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  • 301. Legrell, P E
    et al.
    Nyström, Elisabeth
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Radiographic study of structural changes in the temporomandibular joint after oblique sliding osteotomy: comparison between the extra-oral and intra-oral approaches.1990In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 19, no 4, p. 145-148Article in journal (Refereed)
    Abstract [en]

    Oblique sliding osteotomy of the mandibular rami was performed on 41 patients by either an intra-oral (21 patients) or extra-oral (20 patients) approach. The temporomandibular joints were radiographed preoperatively and then immediately and 18 months postoperatively. Signs of structural changes were recorded so as to compare the two approaches to osteotomy. The most common findings following the operation were signs of sclerosis and bone remodelling in 85% and 73% respectively of the two groups but these differences were not statistically significant.

  • 302.
    Leksell, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hallberg, Ulrika
    Magnusson, Bo
    Ernberg, Malin
    Hedenberg-Magnusson, Britt
    Perceived Oral Health and Care of Children with Juvenile Idiopathic Arthritis: A Qualitative Study2015In: Journal of Oral & Facial Pain and Headache, ISSN 2333-0384, Vol. 29, no 3, p. 223-230Article in journal (Refereed)
    Abstract [en]

    Aims: To increase knowledge about how children diagnosed with juvenile idiopathic arthritis (JIA) perceive their oral health and dental care. Methods: Fifteen interviews with children diagnosed with JIA, aged 6 to 16 years, were analyzed according to classical grounded theory. Results: The children's main concern about their oral health was identified as creating a positive identity after being diagnosed with JIA and learning to live with oral health problems. While attempting to cope with this concern, the children often endured in silence, the core category in the analysis. A variety of aspects were found of this core coping strategy, which were categorized as differentiating from the disease, working on personal caretaking and positive attitude, fighting fears and sadness, control of professional aid, and building supportive relationships. The results emphasize the importance for caregivers to show empathy and interest in the child as a person, to ask precise questions when taking case histories so the child does not remain silent, to provide psychosocial support and suggest positive coping strategies, to describe and administer treatments, and to give hope for the future. Conclusion: Awareness of the social interaction between a child diagnosed with JIA and health professionals as well as awareness of how to approach a child with longstanding illness are crucial for disclosing and treating the child's orofacial symptoms.

  • 303.
    Lerner, Ulf H
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Cell Biology.
    New molecules in the tumor necrosis factor ligand and receptor superfamilies with importance for physiological and pathological bone resorption2004In: Critical Reviews in Oral Biology and Medicine, ISSN 1045-4411, E-ISSN 1544-1113, Vol. 15, no 2, p. 64-81Article, review/survey (Refereed)
    Abstract [en]

    Osteoclasts are tissue-specific polykaryon bone-resorbing cells derived from the monocyte/macrophage hematopoietic lineage with specialized functions required for the adhesion of the cells to bone and the subsequent polarization of the cell membrane, secretion of acid to dissolve mineral crystals, and release of proteolytic enzymes to degrade the extracellular matrix proteins. Most pathological conditions in the skeleton lead to loss of bone due to excess osteoclastic bone resorption, including periodontal disease, rheumatoid arthritis, and osteoporosis. In rare cases, most of them genetic, patients with osteopetrosis exhibit sclerotic bone due either to a lack of osteoclasts or to non-functional osteoclasts. Mainly because of phenotypic findings in genetically manipulated mice or due to spontaneous mutations in humans, mice, and rats, several genes have been discovered as being crucial for osteoclast formation and activation. Recent breakthroughs in our understanding of osteoclast biology have revealed the critical roles in osteoclast differentiation played by RANKL, RANK, and OPG, three novel members of the tumor necrosis factor ligand and receptor superfamilies. The further study of these molecules and downstream signaling events are likely to provide a molecular basis for the development of new drugs for the treatment of diseases with excess or deficient osteoclastic bone resorption.

  • 304.
    Lerner, Ulf H
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Osteoblasts, Osteoclasts, and Osteocytes: Unveiling Their Intimate-Associated Responses to Applied Orthodontic Forces2012In: Seminars in orthodontics, ISSN 1073-8746, Vol. 18, no 4, p. 237-248Article in journal (Refereed)
    Abstract [en]

    Bone is remodeled and modeled by the concerted activities of 3 cell types — osteoblasts, osteocytes, and osteoclasts. Osteoblasts are the cells that produce bone extracellular matrix and are responsible for its mineralization. Osteoblasts also have endocrine activity through secretion of osteocalcin, which regulates fat and energy metabolism. These cells also control the differentiation and activity of osteoclasts. Osteocytes are osteoblasts that have been incorporated into bone matrix and are cells with extensive dendritic processes through which the cells communicate with other osteocytes and with osteoblasts. Mechanical loading is sensitized by the dendritic processes and transferred to biochemical responses involved in control of osteoblast and osteoclast function. Osteocytes also have endocrine activity by releasing fibroblast growth factor 23, which is involved in phosphate secretion in kidneys. Differentiation of osteoclast mononuclear progenitors to mature multinucleated osteoclasts is regulated by macrophage colony-stimulating factor and receptor activator of NF-κB ligand, expressed by stromal cells in bone marrow or osteoblasts in bone, as well as by osteocytes. The integrated endo- and paracrine control of osteoblasts, osteocytes, and osteoclasts is important for maintaining bone mass and for control of remodeling and modeling processes in bone, including during orthodontic-induced tooth movement.

  • 305.
    Lerner, Ulf H
    Umeå University, Faculty of Medicine, Department of Odontology, Molecular Periodontology. Centrum för ben- och artritforskning, Institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet, Göteborg.
    Skelettet i käkar och annorstädes: 4. Skelettet som ett hormonproducerande organ med betydelse för energimetabolism och fosfatutsöndring2012In: Tandläkartidningen, ISSN 0039-6982, Vol. 104, no 8, p. 60-68Article in journal (Refereed)
    Abstract [sv]

    Ny forskning visar att skelettet inte bara regleras av hormoner utan också producerar hormoner. Dessa hormoner påverkar fettceller, insulinproducerande celler i bukspottkörteln och njurens fosfatreglering.

  • 306.
    Lerner, Ulf H
    Umeå University, Faculty of Medicine, Department of Odontology.
    The biology of bone remodelling in jaw bones with and without teeth2012In: Textbook of removable prosthodontics: the Scandinavian approach / [ed] Margareta Molin Thorén och Johan Gunne, Munksgaard Forlag, 2012, 1, p. 51-60Chapter in book (Refereed)
    Abstract [en]

    Bone tissues, together with enamel, dentin and cementum, are unique tissues in the human body because of the presence of large amounts of mineral crystals in the extracellular matrix. It is a common misconception that mineralized tissues of the body are dead tissues with the only task of forming the skeleton and the teeth. However, bone tissue is a living organ with different cell types that have important functions for mineral homeostasis and for remodelling as well as modelling of the skeleton in order to renew it and to adapt to functional demands. Two morphologically distinct bone tissues make up all bones; the cortical bones in the periphery and the network of trabecular bone in the inner part of the bones. Some bones have only small amounts of trabecular bone, whereas others are filled up more densely. It is not known why some osteoblasts are producing cortical bone and others trabecular bone. Interestingly, trabecular bone is more frequently remodelled. This is the reason why metabolic bone diseases, such as osteoporosis, affect bone with large amounts of trabecular bone more severely. Much remains to be understood about the different processes of bone formation, how it is controlled and why we have two types of bone. Although the general view is that all osteoblasts and osteoclasts in the body are very similar, it has become clearer during recent years that a substantial heterogeneity exists in osteoblasts and osteoclasts present in different bones. Most studies are performed on bone cells isolated from calvarial bones and long bones and very few from jaw bones. This is important, since the biology of osteoblasts and osteoclasts in maxilla and mandible is not necessarily similar in all aspects to the one observed in cells from other areas. This chapter presents a brief summary of bone cell biology, bone remodelling and modelling including the effects by inflammatory processes on bone cell activities and, finally, summarizes the relatively spare information available on bone remodelling in the vicinity of removable prosthetic dentures.

  • 307.
    Lerner, Ulf H.
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Centre for Bone and Arthritis Research at Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kindstedt, Elin
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    The critical interplay between bone resorbing and bone forming cells2019In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 46, p. 33-51Article in journal (Refereed)
    Abstract [en]

    Aim: In this article, the interplay between bone resorbing and bone forming cells is reviewed.

    Method: This review examines the comprehensive literature on the interaction between bone resorption and bone formation.

    Results: Coupling between bone resorption and bone formation refers to the process within basic multicellular units, in which osteoclastic bone resorption is met by the differentiation of osteoblasts and their bone forming activity. There are many possible signalling molecules that contribute to coupling at the asynchronously working remodelling sites throughout our skeleton. These include growth factors released from the bone matrix during bone resorption, soluble and membrane products of the osteoclasts and their precursors and signals from osteocytes.

    Conclusions: In this review, we describe the potential roles of a number of these factors, whose interactions are essential for a tight control of coupling within individual remodelling units, in order to control skeletal mass. Both pre‐clinical evidence and clinical evidence pinpoint that molecules in the WNT signalling pathway could be promising bone augmentation therapeutic targets. Regarding oral implications, there is support, from preclinical studies in rats, that anti‐sclerostin antibodies can restore alveolar bone mass.

  • 308.
    Lerner, Ulf H
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Molecular Periodontology.
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology, Molecular Periodontology.
    Brechter, Anna
    Palmqvist, Py
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persson, Emma
    Umeå University, Faculty of Medicine, Department of Odontology.
    Skelettet vid hälsa och sjukdom2008In: Tandläkartidningen, ISSN 0039-6982, Vol. 100, no 5, p. 84-90Article in journal (Other academic)
    Abstract [sv]

    Hur ombyggnaden av benvävnaden i käkar och skelett fungerar och hur processen påverkas vid sjukdomstillstånd som parodontit, benskörhet, tumörer med mera är föremål för omfattande forskning i Umeå.

  • 309.
    Lerner, Ulf H
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Molecular Periodontology. Centrum för ben- och artritforskning, Institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet, Göteborg.
    Mellström, Dan
    Centrum för ben- och artritforskning, Institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet, Göteborg.
    Behandlingsprinciper för olika läkemedel vid osteoporos: skelettet i käkar och annorstädes, del 52012In: Tandläkartidningen, ISSN 0039-6982, Vol. 104, no 11, p. 64-79Article in journal (Refereed)
    Abstract [sv]

    Osteoporos drabbar många individer i hela världen. Från att ha varit en sjukdom utan farmakologisk behandling har ett flertal läkemedel nu utvecklats och fler är på väg. Här beskrivs behandlingsprinciperna för de läkemedel som i dag används vid osteoporos.

  • 310.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Bodin, Ingrid
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Pharyngeal swallowing dysfunction following treatment for oral and pharyngeal cancer: Association with diminished intraoral sensation and discrimination ability2008In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 30, no 10, p. 1344-1351Article in journal (Refereed)
    Abstract [en]

    Background.

    Swallowing disorders following treatment for oral and pharyngeal cancer are mainly considered a surgical sequel. The recent finding that radiotherapy-induced decline in intraoral sensory abilities established an incentive to elucidate any association between the degree of sensory decline and the degree of swallowing dysfunction.

    Methods.

    Oral and pharyngeal swallowing was cineradiographically examined in 15 patients with oral or pharyngeal cancer before and after treatment. The patients were also tested for intraoral sensation, shape recognition, and hole size identification.

    Results.

    Swallowing function deteriorated in 67% of the patients 6 months posttreatment, with no significant improvement after 12 months. The degree of swallowing dysfunction was statistically significantly associated with the degree of diminished intraoral sensation and shape recognition.

    Conclusion.

    In the quest for rehabilitation after treatment for oral and pharyngeal cancer, the impact of impaired intraoral sensation and discrimination ability on swallowing function should be taken into consideration

  • 311.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nilsson, M E
    Isberg, A
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persisting dysphagia after uvulopalatoplasty performed with steel scalpel.1999In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 109, no 1, p. 86-90Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES/HYPOTHESIS: The aim of the present study was to determine the incidence of postoperative persisting dysphagia after uvulopalatoplasty performed with conventional steel scalpel (UPP) and to videoradiographically evaluate the oral and pharyngeal phases of swallowing in patients reporting persisting dysphagia. The hypothesis to be tested was that patients treated with UPP would demonstrate a lower incidence of persisting dysphagia than previously found after uvulopalatoplasty performed with laser technique (LUPP).

    STUDY DESIGN: Retrospective.

    METHODS: Sixty-eight of 76 consecutive patients treated with UPP answered a questionnaire concerning outcome and late complications after the operation. The patients who reported postoperative dysphagia were additionally interviewed at a minimum of 1 year postoperatively, and the oral and pharyngeal phases of swallowing were videoradiographically examined in those with persisting dysphagia.

    RESULTS: The incidence of persisting dysphagia after UPP was 29%. Videoradiographically 71% of the dysphagic patients showed a deviant pharyngeal swallowing pattern.

    CONCLUSION: The incidence of persisting dysphagia after UPP did not differ from that reported after laser uvulopalatoplasty. Dysphagia after UPP was mostly associated with videoradiographic signs of deviant pharyngeal swallowing function. Patients should be informed that there is a risk of developing dysphagia after uvulopalatoplasty.

  • 312. Lewerin, C.
    et al.
    Johansson, H.
    Lerner, Ulf H.
    Umeå University, Faculty of Medicine, Department of Odontology. Center for Bone and Arthritis Research (CBAR) and Geriatric Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, M. K.
    Lorentzon, M.
    Barrett-Connor, E.
    Smith, U.
    Ohlsson, C.
    Mellstrom, D.
    High serum adiponectin is associated with low blood haemoglobin in elderly men: the Swedish MrOS study2015In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 278, no 1, p. 68-76Article in journal (Refereed)
    Abstract [en]

    Objectives: Blood haemoglobin (Hb) concentration declines in elderly men, whilst the level of the adipocyte-derived protein adiponectin increases with age. The association between erythropoiesis and adiponectin in elderly men is unclear. The aim of this study was to determine whether adipokines such as adiponectin and leptin are associated with anaemia and Hb concentration in elderly community-dwelling men.

    Design and setting: The Gothenburg part of the population-based Swedish Osteoporotic Fractures in Men (MrOS) cohort (n=1010; median age 75.3years, range 69-81).

    Main outcome measures: We investigated the associations between levels of adiponectin and Hb before and after adjusting for potential confounders [i.e. age, body composition, erythropoietin (EPO), total oestradiol, leptin, cystatin C and iron and B vitamin status].

    Results: In these elderly men, age was negatively associated with Hb (r=-0.12, P<0.001) and positively associated with adiponectin level (r=0.13, P<0.001). In age-adjusted partial correlations, Hb and adiponectin levels were negatively correlated (r=-0.20, P<0.001); this association remained significant after multivariable adjustment for age, body composition, EPO, fasting insulin, sex hormones, leptin and ferritin. Age-adjusted mean adiponectin concentrations were significantly higher in anaemic men (66/1005; Hb <130gL(-1)) compared to nonanaemic men (14.0 vs. 11.7 gmL(-1), P<0.05). In multivariate analysis, adiponectin together with EPO, total oestradiol, insulin, albumin, transferrin saturation, HDL cholesterol, cystatin C, total body fat mass and free thyroxine, but not leptin, explained 35% of the variation in Hb level. These results remained essentially unchanged after exclusion of men with diabetes.

    Conclusions: Serum adiponectin, but not leptin, was negatively and independently associated with Hb. This finding suggests a possible role of adiponectin in the age-related decline in Hb level observed in apparently healthy elderly men.

  • 313. Lewerin, C.
    et al.
    Nilsson-Ehle, H.
    Jacobsson, S.
    Johansson, H.
    Sundh, V.
    Karlsson, M. K.
    Ljunggren, O.
    Lorentzon, M.
    Kanis, J. A.
    Lerner, Ulf H.
    Umeå University, Faculty of Medicine, Department of Odontology. Göteborgs universitet.
    Cummings, S. R.
    Ohlsson, C.
    Mellström, D.
    Low holotranscobalamin and cobalamins predict incident fractures in elderly men: the MrOS Sweden2014In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 25, no 1, p. 131-140Article in journal (Refereed)
    Abstract [en]

    In a population-based study on cobalamin status and incident fractures in elderly men (n = 790) with an average follow-up of 5.9 years, we found that low levels of metabolically active and total cobalamins predict incident fractures, independently of body mass index (BMI), bone mineral density (BMD), plasma total homocysteine (tHcy), and cystatin C.

    INTRODUCTION: Cobalamin deficiency in elderlies may affect bone metabolism. This study aims to determine whether serum cobalamins or holotranscobalamin (holoTC; the metabolic active cobalamin) predict incident fractures in old men.

    METHODS: Men participating in the Gothenburg part of the population-based Osteoporotic Fractures in Men (MrOS) Sweden cohort and without ongoing vitamin B medication were included in the present study (n = 790; age range, 70-81 years).

    RESULTS: During an average follow-up of 5.9 years, 110 men sustained X-ray-verified fractures including 45 men with clinical vertebral fractures. The risk of fracture (adjusted for age, smoking, BMI, BMD, falls, prevalent fracture, tHcy, cystatin C, 25-OH-vitamin D, intake of calcium, and physical activity (fully adjusted)), increased per each standard deviation decrease in cobalamins (hazard ratio (HR), 1.38; 95 % confidence intervals (CI), 1.11-1.72) and holoTC (HR, 1.26; 95 % CI, 1.03-1.54), respectively. Men in the lowest quartile of cobalamins and holoTC (fully adjusted) had an increased risk of all fracture (cobalamins, HR = 1.67 (95 % CI, 1.06-2.62); holoTC, HR = 1.74 (95 % CI, 1.12-2.69)) compared with quartiles 2-4. No associations between folate or tHcy and incident fractures were seen.

    CONCLUSIONS: We present novel data showing that low levels of holoTC and cobalamins predicting incident fracture in elderly men. This association remained after adjustment for BMI, BMD, tHcy, and cystatin C. However, any causal relationship between low cobalamin status and fractures should be explored in a prospective treatment study.

  • 314.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Vetenskap & klinik: Så kan xylitol användas kliniskt2007In: Tandläkartidningen, ISSN 0039-6982, Vol. 99, no 9, p. 54-57Article in journal (Other (popular science, discussion, etc.))
  • 315.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Odontology.
    Xylitol and its effect on oral ecology: clinical studies in children and adolescents2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Xylitol, classified as a natural sugar substitute, has for about 35 years been known as an agent that may act against caries. The mechanism of action; how it inhibits mutans streptococci (MS) and the clinical dose-response relationship are not however fully investigated. The general aim of the investigations was to evaluate the effect of xylitol on oral ecology in children and adolescents. A series of experimental and controlled clinical trials were performed in which samples of saliva and plaque was collected and analysed with respect to xylitol content, pH, microbial composition and lactic acid production. In paper I, significantly reduced proportions of xylitol-sensitive MS in saliva were demonstrated after 18 weeks of regular use of two dose regimens of xylitol-containing tablets (1.7g and 3.4g xylitol/day) but the acidogenicity in dental plaque was not affected. In paper II, the effect on interdental plaque-pH of two different single dose intakes (2.0g and 6.0g) of xylitol was evaluated. The higher xylitol dose counteracted the pH-drop significantly (p<0.05) when the chewing was followed by a sucrose rinse while the lower dose did not differ from the control. In paper III, the xylitol concentrations in saliva after use of different common xylitol-containing products (0.1g-1.3g) were investigated. Statistically significant elevations of salivary xylitol levels were demonstrated for all products during the first 8-16 min when compared with baseline (p<0.05) but the individual variation was considerable. In samples of supragingival dental plaque, a high dose rinse (6.0g) increased the xylitol concentrations for a longer period (>30 min) than a low dose rinse (2.0g). In paper IV, it was demonstrated that 6.0g of xylitol in chewing gums, every day in 4 weeks, gave significantly less visible plaque and a significantly reduced sucrose-induced lactic acid formation (p<0.05) in saliva. Furthermore, the proportion of MS decreased significantly (p<0.05) compared to baseline. In paper V, the salivary uptake of [14C]-xylitol was compared with a specific assay determining xylitol-sensitive MS and a fair positive correlation (p<0.05) between the two assays was found. In a controlled trial, the proportions of MS and the salivary xylitol uptake decreased significantly (p<0.05) in the xylitol gum test group after 4 weeks compared to baseline which was in contrast to the control gum group. No serious adverse effects were reported in any of the investigations.

    The main conclusions from this thesis were: a) various xylitol-containing products increased the xylitol levels in saliva and plaque, b) 6.0g of xylitol could counteract the interdental pH-drop after sugar consumption and reduce lactic acid formation in saliva c) a daily dose of 6.0g xylitol reduced the amount of visible plaque and altered the salivary microbial composition, d) a transient shift of MS strains in saliva was demonstrated during periods of regular intake of xylitol products but no long-term impact was found after its termination. The relatively high amount of xylitol needed for a beneficial effect on the oral ecology calls for a further development of effective and safe routes for administration.

  • 316.
    Lif Holgerson, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Harnevik, L
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Tanner, ACR
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Mode of birth delivery affects oral microbiota in infants2011In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 90, no 10, p. 1183-1188Article in journal (Refereed)
    Abstract [en]

    Establishment of the microbiota of the gut has been shown to differ between infants delivered by Caesarian section (C-section) and those delivered vaginally. The aim of the present study was to compare the oral microbiota in infants delivered by these different routes. The oral biofilm was assayed by the Human Oral Microbe Identification Microarray (HOMIM) in healthy three-month-old infants, 38 infants born by C-section, and 25 infants delivered vaginally. Among over 300 bacterial taxa targeted by the HOMIM microarray, Slackia exigua was detected only in infants delivered by C-section. Further, significantly more bacterial taxa were detected in the infants delivered vaginally (79 species/species clusters) compared with infants delivered by C-section (54 species/species clusters). Multivariate modeling revealed a strong model that separated the microbiota of C-section and vaginally delivered infants into two distinct colonization patterns. In conclusion, our study indicated differences in the oral microbiota in infants due to mode of delivery, with vaginally delivered infants having a higher number of taxa detected by the HOMIM microarray.

  • 317.
    Lif Holgerson, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Öhman, Carina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Rönnlund, Agneta
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Maturation of oral microbiota in children with or without dental caries2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0128534Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this longitudinal study was to evaluate the oral microbiota in children from age 3 months to 3 years, and to determine the association of the presence of caries at 3 years of age.

    METHODS AND FINDINGS: Oral biofilms and saliva were sampled from children at 3 months (n = 207) and 3 years (n = 155) of age, and dental caries was scored at 3 years of age. Oral microbiota was assessed by culturing of total lactobacilli and mutans streptococci, PCR detection of Streptococcus mutans and Streptococcus sobrinus, 454 pyrosequencing and HOMIM (Human Oral Microbe Identification Microarray) microarray detection of more then 300 species/ phylotypes. Species richness and taxa diversity significantly increased from 3 months to 3 years. Three bacterial genera, present in all the 3-month-old infants, persisted at 3 years of age, whereas three other genera had disappeared by this age. A large number of new taxa were also observed in the 3-year-olds. The microbiota at 3 months of age, except for lactobacilli, was unrelated to caries development at a later age. In contrast, several taxa in the oral biofilms of the 3-year-olds were linked with the presence or absence of caries. The main species/phylotypes associated with caries in 3-year-olds belonged to the Actinobaculum, Atopobium, Aggregatibacter, and Streptococcus genera, whereas those influencing the absence of caries belonged to the Actinomyces, Bergeyella, Campylobacter, Granulicatella, Kingella, Leptotrichia, and Streptococcus genera.

    CONCLUSIONS: Thus, during the first years of life, species richness and taxa diversity in the mouth increase significantly. Besides the more prevalent colonization of lactobacilli, the composition of the overall microbiota at 3 months of age was unrelated to caries development at a later age. Several taxa within the oral biofilms of the 3-year-olds could be linked to the presence or absence of caries.

  • 318.
    Lillqvist, Sandra
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Tissue invasive potential of Streptococcus mutans as shown by binding to oral mucosal tissues in situ2019Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Streptococcus mutans, which is the main bacterial cause of dental caries, expresses surface proteins Cnm and Cbm (collagen adhesin proteins) with specificity for collagen in addition to SpaP (surface protein adhesin) with specificity for salivary agglutinin/DMBT1. Cnm- and Cbm-positive strains of S. mutans have also been implicated in extraoral infections. The present study therefore investigated binding of Cnm- and Cbm-positive strains of S. mutans to oral mucosal tissues in situ. Fluorescence-labelled wildtype and mutant Cnm and Cbm S. mutans strains were tested for presence of binding to buccal mucosa in histological oral epithelial tissue sections at neutral (pH 7) and acidic (pH 2).

    The results showed that both Cnm and Cbm strains bound to subepithelial but not to buccal epithelial tissues and that binding occurred both at pH 2 and 6. Neither epithelial nor subepithelial tissues bound SpaP-positive S. mutans strains devoid of Cnm or Cbm adhesins. In conclusion, our findings show avid binding of S. mutans to collagen-rich subepithelial tissues and thus suggest a tissue invasive potential of the organism.

  • 319.
    Lindberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Resin composites: Sandwich restorations and curing techniques2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Since the mid-1990s resin composite has been used for Class II restorations in stress-bearing areas as an alternative to amalgam. Reasons for this were the patients’ fear of mercury in dental amalgam and a growing demand for aesthetic restorations. During the last decades, the use of new resin composites with more optimized filler loading have resulted in reduced clinical wear. Improved and simplified amphiphilic bonding systems have been introduced. However, one of the main problems with resin composites, its polymerization shrinkage, has not been solved yet. During the polymerization of the resin composites, they shrink as a result of the conversion of the monomers into rigid polymers by a radical addition reaction. The resulting shrinkage stresses in the bonded resin composite restorations may cause adhesive failures at the resin composite/tooth structure interface and/or cohesive failures within the tooth or the resin composite. The interfacial failures may result in post-operative sensitivity, recurrent caries or pulpal injury. This thesis evaluates different restorative and light-curing techniques that are proposed to reduce the polymerization shrinkage and also the effect of new lightcuring units, light-emitting diodes (LED) and high-power quartz tungsten halogen (QTH) light on curing depth and degree of conversion of resin composites. Two restorative techniques using a polyacid-modified resin composite or a flowable resin composite in combination with conventional resin composite in sandwich restorations were evaluated in an intraindividual comparison with a conventional resin composite restoration. The durability of the polyacid-modified resin composite sandwich technique was investigated in a three year clinical follow-up study. A scanning electron microscope replica method was used for evaluation of the interfacial adaptation in vivo of both sandwich combinations. The depth of cure of the flowable resin composite was evaluated with the use of Wallace hardness testing. Degree of conversion for resin composite cured with the new LED units was evaluated with Fourier Transform Raman spectroscopy.

    Major results and conclusions from the studies are:

    • Neither the sandwich restoration with polyacid-modified resin composite nor the flowable resin composite improved the interfacial adaptation of the restorations.

    • No difference in durability was found between the sandwich restorations with polyacidmodified resin composite or the resin composite restorations. A low failure rate was observed for both types of restorations after a clinical observation time of three years.

    • The depth of cure of the flowable resin composite was higher than the depth of cure of the resin composite. It was found that the curing time of the resin composite studied could be reduced or the increment layer thickness increased compared to earlier recommendations.

    • LED curing units of the latest generation were able to cure resin composites to a higher degree of conversion than the control QTH unit

    • The use of soft-start curing did not improve the interfacial adaptation of neither of resin composite restorations tested.

  • 320.
    Lindberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Odontology.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Lindberg, Marianne
    Nine-year evaluation of a polyacid-modified resin composite/resin composite open sandwich technique in Class II cavities2007In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 35, no 2, p. 124-129Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to evaluate in an intraindividual comparison the durability of a polyacid-modified resin composite/resin composite open sandwich restoration in a 9 years follow-up. A polyacid-modified resin composite (PMRC; compomer, Dyract) was placed as an intermediate layer and covered with resin composite (RC, Prisma TPH). A direct RC restoration was used as control. METHODS: Each of 57 patients, received at least one pair of Class II restorations, one open sandwich and one resin composite control. In total 75 pairs of Class II restorations, 68 premolars and 82 molars, all in occlusion, were placed by two dentists. Most of the cavities were surrounded by enamel. The restorations were evaluated at baseline, 6, 12, 24, 36 months and 9 years by slightly modified USPHS criteria. Survival of restorations grouped on the two different techniques was determined using Kaplan-Meier survival curves. RESULTS: After 9 years, 14 of 135 evaluated restorations were estimated as unacceptable, 6 in the sandwich group and 8 in the control group. Over all annual failure rate during the 9-year period was 1.1%. The survival rate was not significant different between the two techniques (p=0.604). Reasons of failure were: secondary caries (8), fracture of tooth (1), fracture of restoration (2), endodontic treatment (3). CONCLUSIONS: Both restorative techniques showed good durability during the 9-year period. No clinical advantage was observed for the sandwich technique.

  • 321. Lindgren, Christer
    et al.
    Mordenfeld, Arne
    Hallman, Mats
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    A Prospective 1-Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 1, p. 41-50Article in journal (Refereed)
    Abstract [en]

    Background: The technique of using bone grafts or different biomaterials for augmentation of the maxillary sinus prior to implant placement is well accepted by clinicians. However, clinical documentation of some bone substitutes is still lacking.

    Purpose: This prospective study was designed to evaluate the success rate of implants placed after maxillary sinus augmentation with a novel synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB), the latter acting as control.

    Material and Methods: Nine edentulous patients and two partially edentulous patients with a mean age of 67 years with a bilateral need for sinus augmentation, < 5 mm residual bone in the floor of the sinus and a crestal width 34 mm, were included in the study. After bilateral elevation of the Schneiderian membrane, all patients were randomized for augmentation with synthetic BCP in one side and DBB in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive surface were placed. Implant survival, graft resorption, plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth, and implant success rate were evaluated after 1 year of functional loading.

    Results: After a mean of 118 days, all patients received their fixed prosthetic constructions. One implant was lost in each biomaterial, giving an overall survival rate of 96.8%. Success rates for implants placed in BCP and DBB were 91.7 and 95.7%, respectively. No significant difference in marginal bone loss was found around implants placed in BCP, DBB, or residual bone, respectively. The mean graft resorption was 0.43 mm (BCP) and 0.29 mm (DBB).

    Conclusion: In this limited study, implant success rate was not dependent on the biomaterial used for maxillary sinus augmentation. Similar results were found after 1 year of functional loading for implants placed after sinus augmentation using BCP or DBB.

  • 322. Lindgren, Christer
    et al.
    Mordenfeld, Arne
    Johansson, Carina B.
    Hallman, Mats
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    A 3-Year Clinical Follow-up of Implants Placed in Two Different Biomaterials Used for Sinus Augmentation2012In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 27, no 5, p. 1151-1162Article in journal (Refereed)
    Abstract [en]

    Purpose: The aims of the present study were to compare a novel biphasic calcium phosphate (BCP) with deproteinized bovine bone (DBB) for maxillary sinus floor augmentation in a split-mouth design and to perform a clinical follow-up of dental implants placed in the augmented sinuses. Materials and Methods: Partially or completely edentulous patients requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) and DBB (control) in the contralateral side. Eight months after grafting, dental implants were placed. After 3 years of graft healing, core biopsy specimens were obtained from the grafted areas for histologic and histomorphometric analyses. After 3 years of functional implant loading, implant survival/success rates and clinical indices were assessed and radiographic examination and resonance frequency analysis were performed. Results: Nine completely edentulous patients and two partially edentulous patients (mean age, 67 years) who required bilateral sinus augmentation were included in the study, and 62 implants were placed. The mean values for the area of newly formed bone in the retrieved specimens were 29% +/- 14.3% and 32% +/- 18.0% for BCP and DBB, respectively; the percentage of graft particles in contact with bone was 38% +/- 10.9% in the BCP group and 44% +/- 12.1% in the DBB group (no statistical significant differences between groups). The mean values for the area of BCP particles and DBB particles were 20% +/- 7.5% and 24% +/- 13.5%, respectively (difference not significant). One dental implant was lost from each group, resulting in an overall implant survival rate of 96.8% after 3 years of loading. Conclusion: After 3 years, a similar amount of newly formed bone was present regardless of the biomaterial used. The choice of biomaterial did not seem to influence implant survival rates. INT J ORAL MAXILLOFAC IMPLANTS 2012;27:1151-1162

  • 323. Lindgren, Christer
    et al.
    Sennerby, Lars
    Mordenfeld, Arne
    Hallman, Mats
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery. Department of oral and maxillofacial surgery, Gävle County Hospital, Gävle, Sweden; Center for research and development, Uppsala University/Gävleborg County Council, Sweden.
    Clinical histology of microimplants placed in two different biomaterials2009In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 24, no 6, p. 1093-1100Article in journal (Refereed)
    Abstract [en]

    Purpose: This randomized, controlled study was designed to compare bone formation around microimplants with a sandblasted, acid-etched surface placed at the time of maxillary sinus floor augmentation with a synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB).

    Materials and Methods: Nine completely edentulous patients and two partially edentulous patients (six women, five men) with a mean age of 67 years (range, 50 to 79 years) requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) in one side and DBB (control) in the contralateral side. At the time of augmentation, one microimplant on each side was placed vertically from the top of the alveolar crest, penetrating the residual bone and the grafting material. After 8 months of graft healing, at the time of ordinary implant placement, all 22 microimplants were retrieved with a surrounding bone core for histologic analyses.

    Results: The bone-to-implant contact in the BCP group was 64.6% +/- 9.0%, versus 55.0% +/- 16.0% for the DBB group. The difference was not significant. The corresponding values for the area of newly formed bone in the biopsies were 41.1% +/- 9.8% and 41.6% +/- 14.0% for BCP and DBB, respectively. There were significantly more DBB particles in contact with newly formed bone than BCP particles (87.9 +/- 18.2% versus 53.9 +/- 26.1%; Wilcoxon rank sum test; P = .007).

    Conclusion: In this randomized, controlled clinical trial, new bone formation and bone-to-implant contact around microimplants with a sandblasted, acid-etched surface was found to be equivalent between sinuses augmented with BCP or DBB. Significantly more DBB particles than BCP particles were in contact with newly formed bone, but the clinical relevance of this has yet to be established.

  • 324.
    Lindgren, Jon
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Materials Science.
    Smeds, Jens
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Materials Science.
    Sjögren, Göran
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Materials Science.
    Effect of Surface Treatments and Aging in Water on Bond Strength to Zirconia2008In: Operative dentistry, ISSN 0361-7734, E-ISSN 1559-2863, Vol. 33, no 6, p. 675-681Article in journal (Refereed)
  • 325.
    Lindh, Tomas
    Umeå University, Faculty of Medicine, Department of Odontology, Periodontology.
    Should we extract teeth to avoid tooth-implant combinations?2008In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 35, no Suppl 1, p. 44-54Article in journal (Refereed)
    Abstract [en]

    The controversy over combining teeth and implants for support of fixed partial dentures still remains after almost three decades of debate. The aim of this review was to evaluate what support that could be found in the literature for extracting teeth in favour of implants, and to elucidate whether tooth-implant prostheses were inferior to solely implant supported constructions in terms of survival and complications. The methods for gathering relevant information entailed electronic searches on PubMed using relevant key words, as well as complementary manual searches in the retrieved publications. The results showed that there was no support for extracting teeth in favour of placing implants. On the contrary, the healthy tooth had a survival that was life-long, which is yet to be shown for the dental implant. Also the use of teeth as abutments in combination with dental implants for support of fixed dental prostheses could be endorsed in certain situations with solid albeit limited scientific support. in a wider sense, such prostheses could be used as a reliable therapy in all regions of the jaws. However the status of the abutment teeth in terms of periodontal support, pulpal status and risk for carious lesions and biomechanical complications should always be considered in relation to the long-term prognosis of the prosthesis. The conclusion was that teeth should not be extracted in favour of placing dental implants without a specific indication, and that tooth-implant supported prostheses should be considered as a viable prosthetic option.

  • 326. Lindh, Tomas
    et al.
    Bäck, Tomas
    Nyström, Elisabeth
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Gunne, Johan
    Umeå University, Faculty of Medicine, Odontology, Prosthetic Dentistry.
    Implant versus tooth-implant supported prostheses in the posterior maxilla: a 2-year report.2001In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 12, no 5, p. 441-449Article in journal (Refereed)
    Abstract [en]

    When implants are used for restoration of a jaw with a residual dentition, the possibility of combining implants with natural abutments may be considered. In a longitudinal comparative study, 26 patients (15 women & 11 men, age 49-84 years) with residual anterior dentitions were treated with two different designs of fixed partial dentures bilaterally in the posterior maxilla. On one side the reconstruction was supported by implants only, while on the contralateral side an implant and a tooth in combination were used. The patients were followed at intervals of 3, 6, 12 and 24 months after loading of the implants. 95 implants were placed, of which 11 non-loaded. A total of 10 implants failed, 7 prior to loading and three within the first three months of service (88.0+/-SE 6.7% cumulative survival for tested implants after two years' follow-up). There was no difference in failure rate for the implants in the two different prosthesis designs. The total mean loss of marginal bone height close to the implants was within acceptable standards, but was more pronounced at the implants not combined with teeth. The results indicate a correlation between the prosthesis design and the loss of marginal bone.

  • 327.
    Lindman, Rolf
    et al.
    University Hospital, Malmö.
    Paulin, Gunnar
    University Hospital, Linköping.
    Stål, Per S
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Morphological characterization of the levator veli palatini muscle in children born with cleft palates2001In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 38, no 5, p. 438-448Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to analyze, morphologically and biochemically, one of the soft palate muscles, the levator veli palatini (LVP), in children born with cleft palate.

    SUBJECTS AND METHODS: Biopsies were obtained from nine male and three female infants in connection with the early surgical repair of the hard and soft palate. Samples from five adult normal LVP muscles were used for comparison. The muscle morphology, fiber type and myosin heavy chain (MyHC) compositions, capillary supply, and content of muscle spindles were analyzed with different enzyme-histochemical, immunohistochemical, and biochemical techniques.

    RESULTS: Compared with the normal adult subjects, the LVP muscle from the infantile subjects with cleft had a smaller mean fiber diameter, a larger variability in fiber size and form, a higher proportion of type II fibers, a higher amount of fast MyHCs, and a lower density of capillaries. No muscle spindles were observed. Moreover, one-third of the biopsies from the infantile subjects with cleft LVP either lacked muscle tissue or contained only a small amount.

    CONCLUSIONS: The LVP muscle from children with cleft palate has a different morphology, compared with the normal adult muscle. The differences might be related to different stages in maturation of the muscles, changes in functional demands with growth and age, or a consequence of the cleft. The lack of contractile tissue in some of the cleft biopsies offers one possible explanation to a persistent postsurgical velopharyngeal insufficiency in some patients, despite a successful surgical repair.

  • 328.
    Lindman, Rolf
    et al.
    Malmö University Hospital.
    Stål, Per S
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Abnormal palatopharyngeal muscle morphology in sleep-disordered breathing2002In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 195, no 1, p. 11-23, Article Number: PII S0022-510X(01)00676-1Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate whether histopathological changes can be detected in two soft palate muscles, the palatopharyngeus and the uvula, in 11 patients with long duration of sleep-disordered breathing (SDB). Muscle samples were collected from patients undergoing uvulo-palatopharyngoplasty (UPPP). Reference samples from the corresponding areas were obtained at autopsy from five previously healthy subjects. Muscle morphology, fibre type and myosin heavy chain (MyHC) compositions were analysed with enzyme-histochemical, immunohistochemical and biochemical techniques. The muscle samples from the patients, and especially those from the palatopharyngeus, showed several morphological abnormalities. The most striking findings were (i) increased amount of connective tissue, (ii) abnormal variability in fibre size, (iii) increased proportion of small-sized fibres, (iv) alterations in fibre type and MyHC compositions, (v) increased frequency of fibres containing developmental MyHC isoforms. Our findings point towards a pathological process of denervation and degeneration in the patient samples. Conclusively, the morphological abnormalities suggest a neuromuscular disorder of the soft palate in SDB patients.

  • 329.
    Lindquist, Susanne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Umeå University, Faculty of Medicine, Department of Odontology.
    Isehed, Catrine
    Umeå University, Faculty of Medicine, Department of Odontology. Folktandvården Gävleborg AV, Region Gävleborg.
    Lie, Anita
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Enamel matrix derivative does not affect osteoclast formation or bone resorption in mouse bone marrow macrophage culturesManuscript (preprint) (Other academic)
  • 330.
    Lindqvist, Berit
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bruxism hos barn1974Doctoral thesis, comprehensive summary (Other academic)
  • 331. Liu, Yen-Chun G
    et al.
    Lerner, Ulf H
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Cell Biology.
    Teng, Yen-Tung A
    Cytokine responses against periodontal infection: protective and destructive roles2010In: Periodontology 2000, ISSN 0906-6713, E-ISSN 1600-0757, Vol. 52, no 1, p. 163-206Article in journal (Refereed)
  • 332.
    Lockner, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Twetman, Svante
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Urinary fluoride excretion after application of fluoride varnish and use of fluoride toothpaste in young children2017In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 27, no 6, p. 463-468Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The efficacy and safety of combined use of topical fluoride products are essential issues that must be monitored.

    AIM: To assess urinary excretion of fluoride after application of two different dental varnishes containing 2.26% fluoride in 3- to 4-year-old children and to compare the levels with and without parallel use of fluoride toothpaste.

    DESIGN: Fifteen healthy children were enrolled to a randomized crossover trial that was performed in two parts: Part I with twice-daily tooth brushing with fluoride toothpaste and Part II with twice-daily brushing with a non-fluoride toothpaste. After a 1-week run-in period, 0.1 mL of the two fluoride varnishes (Duraphat and Profluorid Varnish) was topically applied in a randomized order. Baseline and experimental urine was collected during 6-h periods. The fluoride content was determined with an ion-sensitive electrode.

    RESULTS: There was a statistically significant increase in the 6-h fluoride excretion after application of both experimental varnishes, with and without parallel use of fluoride toothpaste (P < 0.01). When fluoridated toothpaste was used, the mean fluoride excretion was 0.20 mg/6 h after application of Duraphat and 0.29 mg/6 h after application of Profluorid Varnish (P = 0.18).

    CONCLUSIONS: Topical applications of 0.1 mL of fluoride varnish significantly increased the 6-h fluoride excretion. As some individuals displayed excretion levels exceeding the optimal fluoride exposure, a restricted use of fluoride toothpaste in connection with the varnish applications would decrease fluoride exposure.

  • 333. Loguercio, Alessandro Dourado
    et al.
    Reis, Alessandra
    Bortoli, G
    Patzlaft, R
    Kenshima, Silvia
    Rodrigues Filho, Leonardo Eloy
    Accorinte Mde, L
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Influence of adhesive systems on interfacial dentin gap formation in vitro.2006In: Operative dentistry, ISSN 0361-7734, E-ISSN 1559-2863, Vol. 31, no 4, p. 431-441Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study measured: 1) the interfacial dentin gap formation (IGW) of 2 etch & rinse and 3 self-etch systems with different degrees of acidity and determined the correlation between the smear layer thickness and interfacial gap formation after 1 day and 6 months water storage; 2) the hybrid layer thickness (HLT) produced by the adhesives applied under different smear layer thicknesses. METHODS AND MATERIALS: Three self-etch adhesives, a mild (Clearfil SE Bond; SE), a moderate (Optibond Solo Plus Self-Etch Primer; SO) and a strong (Tyrian Self Priming Etchant + One Step Plus; TY), and 2 etch & rinse systems (Single Bond; SB and Scotchbond Multi-Purpose Plus; SBMP) were studied. After flat grinding of the occlusal surfaces, 30 molars were sectioned longitudinally in 2 halves. Dentin surfaces with thick and thin smear layers were obtained for each tooth after polishing different sections on 60- and 600-grit SiC paper, respectively. A resin composite (Z250) build-up was made on each tooth section after randomized application of the adhesives. After 24-hour storage in water, resin-dentin bonded sticks (0.8 mm2) were prepared and divided for 1-day and 6-month measurements. The IGW was measured in a stereomicroscope under 400x. SEM micrographs were also made in order to measure the HLT provided by each adhesive. RESULTS: The thickness of the smear layer did not influence the mean gap width (p>0.05). The etch & rinse systems showed the lowest mean IGW in the 1-day group. Their IGW remained unchanged after 6 months. The self-etch systems showed wider initial IGW, which diminished after 6 months water storage, to sizes similar to the etch & rinse systems. The hybrid layer was thicker when bonded to #60 SiC-treated dentin; however, this difference was only statistically different for the 3-step etch & rinse system (p=0.001). The thickest hybrid layers were observed for the 2 etch & rinse adhesive systems and the thinnest for the mild self-etch. A negative and strong correlation between IGW and HLT was observed for the self-etching adhesive systems tested (r=80.2, p=0.01).

  • 334.
    Loljung, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Coates, Philip J.
    Nekulova, Marta
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Wahlgren, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Wilms, Torben
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Widlöf, Mikael
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hansel, Anna
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    High expression of p63 is correlated to poor prognosis in squamous cell carcinoma of the tongue2014In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 43, no 1, p. 14-19Article in journal (Refereed)
    Abstract [en]

    Backgroundp63 proteins are important in formation of the oral mucosa. Normal oral mucosa shows a balance between the six protein isoforms, whereas an imbalance between them is seen in squamous cell carcinomas (SCC). There is controversy over the clinical impact of p63 in SCC, which may relate to different expression in different areas. In addition, p63 isoforms can act as p53-like molecules (TAp63) or can inhibit p53 functions (Np63) and expression of these isoforms varies in different tumours. Here, we chose to concentrate on the most common intra-oral sub-site, SCC of the mobile tongue. MethodsTotal p63, Np63 and TAp63 were analysed separately using immunohistochemistry. The percentage of cells and intensity of expression of different isoforms of p63 was evaluated using a quick score method and correlated with clinical data in a group of 87 patients with tongue SCC. ResultsAll tumours expressed p63 in at least 60% of the cells when using two different antibodies detecting all 6 isoforms. p63 expression correlated significantly with 2-year survival (P=0.018), with fewer patients surviving 2years if their tumours expressed p63 with strong intensity in at least 80% of the cells (quick score 18). Looking at 5-year survival, this was even more emphasized. Np63 was expressed in all tumours, whereas expression of TAp63 was seen only in 59/87 patients, usually at very low levels. ConclusionsBased on the present data, we recommend using expression of p63 as an additional factor contributing prognostic information in analysis of SCC in the tongue.

  • 335.
    Lundberg, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Cell Biology.
    Koskinen, Cecilia
    Umeå University, Faculty of Medicine, Department of Odontology.
    Baldock, Paul A
    Löthgren, Hanna
    Stenberg, Åsa
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Histology and Cell Biology.
    Lerner, Ulf
    Umeå University, Faculty of Medicine, Department of Odontology.
    Oldenborg, Per-Arne
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Histology and Cell Biology.
    Osteoclast formation is strongly reduced both in vivo and in vitro in the absence of CD47/SIRPalpha-interaction2007In: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, E-ISSN 1090-2104, Vol. 352, no 2, p. 444-448Article in journal (Refereed)
    Abstract [en]

    Physical interaction between the cell surface receptors CD47 and signal regulatory protein alpha (SIRPalpha) was reported to regulate cell migration, phagocytosis, cytokine production, and macrophage fusion. However, it is unclear if the CD47/SIRPalpha-interaction can also regulate macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor (NF)-kappaB ligand (RANKL)-stimulated formation of osteoclasts. Here, we show that functional blocking antibodies to either CD47 or SIRPalpha strongly reduced formation of multinucleated tartrate-resistant acid phosphatase (TRAP)+ osteoclasts in cultures of murine hematopoietic cells, stimulated in vitro by M-CSF and RANKL. In addition, the numbers of osteoclasts formed in M-CSF/RANKL-stimulated bone marrow macrophage cultures from CD47-/- mice were strongly reduced, and bones of CD47-/- mice exhibited significantly reduced osteoclast numbers, as compared with wild-type controls. We conclude that the CD47/SIRPalpha interaction is important for M-CSF/RANKL-stimulated osteoclast formation both in vivo and in vitro, and that absence of CD47 results in decreased numbers of osteoclasts in CD47-/- mice.

  • 336.
    Lundegard, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Danielsson, Karin
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Difficulties detecting miRNA-203 in human whole saliva by the use of PCR2015In: Medicina Oral, ISSN 1698-4447, E-ISSN 1698-6946, Vol. 20, no 2, p. E130-E134, article id 20172Article in journal (Refereed)
    Abstract [en]

    Objectives: Oral Lichen Planus (OLP) is a chronic disease of the oral mucosa, and according to the WHO also a pre malignant condition. Micro-RNAs are short non coding RNAs capable of regulating mRNA expression. MiRNA:scan be detected in tissue, blood and human whole saliva (HWS) and recently we have shown miR-203 to be up-regulated in tissue from OLP lesions. Study Design: In order to see whether mRNA as well as miR-203 could be detected also in HWS, saliva from healthy controls and patients with OLP were analysed using two different PCR methods. Results: Results showed low mRNA and miRNA levels in general in HWS samples, making it hard to generate conclusive results. Conclusions: In order to make HWS a valuable source for different analyses, more sensitive PCR techniques capable of detecting very low levels of mRNA and miRNA as well as more efficient methods for extraction of RNA are needed.

  • 337. Lundegren, Nina
    et al.
    Sohrabi, Melvin M.
    Molin Thorén, Margareta
    Umeå University, Faculty of Medicine, Department of Odontology.
    Akerman, Sigvard
    Prosthetic dental restorations in Swedish samples: prevalence and agreement between self-report, clinical findings, and influence on quality of life2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 4, p. 296-302Article in journal (Refereed)
    Abstract [en]

    Objective: To determine the prevalence of dental prosthetic restorations in an adult population, to study the agreement between self-reports and clinical findings of prosthetic restorations, and to study answers from a questionnaire in relation to the prevalence of prosthetic restorations. Material and methods: A questionnaire was sent to a sample of 10,000 adults. A further sample of 1000 individuals was invited to answer the questionnaire and also participate in a clinical study. The agreement between self-report and clinical findings was analyzed, as were the associations between prosthetic restorations and questionnaire responses, using the chi(2) test. Results: A total of 40% of the sample had fixed dental prostheses (FDP), 2.7% had removable dentures. The agreement between self-report and clinical findings was 93%. 34.7% of the individuals with no prosthetic restorations were university graduates and 4% of individuals with removable complete dentures. Oral health had the greatest impact on the quality of life of younger individuals with FDP, with an OHIP-14 (Oral Health Impact Profile) score of 7.3 for the age group 20-39 years compared to 4.9 for the age group 65-89 years. Conclusion: The questionnaire method can be a cost-effective way to determine the prevalence of prosthetic restorations.

  • 338.
    Lundgren, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Cricchio, Giovanni
    Umeå University, Faculty of Medicine, Department of Odontology. Studio Odontoiatrico Associato "Passaggio dei Poeti", Palermo, Italy.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Clinical outcome and factors determining new bone formation in lateral sinus membrane elevation with simultaneous implant placement without grafting material: a cross‐sectional, 3‐17 year follow‐up study2019In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208Article in journal (Refereed)
    Abstract [en]

    Background: Lateral sinus membrane elevation with simultaneous implant placement without grafting material (graft‐less LSFE) is a widely investigated method for bone augmentation of the maxillary sinus floor. Long‐term follow‐up studies are rare.

    Purpose: This study aimed to investigate the long‐term effects of implants placed with graft‐less LSFE.

    Materials and methods: The study group was comprised of 111 patients previously treated with graft‐less LSFE. The first follow‐up visit, which occurred after a mean of 5 years after surgery, included a clinical examination, cone beam computerized tomography, and panorama or intraoral radiography. The second follow‐up included panorama or intraoral radiography, and it was conducted after a mean of 8 years.

    Results: Overall, 218 implants were placed in 127 sinuses. Nine of the 218 implants failed resulting in an overall implant survival of 95.9%. The average bone gain at the follow‐up was 4.0 ±2.0 mm.

    Conclusion: The implant‐supported rehabilitation achieved using graft‐less LSFE was stable over time, and there was no or little impact on sinus health. Furthermore, it was concluded that the new bone formation and the amount of bone gain is proportional to the length of the implant protruding into the sinus cavity.

  • 339.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Cricchio, Giovanni
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hallman, Mats
    Jungner, Måns
    Rasmusson, Lars
    Sennerby, Lars
    Sinus floor elevation procedures to enable implant placement and integration: techniques, biological aspects and clinical outcomes2017In: Periodontology 2000, ISSN 0906-6713, E-ISSN 1600-0757, Vol. 73, no 1, p. 103-120Article, review/survey (Refereed)
    Abstract [en]

    Implant treatment in an atrophied edentulous posterior maxilla constitutes a challenge for the therapeutic team. The authors of the present study acknowledge that modern micro-rough surface implants in lengths of about 8-10 mm or longer and of different brands are similarly successful. Consequently, the authors propose that the use of different sinus floor elevation techniques should be considered when < 8 mm of bone is available below the maxillary sinus. The type of sinus floor elevation technique selected is mainly based on residual vertical bone height, marginal bone width, local intrasinus anatomy and the number of teeth to be replaced, although other factors (such as surgical training and surgical experience) may have an impact. It is proposed that a transcrestal sinus floor elevation approach can be considered as a first-choice method for single tooth gaps in situations with sufficient width for implant placement and a residual bone height of 5-8 mm, while lateral sinus floor elevation, with or without grafting materials, is indicated when < 5 mm of bone is available and when several teeth are to be replaced. With regard to time of implant placement, a one-stage procedure is preferred provided that high primary stability can be ensured.

  • 340.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Cricchio, Giovanni
    Palma, Vinicius C
    Salata, Luiz A
    Sennerby, Lars
    Sinus membrane elevation and simultaneous insertion of dental implants: a new surgical technique in maxillary sinus floor augmentation.2008In: Periodontology 2000, ISSN 0906-6713, E-ISSN 1600-0757, Vol. 47, p. 193-205Article in journal (Refereed)
  • 341.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Nyström, Elisabeth
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Nilson, Hans
    Umeå University, Faculty of Medicine, Odontology, Prosthetic Dentistry.
    Gunne, Johan
    Umeå University, Faculty of Medicine, Odontology, Prosthetic Dentistry.
    Lindhagen, O
    Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.1997In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 26, no 6, p. 428-434Article in journal (Refereed)
    Abstract [en]

    This study presents the results from 20 consecutive patients treated with an autogenous bone graft from the iliac crest. In ten patients the graft was placed in the maxillary sinuses and the floor of the nose (inlay group). Ten patients, in addition to the inlay graft, had a corticocancellous bone block secured with mini-screws to the anterior maxillary ridge (inlay/onlay group). Endosteal implants (Brånemark) were placed six months after surgery. A total of 136 implants were placed, of which eight failed to integrate during the six-month healing period. A further 15 implants were lost during the follow-up period. For the inlay group the average follow-up period was 22 months and for the inlay/onlay group 19 months. Donor site morbidity was significantly less when iliac bone was harvested with a trephine (inlay group) than in patients treated with our routine procedure for bone harvesting (inlay/onlay group). Surgical technique, donor site morbidity, implant survival and patient acceptance are presented.

  • 342.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery. Umeå University, Faculty of Medicine, Department of Odontology.
    Nyström, Elisabeth
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery. Umeå University, Faculty of Medicine, Department of Odontology.
    Sennerby, Lars
    Sjöström, Mats
    Brechter, Magnus
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Nilson, Hans
    Öberg, Sven
    Lundqvist, Peter
    Jungner, Måns
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Tidehag, Per
    Gunne, Johan
    Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
    Rekonstruktiv käkkirurgi 2: Behandling av den tandlösa atrofiska maxillan2008In: Tandläkartidningen, ISSN 0039-6982, Vol. 100, no 5, p. 72-73Article in journal (Other (popular science, discussion, etc.))
  • 343.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Rasmusson, Lars
    Sjöström, Mats
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Sennerby, Lars
    Simultaneous or delayed placement of titanium implants in free autogenous iliac bone grafts: Histological analysis of the bone graft-titanium interface in 10 consecutive patients1999In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 28, no 1, p. 31-37Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to histologically analyse the bone graft-titanium implant interface after six and twelve months of healing for a simultaneous approach and after six months for a delayed approach. For this purpose, screw-shaped c.p. titanium microimplants, 2 mm in diameter and 5 mm long, were placed and retrieved at different time intervals in ten consecutive patients with severely resorbed maxillae and treated with iliac cortico-cancellous bone grafts and titanium implants in a two-stage procedure. The histomorphometrical analyses of ground sections of the specimens showed a higher degree of bone-implant contact and more bone filling the implant threads in the delayed approach microimplants. This was probably due to the partly revascularized grafted bone in the delayed approach being able to respond to the surgical trauma, resulting in interfacial bone formation. It is concluded that the results from the present study favour the use of a delayed approach when using free autogenous bone grafts and titanium implants for reconstruction of the severely atrophied maxilla.

  • 344.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Sennerby, Lars
    Bone reformation: Contemporary augmentation procedures in oral and maxillofacial implant surgery2008 (ed. 1)Book (Other academic)
  • 345.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Sennerby, Lars
    Bone reformation: Contemporary augmentation procedures in oral and maxillofacial implant surgery2010 (ed. 1)Book (Other academic)
  • 346.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery. Umeå University, Faculty of Medicine, Department of Odontology.
    Sennerby, Lars
    Cricchio, Giovanni
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Salata, Luiz
    Palma, Vinnie
    Lundqvist, Carina
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Ransjö, Maria
    Umeå University, Faculty of Medicine, Department of Odontology.
    Rekonstruktiv käkkirurgi: Behandling av den atrofiska posteriora maxillan hos partiellt betandade patienter2008In: Tandläkartidningen, ISSN 0039-6982, Vol. 100, no 5, p. 70-71Article in journal (Other (popular science, discussion, etc.))
  • 347.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery. Umeå University, Faculty of Medicine, Odontology.
    Sjöström, Mats
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery. Umeå University, Faculty of Medicine, Odontology.
    Nyström, Elisabeth
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery. Umeå University, Faculty of Medicine, Odontology.
    Sennerby, Lars
    Strategies in reconstruction of the atrophic maxilla with autogenous bone grafts and endosseous implants.2008In: Periodontology 2000, ISSN 1600-0757, Vol. 47, p. 143-61Article in journal (Refereed)
  • 348.
    Lundqvist, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    The importance of stromal inflammation in squamous cell carcinoma of the tongue2012In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 41, no 5, p. 379-383Article in journal (Refereed)
    Abstract [en]

    Background: Histological risk assessment evaluating worst pattern of tumour invasion (WPOI), and lymphocytic response (LR), has previously been shown to be of prognostic significance in squamous cell carcinomas of the head and neck (SCCHN). SCCHN is a heterogeneous group of tumours including tumours located in the oral cavity, of which the majority is located in the tongue.

    Methods: Haematoxylin/eosin-stained slides from diagnostic biopsies from 94 cases of SCC on the tongue were evaluated for WPOI and LR. Within the inflammatory infiltrate, the percentage of eosinophilic granulocytes was also estimated. Results were correlated with clinical data such as response to treatment and recurrence.

    Results: For WPOI the majority of patients, 84%, showed small invasive tumours islands with a size <15 cells (grade 4). No correlation with survival, response to treatment or recurrence was seen for WPOI. More than half of the patients showed a dense lymphocytic infiltrate, a factor that was significantly correlated with complete response to radio therapy. Of the patients with dense lymphoid infiltrate, the majority, 63%, did not either have a recurrence. No significant correlation with recurrence, response to treatment or any other factor was seen for presence of eosinophils.

    Conclusions:  Data clearly showed that tongue tumours have a split invasive growth pattern and an intense inflammatory response at the tumour interface. Results also indicated that evaluation of the intensity of the inflammatory infiltrate at the tumour interface in tongue SCC could provide information of potential importance for choice of treatment and prognosis.

  • 349.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry. Odontology, Umeå University.
    Effektiv screeningmetod för vanliga symtom i ansikte och käkar2018In: Best Practice ReumatologiArticle in journal (Other (popular science, discussion, etc.))
  • 350.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Recognition of Temporomandibular Disorders: validity and outcome of three screening questions (3Q/TMD)2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Pain and dysfunction in the temporomandibular region (Temporomandibular Disorders, TMD) are common conditions in the general population with an estimated treatment need of 5-15% in the general population. However, in Sweden, traceable performed treatments are significantly lower. The reasons for this indicated under-treatment are not known. To easily detect patients with a potential TMD related condition, three screening questions, 3Q/TMD, have been introduced. The aim with this project was to evaluate the validity and outcome of the 3Q/TMD with the objective to recognize individuals with TMD and potential treatment need in the Public Dental Health service (PDHS).

    Methods

    The thesis is based on four study samples; three from the PDHS in the county of Västerbotten, Sweden and one sample from the specialized orofacial pain clinic at the Academic Centre for Dentistry, ACTA, Amsterdam, the Netherlands. The bases for all studies are individuals’ answers to the 3Q/TMD and quantitative approaches were used in the analyses. The prevalence of affirmative answers was evaluated in a large cross-sectional study over the lifespan. The validity of the 3Q/TMD in relation to the Diagnostic Criteria for TMD (DC/TMD) as reference standard was established in two case-control studies. The outcome of the 3Q/TMD on TMD treatment within general practice was evaluated in a cohort study.

    Results

    Affirmative answers to the 3Q/TMD increased during adolescence. Women answered affirmatively to the 3Q/TMD significantly more often compared to men for all age groups expect for the first and last parts of a one hundred-year lifespan. The highest prevalence was reported by women during their fertile period in life. In a general population sample, 74% of individuals with an affirmative answer qualified for a DC/TMD pain or dysfunctional diagnosis, as compared to 64% in a specialist patient sample. In the general population sample, for the individual 3Q/TMD questions, as well as combinations of questions, the negative predictive values were high (0.92-0.99). For the specialist sample, when at least one question was answered affirmatively the negative predictive value was high (0.90). The positive predictive value was high (0.89) when all three questions were positive. There was significantly more treatment performed or recommended for 3Q-positives (21.5%) compared to 3Q-negatives (2.2%) (P<0.001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 12.1 (95% CI: 6.3-23.4).

    Conclusion

    The 3Q/TMD is a convenient and valid tool to recognize individuals who would benefit from a further TMD examination within an adult, general population. Within specialized orofacial pain clinics, the questions are useful as guidance for further diagnostics. Although the 3Q/TMD was a factor related to TMD treatment, the majority of individuals with self-reported symptoms of TMD still did not receive traceable assessment or treatment. Factors associated with dentists’ clinical decision-making in relation to TMD warrants further research. The utilization of the 3Q/TMD as a part of a decision tree for the clinician can improve the health care for patients with TMD and is therefore recommended within dentistry.

     

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