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  • 101.
    Ebrahimi, Majid
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Boldrup, Linda
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Wahlin, Ylva-Britt
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Coates, Philip J
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Decreased expression of the p63 related proteins beta-catenin, E-cadherin and EGFR in oral lichen planus2007In: Oral Oncology, ISSN 1368-8375, E-ISSN 1879-0593, Vol. 44, no 7, p. 634-638Article in journal (Refereed)
    Abstract [en]

    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.

  • 102.
    Ebrahimi, Majid
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Endodontics.
    Lundqvist, L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Wahlin, Ylva-Britt
    Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Mucosal lichen planus a systemic disease requiring multidisciplinary care2012In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 18, no Special Issue, Suppl. 1, p. 21-21Article in journal (Other academic)
  • 103.
    Ebrahimi, Majid
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Endodontics. Umeå University, Faculty of Medicine, Department of Odontology, Oral Diagnostics.
    Lundqvist, Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Wahlin, Ylva Britt
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Mucosal lichen planus, a systemic disease requiring multidisciplinary care: a cross-sectional clinical review from a multidisciplinary perspective2012In: Journal of Lower Genital Tract Disease, ISSN 1089-2591, E-ISSN 1526-0976, Vol. 16, no 4, p. 377-380Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aimed to emphasize the importance of seeing mucosal lichen planus (LP) as a systemic disease and not an isolated oral or genital disease and to analyze the proportion of thyroid antibodies among patients with multimucosal LP.

    MATERIALS AND METHODS: All patients examined by the authors and diagnosed with mucosal LP within 1 year were consecutively included. Full medical histories were collected with special emphasis on autoimmune and thyroid diseases. Sera were analyzed for thyroid antibodies and underwent serologic test for herpes virus. The control group comprised 83 healthy volunteers matched regarding sex and age.

    RESULTS: Of the patients, 120 were included, 89 (74%) of whom were women and 31 (26%) were men. The vast majority of the patients had multifocal lesions, whereas oral lesions solely were found in 28% of women and 36% of men. Of the patients, 28% had at least 1 additional autoimmune disease. Approximately half of the women were treated with levothyroxine owing to thyroid disease. Antibodies against herpes simplex virus were found in 60% of the patients and 44% of the controls (p < .03).

    CONCLUSIONS: Lichen planus with mucosal involvement should be considered and taken care of as a systemic disease and not as an isolated oral and/or genital lichen. Contradictory to many former reports, most of our patients have a multimucosal disease that emphasizes the need for a multidisciplinary clinic to get optimal care and treatment.

  • 104.
    Ebrahimi, Majid
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    van der Waal, Isaäc
    Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam .
    Letter to the editor: Reply to H. M. Ögmundsdóttir & W. P. Holbrook by M. Ebrahimi et al.2011In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 40, no 9, p. 732-Article in journal (Refereed)
  • 105.
    Ebrahimi, Majid
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Endodontics.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Van Der Waal, Isaäc
    Oral lichen planus and the p53 family: what do we know?2011In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 40, no 4, p. 281-285Article in journal (Refereed)
    Abstract [en]

    J Oral Pathol Med (2010) Oral lichen planus (OLP) is a relatively common chronic disease of the oral mucosa for which the aetiopathogenesis is not fully understood. It mainly affects middle aged and elderly. The finding of autoantibodies against p63, a member of the p53 family, is a strong indication of autoimmunity as a causative or contributing factor. The WHO classified OLP as a potentially malignant disorder, but still there is an ongoing debate in the literature on this subject. The TP53 gene encodes a tumour suppressor protein that is involved in induction of cell-cycle arrest or apoptosis of DNA-damaged cells. The p63 gene encodes six different proteins that are crucial for formation of the oral mucosa and skin. The coordinated stabilization of p53 and decreased expression of p63 seen in OLP cause induction of apoptosis enabling removal of DNA-damaged cells. In view of the complexity of cancerogenesis, no firm statement can at present be made about the relevance of the observed relationship between p53 and p63 and the possible malignant transformation of OLP.

  • 106. Eckerbom, M
    et al.
    Flygare, Lennart
    Department of Maxillofacial Radiology, Sunderby Sjukhus, Luleå, Sweden.
    Magnusson, T
    A 20-year follow-up study of endodontic variables and apical status in a Swedish population2007In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 40, no 12, p. 940-948Article in journal (Refereed)
    Abstract [en]

    AIM: To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings.

    METHODOLOGY: One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered.

    RESULTS: The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings.

    CONCLUSIONS: There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up.

  • 107.
    Ekman, Agneta
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    On dental health and related factors in Finnish immigrant children in Sweden1989Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    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.

  • 108. Elcock, C
    et al.
    Smith, RN
    Abdellatif, A
    Bäckman, B
    Umeå University, Faculty of Medicine, Odontology.
    Brook, AH
    Simpson, J
    The new enamel defects index: Testing and expansion2006In: European Journal of Oral Science, Vol. 114, no suppl 1, p. 35-38Article in journal (Refereed)
    Abstract [en]

    The Enamel Defects Index (EDI) was created based on three innovative principles: (i) a basic level of the three major categories of defects; (ii) more detailed subcategories of each major category: and (iii) each category scored independently as present ﴾1﴿or absent ﴾0﴿, simplifying decision making. The aim of this investigation was to further test the index in a number of applications and to expand it to record defect subtype and treatment need. Testing was undertaken by operators with different levels of clinical experience. A computer-assisted learning (CAL) package was developed for operator training and calibration. The index was also used on clinical photographs and high-resolution digital images of exfoliated and extracted teeth. Scoring of photographs revealed substantial intra-operator agreement. Training using the CAL package resulted in significant improvement in index use. Intra-operator reproducibility was good to excellent, and interoperator reproducibility was good for buccal surfaces on digital images. Index expansion allowed information on defect subtype, location, and treatment need to be gathered readily. The EDI has high reproducibility and allows more rapid and accurate data collection from clinical and in vitro studies than the Fédération Dentaire Internationale Developmental Defects of Enamel index.

  • 109. Elcock, C
    et al.
    Smith, RN
    Bäckman, Birgitta
    Umeå University, Faculty of Medicine, Odontology.
    Brook, AH
    Simpson, J
    Comparison of methods for measurement of hypoplastic lesions2006In: European Journal of Oral Science, Vol. 114, no suppl 1, p. 365-369Article in journal (Refereed)
    Abstract [en]

    Enamel hypoplasia is a quantitative defect of enamel thickness. Methods previously used for its measurement have limitations in clinical studies. The aim of this study was to investigate new methods of measurement using image analysis. Lesions on 8 teeth affected by enamel hypoplasia were quantified from study models and impression surfaces using an image-analysis system. The measurements made included lesion area and tooth surface area; from these the proportion of tooth surface area affected was calculated. For comparison, manual measurement was performed on impression surfaces and study models, using digital callipers. Images were also acquired of lesions on 12 exfoliated teeth, and the lesion area and total tooth area were calculated. For assessment of intra-operator reliability, the +/-repeatability coefficient was calculated. Measurement of the surface lesions direct from the exfoliated teeth gave the best results overall, followed by direct image analysis of the silicone impression.

  • 110.
    Emanuelsson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Allen, Carl M.
    Rydin, Katarina
    Sjöström, Mats
    Umeå University, Faculty of Medicine, Department of Odontology.
    Osteoblastoma of the temporal articular tubercle misdiagnosed as a temporomandibular joint disorder2017In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 46, no 5, p. 610-613Article in journal (Refereed)
    Abstract [en]

    This is a case report of a benign osteoblastoma in the temporomandibular joint of a 17-year-old female. The patient had a two-and-a-half-year history of reduced mouth opening accompanied by tenderness and swelling in the left temporomandibular joint (TMJ). Initial treatment included stabilization of occlusion with a splint, jaw exercise and analgesics. At first symptoms decreased, but then increased 18 months later, prompting evaluation by a cone beam computed tomography (CBCT) scan of the joint. The radiographic findings showed a somewhat ill-defined, radiolucent, expansile lesion containing small scattered calcifications. The lesion was removed under general anesthesia and sent for histopathological examination. At 12-month follow-up the patient had normal function in the TMJ without clinical symptoms. CBCT examination showed a small recurrence of 3 millimeter. Another 12 months later CBCT showed a 1 mm increase of the recurrence. Function was normal with a subtle tenderness lateral to the left TMJ. The decision from a multidisciplinary meeting was further annually follow-up. The present case illustrates the importance of radiographic examination of patients with temporomandibular dysfunction when conservative treatment of symptoms does not relieve pain or swelling.

  • 111.
    Engström, Kristina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry. Pedodonti.
    LG, Pettersson
    Svante, Twetman
    Inhibition of enamel lesion formation by fluoridated milk assessed by laser fluorescence: an in vitro study.2006In: Clinical oral investigations, Vol. 10, no 3, p. 249-252Article in journal (Refereed)
    Abstract [en]

    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.

  • 112. Engström, Marianne
    et al.
    Eriksson, Kaja
    Lee, Linkiat
    Hermansson, Monika
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nicholas, Anthony P.
    Gerasimcik, Natalija
    Lundberg, Karin
    Klareskog, Lars
    Catrina, Anca Irinel
    Yucel-Lindberg, Tülay
    Increased citrullination and expression of peptidylarginine deiminases independently of P. gingivalis and A. actinomycetemcomitans in gingival tissue of patients with periodontitis2018In: Journal of Translational Medicine, ISSN 1479-5876, E-ISSN 1479-5876, Vol. 16, article id 214Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A relationship between rheumatoid arthritis (RA) and periodontitis has been suggested from findings that individuals with RA are prone to have advanced periodontitis and vice versa. In search of possible common pathogenetic features of these two diseases, we investigated the presence of citrullinated proteins and expression of endogenous peptidylarginine deiminases (PAD2 and PAD4), in periodontal tissue of individuals with periodontitis and healthy controls, in relation to the periodontal pathogens Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), producing leukotoxin as virulence factor. These two oral bacteria have been suggested to be linked to anti-citrullinated protein antibodies in patients with RA.

    METHODS: Gingival tissue biopsies were obtained from 15 patients with periodontitis and 15 individuals without periodontal disease. Presence of CD3-positive lymphocytes, citrullinated proteins, PAD2, PAD4, P. gingivalis as well as A. actinomycetemcomitans and Mannheimia haemolytica produced leukotoxins were analysed by immunohistochemistry, followed by triple-blind semi-quantitative analysis. Mann-Whitney and Fisher's exact tests were used to analyse differences between groups. PADI2 and PADI4 mRNA levels were assessed by RT-qPCR and analysed using Wilcoxon signed rank test.

    RESULTS: Increased staining of citrullinated proteins was observed in gingival connective tissue from subjects with periodontitis (80%, 12/15) compared to healthy gingival tissue (27%, 4/15), whereas no differences were observed in gingival epithelium. There was also an increased staining of the citrullinating enzymes PAD2 and PAD4 in gingival connective tissue of patients with periodontitis whereas similar levels of PAD2 and PAD4 were observed in the gingival epithelium of the two groups. Similarly, the mRNA levels of PADI2 and PADI4 were also increased in the gingival tissue of patients with periodontitis compared to healthy controls. Furthermore, presence of P. gingivalis and leukotoxins was comparable in both epithelium and connective tissue, from the different investigated individuals with and without periodontitis, and there were no correlations between the presence of periodontal pathogens and the expression of citrullinated proteins or PAD enzymes.

    CONCLUSION: Chronic gingival inflammation is associated with increased local citrullination and PAD2 and PAD4 expression in periodontitis. The increased citrullination and PAD2 and PAD4 expression in periodontitis were, however, independent of the presence of periodontal pathogen P. gingivalis and A. actinomycetemcomitans leukotoxin.

  • 113. Engvall, Inga-Lill
    et al.
    Svensson, Björn
    Boonen, Annelies
    van der Heijde, Désirée
    Lerner, Ulf H
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hafström, Ingiäld
    Low-dose prednisolone in early rheumatoid arthritis inhibits collagen type I degradation by matrix metalloproteinases as assessed by serum 1CTP--a possible mechanism for specific inhibition of radiological destruction2013In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 52, no 4, p. 733-742Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the effects of low-dose prednisolone on the osteoclast-regulating proteins osteoprotegerin (OPG) and RANK ligand (RANKL) and on markers of bone resorption, 1CTP generated by MMPs and CTX-1 generated by cathepsin K, in patients with early RA in relation to inflammation and joint destruction.

    METHODS: In 225 patients, who at the start of the first DMARD had been randomized to 7.5 mg prednisolone daily for 2 years, the P-group, or no prednisolone, the NoP-group, OPG and RANKL were analysed at 0-24 months and 1CTP and CTX-1 at 0-12 months. Radiographs of hands and feet were assessed at 0, 1 and 2 years using the modified Sharp-van der Heijde score and radiological progression defined as increase in total Sharp score above 5.8. Data were analysed with a mixed linear model and by the GENMOD procedure.

    RESULTS: In the P-group, RANKL and the ratio OPG/RANKL were stable between baseline and 24 months, whereas in the NoP-group, RANKL increased and the ratio OPG/RANKL decreased. CTX-1 decreased significantly more in the P-group. 1CTP decreased over time in both groups, but more in the P-group, P < 0.001, a difference also present in the subgroups of patients in remission. The decrease in 1CTP was associated with less radiological progression after 2 years and displayed a significant interaction with treatment. CONCLUSION: Low-dose prednisolone may inhibit progression of joint destruction by interfering with MMP activity, seen as a marked decrease in 1CTP, as well as by impairing osteoclast activation, shown by a stable OPG/RANKL ratio.

  • 114.
    Ennibi, Oum Keltoum
    et al.
    Department of Periodontology, School of Dentistry, Mohammed V University, Morocco.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology.
    Akkaoui, Sanae
    Laboratory of Oral Microbiology and Biotechnology, School of Dentistry, Mohammed V University in Rabat, Morocco.
    Reddahi, Sarah
    Department of Periodontology, School of Dentistry, Mohammed V University, Morocco.
    Kwamin, Francis
    Dental School University of Ghana, Ghana.
    Haubek, Dorte
    Section for Pediatric Dentistry, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    High salivary levels of JP2 genotype of Aggregatibacter actinomycetemcomitans is associated with clinical attachment loss in Moroccan adolescents2019In: Clinical and experimental dental research, ISSN 2057-4347, Vol. 5, no 1, p. 44-51Article in journal (Refereed)
    Abstract [en]

    It has previously been shown that the presence of Aggregatibacter actinomycetemcomitans in subgingival plaque is significantly associated with increased risk for clinical attachment loss. The highly leukotoxic JP2 genotype of this bacterium is frequently detected in adolescents with aggressive forms of periodontitis. The aims of the study were to quantify the levels of JP2 and non-JP2 genotypes of A. actinomycetemcomitans in saliva of Moroccan adolescents with the JP2 genotype earlier detected in the subgingival plaque. The salivary concentrations of inflammatory proteins were quantified and linked to the clinical parameters and microbial findings. Finally, a mouth rinse with leukotoxin-neutralizing effect was administrated and its effect on the levels the biomarkers and A. actinomycetemcomitans examined. The study population consisted of 22 adolescents that previously were found to be positive for the JP2 genotype in subgingival plaque. Periodontal registration and sampling of stimulated saliva was performed at baseline. A mouth rinse (active/placebo) was administrated, and saliva sampling repeated after 2 and 4 weeks rinse. The salivary levels of JP2 and non-JP2 were analyzed by quantitative PCR and inflammatory proteins by ELISA. Both the JP2 and the non-JP2 genotype were detected in all individuals with significantly higher levels of the non-JP2. Enhanced levels of the JP2 genotype of A. actinomycetemcomitans was significantly correlated to the presence of attachment loss (≥3 mm). Salivary concentrations of inflammatory biomarkers did not correlate to periodontal condition or levels of A. actinomycetemcomitans. The use of active or placebo leukotoxin-neutralizing mouth rinse did not significantly interfered with the levels of these biomarkers. Saliva is an excellent source for detection of A. actinomycetemcomitans on individual basis, and high levels of the JP2 genotype were significantly associated with the presence of clinical attachment loss.

  • 115.
    Eriksson, Christer
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Frängsmyr, Lars
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Danielsson Niemi, Liza
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Loimaranta, Vuokko
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Holmskov, U
    Bergman, T
    Leffler, H
    Jenkinson, HF
    Strömberg, Nicklas
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Variant size- and glycoforms of the scavenger receptor cysteine-rich protein gp-340 with differential bacterial aggregation2007In: Glycoconjugate Journal, ISSN 0282-0080, E-ISSN 1573-4986, Vol. 24, no 2-3, p. 131-142Article in journal (Refereed)
    Abstract [en]

    Glycoprotein gp-340 aggregates bacteria in saliva as part of innate defence at mucosal surfaces. We have detected size- and glycoforms of gp-340 between human saliva samples (n = 7) and lung gp-340 from a proteinosis patient using antibodies and lectins in Western blots and ELISA measurements. Western blots of saliva samples, and of gp-340 purified, from the seven donors using a gp-340 specific antibody distinguished four gp-340 size variants, designated I to IV (n = 2,2,2 and 1). While saliva gp-340 variants I to III had single bands of increasing sizes, variant IV and lung gp-340 had double bands. Purified I to IV proteins all revealed a N-terminal sequence TGGWIP upon Edman degradation. Moreover, purified gp-340 from the seven donors and lung gp-340 shared N-glycans, sialylated Galbeta1-3GalNAc and (poly)lactosamine structures. However, the larger size gp-340 grouping II/III (n = 4) and smaller size grouping I/IV correlated with a secretor, Se(+), and a non secretor, Se(-), dependent glycoform of gp-340, respectively (p = 0.03). The Se(+) glycoforms contained ABH, Le(b), Le(y) and polylactosamine structures, while the Se(-) glycoforms lacked ABH antigens but expressed Le(a), Le(x) and lactosamine structures. By contrast, lung gp-340 completely lacked ABH, Le(a/b), Le(x/y) or sLe(x) structures. Gp-340 and secretor typing of saliva from additional donors (n = 29) showed gp-340 glycoforms I to IV for 6, 16, 4 and 0 donors, respectively, and 3 non-typeable donors, and verified that gp-340 glycoforms I and II/III correlate with Se(-) and Se(+) phenotypes, respectively (p < 0.0001). The glycoforms of saliva and lung gp-340 mediated differential aggregation of Le(b)- (Helicobacter pylori), sialylpolylactosamine- (Streptococcus suis) or sialic acid- (Streptococcus mutans) binding bacteria. In conclusion, variant size- and glycoforms of gp-340 are expressed by different individuals and may modulate the biological properties of gp-340 pertinent to health and disease.

  • 116.
    Eriksson, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Esberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Haworth, Simon
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Allelic Variation in Taste Genes Is Associated with Taste and Diet Preferences and Dental Caries2019In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 7, article id 1491Article in journal (Refereed)
    Abstract [en]

    Taste and diet preferences are complex and influenced by both environmental and host traits while affecting both food selection and associated health outcomes. The present study genotyped 94 single nucleotide polymorphisms (SNPs) in previously reported taste and food intake related genes and assessed associations with taste threshold (TT) and preferred intensity (PT) of sweet, sour and bitter, food preferences, habitual diet intake, and caries status in healthy young Swedish men and women (n = 127). Polymorphisms in the GNAT3, SLC2A4, TAS1R1 and TAS1R2 genes were associated with variation in TT and PT for sweet taste as well as sweet food intake. Increasing PT for sweet was associated with increasing preference and intake of sugary foods. Similarly, increasing TT for sour was associated with increasing intake of sour foods, whereas the associations between food preference/intake and TT/PT for bitter was weak in this study group. Finally, allelic variation in the GNAT3, SLC2A2, SLC2A4, TAS1R1 and TAS1R2 genes was associated with caries status, whereas TT, PT and food preferences were not. It was concluded that variations in taste receptor, glucose transporter and gustducin encoding genes are related to taste perception, food preference and intake as well as the sugar-dependent caries disease.

  • 117.
    Eriksson, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Holgerson, Pernilla Lif
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Saliva and tooth biofilm bacterial microbiota in adolescents in a low caries community2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, article id 5861Article in journal (Refereed)
    Abstract [en]

    The oral cavity harbours a complex microbiome that is linked to dental diseases and serves as a route to other parts of the body. Here, the aims were to characterize the oral microbiota by deep sequencing in a low-caries population with regular dental care since childhood and search for association with caries prevalence and incidence. Saliva and tooth biofilm from 17-year-olds and mock bacteria communities were analysed using 16S rDNA Illumina MiSeq (v3-v4) and PacBio SMRT (v1-v8) sequencing including validity and reliability estimates. Caries was scored at 17 and 19 years of age. Both sequencing platforms revealed that Firmicutes dominated in the saliva, whereas Firmicutes and Actinobacteria abundances were similar in tooth biofilm. Saliva microbiota discriminated caries-affected from caries-free adolescents, with enumeration of Scardovia wiggsiae, Streptococcus mutans, Bifidobacterium longum, Leptotrichia sp. HOT498, and Selenomonas spp. in caries-affected participants. Adolescents with B. longum in saliva had significantly higher 2-year caries increment. PacBio SMRT revealed Corynebacterium matruchotii as the most prevalent species in tooth biofilm. In conclusion, both sequencing methods were reliable and valid for oral samples, and saliva microbiota was associated with cross-sectional caries prevalence, especially S. wiggsiae, S. mutans, and B. longum; the latter also with the 2-year caries incidence.

  • 118.
    Eriksson, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Esberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Microbial complexes and caries in 17-year-olds with and without Streptococcus mutans2018In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 97, no 3, p. 275-282Article in journal (Refereed)
    Abstract [en]

    Streptococcus mutans is a key bacterial species in the caries process, which affects >90% of the population worldwide. However, other acidogenic and aciduric/acidophilic species may contribute to disease development. In Sweden, a country with low prevalences of caries and S. mutans, a significant portion of caries-affected adolescents lack detectable levels of S. mutans. The objectives of the present study were 1) to characterize the tooth biofilm and saliva microbiota of adolescents with caries disease, with or without detectable S. mutans, from tooth biofilm and saliva samples and 2) to assess taxa clustering in the tooth biofilm and saliva samples and relate this information to caries status. For 17-y-old participants ( N = 154), enamel and dentin caries (the total number of present carious surfaces in the enamel and dentin) and caries experience (the number of decayed and filled tooth surfaces) were recorded, dental biofilm and saliva samples obtained, and information on medical and lifestyle habits collected. Multiplex 16S rDNA (V3-V4) sequencing of bacterial DNA was performed with the Illumina MiSeq platform. The Human Oral Microbiome Database and the ProbeSeq pipeline were used in the HOMI NGS procedure. In subjects with caries experience, high levels of S. mutans were associated with a few species and low levels with a panel of saccharolytic species. Present caries was similarly associated with a panel of saccharolytic species in subjects without S. mutans. Furthermore, tooth biofilm microbiota could be used to establish 4 clusters of subjects with different caries experiences. In particular, high levels of S. mutans were associated with the presence of a few influential species in multivariate modeling, including Scardovia wiggsiae. By contrast, a panel of less avid lactic acid-producing species was influential in patients with undetectable or low S. mutans levels in such modeling. These findings support a prominent role of S. mutans in infected adolescents but also the ecologic concept, especially in S. mutans-free subjects.

  • 119.
    Eriksson, Per-Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia ; Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia.
    Backén, Mattias
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Informatics, County Council of Västerbotten, Umeå, Sweden.
    Instant reduction in postural sway during quiet standing by intraoral dental appliance in patients with Whiplash associated Disorders and non-trauma neck pain2019In: Archives of Oral Biology, ISSN 0003-9969, E-ISSN 1879-1506, Vol. 97, p. 109-115Article in journal (Refereed)
    Abstract [en]

    Objectives: This study tested the hypothesis that modulation of jaw sensorimotor control by intraoral dental appliance can reduce postural sway during quiet standing and hence improve standing balance, in patients with whiplash associated disorders (WAD) and non-trauma neck pain. Design: Postural sway during quiet standing with feet together was examined in 54 WAD patients (40 females) and 10 non-trauma patients (8 females) using wireless 3D movement recording technique. Recordings were performed alternating without and with intraoral dental appliance, and with closed eyes and open eyes, respectively. In this protocol the participants served as their own controls. A reference group of 30 healthy subjects (17 females) was also recorded. Each recording lasted 120 s, followed by 3-5 min of rest. Speed, acceleration and perimeter of postural sway area were documented. Results: In the patients, but not in the healthy group, the intraoral dental appliance instantly and significantly reduced standing postural sway in recordings with closed and open eyes. Conclusions: The prompt reduction in standing postural sway from intervention by intraoral dental appliance i.e. improved standing balance, suggests a potent effect on the postural control system by modulation of the jaw sensorimotor system, probably involving reflex transmission. The result opens for new insight into mechanisms behind postural control and the pathophysiology of balance disorders, and adds to the knowledge on plasticity of the nervous system. It may help developing new procedures for assessment and management of impaired balance in WAD and non-trauma neck pain patients.

  • 120.
    Esberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Haworth, Simon
    Brunius, Carl
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Carbonic Anhydrase 6 Gene Variation influences Oral Microbiota Composition and Caries Risk in Swedish adolescents2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 452Article in journal (Refereed)
    Abstract [en]

    Carbonic anhydrase VI (CA6) catalyses the reversible hydration of carbon dioxide in saliva with possible pH regulation, taste perception, and tooth formation effects. This study assessed effects of variation in the CA6 gene on oral microbiota and specifically the acidophilic and caries-associated Streptococcus mutans in 17-year old Swedish adolescents (n = 154). Associations with caries status and secreted CA6 protein were also evaluated. Single Nucleotide Polymorphisms (27 SNPs in 5 haploblocks) and saliva and tooth biofilm microbiota from Illumina MiSeq 16S rDNA (V3-V4) sequencing and culturing were analysed. Haploblock 4 (rs10864376, rs3737665, rs12138897) CCC associated with low prevalence of S. mutans (OR (95% CI): 0.5 (0.3, 0.8)), and caries (OR 0.6 (0.3, 0.9)), whereas haploblock 4 TTG associated with high prevalence of S. mutans (OR: 2.7 (1.2, 5.9)) and caries (OR: 2.3 (1.2, 4.4)). The TTG-haploblock 4 (represented by rs12138897(G)) was characterized by S. mutans, Scardovia wiggsiae, Treponema sp. HOT268, Tannerella sp. HOT286, Veillonella gp.1 compared with the CCC-haploblock 4 (represented by rs12138897(C)). Secreted CA6 in saliva was weakly linked to CA6 gene variation. In conclusion, the results indicate that CA6 gene polymorphisms influence S. mutans colonization, tooth biofilm microbiota composition and risk of dental caries in Swedish adolescents.

  • 121.
    Esberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Isehed, Catrine
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Periodontology, Public Dental Health County Council of Gävleborg, Gävle County Hospital, Gävle, Sweden; Center for Clinical Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Holmlund, Anders
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Peri-implant crevicular fluid proteome before and after adjunctive enamel matrix derivative treatment of peri-implantitis2019In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 46, no 6, p. 669-677Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore which peri‐implant crevicular fluid (PICF) protein pattern is associated with the active peri‐implantitis process.

    Materials and methods: Peri‐implant crevicular fluid from 25 peri‐implantitis sites were subjected to proteomic analysis using liquid chromatography–tandem mass spectrometry before and at 3, 6 and 12 months after treatment, to identify associations between PICF protein pattern and implant loss, bleeding on probing, pocket depth and enamel matrix derivative (EMD) treatment.

    Results: Clustering of subjects based on their 3–12 months PICF proteomic profiles by principal component analysis defined two major clusters. Cluster 2 differentiated from cluster 3 by 52 proteins (R2 = 90%, Q2 = 80%) and belonging to cluster 2 was associated with implant loss (p = 0.009) and bleeding on probing (p = 0.001). Cluster 3 was associated with implant survival and EMD treatment (p = 0.044).

    Conclusion: Here, we demonstrate that a specific PICF proteomic profile associates with active peri‐implantitis process and implant loss.

  • 122.
    Esberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Isehed, Catrine
    Umeå University, Faculty of Medicine, Department of Odontology. Folktandvården Gävleborg AB, Region Gävleborg.
    Holmlund, Anders
    Folktandvården Gävleborg AB, Region Gävleborg.
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    PICF proteome before and after adjunctive EMD treatment of peri-implantitisManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to explore which peri-implant crevicular fluid (PICF) protein patter that are associated with the active peri-implantitis process.

    Materials and methods: PICF from 25 peri-implantitis sites were subjected to proteomic analysis using liquid chromatography-tandem mass spectrometry before and at 3, 6 and 12 months after treatment, to identify associations between protein expression and implant loss, radiographic bone level change, bleeding on probing, pocket depth, and enamel matrix derivative (EMD) treatment. 

    Results: Clustering of subjects based on their 3 to 12 months PICF proteomic profiles by principal component analysis defined two major clusters. Cluster 2 was differentiated from cluster 3 by 52 proteins (R2=90%, Q2=80%) and belonging to cluster 2 had an odds ratio for implant loss of 7.9 (95% confidence interval 1.8 to 35.9). Cluster 3 was related to implant survival (p=0.007) after 5 years and associated with EMD treatment (p=0.044). Furthermore, cluster 2 was associated with radiographic bone loss (p<0.0001) and bleeding on probing (p=0.001). 

    Conclusion: EMD treatment was associated with the PICF proteomic profile related to implant survival. EMD reduced number of proteins, dominated by proteins associated with implant loss. However, whether these effects are direct or indirect requires further exploration.

  • 123.
    Esberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Sheng, Nongfei
    Umeå University, Faculty of Medicine, Department of Odontology.
    Mårell, Lena
    Umeå University, Faculty of Medicine, Department of Odontology.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persson, Karina
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Borén, Thomas
    Umeå University, Faculty of Medicine, Department of Medical Biochemistry and Biophysics.
    Strömberg, Nicklas
    Umeå University, Faculty of Medicine, Department of Odontology.
    Streptococcus Mutans Adhesin Biotypes that Match and Predict Individual Caries Development2017In: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 24, p. 205-215Article in journal (Refereed)
    Abstract [en]

    Dental caries, which affects billions of people, is a chronic infectious disease that involves Streptococcus mutans, which is nevertheless a poor predictor of individual caries development. We therefore investigated if adhesin types of S.mutans with sucrose-independent adhesion to host DMBT1 (i.e. SpaP A, B or C) and collagen (i.e. Cnm, Cbm) match and predict individual differences in caries development. The adhesin types were measured in whole saliva by qPCR in 452 12-year-old Swedish children and related to caries at baseline and prospectively at a 5-year follow-up. Strains isolated from the children were explored for genetic and phenotypic properties. The presence of SpaP B and Cnm subtypes coincided with increased 5-year caries increment, and their binding to DMBT1 and saliva correlated with individual caries scores. The SpaP B subtypes are enriched in amino acid substitutions that coincided with caries and binding and specify biotypes of S. mutans with increased acid tolerance. The findings reveal adhesin subtypes of S. mutans that match and predict individual differences in caries development and provide a rationale for individualized oral care.

  • 124. Fabrcius, L
    et al.
    Dahlén, G
    Sundqvist, Göran
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology.
    Happonen, R-P
    Möller, ÅJR
    Influence of residual bacteria on periapical tissue healing after chemomechanical treatment and root filling of experimentally infected monkey teeth2006In: European Journal of Oral Sciences, no 114, p. 278-285Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was twofold: first, to determine the influence on the healing of the periapical tissues when selected bacterial strains and combinations thereof remain after root canal treatment; and, second, the relationship to healing of the quality of the root filling. In eight monkeys, 175 root canals, previously infected with combinations of four or five bacterial strains and with radiographically verified apical periodontitis, were endodontically treated, bacteriologically controlled, and permanently obturated. After 2–2.5 yr, the periapical regions were radiographically and histologically examined. Of these teeth, 48 root canals were also examined for bacteria remaining after removal of the root fillings. When bacteria remained after the endodontic treatment, 79% of the root canals showed non-healed periapical lesions, compared with 28% where no bacteria were found. Combinations of residual bacterial species were more frequently related to non-healed lesions than were single strains. When no bacteria remained, healing occurred independently of the quality of the root filling. In contrast, when bacteria remained, there was a greater correlation with non-healing in poor-quality root fillings than in technically well-performed fillings. In root canals where bacteria were found after removal of the root filling, 97% had not healed, compared with 18% for those root canals with no bacteria detected. The present study demonstrates the importance of obtaining a bacteria-free root canal system before permanent root filling in order to achieve optimal healing conditions for the periapical tissues.

  • 125. Falk, Anders
    et al.
    von Steyern, Per Vult
    Franssori, Håkan
    Thoren, Margareta Molin
    Umeå University, Faculty of Medicine, Department of Odontology.
    Reliability of the Impression Replica Technique2015In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 28, no 2, p. 179-180Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the reliability of the impression replica technique with a four-unit zirconia fixed dental prosthesis (FOP). Marginal and internal fit were measured by repeatedly placing the FDP on an epoxy cast using light-body silicone material corresponding to cement. All measured marginal and internal fit points showed varying values. The greatest variations were seen at the most distal margin (33 mu m) and at the distal abutment of the FDP (77 mu m). The results showed that the technique gives moderate variations and is a useful method to evaluate marginal and internal fit.

  • 126.
    Fallgren, Jakob
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Näsström, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    A decision tree did not increase treatment in patients with temporomandibular disorders.2018Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aims: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Previous studies have concluded that further efforts are needed to safeguard the clinical decision process in dentistry for patients with probable TMD. Primarily we evaluated if the implemented intervention in 2015 that was based on the 3Q/TMD increased the clinical decision-making for TMD patients compared to clinics that did not receive the intervention; secondarily we evaluated if other factors could be identified that predict performed or recommended TMD treatment; thirdly we evaluated treatment frequencies between 3Q-positives and 3Q-negatives at the intervention clinics.

    Methods: This case-control study was carried out within the Public dental health service in Västerbotten county, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented at four PDH clinics,intervention clinics. A total of 400 individuals were selected – 200 of 3Q-positives and 200 of 3Q-negatives. Clinics that were not included in the intervention programme was used as reference. The 3Q/TMD answers were analysed in relation to any TMD related decision that was collected from the digital dental records.

    Results: The intervention did not increase the frequencies of traceable clinical decisions among 3Q-positive patients at the interventions clinics when compared to the reference clinics.

    Conclusions: Despite the tailored intervention aimed at optimal use of the 3Q/TMD, the indicated under-treatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.

  • 127.
    Felszeghy, Szabolcs
    et al.
    Department of Anatomy, Histology and Embryology, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
    Holló, Krisztina
    Department of Anatomy, Histology and Embryology, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
    Módis, Laszlo
    Department of Anatomy, Histology and Embryology, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
    Lammi, Mikko
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Type X collagen in human enamel development: a possible role in mineralization.2000In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 58, no 4, p. 171-176, article id 11045371Article in journal (Refereed)
    Abstract [en]

    Although type X collagen is one of the key molecules in endochondral ossification, no data are available on whether it is present in dental structures when mineralization is proceeding. We therefore monitored the appearance of type X collagen in tooth germs of human samples ranging in gestational age from 17-week-old fetuses to 9-week-old newborn. Using immunohistochemistry, ELISA techniques, and Western blotting, we show that type X collagen is present in human tooth germ during enamel maturation. Intense immunohistochemical staining for collagen type X was observed in the enamel and in the apical parts of secretory ameloblast at the bell stage when the dentine and enamel matrix were already under formation. The odontoblasts, the dentine, and the pulp were not stained. In the early (9-week) postnatal stage, the staining for collagen type X in the enamel matrix was diminished, and only a very weak signal could be detected in the secretory ameloblasts. A positive reaction for collagen type X was also observed in ELISA assay of extracts obtained from human embryonic enamel and hypertrophic cartilage samples. The Western blot analysis of the enamel demonstrated that size of the molecule detected by MoAb X53 is characteristic of the type X collagen. This correlates well with our immunohistochemical findings. Based on these data, we propose that type X collagen is one of the candidate molecules present in the enamel matrix that might be involved in mineralization of the enamel.

  • 128. Figdor, D
    et al.
    Sundqvist, Göran KO
    Umeå University, Faculty of Medicine, Department of Odontology, Endodontics.
    A big role for the very small: understanding endodontic microbial flora2007In: Australian dental journal, ISSN 0045-0421, E-ISSN 1834-7819, Vol. 52, no Suppl 1, p. S38-S51Article, review/survey (Refereed)
    Abstract [en]

    Apical periodontitis, an inflammatory process around the apex of a tooth root, is primarily a sequel to microbial infection of the pulp space. The microbial flora is composed of a restricted group of the total oral flora, selected by environmental pressures of anaerobiosis, nutrition and competition with other species and inhabits the root canal as a biofilm of coaggregated communities in an extracellular matrix. The untreated infected canal is generally composed of a polymicrobial mix with approximately equal proportions of Gram-positive and Gram-negative species, dominated by obligate anaerobes. The type of microbial flora in the root-filled tooth with persistent apical periodontitis has very different characteristics. These infections are characterized by one or just a few species, predominantly Grampositive micro-organisms with an equal distribution of facultative and obligate anaerobes. Enterococcus faecalis has been a conspicuous finding in most studies. Because the primary aetiological problem is infection, endodontic treatment is directed at control and elimination of the root canal flora by working in a sterile way. Based on current knowledge, the best available method for obtaining clean, microbe-free root canals is by instrumentation with antimicrobial irrigation reinforced by an intracanal dressing with calcium hydroxide.

  • 129. Figdor, David
    et al.
    Brundin, Malin
    Umeå University, Faculty of Medicine, Department of Odontology.
    Contamination Controls for Analysis of Root Canal Samples by Molecular Methods: An Overlooked and Unsolved Problem2016In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 42, no 7, p. 1003-1008Article, review/survey (Refereed)
    Abstract [en]

    Introduction: It has been almost 20 years since molecular methods were first described for the analysis of root canal microbial flora. Contamination control samples are essential to establish DNA decontamination before taking root canal samples, and this review assessed those studies. Methods: Using PubMed, a search was conducted for studies using molecular microbial analysis for the investigation of endodontic samples. Studies were grouped according to the cleaning protocol, acquisition methods, and processing of control samples taken to check for contamination. Results: Of 136 studies applying molecular analysis to root canal samples, 21 studies performed surface cleaning and checking nucleotide decontamination with contamination control samples processed by polymerase chain reaction. Only 1 study described disinfection, sampling from the access cavity,, and processing by polymerase chain reaction and reported the result; that study reported that all samples contained contaminating bacterial DNA. Conclusions: Cleaning, disinfection, and checking for contamination are basic scientific prerequisites for this type of investigation; yet, this review identifies it as an overlooked issue. On the basis of this review, we call for improved scientific practice in this field.

  • 130.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Näsström, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Patients' perceived treatment need owing to temporomandibular disorders and perceptions of related treatment in dentistry: a mixed method study2019In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 46, no 9, p. 792-799Article in journal (Refereed)
    Abstract [en]

    Background: To easily identify patients who could benefit from a temporomandibular disorder (TMD) examination, three screening questions (3Q/TMD) have been introduced in large parts of Sweden. The questions are related to a TMD diagnosis. However, how the questions relate to a treatment need is unknown.

    Objectives: The first aim of the study was to identify predicting factors for perceived treatment need among adult individuals who screened positive to the 3Q/TMD. The second aim was to explore individuals' thoughts and experiences related to treatment of their TMD complaint.

    Methods: This mixed‐method study with a case‐control design was conducted in Västerbotten, Sweden, during 2014. Individuals who screened positive to at least one of the 3Q/TMD questions were allocated 3Q‐positives, whereas those with negative answers to all questions were allocated 3Q‐negatives. In total, 300 individuals (140 randomly selected 3Q‐positives, and 160 age‐ and gender‐matched 3Q‐negatives) were included. All individuals answered questions related to treatment need. The answers were analysed in a qualitative approach with qualitative content analysis.

    Results: In total, 81% of 3Q‐positives expressed a treatment need related to their TMD symptoms. The perceived treatment need was predicted by frequent pain (Q1) and frequent functional disturbances (Q3). Among the 3Q‐positives, 54% reported mistrust in dentists' ability to treat TMD symptoms. The informants expressed a need for information about their symptoms and possible treatment options.

    Conclusion: Affirmative answers to 3Q/TMD were associated with TMD treatment need. Dentists should give advice to patients with TMD symptoms and address their concerns.

  • 131.
    Flygare, Lennart
    Department of Oral Radiology, Faculty of Odontology, Lund University, Malmö.
    Degenerative changes of the human temporomandibular joint: A radiological, microscopical, histomorphometrical and biochemical study1997Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In five autopsy specimen studies human temporomandibular joints were investigated by conventional tomography, macroscopy, and microscopy for degenerative changes, in particular erosive hard-tissue changes.In the microscopical evaluation special attention was paid to the calcified cartilage. The calcified cartilage was outlined by a flat or gently undulating basophilic tidemark and an irregular osteochondral junction. A significant correlation was found between the thickness of the calcified cartilage and that of the total articular cartilage. Two types of erosive changes were found; an extensive type with complete loss of overlying cartilage and a local type with retained cartilage. The erosive changes were generally more extensive in the condyle. Microscopically, the erosive changes in the condyle were evenly distributed. In the temporal component there was a slight predominance of these changes located to the lateral part of the tubercle. Tomography underestimated both the presence and the extent of the erosive changes. Positive predictive values and negative predictive values were 0.70 and 0.83, respectively, for changes in the condyle and 0.91 and 0.68 for changes in the temporal component. The likelihood ratio for a positive test was 10.6 in the temporal component and 5.6 in the condyle. The likelihood ratio for a negative test was comparable in the two joint components 0.49 and 0.47 respectively. Three different techniques of computer-aided bone histomorphometry (manual, automatic and semi-automatic) were assessed. The variation when assessing the total and trabecular bone volume was evaluated. Good reproducibility in the assessment of the total and trabecular bone volume was achieved with the aid of a single observer and a semi-automatic technique. This technique was therefore used to assess the total and trabecular bone volume in condyles and temporal components of joints with and without microscopically verified erosive changes. Condyles with erosive changes demonstrated both a higher trabecular bone volume (P&lt; 0.05) and higher total bone volume (P&lt; 0.01) than condyles without erosive changes. In a clinical study on patients undergoing diskectomy, the two cartilage matrix macromolecules aggrecan and cartilage oligomeric matrix protein (COMP) were quantified by enzyme-linked immunosorbent assay in lavage fluids from temporomandibular joints before and six months after surgery. The aggrecan/COMP ratio was higher in the lavage fluid of all joints at follow-up as compared to preoperatively. All joints developed radiographic changes indicative of degenerative changes (osteoarthrosis) during the postoperative period.

  • 132. Flygare, Lennart
    et al.
    Hosoki, Hidehiko
    Petersson, Arne
    Rohlin, Madeleine
    Åkerman, Sigvard
    Bone volume in human temporomandibular autopsy joints with and without erosive changes1997In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 55, no 3, p. 167-172Article in journal (Refereed)
    Abstract [en]

    The aim was to compare the trabecular bone volume (TBV) and the total bone volume (TOBV) of human temporomandibular joints (TMJ) with erosive changes with those of joints without erosive changes. We examined 35 TMJ autopsy specimens from 19 individuals aged 66 88 years. Sagittal sections of the joints were analyzed microscopically for erosive hard-tissue changes. The TBV and the TOBV of the sections were assessed with the aid of computerized image analysis. A significant increase in trabecular and total bone volume was found in condyles with erosive changes (TBV = 21%, TOBV = 54%) as compared with condyles without erosive changes (TBV = 15%, TOBV = 40%). The trabecular bone volume of the temporal component was also increased (TBV = 24%) in joints with erosive changes in the condyle as compared with joints with unaffected condyles (TBV = 16%). The findings indicate that the relative bone mass may play a role in the development of erosive changes in the TMJ.

  • 133. Flygare, Lennart
    et al.
    Hosoki, Hidehiko
    Rohlin, Madeleine
    Petersson, Arne
    Bone histomorphometry using interactive image analysis. A methodological study with application on the human temporomandibular joint.1997In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 105, no 1, p. 67-73Article in journal (Refereed)
    Abstract [en]

    The aim was to develop a reproducible method for bone histomorphometry with the aid of a computerized image analysis program, and to examine the variation when assessing the total and the trabecular bone volume. Histologic sections of 18 temporomandibular joint autopsy specimens were read interactively using a cursor. The two parameters total bone volume and trabecular bone volume, of the condyle and the temporal component respectively, were estimated 2 x by 1 observer using 3 different threshold settings: an automatic, a semi-automatic and a manual technique. The threshold was based on the gray-scale distribution of the image. 2 observers read the same sections with the aid of the semi-automatic technique. The intra-observer variation expressed as coefficient of variation ranged between 1.9% and 7.1% for the different parameters, when the automatic threshold setting technique was employed, and between 2.8% and 8.7% with the semi-automatic technique. The manual technique resulted in a high intra-observer variation with a coefficient of variation between 5.2% and 19.9%. There was a systematic difference between the estimates of the 2 observers. In general, intra- and inter-observer variation was higher in the temporal component than in the condyle. The inter-section variation was moderate, the coefficient of variation ranging from 3.8% to 11.1%. The automatic and semi-automatic techniques resulted in comparable intra-observer variation, with a lower bias in the estimates of the semi-automatic technique. By letting one observer apply the semi-automatic technique, it was possible to achieve fast and reproducible analysis of the total and trabecular bone volume.

  • 134. Flygare, Lennart
    et al.
    Klinge, Björn
    Rohlin, Madeleine
    Åkerman, Sigvard
    Lanke, Jan
    Calcified cartilage zone and its dimensional relationship to the articular cartilage in the human temporomandibular joint of elderly individuals1993In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 51, no 3, p. 183-191Article in journal (Refereed)
    Abstract [en]

    The aim was to describe the appearance of the calcified cartilage zone (CCZ) and to determine its dimensional relationship to the articular cartilage thickness in the normal human temporomandibular joint. An autopsy material comprising 21 joints from 12 elderly individuals was examined microscopically. The appearance of the CCZ was examined, and the thickness of the CCZ and of the total articular cartilage was measured in 18 different positions in each joint. The CCZ was outlined by a flat or gently undulating tidemark and an irregular osteochondral junction. The cellularity of the CCZ varied extensively. The cells were numerous in the CCZ when the overlying articular cartilage displayed high cellularity. Statistical analysis of the measurements demonstrated a relationship (p < 0.001) between the thickness of the CCZ and of the articular cartilage. Our findings, both qualitative and quantitative, indicate a close relationship between the physiology of the CCZ and of the overlying articular cartilage.

  • 135.
    Flygare, Lennart
    et al.
    Sundebyns sjukhus, Luleå.
    Legrell, Per Erik
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Kontrastmedel inom odontologisk radiologi2009In: Tandläkartidningen, ISSN 0039-6982, Vol. 101, no 2, p. 68-73Article in journal (Other academic)
  • 136.
    Flygare, Lennart
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Miles, D. A.
    Imaging paranasal sinus disease2001In: Oral and Maxillofacial Surgery Clinics of North America, Vol. 13, no 4, p. 639-655Article in journal (Other academic)
    Abstract [en]

    In short, a proper diagnostic strategy for radiologic investigation of the nose and sinuses is suggested as follows: 1. CR remain useful for the detection of disease. 2. CT is appropriate for trauma, anomalies, recurrent inflammatory conditions, preoperative, and postoperative evaluation. 3. CT MR imaging should be used for mapping of tumors.

  • 137.
    Flygare, Lennart
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Möystad, Anne
    Oslo Universitet.
    Apajalahti, Satu
    Helsingfors Universitetssjukhus.
    Ultraljudsundersökningar i huvud- och halsregionen2009In: Tandläkartidningen, ISSN 0039-6982, Vol. 101, no 2, p. 78-86Article in journal (Refereed)
  • 138. Flygare, Lennart
    et al.
    Rohlin, Madeleine
    Åkerman, Sigvard
    Macroscopic and microscopic findings of areas with radiologic erosions in human temporomandibular joints1992In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 50, no 2, p. 91-100Article in journal (Refereed)
    Abstract [en]

    The aim was to describe the macroscopic and microscopic findings of areas with radiologic erosions in the human temporomandibular joint. An autopsy material of 40 human joints, removed as blocks, was examined with tomography, and an erosion was found in 37 areas. A macroscopic and a microscopic examination focused on the presence of the calcified cartilage zone (CCZ) was performed in these areas. In the condyle 13 of 14 areas with a radiologic erosion showed denudation of bone macroscopically. Microscopically, these areas were covered by a thin fibrocellular tissue, and the CCZ was absent. In the temporal component, only 1 of the 23 areas showed bone exposure macroscopically. Microscopically, the soft tissue in these areas varied in thickness. The CCZ was missing in 13 of the 23 areas, even in some areas that appeared normal macroscopically and were microscopically covered by intact soft tissue. Thus, in areas with a radiologic erosion the macroscopic and microscopic appearance differed between the condyle and the temporal component. The nature of the findings is discussed.

  • 139. Flygare, Lennart
    et al.
    Rohlin, Madeleine
    Åkerman, Sigvard
    Microscopy and tomography of erosive changes in the temporomandibular joint. An autopsy study.1995In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 53, no 5, p. 297-303Article in journal (Refereed)
    Abstract [en]

    Thirty-nine temporomandibular joint autopsy specimens were examined by microscopy and tomography for erosive changes. We found two types of erosive changes, an extensive type with complete loss of cartilage and a local type with retained articular cartilage. On microscopic examination nearly twice as many temporal components as condyles were eroded. The erosions were generally more extensive in the condyle. Erosions in the condyle were evenly distributed. In the temporal component there was a slight predominance of erosions located to the lateral part of the tubercle. The radiologic investigation underestimated both the presence and the extent of the erosions. Positive predictive values and negative predictive values were 0.70 and 0.83, respectively, for erosions in the condyle and 0.91 and 0.68 for erosions in the temporal component. It is suggested that the initial event in osteoarthrosis of the TMJ can occur as a subarticular hard-tissue change. The need for more accurate diagnostic tools than radiography should be stressed.

  • 140. Flygare, Lennart
    et al.
    Wendel, Mikael
    Saxne, Tore
    Ericson, Sune
    Eriksson, Lars
    Petersson, Arne
    Rohlin, Madeleine
    Cartilage matrix macromolecules in lavage fluid of temporomandibular joints before and 6 months after diskectomy1997In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 105, no 4, p. 369-372Article in journal (Refereed)
    Abstract [en]

    The purpose was to investigate if antigenic fragments of aggrecan and cartilage oligomeric matrix protein (COMP) are detectable by enzyme-linked immunosorbent assay in lavage fluids from the temporomandibular joint (TMJ) and to examine if the relative content of these cartilage markers changes during development of osteoarthrosis (OA) after diskectomy. Lavage fluid was obtained at surgery and 6 months postoperatively in 13 patients. Computed tomography or magnetic resonance imaging was without evidence of hard-tissue changes prior to surgery in all patients. In 9 of the patients, sufficient material for analysis was obtained at both examinations. Aggrecan and COMP were detectable in all but 2 fluids, in which the COMP levels were below detection limit. The aggrecan/COMP ratio increased in all 9 patients during the 6-month period, indicating increased release of aggrecan relative to COMP fragments. The changed aggrecan/COMP ratio possibly reflects increased cartilage turnover during development of OA. Changes compatible with OA were present on computed tomography in all cases at the 6-month follow-up. This study shows that the lavage procedure is feasible for obtaining synovial fluid from the TMJ for immunochemical analyses of tissue-derived macromolecules.

  • 141. Fornell, AC
    et al.
    Twetman, Svante
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Prediction of enamel demineralisation (white spots) during orthodontic treatment with fixed appliances.2004In: Orthodontics, Vol. 1, p. 121-5Article in journal (Refereed)
    Abstract [en]

    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.

  • 142.
    Fors, Ronny
    Umeå University, Faculty of Medicine, Odontology.
    Nickel allergy in a Swedish adolescent population and its relation to orthodontic treatment and lifestyle factors2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Nickel stands out as the main cause of contact allergy in both children and adults, which has given rise to concern and the introduction of regulations by official bodies. Today´s youths are frequently exposed to body piercing and orthodontic treatment. Changes in youth lifestyle practices are also likely to influence nickel exposure and thus, the occurrence of nickel allergy. However, against patient and parental concern regarding nickel exposure to orthodontic appliances, often evoked by allergies following piercing, stand results from studies indicating that early orthodontic appliance treatment may reduce, rather than increase, prevalence of nickel allergy; a finding that has been suggested to result from tolerance induction by early exposure to nickel via the oral route.

    The objective of the present thesis was to investigate the association between nickel allergy and exposure to different orthodontic appliances and lifestyle, in particular piercing, as well as to study nickel release from orthodontic appliances into the oral cavity. Furthermore, one objective was to establish baseline prevalence data of nickel allergy in a Swedish adolescent population.

    Data was generated from a cross-sectional survey, in which about 6000 youths completed a questionnaire and almost 4500 of these were patch-tested for contact allergy. Information on exposure to orthodontic appliances was verified by dental records, whilst nickel content in saliva and dental biofilm was measured in a clinical study.

    Questionnaire data demonstrated a reduced risk of nickel allergy when orthodontic treatment preceded piercing (OR 0.5; 95 % CI 0.3-0.8) and similar results were found for data verified from dental records, however statistical significance was lost when adjusting for background factors (OR 0.6, 95 % CI 0.4-1.0). Exposure to full fixed appliances with NiTi-containing alloys, as well as a pooled ‘high nickel-releasing’ appliance group prior to piercing correlated with a significantly reduced risk of nickel allergy and a trend towards a reduced risk with exposure duration. Nickel could also be found in significantly higher concentrations from dental plaque samples, but not saliva samples, in orthodontic patients who were well into treatment compared to patients who had not been exposed to orthodontic appliances. The effect was not found to be due to differences in estimated dietary nickel intake between the two groups.

    Significantly more girls than boys (13.3 % versus 2.5 %) were found to be patch-test positive to nickel. Positive nickel tests were also most prevalent in occupational programmes and least prevalent in natural science programmes, indicating differences in lifestyle and exposure to nickel. Dropout from testing was handled using a missing-value analysis. This internal validation showed that our results overestimated the occurrence of nickel allergy to a minor degree. More girls than boys reported piercing, vegetarian/vegan diet, and smoking practices, whereas an interesting shift in tattooing prevalence was observed with a larger proportion of girls reporting this practice compared to boys. Sex, number of piercings, smoking and orthodontic appliance treatment prior to piercing were found to influence weighted risk estimates of nickel allergy.

    To conclude, although orthodontic patients are exposed to nickel intraorally, we found no increased risk of sensitising adolescents to nickel by the use of oral orthodontic appliances. On the contrary, early orthodontic treatment preceding piercing reduced the risk of nickel allergy by a factor of 1.5-2.0. This reduced risk appears to be associated with estimated nickel release of the appliance and duration of treatment, in all supporting a hypothesised induction of immunological tolerance via oral administration of nickel. Our study also showed a strong association between lifestyle and nickel allergy. Although there have been changes in lifestyle over time, as indicated by the strong shift in tattooing practices, no large change in nickel allergy prevalence was found compared with previous Swedish data. Our data will serve as a baseline for future studies of the effect of nickel exposure regulations, such as the Nickel Directive, and for studies of lifestyle changes and their effects on nickel allergy.

  • 143.
    Fors, Ronny
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nickel in dental plaque and saliva in patients with and without orthodontic appliances.2006In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 28, no 3, p. 292-297Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare the content of nickel in the saliva and dental biofilm in young patients with and without orthodontic appliances. The possible influence of a dietary intake of nickel on recorded nickel levels was examined. Nickel content in unstimulated whole saliva and in dental plaque of 24 boys and girls (mean age 14.8 years) with intraoral fixed orthodontic appliances was compared with 24 adolescents without such an appliance. Sample collection was set up to exclude nickel contamination. Diet intake was recorded for the preceding 48 hours to account for the influence of recent nickel content in food. Saliva and plaque were analysed for nickel content using an electrothermal atomic absorption spectrometric (ETAAS) method. The acidified saliva samples were analysed as Millipore-filtered saliva with filter-retained fractions and plaque following dissolution in acids. No significant difference in nickel content of filtered saliva was found between the test and the control samples (P = 0.607); the median values of nickel content were 0.005 and 0.004 mug/g saliva, respectively. On the other hand, a significant difference was found for the filter-retained fraction (P = 0.008); median values for nickel were 25.3 and 14.9 mug/g, respectively. A significant difference in nickel content between test and control samples was also found in plaque collected at various tooth sites (P = 0.001; median values 1.03 and 0.45 mug/g, respectively). A stronger difference was found when comparing plaque collected from metal-covered tooth surfaces than from enamel surfaces of orthodontic patients. No association could be found between calculated dietary intake of nickel and recorded nickel in the test and control samples. It is concluded that nickel release occurs into the dental plaque and components of saliva of orthodontic patients, a situation that may reflect time dependence of its release from orthodontic appliances into the oral cavity and an aggregation of nickel at plaque sites.

  • 144. Forsberg, Hans
    et al.
    Sjödin, Lars
    Lundgren, Per
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Oral health in the adult population of Västerbotten, Sweden - a comparison between an epidemiological survery and data obtained from digital dental records2008In: Swedish Dental Journal: Oral health in the adult population of Västerbotten, Sweden - a comparison between an epidemiological survey and data obtained from digital records., Vol. 32, p. 17-25Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to analyse the possibilities and limitations of using data drawn from electronic dental patient records (EDPRs) in monitoring dental health among adults in a northern Swedish county. Material and Methods: The study population comprised all 35-, 50-, 65- and 75-year-old patients who were examined and, where required, received treatment at the Public Dental Service (PDS) in Västerbotten, Sweden, in 2003 and in 2004. In total 2,497 patients in 2003, and 2,546 patients in 2004 met the inclusion criteria. As controls, 779 subjects randomly drawn from the adult population in the same age groups and from the same county were used. They participated in an oral health survey and were examined clinically between October 2002 and March 2003. Results: When oral health was estimated based on EDPRs the prevalence of edentulous subject was significantly underestimated, while the mean numbers of teeth and the mean values of sound teeth were significantly overestimated. No statistically significant difference was found in prevalence of primary decayed tooth surfaces (DS). The prevalence of filled teeth (FT) was fairly similar between the study samples. Registrations of periodontal status were mainly missing in the EDPRs. Since registrations related to temporomandibular disorders are not included in the T4 system its prevalence could no be assessed and accordingly not compared with the epidemiological sample. Conclusion: The study shows that clinical registration based on EDPRs is at present not accurate enough to be used as indicators of oral health status among adults in a community.The objective of this study was to analyse the possibilities and limitations of using data drawn from electronic dental patient records (EDPRs) in monitoring dental health among adults in a northern Swedish county. Material and Methods: The study population comprised all 35-, 50-, 65- and 75-year-old patients who were examined and, where required, received treatment at the Public Dental Service (PDS) in Västerbotten, Sweden, in 2003 and in 2004. In total 2,497 patients in 2003, and 2,546 patients in 2004 met the inclusion criteria. As controls, 779 subjects randomly drawn from the adult population in the same age groups and from the same county were used. They participated in an oral health survey and were examined clinically between October 2002 and March 2003. Results: When oral health was estimated based on EDPRs the prevalence of edentulous subject was significantly underestimated, while the mean numbers of teeth and the mean values of sound teeth were significantly overestimated. No statistically significant difference was found in prevalence of primary decayed tooth surfaces (DS). The prevalence of filled teeth (FT) was fairly similar between the study samples. Registrations of periodontal status were mainly missing in the EDPRs. Since registrations related to temporomandibular disorders are not included in the T4 system its prevalence could no be assessed and accordingly not compared with the epidemiological sample. Conclusion: The study shows that clinical registration based on EDPRs is at present not accurate enough to be used as indicators of oral health status among adults in a community.

  • 145.
    Forsgren, Nina
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Structural studies of the surface adhesin SspB from Streptococcus gordonii2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Surface proteins on microorganisms that build up the oral biofilm are key players in the formation of the biofilm. Antigen I/II proteins are surface adhesins found on virtually all oral streptococci and share a conserved multi-domain architecture. These adhesins bind surface components on other bacteria and on host cells. Thus, they are crucial for the development of the biofilm.    

    The objective of this thesis work is the structural characterization of the large multi-domain Antigen I/II protein SspB from the primary colonizing commensal bacterium Streptococcus gordonii.

    The crystal structure of the variable domain of SspB was determined to 2.3 Å resolution. The domain comprises a β-supersandwich and a putative binding cleft stabilized by a calcium ion. Despite high similarity in the overall structure, the cleft within SspB is significantly smaller than the cleft within the homologous protein from Streptococcus mutans, indicating that different substrates may bind in the clefts. A screen for carbohydrate binding resulted in no hits for interaction with the SspB variable domain suggesting that the cleft may not be suitable for binding sugars.

    This thesis also presents the high resolution 1.5 Å structure of a truncated C-terminal domain of SspB, the first of an Antigen I/II C-domain. The structure contains two structurally related domains, each containing one calcium ion and one intramolecular isopeptide bond. The SspB protein shares the feature of intramoleular isopeptide bonds with other surface proteins from Gram positive bacteria, such as pili from Streptococcus pyogenes and Corynebacterium diphtheriae. Intramolecular isopeptide bonds are suggested to be a common feature for retaining stability in a harsh environment. The SspB adherence region, shown to be the recognition motif for Porphyromonas gingivalis attachment to S. gordonii, protrudes from the core protein as a handle available for recognition.

    In conclusion, this thesis work has provided new knowledge about the SspB protein and increased the understanding of the common structure of AgI/II proteins.

  • 146.
    Forsgren, Nina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Lamont, Richard J
    Persson, Karina
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Two intramolecular isopeptide bonds are identified in the crystal structure of the Streptococcus gordonii SspB c-terminal domain2010In: Journal of Molecular Biology, ISSN 0022-2836, E-ISSN 1089-8638, Vol. 397, no 3, p. 740-751Article in journal (Refereed)
    Abstract [en]

    Streptococcus gordonii is a primary colonizer and is involved in the formation of dental plaque. This bacterium expresses several surface proteins. One of them is the adhesin SspB, which is a member of the Antigen I/II family of proteins. SspB is a large multi-domain protein that has interactions with surface molecules on other bacteria and on host cells, and is thus a key factor in the formation of biofilms. Here, we report the crystal structure of a truncated form of the SspB C-terminal domain, solved by single-wavelength anomalous dispersion to 1.5Å resolution. The structure represents the first of a C-terminal domain from a streptococcal Antigen I/II protein and is comprised of two structurally related β-sandwich domains, C2 and C3, both with a Ca2+ bound in equivalent positions. In each of the domains, a covalent isopeptide bond is observed between a lysine and an asparagine, a feature that is believed to be a common stabilization mechanism in Gram-positive surface proteins. S. gordonii biofilms contain attachment sites for the periodontal pathogen Porphyromonas gingivalis and the SspB C-terminal domain has been shown to have one such recognition motif, the SspB adherence region. The motif protrudes from the protein, and serves as a handle for attachment. The structure suggests several additional putative binding surfaces, and other binding clefts may be created when the fulllength protein is folded.

  • 147.
    Forsgren, Nina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Lamont, Richard
    Persson, Karina
    Umeå University, Faculty of Medicine, Odontology.
    A crystallizable form of the Streptococcus gordonii surface antigen SspB C-domain obtained by limited proteolysis2009In: Acta Crystallographica. Section F: Structural Biology and Crystallization Communications, ISSN 1744-3091, E-ISSN 1744-3091, Vol. 65, no 7, p. 712-714Article in journal (Refereed)
    Abstract [en]

    SspB is a 1500-residue adhesin expressed on the surface of the oral bacterium Streptococcus gordonii. Its interaction with other bacteria and host cells initiates the development of dental plaque. The full-length C-terminal domain of SspB was cloned, overexpressed in Escherichia coli and purified. However, the protein could not be crystallized. Limited proteolysis of the full-length C-domain identified a core fragment. The proteolysis product was cloned, expressed and purified. The protein was crystallized using the hanging-drop vapour-diffusion method. X-ray data were collected and processed to a maximum resolution of 2.1 A with 96.4% completeness. The crystals belonged to space group P2(1), with one molecule in the asymmetric unit, a solvent content of 33.7% and a corresponding Matthews coefficient of 1.85 A(3) Da(-1).

  • 148.
    Friskopp, Johan
    et al.
    Department of Periodontology, Public Dental Services, SE-164 42 Kista, Sweden.
    Nilsson, Marie
    AstraZeneca, Clinical R&D, SE-151 85 Södertälje, Sweden.
    Isacsson, Göran
    AstraZeneca, Clinical R&D, SE-151 85 Södertälje, Sweden.
    The anesthetic onset and duration of a new lidocaine/prilocaine gel intra-pocket anesthetic (Oraqix) for periodontal scaling/root planing2001In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 28, no 5, p. 453-458Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A new non-injection anesthetic, lidocaine/prilocaine gel (Oraqix, AstraZeneca) in a reversible thermosetting system, has been developed to provide local anesthesia for scaling/root planing (SRP). The aim of this study was to determine the anesthetic onset and duration of the gel for SRP in patients with periodontitis.

    METHODS: 30 patients were randomized to either 30 s, 2 min, or 5 min of treatment with the gel prior to SRP of a tooth. The gel was applied to periodontal pockets with a blunt applicator. On completion of the SRP of each tooth (2-3 teeth treated/patient), the patients rated their pain on a 100-mm visual analogue scale (VAS).

    RESULTS: The median VAS pain score was 7.5 mm in the 30-s group, 28.5 mm in the 2-min group, and 15.5 mm in the 5-min group, with a significant difference between the 30-s and 2-min groups (p=0.03). In 2 patients in the 5-min group, but none in the other groups, the SRP was interrupted due to pain. The mean duration of anesthesia measured as pain on probing were 18.1, 17.3, and 19.9 min in the 30-s, 2-min, and 5-min groups, respectively. There were no reports of numbness of the tongue, lip, or cheek, neither were there any adverse local reactions in the oral mucosa. The gel was easy to apply and did not interfere with the SRP procedure.

    CONCLUSION: Oraqix provides anesthesia after an application time of 30 s, with a mean duration of action of about 17 to 20 min.

  • 149.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology.
    Carotid calcifications in panoramic radiographs in relation to carotid stenosis2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Calcifications in carotid atheromas can be detected in a panoramic radiograph (PR) of the jaws. A carotid artery calcification (CAC) can indicate presence of significant (≥ 50%) carotid stenosis (SCS). The aim of this thesis was to (1) determine the prevalence of SCS and burden of atherosclerotic disease among patients revealing CACs in PRs, (2) determine the prevalence of CACs in PRs among patients with SCS, (3) analyze whether the amount of calcium and/or (4) the radiographic appearance of the CACs, can improve the positive predictive value (PPV) for SCS detection among patients with CACs in PRs.

    The thesis is based on four cross-sectional studies. Two patient groups were prospectively and consecutively studied. Group A represented a general adult patient population in dentistry examined with PR presenting incidental findings of CACs. These patients were examined with carotid ultrasound for presence or absence of SCS and their medical background regarding atherosclerotic related diseases and risk factors was reviewed. An age and gender matched reference group was included for comparisons. Group B comprised patients with ultrasound verified SCS, examined with PR prior to carotid endarterectomy. The PRs were analysed regarding presence of CACs. The extirpated plaques were collected and examined with cone-beam computed tomography (CBCT) to determine the amount of calcium. The radiographic appearance of CACs in PRs from Group A and B were evaluated for possible association with presence of SCS.

    In Group A, 8/117 (7%) of patients with CAC in PRs revealed SCS in the ultrasound examination, all were found in men (8/64 (12%)). Patients with CACs in PRs revealed a higher burden of atherosclerotic disease compared to participants in the reference group (p <0.001). In Group B, where all patients had SCS, 84% revealed CACs in PRs and 99% of the extirpated plaques revealed calcification. CACs with volumes varying between 1 and 509 mm3 were detected in the PRs. The variation in volume did not correlate to degree of carotid stenosis. The radiographic appearance that was most frequently seen in neck sides with SCS (65%) was also frequently found in neck sides without SCS (47%) and therefore the PPV did not improve compared to the PPV solely based on presence of CACs.

    CACs in PRs are more associated with SCS in men than in a general population and patients with CACs in PRs have a higher burden of atherosclerotic disease. The majority of patients with SCS show CACs in PRs and the majority of extirpated carotid plaques reveal calcification. The volume of CAC and specified radiographic appearance does not increase the PPV for SCS in patients with CACs in PRs. In conclusion patients with CACs in PRs, and without previous record of cardiovascular disease, should be advised to seek medical attention for screening of cardiovascular risk factors.

  • 150.
    Garoff, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Clinical Sciences, Karolinska Insititutet, Danderyds hospital, Stockholm.
    Carotid calcification in panoramic radiographs: radiographic appearance and the degree of carotid stenosis2016In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 45, no 6, article id 20160147Article in journal (Refereed)
    Abstract [en]

    Objectives: Approximately 7% of patients examined with panoramic radiographs (PRs) for odontological reasons, and with incidental findings of carotid artery calcification (CAC), have significant (≥50%) carotid stenosis (SCS). The aim of this study was to determine if the radiographic appearance of CACs in PRs could be categorized such that we could improve the positive-predictive value (PPV) for SCS detection.

    Methods: This cross-sectional study included 278 patients with CACs identified by PRs, 127 with SCS and 151 without SCS. CACs were categorized based on the following appearances: (1) single, (2) scattered or (3) vessel-outlining. Correlates were derived for each category according to positivity or not for SCS in the corresponding neck sides. For a representative adult population (in dentistry) presenting with CACs in PRs, PPVs for SCS prediction were then calculated for three subgroups based on different combinations of appearances (2) and/or (3).

    Results: Vessel-outlining CACs corresponded to 65% of neck sides with SCS vs 47% without SCS (p < 0.001). Single CACs corresponded to 15% of neck sides with SCS vs 27% without SCS (p = 0.006). Scattered CACs corresponded to 20% of neck sides with SCS vs 26% without SCS (p  = 0.127). In the representative population, the PPVs for SCS detection were comparable (7.2–7.8%) for all three subgroups and when the presence of a CAC is the sole criterion (7.4%).

    Conclusions: Stratifying the radiographic appearance of CACs in PRs does not improve the PPV for SCS detection. Whether different radiographic appearances are associated with future risk of stroke, or other cardiovascular events, remains unknown.

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