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  • 1. Gerdin, EW
    et al.
    Angbratt, M
    Aronsson, K
    Eriksson, E
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Dental caries and body mass index by socio-economic status in Swedish children2008In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 36, no 5, p. 459-465Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the present study was to evaluate the association between dental caries, childhood body mass index (BMI), and socioeconomic status in Swedish children. Methods: The study cohort consisted of 2303 10-year-old children with data on socioeconomic status, BMI at 4, 5, 7 and 10 years of age, and caries at 6, 10 and 12 years of age. Anthropometric measures were carried out by trained nurses according to standardized routines. The occurrence of caries was registered from county records, and the children were classified into one of five socioeconomic clusters based on their census registration address. Results: Caries prevalence decreased with increasing socioeconomic status at all ages, whereas childhood BMI and proportion of overweight/obese children were unrelated to socioeconomic status. Obese, but not overweight, children had more caries affected teeth than non-obese, and BMI had an independent, though weak, effect on caries variation in multiple regression. Interestingly, overweight/obese 4-year-olds, who had normal body weight at 5, 7 and 10 years of age, had significantly less caries than children who had normal body weight from 4 to 10 years of age. Conclusions: Overweight and caries prevalence are significantly associated in Swedish children. However, the association is weak. Nevertheless, the concept that child dental services and child welfare services can benefit from joint programs is supported.

  • 2. Haworth, Simon
    et al.
    Shungin, Dmitry
    Kwak, So Young
    Kim, Hae-Young
    West, Nicola X
    Thomas, Steven J
    Franks, Paul W
    Timpson, Nicholas J
    Shin, Min-Jeong
    Johansson, Ingegerd
    Tooth loss is a complex measure of oral disease: Determinants and methodological considerations.2018In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.

    METHODS: An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years.

    RESULTS: In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).

    CONCLUSIONS: Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.

  • 3.
    Johansson, Ingegerd
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Tidehag, P
    Lundberg, V
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Dental status, diet and cardiovascular risk factors in middle-aged people in northern Sweden.1994In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 22, no 6, p. 431-436Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to compare the dietary intake and the levels of traditional cardiovascular (CVD) risk factors in edentulous middle-aged individuals and individuals of the same age and sex who still had natural teeth. The study was performed within the framework of the MONICA-project. Population registers were used to sample randomly 1287 men and 1330 women aged 25-64 yr. Data were collected from a mailed questionnaire, blood analyses, registrations of blood pressure and anthropometric measures. The estimated daily energy intake did not differ between the two groups, but edentulous men and women ate more sweet snacks compared to those who still had teeth. Edentulous men also ate less fruits, vegetables and fibre and edentulous women ate more fat than dentates. Edentulous men and women were more obese and had lower serum HDL-cholesterol concentrations than those with remaining teeth. Edentulous women also had significantly higher concentrations of total cholesterol and triglycerides in serum than dentate women. Edentulous men and women were more often regular smokers, but not snuff users, than dentates of the same age and sex. Thus, the presence of two or more cardiovascular risk factors was more common in edentulous individuals than in those who still had natural teeth. In summary, these results support the hypothesis that edentulous middle-aged individuals have a more unfavourable risk factor profile for CVD. Counselling on balanced dietary habits and non-smoking given by dental personnel to orally diseased patients--recommendations given to improve resistance to dental caries or periodontitis--might therefore improve general health and possibly also improve risk factors for CVD.

  • 4. Larsson, B
    et al.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ericson, T
    Relationship between dental caries and risk factors for atherosclerosis in Swedish adolescents?1995In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 23, no 4, p. 205-210Article in journal (Refereed)
    Abstract [en]

    In an earlier study on a selected group of adolescents with high caries prevalence we found dietary habits that resembled those considered to promote the development of atherosclerosis. In the present study we have compared DMF-score with factors traditionally associated with the risk for development cardiovascular diseases (CVD). All 15-yr-olds living in an urban community in Northern Sweden 1987-1989 were included. Medical variables related to the risk of developing CVD were evaluated in groups of adolescents with various levels of manifest caries expressed as decayed and filled surfaces (DFS). The proportion of individuals with no medical risk factor at an unfavorable level was significantly higher in a caries free than in a high-caries (DFS > or = 9) group. Adolescents with two or more medical factors reaching unfavorable levels had a significantly higher caries score than the group with no factor at unfavorable level. A significant positive correlation was found for the whole group between DFS-score and relative body weight (body mass index) in an univariate correlation test as well as multiple linear regression analysis. The hypothesis that high caries score can be an indicator for unfavorable levels of traditional risk factors for CVD is not contradicted by the results in the present study but supported by the observed covariation with BMI. We therefore suggest that dietary counseling to adolescents with a high caries score in combination with a moderate obesity can be of advantage in reducing the caries risk as well as the risk for development of CVD at higher ages.

  • 5.
    Oscarson, Nils
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Odontology.
    Källestål, Carina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Odontology.
    Fjelddahl, Anna
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Cost-effectiveness of different caries preventive measures in a high-risk population of Swedish adolescents2003In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 31, no 3, p. 169-178Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: A total of 3373 12-year-olds agreed to participate in an intervention study evaluating different caries preventive measures. The study, titled 'Evaluation of caries preventive measures', was performed between 1995 and 1999 at 26 dental health clinics throughout Sweden. At the start of the study, the subjects were classified as individuals at high or low risk of developing caries. The high-risk group consisted of 1165 subjects. The children in the high-risk group were randomly assigned to one of four preventive programs. The programs represent a step-wise increase in fluoride content, contact with dental personnel and cost. The aim of the present cost-effectiveness analysis (CEA) study performed from a societal perspective is to compare costs and consequences of caries preventive programs in a caries high-risk population. By 'costs' is meant both treatment costs and costs contributed by the patient and the patient's family. Costs contributed by patients and their families consist of out-of-pocket expenses, transportation costs, and time. Conclusions are that it is important to consider the perspective from which a study is carried out. Costs contributed by the patient and the patient's family have a high impact on total costs for children and younger adolescents but decrease with time as the adolescents get older. The present study shows an incremental cost-effectiveness of 2043 SEK (8.54 SEK = 1 US dollar, December 1999) per averted decayed enamel and dentine missing and filled surface (DeMFS), of which treatment costs represent 1337 SEK using the unit cost for a nurse. This means a yearly cost of approximately 334 SEK.

  • 6.
    Oscarson, Nils
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Odontology.
    Källestål, Carina
    Umeå University, Faculty of Medicine, Odontology.
    Karlsson, Göran
    Methods of evaluating dental care costs in the Swedish public dental health care sector1998In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 26, no 3, p. 160-165Article in journal (Refereed)
    Abstract [en]

    Twenty-six Swedish dental health care clinics participating in the intervention study "Evaluation of caries preventive measures" have been analysed with focus on costs, with the aim of demonstrating techniques suitable for evaluating direct dental care costs and also finding out whether charges are acceptable as a proxy for real costs. Three different approaches to calculating unit costs are discussed: average treatment time cost and two methods of different allocation of overhead cost. Average treatment time cost shows treatment time cost regardless of who (dentist, dental hygienist or nurse) provides the dental care. The other two methods reflect both the differences of treatment costs depending on practitioners' skill level and competence (salary) and the methods of handling overhead cost allocation. Our conclusions are that the proposed methods seem useful for evaluating costs in cost-effectiveness and cost-benefit analysis. The alternative to average treatment time cost or unit time cost depends on what data is available and the perspective of the analysis. This study also concludes that charges are not sufficient as an alternative to a more detailed cost evaluation, at least not in Swedish public dental health care, since charges do not cover costs.

  • 7.
    Sundström, Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Bergdahl, Jan
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Bergdahl, Maud
    Institute of Clinical Dentistry, University of Tromsø, Tromsø, Norway.
    Nilsson, Lars-Göran
    Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Stressful negative life events and amalgam-related complaints2011In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 39, no 1, p. 12-18Article in journal (Refereed)
    Abstract [en]

    Objectives:  The role of stressful life events in the onset of self-reported amalgam-related complaints is unclear. The aim of this study was to examine the relationship between life events and amalgam-related complaints.

    Method:  The participants were selected from a longitudinal population-based study. One-to-one matching of 337 participants with amalgam-related complaints to 337 participants without such complaints was performed. For 81 of the participants with amalgam-related complaints and their matched controls, data was also available approximately 5 years before the onset of complaints, making longitudinal analysis possible. All participants completed questionnaires assessing the occurrence of 55 life events.

    Results:  The results showed that many participants with amalgam-related complaints experienced negative life events before and at the onset of amalgam-related complaints. They also reported more unexpected and uncontrollable events difficult to adjust to in comparison with controls. The groups did not differ on positive or neutral life events. Somatic illness or surgical operation was the most common life event. Death of a very close family member and a major change in financial situation were also commonly reported.

    Conclusions:  This study indicates that adverse negative life events could play a vital role in understanding and explaining amalgam-related complaints.

  • 8.
    Tillberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berglund, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Technology/Dental Materials Science.
    Mårell, Lena
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bergdahl, Jan
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Eriksson, Nils
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Linden, Gerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Widman, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Changes in health over time in patients with symptoms allegedly caused by dental restorative materials2005In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 33, no 6, p. 427-437Article in journal (Refereed)
    Abstract [en]

    Abstract –  Objectives:  In Sweden, many patients with symptoms allegedly caused by their dental materials have exchanged their restorations, but the effects of the exchange have been insufficiently investigated. Therefore, the aim of the study was to describe the change in health over time for these patients and the hypothesis was that the patients could be divided based on their symptoms and that the ability to recover differs between these groups. Furthermore, we also examined if other factors such as replacement of dental restorative materials and follow-up time had any impact on the perceived health status.

    Methods:  A questionnaire was sent to 614 patients who had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental restorative materials. The response rate was 55%.

    Results:  The risk of having any further complaints was higher for patients with complex symptoms (P = 0.03) and these patients had exchanged their restorations to a significantly larger extent than the others (P = 0.03). The remaining complaints was more frequent among men (P = 0.02). Exchange of dental restorative materials had no significant impact on the ability to recover completely. However, the patients who had exchanged their restorations completely perceived a significantly larger alleviation of their symptoms than the others (P < 0.01), although the frequency of most of the symptoms had increased.

    Conclusions:  Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with localized symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. The reason for this improvement, however, is unclear. Further analyses regarding other possible explanations than the ‘odontological/medical’ are needed.

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