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The aim was to assess how accurately some commonly used risk factors/risk markers (predictors) for caries development could identify children with and without approximal caries as judged from bitewing radiography. 267 consecutive 5-year-old children from two Swedish cities participated. Three experienced dentists examined the children. The predictors were the overall dmfs value (canines and molars), the number of occlusal dmfs, the frequency of intake of between meal sugary products, visible plaque on free smooth surfaces of second primary molars, toothbrushing habits, and (before bitewing examination) an overall judgement by the examining dentist. The mean dmfs without bitewing examination (BW) was 0.40 (SD = 1.22). Twelve percent of the children had at least one dentin lesion and 33 % at least one enamel lesion that were detected from BW only. The gain from adding BW to clinical examination amounted to a mean of 1.2 approximal enamel and/or dentin lesions. Results: The ability to correctly identify children with approximal caries from the predictors was limited; sensitivity ranged from 0.27 to 0.75 and specificity ranged from 0.41 to 0.93. The single best predictor was the dentist's overall judgement with an average precision of 73 %; average sensitivity for the presence of enamel and dentin lesions was 0.48 and for the presence of dentin lesions 0.66. The rest of the predictors added little to the predictive power. It is concluded that 33 % of the 5-year-olds, representing a low caries prevalence population, benefited from BW. The ability to identify these children from the predictors was, however, limited.

OBJECTIVE: To evaluate the clinical durability of flowable resin composite and resin-modified glass ionomer cement when used as class II restoratives in primary molars. MATERIAL AND METHODS: A total of 190 restorations were placed in 61 children, age in the range of 5-11 years. The restoratives, Tetric Flow, in combination with the adhesives, Excite or Prompt-L-Pop and Vitremer, were used in class II cavities in primary molars. An intra-individual study design was used and the restorations were evaluated by modified USPHS criteria over a 2-year period. RESULTS: 146 of the restorations could be evaluated at 2 years. The cumulative failure rate was 10.6% for Vitremer and 13.6% for Tetric Flow. No statistically significant differences were found in failure rates between different materials or between bonding systems. The main cause of failure for Tetric Flow was secondary caries and for Vitremer wear and dissolution. CONCLUSIONS: Vitremer and Tetric Flow showed no significant difference concerning clinical durability at 2 years when used as class II restoratives in primary molars. Both materials demonstrated acceptable clinical results.

PURPOSE: To evaluate the durability of a modified open-sandwich restoration utilizing a resin-modified glass ionomer cement (RMGIC) in large cavities. METHODS: 268, mostly extensive, Class II Vitremer/Z100 restorations were placed in 151 patients. 47% of the restorations were placed in patients considered as caries-risk patients. Six experimental groups, differing from each other in thickness of RMGIC layer and preconditioning, were evaluated at baseline and annually during 6-7 years according to modified USPHS criteria. RESULTS: After 6 years, 220 restorations were evaluated. 42 failures (19%) were observed. The most frequent reasons for failure were material fracture (n = 11), tooth fractures (n = 9) and secondary caries (n = 10). Non-acceptable proximal dissolution of the RMGIC was seen in six restorations. Significantly more failures, but similar dissolution of the RMGIC, were recorded in high caries risk patients. No differences were seen between the experimental groups or between restorations with thick or thin RMGIC layer. 160 restorations were also evaluated at 7 years. Another 13 failures were observed, eight with non-acceptable dissolution, three secondary caries and two fractures. It can be concluded that the modified open sandwich restoration showed an acceptable durability for the extensive restorations evaluated. An accelerating dissolution of the RMGIC was observed at the end of the study.

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 caries-preventive 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.

PURPOSE: To evaluate and compare the long-term outcome of a population-based and a risk-based strategy of applying fissure sealants in newly erupted first permanent molars. DESIGN AND SETTING: Retrospective cohort study in primary dental care. MATERIALS AND METHODS: Four hundred and ninety-six subjects from two cohorts were included. In group P (n = 236), routine applications of fissure sealants were conducted while sealants were placed on the basis of subjective criteria in Group R (n = 260). Data of applications, maintenance, decay, restorations, extractions, and cumulative time of applications from six to 19 years were extracted from the dental records and bite-wing radiographs by two of the authors simultaneously. The main outcome measures were the total caries prevalence at the age of 19 years as well as the fate of each sealed and non-sealed occlusal surface. RESULTS: In group P, 87.7% of all first permanent molars were sealed compared with 20.2% in group R. There was no statistically significant difference concerningthe total DFT at 19 years of age between the groups (mean 3.5 +/- 3.8 vs. 3.7 +/- 3.4). Considering the occlusal surfaces of the first permanent molars only, a statistically significant treatment effect was demonstrated in group P with an odds ratio of 4.6 (95% CI: 3.0 - 6.7; p < 0.05). The absolute risk reduction was 36.3% and the number needed to treat was 2.8. In Group R, no statistically significant treatment effect was disclosed (OR = 1.3; 95% CI: 0.9 - 1.7; risk reduction 5.5%). CONCLUSION: This 13-year follow-up showed that population-based applications of fissure sealants in first permanent molars shortly after eruption showed a statistically significant treatment effect on the occlusal surfaces at the age of 19 years, which was in contrast to findings from a cohort in which sealants were applied on the basis of an individual risk-based strategy. There were, however, no significant differences concerning the total caries experience between the two cohorts

Purpose: This study surveyed dental implant treatment in children up to age 16 years in Sweden between 1985 and 2005, with special reference to young children with ectodermal dysplasia (ED) and anodontia in the lower jaw.

Materials and Methods: A questionnaire was sent to Swedish specialist clinics in oral and maxillofacial surgery and prosthetic dentistry. Also, the teams who had treated children with ED were asked to submit their records for these children for a discussion on reasons for implant failure.

Results: Six out of 30 specialist centers (20%) in Sweden had treated 26 children with dental implants between 1985 and 2005. Twenty-one patients had received 33 implants to replace teeth missing from nonsyndromic agenesis or trauma at ages 14 or 15 years; 2 (6.1%) of these implants were lost. Five children with ED received 14 implants at 5 to 12 years of age; 9 (64.3%) of these implants were lost before loading.

Conclusions: Dental implant placement has been a rarely used treatment modality in Swedish children less than 16 years old in the last 20 years. The failure rate in children treated because of tooth agenesis was only slightly higher than that reported for adult individuals, whereas in young children with ED and anodontia in the mandible, implants seemed to present special challenges, and the failure rate was very high. The small jaw size and peroperative conditions, rather than ED per se, were thought to be the main risk factors. Centralizing implant operations in young children with ED and monitoring outcomes in implant registers are strongly advocated. Int J Oral Maxillofacial Implants 2008;23:520–524

AIM: To determine the concentration of fluoride in saliva and supragingival dental plaque at designated time intervals after consumption of snacks prepared with a standardised amount of fluoridated salt. STUDY DESIGN: The investigation had a single blind prospective crossover design. METHODS: A group of 11 healthy young adults volunteered to participate after verbal and written information and consent. After a 1-week fluoride depletion period, the subjects consumed popcorn prepared with either fluoridated (250 mg/kg) or non-fluoridated salt during 30 minutes. Unstimulated whole saliva and samples of supragingival plaque were collected before consumption (baseline) and at 30, 60 and 120 minutes after the intake. Fluoride concentration was determined with a fluoride-specific electrode and the post-ingestion levels were compared with baseline by ANOVA. RESULTS: In saliva, the mean fluoride concentrations at baseline ranged from 0.021 to 0.027 mg/L and after the 30 minutes consumption of fluoride prepared snacks a 15-fold increase (p<0.001) was found. The same pattern was disclosed in the plaque samples. In both saliva and plaque, the fluoride levels remained significantly elevated after 2 hours (p<0.001 and p<0.05, respectively). CONCLUSION: Consumption of snacks prepared with fluoridated table salt resulted in significantly increased fluoride levels in saliva and supragingival plaque for a period of at least two hours.

OBJECTIVE: To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment. MATERIALS AND METHODS: Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies. RESULTS: The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective. CONCLUSIONS: This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.

OBJECTIVES: The aims of the present study were to describe eating, toothbrushing and smoking habits in a cohort of Swedish female adolescents, and to relate the findings to dental caries increment. DESIGN: The research took the form of a longitudinal study. SUBJECTS AND METHODS: The study sample consisted of a cohort of 162 girls under regular dental care, aged 12 years at baseline, who were followed for 3 years, from the sixth to the ninth grade. Eating, oral cleaning and smoking habits were self-reported three times per year through a questionnaire, and caries data at baseline and after 3 years were collected from dental records. RESULTS: The results showed significantly (P < 0.05) impaired eating habits during the study period and that adherence to regular main meals diminished. In the eighth grade, one-third of the girls skipped breakfast before school and only 50% had their free school lunch daily. The omission of breakfast and irregular main meals, as well as smoking were significantly associated with caries (decayed, missed and filled surfaces) increment in the eighth grade (odds ratio = 4.1-4.9, P < 0.05). Snacks, light meals, soft drinks and sweets were already frequently consumed at baseline and continued to be so over the years. Although > 95% of subjects reported that they brushed their teeth at least once a day, approximately 20% did not do it every evening, and this figure remained stable over the study period. However, snacks, soft drinks and sweets, and toothbrushing habits had no significant influence on caries development. CONCLUSION: Dietary advice for caries prevention in adolescent girls should focus on the importance of retaining regular main meals, and especially, not skipping breakfast.

The aim of this study was to investigate the relationship between salivary buffer capacity and menarche, and to explore any association with levels of the sex hormone progesterone in stimulated whole saliva in adolescent girls. The material comprised 162 girls, 12 years of age at baseline in the 6th grade, who were followed for 3 years. Every 4th month, a stimulated whole saliva sample was collected, secretion rate and buffer capacity were determined, and information was gathered on menarche, ongoing menses, and caries increment. Once yearly, the salivary concentration of progesterone was determined with an enzyme immunoassay kit. The results showed a significantly impaired salivary buffer capacity over the years (P < 0.05). Low buffer capacity was significantly correlated with low secretion rate (r = 0.42; P< 0.001) and DMFT increment (r=0.20; P<0.05). Pre-menarche buffer capacity did not differ from the postmenarche scores. The concentration of progesterone in saliva increased with age but displayed no significant relationship to buffer capacity, flow rate, or caries increment. In conclusion, the findings of this study suggest that the salivary buffer capacity may be impaired over the adolescent years in females, but the reason remains unclear.

Amelogenesis imperfecta (AI) is a genetically determined enamel defect characterized by genetic and clinical heterogeneity .

The prevalence and incidence of AI were established in the county of Västerbotten, northern Sweden, in 3-19-yr-olds born 1963-79, as were the mode of inheritance and clinical manifestation of AI. The distribution of the inorganic component in the enamel of AI teeth was studied as well as the surface morphology and other morphological details, and the findings were correlated to genetic and clinical data.

AI was diagnosed in 79 children and adolescents (index cases). The prevalence in the study population was 1.4:

1 000. The mean yearly incidence 1963-79 was 1.3:1 000.

The inheritance patterns for AI were established in 78 index cases from 51 families. Pedigree and segregation analyses suggested autosomal dominant (AD) inheritance in 3 3 families, autosomal recessive (AR) in six families, and X- linked recessive in two families; in ten families only sporadic cases were found. In one of the families with an AD inheritance pattern, X-linked dominant was a possible alternative.

Examination of the families of the 78 index cases revealed 107 new cases of AI. The hypoplastic form was seen in 72% of all diagnosed cases and the hypomineralization form in 28% of the cases.

A further classification of the clinical manifestations led to the identification of eight clinical variants. In 3 3 of the 51 families the same clinical variant was found in all affected members. In eight families affected members were assigned to different clinical variants. In three families with an X-linked inheritance pattern for AI, the clinical manifestation differed between women and men due to lyo- nization. Among the remaining five families, with an AD inheritance pattern for AI, variants clinically characterized by hypoplasia as well as variants characterized by hypomineralization were found in three families; in the other two families the clinical manifestation varied within the same main form of AI, i.e. hypoplasia or hypomineralization.

Hypoplasia as well as hypomineralization were observed microradiographically in the enamel of most of the examined teeth. These findings were supported by scanning electron microscopy (SEM).

Both clinically and microradiographically as well as by SEM, similar variants of AI were found as AD and AR traits and/or among the sporadic cases. In the families with AI as an X-linked trait the genetic hypothesis was confirmed by the clinical, microradiographic and scanning electron microscopic findings.

The aim was to evaluate the effect of xylitol and probiotic chewing gums on salivary mutans streptococci (MS) and lactobacilli (LB). The material consisted of 80 healthy young adults (21-24 years) who volunteered after informed consent. They were assigned by random into one of four parallel study groups: A, probiotic gum group; B, xylitol gum group; C, probiotic + xylitol gum group; and D, placebo gum group. The gums were taken three times daily after meals, and the intervention period was 3 weeks. The probiotic gums contained two strains of Lactobacilli reuteri (ATCC 55730 at a dose of 1 x 10(8) CFU/gum and ATCC PTA 5289 at a dose of 1 x 10(8) CFU/gum), and each pellet of the xylitol gum contained approximately 1.0 g xylitol as single sweetener. Pretreatment and posttreatment samples of stimulated whole saliva were collected and quantified for MS and LB with chair-side kits. A statistically significant reduction (p < 0.05) of salivary MS was displayed in group A and B after the intervention when compared with baseline. A similar but nonsignificant tendency was seen in group C. No alterations of salivary LB was demonstrated in any group. In conclusion, daily chewing on gums containing probiotic bacteria or xylitol reduced the levels of salivary MS in a significant way. However, a combination of probiotic and xylitol gums did not seem to enhance this effect.

PURPOSE: To evaluate the salivary levels of chlorhexidine (CHX) after a single professional treatment with an antibacterial dental varnish (Cervitec) containing 1% CHX and 1% thymol. METHODS: Unstimulated whole saliva from 21 healthy young adults was collected at baseline and up to 24 hours after treatment at designated time intervals and the CHX levels in saliva were quantified with high-performance liquid chromatography. Post-treatment saliva samples were added to suspensions of mutans streptococci and supragingival dental plaque for a growth inhibition. RESULTS: CHX concentration in saliva showed a peak value (76.5 microg/ml) after 5 minutes followed by a slow decrease with time. The elevation was statistically significant (P < 0.05) up to 4 hours after the application of the varnish and the recorded values were back to baseline levels after 24 hours. The 2- and 4-hour post-treatment saliva samples inhibited growth of mutans streptococci by 46% and 33%, respectively.

Oral lichen planus (OLP) is a chronic inflammatory disease and although classified by WHO as a premalignant condition, the risk for transformation into squamous cell carcinoma of the head and neck (SCCHN) is a matter of great controversy. The p63 gene encodes six different proteins which are required for development of ectodermally derived tissues such as oral mucosa, salivary glands, teeth and skin. p63 is highly expressed in SCCHN whereas decreased expression is seen in OLP. beta-catenin, E-cadherin and epidermal growth factor receptor (EGFR) are p63 related proteins, and abnormalities in their expression suggested they are involved in development of squamous cell carcinoma of the head and neck (SCCHN). In this study we mapped the expression of these p63 related proteins in OLP and matched normal healthy controls. Results showed decreased expression of beta-catenin, E-cadherin and EGFR in the vast majority of OLP samples compared with the normal controls. This is the first comprehensive study mapping expression of several p63- and SCCHN-related proteins in tissue from patients with OLP. Results showed a mixed expression pattern with OLP variably resembling normal as well as tumour tissue. Based on our present and previous data it cannot be judged whether OLP lesions are at an increased risk of malignant development.

In the postwar period Swedish communities have become more multicultural. Although there are about 120,000 Finnish immigrant children below the age of 18 in Sweden, knowledge about their dental health is rather sparse.

Dental health and related factors were studied in Finnish immigrant children aged 5,8 and 14 years, living in the city of Luleå, northern Sweden. The effect of early dental health education to parents at the Child Health Centres was studied in one age group in Luleå and in one in the municipality of Botkyrka, Stockholm county. All groups of Finnish children were compared to Swedish children matched for age, sex and social class.

At the age of 5 the prevalence of dental caries was higher than in Swedish control children. At the age of 8, this difference persisted, but was less pronounced in the permanent than in the primary dentition. The net mean caries increment between 5 and 8 years of age was 11.2 in the Finnish group compared to 7.4 in the Swedish. The proportion of children selected for individual prophylaxis and the time used between age 5 and 8 did not differ between the Finnish and the Swedish groups.

In the Finnish teenagers, the prevalence of dental caries was higher than in the Swedish teenagers. Periodontal health was equally good in all age groups of Finnish and Swedish children. The difference in caries prevalence between the two groups was mainly explained by a more frequent between-meal eating and a higher intake of sucrose-containing products between meals in the Finnish children. Even though they had been included in organized dental care with individual prophylaxis, this was obviously not enough to guarantee them as good a dental health as in the Swedish children.

Flourides were used to an equal extent in the Finnish and Swedish groups. Toothbrushing was less frequent in all Finnish age groups than in the Swedish controls.

The Finnish parents were less convinced than the Swedish about their ability to influence the child’s dental health, and more Finnish than Swedish parents also found it necessary to visit a dentist only when they had toothache.

The Finnish teenagers who had received almost twice as many hours of individual prophylaxis as the Swedish, knew less about the etiology of dental caries but equally much about the etiology of gingivitis.

The best result of early dental health education to parents, evaluated by comparing prevalence of dental caries of the children at the age of 3, was obtained when information was given three times in Finnish. If information in the mother tongue cannot be offered, an extra session of information in Swedish can also benefit the dental health of the child.

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.

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.

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 fluoride depletion period, 250 ml of fluoridated standard milk (5ppm; total amount 1.25 mg F) or non-fluoride 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 at 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 fluoride-containing milk. No differences were found after 60 and 180 min compared with baseline for any of the milks. Conclusion: The findings suggest that fluoride added to milk may counteract the lactic acid formation that follows a non-fluoridated milk intake.

The primary aims were to investigate the total number of radiographs and the reason for dental radiography in children and adolescents in the Public Dental Health Service. Secondary aims were to study the influence of caries experience and orthodontic treatment on the number of radiographs. For this retrospective study, 544 adolescents regularly attending three Public Dental Health clinics in the county of Västerbotten, northern Sweden were selected. The number of radiographs exposed each year from 3 to 19 years of age was registered. Information on reason for the radiographic examination was extracted from dental records as well as the caries experience at 19 years of age. The attrition rate was 7% due to incomplete data. The total mean number of radiographs exposed was 23+/-6 of which 1+/-2 were extra-oral radiographs. Bitewing radiographs for caries registration constituted 87% of the intra-oral radiographs with a mean number of 19+/-4 exposures. There was a statistically significant difference (p<0.01) between subjects with caries experience (20+/-4) and those with no caries (16+/-4). No gender-related differences were displayed. During preschool ages, bitewing radiographs were taken in less than 10% of the children. Children treated at specialist clinics in orthodontics displayed higher number of radiographic examinations than non-referred children (p<0.01). CONCLUSION: A mean of 23 radiographs were exposed and bitewings for caries detection were the most common radiographic examination. Fewer bitewing radiographs were exposed in caries-free subjects over time but its use during the preschool ages was low. Orthodontics treatment increased the frequency of radiography significantly.

Purpose: To determine the incidence and distribution of enamel demineralisation (white spot lesions, WSL) adjacent to fixed orthodontic brackets in a low-caries population and to evaluate the value of pre-treatment bitewing radiographs in predicting such lesions. Material and methods: A group of 495 consecutive patients under the age of 19-years (mean 13 yrs) that were treated with fixed appliances during at least 6 months was included. Approximal enamel lesions were scored on bitewing radiographs exposed at onset and immediately after treatment and the incidence of WSL was registered clinically at de-bonding. Results: The incidence of WSL around brackets was 23% and mandibular premolars and cuspids and maxillary cuspids and lateral incisors were most frequently affected. The number of approximal enamel lesions at treatment onset were significantly correlated to WSL development during active treatment (r=0.35, p<0.001). When the onset presence of approximal enamel lesions (≥1) was used as predictor for enamel demineralisations at debonding, the odds ratio for becoming white spots during treatment was 5.6 (p<0.001), with a sensitivity of 0.74 and a specificity of 0.67. Conclusions: The orthodontic team should take pre-treatment bitewing radiographs into consideration when informing the patients on the risk of caries-related adverse effects following orthodontic treatment.

OBJECTIVES: To examine attitudes and experiences of parents whose children have complex congenital heart disease (CHD) with respect to dental health information and advice, dental care, and service and to compare the results with data from an age- and gender-matched control group without any medical problems.

SETTING: Faculty of Medicine (Paediatric Cardiology and Paediatric Dentistry), Umea University, Umea, Sweden.

SAMPLE AND METHOD: Each group comprised parents of 33 children; the children's mean age was 9.4 years. All the cases and the controls resided in the county of Vasterbotten, northern Sweden. Data were collected with a questionnaire with 20 joint questions to both groups and four additional questions to the CHD group.

RESULTS: Of the 20 joint questions, significant differences were displayed in the following areas: the professional group that provided the parents with dental health information and advice (P < 0.01), attitudes to reception at the dental clinic, and experience of sedation before operative dental treatment (P < 0.05). Parents to 11 children with CHD who were patients at a specialist clinic for paediatric dentistry scored the reception at the dental clinic as excellent in nine cases and satisfactory in two, compared to excellent (3), satisfactory (11), decent (4), and poor (4) among those who were patients in general dental practice (P < 0.01). No statistically significant differences in educational level or in parental experience of dental health were noted between the two groups (P > 0.05).

CONCLUSION: Children with CHD in northern Sweden mainly receive their dental health information from a physician or a dentist, and healthy children mainly receive information from a dental hygienist indicating that children with CHD are given priority in the dental care system. Parental attitudes to reception in the dental service differed, and parents of healthy children scored the reception at the dental clinic better than parents of children with CHD. It is suggested that children with severe CHD should receive dental care in clinics for paediatric dentistry, particularly at early ages.

BACKGROUND: Infants with moderate to severe congenital heart disease (CHD) are at a higher risk for growth failure and malnutrition due to increased metabolic demands and inadequate energy intake. This state requires meals that are more frequent and a special enriched diet, which may have negative implications on oral health.

AIM: To examine the oral colonisation of some bacteria associated with caries development during infancy; mutans streptococci (MS) and lactobacilli (LCB) in infants with CHD and whether their dietary intake had an impact on the bacterial levels.

DESIGN: This was a prospective case-control study. 11 infants with CHD and 22 healthy, age-matched infants were enrolled. Saliva samples and food diaries were collected at 6, 9, and 12 months of age. The total viable counts of MS and LCB in saliva were determined, and energy intake, meal frequency, intake of proteins, fat, carbohydrates and sucrose were calculated.

RESULTS: At 12 months of age, the MS count was higher in the CHD group than in the controls (p<0.01), and MS constituted a higher ratio of the total viable count of oral bacteria (p<0.01). Meal frequency was higher in the CHD group at 6 and 9 months of age than in the controls (p<0.05). The intake of sucrose did not differ between the groups, while the total carbohydrate intake was higher in the control group at 6 and 12 months of age (p<0.05). Compared with the control group, which had six courses of antibiotic administration, the CHD infants had 21 courses (p<0.05).

CONCLUSIONS: Infants with severe CHD have higher levels of MS at 12 months of age than the healthy controls. A higher meal frequency and use of diuretic medication and antibiotics may have influenced MS colonisation.

The selected probiotic strains showed a significant but somewhat varying ability to inhibit growth of oral mutans streptococci and Candida albicans in vitro.

AIM: To conduct a systematic review of literature in order to examine the evidence of an increased prevalence of dental caries in children with cleft lip and palate (CLP).

METHODS: A search of the PubMed database was conducted through May 2006. Sex- and age-matched case-control studies with noncavitated and manifest caries lesions as endpoint were targeted (n = 6). The studies were assessed independently by two reviewers and scored A-C according to predetermined criteria for methodology and performance.

RESULTS: Significantly more caries in CLP children were reported in two of the four studies in the permanent dentition and in three out of four publications dealing with primary teeth. None of the articles were, however, assessed with the highest grade 'A' and the level of evidence was therefore based on three papers graded 'B'. There was a tendency towards higher caries scores in preschool children, but as conflicting results were revealed, the evidence that children with CLP exhibit more caries than noncleft controls was inconclusive.

CONCLUSION: This systematic review of literature was unable to find firm evidence for the assumption that CLP children have an increased prevalence of dental caries.

INTRODUCTION: Food supplemented with probiotic bacteria is a rapidly growing sector of the market. The aim of the present study was to evaluate and compare the acid production of selected probiotic strains available in commercial products.

METHODS: Six Lactobacillus strains (Lactobacillus plantarum 299v and 931; Lactobacillus rhamnosus GG and LB21; Lactobacillus paracasei subsp. paracasei F19, and Lactobacillus reuteri PTA 5289) were cultivated at 37 degrees C in an anaerobic atmosphere on Man, Rogosa, Shape (MRS) agar for 48 h or MRS broth for 16 h. After centrifugation, the cells were washed and resuspended in sterile phosphate-buffered saline and immediately subjected to a fermentation assay with 12 different carbohydrates (nine sugars and three sugar alcohols) in microtiter plates with a pH indicator. The plates were examined for color changes after 24, 48, and 72 h of incubation under aerobic and anaerobic conditions. Three scores were used: negative (pH > 6.8); weak (pH 5.2-6.8), and positive (pH < 5.2). The strains were characterized with the API 50 CH system to confirm their identity.

RESULTS: L. plantarum fermented all the sugars except for melibiose, raffinose, and xylitol. Both L. rhamnosus strains were generally less active although L. rhamnosus GG was slightly more active than strain LB21 in the 5% CO(2) setting. The latter strain exhibited negative reactions for sucrose, maltose, arabinose, and sorbitol under anaerobic conditions. The assays with L. paracasei and L. reuteri had negative or weak reactions for all tested sugars under both aerobic and anaerobic conditions.

CONCLUSION: The metabolic capacity to form acid from dietary sugars differed significantly between the various probiotic strains.

The aim was to determine the fluoride concentration in saliva after intake of a dinner meal prepared with fluoridated salt. The investigation had a randomized cross-over design, and 10 healthy adolescents with natural fluoride content (1.06 ppm) in their drinking water participated after informed consent. After a run-in week, the subjects were served a standardized dinner of spaghetti with minced meat sauce prepared with either fluoridated salt (test arm) or non-fluoridated salt (control arm). The fluoride concentration of the test salt was 250 ppm. Samples of stimulated whole saliva was collected at baseline, directly after eating (0 min) and then after 10, 30 and 180 min. After a 1-week wash-out period, the experimental procedure was repeated with the opposite salt. Fluoride concentration in saliva was measured with a fluoride-specific electrode and the post-ingestion levels were compared with baseline using repeated-measures ANOVA.The mean baseline concentrations were 10.9 and 8.0 microg/l in the test and control arms, respectively. Immediately after the intake, the mean fluoride values increased significantly to 81.6 microg/l in the test arm and to 31.5 microg/l in the control arm (p<0.05). The fluoride levels remained elevated (p<0.05) for 30 min after ingestion of the test meal but not following the control meal. In conclusion, consumption of a dinner meal prepared with fluoridated salt increased the salivary fluoride levels for about 30 min

OBJECTIVE: The aim of this study was to investigate the effect of a fixed daily dose of xylitol on mutans streptococci in saliva and the amount of visible dental plaque. A second aim was to explore if the possible effects differed between children with and without caries experience. METHODS: The study was designed as a double-blind randomized controlled trial with two parallel arms. All pupils (n=149) in grades 1-6 in a comprehensive school in northern Sweden were invited, and 128 children (mean age=12.7 years) consented to participate. The children were stratified as having caries experience (DMFS/dmfs>or=1) or not before the random allocation to a test or control group. The control group (A) was given two pellets containing sorbitol and maltitol three times daily for 4 weeks, and the test group (B) received corresponding pellets with xylitol as single sweetener (total dose=6.18 g day). Clinical scoring and saliva samples were collected at baseline and immediately after the test period. The outcome measures were visible plaque index, salivary mutans streptococci counts and salivary lactic acid production. RESULTS: The amount of visible plaque was significantly reduced in both groups after 4 weeks (P<0.05). Likewise, the sucrose-induced lactic acid formation in saliva diminished in both groups (P<0.05). The proportion of mutans streptococci decreased significantly in the test group compared to baseline, but not in the control group (P<0.05). The alterations in the test group seemed most prominent among children without previous caries experience. CONCLUSIONS: The results suggest that chewing gum with xylitol or sorbitol/maltitol can reduce the amount of dental plaque and acid production in saliva in schoolchildren, but only the xylitol-containing gum may also interfere with the microbial composition.

Objectives. (i) To validate caries risk profiles assessed with a computer program against actual caries development in preschool children, (ii) to study the possible impact of a preventive program on the risk profiles, and (iii) to compare the individual risk profiles longitudinally. Material and methods. Caries risk was assessed in 125 two-year-old children invited to participate in a 2-year caries-preventive trial with xylitol tablets. At 7 years of age, 103 were available for follow-up, 48 from the former intervention group and 55 from the control group. At baseline and after 5 years, 7 variables associated with caries were collected through clinical examinations and questionnaires, and scored and computed with a risk assessment program (Cariogram). Results. Children assessed as having a "low chance (0-20%) of avoiding caries" had significantly higher caries at 7 years of age compared to children with a lower risk in the control group (p<0.05) but not in the intervention group. Overall predictive accuracy and precision, however, were moderate in both groups. Less than half of the children remained in the same risk category at both ages, despite a largely unchanged consumption pattern of sugar. The majority of the children who changed category displayed a lowered risk at 7 years. The intervention program seemed to impair the predictive abilities of Cariogram. Conclusion. A modified Cariogram applied on preschool children was not particularly useful in identifying high caries risk patients in a low-caries community.

The aims of this study were to compare the caries risk profiles of children and elderly, the actual annual caries increment and the impact of some selected caries related factors. Another aim was to find out if there were gender differences among the participants. The risk profiles were created by a computerised risk assessment program, the Cariogram, which evaluates data and presents the weighted and summarized result as one figure, illustrating the ‘percent chance of avoiding caries’ in the future. Methods: The Cariogram was earlier evaluated in two longitudinal studies for its capacity to assess caries risk. One study comprised about 400 children, 10-11 years of age and the other study included about 150 elderly (age 55, 65 and 75). At baseline, information on past caries experience, diet, oral hygiene and use of fluoride was obtained. Saliva analyses included mutans streptococci and lactobacilli, buffering capacity and secretion rate. The caries risk was assessed and the participants were divided into five groups according to the calculated Cariogram risk profiles. After two and five years, respectively, caries was re-evaluated and the incidence was compared with the predictions. Results: The Cariogram risk predictions were statistically in agreement with the actual caries increment. Fifty percent of the children, but only two percent of the elderly appeared in the lowest caries risk group. Of the elderly, 26.4% belonged to the highest caries risk group versus 3.1% of the children. The median value ‘chance of avoiding caries’ was 44% for the elderly and 80% for the children. The main Cariogram sectors contributing to the observed higher caries risk among elderly was the bacterial components in combination with higher susceptibility. Individual factors contributing significantly to the higher risk profiles for the adults compared to the children were higher plaque scores, higher counts of mutans streptococci and lower buffering capacity. Conclusion: comparing the risk profiles of the children and the elderly showed that the elderly were at a higher risk developing caries lesions. Overall one may say that the risk for caries, as assessed by the Cariogram, was twice as high for the elderly.

Objective: Co-aggregation and growth inhibition abilities of probiotic bacteria may play a key role in their interference with the oral biofilm. The aim was to investigate the in vitro ability of selected commercial probiotic lactobacilli to co-aggregate and inhibit growth of oral mutans steptococci isolated from adults with contrasting levels of caries.

Materials and methods: Mutans streptococci (MS) strains were isolated from caries-free (n = 3) and caries-susceptible (n = 5) young adults and processed with eight commercial probiotic lactobacilli strains. One laboratory reference strain (S. mutans Ingbritt) was selected as control. Co-aggregation was determined spectrophotometrically and growth inhibition was assessed with the agar overlay technique.

Results: All probiotic lactobacilli showed an ability to co-aggregate with the isolated MS strains. Statistically significant differences (p < 0.05) were found between strains from different individuals when compared with the reference strain. The selected lactobacilli inhibited MS growth, but the ability varied between the strains and was clearly related to pH. No differences were observed between the different MS strains from caries-free and caries-susceptible individuals.

Conclusions: The selected lactobacilli displayed co-aggregation activity and inhibited growth of clinical mutans streptococci. The growth inhibition was strain-specific and dependent on pH and cell concentration. The findings indicate that the outcome of lactobacilli-derived probiotic therapy might vary between individuals and depend on the specific strain used.

The aim of this study was to investigate the effectiveness of tablets containing two probiotic Lactobacillus reuteri strains in inhibiting regrowth of salivary mutans streptococci (MS) after full-mouth disinfection (FMD) with chlorhexidine. The null hypothesis was that the levels of MS would not differ in comparison with a placebo protocol. The study population was comprised of 62 young adults (mean age 23 years) with moderate or high counts of salivary MS who volunteered after informed consent. The study was a double-blinded randomized controlled trial with two parallel groups. After a 3-day chlorhexidine regimen, the subjects were randomly assigned to a test group (n = 32) with probiotic lozenges (2/day) or a placebo group (n = 30). The intervention period was 6 weeks, and stimulated whole saliva was collected at baseline and after 1, 6, and 12 weeks. The samples were processed for MS by a chair-side test and DNA-DNA hybridization as an estimate of 19 bacterial strains associated with oral health and disease. There was no significant difference between the groups at inclusion, and FMD reduced the salivary MS levels significantly in both groups. The MS suppression lasted less than 6 weeks and there were no statistical differences in salivary MS regrowth between the test and control groups at any of the follow-ups. Likewise, there were no major differences in the regrowth patterns of the checkerboard panel between the two groups. We conclude that daily oral administration of L. reuteri did not seem to affect or delay the regrowth of salivary MS after FMD with chlorhexidine. Copyright (c) 2012 S. Karger AG, Basel

Abstract. The aim was to investigate the effect of high and low amounts of xylitol on the interdental plaque-pH, directly and after sucrose challenge in schoolchildren with a habitual consumption. The study group consisted of 11 healthy children (10-15 years) with low caries risk and the experiment had a single-blind crossover (Latin square) design. After a 2-week run-in period with a daily 4.0 g xylitol intake, the children were subjected to single-dose exposures of chewing gums with i) paraffin (CTR; no xylitol), ii) low dose xylitol (LX; 2.0g xylitol), and iii) high dose xylitol (HX; 6.0g xylitol) in a randomised order separated by a wash-out period of one week. Samples of chewing-stimulated whole saliva were collected prior to and after the experimental period for determination of bacterial counts. The outcome measures were in situ plaque-pH (micro-touch method) and area under the curve (AUC) above pH 6.0. The AUC was significantly greater (p<0.05) in the HX group compared to the LX and control groups during the first 5 minutes after chewing. After a 10% sucrose rinse, the interdental plaque-pH dropped in all groups but the HX regimen displayed significantly less reduction 0-5 min after chewing (p<0.05). No significant alterations of the total viable counts or mutans streptococci levels in saliva were disclosed during the 4-week experimental period. The present results suggested that a high single dose of xylitol had a short and limited beneficial effect on interdental plaque-pH in habitual xylitol consumers while a low single dose, resembling a normal chewing gum use, did not differ from the control.

BACKGROUND: Hypohidrotic ectodermal dysplasia (HED) is a genetic disorder characterized by defective development of teeth, hair, nails and eccrine sweat glands. Both autosomal dominant and autosomal recessive forms of HED have previously been linked to mutations in the ectodysplasin 1 anhidrotic receptor (EDAR) protein that plays an important role during embryogenesis.

METHODS: The coding DNA sequence of the EDAR gene was analyzed in two large Swedish three-generational families with autosomal dominant HED.

RESULTS: A non-sense C to T mutation in exon 12 was identified in both families. This disease-specific mutation changes an arginine amino acid in position 358 of the EDAR protein into a stop codon (p.Arg358X), thereby truncating the protein. In addition to the causative mutation two polymorphisms, not associated with the HED disorder, were also found in the EDAR gene.

CONCLUSION: The finding of the p.Arg358X mutation in the Swedish families is the first corroboration of a previously described observation in an American family. Thus, our study strengthens the role of this particular mutation in the aetiology of autosomal dominant HED and confirms the importance of EDAR for the development of HED.

OBJECTIVE: The aim of this systematic literature review was to evaluate associations between different malocclusions, orthodontic treatment, and signs and symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: This review was part of a project at the Swedish Council on Technology Assessment in Health Care focusing on malocclusion and orthodontic treatment from a health perspective. As a first step, the literature was searched in the Medline and Cochrane Library databases from 1966 to May 2003. A later update was made in January 2005. Human studies in English or in Scandinavian languages were included. RESULTS: Associations between certain malocclusions and TMD were found in some studies, whereas the majority of the reviewed articles failed to identify significant and clinically important associations. TMD could not be correlated to any specific type of malocclusion, and there was no support for the belief that orthodontic treatment may cause TMD. Obvious individual variations in signs and symptoms of TMD over time according to some longitudinal studies further emphasized the difficulty in establishing malocclusion as a significant risk factor for TMD. A considerable reduction in signs and symptoms of TMD between the teenage period and young adulthood has been shown in some recent longitudinal studies. CONCLUSIONS: Associations between specific types of malocclusions and development of significant signs and symptoms of TMD could not be verified. There is still a need for longitudinal studies.

The aim of this study was to compare the caries risk profiles of children and elderly, the actual annual caries increment and the impact of some selected caries related factors.The risk profiles were created by a computerised risk assessment program, the Cariogram, which evaluates data and presents the weighted and summarized result as one figure, illustrating the 'percent chance of avoiding caries' in the future. The data used originated from two separate longitudinal studies illustrating the Cariogram's capacity to assess caries risk. One study comprised about 400 children; the other included about 150 elderly. At baseline, information on past caries experience, diet, oral hygiene and use of fluoride was obtained. Saliva analyses included mutans streptococci and lactobacilli, buffering capacity and secretion rate. The caries risk was assessed and after two and five years, respectively, caries was re-evaluated and the incidence was compared with the predictions. Fifty percent of the children, but only two percent of the elderly appeared in the lowest caries risk group. Of the elderly, 26% belonged to the highest caries risk group versus 3 % of the children.The mean DFS increment per year for the total group of children was 0.4 +/- 0.8 (SD) and 1.2 +/- 1.9 for the elderly. Individual factors contributing significantly to the higher risk profiles for the adults were higher plaque scores, higher counts of mutans streptococci and lower buffering capacity. Over all, the risk for caries, as assessed by the Cariogram, was twice as high for the elderly.

Aim: To evaluate the effect of xylitol-containing tablets on mutans streptococci colonisation and caries development in preschool children. Study design: Randomised single-blind prospective design. Methods: The material consisted of 132 healthy 2-year-old children that were assigned to a xylitol tablet (test) group or a non-intervention control group. The test group was given 1-2 xylitol tablets (0.5-1g) per day during 1.5 years. Mutans streptococci enumeration was performed at baseline and semi-annually with a chair-side technique. Caries prevalence was scored at baseline and the age of 4 years. Results: No statistically significant differences in mutans streptococci colonisation were disclosed between the test and control groups at baseline or any of the designated follow-ups. A statistically significant positive relationship was found between the maternal salivary mutans streptococci levels and the colonisation of the children in the control group (r=0.35; p<0.05) but not in the xylitol tablet group. The mean caries prevalence was lower in the test group compared with the control group at 4 years of age (dmfs 0.38 ±1.05 vs. 0.80 ±2.60) but the difference was not statistically significant. Conclusion: The findings do not support a low-dose xylitol tablet program for caries prevention in preschool children.

The aims of this study were to compare the caries risk profiles of children and elderly, the actual annual caries increment and the impact of some selected caries related factors. Another aim was to find out if there were gender differences among the participants. The risk profiles were created by a computerised risk assessment program, the Cariogram, which evaluates data and presents the weighted and summarized result as one figure, illustrating the ‘percent chance of avoiding caries’ in the future. Methods: The Cariogram was earlier evaluated in two longitudinal studies for its capacity to assess caries risk. One study comprised about 400 children, 10-11 years of age and the other study included about 150 elderly (age 55, 65 and 75). At baseline, information on past caries experience, diet, oral hygiene and use of fluoride was obtained. Saliva analyses included mutans streptococci and lactobacilli, buffering capacity and secretion rate. The caries risk was assessed and the participants were divided into five groups according to the calculated Cariogram risk profiles. After two and five years, respectively, caries was re-evaluated and the incidence was compared with the predictions. Results: The Cariogram risk predictions were statistically in agreement with the actual caries increment. Fifty percent of the children, but only two percent of the elderly appeared in the lowest caries risk group. Of the elderly, 26.4% belonged to the highest caries risk group versus 3.1% of the children. The median value ‘chance of avoiding caries’ was 44% for the elderly and 80% for the children. The main Cariogram sectors contributing to the observed higher caries risk among elderly was the bacterial components in combination with higher susceptibility. Individual factors contributing significantly to the higher risk profiles for the adults compared to the children were higher plaque scores, higher counts of mutans streptococci and lower buffering capacity. Conclusion: comparing the risk profiles of the children and the elderly showed that the elderly were at a higher risk developing caries lesions. Overall one may say that the risk for caries, as assessed by the Cariogram, was twice as high for the elderly.

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 clinical research of high quality, incorporating modern concepts of clinical performance and evaluation to assess dental caries control using professional fluoride varnish.

BACKGROUND: The need for improved oral hygiene routines in individuals with disabilities has been documented in many reports. The aim of this study was to evaluate whether visual pedagogy is a suitable way to teach children with autism how to brush their teeth. METHODS: The investigation took the form of a prospective study including clinical examinations and structured interviews. Based on visual pedagogy, a series of pictures were produced that showed a structured method and technique of tooth brushing. The pictures were placed in the bathroom or wherever tooth brushing was performed. Fourteen children with autism aged between 5 and 13 years (mean age = 9.3 years), and their parents participated. RESULTS: Before the study, all parents found it difficult/very difficult to maintain good oral hygiene in their child. All children had visible plaque on their maxillary incisors and canines. After 12 months, the amount of visible plaque was reduced. After 18 months, most parents found maintaining good oral hygiene easier than before the study. All but one child/parent adopted the programme. CONCLUSIONS: Visual pedagogy is a useful tool in helping people with autism to improve their oral hygiene.

The aim of this project was to study possible influences of Turner syndrome (TS) karyotype and the number of X chromosomes with intact short arm (p-arm) on dental crown width. Primary and permanent mesio-distal crown width was measured on plaster casts from 112 TS females. The influence on crown width of four karyotypes: 1. monosomy (45,X), 2. mosaic (45,X/46,XX), 3. isochromosome, and 4. other, and the number of intact X chromosomal p-arms were investigated. In comparisons between karyotypes, statistically significant differences were found for isochromosome karyotype maxillary second premolars, canines, laterals, mandibular first premolars, and canines, indicating that this karyotype was the most divergent as shown by the most reduced crown width. When each karyotype group were compared versus controls, all teeth in the isochromosome group were significantly smaller than controls (P < 0.01-0.001). The 45,X/46,XX karyotype expressed fewer and smaller differences from controls, while 45,X individuals seemed to display an intermediate tooth width compared with 45,X/46,XX and isochromosomes. No significant difference in crown width was found comparing the groups with one or two intact X chromosomal p-arms. Both primary and permanent teeth proved to have a significantly smaller crown width in the entire group of TS females compared to healthy females. We conclude that the isochromosome group deviates most from other karyotypes and controls, exhibiting the smallest dental crown width, while individuals with 45,X/46,XX mosaicism seemed to have a less affected crown width. An influence of the number of intact p-arms on crown width could not be demonstrated in this study.

Congenital heart disease (CHD) is one of the most common congenital anomalies with an incidence of approximately 8–10 cases per 1000 live births. Technical development and continuing improvement in surgical methods have led to early interventions and an increased survival and consequently also a new group of patients in dentistry. The general aim of this thesis was to study the caries prevalence and some possible background factors in children with complex CHD.Paper I examined the caries prevalence in 41 children with complex CHD and 41 healthy age- and gender-matched controls. CHD children had higher dmfs-values 5.2 ± 7.0 vs. 2.2 ± 3.5 in the controls (p < 0.05). CHD children on digoxin medication had higher dmfs values 10.1 ± 8.5 vs. 3.7 ± 5.3 in the other CHD children (p < 0.05). CHD children had received more fluoride varnish treatments and fluoride tablets (p < 0.01).Paper II investigated attitudes and experiences of dental health information and advice, dental care, and service in 33 parents of children with complex CHD and 33 parents of age- and gender-matched controls. Differences were displayed in the professional group that provided the parents with dental health information and advice, attitudes to reception at the dental clinic, and experience of sedation before operative dental treatment (p < 0.05).Paper III examined 183 Swedish general dentists’ experiences of and attitudes to dental care for children with CHD. Eighteen % of the dentists had received special education or information to treat children with CHD, while almost half of the dentists had one or more patients with CHD and a majority of them stated that their CHD patients had a caries problem. The dentists had a different opinion regarding the provision of dental treatment for children with CHD compared to the current situation (p < 0.001).Paper IV studied salivary secretion, salivary buffering capacity, viable count of bacteria (TVC), mutans streptococci (MS) and lactobacilli (LBC), calcium, chloride, magnesium, potassium, sodium, and IgA in 24 children on heart failure medication and 24 healthy controls. Seven children (29 %) had stimulated secretions below 0.5 ml/min compared to no child among the controls (p < 0.01). TVC were 1.4 × 106 ± 1.2 × 107 in the cardiac group vs. 2.7 × 106 ± 2.9 × 107 in the control group (p < 0.05). MS ratio of TVC constituted 0.11 ± 0.35 % vs. 0.01 ± 0.02 % for the controls (p > 0.05).Paper V studied the endogenous pH and titratable acidity and dissolution of calcium and phosphate from dental hard tissues by 13 pharmaceutical preparations used in paediatric cardiology. Six of the preparations had an endogenous pH below the critical value for enamel dissolution.It is concluded that (i) children with complex CHD had a higher caries experience in the primary dentition than healthy matched controls, (ii) children on digoxin medication had a higher caries experience than other children with complex CHD, (iii) children with complex CHD had received more caries prevention than healthy controls, (iv) parents of children with complex CHD were less satisfied with the reception and care they received than parents of healthy children, (v) general dentists had a different opinion regarding the provision of dental treatment to children with CHD compared to the current situation (vi) children on heart failure medication can have a low saliva secretion, (vii) pharmaceutical preparations used on long-term basis in paediatric cardiology may pose a hazardous threat to dental hard tissues due to their acidity.

Background: The knowledge of oral health effects caused by long-term medication in medically compromised children is sparse. Besides the effects on salivary secretion, pharmacotherapy may also act directly on the dental hard tissues, with dental caries and/or erosive lesions as possible outcomes of their acid and fermentable sugar content.

Methods: Thirteen pharmaceutical preparations commonly used on a long-term basis in paediatric cardiology were selected. The endogenous pH of water solutions of tablets, capsules, and liquid medicines were measured with a pH meter. The titratable acidity and the dissolution of calcium and phosphate after immersion of tooth specimens were quantified for preparations with an endogenous pH below 5.5.

Results: The endogenous pH values varied between 3.03 and 9.02. Six of the 13 preparations (46%) had an endogenous pH below the critical value for enamel dissolution (pH 5.5). The captopril (12.5 mg) tablet water solution had the lowest pH while the propranolol hydrochloride mixture displayed the highest titratable acidity. The highest dissolved calcium and phosphate was displayed for captopril (12.5 mg) tablet water solution followed by acetylsalicylic acid (75 mg) tablet water solution.

Conclusion: It is concluded that some pharmaceutical preparations that are commonly used on a long-term basis in paediatric cardiology may pose a hazardous threat to dental hard tissues due to their acidity.

AIM: To study the saliva profiles in children with severe heart disease taking heart failure medication compared with the saliva from healthy age and gender matched controls.

STUDY DESIGN: Cross sectional case-control design.

METHODS: Twenty-four age and gender matched pairs of children, mean age 12.0 years participated. Stimulated saliva was collected in a standardized way before lunchtime and the subjects were asked to refrain from all eating, drinking and tooth brushing 90 mins before sampling. Stimulated salivary secretion rate, buffering capacity, total salivary viable count of bacteria, mutans streptococci and lactobacilli, calcium, chloride, magnesium, potassium, sodium and salivary IgA were determined.

RESULTS: There were 7 of the 24 children in the cardiac group who had secretions below 0.5 ml/min compared with no child in the control group (p<0.01). Lower [corrected] total viable counts of bacteria (TVC) were detected in the cardiac group 1.4x10⁶ ± 1.2x10⁷ vs. 2.7x10⁶ ± 2.9x10⁷ in the control group (p<0.05). Mutans streptococci (MS) in the cardiac group were 5.2x10⁴ ± 1.5x10⁵ vs. 8.1 x10³ ± 1.3x10⁴ in the control group, (p>0.05) and MS ratio of TVC constituted 0.11±0.35 per cent compared to 0.01±0.02 per cent for the control group (p>0.05).

STATISTICS: Continuous data were analysed by an analysis of variance (ANOVA) and categorical data by chi-square test.

CONCLUSION: Reduced salivary secretion could be a caries risk factor in children taking heart failure medication.

This study was conducted in order to examine the experience of and attitudes to dental care for children with congenital heart disease (CHD) among Swedish general dentists. 183 general dentists employed in the Public Dental Health Service in the counties of Västerbotten and Uppsala, and private practitioners listed with dentistry for children in the county of Västerbotten, Sweden, were enrolled in the study. Data were collected with a questionnaire with 18 questions. Eighteen per cent of the dentists stated that they had received special education or information except the graduate training to treat children with CHD. Forty-eight per cent of the dentists had one or more patients with CHD. Seventy-two per cent of these stated that their CHD-patients had a caries problem. Statistically significant differences were displayed between answers on the questions "who in the dental team perform the major part of the dental care for children with CHD" and "what is your opinion on which personal category that should perform the major part of the dental care for this group of children" (p < 0.001). Among dentists whose clinical time mainly was used for dentistry for children, it was more common to treat children with CHD (p < 0.001) than for dentists with a lower degree of dentistry for children. The study showed that the Swedish dental care for children with CHD today mainly is performed by dental nurses, dental hygienists and general dentists. This strongly differs from the dentist's opinion on who should perform the major part of the dental care for this group of children. These findings taken together with the very low number of dentists that had received special education or information except the graduate training to treat children with CHD indicates that the Swedish dentists are unsettled and insecure in the dental treatment of children with heart defects. An early and close cooperation between specialists in pediatric dentistry, dentists with special training and general dentists is strongly desirable to support the dentists and facilitate the dental care for children with CHD.