduces the need
for postoperative orthodontics.
Gerodontology. 1998;15(2):61-6.
Attitudes to the importance of retaining natural teeth in an adult Swedish population.
Nederfors T.
Department of Dentistry, Central Hospital, Halmstad, Sweden. [email protected]
OBJECTIVES: To evaluate the attitudes to retaining natural teeth in an adult Swedish
population, and to correlate the attitude to retaining natural teeth with some presumed
influencing background factors. DESIGN: Cross-sectional study using a newly
developed questionnaire. SUBJECTS: From the national census register of four
municipalities in the southern part of the province of Holland, Sweden, with a total
population of 126,878 adult (> or = 20 years) inhabitants, 4,200 persons were selected at
random. The sample was randomised by age and sex, and 300 men and 300 women from
the age groups 20, 30, 40, 50, 60, 70, and 80 years were included. INTERVENTION
AND MAIN OUTCOME MEASURES: The questionnaire aimed to evaluate the number
of remaining natural teeth, the dental care habits, the self-estimated quality of natural
teeth, and the attitude to retaining natural teeth in the studied population, and also to
evaluate the possible correlation between those factors, in particular, the attitude to
retaining natural teeth versus the other factors. RESULTS: It was found that the attitude
to the importance of retaining natural teeth was strongly correlated with the number of
remaining natural teeth, the dental care habits, and the self-estimated quality of natural
teeth. Also sex had an influence on this attitude but not age. CONCLUSIONS: The
attitude to the importance of retaining natural teeth in an adult Swedish population is
correlated with the number of remaining natural teeth, the dental care habits, the selfestimated quality of natural teeth, and sex, but not with age.
Spec Care Dentist. 1998 Nov-Dec;18(6):234-42.
Evaluation of an oral health education program for nursing personnel in special housing facilities for the
elderly.
Paulsson G, Fridlund B, Holmen A, Nederfors T.
Centre for Health Promotion Research, Halmstad University, Sweden.
The aim of this study was to evaluate the influence of an oral health education program
(OHEP) on attitudes among the responsible nursing personnel toward performing oral
health procedures for care receivers. A total of 2882 nursing personnel were offered
participation in the OHEP, and the effect was evaluated by means of a questionnaire
distributed pre-educationally as well as 1-2 months post-educationally. The nursing
personnel were allocated, on the basis of nursing education, to either a "high level of
health care education" group (HHCE), including registered and enrolled nurses, or a
"low level of health care education" group (LHCE), including nursing assistants and
home care aides. Statistical analysis was performed by means of descriptive and
analytical statistics. After the OHEP, the nursing personnel estimated their ability to
perform oral hygiene procedures for care receivers to be significantly increased. Posteducationally, a significant shift in importance was observed from knowledge regarding
the diseased oral cavity to knowledge regarding the healthy oral cavity. It was also
observed that, in the LHCE group, the OHEP favored practical procedures, while in the
HHCE group, theoretical considerations were favored. This indicates that, when oral
health education programs are designed, due attention should be paid to the nursing
personnel's education level.
J Clin Periodontol. 1998 Jul;25(7):585-95.
Guided tissue regeneration for the treatment of intraosseous defects using a biabsorbable membrane. A
controlled clinical study.
Mayfield L, Soderholm G, Hallstrom H, Kullendorff B, Edwardsson S, Bratthall G, Bragger U, Attstrom R.
Lund University, Faculty of Odontology, Malmo, Sweden.
The aim of this controlled, clinical study was to evaluate guided tissue regeneration
using a bioabsorbable membrane in periodontal intraosseous defects. Forty patients, each
contributing one defect > or =4 mm in depth participated. The control group (18
individuals) received conventional flap therapy, while the test group (22 individuals)
was treated using the bioabsorbable membrane, Guidor. Clinical assessments were made
by one examiner, blinded with respect to treatment group, at baseline, 6 and 12 months
following surgery. Baseline probing pocket depths of 7.7+/-1.4 mm in the membrane
group and 7.6+/-1.9 mm in the control group were measured. Twelve month results
showed a significant clinical attachment level gain in both control (1.1+/-1.8 mm), and
membrane group (1.3+/-2.1 mm). Probing pocket depth reduction of 2.6+/-1.9 mm and
2.7+/-1.9 mm was observed in the respective groups. Bone sounding showed a nonsignificant gain of 0.4+/-1.8 mm and 0.6+/-1.4 mm at membrane and control sites,
respectively. Radiographic evaluation confirmed these results. There were no significant
differences found between treatment groups for any of the tested variables. Smoking had
a negative effect on healing in both groups. In conclusion, clinical and radiographic
results indicate that guided tissue regeneration using a bioabsorbable membrane at
intraosseous defects did not predictably achieve greater clinical attachment level gain
nor bone gain when compared to conventional flap therapy.
Eur J Oral Sci. 1998 Feb;106(1):571-5.
Effect of a chlorhexidine/thymol-containing varnish on prostaglandin E2 levels in gingival crevicular fluid.
Skold K, Twetman S, Hallgren A, Yucel-Lindberg T, Modeer T.
Department of Orthodontics, Medical and Dental Center, Halmstad, Sweden.
The aim was to study the effect of a chlorhexidine/thymol-containing varnish (Cervitec)
on the levels of prostaglandin E2 (PGE2) in gingival crevicular fluid (GCF). The
material consisted of 25 adolescents and young adults with fixed orthodontic appliances
exhibiting gingival inflammation. Four buccal sites, adjacent to bands and brackets, were
selected on each patient and randomly treated with either a varnish containing
chlorhexidine diacetate (1% w/w) and thymol (1% w/w) or a placebo varnish without
active ingredients. After baseline registration, the varnishes were applied twice within 3
d. Follow-up examinations were performed after 3, 8 and 30 d. The gingival
inflammation was assessed by bleeding on probing, volume of GCF with a Periotron
8000 and PGE2 level in GCF by using a radioimmuno assay. Compared with baseline, a
statistically significant reduction in the volume of GCF was recorded at the
chlorhexidine/thymol treated sites in contrast to the placebo. The mean PGE2 levels
were significantly reduced after the test varnish treatment compared with baseline and
differed significantly from placebo after 8 d. The findings suggest that treatments with
the antibacterial varnish result in reduced gingival inflammation and may thus be
beneficial for patients with fixed orthodontic appliances.
Eur J Oral Sci 1998 Feb;106(1):564-70
Fluoride concentration in the approximal area after using toothpicks and other fluoride-containing products.
Kashani H, Birkhed D, Petersson LG.
Department of Cariology, Faculty of Odontology, Goteborg University, Sweden. [email protected]
The aim of this work was to study the fluoride (F) concentration in the approximal area
after using toothpicks and other F-containing products. The exposure time was
standardised to 2 min. 24 subjects participated, divided into 4 groups, with 6 individuals
per group. In 3 of the groups, the following 4 products were compared: (1) a toothpick
impregnated in 4% NaF; (2) a dentifrice containing 0.32% NaF; (3) a mouthrinse
solution containing 0.025% NaF; (4) a tablet containing 0.55 mg NaF. In the 4th group,
3 commercial F toothpicks and 2 F dental flosses were compared. In all 4 groups, the F
concentration was determined up to 60 min at 4 approximal sites. On each sampling
occasion, 3 triangle-shaped paper points were used, absorbing 3 x 1 microl. In general,
the toothpick gave similar or somewhat higher F concentrations in the approximal area
than the dentifrice, mouthrinse solution and tablet. Comparing the various commercial
toothpicks and dental flosses, 2 of the toothpicks gave higher approximal F
concentrations than the other 3 products. When comparing the series in which the very
first sample was collected from 2-20 min after the F treatment, it was found that the
sampling procedure itself reduced the subsequent approximal F concentration. The main
conclusion from this study is that an F-impregnated toothpick is a promising vehicle for
delivery of fluoride to the approximal area.
Caries Res 1998;32(6):422-7
Effect of toothpicks with and without fluoride on De- and remineralization of enamel and dentine in situ.
Kashani H, Birkhed D, Arends J, Ruben J, Petersson LG, Odelius H.
Department of Cariology, Faculty of Odontology, Goteborg University, Goteborg, Sweden.
The aim of this investigation was to study the effect of the interproximal use of fluoride
(F)-impregnated and non-impregnated birch toothpicks on the degree of de- and
remineralization of enamel and dentine in situ. Ten volunteers with complete dentures in
the upper jaw participated. Each subject had four specimens: (1) sound enamel, (2)
demineralized enamel, (3) sound dentine and (4) demineralized dentine; placed pairwise
at two approximal sites (15/16 and 25/26) of the maxillary prosthesis. The study
involved three test periods (A, B and C), each lasting 4 weeks. In A, the subjects used F
toothpicks (impregnated in 4% NaF) and, in B, nonimpregnated toothpicks 3 times daily.
During period C, no toothpicks were used. Dentifrice or other F-containing products
were not allowed during the 4-week periods. Transversal microradiography was used to
determine lesion depth (ld) and mineral loss (DeltaZ). The results revealed that all the
sound samples lost mineral during the three experimental periods; DeltaZ for both
enamel and dentine was less for A and B compared with C (p<0.01) and less for A
compared with B and C for dentine (p<0.05, p<0.01). The demineralized samples also
lost mineral, apart from dentine, during periods A and B, i.e. when F-impregnated and
non-impregnated toothpicks were used; ld for enamel and DeltaZ for dentine were less
for A compared with C (p<0.05). Four weeks' use of toothpicks, especially Fimpregnated toothpicks, thus reduces the demineralization of enamel and dentine at
approximal sites in situ.
Eur J Oral Sci 1998 Apr;106(2 Pt 1):623-7
Effect of semi-annual applications of a chlorhexidine/fluoride varnish mixture on approximal caries incidence
in schoolchildren. A three-year radiographic study.
Petersson LG, Magnusson K, Andersson H, Deierborg G, Twetman S.
Department of Preventive Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
[email protected]
Development and progression of approximal caries is still difficult to prevent and control
even in societies with declining caries prevalence. In this study, a test group of 115 12-yr
old children were treated semi-annually with a mixture (1:1) of a varnish containing
0.1% F (Fluor Protector) and 1.0% chlorhexidine (Cervitec). A reference group of 104
children received fluoride varnish treatment (Fluor Protector) semi-annually.
Approximal caries was recorded from bitewing radiographs at baseline and after 3 yr. At
baseline, total decayed and filled surfaces (DFS) including enamel caries were 1.79+/2.36 in the reference group and 2.0+/-2.77 in the test group. After 3 yr, the mean
approximal caries incidence including enamel caries was 3.01+/-3.74 and 3.78+/-4.32,
respectively. The differences at baseline as well as after 3 yr were not statistically
significant. The results showed that both groups had a comparatively low incidence of
approximal caries during the experimental period, and suggest that a mixture of fluoride
and antibacterial varnish had no additional preventive effect on approximal caries
incidence compared with fluoride varnish treatments alone.
Eur J Oral Sci 1998 Dec;106(6):1048-51
Erratum in:
Eur J Oral Sci 1999 Apr;107(2):154
Approximal caries development following intensive fluoride mouthrinsing in teenagers. A 3-year radiographic
study.
Petersson LG, Svanholm I, Andersson H, Magnusson K.
Department of Preventive Dentistry, Medical and Dental Health Centre, Halmstad, Sweden.
[email protected]
Caries development on approximal surfaces was studied in 139 adolescents for a period
of 3 yr. A test group was randomly sampled (n=69) and subjected to a new intensive
mode of fluoride (F) mouthrinsings using 10 ml of 0.045% NaF neutral solution once a
day for 3 d, twice a year in all, i.e., 6 rinses per year. A control group (n = 70) rinsed in a
similar mode using fluoride-free tap water. The two groups received the same basic
prophylactic program during the trial. Detection of approximal caries lesions and fillings
was based on bitewing radiographs at baseline and after 3 yr. The test group developed
an average of 2.75 + 4.76 (mean +/- SD) approximal DFS compared with 3.21 + 4.74
DFS in the control group (n.s.). However, among those teenagers who were caries free
(DFS = 0) at baseline, the incidence of approximal carious and filled surfaces was
1.76+/-4.52 in the F-rinsing group (n = 26) compared with 2.76+/-5.01 DFS in the
control group (n = 32), a 36% caries reduction which was statistically significant. The
intensified mouthrinsing procedure seems to be a promising prophylactic mode for
collective caries prevention.
J Public Health Dent 1998 Winter;58(1):57-60
The efficiency of semiannual silane fluoride varnish applications: a two-year clinical study in preschool
children.
Petersson LG, Twetman S, Pakhomov GN.
Department of Preventive Dentistry, Medical and Dental Center, Halmstad, Sweden. [email protected]
OBJECTIVE: The aim of this two-year community demonstration trial was to study the
caries inhibitory effects of semiannual applications of a fluoride varnish in preschool
children. METHODS: Twenty-four public dental health clinics in the county of Halland,
Sweden, with 5,137 preschool children, 4 and 5 years of age, were matched and equally
allocated to a fluoride varnish group (n = 2,535) and a reference group (n = 2,602). The
children in the fluoride varnish group were treated every six months with topical
applications of a silane fluoride varnish, Fluor Protector (0.1% F), while no fluoride
varnish was used in the reference group. Both groups received a basic preventive
program at annual checkups consisting of dietary counseling and instructions to parents
to brush their children's teeth at least once daily with fluoridated dentifrice. Caries data
were collected by clinical examinations at baseline and after one and two years.
RESULTS: Caries prevalence at baseline did not differ significantly between the groups.
After two years, the mean caries incidence was low and no statistical difference was
found in the total number of carious and filled surfaces (dfs) between the two groups.
However, the incidence of approximal lesions (dfsa) was significantly lower (P < .05) in
the fluoride varnish group than the reference group. Children in the fluoride varnish
group with dfs scores of 1-4 and > or = 5 at the start of the study exhibited a statistically
significant (P < .05) reduction in approximal caries incidence of 19 percent and 25
percent, respectively, when compared with the reference group. CONCLUSION:
Preschool children 4 and 5 years of age with clinical caries who receive semiannual
applications of a silane fluoride varnish containing 0.1 percent F experience a reduced
incidence of approximal caries over two years.
Acta Odontol Scand. 1998 Aug;56(4):229-32.
Acceptance of dental care following early extractions under rectal sedation with diazepam in preschool
children.
Jensen B, Schroder U.
Department of Pedodontics, Faculty of Odontology, Lund University, Malmo, Sweden.
The aim of the study was to evaluate the effect of amnesia in preschool children on their
later acceptance of dental care. Forty-six 4-6-year-old children, who between 2 and 4
years previously had had primary incisors extracted because of trauma, were reexamined
for dental health and acceptance of dental care. The extractions had been performed
under rectal sedation with diazepam (0.7 mg/kg body weight). Information about dental
treatment and degree of cooperation during the intervening period was obtained from
records at the referring clinic. The parents were interviewed about their child's
experience of amnesia concerning the extractions, background variables, and
experiences of dental care before the follow-up examination. Amnesia concerning the
extractions was reported in 85% of the children. Twenty-nine percent had on some
occasion exhibited behavior management problems (BMP) during the intervening
period. Lack of amnesia was significantly associated with BMP (P< 0.002). Children
without amnesia concerning the extractions tended to accept dental care less well at the
reexamination. Parents were able to predict their child's acceptance of dental care at the
follow-up with a significant degree of success (P= 0.02). In conclusion, amnesia in
preschool children concerning extractions seems to be essential to facilitate positive
acceptance of future dental care.
Caries Res 1998;32(6):412-6
Fluoride concentration in whole saliva and separate gland secretions in schoolchildren after intake of
fluoridated milk.
Twetman S, Nederfors T, Petersson LG.
Department of Dentistry, Medical and Dental Center, Central Hospital, Halmstad, Sweden
[email protected]
Fluoride concentration in whole saliva and in separate gland secretions was studied after
a 7-day fluoridated milk regimen (1mg F per day) in 12 healthy schoolchildren aged 1013 years. A 2-week fluoride-free run-in period preceded the tests in order to establish the
endogenous baseline levels. Unstimulated and stimulated whole saliva and stimulated
parotid and submandibular-sublingual saliva were collected at 1, 3, 6, 12 and 24h after
F-milk ingestion, and fluoride concentrations were determined with an ion-selective
electrode. Typical time-dependent excretion curves were obtained in all collected
secretions. The fluoride levels were significantly elevated 1 and 3h in whole saliva and
up to 6h in the gland secretions after intake of fluoridated milk when compared to
baseline values. When acid-stimulated, the submandibular-sublingual glands were the
major contributors of fluoride in the oral cavity. In conclusion, the results of this study
demonstrate that fluoride ingested with milk is excreted through the salivary glands,
indicating that the bioavailability of fluoride from milk equals that of other vehicles.
Caries Res 1998;32(2):113-8
Comparison of the efficacy of three different chlorhexidine preparations in decreasing the levels of mutans
streptococci in saliva and interdental plaque.
Twetman S, Petersson LG.
Department of Paediatric Dentistry, Medical and Dental Health Centre, Halmstad, Sweden.
The aim of the present study was to evaluate and compare the effects of three different
chlorhexidine (CHX)-containing preparations on mutans streptococci (MS) levels in
interdental plaque and whole saliva. Ninety-three healthy school-children (8-10 years
old) with high scores of salivary MS were selected by a screening procedure and
randomised into three equally sized groups. MS were enumerated at all mesial
interdental sites of the first permanent molars with aid of a modified chairside technique.
The patients were then treated three times within 2 weeks with either a 1% CHX/thymolcontaining varnish (group A) or a 1% CHX gel (group B), or they were subjected to
daily supervised toothbrushing with a 0.4% CHX dentifrice for 1 month (group C).
Follow-up samples of saliva and plaque from the interdental sites were collected 1 and 3
months after termination of treatment. A statistically significant reduction of MS levels
in saliva and interdental plaque was found in all groups after 1 month. The CHXcontaining dentifrice (group C) was the most effective method in reducing MS levels in
saliva, and a significantly stronger (p < 0.05) suppression was found after 1 and 3
months when compared with the gel and the varnish forms. The gel (group B) tended to
be slightly more effective than the varnish (group A). In the interdental plaque, the
reduction of MS was less marked than in the saliva, and the three groups exhibited MS
reductions of similar magnitude (20%) and duration, persisting up to 3 months.
However, a high proportion (approximately 50%) of all interdental sites were relatively
unaffected by the treatments. In conclusion, our results suggest that the interdental MS
colonisation was difficult to combat, irrespective of CHX preparation and method, while
the salivary levels were more easily affected. Daily tooth-brushing with a CHXcontaining dentifrice was more effective in reducing MS in saliva compared with the gel
or varnish applications.
Int J Prosthodont. 1997 Jul-Aug;10(4):366-74.
Implant-supported overdenture therapy: a retrospective study.
Ekfeldt A, Johansson LA, Isaksson S.
Department of Prosthetic Dentistry, Dental and Medical Health Centre, Halmstad, Sweden.
All patients (n = 46) treated with implant-supported overdentures at the Department of
Prosthetic Dentistry, Dental and Medical Health Centre, Halmstad, Sweden, from 1986
to 1993 were studied. The clinical examination was completed in 1994. The material
was divided into two subgroups: Group A had been initially treatment planned for an
implant-supported overdenture, and Group B had been planned for fixed prostheses but
because of loss of implants before loading, treatment with a fixed prosthesis was not
possible. The authors present their experience and patient reactions to overdenture
therapy in two defined groups of patients. The implant failure rate before loading for
Group A (n = 12) was 15% (six implants out of 39), and the rate before loading for
Group B (n = 29) was 43.6% (68 implants out of 156). After prosthodontic treatment in
Group A, the implant success rate after loading was 87.9%, and the overdenture stability
was 84.6%. In group B, 17 implants placed in the maxillae were lost after overdenture
therapy, which resulted in an implant success rate of 79.3%. A total of eight
overdentures, all of which had been placed in the maxillae, were lost, resulting in an
overdenture stability of 73.3%. In this study "change of retentive clips" was the
predominant prosthodontic complication related to the overdentures, especially in Group
B. Most of these complications (62%) occurred in patients with clinical signs of
bruxism. Patient reactions to treatment with an overdenture were positive regarding
esthetics for both groups. More negative views were recorded in Group B than in Group
A in response to function and retention of the overdenture.
Community Dent Oral Epidemiol. 1997 Jun;25(3):211-6.
Prevalence of perceived symptoms of dry mouth in an adult Swedish population--relation to age, sex and
pharmacotherapy.
Nederfors T, Isaksson R, Mornstad H, Dahlof C.
Department of Pharmacology and Clinical Pharmacology, Faculty of Odontology, Goteborg University.
The aim of the study was to evaluate the prevalence of subjective perception of dry
mouth in an adult population and to determine the prevalence of pharmacotherapy in this
population. An additional aim was to assess a possible co-morbidity between symptoms
of dry mouth and continuing pharmacotherapy. Four-thousand-two-hundred persons
were selected at random from the national census register of the adult population of the
southern part of the province of Halland, Sweden. The sample was stratified according
to age and sex, and 300 men and an equal number of women aged 20, 30, 40, 50, 60, 70
and 80, were included. A newly developed questionnaire was mailed to each individual.
In addition to questions about subjective perception of dry mouth, the subjects were
asked to report on present diseases and continuing pharmacotherapy. Three-thousandthree-hundred and thirteen (80.5%) evaluable questionnaires were returned. The
estimated prevalence of xerostomia in the population was 21.3% and 27.3% for men and
women, respectively. This difference between the sexes was statistically significant. In
non-medicated subjects, women tended to report a higher prevalence of xerostomia
compared with men, 18.8% vs. 14.6%, and also among medicated subjects the estimated
prevalence of dry mouth was higher for women than for men, 32.5% vs. 28.4%. There
was a strong association between xerostomia and increasing age and also between
xerostomia and continuing pharmacotherapy. The average prevalence of dry mouth
among medicated and non-medicated subjects was 32.1% and 16.9%, respectively, the
difference being statistically significant. There was also a strong association between
xerostomia and the number of medications. In a logistic regression, the probability of
reporting mouth dryness was significantly greater in older subjects and in women, and
the probability increased with the number of medications taken. In conclusion, this
epidemiological survey of an adult population has demonstrated that women,
independent of age, do report a higher prevalence of xerostomia than men and that the
symptom of dry mouth is strongly associated with age and pharmacotherapy. It is,
however, not possible to discriminate between disease and pharmacotherapy as causal
factors.
J Oral Maxillofac Surg. 1997 Jun;55(6):568-74; discussion 574-5.
A comparison of skeletal stability after mandibular advancement and use of two rigid internal fixation
techniques.
Blomqvist JE, Ahlborg G, Isaksson S, Svartz K.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
PURPOSE: Two different methods of rigid fixation were compared for postoperative
stability 6 months after mandibular advancement for treatment of Class II malocclusion.
MATERIAL AND METHODS: Sixty (30 + 30) patients from two different oral and
maxillofacial units treated for a Class II malocclusion by bilateral saggital split
osteotomy (BSSO), and two different methods of internal rigid fixation were
prospectively investigated. Two groups (S1, n = 15; S2, n = 15) had bicortical
noncompressive screws inserted in the gonial area through a transcutaneous approach,
and the other two groups (P1, n = 15; P2, n = 15) had the bone segments fixed with
unicortical screws and miniplates on the lateral surface of the mandibular body.
Cephalograms were taken preoperatively, 2 days postoperatively and 6 months after the
operation. A computer program was used to superimpose the three cephalograms and to
register the mandibular advancement and postoperative change both sagittally and
vertically. RESULTS: These were minor differences in the advancement and
postoperative changes between the four groups, but statistically no significant difference
was shown in either sagittal or vertical directions. However, statistically verified
differences proved that increasing age was associated with a smaller amount of
postsurgical relapse. Low-angle cases (ML/NSL < 25 degrees) had a bigger amount of
surgical (P = .0008) and postsurgical (P = .0195) movement compared with the patients
in the high-angle group (ML/NSL < 38 degrees). Using a multiple regression test, a
positive correlation was also shown between the amount of surgical advancement and
the amount of postsurgical instability (P = .018). CONCLUSIONS: This prospective
dual-center study indicates that the two different methods of internal rigid fixation after
surgical advancement of the mandible by BSSO did not significantly differ from each
other, and it is up to the individual operator to choose the method for internal rigid
fixation.
J Oral Maxillofac Surg. 1997 Aug;55(8):804-10.
Sinus inlay bone augmentation: comparison of implant positioning after one- or two-staged procedures.
Blomqvist JE, Alberius P, Isaksson S.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
PURPOSE: This study was undertaken to compare implant angulation and position after
one- or two-stage sinus inlay bone augmentation. PATIENTS AND METHODS:
Twenty patients were retrospectively selected; group 1 (n = 10) was operated on with a
one-stage procedure, and group 2 (n = 10) with a two-stage operation. Casts processed
for the final permanent or temporary bridgework were collected and photographed from
an oblique anterior view paralleling the alveolar crest on the right and left sides, as well
as from an occlusal view. The angle between impression pins inserted in the abutments
relative to the true vertical was recorded. In the occlusal view, the midpoints of the
abutments were related to an individual computerized superimposed parabola.
RESULTS: The implants inserted during the one-stage procedure were generally placed
more palatally (Wilcoxon rank sum test, P = .0101) and angled more palatally (P =
.0009) compared with those placed with the two-stage operation. CONCLUSION: This
study showed that the two methods of treating patients by sinus inlay bone augmentation
differed significantly with regard to placement and angulation of the implants. A twostage procedure seems to offer the surgeon more optimal conditions for positioning the
implants.
Am J Dent. 1997 Jun;10(3):115-9.
2-year clinical performance of a fluoride-containing fissure sealant in young schoolchildren at caries risk.
Carlsson A, Petersson M, Twetman S.
Public Dental Clinic, Vallas, Sweden.
PURPOSE: To evaluate the clinical performance of Helioseal-F, a fluoride-containing
fissure sealant, in school children at caries risk. MATERIALS AND METHODS: A
caries risk assessment based on past caries experience, saliva microbial tests, buffer
capacity and frequency of sugar intake was carried out in 204 healthy children, 6-7 years
of age. Children exhibiting one or more risk factors were considered at caries risk (n =
121) and their permanent molars were sealed with a fluoride-containing fissure sealant,
thus forming a fissure sealant group (FSG). The remaining 83 children with low caries
risk received no fissure sealants and constituted a reference group (RG). Both groups
were followed for 2 years. From 15 children of both groups, unstimulated whole saliva
was collected 1 month after sealant placement in order to determine fluoride levels. In
another 20 children, a split-mouth study design was utilized to compare the colonization
of mutans streptococci adjacent to and on F-containing sealants and conventional
controls. The sealants were placed by dental hygienists according to the manufacturers'
instructions. RESULTS: A total of 431 fissure sealants were placed at baseline.
Complete retention was found in 76.6% during the study period while 22.0% were
partially lost. Six sealants (1.4%) were completely lost. The enamel caries incidence was
45% lower (P < 0.05) in the permanent molars of the caries risk FSG compared with the
low risk RG. There was no significant increase in saliva fluoride concentration following
placement of the sealants and the proportion of mutans streptococci in relation to total
viable counts was unaffected by type of material. The levels of salivary mutans
streptococci were mainly unchanged in both groups during the study period, while the
levels of salivary lactobacilli decreased in the FSG.
Swed Dent J. 1997;21(3):93-9.
Patients' assessment of surgical removal of mandibular third molars. An inquiry study.
Blomqvist JE, Isaksson S, Lundberg T.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
The aim of this study was to find out patients' experience of pain and discomfort in
connection with removal of lower third molars under local anaesthesia. Patients
consecutively referred to the Oral and Maxillofacial Unit in Halmstad for removal of
lower impacted third molars were the selection for this study. Three surgeons operated
294 lower third molars under local anaesthesia. The Visual Analogue Scale was used to
register pain at several occasions during the surgical performance. The patients
experienced the operation as an acceptable procedure and the most painful event during
the operation was the injection of local anaesthetic solution. The study showed that the
surgical procedure was very well tolerated by the patients with only a minor incident of
inconvenience or excessive pain.
Swed Dent J. 1997;21(5):169-75.
Cariostatic effect of glass ionomer retained orthodontic appliances. An in vivo study.
Twetman S, McWilliam JS, Hallgren A, Oliveby A.
Department of Pedodontics, School of Dentistry, Karolinska Institute, Huddinge Sweden.
The cariostatic effect of a fluoride releasing bonding agent was investigated and
compared with a conventional composite based material in connection with bonding of
orthodontic brackets in 22 homologous pairs of premolars. All subjects had
malocclusions requiring orthodontic treatment with fixed appliances and extraction of at
least two premolars. 6-13 weeks prior to extraction, orthodontic brackets were bonded to
the labial surfaces of the extraction teeth with either a glass ionomer cement or a bisGMA resin. Initially, the children were instructed in tooth brushing and the regular use
of fluoride. After extraction, the bonded teeth were stained and evaluated in a stereomicroscope regarding the incidence and extension of initial enamel demineralisation.
The zone of intact enamel adjacent to the bracket base and bonding material was
measured in a stereo-microscope at four predetermined locations with the aid of an
electronic ruler and scored according to four categories. The incidence of enamel
demineralisation adjacent to glass ionomer bonded and composite bonded brackets was
68% and 77% respectively. In 12 pairs of premolars however, the demineralisation
appeared to a lesser extent on the enamel around the brackets was generally wider when
glass ionomer cement was used compared to the composite resin. These differences were
statistically significant (p < 0.05) mesially and distally, but non-significant cervically
and incisally. The results indicate that bonding with glass ionomer cement may have a
local cariostatic effect in children requiring fixed orthodontic appliances.
Caries Res 1997;31(3):189-93
Effect of different chlorhexidine varnish regimens on mutans streptococci levels in interdental plaque and
saliva.
Twetman S, Petersson LG.
Department of Paediatric Dentistry, Medical and Dental Health Centre, Halmstad, Sweden.
The aim of the present study was to evaluate and compare the effects of an intensive and
a monthly mode of antibacterial varnish application on the levels of mutans streptococci
(MS) in interdental plaque and whole saliva. Eighty-eight healthy schoolchildren (11-13
years) with high scores of salivary MS were selected by a screening procedure and
randomised into two groups, MS were enumerated at all mesial interdental sites of the
first permanent molars with the aid of a modified chair-side technique, disclosing a total
of 161 sites with moderate or high colonisation levels. The subjects were treated with a
1% chlorhexidine-thymol-containing varnish (Cervitec) either in an intensive mode (IM)
with 3 applications within a 2-week period or in a monthly mode (MM) during a 3month period. The varnish was applied with a miniball burnisher after the teeth had been
cleaned interdentally with dental floss and dried with air. Follow-up samples of saliva
and plaque from the interdental areas were collected after 1, 3 and 6 months. Both
groups exhibited a statistically significant (p > 0.05) reduction of interdental MS after 1
month when compared with baseline. An eliminated MS growth appeared more
frequently following the IM compared with the MM. After 3 months, a significant
reduction compared with baseline was still found in the IM group but not in the MM
group. No reduction was found in either group after 6 months. MS levels in saliva were
mainly unaffected at the follow-up samplings, with the exception of a slight reduction in
the IM group after 1 month. In conclusion, the results suggest that an intensive mode of
chlorhexidine-thymol varnish application is more effective against interdental MS than
the monthly mode of application. Bacterial growth should be monitored in a site-specific
way, since interdental reductions were not adequately reflected in whole saliva samples.
Caries Res 1997;31(5):361-5
Efficacy of a chlorhexidine and a chlorhexidine-fluoride varnish mixture to decrease interdental levels of
mutans streptococci.
Twetman S, Petersson LG.
Department of Paediatric Dentistry, Karolinska Institute, Huddinge, Sweden.
The aim of the present study was to evaluate and compare the efficacy of a
chlorhexidine/thymol-containing (CHX) and a chlorhexidine/thymol/fluoride-containing
(CHX + F) varnish to decrease interdental levels of mutans streptococci (MS). Eightytwo healthy schoolchildren (11-13 years) with high scores of salivary MS were selected
by a screening procedure and randomised into two groups. MS were enumerated at all
mesial interdental sites of the first permanent molars with the aid of a modified chairside technique. The interdental molar and premolar sites were treated with either a 1%
CHX varnish (Cervitec) or a 1:1 mixture of the CHX varnish and a fluoride varnish
containing 0.1% w/w difluorsilane (Fluor Protector; CHX + F) on two occasions within
a 2-week period. The varnishes were applied with a small brush after cleaning with
dental floss and drying with air. Follow-up samples from the interdental areas were
collected after 1 and 3 months. Both groups exhibited a similar statistically significant (p
< 0.05) reduction of interdental MS after 1 month when compared with baseline. After 3
months, a significant reduction (p < 0.05) was still found in the CHX + F varnish group
but not in the CHX varnish group. In conclusion, the results suggest that the addition of
fluoride to an antibacterial varnish might improve the long-term efficacy in diminishing
the cariogenic microbial challenge. Thus, the mixed varnish concept should be further
developed and warrants an implementation of clinical studies.
Nat Toxins. 1997;5(5):186-92.
Toxicological evaluation of myristicin.
Hallstrom H, Thuvander A.
Division of Toxicology, National Food Administration, Uppsala, Sweden. [email protected]
Myristicin, or methoxysafrole, is the principal aromatic constituent of the volatile oil of
nutmeg, the dried ripe seed of Myristica fragrans. Myristicin is also found in several
members of the carrot family (Umbelliferae). Several intoxications have been reported
after an ingestion of approximately 5 g of nutmeg, corresponding to 1-2 mg
myristicin/kg body weight (b.w.). Although these intoxications may be ascribed to the
actions of myristicin, it is likely that other components of nutmeg may also be involved.
The metabolism of myristicin resembles that of safrole. No information is available,
however, concerning the quantitative importance of the different metabolic pathways.
The acute toxicity of myristicin appears to be low. No toxic effects were observed in rats
administered myristicin perorally at a dose of 10 mg/kg b.w., while 6-7 mg/kg b.w. may
be enough to cause psychopharmacological effects in man. A weak DNA-binding
capacity has been demonstrated, but there are no indications that myristicin exerts
carcinogenic activity in short-term assays using mice. Intake estimations indicate that
nonalcoholic drinks may be the most important single source of myristicin intake. Based
on available data, it seems unlikely that the intake of myristicin from essential oils and
spices in food, estimated to a few mg per person and day in this report, would cause
adverse effects in humans. It is, however, at present not possible to make a complete risk
assessment, as studies regarding genotoxicity and chronic toxicity, including
reproductive toxicity and carcinogenicity, are still lacking.
Int J Oral Maxillofac Implants. 1997 Jan-Feb;12(1):52-8.
Three-year evaluation of Branemark implants connected to angulated abutments.
Balshi TJ, Ekfeldt A, Stenberg T, Vrielinck L.
Department of Prosthetic Dentistry, Center for Medical and Dental Health, Halmstad, Sweden.
A 3-year multicenter study on 63 maxillary and 10 mandibular fixed prostheses in 71
patients is reported. Angulated abutments or a combination of angulated and standard
abutments were used to support prostheses; all components were from the Branemark
System. Of 425 implants initially placed, 4 were lost before abutment connection. Of the
remaining 421 implants, 209 angulated (test) abutments and 212 standard (control)
abutments were placed to support fixed prostheses. The prosthesis success rates were
96.8% for maxillae and 100% for mandibles. A total of 5.3% of the loaded test implants
and 7.5% of the loaded control implants failed. The survival rates after 3 years were
91.3% for maxillary control implants, 94.8% for maxillary test implants, 97.4% for
mandibular control implants, and 94.1% for mandibular test implants. The findings in
this study pointed out that angulated abutments will not necessarily promote periimplant mucosal problems. The study indicated that angulated abutments on Branemark
System implants have exhibited good preliminary results and should be comparable to
the standard abutment as a predictable modality in prosthetic rehabilitation.
J Clin Periodontol. 1996 Dec;23(12):1068-72.
Saliva composition in children and young adults with Papillon-Lefevre syndrome.
Lundgren T, Twetman S, Johansson I, Crossner CG, Birkhed D.
Department of Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
The aim of the present study was to evaluate the salivary secretion rate and composition
in a group of 16 children and young adults (6-27 years) with Papillon-Lefevre Syndrome
(PLS), and to compare the findings with a group (n = 16) of healthy controls.
Unstimulated and stimulated whole saliva was collected at least 2 h after meals and the
secretion rate determined. The stimulated saliva was assessed for buffer capacity, total
protein, peroxidase and hexosamine, while the unstimulated samples were evaluated for
total protein, lysozyme, thiocyanate, lactoferrin and salivary IgA. Both the unstimulated
(p < 0.01) and stimulated (p < 0.05) saliva secretion rates were significantly lower
among the PLS patients compared with the controls. Furthermore salivary buffer
capacity was significantly (p < 0.01) lower in the PLS patients. The total protein content
in saliva was comparatively high in the study group, while the concentrations of
immunoglobulins and non-immunoglobulins were within normal ranges. When
calculating the output of the assessed antimicrobial factors, the mean peroxidase level in
stimulated whole saliva was found to be significantly (p < 0.01) lower in the PLS
patients than in the healthy controls. In conclusion, the present study indicates an
impaired water secretion and a somewhat altered saliva gland function in children and
young adults with PLS.
Int J Prosthodont. 1996 Nov-Dec;9(6):539-46.
Changes of masticatory movement characteristics after prosthodontic rehabilitation of individuals with
extensive tooth wear.
Ekfeldt A, Karlsson S.
Department of Prosthetic Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
The masticatory cycles of 11 men (mean age 51.5 years) with extensive tooth wear were
investigated before and after rehabilitation with fixed partial dentures. Parameters such
as the tooth wear index (IA) and masticatory mandibular movement were recorded.
Before treatment, the patients were also given a questionnaire related to possible
background factors of importance to tooth wear. At baseline a mean score of 48.6 (range
0 to 100) for the tooth wear index (IA) was found. The clinical recall examination 3
years after prosthodontic rehabilitation displayed obvious wear of restorative material
for two patients, and, in another patient, one of the fixed partial dentures had to be
remade because of fracture of abutment teeth. Following rehabilitation, the duration of
the masticatory mandibular opening movement increased and mandibular movement
velocity decreased. The mandibular closing angle, near to occlusal contact, became
steeper after prosthodontic treatment, indicating a changed mandibular movement
pattern.
Acta Odontol Scand. 1996 Aug;54(4):263-70.
Incisal and occlusal tooth wear in children and adolescents in a Swedish population.
Hugoson A, Ekfeldt A, Koch G, Hallonsten AL.
Institute for Postgraduate Dental Education, Jonkoping, Sweden.
The material consisted of 527 randomly selected children and adolescents from the
community of Jonkoping, Sweden, who in 1983 reached the age of 3, 5, 10, 15, or 20
years. The degree of incisal or occlusal tooth wear was evaluated for each single tooth in
accordance with the following criteria: score 0 = no wear or negligible wear of enamel;
score 1 = obvious wear of enamel or wear through the enamel to the dentin in single
spots; score 2 = wear of the dentin up to one-third of the crown height; and score 3 =
wear of the dentin more than one-third of the crown height. In the age groups 3 and 5
years the primary dentition was studied, and in the age groups 10, 15, and 20 years the
permanent dentition. In the 3-year-old children 63% and in the 5-year-olds 19% had no
or slight incisal or occlusal wear in the primary dentition. In the permanent dentition the
corresponding figures for the 10-, 15-, and 20-year-olds were 78%, 51%, and 35%,
respectively. The 5-year-olds had the highest percentage of primary teeth with incisal or
occlusal wear related to existing teeth in accordance with criteria 1-3 (32.2%), and the
10-year-olds had the lowest score for permanent teeth (2.5%). There were small or no
differences in tooth wear between the sexes in these age groups. Eighteen children
(17%) among the 5-year-olds had one or more teeth with wear scored 2 in the primary
dentition, and one individual had 4 primary teeth scored 3. The corresponding figures for
the 3-, 10-, 15-, and 20 year-olds were 2%, 1%, 7% and 6%, respectively. No permanent
teeth with wear scored 3 were found in these age groups. The number of teeth with
incisal or occlusal wear increased with age both in the primary and in the permanent
dentition.
Int J Oral Maxillofac Surg. 1996 Feb;25(1):63-8.
Factors in implant integration failure after bone grafting: an osteometric and endocrinologic matched
analysis.
Blomqvist JE, Alberius P, Isaksson S, Linde A, Hansson BG.
Department of Oral and Maxillofacial Surgery, University of Lund, Sweden.
In a retrospective analysis of 49 patients who received bone graft augmentation to the
maxillary sinuses in conjunction with implant insertion, 11 patients had a significantly
reduced success rate. The aim of the present study was to determine whether bone
quality, as assessed by osteometry and selected haematologic and urinary tests,
influences the integration of implants, and whether such data can be prognostically
useful. Relative bone mass density (BMD%) differed significantly among these patients
as compared to age- and sex-matched control patients receiving the same reconstructive
treatment (P=0.01). Other parameters tested did not demonstrate any significant
differences. In addition to local complications, general disorders, such as osteoporosis,
must be considered in cases of excessive implant loss.
Int J Oral Maxillofac Implants. 1996 Jul-Aug;11(4):512-21.
Retrospective analysis of one-stage maxillary sinus augmentation with endosseous implants.
Blomqvist JE, Alberius P, Isaksson S.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
The aim of the present retrospective study was to evaluate the results of a one-stage
reconstructive procedure using titanium implants placed in iliac corticocancellous bone
blocks grafted to the floor of maxillary sinuses. Forty-nine patients received 314
Branemark implants, of which 171 implants of various lengths were placed in the grafted
bone and 143 implants in the adjacent maxillary alveolar process (which includes 11
implants placed in onlay grafts). Five patients also received onlay grafts to the anterior
maxilla. Follow-up time was 3 to 49 months after abutment connection, which was
performed 9 months after implant placement. Eighty-two percent of the implants were
successfully integrated in the grafted area and 84.8% in the adjacent bone. Eleven
patients (22.4%) lost one to four implants or a few implants in strategic positions,
requiring secondary implant placement prior to the manufacturing of fixed prostheses,
whereas 35 (71.4%) received primary fixed restorations. Only two individuals (4.1%)
received permanent implant-supported overdentures. Assessments of esthetics,
phonetics, and function were made by the surgical-prosthodontic team and compared
with those of the patients. Opinions regarding the functional outcome of treatment
appeared least correlated. The total implant survival rate compares favorably with other
reports.
Eur J Oral Sci. 1996 Jun;104(3):262-8.
Effects on salivary flow rate and composition of withdrawal of and re-exposure to the beta 1-selective
antagonist metoprolol in a hypertensive patient population.
Nederfors T, Dahlof C.
Department of Pharmacology and Clinical Pharmacology, Faculty of Odontology, University of Goteborg, Sweden.
Secretion rates and composition of unstimulated and chewing-stimulated whole saliva
and 3% citric acid stimulated parotid and submandibular-sublingual secretions were
studied in 12 hypertensive patients during withdrawal of and re-exposure to
antihypertensive pharmacotherapy. All the patients' blood pressures were well controlled
by monotherapy with metoprolol, a beta 1-selective adrenoceptor antagonist. Blood
pressure measurements and saliva sampling were performed at about 9:30 a.m., 2 h after
intake of breakfast, on days 0 (medicated baseline), 7, 14, 28 (nonmedicated
experimental values and nonmedicated baseline) and 35 (medicated experimental
values). A significant increase in unstimulated whole saliva secretion rate was observed
when metoprolol was withdrawn and a corresponding decrease when the drug was
reintroduced. A positive correlation was found between diastolic blood pressure levels
and chewing-stimulated whole saliva secretion rates. In unstimulated whole saliva and
3% citric acid stimulated submandibular-sublingual secretion, the output of total protein,
amylase, potassium, calcium and phosphate was significantly increased during the
withdrawal period and decreased when metoprolol was reintroduced. For chewingstimulated whole saliva, the corresponding changes were restricted to output of total
protein and amylase, while for citric acid stimulated parotid secretion, no changes in
salivary composition were observed. Finally, in all secretions one or both of the ratios
hexosamine/total protein and sialic acid/total protein were affected, indicating a possible
effect of beta-adrenoceptor antagonists on salivary protein synthesis.
Swed Dent J Suppl. 1996;116:1-70.
Xerostomia: prevalence and pharmacotherapy. With special reference to beta-adrenoceptor antagonists.
Nederfors T.
Department of Pharmacology, Faculty of Odontology Goteborg University.
The main objective of this thesis was to estimate the prevalence of subjectively
perceived dry mouth, xerostomia, in a representative general adult population, and the
possible co-morbidity between xerostomia and on-going pharmacotherapy. Further, to
evaluate the effects of beta-adrenoceptor antagonists on saliva flow rate and
composition. The prevalence of xerostomia was evaluated by means of a questionnaire
mailed to a random sample of 4.200 adult subjects living in the southern part of the
province of Halland, Sweden. Three hundred men and equally many women aged 20,
30, 40, 50, 60, 70 and 80 years were selected from the national census register. From
3311 (81%) evaluable questionnaires was concluded that, in the studied population,
21.3% of the men and 27.3% of the women reported xerostomia. The difference between
the sexes was statistically significant, women reporting higher prevalence of dry mouth
than men. It was also found that xerostomia was significantly age-related. Further, it was
demonstrated that there was a strong co-morbidity between reported prevalence of dry
mouth and on-going pharmacotherapy. Generally, no specific drug or drug-group proved
to be especially xerogenic, rather, polypharmacy was strongly correlated to reported
symptoms of dry mouth, and it was also a significant correlation between increasing
xerostomia and the number of medications taken. The effects of beta-adrenoceptor
antagonists on saliva flow rate and composition were evaluated both in healthy
volunteers and in hypertensive patients. The effects of one week of treatment with the
non-selective (propranolol) and the beta 1-selective (atenolol) adrenoceptor antagonists
were compared with that of placebo in three different clinical trials, including 38, 11 and
19 healthy volunteers, respectively. Two of these studies were focused on the effects on
whole saliva secretion rate and composition and the third study on the secretions from
the parotid and the submandibular-sublingual glands. Salivary composition but not
saliva flow rates were affected by the beta-adrenoceptor antagonists, and the most
pronounced effects were observed for total protein composition and amylase activity,
both being significantly decreased during treatment with any of the antagonists,
however, more accentuated during treatment with atenolol. Twelve hypertensive patients
who were well-controlled in their blood-pressure by means of monotherapy with
metoprolol, a beta 1-selective adrenoceptor antagonist, were observed during four weeks
of withdrawal and after re-exposure to this antihypertensive treatment. The observed
effects on salivary composition were essentially the same as those found in healthy
volunteers. In the hypertensive group, however, whole saliva flow rates increased
significantly on drug withdrawal and decreased again on re-exposure to metoprolol.
Br J Oral Maxillofac Surg. 1996 Apr;34(2):181-5.
A clinical follow-up study of 278 autotransplanted teeth.
Lundberg T, Isaksson S.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Sweden.
This open study was undertaken to investigate the outcome of autotransplanted teeth
over a 6-year period. The subjects were 296 patients who underwent autotransplantation
in the 6-year period September 1986-August 1992 and outcome was measured by
considering root formation, occlusion, endodontal and periodontal complications. 18
patients were excluded because of inadequate notes or radiographs (n = 3) or because
they were lost to follow-up (n = 15). The groups were divided into open apex and closed
apex, and duration of follow up was 6 months-5 years. Aplasia was the indication for
operation in 158 (77 percent) of the open apex group but only 10 (14 percent) of the
closed apex group, whereas caries and associated disease was the most common in the
latter (n = 45, 61 percent compared with 20, 10 percent). There were 24 complete
failures, 12 in each group (p <0.01). Only 7 teeth in total developed full roots, and 159
showed incomplete growth. In the open apex group 112 teeth were in occlusal contact
and 4 were extracted for severe infraocclusion. In the closed apex group there were 10
cases of mild infraocclusion, none of which required treatment. There were 7 cases of
pulp necrosis in the open apex group, 4 of which required extraction. Two teeth in the
closed apex group were extracted for endodontic reasons. Only 1 tooth (in the closed
apex group) had to be extracted for periodontal reasons. Autotransplantation is a reliable
method with a good prognosis for donor teeth with both open and closed apexes. The
technique is applicable whatever the aetiology of the agenesis, and is worthy of
consideration should there be a suitable donor tooth.
Caries Res 1996;30(5):347-53
Caries incidence in relation to salivary mutans streptococci and fluoride varnish applications in preschool
children from low- and optimal-fluoride areas.
Twetman S, Petersson LG, Pakhomov GN.
Department of Pediatric Dentistry, Medical and Dental Center, Halmstad, Sweden.
Caries incidence during a 2-year period was studied in 4- to 5-year-old children from
three areas with contrasting levels of natural fluoride (F) in the drinking water and
different regimens of topical fluoride varnish applications; group A (n = 448) was from
an area with a low level of F (0.1 ppm) and semi-annual applications of fluoride varnish;
group B (n = 374) was from a low F area (0.1 ppm) and no fluoride varnish treatments;
group C (n = 206) was from an area with optimal F (1.2 ppm) and fluoride varnish
treatments. All children were clinically assessed at baseline and after 2 years according
to WHO criteria. The number of salivary mutans streptococci was estimated and scored
at baseline and after 2 years with the Strip mutans method. The varnish containing 0.1%
F was applied every 6 months on all accessible tooth surfaces after cleaning with a
pumice paste. Basic preventive care was given to all children and restorative treatment
on individual indications. Higher levels (p < 0.05) of salivary mutans streptococci were
found in the low-fluoride areas compared to the optimal fluoride area at baseline and
after 2 years. The caries incidence (mean dft +/- SD) in the different groups was A: 0.65
+/- 1.40; B: 1.09 +/- 1.85; C: 0.53 +/- 1.09. The difference between group B and groups
A and C was statistically significant (p < 0.05). A positive relationship (p < 0.05-0.001)
between salivary mutans streptococci scores at baseline and caries incidence was found
in all three groups. This study confirms the close association between salivary mutans
streptococci and caries incidence in preschool children and suggests a caries-reducing
effect of topical applications of the fluoride silane varnish.
Eur J Oral Sci 1996 Oct-Dec;104(5-6):523-8
Prediction of caries in pre-school children in relation to fluoride exposure.
Twetman S, Petersson LG.
Department of Pediatric Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
The levels of salivary mutans streptococci and caries experience were used as predictors
for caries incidence in 3 groups of pre-school children from areas with different levels of
natural and topical fluoride exposure. Altogether 1022 children, 4-5 years of age at
baseline, were examined according to the WHO-criteria and followed for 2 years. The
low fluoride group (n = 374) had a low fluoride level in the piped water and no topical
fluoride applications; the F-varnish group (n = 442) had low water fluoride but
semiannual topical applications of a fluoride varnish; the optimal fluoride group (n =
206) had an optimal level of fluoride in the drinking water and semiannual F-varnish
applications. The number of salivary mutans streptococci was estimated and scored at
baseline with the Strip mutans chair-side method. The sampling procedure was repeated
in 337 children of the low fluoride group 3 weeks after baseline. In comparison with the
low fluoride group, caries incidence was 30% and 60% lower in the F-varnish and the
optimal fluoride group respectively. The caries predictive ability decreased with
increasing fluoride exposure. The sum of sensitivity and specificity decreased from
151% (65% + 86%) in the low fluoride group to 131% (40% + 91%) in the optimal
fluoride group. The positive predictive value was highest (62%) in the low fluoride
group. Repeated salivary samplings at baseline did not improve the caries predictive
power. The results suggest that the overall fluoride exposure should be taken into
account when caries risk assessment strategies for preschool children are developed and
implemented.
J Clin Periodontol. 1996 Mar;23(3 Pt 1):176-9.
Systemic retinoid medication and periodontal health in patients with Papillon-Lefevre syndrome.
Lundgren T, Crossner CG, Twetman S, Ullbro C.
Department of Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
Periodontal health in relation to systemic retinoid medication was evaluated
retrospectively in patients with Papillon-Lefevre Syndrome (PLS). The material
consisted of 18 children/young adults ranging from 8 to 28 years of age, all with a
confirmed diagnosis of PLS. 9 participants, comprising a medication group, had been on
long-term (range 1.5-9 years) retinoid medication for their cutaneous lesions. The
remaining 9 served as controls. Regardless of whether or not retinoid medication was
received, every patient experienced an early and devastating periodontitis, with atypical
edematous and erythematous gingiva, suppuration from deep gingival pockets and
premature loss of teeth. No correlation could be found between the severity of skin
involvement and the severity of periodontal involvement. An improvement with age
could be seen for the cutaneous lesions but not for the periodontal condition. Systemic
medication with retinoids had a favorable therapeutic effect on cutaneous lesions, and no
severe complication/side effect could be seen after several years of continuous use.
However, from the results of this study it can be concluded that, at least in a situation
with poor compliance of daily oral home-care, no positive effect on the periodontal
health in patients with PLS could be seen by the retinoid medication.
Eur J Oral Sci. 1995 Dec;103(6):351-4.
Effects of the antihypertensive drug captopril on human salivary secretion rate and composition.
Nederfors T, Dahlof C, Ericsson T, Twetman S.
Department of Pharmacology and Clinical Pharmacology, Faculty of Odontology, Goeteborg University, Sweden.
The effects of the antihypertensive drug captopril on salivary secretion rate and
composition was evaluated in 24 healthy adults (18-46 yr) according to a double-blind,
cross-over design. Unstimulated and paraffin-chewing stimulated whole saliva and 3%
citric acid stimulated parotid and submandibular-sublingual (SM-SL) secretion were
collected at 10.30 a.m. (about 2h after intake of breakfast) on day 0 (baseline values),
day 1 (experimental acute values) and day 7 (experimental chronic values) in each
treatment period. In 8 of the subjects, also morning samples were collected at 7.30 a.m.,
with the test subjects in a fasting condition. Whole saliva was assessed for flow rate and
for concentrations of sodium, potassium, chloride, calcium and phosphate. In addition,
parotid and SM-SL secretion were assessed for concentrations of total protein,
hexosamine, sialic acid, lactoferrin and salivary IgA and for activities of amylase,
lysozyme and salivary peroxidase. During treatment with the angiotensin converting
enzyme inhibitor captopril, the secretion rates tended to increase for unstimulated and
paraffin-chewing stimulated whole saliva and for parotid secretion. For salivary
composition, no alterations were observed in any of the collected secretions.
Clin Exp Rheumatol. 1995 Nov-Dec;13(6):693-6.
Sjogren's syndrome: terminology.
Oxholm P, Asmussen K, Axell T, van Bijsterveld OP, Jacobsson L, Konttinen Y, Manthorpe R, Nederfors T,
Prause JU, Schiodt M, et al.
Sjogren's Syndrome Research Centres at: Rigshospitalet, National University Hospital, Copenhagen, Denmark.
In spite of our continuously improved pathobiological understanding, there is still no
consensus on terminology and disease criteria in Sjogren's syndrome (SS). This survey
points out discrepencies in the current description of the syndrome, and argues for a new
classification model. We suggest that the present nomenclatures for the global disease
(Sjogren's disease) and disease subsets (primary and secondary SS) be retained until
additional pathobiological insights give rise to new and descriptive terms. We do find
evidence, however, to support a new terminology and classification of the main
immunoinflammatory manifestations of primary SS. Accordingly, three "exocrine" and
four "non-exocrine" subgroups of disease manifestations are here defined. The
usefulness of the proposed model should be evaluated in clinical studies and in a debate
engaging all of the medical specialities involved.
Swed Dent J 1995;19(3):103-8
Influence of xylitol in dentifrice on salivary microflora of preschool children at caries risk.
Twetman S, Petersson LG.
Department of Pediatric Dentistry, Medical and Dental Center, Halmstad, Sweden.
The aim was to study whether the use of a xylitol-containing dentifrice could affect the
number of mutans streptococci and lactobacilli in preschool children with medium and
high initial salivary counts. After screening 147 healthy preschool children, 3-6 years of
age, 70 were selected and randomly assigned into two groups for 3-month's use of either
a xylitol (9.7%) or a non-xylitol-containing fluoride dentifrice. The parents were trained
to brush the teeth of their children twice daily in a standardized manner and the study
was carried out double blind. Bacterial levels at screening and after 3 months were
enumerated with aid of chair-side methods. No significant differences in mutans
streptococci levels or lactobacilli counts after 3 months were obtained, either in
comparison to baseline or between the groups. About 50% of all children exhibited
unchanged bacterial scores at the end of the test period but more children in the xylitol
group disclosed reduced scores of salivary mutans streptococci compared with the nonxylitol group (38% vs 16%). The results suggest that the dose level achieved by using
this xylitol-containing dentifrice in preschool children, did not provide sufficient
antibacterial action to suppress caries associated microorganisms in the saliva of those
with high initial counts.
Eur J Oral Sci 1995 Apr;103(2 ( Pt 1)):112-5
Uptake and release of fluoride from birch and lime toothpicks.
Kashani H, Birkhed D, Petersson LG.
Department of Cariology, Faculty of Odontology, Goteborg University, Sweden.
Birch and lime toothpicks were impregnated in a 4% sodium fluoride (NaF) solution for
different periods of time, viz. 30 s, 30 min and 3 d. After impregnation for 30 min, an
average of 4.1 mg NaF per birch toothpick was taken up. The corresponding value for
lime toothpicks was 5.1 mg. About 60% of the fluoride (F) was released within 1 h in
vitro when the toothpicks were kept in water. In vivo, the concentration of F was
determined in whole saliva from five adults during 30 min after using birch toothpicks
immersed in a 4% NaF solution. After 2 min, the mean salivary F concentration was 2.7
mM. Impregnation of birch toothpicks in 1, 2 or 3% NaF resulted in lower F
concentrations both in vitro and in vivo, with a clear dose-response effect. When
comparing the use of a 4% NaF impregnated birch toothpick, a mouthrinse with 10 ml of
0.025% NaF, sucking on a F tablet containing 0.55 mg NaF, and toothbrushing with 1 g
of an 0.068% F (as NaF) dentifrice--all procedures carried out in the mouth during 2
min--the highest concentration of F in saliva was obtained after using the fluoridated
toothpick. Thus, NaF impregnated birch and lime toothpicks show a quick release of F in
vitro as well as in vivo and may be suitable as home care products for prevention of
dental caries.
Community Dent Oral Epidemiol 1995 Aug;23(4):211-6
Radiographic study of approximal restorative treatment in children and adolescents in two Swedish
communities differing in caries prevalence.
Lith A, Pettersson LG, Grondahl HG.
Department of Oral Diagnostic Radiology, Faculty of Odontology, Goteborg University, Sweden.
In two groups of patients, differing in caries prevalence, the restorative treatment of
posterior approximal surfaces in permanent teeth was studied in radiographs obtained as
part of the dental care provided from age 6 up to and including age 18. The study
determined at what age, at which lesion depth and in which surfaces restorative
treatment was performed. Furthermore, the conditions of nonrestored dentin lesions were
evaluated over time. Nearly 50% of the restorations were placed in the mesial surface of
the first molars. In both groups more than 2/3 of the restorations were placed in surfaces
with dentin lesions. In the group with the highest caries prevalence 50% of the lesions in
the outer half of the dentin were restored when first detected in contrast to 20% in the
groups with the lower prevalence. For the superficial dentin lesions not immediately
restored, average time between their detection and restoration, the end of the study or,
detection in the inner half of the dentin was practically the same in both groups (19.3
and 20.4 months). The variation in this average time was only to a limited degree
explained by the variation in the caries experience of the patients.
Swed Dent J 1995;19(3):83-94
The effect of a low fluoride containing toothpaste on the development of dental caries and microbial
composition using a caries generating model device in vivo.
Petersson LG, Edwardsson S, Koch G, Kurol J, Lodding A.
Department of Preventive Dentistry, Medical and Dental Center, Halmstad, Sweden.
The purpose of the study was to evaluate the effect of daily use of a low fluoride
containing toothpaste (250 ppm F) on the uptake of fluoride and development of enamel
lesions as well as the prevalence of lactobacilli and mutans streptococci in dental plaque
compared to the use of placebo toothpaste. 16 children were selected with homologous
premolar teeth. The teeth were cemented with orthodontic bands ad modum Ogaard for
plaque accumulation and enamel lesion development. The plaque accumulated during 4
weeks was collected and analysed for lactobacilli and mutans streptococci. The teeth
were further analysed by secondary ion mass spectrometry (SIMS), determining the
concentration profiles of fluoride and other elements in the outermost enamel and in the
lesion. The results show that although significant amounts of fluoride were taken up in
the surface enamel from the fluoride toothpaste, the extent of the lesions was not
influenced compared to teeth brushed with a non F-toothpaste. Neither were
microbiological differences in the dental plaque found between the groups. An
interesting observation was that early demineralization of enamel took place without
detectable levels of mutans streptococci in the overlaying dental plaque. The conclusion
is that fluoride taken up in enamel from F-toothpaste has no significant influence on
enamel lesion development if a cariogenic dental plaque with high levels of acid
producing microorganisms is continuously attached to the enamel surface.
Caries Res 1995;29(3):188-91
Effect of an antibacterial varnish on mutans streptococci in plaque from enamel adjacent to orthodontic
appliances.
Twetman S, Hallgren A, Petersson LG.
Department of Pedodontics, Medical and Dental Centre, Halmstad, Sweden.
The effect of an antibacterial varnish (Cervitec) on the levels of mutans streptococci in
plaque adjacent to bonded orthodontic brackets was evaluated in 18 children using a
split-mouth technique with a placebo varnish control. The test varnish contained 1%
chlorhexidine and 1% thymol as active ingredients. Both varnishes were applied on four
occasions during a 3-month period, and plaque was subsequently collected between 1
week and 6 months after the onset of treatment. All teeth involved in the study were
carefully examined and clinically assessed for enamel demineralization prior to onset of
the fixed appliances and immediately after debonding. The results showed a more
frequent growth of mutans streptococci in the dental plaque collected from placebotreated quadrants as compared with the test quadrants on all sampling occasions. The
proportion of mutans streptococci within the plaque microflora was significantly (p <
0.05-0.01) lower on the test sides than on the opposite sides at the 1-week and 1-month
examinations. The incidence of incipient enamel lesions around the brackets and along
the gingival margin was generally low, and no differences were found between the test
and placebo varnish treated quandrants at the time of debonding. The results suggest that
mutans streptococci in plaque from orthodontic patients can be suppressed effectively by
topical applications of an antibacterial varnish.
Int J Paediatr Dent. 1994 Dec;4(4):245-50.
Use of the strip mutans test in the assessment of caries risk in a group of preschool children.
Twetman S, Stahl B, Nederfors T.
Department of Pedodontics, Medical and Dental Health Centre, Halmstad, Sweden.
The purpose of this study was to evaluate the use of a chair-side test involving a count of
salivary mutans streptococci (the Strip mutans test) in the assessment of caries risk in a
group of preschool children living in an area with a low caries prevalence. A group of
528 4-year-old children were randomly allocated to a study or a control group. In the
study group, the baseline microbial data, together with clinical findings of past caries
experience, were used for caries risk assessment and for planning subsequent preventive
treatment. All children were examined at baseline and after 2 years. Caries experience
was assessed according to WHO criteria. There was no difference in caries experience
between the study group and the control group at baseline. Within the study group,
caries increment was positively correlated (P < 0.01) with the number of mutans
streptococci in saliva at baseline, and children assessed 'at risk' at baseline (Strip mutans
score > or = 2 and/or > or = 1 dmfs) developed more new lesions than those considered
as 'low risk' (mean dmfs 2.6 v 0.9; P < 0.05). The sensitivity and specificity of this
combined clinical and microbial caries risk selection were 67% and 75%, respectively,
disease being defined as an increment of at least one carious lesion over the 2-year
period. In both groups, 50% of the children remained caries inactive during the study.
The mean caries increment was, however, lower in the study group than in the control
group (mean dmfs 1.7 v 2.1) but the difference was not statistically
significant.(ABSTRACT TRUNCATED AT 250 WORDS)
J Oral Maxillofac Surg. 1994 Nov;52(11):1133-7.
Skeletal stability after mandibular advancement: a comparison of two rigid internal fixation techniques.
Blomqvist JE, Isaksson S.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
OBJECTIVE: To compare two different methods of rigid fixation for any difference in
postoperative stability after mandibular advancement. MATERIAL AND METHODS:
Thirty-eight patients with Class II malocclusion treated by bilateral sagittal split
osteotomy (BSSO) and mandibular advancement were selected for this retrospective
study. Group A (n = 16) had noncompressive bicortical screws inserted in the gonial
area through a transcutaneous approach and Group B (n = 22) had the bone segments
fixed with unicortical screws and miniplates on the lateral surface of the mandibular
body. Cephalograms were taken preoperatively, 2 days postoperatively, and 6 months
after the operation, and a computer program was used to superimpose the three
cephalograms and register the advancement and postoperative instability. RESULTS:
There was a minimal difference in advancement of the mandible in the two groups.
Statistical analysis showed no significant difference in postsurgical stability. However,
positive correlation between the amount of advancement and the amount of postsurgical
instability was demonstrated using a linear multiple regression test (P = .0002).
CONCLUSION: This study indicates that the two different methods of internal rigid
fixation of the segments after surgical advancement of the mandible give equal stability
postoperatively and their use is a matter of surgical choice.
Scand J Dent Res. 1994 Aug;102(4):235-7.
Effects of the beta-adrenoceptor antagonists atenolol and propranolol on human unstimulated whole saliva
flow rate and protein composition.
Nederfors T, Dahlof C, Twetman S.
Faculty of Odontology, University of Gothenburg, Sweden.
The effects of 1-wk medication with two beta-adrenoceptor antagonists on unstimulated
whole saliva flow rate and protein composition were evaluated in 11 healthy young men
in a randomized, double-blind, placebo-controlled, cross-over study. Unstimulated
whole saliva was collected before each treatment period and then again after 7 days. The
saliva was assessed for flow rate, total protein, and hexosamine and sialic acid
concentrations and for amylase activity. No significant effect on saliva secretion rate
was found. A statistically significant reduction of salivary total proteins was registered
during atenolol medication. The amylase activity decreased significantly during
treatment with both atenolol and propranolol. Significant changes of the calculated ratios
of sialic acid/hexosamine and hexosamine/total protein indicated an alteration in
glandular protein synthesis after atenolol treatment.
Swed Dent J 1994;18(3):69-73
In vitro and in vivo studies of an NaF impregnated toothpick.
Petersson LG, Kashani H, Birkhed D.
Department of Preventive Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
Fluoridated toothpicks (John O. Butler Co.), containing an average of 0.80 mg F as NaF,
demonstrated a quick F release in vitro after 1 min immersion in distilled water (0.13
mg; 16%). Continued F release was found after 5 (0.22 mg; 28%) and 60 min (0.35 mg;
44%) and 24 hr (0.55 mg; 69%). In addition, F concentrations were measured in whole
saliva of 10 adults before and after 1 min use of an F toothpick and after sucking on an
0.25 mg F tablet (Fludent). Baseline F concentrations of about 1 microM/L increased to
35 microM/L after using the toothpick. In comparison, the F tablet gave a mean salivary
F concentration of 71 microM/L. The F levels in saliva after 1 hr were for the F
toothpick 3 microM/L and for the F tablet 8 microM/L. Thus, F impregnated toothpick
seems to be an interesting vehicle for F release in the oral cavity and merits further
studies from a cariostatic point of view.
Caries Res 1994;28(1):59-63
Intensive fluoride varnish program in Swedish adolescents: economic assessment of a 7-year follow-up study
on proximal caries incidence.
Petersson LG, Westerberg I.
Department of Preventive Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
The aim of this study was to assess the long-term effect after 7 years of an intensive
fluoride varnish program in the age interval 11-14 compared to a standard biannual
fluoride varnish program. Special reference was made to factors explaining the
individual variance in caries incidence between 11-14 and 11-17 years as well as the net
benefit of the intensified fluoride varnish program. Two caries measures, one
unweighted (DFS0) and one weighted (DFS1), were used. Besides three caries measures
D1-D3 were used to distinguish different grades of decay where D1 is enamel lesion and
D3 dentinal lesion. The results show statistically significant differences for the age
interval 11-17 years according to mean values of DFS0, DFS1 and D1. Regression
analyses for caries incidence in the time interval 11-14 gives only explanation (i.e.
significant estimated coefficient value) for caries prevalence at 11 years of age
irrespective of caries measure, but in the age interval 11-17 years regression analysis
also gives explanation for the variable father's education and the fluoride preventive
measures in the age interval 11-14. The cost/benefit analysis shows net total costs of
3,880 SEK and net total benefits of 5,000 SEK over a time span of 10 years discounted
to 1982 using an annual discount rate of 5%.
Int J of Oral & Maxillofacial Implants 1994;9:679-688.
Evaluation of Three Bone Grafting Techniques for Severely Resorbed Maxillae in Conjunction With
Immediate Endosseous Implants.
Isaksson S.
Significant atrophy of the edentulous maxilla was treated with one of three bone grafting
techniques: (1) onlay augmentation of the alveolar crest; (2) inlay grafting of the floors
of the nose and maxillary sinuses following a Le Fort I osteotomy; and (3) inlay grafting
of the maxillary sinus. Autogeneic iliac composite bone blocks were used with
immediate placement of Brånemark implants. The first 10 consecutively treated patients
for each treatment regime were followed between 33 and 95 months. Sixty-eight percent
to 86 % (onlay 83 %, Le Fort I 68 %, inlay 86 %) of the 124 total implants placed into
the bone graft were well integrated at the latest follow-up. However, although the
primary intention was to provide all patients with a fixed prosthesis, five patients
received a removable overdenture because of a reduced number of existing implants.
Also, two patients in the Le Fort I group received removable overdentures due to a
remaining large sagittal discrepancy between the jaws. In general, patients had good
intraoral function; eight patients had minor phonetic problems, and three were not fully
satisfied with the esthetic result. The specific indication for each of the techiques
described is discussed and constitutes valuable means for treatment of severely atrophic
maxillae.
Int J Oral Maxillofac Implants. 1994 Mar-Apr;9(2):179-83.
Clinical evaluation of single-tooth restorations supported by osseointegrated implants: a retrospective study.
Ekfeldt A, Carlsson GE, Borjesson G.
Department of Prosthodontics, County Hospital, Halmstad, Sweden.
This retrospective study of Branemark implants presents results from 93 implants for
single-tooth replacements placed in 77 patients from 1987 to 1990. Only two implants
were lost: one before the abutment operation and one during the first year in function.
Patients' reactions to the rehabilitations were very positive regarding esthetic aspects and
function. The most obvious problem was related to loose abutment screws. Forty-three
percent of the abutment screws had to be retightened during the follow-up period, and
for this reason, nine cemented crowns had to be remade.
Br J Orthod. 1994 Feb;21(1):23-6.
L(+)-lactic acid production in plaque from orthodontic appliances retained with glass ionomer cement.
Hallgren A, Oliveby A, Twetman S.
Department of Orthodontics, Lanssjukhuset, Halmstad, Sweden.
The lactic acid production in suspensions of plaque collected adjacent to orthodontic
brackets retained with a glass ionomer cement (GIC), or a resin-based composite was
investigated using a split-mouth technique. Forty-eight-hour-old plaque was collected at
3, 8, and 28 days, and 3 months after the onset of orthodontic treatment. Acid
fermentation was induced by glucose and the L(+)-lactic acid concentrations were
determined enzymatically after a 30-minute incubation period. Significantly (P < 0.05)
lower levels of lactic acid were found in plaque from GIC-retained brackets compared
with the composite controls at the 28 days and 3 months sampling occasions,
respectively. The results suggest that the use of GIC as a bonding agent in orthodontics
can be beneficial for patients assessed at risk of caries development.
J Dent Res. 1994 Jan;73(1):5-10.
Effects of the beta-adrenoceptor antagonists atenolol and propranolol on human parotid and submandibularsublingual salivary secretion.
Nederfors T, Ericsson T, Twetman S, Dahlof C.
Department of Pharmacology and Clinical Pharmacology, Faculty of Odontology, University of Gothenburg,
Sweden.
The aim of the study was to evaluate the effects of a beta 1-selective (atenolol 50 mg
q.d.) and a non-selective (propranolol 80 mg b.i.d.) beta-adrenoceptor antagonists on
human stimulated parotid and submandibular-sublingual (SM-SL) gland secretion. A
randomized double-blind, placebo-controlled cross-over ("Latin square") design was
used in 19 healthy male volunteers. Stimulated parotid and SM-SL saliva were sampled
immediately before and 7 days after the start of each treatment period. Stimulation of
salivary secretion was achieved by use of a 3% citric acid solution. Plasma
concentrations of propranolol and atenolol were determined from blood samples. The
salivary secretion of both glands was assessed for flow rate, amylase, lysozyme, and
salivary peroxidase activity and for concentrations of total protein, hexosamine, sialic
acid, Ca2+, Cl-, K+, Mg2+, Na+, and PO4(3-). In both parotid and SM-SL secretions,
the total protein and phosphate concentrations and amylase activity were significantly
decreased during the two active treatment periods. In SM-SL gland secretion, there were
significant changes in potassium and calcium concentrations during active treatment as
compared with baseline, with potassium showing a decreased and calcium an increased
concentration. During atenolol treatment, salivary peroxidase activity decreased
significantly in SM-SL secretion. In parotid secretion, the hexosamine/total protein ratio
decreased and the sialic acid/hexosamine ratio increased during atenolol treatment,
which may indicate an effect on protein synthesis. No significant effects on salivary
secretion rates were disclosed.
Int J Oral Maxillofac Surg. 1993 Dec;22(6):375-81.
Influence of three alloplastic materials on calvarial bone healing. An experimental evaluation of HTRpolymer, lactomer beads, and a carrier gel.
Isaksson S, Alberius P, Klinge B.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
This study evaluated experimentally three alloplastic materials (HTR-polymer, lactomer
beads, and a resorbable gel substance). A bioassay performed in a critical size defect rat
model disclosed no osteoinductive capacity of any material. A total of 72 trephine
calvarial 5-mm defects were created in 18 rabbits. The inlays were tested relative to
control (empty) defects in a varied pattern, and the results were assessed by light
microscopy and contact radiography after 4 and 15 weeks. The HTR-polymer alone or
combined with bone chips displayed the most rapid early bone regeneration and more
mature bone marrow redevelopment. The present form of the gel material seems to be
less suitable for use as a carrier substance because of the intense inflammatory response
produced.
Community Dent Oral Epidemiol. 1993 Dec;21(6):365-9.
Prediction of caries incidence in schoolchildren living in a high and a low fluoride area.
Mattiasson-Robertson A, Twetman S.
Department of Pedodontics, Faculty of Odontology, University of Gothenburg, Sweden.
A salivary mutans streptococci test and past caries experience were used as predictors
for caries increment in a 3-yr study comprising 655 12-yr-old schoolchildren from two
areas with contrasting levels of fluoride in the drinking water. The mean caries (DMFS)
increment was similar in both groups during the study period, but a significantly (P <
0.05) higher incidence of approximal enamel lesions was registered in children from the
high fluoride area. In both groups, a statistically significant (P < 0.05-0.001) positive
relationship between salivary mutans streptococci score and/or past caries experience at
baseline on one hand and caries increment during the study period on the other was
established. The past caries experience was the most powerful predictor of caries risk in
both the low fluoride and the high fluoride area. The sum of the sensitivity and
specificity was somewhat higher in the low fluoride area (138%) compared to the high
fluoride area (123%). The salivary bacterial enumeration used alone or in combination
with past caries experience as well as past approximal caries experience were less useful
as predictors in both groups. The present findings indicate that the natural fluoride
exposure has a limited influence on caries risk assessment and the caries predictive
ability of the salivary bacterial test and past caries in populations with a low level of
disease.
Caries Res 1993;27 Suppl 1:35-42
Fluoride mouthrinses and fluoride varnishes.
Petersson LG.
Department of Preventive Dentistry, Medical and Dental Center, Halmstad, Sweden.
The cariostatic efficacy of rinsing with a 0.05-0.2% neutral sodium fluoride solution has
been clearly demonstrated, especially in supervised school-based programmes in
moderate and high caries risk children. The cost-benefit effect, however, is questionable
in populations with low caries prevalence, and fluoride rinsing programmes are
gradually being replaced by more individual fluoride therapy comprising combinations
of fluoride toothpastes, tablets, or varnishes. Fluoride varnishes were developed as
individual alternatives to conventional topical fluoride application and are today gaining
acceptance for clinical application. Two varnishes, Duraphat containing 5% wt NaF and
Fluor Protector with 0.9% wt fluor silane, are available commercially. The clinical
effects seem to depend mainly on application frequency, especially in high caries risk
groups. The cost-benefit effect is high, but can be increased by delegating application to
auxiliary personnel in conjunction with regular dental visits. Toxicologically both
fluoride mouthrinses and fluoride varnishes are safe if used as directed.
Caries Res. 1993;27(1):51-4.
Fluoride concentration in plaque adjacent to orthodontic appliances retained with glass ionomer cement.
Hallgren A, Oliveby A, Twetman S.
Department of Orthodontics, Medical and Dental Health Center, Halmstad, Sweden.
The fluoride concentrations in dental plaque adjacent to orthodontic brackets retained
with a glass ionomer cement (GIC) or a resin-based composite were investigated using
the split-mouth technique. 48-hour plaque was collected at 3, 8, 28 days and 6 months
after the onset of orthodontic treatment. The fluoride content of the plaque samples was
determined after a microdiffusion procedure with a fluoride-sensitive electrode.
Significantly (p < 0.001-0.05) elevated concentrations of fluoride were found in the
plaque samples collected adjacent to GIC-retained brackets compared to plaque sampled
from composite-retained brackets on all sampling occasions. The results suggest that
GIC-bonded brackets in orthodontic treatment may act as local long-term fluoridereleasing devices.
Acta Odontol Scand. 1993 Oct;51(5):299-311.
Occlusal wear of teeth and restorative materials. A review of classification, etiology, mechanisms of wear, and
some aspects of restorative procedures.
Dahl BL, Carlsson GE, Ekfeldt A.
Department of Prosthetic Dentistry and Stomatognathic Physiology, University of Oslo, Norway.
This paper is a literature review of various aspects of the wear of occluding tooth
surfaces. It presents classification and terminology of occlusal tooth wear, and discusses
etiology and differential diagnosis. It may be difficult to differentiate among abrasion,
attrition, and erosion because there is nearly always a combination of the various
processes. These processes of wear are described, and the in vitro and in vivo wear of
some restorative materials is discussed. Treatment of severe tooth wear is considered
difficult; prophylactic measures are therefore important. Some guidelines for restorative
treatment of patients with extensive occlusal tooth wear are given, with special emphasis
on the type of treatment, the vertical dimension of occlusion, the space available, and
choice of material for the restorations.
Scand J Dent Res. 1993 Aug;101(4):210-4.
A modified device for collection and flow-rate measurement of submandibular-sublingual saliva.
Nederfors T, Dahlof C.
University of Gothenburg, Department of Clinical Pharmacology, Sahlgrenska Hospital, Gothenburg, Sweden.
The aims of the present study were to measure stimulated submandibular-sublingual
(SM-SL) salivary flow rate with a modified Block-Brottman collection device, and,
further, to evaluate the reliability of measurements of stimulated SM-SL salivary flow
rate by means of this modified Block-Brottman device, as compared to measurements of
parotid flow rate using modified Carlson-Crittenden cups. Twenty-nine healthy female
volunteers, aged 36 +/- 7 yr, were included. Saliva stimulation was achieved by
application of a 3% citric acid solution to the rims of the tongue four times/min, for 3 s
every 15 s. On 3 consecutive days, stimulated parotid and SM-SL salivas were collected
for 2 min at 07.30, before breakfast (morning value), and at 10.00, 2 h after a standard
breakfast (lunchtime values). SM-SL saliva was also collected on one occasion for 2 min
x 3. For parotid and SM-SL saliva, the mean stimulated flow rates were in the morning,
1.50 +/- 0.83 and 2.25 +/- 1.12 ml/min, and at lunchtime, 1.71 +/- 1.16 and 2.54 +/- 1.01
ml/min, respectively. For both salivas, lunchtime values were significantly higher than
morning values by about 13-14%. Comparing parotid and SM-SL saliva flow rates, we
found the SM-SL saliva flow rate to exceed the parotid flow rate by about 50% both in
the morning and at lunchtime. Variations in flow rate were analyzed by means of
ANOVA. Interindividual variance and variance between measurement days and times of
day made up 88% of parotid and 83% of SM-SL total variance.(ABSTRACT
TRUNCATED AT 250 WORDS)
Int J Oral Maxillofac Surg. 1993 Jun;22(3):144-8.
Early results from reconstruction of severely atrophic (Class VI) maxillas by immediate endosseous implants
in conjunction with bone grafting and Le Fort I osteotomy.
Isaksson S, Ekfeldt A, Alberius P, Blomqvist JE.
Department of Oral and Maxillofacial Surgery, Lanssjukhuset, Halmstad, Sweden.
This report presents our experience with 12 consecutive patients treated by the method
of SAILER19, comprising bone grafting to the floor of the nose and the maxillary sinus
after a Le Fort I inferior repositioning of the maxilla followed by immediate
implantation of endosseous implants. The corticocancellous grafts were harvested from
the iliac crest. Fifty-nine implants were inserted in the bone grafts and eight in the
adjacent nongrafted bone. Fourteen implants (21%) had to be removed because of
nonintegration, of which 10 had been placed in two patients. The follow-up ranged from
11 to 24 months. No implants have been lost after loading. Six patients received fixed
prostheses, and four overdentures. The importance of complete preoperative positional
stability of the bone grafts and implants is emphasized.
Acta Odontol Scand. 1993 Apr;51(2):99-107.
Wear resistance of some prosthodontic materials in vivo.
Ekfeldt A, Fransson B, Soderlund B, Oilo G.
Department of Prosthetic Dentistry, Faculty of Odontology, University of Goteborg, Sweden.
The purpose of this study was to compare a gravimetric method and an impression
technique in the evaluation of occlusal substance loss. The wear of gold, porcelain, and
microfilled resin was studied in vivo. The gravimetric method showed lower substance
loss for porcelain than for gold, whereas the microfilled resin had the highest substance
loss. To obtain a higher accuracy for the measurement of occlusal substance loss of
restorative materials with an impression technique, the test area has to be restricted, the
antagonizing occlusal contacts carefully recorded before the test period, and the number
of cuts increased. The observed structure of wear facets (SEM) corroborated with
previous findings of the wear mechanism of these materials; that is, gold has mainly
abrasive wear in contact with porcelain, whereas porcelain has a fatigue type and
microfilled resin a tribochemical type of wear.
Scand J Dent Res. 1993 Feb;101(1):44-8.
Oral mucosal friction and subjective perception of dry mouth in relation to salivary secretion.
Nederfors T, Henricsson V, Dahlof C, Axell T.
Department of Clinical Pharmacology, Sahlgrenska Hospital, Faculty of Odontology, University of Gothenburg,
Sweden.
Assessment of oral mucosal friction and subjective perception of dry mouth was
performed during treatment with thiazide diuretic bendroflumethiazide (2.5 mg o.d.) or
placebo in a randomized, double-blind, cross-over study (2 x 2 wk) in 34 healthy
volunteers. Treatment with bendroflumethiazide was associated with a 10% reduction in
the stimulated whole saliva secretion rate and a 15% reduction in the salivary sodium
concentration, as compared with placebo. Oral mucosal friction was concomitantly
measured on the buccal mucosa and on the mucosa of the lower lip by means of a newly
developed sliding friction device. In addition, a questionnaire was used to evaluate how
the treatment was subjectively perceived with regard to symptoms of dry mouth.
Mucosal friction of the lower lip increased significantly during treatment with
bendroflumethiazide, as compared with placebo. When the test subjects, regardless of
pharmacologic treatment, were divided into groups according to subjective perception of
dry mouth, the dry mouth group showed significantly lower resting and stimulated flow
rate and higher mucosal friction in comparison to the nondry group. When, in addition,
pharmacologic treatment was also considered, the differences between the dry and the
nondry group were restricted to resting whole saliva flow rate and mucosal friction
during bendroflumethiazide treatment. It is concluded that resting whole saliva flow rate
is the best predictive factor for evaluating subjectively perceived dry mouth. However,
the sensitivity of the developed sliding friction device is capable of detecting minor
changes in salivary secretion rate. In addition, measurements of oral mucosal friction
may serve as an easily available method to complement sialometry when evaluating, for
example, drug-induced dryness of the mouth.
J Clin Periodontol. 1992 Oct; 19(9 Pt 2): 723-9.
Clinical responses to subgingival application of a metronidazole 25% gel compared to the effect of subgingival
scaling in adult periodontitis.
Ainamo J, Lie T, Ellingsen BH, Hansen BF, Johansson LA, Karring T, Kisch J, Paunio K, Stoltze K.
University of Helsinki, Finland.
A newly developed metronidazole 25% dental gel was compared with subgingival
scaling in the treatment of adult periodontitis. 206 patients in 9 centres participated in
the study. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded
before treatment and 2, 6, 12, 18, and 24 weeks after the treatment. All patients had at
least 1 tooth in each quadrant with a PPD of 5 mm or more. The treatments consisted of
2 applications of dental gel (days 0 and 7) in 2 randomly selected quadrants (split mouth
design) and 2 sessions of subgingival scaling (1 quadrant on day 0, and 1 quadrant on
day 7). Instruction in oral hygiene was given 2 weeks after completed treatment. The
average PPD and the average frequency of BOP were calculated over all sites with initial
PPD of 5 mm or more. PPD and BOP were thus, at each examination, calculated from
the same sites. The mean PPD was 5.9 mm before gel application and 5.8 mm before
scaling (p = 0.31). BOP was 88% in both treatment groups. 24 weeks after the treatment,
PPD and BOP were significantly reduced in both groups and for both parameters (p <
0.01). PPD was reduced by 1.3 mm after gel application and 1.5 mm after scaling; BOP
was reduced by 32% and 39%, respectively. The difference between the treatments was
statistically significantly, but considered as clinically unimportant.
Am J Dent. 1992 Oct;5(5):280-2.
Pit and fissure sealing and mutans streptococci levels in saliva.
Carlsson A, Jonsson Y, Svensson K, Stahl B, Twetman S.
Public Dental Clinic, Falkenberg, Sweden.
The effect of preventive pit and fissure sealants with a resin-based material on the
number of salivary mutans streptococci was evaluated in 46 healthy 12-year-old school
children (F group) with medium or high counts during a 1-year study period. As controls
served 33 children of the same age with the same bacterial levels at baseline (C group)
and 55 children with low levels (L group). Caries prevalence and incidence were
registered clinically and radiographically. Sealing of all accessible pit and fissures was
carried out in the F group with a light-cured Bis-GMA sealant. Bacterial levels at
baseline and 3, 6, 12 and 52 weeks after treatment were estimated with a chairside
method. The results disclosed a significant (P < 0.05) drop in the number of salivary
mutans streptococci in the F and C groups at all sampling occasions compared to
baseline. There were however no differences between the groups during the study
period. Both the caries prevalence and incidence were significantly (P < 0.05) higher in
F and C groups when compared to the L group. The results suggest that preventive pit
and fissure sealing with a resin based material does not affect salivary mutans
streptococci levels.
Scand J Plast Reconstr Hand Surg 26:147-153, 1992
Regenerative response to memranous and enchondral lyophilized allogeneic bone in rabbit skull defects
Sten Isaksson, Per Alberius, Björn Klinge, Jörgen Jönsson, Eric Hallberg and Mikael Wedel
Department of Oral Surgery, Länssjukhuset Halmstad.Plastic Surgery, Malmö General Hospital. Department of
Laboratory Animal Research, Faculty of Odontology, University of Lund, Malmö and Department of Zoology and
Physiological Chemistry, University of Lund, Lund, Sweden.
The regenerative responses of inlays of lyophilized allogenic bone of membranous
(skull) and enchondral (tibia) origin were studied in an experimental cranioplasty model
in rabbits. The lyophilized bone particles were also bioassayed for inductive bone
production in an orthotopic critical size defect rat model. Three trephined calvarial
defects were evaluated in each of 14 adult rabbits. The exprimental materials were
implanted into two of the defects and the third was left empty for control purposes. The
implants disclosed no major structural divergencies as assessed by scanning electron
microscopy. Healing was evaluated by light microscopy and contact radiography after
periods of four and 15 weeks. The lyophilized bone allografts of both embryonic origins
displayed a similar fashion of bone regeneration, bone marrow reappearance, and
volumetric density of trabecular bone substance and displayed no obvious differences
between experimental groups or intervals. The two materials exhibited low
osteoinductive potential.
J Oral Rehabil. 1992 Jul;19(4):313-7.
Influence of lower lip support on recording of vertical dimension in edentulous patients.
Ekfeldt A, Karlsson S.
Department of Prosthetic Dentistry, Faculty of Odontology, Goteborg University, Sweden.
The purpose of this investigation was to assess the influence of differences in design of
the occlusion rim on recorded vertical dimension in complete denture therapy.
Edentulous patients were studied with an opto-electronic method when the vertical
dimension of rest was established with and without labial support of the occlusion rim.
As no significant differences were found, the results did not support the hypothesis that
the contour of the lip support will influence the recorded physiological rest position.
However, a significant difference between intra and extraoral placement of the point of
measurement was found.
Scand J Dent Res. 1992 Jun;100(3):140-3.
Caries associated microflora in plaque from orthodontic appliances retained with glass ionomer cement.
Hallgren A, Oliveby A, Twetman S.
Department of Orthodontics, Medical and Dental Health Center, Halmstad, Sweden.
The caries associated microflora in dental plaque adjacent to orthodontic brackets
retained with a glass ionomer cement (GIC) and a resin based composite was
investigated using the split-mouth technique. 3, 8, and 28 days after the onset of the
appliances, 48-h-old plaque was sampled. An increasing prevalence of mutans
streptococci and lactobacilli in plaque from both retaining materials was found. A
tendency to colonize more frequently around the composite retained brackets was
noticed for both types of bacteria. The proportion of mutans streptococci in relation to
the total viable count was significantly higher in plaque samples from composite
retained brackets compared to GIC retained 1 month after onset of treatment. The results
suggest that a less caries inducing microflora may develop when GIC is used as luting
agent in orthodontic dentistry.
Pediatr Dent. 1992 May-Jun;14(3):184-8.
Two-year longitudinal observations of salivary status and dental caries in children with insulin-dependent
diabetes mellitus.
Twetman S, Nederfors T, Stahl B, Aronson S.
Karolinska Institute, Stockholm.
Salivary status and caries incidence were studied in 28 young, Type 1 diabetics from the
onset of the disease and during a two-year period. Flow rate, buffer capacity, glucose
content, total protein concentration and levels of mutans streptococci and lactobacilli
were determined in stimulated whole saliva every third month. Dental caries was
recorded at onset and then once a year. Forty-six per cent of the children developed
caries during the observation period. Caries incidence was significantly higher (P less
than 0.05) during the first year of diabetes, compared with the second. Caries-active
children displayed significantly higher HbA1c levels (P less than 0.001), compared with
caries-inactive diabetics. The number of salivary lactobacilli dropped significantly (P
less than 0.05) during the first six months of the disease, while mutans streptococci
levels remained unchanged during the study period. Salivary glucose concentration
showed a considerable individual variation, but tended to be lower during the second
year. The results suggest a possible relationship between Type 1 diabetes treatment and
caries.
Arch Oral Biol. 1992;37(7):579-84.
Effects of the beta-adrenoceptor antagonists atenolol and propranolol on human whole saliva flow rate and
composition.
Nederfors T, Dahlof C.
Department of Clinical Pharmacology, Sahlgrenska Hospital, University of Gothenburg, Sweden.
The effects of beta-adrenoceptor antagonists on salivary secretion have been extensively
studied in animals but not in man. The aim here was to compare salivary flow rate and
composition in man during 1 week of treatment with a non-selective (propranolol 80 mg
b.i.d.) and a beta 1-selective (atenolol 50 mg o.d.) antagonist with that of placebo. The
randomized, double-blind, cross-over ("Latin square") design was used and 42 healthy
male volunteers were recruited to the study. The treatment periods were separated by a
wash-out period of 2 weeks. Whole saliva was sampled on day 0 (before) and on day 7
during each treatment. The plasma concentration of propranolol and atenolol was
determined from blood samples obtained on day 7. Resting saliva was assessed for flow
rate, amylase activity and concentration of total protein, hexosamine and sialic acid.
Stimulated saliva was assessed for flow rate, pH, buffer pH, amylase activity and
concentration of total protein, Ca2+, Mg2+, Na+, K+, Cl- and PO4(2-). In resting as well
as stimulated whole saliva both the total protein concentration and the amylase activity
were significantly decreased during the active treatment periods (p less than 0.05-p less
than 0.001). At lunchtime during atenolol treatment the hexosamine/total protein and the
sialic acid/total protein ratios were significantly increased (p less than 0.05-p less than
0.01), suggesting a possible effect on protein synthesis. In addition, the concentrations of
Ca2+, PO4(2-), Cl- and Mg2+ were significantly altered during the active treatment
periods (p less than 0.05-p less than 0.001).(ABSTRACT TRUNCATED AT 250
WORDS)
Br J Oral Maxillofac Surg. 1992 Feb;30(1):46-9.
A technique for inserting endosseous implants in the atrophic maxilla in a single stage procedure.
Loukota RA, Isaksson SG, Linner EL, Blomqvist JE.
Leeds Dental Hospital, Sweden.
A technique is described for inserting autogenous iliac bone into the maxillary sinus of
the edentulous patient via a fenestration of the anterolateral maxillary wall, maintaining
the mucous membrane lining of the sinus intact, and allowing insertion of titanium screw
implants into the atrophic maxilla at the same operation. This method avoids a Le Fort I
osteotomy approach with its possible attendant complications.
J Craniomaxillofac Surg. 1992 Aug-Sep;20(6):257-60.
Guided bone regeneration of cranial defects, using biodegradable barriers: an experimental pilot study in the
rabbit.
Lundgren D, Nyman S, Mathisen T, Isaksson S, Klinge B.
Dept. of Periodontology, Institute for Postgraduate Dental Education, Jonkoping, Sweden.
The aim of this study was to test if a biodegradable barrier could be used to achieve
proper bone healing of full-thickness trephine skull defects, applying the biological
principle of guided tissue regeneration (GTR). Two New Zealand white rabbits were
used. In each animal, 2 circular through-and-through bone defects with a diameter of 8
mm were created in the midline of the frontal and parietal bones of the calvarium. One
defect was covered with the mucoperiosteal flaps without placement of an intervening
membrane barrier (control). One test defect (test 1) was covered by a biodegradable,
non-porous polylactic acid membrane on the outer (supra-calvarial) side of the defect,
and 2 test defects (tests 2 and 3) were covered by similar membranes on both the outer
and the inner aspects of the defects, prior to flap closure. 6 weeks postsurgically, the
animals were sacrificed and the defect areas including surrounding tissues were
harvested for histological preparation. The control defect was essentially occupied by
supra-calvarial soft tissue, located in direct contact with the dural tissue. In the test
cavities, there was a continuous bridge of regenerated bone extending from one edge of
the defect to the other, although in test 1 not attaining the same thickness as the bone
bordering the defect. In the 2 other test defects, the regenerated bone had reached a
thickness almost corresponding to that of the surrounding bone. The bone regeneration
was achieved without recourse to adjunctive bone graft materials. In conclusion, this
study has shown the applicability of the GTR principle in attaining bone regeneration of
skull defects by means of biodegradable barriers without resorting to supplementary
bone grafts or bone substitutes.
J Craniomaxillofac Surg. 1992 Feb-Mar;20(2):73-80.
Comparison of regenerative capacity elicited by demineralized bone matrix of different embryonic origins.
Isaksson S, Alberius P.
Department of Oral Surgery, Lanssjukhuset S, Halmstad, Sweden.
In the cranio-maxillo-facial field, extensive research has been conducted to find
substitutes for autogeneic bone as a grafting material. The present study examined the
effect of demineralized allogeneic bone material of membranous and enchondral origin
compared with autogenous bone chips on the healing response in rabbit skull defects.
The demineralized bone matrix (DBM) was bioassayed in a critical-size defect rat
model. Four trephined calvarial defects were created in each of 14 adult rabbits and the
experimental materials implanted into three defects leaving the fourth defect empty for
control purposes. The results were assessed by light microscopy and contact
radiography after periods of 4 and 15 weeks. The DBM of both origins displayed
extensive osteoinductive capacity and early bone production significantly exceeded that
of the two control groups. The embryological origin implied minor effects on the initial
regenerative response and bone marrow redevelopment. The clinical significance of
these findings is discussed.
Scand J Dent Res. 1992 Oct;100(5):274-8.
Contribution of autogeneic membranous bone chips and bone paste to healing of rabbit skull defects.
Isaksson S, Alberius P, Klinge B, Jonsson J.
Department of Oral Surgery, Lasarettet, Halmstad, Sweden.
In skeletal surgery, bone chips and bone paste are often used to facilitate bony repair.
However, no comparative investigation between these forms of bone graft implantation
has been undertaken. In this study four trephine skull defects were produced in each of
14 adult rabbits and inlays of bone paste and two separate amounts of bone chips were
then implanted in each animal. The results were compared relative to a control defect
and assessed by gross inspection, light microscopy, and contact radiography after
periods of 4 and 15 wk. Bone chips offered only minor advantages over controls in the
defects investigated and differences in bony regeneration between the diversified
amounts of bone chips were negligible. After bone paste implantation, a cellular and
mature bone was rapidly produced. The clinical significance of these findings is
discussed.
Swed Dent J 1992;16(5):183-9
Antimicrobial effect of a dental varnish, in vitro.
Petersson LG, Edwardsson S, Arends J.
Department of Preventive Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
The effects of a polymer based antimicrobial releasing varnish Cervitec were
investigated against different gram-positive and gram-negative bacterial strains as well
as a yeast using the agar diffusion inhibitory test (ADT-test in vitro). As positive
controls a 1% chlorhexidine gel and 1% aqueous solution of thymol and a placebo
polymer varnish without active agents were employed. The test experimental varnish
containing 1% chlorhexidine and 1% thymol showed antimicrobial activity against all
gram-positive and gram-negative microorganisms tested including one Candida strain.
The positive controls were similar in effect compared to the test varnish. No
antimicrobial effect was observed with the placebo varnish without active ingredients.
Toothpicks and dental floss treated with the test varnish showed an antimicrobial effect
against S. mutans even after storing in room temperature up to 12 months. The results
from this study support earlier laboratory studies that chlorhexidine and thymol diffuse
out of the experimental varnish and that the varnish is active against various of oral
pathogens. The possibility to use toothpicks or dental floss impregnated with the varnish
with the aim to become chemotherapeutically active against periodontal diseases as well
as against dental caries, is promising and should be tested in vivo.
J Oral Maxillofac Surg. 1992 Mar;50(3):241-9.
Osseous response to implanted natural bone mineral and synthetic hydroxylapatite ceramic in the repair of
experimental skull bone defects.
Klinge B, Alberius P, Isaksson S, Jonsson J.
Department of Laboratory Animal Research, Faculty of Odontology, University of Lund, Malmo, Sweden.
The purpose of this study was to assess and compare the osseous responses to implanted
particles of resorbable anorganic xenograft bone mineral and non-resorbable dense
synthetic hydroxylapatite of two different granule sizes. Four trephine calvarial defects
were produced in each of 13 adult rabbits. The experimental materials were
subsequently implanted in three defects, leaving the fourth defect for control purposes.
Six animals were killed 4 weeks after surgery and seven at 14 weeks. The tissue
responses were assessed by contact radiography, light microscopy, and histometry. The
biocompatibility of the implants was confirmed. All defects healed uneventfully,
although the resorbable hydroxylapatite seemed to promote initial bone regeneration.
The importance to orthognathic surgery of early and effective healing of bone gaps, as
well as of the advantage of implant resorbability to bone remodeling, are discussed.
J Craniomaxillofac Surg. 1992 Jan;20(1):2-7.
Maxillary alveolar ridge augmentation with onlay bone-grafts and immediate endosseous implants.
Isaksson S, Alberius P.
Department of Oral Surgery, Lanssjukhuset, Halmstad, Sweden.
Management of the atrophic maxilla can be a taxing surgical problems. One treatment
alternative is to use autogenous bone transplants and immediate titanium fixture
implantation. Despite the extensive literature on routine implant treatment of the
edentulous jaws, only very few reports have dealt with the outcome of bone graft
reconstructive surgery as part of the dental implant restoration. This study presents the
treatment and healing results of 8 consecutive patients, who, over a period of 2 years and
8 months, were treated using onlay iliac bone grafts to atrophic maxillary alveolar ridges
with immediate implant insertion. The patients were followed for 32-64 months. 83% of
the fixtures (n = 46) were well-integrated. Two fixtures in each of 2 patients were lost
due to traumatic bone-graft fractures. Palpatory bone-graft volume and prosthetic
function were, with the exception of 1 patient, good. Radiological examination
demonstrated preservation of the major part of the vertical dimension of the grafted
bone. Patient's assessment was of good aesthetics and intraoral function; 2 patients had
minor phonetic problems. In conclusion, similar success to routine maxillary implant
treatment can be achieved in the event of extreme maxillary bone deficiency, by bone
grafting and immediate fixture insertion.
Caries Res 1991;25(4):304-10
Effect of partial substitution of invert sugar for sucrose in combination with Duraphat treatment on caries
development in preschool children: the Malmo Study.
Frostell G, Birkhed D, Edwardsson S, Goldberg P, Petersson LG, Priwe C, Winholt AS.
Department of Cariology, Faculty of Odontology, Karolinska Institute, Huddinge, Sweden.
The aim was to study the effect of substitution of invert sugar for sucrose, in
combination with fluoride varnish (Duraphat) treatment twice a year, on caries
development in preschool children. One hundred and eighty-seven 4-years-olds were
divided randomly into four sugar groups: (1) sucrose (S), (2) sucrose-Duraphat (SD), (3)
invert sugar (I), and (4) invert sugar-Duraphat (ID). All families were asked to buy
beverages, biscuits, breakfast cereals, marmalade, ice cream, jam, ketchup, sweets and
table sugar, totally 32 different food items, sweetened with invert sugar or sucrose. The
substitution was, thus, restricted to a number of sugar-rich between-meal products. The
study was carried out double-blind for 2 years. The children of those parents who did not
want to participate in the sugar groups were divided randomly into one of the following
two groups: (5) Duraphat (D), and control (C). Because of lack of cooperation, only 114
of the 187 children (61%) were considered to have completed the study. The mean caries
increment, including initial lesions, was 3.86 dmfs in the combined groups S and SD (n
= 63) and 3.10 dmfs in the combined groups I and ID (n = 51) during the 2 years (p =
0.34). The corresponding values for the 2nd year only were 1.84 and 0.67 dmfs,
respectively (p = 0.09). The mean caries increment was 2.86 dmfs in group D (n = 113)
and 4.10 dmfs (p = 0.08) in group C (n = 93). If initial caries lesions were excluded from
the index, the difference between groups D and C was significant (p =
0.008).(ABSTRACT TRUNCATED AT 250 WORDS)
Oral Microbiol Immunol 1991 Oct;6(5):284-7
Mutans streptococci in saliva and interdental spaces after topical applications of an antibacterial varnish in
schoolchildren.
Petersson LG, Maki Y, Twetman S, Edwardsson S.
Medical and Dental Health Center, Lanssjukhuset, Halmstad, Sweden.
The effect of a chlorhexidine-containing varnish on the levels of mutans streptococci in
saliva and in interdental spaces was investigated in 33 15-year-old schoolchildren. Each
child was treated with an active (1% chlorhexidine; 1% thymol) and a placebo varnish
preparation following the split-mouth technique. The varnishes were applied twice in
small amounts into upper interdental areas with a 2-d interval. Mutans streptococci in
saliva and interdental plaque was sampled and enumerated during 3 months. The results
showed an immediate reduction of the number of interdental mutans streptococci on
both test and placebo side after the varnish applications. The levels, however, were
significantly lower in the test quadrants compared with the placebo-treated sides after 8,
30 and 90 d. Thus, the findings indicate a slower recolonization in interdental spaces
treated with the active preparation. The levels of mutans streptococci in saliva were
significantly reduced 1 and 3 months after varnish treatment, suggesting a long-term
effect of the antibacterial varnish.
Caries Res 1991;25(1):70-3
Caries-inhibiting effects of different modes of Duraphat varnish reapplication: a 3-year radiographic study.
Petersson LG, Arthursson L, Ostberg C, Jonsson G, Gleerup A.
Department of Preventive Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
One hundred and sixty 11-year-olds were randomly allocated to two experimental
groups, one test (group 1) and one control group (group 2), for a 3-year clinical test
comparing different modes of fluoride varnish treatment. In the test group, children
received Duraphat varnish treatments 3 times a week, once a year. The children in group
2 were treated with Duraphat every 6 months. During the experimental period, children
in group 1 received 9 fluoride varnish applications, and in group 2, 6 applications. Four
bitewing radiographs were taken in each child each year for the measurements of the
incidence and progression of proximal caries. Repeated fluoride varnish treatment with
Duraphat, 3 times a week once a year, appears to inhibit proximal caries progression and
development since the children in this group showed even a lower caries status, 1.3 +/0.3 DS, at the end of the study compared to 1.6 +/- 0.2 DS at the outset. In group 2, the
children increased their caries status from 1.7 +/- 0.2 to 2.4 +/- 0.4 DS during the
experimental period. The caries difference was statistically significant (p less than 0.05)
between the two groups. A health economic comparison of the two modes of application
showed 30% lower costs for the children in the test group based on time used for
preventive measures and assumed filling therapy.
Caries Res 1991;25(1):74-9
Caries-preventive effect of dentifrices containing various types and concentrations of fluorides and sugar
alcohols.
Petersson LG, Birkhed D, Gleerup A, Johansson M, Jonsson G.
Medical and Dental Health Center, Halmstad, Sweden.
The caries-inhibiting effect of unsupervised daily use of four different toothpastes was
compared in a 3-year clinical and microbiological study: (1) 0.8% sodium
monofluorophosphate (MFP) with 3% xylitol and 6% sorbitol; (2) 0.03% sodium
fluoride with 3% xylitol and 6% sorbitol; (3) 0.8% MFP with 9% sorbitol, and (4) 0.03%
sodium fluoride with 9% sorbitol. In all 284 children, 12-13 years old at baseline, took
part in the study. After 3 years, no statistically significant differences were found
between the different toothpaste groups concerning either development of initial or gross
caries lesions or number of mutans streptococci and lactobacilli in saliva. However,
children with no detectable approximal caries at baseline, who used the MFP toothpaste
with the xylitol-sorbitol mixture, showed a lower (p less than 0.05) caries increment as
compared with children who used the MFP toothpaste with sorbitol alone.
J Clin Periodontol. 1991 Aug; 18(7): 521-8.
Autotransplantation of third molars as treatment in advanced periodontal disease.
Kristerson L, Johansson LA, Kisch J, Stadler LE.
Department of Oral Surgery, County Hospital, Halmstad, Sweden.
The aim of this study was to investigate the prognosis of replacing molars with advanced
periodontitis by autotransplanted fully developed third molars. The patient sample
consisted of 18 subjects, 24-58 years of age. The patients selected had at least 1 molar
with advanced periodontal tissue destruction. After extraction of the diseased molar,
autotransplantation of a third molar was immediately performed. After a splinting and
healing period of 2-3 weeks, endodontic treatment was carried out. The follow-up
included recordings of the clinical parameters, probing periodontal pocket depth,
probing attachment level, percussion sound, and mobility. Radiographs were taken
immediately after the surgical procedure, after 6 months, 1 year, and thereafter annually.
The results of this study indicate that autotransplantation may be an alternative treatment
procedure for molars with advanced periodontal disease
Swed Dent J. 1991;15(3):145-51.
Salivary mutans streptococci and caries prevalence in 8-year-old Swedish schoolchildren.
Twetman S, Frostner N.
Department of Pedodontics, Lanssjukhuset, Halmstad, Sweden.
The aim of this study was to obtain cross-sectional information about the quantitative
distribution of salivary mutants streptococci assessed with a clinically applicable
microbiological method and the relation to dental caries in young schoolchildren. A total
of 355 8-year-old children were examined for the presence and number of mutants
streptococci in saliva by a specially prepared strip, the "Strip-mutans" method, cultivated
in a selective broth. The strips were first visually examined and grouped by aid of a
templet provided by the manufacturer and thereafter transferred to a laboratory for
enumeration of colony forming units (CFU) with aid of a stereomicroscope. Caries
scores were obtained from the dental records. Mutans streptococci were identified in
70% of all children. 46% were free from the bacterium or harboured low levels (0-10
CFU) while high levels (greater than or equal to 500 CFU) were found only in 6% of the
material. Strong positive correlations (p less than 0.001) were found between different
levels of mutans streptococci infection and the caries experience in both the primary
(dmfs) and the permanent (DMFS) dentition. A statistically significant correlation
between the direct examination and the microscopic enumeration was disclosed (r =
0.84). The bacterial culturing technique used in this study proved to be practical and
reliable and thus useful in clinical routines of pediatric dentistry.
Community Dent Oral Epidemiol 1990 Oct;18(5):249-52
Dental caries, mutans streptococci, lactobacilli, and saliva secretion rate in adults.
Klock B, Svanberg M, Petersson LG.
Department of Public Dental Health, Bohusian-County Council, Sweden.
In 718 Swedish patients, equally divided into four age groups (19-25, 26-45, 46-60,
greater than 60 yr), salivary levels of mutans streptococci and lactobacilli, saliva
secretion rate, and DMFS were registered. No significant differences were found
between the various age groups either in salivary factors or in caries (D). Number of
missing (M) and filled (F) surfaces increased with age. Prevalence of root caries, which
increased with age, was significantly correlated to number of exposed root surfaces
independent of age. Of the total study group, 50% had greater than or equal to 10(6)
mutans streptococci and 40% had greater than or equal to 10(5) lactobacilli per mL
saliva. Three percent had a saliva secretion rate of less than or equal to 0.5 mL/min.
Correlation analyses showed that both mutans streptococci and lactobacilli significantly
correlated to the caries prevalence but the r-value never exceeded 0.34.
Acta Odontol Scand. 1990 Oct;48(5):343-9.
An individual tooth wear index and an analysis of factors correlated to incisal and occlusal wear in an adult
Swedish population.
Ekfeldt A, Hugoson A, Bergendal T, Helkimo M.
Department of Prosthetic Dentistry, Faculty of Odontology, Gothenburg University, Sweden.
The aim of the study was to introduce an individual tooth wear index and to use this
index to investigate factors correlated to occlusal wear. The material consisted of 585
randomly selected dentate individuals from the community of Jonkoping, Sweden, who
in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal and
occlusal wear was evaluated for each single tooth in accordance with criteria presented
earlier. An individual tooth wear index, which made it possible to rank individuals in
accordance with incisal and occlusal wear, was used as dependent variable to investigate
factors related to incisal and occlusal wear. Of all factors analyzed, the following were
found to correlate significantly with increased incisal and occlusal wear: number of
existing teeth, age, sex, occurrence of bruxism, use of snuff, and saliva buffer capacity.
Stepwise multiple regression analysis gave a total explanation factor of R2 = 0.41. It was
also possible to distinguish well between groups of individuals with and without tooth
wear by means of these factors.
J Craniomaxillofac Surg. 1990 Aug;18(6):271-9.
Regeneration of cranial suture and bone plate lesions in rabbits. Implications for positioning of osteotomies.
Alberius P, Isaksson S, Klinge B, Sjogren S, Jonsson J.
Dept. of Plastic Surgery, Sahlgrenska Hospital, Goteborg, Sweden.
The positioning of osteotomies in intramembranous cranial bone was studied by
exploring the pattern of bone regeneration in growth areas (the sutural region) as
compared to that of the bone plate proper. Trephine defects in the left coronal suture
area and the right parietal bone were produced in fifty-nine young rabbits. A pilot study
to refine operative and analytical methods comprised 22 animals. The experiments were
terminated at one, three, and six weeks after surgery. The bone regenerative response
was assessed by x-ray planimetry, plain microscopy, enzyme histochemistry, and
fluorescent labelling. Only minor divergences in healing capacity between the two
defects were found. No adverse effects on the growth process were indicated. As to
clinical management, the findings suggest that osteotomies designed to traverse sutural
areas will, under normal circumstances, regenerate in a similar manner and rate to
adjoining bone plates.
Am J Dent. 1990 Aug;3(4):175-6.
Cryosurgical treatment of mucocele in children.
Twetman S, Isaksson S.
Lanssjukhuset, Halmstad, Sweden.
Cryosurgery of superficial mucoceles located in the lower lip of eight children is
reported. The treatment did not require administration of local anesthetics and was easily
performed and well-tolerated even by small children. Healing proceeded uneventfully in
all patients. No recurrence during a 1-year follow-up period was observed. Cryosurgery
proved to be an effective and essential tool in the management of mucocele in children.
Oral Microbiol Immunol. 1990 Jun;5(3):169-71.
Mutans streptococci in saliva and dental caries in children living in a high and a low fluoride area.
Twetman S, Mattiasson A, Varela, Bratthall D.
Medical and Dental Health Center, Lanssjukhuset, Halmstad, Sweden.
The aim of this study was to obtain information about the quantitative distribution of
salivary mutans streptococci and the relation to dental caries in children with contrasting
levels of natural water fluoride. A total of 698 schoolchildren aged 12 yr were selected
from areas with high (1.2 ppm) or low (0.1 ppm) fluoride concentration in the drinking
water. They were all examined for the presence and number of mutans streptococci in
saliva by a specially prepared plastic strip, the "Strip mutans" method, cultivated in a
selective broth. Data on the caries experience were obtained from the dental records and
from bite-wing radiographs. Mutans streptococci were identified in 82% of all children
with no difference between the two areas. The number of mutans streptococci was
however significantly (p less than 0.05) lower among the children from the high fluoride
area than those from the low fluoride area. Children with no detectable or low levels (010 CFU) of mutans streptococci had less caries experience than children with moderate
or high levels (11- greater than 500 CFU) in both areas investigated
Caries Res. 1990;24(1):44-7.
Diurnal fluoride concentration in whole saliva in children living in a high- and a low-fluoride area.
Oliveby A, Twetman S, Ekstrand J.
Department of Cariology, School of Dentistry, Karolinska Institutet, Huddinge, Sweden.
Salivary fluoride concentrations were investigated in 12-year-old children living in areas
with low (0.1 ppm) or high (1.2 ppm) fluoride concentration in the drinking water.
Unstimulated whole saliva was collected from 27 children from the respective areas
every 2nd hour for 46 h except during sleep. The mean salivary fluoride concentration
was 0.32 +/- 0.013 mumol/l (n = 419) in the low-fluoride (LF) area and 0.87 +/- 0.047
mumol/l (n = 401) in the high-fluoride (HF) area. No significant rhythm could be found
for the diurnal variations in the mean or individual salivary fluoride concentrations.
However, in the HF area the individual salivary fluoride concentrations fluctuated
widely and randomly.
Caries Res. 1990;24(4):239-41.
Salivary fluoride concentrations in children with glass ionomer cemented orthodontic appliances.
Hallgren A, Oliveby A, Twetman S.
Medical and Dental Health Center, Halmstad, Sweden.
Salivary fluoride concentrations were determined in 10 children (mean age 12.0 years)
undergoing fixed orthodontic therapy. The orthodontic appliances, a minimum of 4
bands and 8 brackets, were cemented with a glass ionomer cement. Unstimulated whole
saliva was collected 4 times a day before (baseline value) and at 1, 7, 14 and 28 days
after cementation. The samples of saliva were centrifuged and the supernatants were
analyzed with a fluoride-sensitive electrode. At baseline, the mean salivary fluoride
concentration was 0.85 mumol/l. There was a significant increase during the day after
cementation (1.88 mumol/l). After 7, 14 and 28 days, salivary fluoride levels were
slightly elevated, but not statistically different from the baseline values. The ingested
fluoride dose during the 1st day was estimated to be 0.02 mg. It is concluded that in
orthodontic treatment with fixed appliances, a slow release of fluoride from glass
ionomer cements could exert a local cariostatic effect on adjacent caries-susceptible
enamel.
J Oral Rehabil. 1990 Mar;17(2):117-29.
Wear of prosthodontic materials--an in vivo study.
Ekfeldt A, Oilo G.
Department of Prosthetic Dentistry, Faculty of Odontology, Gothenburg University, Sweden.
The aim of this investigation was to study quantitative and qualitative aspects of the
wear process of some prosthodontic materials in three different persons in vivo. The in
vivo models combined two methods: removable double crowns and a replica technique.
The wear resistance of gold (types III and IV), porcelain and a microfilled resin was
studied opposing metal ceramic crowns and in one person when opposing all four
materials. All three persons had earlier histories of occlusal wear of teeth and/or
restorations. The wear rate of gold and porcelain showed equal values antagonizing
metal ceramic crowns in all three persons. The microfilled resin had a wear rate three or
four times higher in the same situations. No significant difference in wear resistance
could be found between type III and type IV gold alloys. The wear mechanism seemed
to be a fatigue type in porcelain, and in gold a combined fatigue and abrasive type of
wear. The microfilled resin showed mainly a fatigue type of wear but some observations
indicating a tribochemical reaction were also made.
HMO Pract. 1990 Jan-Feb;4(1):24-9.
Psychotherapy in the HMO: clinical perspectives.
Kisch J, Makover RB.
Community Health Care Plan, New Haven, Connecticut.
Tensions between expectations and possibilities in providing mental health services are
more evident in closed systems like an HMO. These stresses have an impact on clinical
providers of psychotherapy. Because further contact cannot substitute for lack of clinical
success, special demand is placed on the clinician to achieve an alliance and then reach
closure. The situation of the psychotherapist in the HMO is discussed.
Scand J Dent Res. 1989 Dec;97(6):520-7.
Effects of the thiazide diuretic bendroflumethiazide on salivary flow rate and composition.
Nederfors T, Twetman S, Dahlof C.
Public Dental Service, County Hospital, Halmstad, Sweden.
Thiazide diuretics are among the first-line alternatives in the treatment of primary
hypertension. The effects of thiazide treatment on salivary production are, however, little
studied and the results so far available are not decisive. The aim of the present study was
to evaluate and compare salivary flow rate and composition during treatment with the
thiazide diuretic bendroflumethiazide in a low dose (2.5 mg o.d.) and placebo. The study
was performed with a randomized, double-blind, cross-over design (2 x 2 wk) in 34
healthy volunteers. The treatment periods were separated by a wash-out period of 2 wk.
Resting and stimulated whole saliva was sampled three times daily on scheduled days
during the treatment periods. Flow rate was assessed for resting saliva, whereas flow
rate, pH, buffer capacity, amount of total proteins and concentrations of sodium,
potassium, calcium, phosphate and magnesium were measured for stimulated whole
saliva. No effect of bendroflumethiazide on the resting salivary flow rate could be
detected, while the stimulated flow rate was significantly reduced by about 10% during
the thiazide treatment. The total sodium output was significantly decreased by
approximately 30%, without any detectable change in total potassium output. All other
variables of stimulated whole saliva studied were not different from placebo. It is
concluded that treatment with bendroflumethiazide in a low dose significantly reduces
the stimulated whole salivary flow rate and total sodium output in healthy volunteers.
Oral Microbiol Immunol. 1989 Sep;4(3):165-8.
Mutans streptococci and lactobacilli in saliva from children with insulin-dependent diabetes mellitus.
Twetman S, Aronsson S, Bjorkman S.
The quantitative distribution of mutans streptococci and lactobacilli in saliva of insulindependent diabetic children was compared with a group of healthy children and related
to the metabolic control of the disease. The study group, consisting of 94 boys and girls
(age 4-19) with type 1 diabetes was matched by sex and age with a non-diabetic control
group. Stimulated whole saliva was collected and flow rate, buffer capacity and the
levels of mutans streptococci and lactobacilli were analysed in all children. In the
diabetic group, total salivary proteins and glucose content of saliva were determined.
Data on caries experience were recorded from the dental cards of all children. There
were no difference in the distribution or number of mutans streptococci between the
groups, but significantly (p less than 0.05) lower levels of lactobacilli were found among
the diabetic children. The number of lactobacilli was positively correlated (p less than
0.05) to glucose concentration in saliva. There was no difference in the prevalence of
caries between the groups. The present findings suggest that the dietary treatment of
young insulin dependent diabetics gives rise to a reduced number of lactobacilli in saliva
but does not affect the mutans streptococci.
Scand J Dent Res. 1989 Jun;97(3):268-77.
Oral mucous membrane lesions in children treated with bone marrow transplantation.
Dahllof G, Heimdahl A, Modeer T, Twetman S, Bolme P, Ringden O.
Department of Pedodontics, School of Dentistry, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
Oral mucous membrane lesions were studied in 54 children below 12 yr of age treated
with allogeneic bone marrow transplantation mainly because of hematological
malignancies. Sixty-two percent of the children exhibited a wide range of oral side
effects during therapy. Lesions observed during the first 2 wk prior to engraftment of the
donor marrow were related to the chemo- and radiotherapy given. Oral ulcerations were
seen in 34% of the children. Children given methotrexate as graft-versus-host disease
(GVHD) prophylaxis exhibited oral ulcerations significantly (P less than 0.05) more
often than those given cyclosporin. Oral lesions related to acute GVHD were only
observed in two patients. Reactivating herpes simplex virus infection was seen in 35% of
the children who were seropositive prior to BMT. An extensive oral candidiasis was
observed in 15% of the patients. All six children with a chronic GVHD exhibited
changes in the oral mucosa 2-4 yr after transplantation such as erythma of the mucous
membranes, tongue atrophy and also lichenoid changes in the buccal mucosa.
Lab Anim. 1989 Jan;23(1):70-2.
Management of craniotomy in young rabbits.
Alberius P, Klinge B, Isaksson S.
Department of Plastic Surgery, Sahlgrenska Hospital, Goteborg, Sweden.
A safe and easy-to-manage technique for various craniotomy procedures in young
rabbits has been developed. This technique, which minimizes the need for special
instrumentation, has been tested in 90 animals with a minimal mortality and morbidity:
one death perioperatively caused by sagittal sinus bleeding and one rabbit disclosing a
brief period of postoperative illness, respectively. The technique, including postsurgical
strategy, is described in detail.
Caries Res 1989;23(3):135-40
Effect of topical F- solutions on caries-like lesions in root surfaces.
Derand T, Lodding A, Petersson LG.
Department of Oral Technology, School of Dentistry, University of Lund, Malmo, Sweden.
Topical F- solutions, NaF, SnF2, TiF4, or Fe-Al-NaF, were applied to root surfaces to
examine the effect on caries-like lesions produced in vitro. Extracted premolars were
treated with a solution for 10 min prior to a 20-day period in acid gel. The lesions were
studied by microradiography and light microscopy, and concentration profiles of 12
elements were determined by secondary ion mass spectrometry. The results indicated
that the solutions retarded the development of lesions. The greatest effect was obtained
with TiF4 and SnF2 solutions. Element analyses revealed that high concentrations of F
(up to 3.5%) accumulated in the outer third of the lesion and that SnF2 and TiF4 formed
depots in the cementum, although both Sn and Ti also penetrated the lesion. NaF had a
weaker effect on lesion formation, but induced a high F concentration in the
demineralized zones. The Fe-Al-F solution affected the lesion only marginally and
deposited a relatively low F concentration in the lesion, although Fe and Al penetration
and depot formation were noted.
Swed Dent J 1989;13(1-2):69-76
Oral status and estimated treatment need in Swedish air force conscripts.
Petersson LG, Jonsson G, Stadler LE, Samfors KA, Gleerup A.
Department of Preventive Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
The oral status of a platoon of 53 air-force conscripts was investigated. Interviews on
regularity of dental care, diet and oral hygiene habits were included. The estimated
treatment need was analysed in terms of time required for treatment by dentist or
auxiliaries, i.e. hygienist or preventive dental assistant. There was a high prevalence of
dental plaque, gingivitis and caries. It was estimated that 16 hours of dentist time would
be required for restorations, but no dentist time would be necessary for periodontal
treatment. The total time needed for preventive dentistry was estimated at 61 hours of
treatment by preventive dental assistants. Such epidemiological data are valuable for
estimating prospective treatment needs in population groups and as indicators for needsrelated dental manpower planning.
Swed Dent J 1989;13(5):177-83
Fluorine profiles in human enamel after in vitro treatment with dentifrices of different compositions and
acidities.
Petersson LG, Lodding A, Hakeberg M, Koch G.
Department of Preventive Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
Fluorine uptake has been measured in human enamel after in vitro treatment with
slurries of dentifrices of different compositions and acidities. Secondary ion mass
spectrometry (SIMS) was used to determine the quantitative in-depth distribution
profiles of fluorine. Five dentifrices were examined: ACTA (pH 5.5) with 250, 1000 and
1500 ppm F as NaF; Colgate (pH 7) with 1000 ppm F as MFP and 400 ppm F as NaF;
and Pepsodent (pH 7) with 1000 ppm F as MFP. The results establish that acidulated
dentifrice with low F concentration gives about the same fluorine uptake in near-surface
enamel as do pH 7 dentifrices with higher F contents. In addition, at depths greater than
ca 3 microns, the low F acid dentifrice in fact introduces considerably higher levels of
fluorine, and yields at least three times deeper penetration, than do the non-acidulated
toothpastes. The study illustrates the advantages of enhanced fluorine uptake, and
thereby improved cariostatic effect, by using acidulated dentifrices even at relatively low
fluoride concentration.
Swed Dent J 1988;12(6):221-5
Fluoride uptake on dry versus water-saliva wetted human enamel surfaces in vitro after topical application of
a varnish (Duraphat) containing fluoride.
Koch G, Hakeberg M, Petersson LG.
Institute for Postgraduate Dental Education, Jonkoping, Sweden.
The uptake of fluoride was studied in vitro after application of Duraphat varnish on dry
versus wetted enamel surfaces. 30 sound premolar teeth extracted for orthodontic
reasons were randomly divided into three experimental groups. Duraphat varnish was
topically applied for 6 hours to the air dried surfaces of ten teeth (group 1). In group 2,
10 teeth were also treated with Duraphat but the enamel surfaces were water-wetted. In
group 3, surfaces were wetted with fresh chewing-stimulated human saliva. The varnish
was allowed to remain on the surfaces for 6 hours in all groups whereafter all teeth
stored in synthetic saliva (37 degrees C) for one week before F-analysis performed by
the acid etching method. The results indicate that the F-uptake from Duraphat varnish is
increased significantly by its application to dry surfaces compared to wetted surfaces.
This observation may be of clinical importance and should be further investigated.
Swed Dent J. 1988;12(5):213-6.
Increased (L+)-lactic acid production in lysozyme-inactivated suspensions of human dental plaque.
Twetman S, Dahllof G, Lindqvist L.
Department of Pedodontics, Karolinska Institute, Huddinge University Hospital, Sweden.
The effect of lysozyme-inactivation on L(+)-lactic acid (LA) production in dental plaque
suspensions was evaluated. From 10 children 24-h plaque was collected and lysozyme
activity inhibited by addition of goat antiserum to human lysozyme. Acid production
was stimulated by addition of glucose. The results showed significantly increased LA
levels (50-150%) in lysozyme-inactivated plaque suspensions from 8 of the subjects
compared to untreated controls. The increase in acid production activity was not related
to plaque lysozyme levels. The findings indicate that the presence of lysozyme may be
limiting on acid production in the early dental plaque.
Swed Dent J 1987;11(3):95-101
Fluoride clearance of whole saliva in young school children after topical application.
Petersson LG, Ludvigsson N, Ullbro C, Gleerup A, Koch G.
The importance of fluoride in the saliva after topical F-application has been a matter of
discussion in recent years. Therefore the aim of this study was to determine the elevation
and clearance of fluoride in whole saliva in 24 seven-year-old children, 5, 30 and 120
minutes after the following topical fluoride treatments. Exp. 1: chewing F-tablets - (0.25
mg F - ACO); Exp. 2: sucking F-tablets - (0.25 mg F - Fludent); Exp. 3: F-chewing gum
- (0.25 mg F - Fluomin); Exp. 4: F-mouthrinsing - (0.2% NaF); Exp. 5: F-toothpaste (250 ppm F - ACTA); Exp. 6: F-toothpaste - (1000 ppm F); Exp. 7: F-varnish - (2.3% F
- Duraphat). Statistical analysis (ANOVA) showed "the time factor" was statistically
significant. The interaction between "time factor" and "treatment factor" is obvious.
After F-varnish (Duraphat) and F-mouthrinsing treatment there was a significantly
increased fluoride concentration in the saliva even after 120 minutes compared to the
other treatments. After F-varnish treatment, the concentration in saliva two hours after
application was statistically significantly higher than for the other treatments. The
mouthrinsings resulted in comparison to the F-varnish in a lower F-concentration after
30 and 120 minutes which however was statistically significantly higher than the Fconcentration following the other treatments. No statistical difference was found
between F-applications after 30 and 120 minutes.
Scand J Dent Res. 1987 Apr;95(2):128-31.
Lysozyme activity and L(+)-lactic acid production in saliva in schoolchildren with high Lactobacillus counts.
Twetman S, Dahllof G, Wikner S.
Out of 374 schoolchildren, aged 13-15 yr, 42 with high counts of salivary lactobacilli
(greater than or equal to 10(5] were selected for this study. Lysozyme activity in saliva
and L(+)-lactic acid (LA) production after addition of glucose were determined. The
mean values of lysozyme activity and LA concentration were 19.4 micrograms/ml and
1.4 mmol/l respectively. The levels of LA produced without addition of glucose were
less than 0.2 mmol/l. The results showed a statistically significant (P less than 0.05)
negative correlation between lysozyme activity and the levels of LA produced. The
findings of this study suggest that lysozyme may be of importance in limiting acid
production in saliva.
Swed Dent J. 1987;11(4):163-8.
Effect of inactivated salivary lysozyme on L(+)-lactic acid production in saliva and in cultures of
Streptococcus mutans BHT.
Twetman S, Lindqvist L.
Department of Pedodontics, Karolinska Institute, Huddinge University Hospital, Sweden.
The aim of this study was to evaluate the antimicrobial contribution of human lysozyme
in saliva. In one series of experiments, L(+)-lactic acid (LA) production in exponential
phase cultures of Streptococcus mutans BHT treated with lysozyme-deficient salivary
supernatant was determined. In other experiments, LA concentration was measured in
whole saliva samples from 22 school-children where the lysozyme activity had been
inhibited by the addition of goat antiserum to human lysozyme (GAsL). LA production
in both S. mutants cultures and saliva samples was stimulated by D-glucose addition.
The results indicated a time dependent increase (approximately 30%) in LA production
in lysozyme-deficient reaction-mixtures compared to untreated controls. The mean LA
concentration in lysozyme-inactivated whole saliva samples was significantly higher (p
less than 0.01) compared to untreated saliva. However, in 4 out of 22 children the GAsLtreatment did not affect LA production. The individual differences could not be related
to salivary secretion rate, lysozyme activity or the number of S. mutans and lactobacilli
in saliva. The findings of this study suggest a protective role for lysozyme in limiting
acid production in saliva, but individual differences exist.
J Clin Microbiol. 1987 Oct;25(10):1985-8.
Improved selective culture media for Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus.
Holm A, Rabe P, Kalfas S, Edwardsson S.
Department of Oral Microbiology, University of Lund School of Dentistry, Malmo, Sweden.
By modifying the previously described media tryptic soy-serum-bacitracin-vancomycin
(TSBV) agar and tryptic soy-serum-bacitracin-vancomycin-fluoride (TSBVF) agar, two
improved selective culture media were developed for isolation and enumeration of
Actinobacillus actinomycetemcomitans (A medium) and Haemophilus aphrophilus (H
medium) in oral specimens. Both media were supplemented with fusidic acid and
spiramycin, and carbenicillin was also added to A medium. The growth yields of pure
cultures of A. actinomycetemcomitans on A medium and of H. aphrophilus on H
medium were comparable with those on the reference media. Compared with blood agar,
the selective media inhibited these species about 10-fold or less. In addition, A and H
media suppressed the growth of pure cultures of Capnocytophaga spp. and Neisseria
spp., commonly found as contaminants on TSBV and TSBVF, 10(5) times or more
compared with that on blood agar. In samples from diseased periodontal pockets, the
recoveries of A. actinomycetemcomitans on A medium and H. aphrophilus on H
medium equaled those on TSBV and TSBVF, respectively. In about 50% of the cultures
on the reference media, contaminating bacteria were detected at levels higher than 10(4)
CFU/ml of sample. The corresponding value for both A and H media was about 2%.
Int J Oral Maxillofac Surg. 1986 Dec;15(6):722-6.
Presurgical planning for osseointegrated implants in the maxilla. A tomographic evaluation of available
alveolar bone and morphological relations in the maxilla.
Eckerdal O, Kvint S.
A clinical tomographic method of defining and demonstrating the hard and soft tissue
morphology of those parts of the maxilla which are intended for osseointegrated
implants is described. This preoperative examination is an useful aid in the choice and
planning of the treatment as such, and in the decision concerning the calibre and position
of the implants. Hence, it facilitates the surgical procedure.
Swed Dent J. 1986;10(1-2):37-43.
Instrumentation of the curved root canal using filing or reaming technique--a clinical study of technical
complications.
Stadler LE, Wennberg A, Olgart L.
The technical results of two different techniques for instrumentation of root canals were
evaluated. The study comprised 520 roots with various degree of curvature treated by
supervised dental students using either a reaming of a filing technique. The results
indicated that treatment complications were mainly associated with severely curved
(greater than or equal to 35 degrees) canals (15-20% of the molars). Instrument breakage
and lateral deviation from original canal curvature were more frequent with the reaming
technique whereas overfilling and root perforation dominated with the filing technique.
Loss in working length occurred with both techniques. It is suggested that the frequency
of complications during instrumentation of curved canals might be diminished if files are
used for the enlargement of the canal and reamers are used for the final shaping of the
apical part.
J Clin Periodontol. 1986 Feb;13(2):131-4.
Longitudinal observation of "unattached," mobile gingival areas.
Kisch J, Badersten A, Egelberg J.
Facial gingival surfaces over cuspids and bicuspids in 20 patients were monitored for 5
years to evaluate the importance of attached gingiva in the maintenance of a stable
periodontium. 43 surfaces "at risk" were compared to 36 "non-risk" surfaces within these
patients. Surfaces "at risk" had to meet the following 3 criteria as established by both of
2 independent examiners: width of keratinized gingiva less than or equal to 1.0 mm;
absence of attached gingiva; mobility of the gingival margin. During the 5 years of
observation, "non-risk" surfaces showed a trend toward decrease in mean width of
keratinized gingiva, while this measurement remained unchanged for the surfaces "at
risk" Probing depths remained unaltered for both groups. A trend toward gingival
recession and loss of probing attachment was observed for both "risk" and "non-risk"
surfaces. Thus, this study failed to demonstrate that "unattached" and mobile facial
gingival surfaces are more susceptible to periodontal breakdown than "attached"
surfaces.
Am J Orthod. 1986 Feb;89(2):146-50.
Influence of orthodontic treatment on root development of autotransplanted premolars.
Lagerstrom L, Kristerson L.
The aim of this study was to clarify whether orthodontic movement of autotransplanted
premolars will affect the final root length of the transplants. A group of 29
autotransplanted premolars that had been orthodontically treated was compared with a
group of 30 autotransplanted premolars that had not been orthodontically treated.
Contralateral teeth in both groups served as controls. The root lengths of the transplants
as well as the controls were measured on the radiographs immediately after
transplantation and also after orthodontic treatment and complete root formation. The
results demonstrated that there was no statistically significant difference between the
original and final root lengths of the transplants in the two samples or between the
contralateral teeth. The autotransplantation of the premolars resulted in an average
shortening of 1 to 2 mm compared to the contralateral control teeth. Futhermore,
orthodontic movement of the transplants appeared to have a tendency to shorten the final
root length.
Caries Res. 1986;20(3):223-9.
Effect of human lysozyme on 2-deoxyglucose uptake by Streptococcus mutans and other oral microorganisms.
Twetman S, Lindqvist L, Sund ML.
Abstract not available.
Inf Orthod Kieferorthop. 1986;18(3):333-9.
[Effect of orthodontic treatment on root formation of autotransplanted
premolars]
[Article in German]
Lagerstrom L, Kristerson L.
PMID: 3468074 [PubMed - indexed for MEDLINE]
Swed Dent J 1985;9(2):49-53
Fluoride supplemented and non gamma 2 amalgam. A comparative clinical study into the primary and
permanent dentition in children.
Petersson LG, Rasmusson CG, Hagborg S, Isacsson P.
The purpose of the present study has been to test and compare the clinical performance
of two dental analgams, a non gamma 2 amalgam (Amalcap) and a fluoride
supplemented amalgam (Yata) containing 0,5% fluoride as stannous fluoride. During a
period of almost one year, 196 fillings were made on contralateral cavities in primary as
well as permanent teeth. The patients, all school children, received on the same
occasion, randomly in one side of the mouth the F-supplemented amalgam and, in the
corresponding contralateral tooth surface, the non gamma 2 amalgam. After four years
of observation, no significant differences were found between the two tested amalgams
concerning their clinical qualities such as corrosion, tooth colouration, filling edges,
over- and underfilling, isthmus fractures or secondary caries. However, the low number
of secondary caries occurring during the test period (2-3%) did not permit any
conclusion about the preventive effect of the F-supplemented amalgam against
secondary caries to be drawn. Further clinical studies, therefore, will show if fluoride
supplemented amalgam is a really effective way to prevent secondary caries. Many
categories of patients with extremely long intervals between dental treatments i e
military and fleet personnel, certain foreign personnel, some handicapped groups and
specific risk ages, as well as other specific intra-oral situations should benefit from
filling therapy with fluoride supplemented amalgam. Such studies should be undertaken
in order to evaluate the preventive clinical effect from fluoride supplemented amalgams.
Swed Dent J 1985;9(3):97-104
Effect on caries of different fluoride prophylactic programs in preschool children. A two year clinical study.
Petersson LG, Koch G, Rasmusson CG, Stanke H.
376 three-year old children were divided into four experimental groups and exposed to
different combinations of preventive programs for a period of two years. All the groups
were given the same basic prophylactic information. Additionally Group I received
fluoride tablets (FLUDENT) for daily sucking twice a day plus a placebo dentifrice free
of fluoride. Group II was given a fluoride dentifrice containing 0.025% F, (ACTA).
Group III was given a placebo dentifrice plus fluoride varnish (Duraphat) twice a year.
Group IV a fluoride dentifrice containing 0.025% F (ACTA) plus fluoride varnish
(Duraphat) twice a year. No statistically significant difference in caries increment during
the two experimental years was found between the groups. A tendency to lower caries
increment was found in Group IV, i.e. in the children using the low fluoride dentifrice
and treated twice a year with fluoride varnish.
Caries Res. 1985;19(5):450-3.
Time dependence of F uptake in demineralized enamel from 1,000-ppm fluoride NaF and Na2FPO3 solutions.
A secondary ion mass spectrometric study.
Arends J, Schuthof J, Petersson L, Lodding A.
Abstract not available.
Scand J Dent Res. 1985 Aug;93(4):315-9.
Fluorine levels in in vitro remineralized enamel after treatment with 1000 ppm F as NaF, MFP or mixed
solutions.
Lodding A, Odelius H, Petersson L, Schuthof J, Arends J.
By means of secondary ion mass spectrometry (SIMS) an investigation has been made
of the F uptake and the transport of fluorine-carrying ions in artificially carious human
enamel after in vitro remineralization. The fluoridation was effected from solutions of
pure Na2FPO3 (MFP), pure NaF, or mixtures of MFP and NaF, always with a total F
content of 1000 atom-ppm. The recorded in depth profiles of F concentration show that,
after 14 days of remineralization, 1) neither the acquired F levels nor the F distributions
are greatly dependent on whether fluoridation is from NaF, MFP or mixtures, 2) the F
distribution shape is not strongly influenced by a 3-month storage followed by
remineralization, 3) the penetration of F beyond the lesion is generally deeper from NaF
than from MFP, and 4) the effect of long storage on penetration depth is mainly
noticeable for MFP-treated specimens.
Swed Dent J 1985;9(5):193-9
The effect of a jet abrasive instrument (Prophy Jet) on root surfaces.
Petersson LG, Hellden L, Jongebloed W, Arends J.
A Prophy Jet instrument was tested in order to analyze the abrasive effect and surface
alterations on human root cementum and dentine. Photomicrographs from scanning
electron microscopy (SEM) and a profilometer technique for depth analyses were used
for evaluation. The results of the experiments demonstrated that the Prophy Jet
technique had an abrasive effect reaching about 25 microns in depth after 30 seconds
treatment. The root surface, cementum as well as dentine also became rougher after
treatment judging from the SEM micrographs. Clinical advantages and disadvantages by
using the Prophy Jet instrument will be discussed. Further studies seems to be justified
concerning the jet abrasive technique.
Int J Oral Surg. 1985 Apr;14(2):200-13.
Autotransplantation of human premolars. A clinical and radiographic study of 100 teeth.
Kristerson L.
The purpose of the present study was to identify factors which might influence the
success of autotransplantation, such as root development, root resorption, pulp condition
and tooth eruption. The material consisted of 100 human premolars transplanted in 87
patients. The observation period ranged from 3-18 years, with a mean value 6.3 years.
Clinical and radiographic examinations were performed. The transplanted premolars
were divided into 7 stages of root development. At the final control, 93 teeth remained
and 7 teeth were extracted. Periodontal healing without root resorption was related to
stage of root development. It decreased from 93% in teeth with 3/4 root development to
37% in teeth with fully developed roots. Inflammatory root resorption was seen in 7
cases and replacement root resorption in 12 cases. Pulp revascularization was observed
in 100% in stages with initial root development to 1/2 root development and decreased
to 0% for teeth with fully developed roots. Pulp obliteration was observed in all cases
with revascularized pulp tissue. The gingival condition was similar to contralateral, not
transplanted premolars or adjacent teeth. Root growth increased with the stage of root
development at the time of transplantation. It is concluded that transplantation of
premolars with 1/2-3/4 root development provides a good chance of pulp survival,
limited risk of root resorption and ensures sufficient final root length, and is thus
recommended.
Swed Dent J 1984;8(4):203-7
Fluorine concentration in primary tooth enamel in 6-year-olds after 3 years of daily intake of fluoridecontaining tablets (Fludent).
Widenheim J, Petersson LG, Koch G.
The purpose of this study was to determine the posteruptive uptake of fluorine in
primary tooth enamel after daily consumption of a fluoride-containing sucking tablet for
three years. The material consisted of 17 children, who had been advised to suck on 1
NaF tablet (Fludent, 0.25 mg F) daily at bedtime from 3 to 6 years of age (test group),
and 17 children without tablet supply (control group). No other fluoride preparation was
used during the period. A chemical biopsy method, described by Koch et al. (1982), was
used to determine the fluorine concentration in enamel at the age of 6. Two consecutive
layers on the upper central primary incisors of each child were etched off by perchloric
acid. Chemical analysis of the test solutions was used to determine the thickness of the
enamel layers and the fluorine content. Statistical evaluations were performed by
analysis-of-variance. The results showed that fluorine was incorporated in primary tooth
enamel as a topical effect of the fluoride tablet intake. There was a statistically
significant difference (p less than 0.05) between the groups regarding fluorine measured
on the layers combined and in the out layer (approximately equal to 5 micron thick), but
not in the inner layer (approximately equal to 8 micron). It was concluded that the
posteruptively increased enamel fluorine concentration probably contributes to the
caries-preventive effect of NaF tablets.
J Clin Periodontol. 1984 Nov; 11(10): 689-99.
Evaluation of cause-related periodontal therapy and compliance with maintenance care recommendations.
Johansson LA, Oster B, Hamp SE.
An evaluation of the long-term clinical effects of an intense period of cause-related
periodontal therapy provided by dental hygiene students, was made in patients with
moderately advanced periodontitis. By the evaluation, we also intended to gain
information about compliance with given recommendations for periodontal health
maintenance. The results after 3 years without supervision by the specialist team showed
that achieved beneficial effects on the gingival conditions were maintained despite a
significant increase in plaque prevalence. Recommendations as to the daily use of a
variety of additional oral hygienic measures besides toothbrushing met with a
considerable lack of compliance. Maintenance visits to the referring general practitioner
were mostly made once a year and included regular dental care. Despite this, no further
deterioration of periodontal status was observed. The results indicate that it may be
possible to maintain successful effects of periodontal therapy in this patient category
with less personal and professional effort than traditionally recommended.
J Clin Periodontol. 1984 Oct; 11(9): 590-9.
Marginal bone height in adolescents participating in different preventive dental care programs.
Teiwik A, Johansson LA, Hamp SE.
A radiographic evaluation was made of the marginal bone height in youth, subject to
different preventive dental care regimens. A test group consisted of 14-15-year-olds who
for 4 years had received preventive dental care based on oral hygiene education,
professional tooth cleaning and topical fluorides and/or mouth rinsings every 3rd week.
A comparison group had been given solely fluoride mouth rinsings every 2nd week with
no particular emphasis on oral hygiene measures. The radiographic evaluation showed
average differences between the investigated groups of less than 0.3 mm in the distance
from the cementoenamel junction to the alveolar bone crest. In the mandibular premolarmolar region of the comparison group, the marginal bone height differed significantly
from the corresponding region in the test group. No such differences in the maxillary
regions were noted. The clinical relevance of the results is discussed.
Int J Oral Surg. 1984 Aug;13(4):324-33.
Autotransplantation and replantation of tooth germs in monkeys. Effect of damage to the dental follicle and
position of transplant in the alveolus.
Kristerson L, Andreasen JO.
The effect of damage to the follicle and of superficial positioning of tooth germs after
replantation or autotransplantation was studied in green Vervet monkeys. Radiographs
were taken immediately after surgery and 3, 6 and 9 months postoperatively, whereafter
the animals were sacrificed. The tissue blocks were sectioned in step serial sections
along a frontal plane and histologic and radiographic evaluation was made. Tooth germs
whose follicle was either damaged or removed showed no sign of eruption, while tooth
germs which were replanted with an intact follicle were fully erupted within 3 months.
Non-operated control teeth were fully erupted within 6 months. Histologic examination
revealed that roots of replanted teeth were only slightly shorter than the non-operated
control teeth. Transplantation of tooth germs in different positions in relation to the
alveolar crest showed that teeth placed in their original position attained an average
tooth length of 12.5 mm, whereas teeth placed in a semi-erupted position achieved an
average length of only 9.7 mm. A control group of non-operated incisors demonstrated
an average tooth length of 13.7 mm. This study indicates that damage to the follicle at
the time of replantation of tooth germs is of major importance for tooth eruption and that
placing tooth germs in a semi-erupted position adversely influences later root
development.
Int J Oral Surg. 1984 Aug;13(4):313-23.
Influence of root development on periodontal and pulpal healing after replantation of incisors in monkeys.
Kristerson L, Andreasen JO.
The influence of root development on periodontal and pulpal healing after replantation
was examined in 30 green vervet monkeys (Cercopithecus aethiops) in which a total of
50 teeth were replanted. Maxillary central incisors with different stages of root
development (immature, young mature and mature root formation) were replanted with
untreated pulps or after root canal treatment with gutta percha and Kerr sealer. The
extra-alveolar period in all groups was 18 min. The animals were sacrificed 8 weeks
after replantation and the teeth examined histologically. The following histologic
parameters were registered for each tooth: surface resorption, inflammatory resorption,
replacement resorption (ankylosis), downgrowth of pocket epithelium, periapical
inflammatory changes and extent of vital pulp. Histologic analysis showed that the
extent of vital pulp was significantly related to the stage of root development, being
almost complete in teeth with immature roots and almost totally lacking in young mature
and mature teeth. Surface resorption was found with the same frequency in the different
root development groups while inflammatory resorption was slightly more frequent in
young mature teeth than in mature teeth, a finding possibly related to a protective action
of a thick cementum layer in the mature teeth. Replacement resorption was found with
almost the same frequency in the different root development groups in nonendodontically treated teeth. As ankylosis is the most important factor determining the
prognosis of replanted and autotransplanted teeth, the present findings indicate that
replantation and autotransplantation of mature teeth could be of clinical use.
J Clin Periodontol. 1984 May; 11(5): 321-30.
Effect of combined systemic antimicrobial therapy and mechanical plaque control in patients with recurrent
periodontal disease.
Lundstrom A, Johansson LA, Hamp SE.
The aim of the present study was to analyze the effect of systemic antimicrobial therapy
and mechanical plaque control in patients with recurrent periodontal disease. 9 patients
volunteered for the combined therapy. At a baseline examination they were randomly
distributed into 2 groups, one given tetracycline therapy for 2 weeks and the other
metronidazole therapy for 1 week. A mechanical plaque control program comprising
oral hygiene training, professional cleaning of all teeth and subgingival debridement at
diseased sites was carried out at the baseline examination and at all recall visits, i.e. once
every month during the first 6 months and then after 9, 12, and 18 months. The results
demonstrated clinically and microbiologically that a combination of an initial
antimicrobial and a continuous systematic mechanical plaque control program may be a
valuable therapeutic approach in a strictly selected group of refractory patients.
Recurrent periodontal lesions which still displayed severe inflammation despite renewed
conventional therapy showed a marked reduction in probing depths, bleeding and
suppuration from the pockets, and further, a reduced presence of spirochetes and motile
rods during the trial. The results indicate that the level and longevity of success is also
related to whether or not self-performed oral hygiene measures are sufficiently carried
out. No superior effect of the combined program could be observed in cooperating
patients receiving tetracycline as compared with those given metronidazole.
Acta Odontol Scand. 1984 Apr; 42(2): 99-108.
Clinical effects of preventive regimens for young people in their early and middle teens in relation to previous
experience with dental prevention.
Hamp SE, Johansson LA, Karlsson R.
The clinical effects of different preventive regimens provided for young people in their
early and middle teens were studied during a 2-year period. The regimens studied during
the 1st year of the trial were professional tooth-cleaning plus fluoride mouth-rinsing
every 3rd week versus fluoride varnish treatment every 6 months. During the 2nd year,
the preventive measures were given in accordance with the estimated needs of each
individual. The results were related to the individuals' previous experience with dental
prevention to determine whether this had a significant influence. The results showed that
fairly good or excellent effects on the individuals' oral hygiene and gingival status were
readily achieved and maintained with a professional tooth-cleaning plus fluoride mouthrinsing regimen. The study failed to demonstrate any superior caries-preventive effect of
the fluoride varnish treatments. Subsequent individualized prevention produced similar
average end results in all groups. Differences in the results in accordance with the
individuals' previous experience with dental prevention indicate a superior and
prolonged influence on dental health of professional tooth-cleaning plus fluoride mouthrinsing in comparison with a fluoride-based program alone.
Swed Dent J 1983;7(2):69-75
Kinetics of fluorine in deciduous enamel after application of fluoride-containing varnish (Duraphat). II. A
statistical approach to the design and evaluation of a clinical experiment.
Gleerup A, Koch G, Petersson LG.
The aim of this report is to discuss the design and technique for evaluation of an in vivo
experiment on the kinetics of fluorine in deciduous enamel after application of fluorinecontaining varnish (Duraphat). The analysis of variance technique used in the analysis of
the results of the experiments is described in more detail than in the preceding report.
The figure technique used in this report series is described. The method error study
performed before carrying out the main experiment is analysed. A brief discussion
follows about the consequences that different method errors have on the design of the
experiment. The conclusion is that analysis of variance is a more reliable tool than
multiple t-test, when evaluation of experiments is to be carried out.
Int J Oral Surg. 1983 Aug;12(4):239-49.
The effect of splinting upon periodontal and pulpal healing after autotransplantation of mature and immature
permanent incisors in monkeys.
Kristerson L, Andreasen JO.
The effect of splinting upon periodontal and pulpal healing after autotransplantation of
teeth with complete and incomplete root formation was studied in 16 green Vervet
monkeys (Cercopithecus aethiops). 2 maxillary incisors were extracted in each monkey
and autotransplanted to the contralateral socket. One of these teeth was stabilized with
an acrylic splint for either 2 or 6 weeks, while the other incisor was non-splinted. The
animals were sacrificed 8 weeks after autotransplantation and the autotransplanted teeth
were examined histologically. The following histologic parameters were registered for
each tooth: surface resorption, inflammatory resorption, replacement resorption
(ankylosis), downgrowth of pocket epithelium, periapical inflammatory changes and
extent of pulp necrosis. The histometric analysis demonstrated that splinting increased
the extent of pulp necrosis and inflammatory root resorption compared to non-splinting.
Furthermore, the extent of normal periodontium was decreased among the splinted teeth,
when compared to the non-splinted teeth. It is concluded that splinting not only failed to
improve healing but apparently exerted a harmful effect upon periodontal and pulpal
healing after autotransplantation.
Tidsskr Tandlaeger. 1982 Jun;2(3):7-14.
[Autotransplantation of teeth: a clinical treatment method]
[Article in Danish]
Kristerson L, Kvint S.
Community Dent Oral Epidemiol 1982 Apr;10(2):55-9
Caries increment in primary teeth after application of Duraphat fluoride varnish.
Grodzka K, Augustyniak L, Budny J, Czarnocka K, Janicha J, Mlosek K, Moszczenska B, Szpringer M,
Wacinska M, Petersson L, Frostell G.
In order to evaluate the possible cariostatic effect of a fluoride varnish in the primary
dentition, Duraphat varnish was applied twice yearly for 2 years to the teeth of 195 3
1/2-year-old children of both sexes attending nine preparatory schools in the Warsaw
area. A control group of 127 children attending nine other preparatory schools was also
examined. For each child a dmfs1 index (including "caries without macroscopic defect")
and a dmfs2 index ("caries without macroscopic defect" excluded) were determined as
well as a dmft1 and a dmft2 index. After 2 years the difference between the test and the
control groups regarding the mean dmfs1 and dmft2 index increments was 9.39% (P
greater than 0.1) and 24.09% (P less than 0.05), respectively. No significant differences
were found, however, concerning the dmft2 and dmfs2 indices, the percentage children
with new gingival caries, the number of teeth extracted on account of caries and the
number of remaining teeth. A test group of 46 children treated with fluoride varnish in
which a complete radiological examination could be carried out before and after the
experimental period and which was treated with fluoride varnish was compared with a
similar group of 27 children, which was not treated with fluoride varnish. The
differences in caries increments were small, less than 15%, and were not significant.
Taking into consideration the great variation between the schools it was concluded that
the cariostatic effect of Duraphat application twice yearly in the primary dentition of
these children was slight.
J Periodontal Res. 1982 Mar; 17(2): 122-30.
Bacteroides gingivalis antigens and bone resorbing activity in root surface fractions of periodontally involved
teeth.
Patters MR, Landesberg RL, Johansson LA, Trummel CL, Robertson PB.
Swed Dent J 1982;6(3):117-20
Inhibiting effect on demineralization of permanent root surfaces after different topical application of fluorides
and a solution containing Fe- and Al-ions.
Derand T, Petersson LG.
Fifteen roots were used in this study to compare different topical fluoride compounds on
the inhibiting effect of artificial root surface carious lesions. A 2% NaF-solution,
Duraphat and a test solution-containing Fe+3, Al+3 with and without fluoride were
tested. The results indicated that only the test solution independent of fluoride was able
to increase acid resistance. No differences could be observed between the controls and
the surfaces treated with the other fluoride agents. The test solution thus seem to be
applicable against root surface caries.
Swed Dent J 1982;6(6):233-8
Effect of 250 and 1000 ppm fluoride dentifrice on caries. A three-year clinical study.
Koch G, Petersson LG, Kling E, Kling L.
In a 3-year clinical trial, the caries prophylactic effect of two dentifrices containing 1000
ppm F and one containing 250 ppm F was compared. 541 twelve and thirteen-year-old
children took part in the study. The children were randomly divided into three groups.
Each group of children and their families used one of the dentifrices daily at home. The
children were examined for caries at the start of the study and again after an interval of
one year. The caries increment was equal in the three groups during the experimental
period. This indicates that a 250 ppm F dentifrice has the same caries preventive effect
as a 1000 ppm F dentifrice.
Swed Dent J 1982;6(1):39-44
Kinetics of fluorine in deciduous enamel after application of fluoride-containing varnish (Duraphat).
Koch G, Petersson LG, Gleerup A, Lowstedt E.
The fluorine concentration in tooth enamel was determined in vivo after one single
application of Duraphat fluoride varnish from 24 hours up to six months after treatment.
A micro-acid-drop technique was used in 68 clinically intact deciduous upper central
incisors in 34 pre-school children 4-5 years of age to determined the fluoride
concentration in the enamel. The experimental data from the biopsy procedures were
analysed by means of analysis of variance. The application of fluoride varnish results in
an increase in fluoride in surface as well as subsurface enamel 24 hours after treatment.
Thereafter a releasing process of fluorine from the enamel seems to start. Therefore the
results indicate that there might be a caries inhibiting effect of fluoride varnish in
primary enamel based more upon the kinetics of fluorine rather than a permanent uptake.
J Clin Periodontol. 1982 Jan; 9(1): 22-34.
Dental prophylaxis for youths in their late teens. I. Clinical effect of different preventive regimes on oral
hygiene, gingivitis and dental caries.
Hamp SE, Johansson LA.
Swed Dent J 1981;5(5-6):219-23
Development of artificial carious lesions in enamel after F-varnish (Duraphat) and F-Fe-Al-solution
treatment.
Petersson LG, Derand T.
An acidified gel system was used to study the development of initial enamel lesions
using a test solution containing fluoride in combination with iron and aluminium ions
compared to a fluoride varnish (Duraphat). The experiments were performed on both
permanent and deciduous teeth. The results showed that the fluoride varnish was
superior in retarding the development of initial enamel lesions compared to the test
solution. The expected positive effect of trace elements in combination with fluorine
could be demonstrated in this experiment. Deciduous enamel showed less acid resistance
than permanent enamel under similar experimental conditions.
J Endod. 1981 Aug;7(8):349-54.
The effect of extra-alveolar root filling with calcium hydroxide on periodontal healing after replantation of
permanent incisors in monkeys.
Andreasen JO, Kristerson L.
Tandlakartidningen. 1981 Jun 1;73(11):598-606.
[Autotransplantation of teeth--a 10-year experience]
[Article in Swedish]
Kristerson L, Kvint S.
Int J Oral Surg. 1981 Jun;10(3):189-201.
Evaluation of different types of autotransplanted connective tissues as potential periodontal ligament
substitutes. An experimental replantation study in monkeys.
Andreasen JO, Kristerson L.
The purpose of the present study was to investigate connective tissue autotransplants as
potential periodontal ligament substitutes. Green Vervet monkeys (Cercopithecus
aethiops) were used. Maxillary permanent central incisors were extracted, root filled
extraorally and the periodontal ligament removed from the root surface and the socket
wall. Two circular cavities were prepared mesially and distally on the root surface.
Different types of connective tissue autotransplants were then placed in these cavities,
whereafter the teeth were replanted. The animals were sacrificed 8 weeks after
replantation and the replanted teeth were examined histometrically. The connective
tissue autotransplants were then examined for their capability of preventing root
resorption or inducing or forming a new periodontal ligament, including periodontal
fibers and cementum. Autotransplanted cutaneous and mucosal connective tissue as well
as periosteum and fascia were all found to partially prevent ankylosis by forming a
fibrous barrier between the root surface and the alveolus. However, no new cementum
was formed. Periodontal ligament transplants, dental follicular tissue and possibly
gingival connective tissue were the only tissues capable of both preventing ankylosis and
forming a hard tissue on the surface of the cavity with a morphology similar to
cementum. It is concluded that cementogenesis requires a highly specialized connective
tissue. In this experiment, only odontogenic tissues had this capacity.
Int J Oral Surg. 1981 Apr;10(2):128-36.
Repair processes in the cervical region of replanted and transplanted teeth in monkeys.
Andreasen JO, Kristerson L.
The repair processes in the cervical region of replanted teeth where the periodontal
ligament was injured by either extensive drying or removal was studied. These repair
processes were related to various clinical factors, such as splinting, traumatic occlusion
and exactness of repositioning. Permanent incisors were extracted, root filled extraorally
and allotted to the following experimental groups: (1) PDL injured by drying, no
splinting; (2) PDL injured by drying, splinting for 2 weeks; (3) PDL injured by drying,
replanted tooth in traumatic occlusion; (4) PDL injured by drying, no splinting, nonexact repositioning of the replanted tooth; (5) PDL removed, no splinting. The animals
were sacrificed 8 weeks after replantation and the replanted teeth examined
histometrically. The different groups demonstrated area with normal periodontal
ligament extending from 0.4 to 1 mm apically from the crestal margin, where the
greatest extent was found in teeth with non-exact repositioning. The possible role of the
gingiva in these repair processes is discussed.
Acta Odontol Scand. 1981;39(1):1-13.
The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of
mature permanent incisors in monkeys.
Andreasen JO, Kristerson L.
The effect of limited drying or removal of the periodontal ligament upon periodontal
healing after replantation of incisors was studied in green Vervet monkeys. All teeth
were examined histologically either 2-, 4- or 8 weeks after replantation. The drying
experiment demonstrated that an area of ankylosis was established after 2 weeks
corresponding to the dried portion of the root and was removed by a resorptive process
in the majority of cases after 8 weeks. The removal of the periodontal ligament led to
development of surface-, inflammatory- and replacement resorption. Furthermore, 1
mm2 and 4 mm2 lesions on the root surface developed transient ankylosis which
disappeared after 8 weeks while lesions of 9 mm2 or 16 mm2 in size resulted in an
ankylosis which, in most cases, persisted after 8 weeks. Based on these findings, it is
postulated that physical removal or extended drying of the periodontal ligament initiates
a rapid osteogenesis in the alveolus which establishes an ankylosis. If the damaged area
is placed next to a zone on the root surface with a vital periodontal ligament, a later
resorptive process is established from this zone, whereby the ankylosis area is gradually
resorbed. It is estimated that the extent of this process in this experiment amounted to
possibly 1 -- 1.5 mm.
Publications Maxillofacial Unit Halmstad
German
Signature 1997, Band 2;No 1 8-11.
Antibakterieller Lack: Die moderne Kariesprävention.
Lars G. Petersson, DDS, PhD.
Bei Patienten mit Kariesrisiko soll ein antibakterieller Lack (Cervitec, Vivadent, Schaan,
Liechtenstein) in erster Linie die kariesverursachenden Mikroorganismen auf Wurzelund Schmelzflächen reduzieren und eliminieren. Dank seiner einfachen Anwendung ist
dieser antibakterielle Lack für die regelmäßige Behandlung zur Bekämpfung der
kariesassoziierten Mikroorganismen und bakteriellen Beläge in der Mundhöhle und für
die Verhütung der Wurzel- und Schmelzkaries im Frühstadium geeignet. Der Lack kann
an den verschiedenen Stellen, an denen sich Plaque anlagert, aufgetragen werden, um
kariogene Prozesse zu kontrollieren und gleichzeitig die professionelle Prophylaxe und
Fluoridbehandlung zu unterstützen. Es ist zu erwarten, dass die regelmäßige Behandlung
mit dem Lack für viele Patienten von Nutzen sein wird.
Publications Maxillofacial Unit Halmstad
Swedish
Tandläkartidningen 2003;11:42-48
Motbitningens inverkan på implantatöverlevnad i överkäken.
Abrahamsson P, Becktor J, Isaksson S, Blomqvist JE.
Käkbensförankrade implantat är i dag en accepterad och flitigt använd
behandlingsmetod som i många fall uppvisar en god lyckandefrekvens. De flesta
implantatförluster som trots allt sker uppstår under inläkningsfasen. Därför är det viktigt
att se till att implantaten får läka in i en stressfri miljö. Målet med studien var att se hur
underkäkens motbitning inverkar på implantatöverlevnaden i den tandlösa överkäken
under inläkningstiden. 178 patienter delades in i fyra grupper efter motbitningens
utseende: grupp 1 med 0-1 ocklusala enheter, grupp 2 med 2-3 ocklusala enheter, grupp
3 med minst två bilaterala ocklusala enheter och grupp 4 med unilaterala ocklusala
enheter. Grupperna jämfördes sedan med avseende på implantatöverlevnaden i
överkäken. Resultatet visar att det förekom flest implantatförluster i grupp 4: gruppen
med unilaterala ocklusala enheter. Studien antyder även att ocklusion och funktion är
faktorer som är viktiga att beakta. Författarna efterlyser fler prospektiva studier som kan
ge svar på hur ocklusion och funktion påverkar inläkningen av implantaten och hur en
behandling ska planeras för att få ett säkrare resultat.
Svensk Sjukhustandläkartidning 2002;27(4):22-5.
Opportunistisk munflora hos sjukhustandvårdspersonal.
Laurizohn C.
Abstract saknas.
Tandläkartidningen 1996;18:1107
Rekonstruktionsmetoder vid svåra resorptionsdefekter.
Sten Isaksson, Stefan Lundgren och Bo Rosenquist
Avancerade rekonstruktionsmetoder används i allt större omfattning för att återskapa
normala anatomiska förhållanden vid svåra resorptionsdefekter i käkarna.
Bentransplantat kombinerade med titanimplantat kan därvid ge mycket goda estetiska
och funktionella resultat, i underkäken ibland efter förflyttning av n alveolaris inferior.
Svensk Sjukhustandläkartidning 1995;20(2):30-2.
Bro i svalget – undersköterska anmäld till hälso- och sjukvårdens ansvarsnämnd.
Laurizohn C.
Abstracts saknas.
Svensk Sjukhustandläkartidning 1993;18(4):22-4.
SOMS-möte i Hook.
Laurizohn C.
Abstract saknas.
Tandläkartidningen 1993;13:745
Fluorrutiner inom landstingens allmäntandvård.
Bo Bjerner, Per Axelsson, Arne Halling, Lars G Petersson och Göran Solén
Fluorrutinerna inom landstingens allmäntandvård analyseras fortlöpande internt inom
respektive huvudmannaområde. Den förbättrade tandhälsan har inneburit att
fluorrutinerna ändrats i ett flertal avseenden under senare år. Det finns anledning att
ifrågasätta en del av dessa förändringar. I denna artikel redovisas fluorrutinerna inom
landstingens allmäntandvård 1992. Samtliga huvudmannaområden har kartlagts – ett
arbete med många intressanta resultat.
Svensk Sjukhustandläkartidning 1992;16(3):34-45.
Råd till dig som föreläsare för sjukvårdspersonal.
Bokesson-Lagerqvist B, Laurizohn C.
Abstract saknas.
Svensk Sjukhustandläkartidning 1991;16(1):34-7.
Blödningsriskpatienter – information och behandlingsrekommendationer.
Laurizohn C.
Abstract saknas.
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Spiechowicz E, Glantz P-O, Axéll T, Chmielewski W. Oral exposure to a nickel-containing dental alloy of
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Axéll T, Holmstrup P, Kramer IRH, Pindborg JJ, Shear M. International seminar on oral leukoplakia and
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Henricsson V, Axéll T. Treatment of recurrent aphthous ulcers with AureomycinR mouth rinse or ZendiumR
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Axéll T, Simonsson T, Birkhed D, Rosenborg J, Edwardsson S. Evaluation of a simplified diagnostic aid (OricultNR) for detection of oral candidosis. Scand J Dental Res 1985;93:52-5.
Axéll T, Henricsson V. The occurence of recurrent aphthous ulcers in an adult Swedish population. Acta
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Axéll T, Henricsson V. Association between recurrent aphthous ulcers and tobacco habits. Scand J Dent Res
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Könsberg R, Thufvesson K, Axéll T. Evaluation of an index for assessing plaque and mucosa in the oral cavity
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1985;10:3-10.
Ekfeldt A, Floystrand F, Olio G. Replica techniques for in vivo studies of tooth surfaces and prosthetic
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Axéll T, Spiechowicz E, Glantz P-O, Andersson G, Larsson, Å. A new method for intraoral patch testing. Contact
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Matsson L, Klinge B, Hallstrom H. Effect on periodontal healing of saline irrigation of the tooth socket before
replantation. Endod Dent Traumatol. 1987 Apr;3(2):64-7.
Axéll T, Rundquist L. Oral lichen planus - a demographic study. Community Dent Oral Epidemiol 1987;15:52-6.
Axéll T. Occurrence of leukoplakia and some other oral white lesions among 20 333 adult Swedish people.
Community Dent Oral Epidemiol 1987;15:46-51.
Ekfeldt A, Oilo G. Occlusal contact wear of prosthodontic materials. An in vivo study. Acta Odontol Scand.
1988 Jun;46(3):159-69.
el Ghazali S, Glantz PO, Randow K. On the clinical deformation of maxillary complete dentures. Influence of
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Hugoson A, Bergendal T, Ekfeldt A, Helkimo M. Prevalence and severity of incisal and occlusal tooth wear in an
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Mörnstad H, Axéll T, Sundström B. Clinical picture of snuff dipper's lesion in Swedes. Community Dent Oral
Epidemiol
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Axéll T, Budtz-Jørgensen E, Oksala E, Olsen I, Skoglund LA. Treatment of oral candidiasis. (In Norwegian with
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Axéll T. Registration procedures and exchange of data in the Sjögren's syndrome research team with special
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Andersson G, Larsson Å, Axéll T. Histologic changes associated with the use of loose and portion-bag packed
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el Ghazali S, Glantz PO, Strandman E, Randow K. On the clinical deformation of maxillary complete dentures.
Influence of denture-base design and shape of denture-bearing tissue. Acta Odontol Scand. 1989 Apr;47(2):6976.
Axéll T, Anderberg U, Priwe C, Scheutz F. Dental care of HIV-infected patients: attitudes and behavior among
Swedish dentists. Tandläkartidn (In Swedish) 1989;81:1308-14
Ekfeldt A. Incisal and occlusal tooth wear and wear of some prosthodontic materials. An epidemiological and
clinical study. Swed Dent J Suppl. 1989;65:1-62.
Ekfeldt A, Oilo G. Wear mechanisms of resin and porcelain deture teeth. Acta Odontol Scand. 1989
Dec;47(6):391-9.
Axéll T, Liedholm R. Occurrence of recurrent herpes labialis in an adult Swedish population. Acta Odontol
Scand 1990;48:119-23
Axéll T, Zain RB, Siwamogstham P, Tantiniran D, Thampipit J. Prevalence of oral soft tissue lesions in outpatients at two Malaysian and Thai dental schools. Community Dent Oral Epidemiol 1990;18:95-9
Björnström M, Axéll T, Birkhed D. Comparison between saliva stimulants and saliva substitutes in patients
with dry mouth. A multicentre study. Swed Dent J 1990;14:153-61
Holmstrup P, Axéll T. Classification and clinical manifestations of oral yeast infections. Acta Odontol Scand
1990;48:57-9
Henricsson V, Svensson A, Axéll T. Evaluation of some electrical methods for objective assessment of oral
mucosal dryness. Scand J Dent Res 1990;98:520-8
Henricsson V, Svensson A, Axéll T, Olsson H. Evaluation of a new device for measuring oral mucosal surface
friction Scand J Dent Res 1990;98:529-36
Andersson G, Axéll T, Larsson Å. Impact of consumption factors on soft tissue changes in Swedish moist snuff
users: a histologic study. J Oral Pathol Med 1990;19:453-8
Hedin CA, Axéll. Oral melanin pigmentation in 467 Thai and Malaysian people with special emphasis on
smoker's melanosis. J Oral Pathol Med 1991;20:8-12
Carlsson A, Olsson H, Axéll T, Lodén M, Bogentoft C. A novel in situ gelling system for drug delivery. 3.
Biological aspects. Proceed Intern Symp Control Rel Bioact Mater 1991;18
Henricsson V, Svensson A, Axéll T. Evaluation of an infrared light absorption method for objective assessment
of oral mucosal dryness. Acta Odontol Scand 1991; 49: 219-23
Larsson Å, Axéll T, Andersson G. Reversibility of snuff dipper´s lesion in Swedish moist snuff users: a clinical
and histologic follow-up study. J Oral Pathol Med 1991; 20: 258-64
Olsson H, Axéll T. Objective and subjective efficacy of saliva substitutes containing mucin and
carboxymethylcellulose. Scand J Dent Res 1991; 99: 316-9
Andersson G, Axéll T, Larsson Å. Clinical classification of Swedish snuff dipper's lesions supported by
histology. J Oral Pathol Med 1991; 20: 253-7
Olsson H, Spak C-J, Axéll. The effect of a chewing gum on salivary secretion, oral mucosal friction, and the
feeling of dry mouth in xerostomic patients. Acta Odontol Scand 1991; 49: 273-9
Hedin CA, Axéll T. Oral melanin pigmentation in 467 Thai and Malaysian people with special reference on
smoker's melanosis. J Oral Pathol Med 1991; 1991: 8-12
Olsson H, Henricsson V, Axéll T. A new device for measuring oral mucosal friction - reference values. Scand J
Dent Res 1991; 99: 329-32
Lodén M, Olsson H, Skare L, Axéll T. Instrumental and sensory evaluation of the frictional response of the skin
following a single application of five moisturizing creams. J Soc Cosm Chem 1992; 43: 13-20
Axéll T. The oral mucosa as a mirror of general health or disease. Scand J Dent Res 1992; 100: 6-16
Lodén M, Olsson H, Axéll T, Linde YW. Friction, capacitance and transepi- dermal water loss (TEWL) in dry
atopic and normal skin. Br J Dermatol 1992; 126: 137-41
Sandberg-Wollheim M, Axéll T, Hansen BU, Henricsson V, Ingesson E, Jacobsson L, Larsson Å, Lieberkind K,
Manthorpe R. Primary Sjögren's syndrome in patients with multiple sclerosis. Neurology 1992; 42: 845-7
Axéll T, Andersson, Larsson Å. Oral mucosal findings associated with chewing tobacco in Sweden - a clinical
and histological study. J Dent Assoc S Afr 1992; 47: 194-6
Pameijer CH, Hulten J, Glantz PO, Randow K. Influense of low-viscosity liners on the retention of three luting
materials. Int J Periodontics Restorative Dent. 1992;12(3):195-205.
Axéll T, Anderberg U. Blood infection - attidudes, knowledge and behavior among Swedish dentists. (In
Swedish). Tandläkartidn 1993; 85: 4-8
Olsson H, Axéll T, Carlsson A, Bogentoft C. Objective and subjective efficacy of various polymerbased saliva
substitutes. Scand J Dent Res 1993; 101: 37-9
Williams D, Axéll T, Azul A et al. Classification and diagnostic criteria for oral lesions in HIV infection. J Oral
Pathol Med. 1993; 22: 289-91
Axéll T. Oral mucosal changes related to smokeless tobacco usage: Research findings in Scandinavia. Oral
Oncology. Eur J Cancer 1993; 29B: 299-302
Axéll T, Johansson K. Oral health in a Tanzanian village. Trop Dent J 1993; 16: 15-20
Hedin A, Pindborg JJ, Axéll T. Disappearance of smoker's melanosis after reducing smoking. J Oral Pathol Med
1993; 22: 228-30
Glantz PO, Ranger B, Svensson A, Stafford GD, Arnvidarson B, Randow K, Linden U, Hulten J. On clinical
loading of osseointegrated implants. A methodological and clinical study. Clin Oral Implants Res. 1993
Jun;4(2):99-105.
Randow K, Derand T. On functional strain in some fixed and removable partial dentures. An experimental in
vitro study. Acto Odontol Scand. 1993 Jun;51(3):153-9.
Randow K, Derand T. On functional strain in fixed and removable partial dentures. An experimental in vivo
study. Acta Odontol Scand 1993 Dec; 51(6):333-8.
Manthorpe R, Kirtava Z, Axéll T, Henricsson V, Tabery H, Jacobsson L. Clinical and demographic data at the
time of diagnosis for primary Sjögren's syndrome. Proceed IVth Intnl Symp on SS. State of the Art 1994 pp. 3679
Könsberg R, Axéll T. Treatment of Candida-infected denture stomatitis with a miconazole lacquer. Oral Surg
Oral Med Oral Pathol 1994; 78: 306-11
Eriksson I, Randow K, Glantz PO, Lindhe J, Nilner K. Clinical and radiographical features of submerged and
nonsubmerged titanium implants. Clin Oral Implants Res. 1994 Sep; 5(3):185-9.
Pinheiro Fernandes C, Randow K, Svensson A. The influence of the palatal major conccector on the rigidity of a
conical crown retained denture. Eur J Prosthodont Restor Dent. 1994 Dec;3(2):73-7.
Klinge B, Johansson C, Albrektsson T, Hallstrom H, Engdahl T. An new method to obtain bone biopsies at
implant sites peri-operatively: technique and bone structure. Clin Oral Omplants Res. 1995 Jun; 6(2):91-5.
Ikeda N, Handa Y, Khim SP, Durward C, Axéll T, Mizuno T, Fukano H,
Kawai T. Prevalence study of oral mucosal lesions in a selected Cambodian population. Community Dent Oral
Epidemiol 1995; 23: 49-54
Andersson G, Axéll T, Curwall M. Reduction in nicotine intake and oral mucosal changes among users of
Swedish oral moist snuff after switching to a low-nicotine product. J Oral Pahtol Med 1995; 24: 244-50
Olsson H, Henricsson V, Svensson A, Axéll T. Evaluation of in vitro properties of films of saliva substitutes in
contact with different surfaces. A comparative study with instruments for measurements of friction an
rheologic properties. Acta Odontol Scand 1995; 53: 334-8
Hallstrom H. [ Sulfite in food—a risk to health? Hypersensitivity was noticed in patients with asthma]
Lakartidningen. 1995 Jan 25; 92(4). Swedish.
Blomgren J, Axéll T, Sandahl O, Jontell M. Adverse reactions in the oral mucosa associated with anterior
composite restorations. J Oral Pathol Med 1996; 25: 311-3.
Zain RB, Razak IA, Ikeda N, Axéll T, Downer MC. Training examiners for a national epidemiological survey of
oral mucosal lesions. Int Dent J 1996; 46: 536-42.
Zain RB, Ikeda N, Razak IA, Axéll T, Majid ZA, Gupta PC, Yacoob M. A national epidemiologic survey of oral
mucosal lesions in Malaysia. Community Dent Oral Epidemiol 1997; 25: 377-83.
Zain RB, Gupta PC, Warnakulasuriya S, Shrestha P, Ikeda N, Axéll T. Oral lesions associated with betel quid and
tobacco chewing habits. Meeting report. Oral Diseases 1997; 3: 204-5.
Axéll T, Samaranayake LP, Reichart P, Olsen I. A proposal for reclassification of oral candidosis. Guest
editorial. Oral Surg Oral Med Oral Pathol 1997; 84: 111-2.
Jensen JL, Uhlig T, Kvien TK, Axéll T. Characteristics of rheumatoid arthritis patients with self-reported sicca
symptoms: evaluation of medical, salivary and oral parameters. Oral Diseases 1997; 3: 254-61.
Jensen JL, Bergem HO, Gilboe I-M, Husby G, Axéll T. Oral and ocular sicca symptoms and findings are
prevalent in systemic lupus erythematosus. J Pathol Med 1999; 28: 217-22.
Uhlig T, Kvien TK, Jensen JL, Axéll T. Sicca symptoms, saliva and tear production, and disease variables in
636 patients with rheumatoid arthritis. Ann Rheum Dis 1999; 58: 415-22.
Henriksen BM, Ambjørnsen E, Axéll TE. Evaluation of a mucosal-plaque index (MPS) designed to assess oral
care in groups of elderly. Spec Care Dent 1999; 19: 154-7.
Spiechowicz E, Glantz PO, Axell T, Grochowski P. A long-term follow-up of allergy to nickel among fixed
prostheses wearers. Eur J Prosthodont Restor Dent 1999; 7: 41-4.
Aase S, Koppang HS, Solheim T, Kjærheim Å. Axéll T, Storhaug K, Refsum S. Crohns sykdom i munnhulen,
belyst med noen kasuistikker. Tidskr Nor Lægeforen 2001; 121: 2489-91; Nor Tannlegeforen Tid 2001; 111: 87880.
Paulsson G, Soderfeldt B, Nederfors T, Fridlund B. The effect of an oral health education program after three
years. Spec Care Dentist. 2003;23(2):63-9.
Ullbro C, Crossner CG, Nederfors T, Alfadley A, Thestrup-Pedersen K. Dermatologic and oral findings in a
cohort of 47 patients with Papillon-Lefevre syndrome. J Am Acad Dermatol. 2003 Mar;48(3):345-51.
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Antibacterial effects of human salivary lysozyme with special reference to Streptococcus mutans.
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