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  • 1. Bergendal, Birgitta
    et al.
    Klar, Joakim
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Norderyd, Johanna
    Dahl, Niklas
    Isolated oligodontia associated with mutations in EDARADD, AXIN2, MSX1, and PAX9 genes2011In: American Journal of Medical Genetics. Part A, ISSN 1552-4825, E-ISSN 1552-4833, Vol. 155, no 7, p. 1616-1622Article in journal (Refereed)
    Abstract [en]

    Oligodontia is defined as the congenital lack of six or more permanent teeth, excluding third molars. Oligodontia as well as hypodontia (lack of one or more permanent teeth) are highly heritable conditions associated with mutations in the AXIN2, MSX1, PAX9, EDA, and EDAR genes. Here we define the prevalence of mutations in the AXIN2, MSX1, PAX9, EDA, and EDAR genes, and the novel candidate gene EDARADD in a cohort of 93 Swedish probands with non-syndromic, isolated oligodontia. Mutation screening was performed using denaturing gradient gel electrophoresis and DNA sequence analysis. Analyses of the coding sequences of the six genes showed sequence alterations predicted to be damaging or potentially damaging in ten of 93 probands (10.8%). Mutations were identified in the EDARADD (n = 1), AXIN2 (n = 3), MSX1 (n = 2), and PAX9 (n = 4) genes, respectively. None of the 10 probands with mutations had other self-reported symptoms from ectodermal tissues. The oral parameters were similar when comparing individuals with and without mutations but a family history of oligodontia was three times more frequent for probands with mutations. EDARADD mutations have previously been reported in a few families segregating hypohidrotic ectodermal dysplasia and this is, to our knowledge, the first report of an EDARADD mutation associated with isolated oligodontia.

  • 2.
    Bergendal, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    McAllister, Anita
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Orofacial dysfunction in ectodermal dysplasias measured using the Nordic Orofacial Test-Screening protocol2009In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, ISSN 1502-3850, Vol. 67, p. 377-381Article in journal (Refereed)
  • 3.
    Falk Kieri, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bergendal, Birgitta
    Lind, Lisbet K
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    EDAR-induced hypohidrotic ectodermal dysplasia: a clinical study on signs and symptoms in individuals with a heterozygous c.1072C > T mutation2014In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 15, p. 57-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mutations in the EDAR-gene cause hypohidrotic ectodermal dysplasia, however, the oral phenotype has been described in a limited number of cases. The aim of the present study was to clinically describe individuals with the c.1072C > T mutation (p. Arg358X) in the EDAR gene with respect to dental signs and saliva secretion, symptoms from other ectodermal structures and to assess orofacial function.

    METHODS: Individuals in three families living in Sweden, where some members had a known c.1072C > T mutation in the EDAR gene with an autosomal dominant inheritance (AD), were included in a clinical investigation on oral signs and symptoms and self-reported symptoms from other ectodermal structures (n = 37). Confirmation of the c.1072C > T mutation in the EDAR gene were performed by genomic sequencing. Orofacial function was evaluated with NOT-S.

    RESULTS: The mutation was identified in 17 of 37 family members. The mean number of missing teeth due to agenesis was 10.3 ± 4.1, (range 4-17) in the mutation group and 0.1 ± 0.3, (range 0-1) in the non-mutation group (p < 0.01). All individuals with the mutation were missing the maxillary lateral incisors and one or more of the mandibular incisors; and 81.3% were missing all four. Stimulated saliva secretion was 0.9 ± 0.5 ml/min in the mutation group vs 1.7 ± 0.6 ml/min in the non-mutation group (p < 0.01). Reduced ability to sweat was reported by 82% in the mutation group and by 20% in the non-mutation group (p < 0.01). The mean NOT-S score was 3.0 ± 1.9 (range 0-6) in the mutation group and 1.5 ± 1.1 (range 0-5) in the non-mutation group (p < 0.01). Lisping was present in 56% of individuals in the mutation group.

    CONCLUSIONS: Individuals with a c.1072C > T mutation in the EDAR-gene displayed a typical pattern of congenitally missing teeth in the frontal area with functional consequences. They therefore have a need for special attention in dental care, both with reference to tooth agenesis and low salivary secretion with an increased risk for caries. Sweating problems were the most frequently reported symptom from other ectodermal structures.

  • 4. Falk Kieri, Catarina
    et al.
    Twetman, Svante
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Use of radiography in public dental care for children and adolescents in northern Sweden.2009In: Swedish Dental Journal, ISSN 0347-9994, Vol. 33, no 3, p. 141-8Article in journal (Refereed)
    Abstract [en]

    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.

  • 5.
    Grahn, K
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Wikström, S
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Nyman, Linda
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Attitudes about dental care among parents whose children suffer from severe congenital heart disease: a case-control study2006In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 16, no 4, p. 231-238Article in journal (Refereed)
    Abstract [en]

    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.

  • 6.
    Hansson, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Oral microflora and dietary intake in infants with congenital heart disease: a case control study2012In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 13, no 5, p. 238-243Article in journal (Refereed)
    Abstract [en]

    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.

  • 7.
    Hasslöf, Pamela
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Hedberg, Maria
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Microbiology.
    Twetman, Svante
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Growth inhibition of oral mutans streptococci and candida by commercial probiotic lactobacilli: an in vitro study2010In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 10, p. 18-Article in journal (Refereed)
    Abstract [en]

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

  • 8.
    Hedberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Microbiology.
    Hasslöf, Pamela
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Sjöström, I
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, S
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Sugar fermentation in probiotic bacteria: an in vitro study2008In: Oral Microbiology and Immunology, ISSN 0902-0055, E-ISSN 1399-302X, Vol. 23, no 6, p. 482-485Article in journal (Refereed)
    Abstract [en]

    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.

  • 9.
    Hedberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral Microbiology.
    Hasslöf, Pamela
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Sjöström, Inger
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Twetman, Svante
    University of Copenhagen.
    In vitro inhibition of mutans streptococci by probiotic lactobacilli2009Report (Other academic)
  • 10.
    Holgerson, Pernilla L
    et al.
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry. Pedodonti.
    Sjöström, Inger
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry. Pedodonti.
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry. Pedodonti.
    Twetman, Svante
    Dental plaque formation and salivary mutans streptococci in schoolchildren after use of xylitol-containing chewing gum.2007In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 17, no 2, p. 79-85Article in journal (Refereed)
    Abstract [en]

    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.

  • 11.
    Holgerson, Pernilla Lif
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, Svante
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Validation of an age-modified caries risk assessment program (Cariogram) in preschool children.2009In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 67, no 2, p. 106-112Article in journal (Refereed)
    Abstract [en]

    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.

  • 12. Keller, Mette Kirstine
    et al.
    Hasslöf, Pamela
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, Svante
    Co-aggregation and growth inhibition of probiotic lactobacilli and clinical isolates of mutans streptococci: an in vitro study2011In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 69, no 5, p. 263-268Article in journal (Refereed)
    Abstract [en]

    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.

  • 13. Keller, MK
    et al.
    Hasslöf, Pamela
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Dahlen, G
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, S
    Probiotic supplements (Lactobacillus reuteri DSM 17938 and ATCC PTA 5289) do not affect regrowth of mutans streptococci after full-mouth disinfection with chlorhexidine: a randomized controlled multicenter trial2012In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 46, no 2, p. 140-146Article in journal (Refereed)
    Abstract [en]

    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

  • 14.
    Lif Holgerson, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Stecksén-Blicks, Christina
    Sjöström, Inger
    Öberg, Monika
    Twetman, Svante
    Xylitol concentration in saliva and dental plaque after use of various xylitol-containing products2006In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 40, no 5, p. 393-397Article in journal (Refereed)
    Abstract [en]

    The study consisted of two sets of experiments, one in saliva and one in dental plaque. The xylitol concentration in saliva was determined enzymatically in 12 children (mean age 11.5 years) after a standardised use of various xylitol products: (A) chewing gums (1.3 g xylitol), (B) sucking tablets (0.8 g xylitol), (C) candy tablets (1.1 g xylitol), (D) toothpaste (0.1 g xylitol), (E) rinse (1.0 g xylitol), and (F) a non-xylitol paraffin. Unstimulated saliva was sampled 1, 3, 8, 16 and 30 min after use. The concentration in dental plaque was determined after mouthrinses with contrasting amounts of xylitol (LX = 2.0 g, HX = 6.0 g, and control) and supragingival plaque was collected and pooled after 5, 15 and 30 min. The mean xylitol concentration in saliva at baseline was approximately 0.1 mg/ml. All xylitol-containing products resulted in significantly increased levels (p < 0.05) immediately after intake and remained elevated for 8-16 min in the different groups. The highest mean value in saliva was obtained immediately after use of chewing gums (33.7 +/- 16.4 mg/ml) and the lowest was demonstrated after using toothpaste (8.2 +/- 4.9 mg/ml). No significant differences were demonstrated between chewing gums (A), sucking tablets (B), candy (C) and rinses (E). In dental plaque, the mean values were 8.6 +/- 5.4 and 5.1 +/- 4.0 mg/ml 5 min after HX and LX rinses. Concerning the higher concentration, the values remained significantly elevated (p < 0.05) during the entire 30-min follow-up. In conclusion, commonly advocated xylitol-containing products gave elevated concentrations of xylitol in unstimulated whole saliva and dental plaque for at least 8 min after intake. Copyright 2006 S. Karger AG, Basel.

  • 15.
    Lind, Lisbet K
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Lejon, Kristina
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    EDAR mutation in autosomal dominant hypohidrotic ectodermal dysplasia in two Swedish families2006In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 7, p. 80-Article in journal (Refereed)
    Abstract [en]

    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.

  • 16. Mejàre, Ingegerd A.
    et al.
    Klingberg, Gunilla
    Mowafi, Frida K.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Twetman, Svante H. A.
    Tranaeus, Sofia H.
    A Systematic Map of Systematic Reviews in Pediatric Dentistry: What Do We Really Know?2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 2, article id e0117537Article in journal (Refereed)
    Abstract [en]

    Objectives To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. Methods A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. Results Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. Conclusion There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.

  • 17. Oscarson, Per
    et al.
    Lif Holgerson, Pernilla
    Sjöström, Inger
    Twetman, Svante
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Influence of xylitol-containing tablets on mutans streptococci colonisation2006In: European Archives of Paediatric Dentistry, Vol. 7, no 3, p. 142-147Article in journal (Refereed)
    Abstract [en]

    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.

  • 18. Rizell, Sara
    et al.
    Barrenäs, Marie-Louise
    Andlin-Sobocki, Anna
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Kjellberg, Heidrun
    45,X/46,XX karyotype mitigates the aberrant craniofacial morphology in Turner syndrome2013In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 35, no 4, p. 467-474Article in journal (Refereed)
    Abstract [en]

    The aim of this project was to study the impact on craniofacial morphology from Turner syndrome (TS) karyotype, number of intact X chromosomal p-arms, and age as well as to compare craniofacial morphology in TS with healthy females. Lateral radiographs from 108 females with TS, ranging from 5.4 to 61.6 years, were analysed. The TS females were divided into four karyotype groups: 1. monosomy (45,X), 2. mosaic (45,X/46,XX), 3. isochromosome, and 4. other, as well as according to the number of intact X chromosomal p-arms. The karyotype was found to have an impact on craniofacial growth, where the mosaic group, with presence of 46,XX cell lines, seems to exhibit less mandibular retrognathism as well as fewer statistically significant differences compared to the reference group than the 45,X karyotype. Isochromosomes had more significant differences versus the reference group than 45,X/46,XX but fewer than 45,X. To our knowledge, this is the first time the 45,X/46,XX and isochromosome karyotypes are divided into separate groups studying craniofacial morphology. Impact from p-arm was found on both maxillary and mandibular length. Compared to healthy females, TS expressed a shorter posterior and flattened cranial base, retrognathic, short and posteriorly rotated maxilla and mandible, increased height of ramus, and relatively shorter posterior facial height. The impact of age was found mainly on mandibular morphology since mandibular retrognathism and length were more discrepant in older TS females than younger.

  • 19. Rizell, Sara
    et al.
    Barrenäs, M-L
    Andlin-Sobocki, Anna
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Kjellberg, Heidrun
    Turner syndrome isochromosome karyotype correlates with decreased dental crown width2012In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 34, no 2, p. 213-218Article in journal (Refereed)
    Abstract [en]

    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.

  • 20.
    Rosén, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sjöström, Inger
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Lundgren, Ted
    Intitute of Odontology, the Sahlgrenska acadamy, University of Gothenburg.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Acidity and in vitro effects on dental hard tissues of pharmaceutical preparations used in paediatric cardiologyManuscript (preprint) (Other academic)
    Abstract [en]

    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.

  • 21.
    Rosén, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sjöström, Inger
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Saliva profiles in children using heart failure medication: a pilot study2010In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 11, no 4, p. 187-191Article in journal (Refereed)
    Abstract [en]

    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.

  • 22.
    Rosén, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Experience of dental care for children with congenital heart disease among Swedish dentists2007In: Swedish Dental Journal, ISSN 0347-9994, Vol. 31, no 2, p. 85-90Article in journal (Refereed)
    Abstract [en]

    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.

  • 23.
    Sandström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Cressey, Janet
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Tooth-brushing behaviour in 6-12 year olds2011In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 21, no 1, p. 43-49Article in journal (Refereed)
    Abstract [en]

    Plaque removal from buccal surfaces from brushing was poor and averaged 19% for 6-year olds and 30% for older children. The results of brushing for children aged 8-12 years could benefit from increasing tooth-brushing time. Children could be given an increasing responsibility from 7 to 8 year of age but parental help is motivated up to 10 years of age.

  • 24.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Hasslöf, Pamela
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Kieri, Catarina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Widman, Kjerstin
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Caries and background factors in Swedish 4-year-old children with special reference to immigrant status2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 852-858Article in journal (Refereed)
    Abstract [en]

    Objective. This study assesses the prevalence of caries and some background factors in 4-year-old children in the city of Umse, northern Sweden, and compares this with data from earlier studies to reveal changes over time. Materials and methods. Children from the catchment areas of three Public Dental Health Service clinics in Umea (n = 224) born during the third quarter of 2008 were invited to undergo a clinical dental examination. Decayed surfaces (including both dentine and enamel, except for enamel lesions on buccal and lingual surfaces), missing and filled surfaces (dmfs) were recorded using the same methods and criteria as in a series of earlier studies performed between 1980-2007. Background data were collected in a case-history and a questionnaire. Results. The proportion of children with caries significantly decreased from 2007 (38%) to 2012 (22%) (p < 0.05). In addition, the distribution of dmfs differed significantly between these years (p < 0.05). More immigrant children had caries (42%) than non-immigrant children (15%) (p < 0.05). For children with caries, there were no significant changes in the distribution of dmfs between 1980-2012 (p > 0.05). An immigrant background was associated with a lower frequency of tooth brushing and a higher intake of ice cream, sweets and chocolate drinks (p < 0.05). Conclusion. Although the proportion of children with caries declined between 2007-2012, this decline was limited to non-immigrant children. Since 1980 the distribution of dmfs remained unchanged among children with caries. More research on interventions for changing oral health behaviours is needed, specifically for immigrant children.

  • 25.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Kieri, Catarina
    Umeå University, Faculty of Medicine, Odontology.
    Nyman, JE
    Umeå University, Faculty of Medicine, Odontology.
    Pilebro, Carin
    Umeå University, Faculty of Medicine, Odontology.
    Borssén, Eva
    Umeå University, Faculty of Medicine, Odontology.
    Caries prevalence and background factors in Swedish 4-year-old children - a 40-year perspective.2008In: International journal of paediatric dentistry, Vol. 18, no 5, p. 317-24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Periodic and well-controlled studies of caries and background factors are important for organizing dental care and how prevention should be addressed. AIMS: The aims of this study were to compare data on caries prevalence and background factors in 4-year-old children from 2007 with data collected periodically between 1967 and 2002 with the same methods and criteria, and to compare immigrant and non-immigrant children concerning caries prevalence and background factors. DESIGN: A cross-sectional study in 4-year-old children living in Umeå, northern Sweden (n = 218), was performed. Caries recordings included both cavitated and non-cavitated caries lesion, and bite-wing radiographs were used on indications. Data on oral hygiene, use of fluorides, general health, and medication and sugar consumption were collected using the same questions and questionnaire as in the previous studies. RESULTS: In 2007, 38% of the children displayed caries compared to 46% in 2002. The distribution of decayed, missing, or filled surfaces-primary teeth values was statistically significantly different in 2007 compared to 2002 (P < 0.05). The intake frequency of sugary between-meal products was generally lower, and toothbrushing frequency was higher in 2007 compared with data from the 2002 study. In children with immigrant background, the frequency of toothbrushing was statistically significantly lower, and snacking was more common (P < 0.05). Sixteen per cent had immigrant background and 59% had caries compared to 32% in the rest of the cohort (P < 0.01). CONCLUSION: Important changes in caries prevalence of 4-year-old children have taken place since 2002 concurrently with a decreased intake of sugary between-meal products and increased toothbrushing frequency. Immigrant background had a significant association with caries prevalence in 2007.

  • 26.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, Svante
    Department of Cariology and Endodontics, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
    Effect of xylitol and xylitol-fluoride lozenges on approximal caries development in high-caries-risk children2008In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 18, no 3, p. 170-177Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the effect of xylitol- and xylitol/fluoride-containing lozenges on approximal caries development in young adolescents with high caries risk.

    Study design: A 2-year double-blind trial with two parallel arms and a nonrandomized reference group.

    Material and methods: One hundred and sixty healthy 10- to 12-year-old children with high caries risk were selected. After informed consent, they were randomly assigned into a xylitol and a xylitol/fluoride group. They were instructed to take two tablets three times a day (total xylitol and fluoride dose 2.5 g and 1.5 mg, respectively). The compliance was checked continuously and scored as good, fair, or poor. A reference no-tablet group was also selected (n = 70) for group comparison. The outcome measure was approximal caries incidence.

    Results: The dropout rate was 28%, and 41% exhibited a good compliance with the study protocol. No statistically significant differences in caries incidence could be found between the study groups (P > 0.05). Among a subgroup of children who demonstrated good compliance, the mean DeltaDMFSa value was significantly lower in the xylitol/fluoride group compared to the xylitol group, 1.0 +/- 2.3 vs. 3.3 +/- 4.6 (P < 0.05), while no difference could be displayed between any of the study groups and the reference group (P > 0.05).

    Conclusions: The results from this 2-year trial did not support a self-administered regimen of xylitol- or xylitol/fluoride-containing lozenges for the prevention of approximal caries in young adolescents with high caries risk.

  • 27.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Lif-Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, Svante
    Caries risk profiles in two-year-old children from northern Sweden2007In: Oral health & preventive dentistry, ISSN 1602-1622, Vol. 5, no 3, p. 215-221Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate existing caries risk factors in preschool children and to illustrate their caries risk profiles graphically with aid of a computer-based program.

    Materials and Methods: All 2-year-old children from a small town in northern Sweden were invited and 87% (n = 125) accepted to participate. Data was collected with a questionnaire concerning the child’s normal diet and sugar consumption. Special care was taken to note the intake of sweet drinks and sugary between-meal products. Questions on general health and medication, toothbrushing frequency with parental help and use of fluorides were also included. The caries prevalence was recorded with mirror and probe and the level of oral mutans streptococci was enumerated with a chair-side technique. The obtained data were computerised in a risk assessment program (Cariogram) and a graphical profile of each child was constructed.

    Results: The caries prevalence was 6%, and 18% had detectable levels of oral mutans streptococci. The sugar consumption was strikingly high with 82% and 97% having ice cream and sweets once a week or more often. In 22% of the families, toothbrushing with parental help was not a daily routine. Of the children, 51% displayed a low chance (0–20%) of avoiding caries in the future. The frequency of sugar consumption was the most pertinent factor in the children’s caries risk profiles.

    Conclusions: Half of the subjects exhibited a low chance of avoiding caries in the near future and the strongest single factor was frequent sugar consumption. Thus efforts to limit and reduce the sugar intake in young children are important measures for primary caries prevention.

  • 28.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Renfors, G
    Nils, Oscarson
    Bergstrand, F
    Twetman, Svante
    Caries-Preventive Effectiveness of a Fluoride Varnish: A Randomized Controlled Trial in Adolescents with Fixed Orthodontic Appliances.2007In: Caries research, Vol. 7, no 41, p. 455-459Article in journal (Refereed)
    Abstract [en]

    The aim was to evaluate the efficacy of topical fluoride varnish applications on white spot lesion (WSL) formation in adolescents during treatment with fixed orthodontic appliances. The study design was a double-blinded randomized placebo-controlled trial with two parallel arms. The subjects were 273 consecutive 12- to 15-year-old children referred for maxillary treatment with fixed orthodontic appliances. The patients were randomly assigned to a test or a control group with topical applications of either a fluoride varnish (Fluor Protector) or a placebo varnish every 6th week during the treatment period. The outcome measures at debonding were incidence and progression of WSL on the upper incisors, cuspids and premolars as scored from digital photographs by 2 independent examiners. The attrition rate was 5%. The mean number of varnish applications was 10 (range 4-20) in both groups. The incidence of WSL during the treatment with fixed appliances was 7.4% in the fluoride varnish compared to 25.3% placebo group (p < 0.001). The mean progression score was significantly lower in the fluoride varnish group than in the placebo group, 0.8 +/- 2.0 vs. 2.6 +/- 2.8 (p < 0.001). The absolute risk reduction was 18% and the number needed to treat was calculated to 5.5. The results from the present study strongly suggest that regular topical fluoride varnish applications during treatment with fixed appliances may reduce the development of WSL adjacent to the bracket base. Application of fluoride varnish should be advocated as a routine measure in orthodontic practice. Copyright (c) 2007 S. Karger AG, Basel.

  • 29.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nyman, Linda
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Asplund, S
    Svanberg, C
    Dental caries experience in children with congenital heart disease: a case-control study2004In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 14, no 2, p. 94-100Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare the dental health in a group of children with complex congenital heart disease with age and gender matched healthy controls.

    Design: Case-control study.

    Setting: Faculty of Medicine and Odontology/ Pediatric cardiology and Pedodontics, Umeå university, Sweden

    Sample and Methods: All the cases and their controls lived in the county of Västerbotten in northern Sweden. Each group comprised 41 children with a mean age of 6.5 years. Data were collected from medical and dental records. All bitewing radiographs were read separately by one of the authors.

    Results: Children with congenital heart disease had significantly more caries in their primary teeth than the control group. The mean dmfs-value was 5.2 + 7.0 in the cardiac group compared to 2.2 + 3.5 in the control group (p < 0.05). Twenty-six of the children had all four 6-year molars, and their mean DMFS-values were 0.9 + 1.9 in the cardiac group compared to 0.3 + 0.6 in the control group (p > 0.05). The children with congenital heart disease had received more caries prevention based on the use of fluorides than the control group. There was a significant correlation between the number of fluoride varnish treatments and the dmfs value of the child (r = 0.411, p < 0.01). Fifty-two per cent of the children in the cardiac group were prescribed fluoride tablets on one or more occasions compared to 17% in the control group (p < 0.01). Number of month on digoxin medication and the dmfs-value had a significant correlation (r = 0.368, p < 0.05). Ten of the children had been on digoxin medication between 6 and 87 months and they had a mean dmfs-value of 10.1 + 8.5.

    Conclusion: Swedish children with complex congenital heart disease have poorer dental health than healthy age and gender matched controls in spite of intensified preventive efforts. In many cases, intervention had been given when caries were present. A closer cooperation between paediatric cardiology and paediatric dentistry is needed.

  • 30.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Twetman, Svante
    Caries distribution in the dentition and significant caries index in Swedish 4-year-old children 1980-2002.2006In: Oral Health and Preventive Dentistry, Vol. 4, no 3, p. 209-14Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To analyse possible changes in the severity and distribution of dental caries within the dentition in five groups of 4-year-old children examined with the same methods and criteria between 1980 and 2002. MATERIALS AND METHODS: The material consisted of retrospective caries recordings from cross-sectional studies performed in 1980, 1987, 1992, 1997 and 2002 in Umea, Sweden. The distribution of dmfs within the dentition was analysed in the whole groups and in one third of each group with the highest dmfs-values (mSiC-index). RESULTS: When comparing the whole groups, no statistically significant changes were found over the years concerning total dmfs, or dmfs in molars and canines or in occlusal surfaces (p > 0.05). There was a significant increase in dmfs-values in incisors observed between 1980 and 1987, while a similar reduction was observed between 1987 and 1992 (p < 0.05). When comparing subgroups constituting 33% of those with the highest dmfs-values for all teeth in each group, the mean values of dmfs for all teeth was higher in 2002 than in 1997 (6.0 compared with 5.3), but the rank sum test of dmfs-values displayed a non-significant difference (p > 0.05). There was, however, a statistically significant increase in the dmfs-values for molars and canines between 1997 and 2002 (p < 0.05). Between 1987 and 1992, a statistically significant decrease in dmfs-values in incisors (p < 0.01) was found, while the opposite trend occurred between 1992 and 1997 (p < 0.05). CONCLUSION: By analysing caries distribution within the dentition and in subgroups, trends can be detected over time that otherwise are obscured. The findings should be considered in future epidemiological studies, as even significant changes could be overlooked and disregarded.

  • 31.
    Stecksen-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Sunnegårdh, Karin
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Borssen, Eva
    Caries experience and background factors in 4-year-old children: time trends 1967-2002.2004In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 38, no 2, p. 149-155Article in journal (Refereed)
    Abstract [en]

    In cross-sectional studies conducted in 1967, 1971, 1976, 1980, 1987, 1992, 1997 and 2002, 4-year-old children in Umea, a city in northern Sweden, were examined for dental caries and background factors such as oral hygiene habits, use of fluorides, and sugar consumption. The same methods and criteria have been used in each of the studies from 1967 to 2002. The number of children with caries had declined from 87% in 1967 to 42% in 1987, but then the decline levelled out. In 2002, 46% of the children had caries with a mean dmfs value of 2.0 +/- 3.6. Six percent of the children had 10 or more dmfs. Immigrant children had a higher caries prevalence (p < 0.01). A significant difference in the dmfs values was found in children according to tooth-brushing frequency (p < 0.01). Although the consumption of sugary products between meals increased between 1987 and 1997, no changes were noted from 1997 to 2002. In conclusion, no important changes in caries prevalence have taken place during the last 15 years. The frequency of tooth-brushing and immigrant background had a significant association with caries prevalence.

  • 32.
    Stecksén Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Karies hos barn: ett folkhälsoproblem2012In: Barnläkaren, ISSN 1651-0534, no 6, p. 12-13Article in journal (Other academic)
    Abstract [sv]

    Karies är ett folkhälsoproblem som kan kopplas både till biologi och till frågor som rör sociala förhållanden och livsstil. Trots att det finns starkt vetenskapligt stöd för hur karies kan förebyggas – kvarstår problematiken och många drabbas. Karies är fortfarande ett stort problem hos barn med en tydlig och ökande polarisering mot socioekonomiskt svaga grupper.

  • 33.
    Stecksén-Blicks, C
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Sjöström, I
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, S
    Effect of Long-Term Consumption of Milk Supplemented with Probiotic Lactobacilli and Fluoride on Dental Caries and General Health in Preschool Children: A Cluster-Randomized Study.2009In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 43, no 5, p. 374-381Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effect of milk supplemented with probiotic bacteria and fluoride on caries development and general health in preschool children. Children 1-5 years of age (n = 248) attending 14 day care centres with 27 units in northern Sweden entered the study. The centres were randomly assigned to two parallel groups: children in the intervention group were served 150 ml milk supplemented with Lactobacillus rhamnosus LB21 (10(7) CFU/ml) and 2.5 mg fluoride per litre for lunch while the control group received standard milk. The double-blind intervention lasted for 21 months (weekdays) and data were collected through clinical examinations and questionnaires. The primary outcome was caries increment and secondary outcomes were measures of general health. The dropout rate was 25%. The mean baseline caries experience was 0.5 dmfs in the intervention units and 0.6 in the control units and after 21 months 0.9 and 2.2 (p < 0.05). The number of days with sick leave was similar in both groups but the children of the intervention units displayed 60% fewer days with antibiotic therapy (mean 1.9 vs. 4.7 days) and 50% less days with otitis media (0.5 vs. 1.0) (p > 0.05). In children who had participated during the whole 21-month intervention, fewer days with otitis media were reported (0.4 vs. 1.3 days, p < 0.05). No serious side effects were reported. It is concluded that daily consumption of milk containing probiotic bacteria and fluoride reduced caries in preschool children with a prevented fraction of 75%. Additional beneficial health effects were evident.

  • 34.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry. Umeå University, Faculty of Medicine, Department of Odontology, Oral Microbiology.
    Epidemiological studies of dental caries in groups of Swedish children1986Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In a cross-sectional study the extent and distribution of dental caries was studied in 817 children, 4, 8 and 13 years old in three areas inSweden. The importance of dietary habits, sugar intake, social conditions, professional dental care, oral hygiene and the use of fluorides on caries prevalence was analyzed. In a subsample, con­sisting of 88 8-year-olds and 91 13-year-olds the net caries increment during aone-year period was studied.In this longitudinal study, the salivary levels of lactobacllli and S. mutans were determined and correlated to sugar intake and caries increment.

    The cross-sectional study showed obvious differences in caries preva­lence among the studied areas. These differences could mainly be explained by variations in the age from which children had received professional dental care, frequency of tooth-brushing and the use of topical fluorides. There were no differences in dietary habits or sugar intake that could explain the differences in caries prevalence among the areas studied.

    Examples are given of how changes in some determinants may affect the caries prevalence by means of path analysis.

    The longitudinal study showed that caries Increment was higher when sugar intake and meal frequency were high (> the mean value for the age group). The highest mean caries increment was found in children with high prevalence of lactobacllli and S. mutans in the saliva combined with a high sugar intake.

    Groups of children with high salivary levels of both Iactobac ì II i and S. mutans developed 3-4 times more caries than other children. This relation did not always exist in the Individual case.

    Children with a low caries Increment during one year (0-2 surfaces) brushed their teeth more often and rinsed their mouths more frequently with fluoride solution than children with a high caries increment (> 3 surfaces). The use of fluoridated toothpaste was somewhat more common, however, in the low carles increment group only in the.8-year-oIds.

    The gingival status was used as a measure of oral hygiene and gingivitis scores revealed statistically significant differences between groups with a low caries increment and a high carles increment (p < 0.01, p < 0.05) in the two age groups, respectively.

    With the variables frequency of meals, total sugar intake, salivary level of lactobacilli and S. mutans, oral hygiene and use of topical fluorides the net caries increment during one year could be correctly predicted in 79 % of the 8-year-olds and 81 % of the 13-year-olds when the children were divided Into two groups according to their net car­ies increment; 0-2 surfaces and > 3 surfaces.

  • 35.
    Stecksén-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Olsson, Martin
    Bylund, Britt
    Sjöström, Inger
    Umeå University, Faculty of Medicine, Department of Odontology.
    Sköld-Larasson, Kerstin
    Kalfas, Sotos
    Twetman, Svante
    Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances2004In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 112, no 3, p. 244-248Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate two dose regimens of xylitol-containing tablets on the ecology of dental plaque and saliva during treatment with fixed orthodontic appliances. The study group comprised 56 healthy patients (mean age 15.8 yr) randomly assigned into the following groups: A, (n = 23) two xylitol tablets two times a day (1.7 g xylitol d(-1)) for 18 wk; B, (n = 23) two tablets four times per day (3.4 g xylitol d(-1)) for 18 wk; and C, (n = 10) no tablets. The levels of mutans streptococci (ms) were enumerated in plaque and saliva and the proportion of xylitol-sensitive (X(S)) strains in saliva was determined by autoradiography with [(14)C]-xylitol at baseline and at 6, 12, and 18 wk. The lactic acid formation rate was assessed enzymatically in sucrose-challenged plaque suspensions. A drop in salivary ms levels was found in Group A after 6 wk but not after 12 or 18 wk. The proportion of X(S) ms was decreased after 6 wk in groups A and B and remained so during the experimental period. The lactic acid formation rates decreased slightly ( approximately 10%) in the two xylitol groups compared with baseline. In conclusion, our results showed that although an alteration of ms strains was demonstrated following a regular daily low-dose intake of xylitol, the long-term total ms counts in plaque and saliva as well as plaque acidogenicity remained unchanged.

  • 36. Twetman, Lisa
    et al.
    Larsen, Ulla
    Fiehn, Nils-Erik
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Twetman, Svante
    Coaggregation between probiotic bacteria and caries-associated strains: an in vitro study2009In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 67, no 5, p. 284-288Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the in vitro abilities of probiotic bacteria derived from consumer products to coaggregate with caries-associated mutans streptococci.

    Material and Methods. Six lactobacillus strains (L. acidophilus (CCUG 5917), L. plantarum 299v, L. rhamnosus GG and LB21, L. paracasei F19, L. reuteri PTA5289) were cultivated under anaerobic conditions at 37 degrees C in Man Rogosa Sharpe (MRS) broth for 24 h. Four strains of human streptococci (S. mutans Ingbritt, S. mutans (ATCC 25175), S. mutans GS-5, S. sobrinus (ATCC 33478) were similarly grown in Brain Heart Infusion (BHI) broth. A gastrointestinal pathogen (Escherichia coli) was aerobically cultivated on BHI broth as a positive control. After incubation, the bacteria were aerobically harvested, washed, and suspended in 10 mmol/l phosphate-buffered saline (pH 7.2). The probiotic strains were characterized with the API 50 CH system to confirm their identity. Coaggregation was determined by spectrophotometry in mixtures and bacterial suspensions alone after 1, 2, 4, and 24 h and expressed as the aggregation ratio (%).

    Results. All probiotic strains showed coaggregation abilities with the oral pathogens and the results were strain specific and dependent on time. S. mutans GS-5 exhibited a significantly higher ability to coaggregate with all the probiotic strains than the other mutans streptococci and E. coli. The differences among the probiotic strains were modest with L. acidophilus being the most prone and L. rhamnosus LB21 the least prone to coaggregate with the oral streptococci.

    Conclusions. The results demonstrated different abilities of lactobacilli-derived probiotic bacteria to coaggregate with selected oral streptococci. Aggregation assays may be a useful complement for screening of probiotic candidates with possible anti-caries properties.

  • 37. Twetman, Svante
    et al.
    Derawi, Bilal
    Keller, Mette
    Ekstrand, Kim
    Yucel-Lindberg, Tulay
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Short-term effect of chewing gums containing probiotic Lactobacillus reuteri on the levels of inflammatory mediators in gingival crevicular fluid2009In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 67, no 1, p. 19-24Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the effect of a chewing gum containing probiotic bacteria on gingival inflammation and the levels of selected inflammatory mediators in gingival crevicular fluid (GCF). MATERIAL AND METHODS: Forty-two healthy adults with moderate levels of gingival inflammation entered a double-blind placebo-controlled study design. The subjects were randomly assigned to one of three parallel arms: Group A/P was given one active and one placebo gum daily, Group A/A received two active chewing gums, and Group P/P two placebo gums. The chewing gums contained two strains of Lactobacillus reuteri: ATCC 55730 and ATCC PTA 5289 (1 x 10(8) CFU/gum, respectively). The subjects were instructed to chew the gums for 10 min over the course of 2 weeks. Bleeding on probing (BOP) and GCF sampling were conducted at baseline and after 1, 2 and 4 weeks. The levels of IL-1beta, TNF-alpha, IL-6, IL-8 and IL-10 were determined using luminex technology and multiplex immunoassay kits. RESULTS: BOP improved and GCF volume decreased in all groups during the chewing period, but the results were statistically significant (p<0.05) only in Groups A/P and A/A. The levels of TNF-alpha and IL-8 decreased significantly (p<0.05) in Group A/A compared with baseline after 1 and 2 weeks, respectively. A non-significant decreasing tendency was also observed concerning IL-1beta during the chewing period. The levels of IL-6 and IL-10 were unaffected in all groups after 1 and 2 weeks. CONCLUSIONS: The reduction of pro-inflammatory cytokines in GCF may be proof of principle for the probiotic approach combating inflammation in the oral cavity.

  • 38. Twetman, Svante
    et al.
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Probiotics and oral health effects in children.2008In: International journal of paediatric dentistry, Vol. 18, no 1, p. 3-10Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    BACKGROUND: Probiotics are living micro-organisms added to food which beneficially affect the host by improving its intestinal microbial balance. OBJECTIVE: This paper aims to present a general background on probiotics and its health effects in children, and to examine the evidence for oral colonization and the possible impact on oral health in children and young adults. METHODS: For delivery and general health effects, recent systematic reviews, meta-analyses, and other relevant papers were used. Concerning oral installation and oral effects, a broad search for publications in English was conducted through February 2007 in PubMed. Studies describing an installation or intervention trial in humans with a controlled design and an oral endpoint measure were considered. Fourteen papers with dental focus were identified, of which two were narrative reviews. RESULTS: Only one study of dental interest was conducted in children. Four papers dealt with oral installation of probiotic bacteria, and although detectable levels were found in saliva shortly after intake, the studies failed to demonstrate a long-term installation. Seven papers evaluated the effect of lactobacilli- or bifidobacteria-derived probiotics on the salivary levels of caries-associated bacteria in placebo-controlled designs. All but one reported a hampering effect on mutans streptococci and/or yeast. The single study carried out in early childhood reported a significant caries reduction in 3- to 4-year-old children after 7 months of daily consumption of probiotic milk. CONCLUSION: Bacteriotheraphy in the form of probiotic bacteria with an inhibitory effect on oral pathogens is a promising concept, especially in childhood, but this may not necessarily lead to improved oral health. Further placebo controlled trials that assess carefully selected and defined probiotic strains using standardized outcomes are needed before any clinical recommendations can be made.

  • 39.
    Vestman, Nelly Romani
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Hasslöf, Pamela
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Keller, Mette K
    Granström, Elisabeth
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Roos, Stefan
    Twetman, Svante
    Stecksen-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Lactobacillus reuteri influences regrowth of mutans streptococci after full-mouth disinfection: a double-blind, randomised controlled trial2013In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 47, no 4, p. 338-345Article in journal (Refereed)
    Abstract [en]

    This study assessed whether the persistence of Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 in saliva could delay the regrowth of mutans streptococci (MS) after a full-mouth disinfection with chlorhexidine (CHX). A randomised, double-blind, placebo-controlled study with a 6-week intervention period and 3- and 6-month follow-up was performed. 62 healthy subjects with moderate to high counts of MS were randomly assigned to a test group (n = 32) or a placebo group (n = 30). Before onset of the intervention, subjects received two sessions of professional cleaning, flossing, and application of CHX varnish and rinsed their mouth with a CHX solution between the sessions (2 days). Thereafter, the test group used probiotic lozenges (2/day) containing L. reuteri (DSM 17938 and ATCC PTA 5289; 1 × 108 CFU of each strain), and the placebo group used identical lozenges lacking the lactobacilli. Saliva samples were collected and cultured onto selective media, and isolates of L. reuteri as well as DNA directly extracted from saliva were tested by polymerase chain reaction (PCR) with specific primers. Presence of salivary MS was analysed with a chair-side test. L. reuteri was frequently detected by culture during the intervention period but in only 3 test group subjects at follow-ups. Regrowth of MS statistically significantly differed depending on the presence or absence of L. reuteri DSM 17938 detected by PCR. We conclude that cultivable L. reuteri strains may only sporadically be confirmed after termination of the intervention, but subjects with PCR-detected L. reuteridemonstrated slower regrowth of MS.

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