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To assess the craniofacial changes related to growth and/or to orthodontic and orthognathic treatments, it is necessary to superimpose serial radiographs on stable structures. However, conventional superimposition provides only a graphical illustration of these changes. To increase the precision of growth and treatment evaluations, it is desirable to quantitate these craniofacial changes. The aims of this study were to (1) evaluate a superimposition-based cephalometric method to process numerical data for craniofacial growth changes and (2) identify a valid, reliable, and feasible method for superimposition. Forty pairs of cephalograms were analyzed at T1 and T2 (mean age 9.9 and 15.0 years, respectively). The superimposition-based cephalometric method involved relating the sagittal and vertical measurements on the T2 radiographs to the nasion and sella landmarks on the T1 radiographs. Validity and reliability were evaluated for three superimposition methods: the sella-nasion (SN); the tuberculum sella-wing (TW); and Björk’s structural. Superimposition-based cephalometrics can be used to quantify craniofacial changes digitally. The numerical data from the superimposition-based cephalometrics reflected a graphical illustration of superimposition and differed significantly from the data acquired through conventional cephalometrics. Superimposition using the TW method is recommended as it is valid, reliable, and feasible.

Background: In long-term studies of orthodontic, orthognathic, and prosthodontic treatments, control subjects are needed for comparison.

Objectives: To study the craniofacial (skeletal, soft tissue, and dental) changes that occur in untreated subjects with normal occlusion between13 and 62 years of age.

Materials/Methods: Thirty subjects with a Class I normal occlusion and harmonious facial profle were studied. X-ray examinations were performed at 13 (T1), 16 (T2), 31 (T3), and 62 (T4) years of age, and data were obtained from cephalograms. In total, 53 angular and linear parameters were measured using superimposition-based and conventional cephalometric methods to describe the craniofacial changes.

Results: The jaws showed signifcant anterior growth from T1 to T2, and signifcant retrognathism from T3 to T4. The anterior face height andjaw dimensions increased signifcantly until T3. Signifcant posterior rotation of the mandible and opening of the vertical jaw relation, in additionto signifcant retroclination of the incisors and straightening of the facial profle, were found from T3 to T4.Limitations: Given the small sample size at T4, it was not possible to analyse the gender dimension.

Conclusions/Implications: Craniofacial changes continue up to the sixth decade of life. These changes are consistent, albeit to a lesser extent,with the adolescent growth patterns for most of the studied parameters, with the exceptions of incisor inclination, sagittal jaw position, verticaljaw relation and inclination, and posterior face height.

Background: The long-term effects on dentofacial morphology of interceptive treatment with premolar extractions, in the absence of subsequent orthodontic treatment, have not been fully explored.

Objective: The aim was to investigate the effects of premolar extractions (without subsequent orthodontic treatment) on the dentoskeletal and soft tissue profile of patients aged between 12 and 62 years with Class I malocclusion with severe crowding, as compared to untreated controls.

Materials and methods: The Extraction group (N = 30 with Class I crowding malocclusion) had their first premolars removed in early adolescence without subsequent orthodontic treatment. The Control group included 30 untreated subjects with Class I normal occlusion. Cephalograms were taken at 12 (T1), 15 (T2), 30 (T3), and 62 (T4) years of age. A superimposition-based cephalometric method was used to assess the dentoskeletal and soft tissue changes.

Results: There were no significant differences between the Extraction and Control groups in terms of skeletal sagittal relation, incisor inclination, and protrusion, or most of the soft tissue parameters throughout the observation period. However, significant differences were observed between the groups with respect to the vertical relations in T2-T3, such that the Extraction group showed more-pronounced decreases in the ML/NSL, ML/NL, and Gonial angles and more-pronounced increases in facial heights.

Conclusions and implications: Treatment for subjects with Class I malocclusion with severe crowding by the extraction of four premolars, without subsequent orthodontic treatment, does not affect the long-term dentoskeletal and soft tissue profile, as compared to an untreated Control group. The degree of crowding, rather than changes in dentofacial morphology, is crucial in deciding on extraction therapy.

Objectives: The aim of this study was to map the vertical locations of calcified carotid plaques (CCPs), osseous anatomic structures, and calcified soft tissues in the area of the carotid artery, determine to what extent CCPs are superimposed on the cervical spine in coronal images, and analyze the differences between men and women.

Study Design: Computed tomography angiography (CTA) scans of 79 patients were studied. CCPs were discovered in 152 of the total 158 neck sides. Evaluations were performed by using sagittal and coronal reformatted CTA images with maximum intensity projection.

Results: Most of the calcified anatomic structures studied, including the carotid bifurcation, were found in close relationship to the level of the third and fourth cervical vertebrae. In the coronal view, all or most of the areas of the CCPs were superimposed on the cervical spine in 22 of 44 (50%) neck sides with CCP in women and in 37 of 108 (34.2%) in men (P = .070).

Conclusions: The carotid bifurcation is in close proximity to various calcified anatomic structures. This should be taken into account when diagnosing CCPs in panoramic radiographs. In the coronal view, CCPs and the cervical spine are often superimposed; thus, coronal images are not recommended for confirmation of putative carotid calcifications diagnosed on the basis of panoramic radiographs.

Objective: The aim was to optimize diagnostics for carotid artery calcifications (CACs) on panoramic radiographs (PRs) to identify cardiovascular disease (CVD) by investigating how 4 defined CAC shapes are associated with ultrasound (US) findings indicating CVD.

Study Design: The study included 414 participants (802 neck sides) from the Malmö Offspring Dental Study, examined with PRs. The PRs were assessed for CAC shapes stratified into 4 categories: single, scattered, vessel-width defining, and vessel-outlining. The carotid arteries were examined with US for signs of CVD: the presence of plaques, largest individual area of a plaque, number of plaques, and percentage reduction of the lumen. Associations between the different CAC categories and US characteristics were analyzed.

Results: All categories of CAC were significantly associated with a higher degree of US findings indicating CVD compared with no CAC (P < .001). The most significant differences were found for vessel-outlining CAC, with the mean of the largest individual plaque area of 17.9 vs 2.3 mm2, mean number of plaques 1.6 vs 0.2, and mean percentage reduction of the lumen 24.1% vs 3.5% (all P < .001).

Conclusions: Independent of shape, CACs detected on PRs were associated with a higher degree of US findings of CVD. This was most pronounced for vessel-outlining CAC. With refined differential diagnostics of CACs in PRs, dentists may contribute to improved identification of patients in need of cardiovascular prevention.

BACKGROUND: Patients with unilateral oral or pharyngeal cancer often receive bilateral radiotherapy because of the potential for metastases. Because postoperative sequelae are evident on the tumor side, to date little attention has been paid to sensory alterations after radiotherapy on the healthy, nontumor side. The objective of this study was to investigate possible sensory alterations. METHODS: Intraoral sensation was tested bilaterally at standardized sites in 27 patients and 20 controls. Preoperative radiotherapy was bilateral in 19 patients and unilateral in eight patients. Patients were tested before treatment, after radiotherapy, and after surgery at 6 months and 1 year. Comparisons were performed interindividually and intraindividually and between groups. RESULTS: A delayed deterioration of sensation was revealed on the nontumor side 6 months after radiotherapy. There was no recovery 1 year after treatment. CONCLUSIONS: Intraoral sensation cannot be evaluated directly after radiotherapy. It is plausible that sensory deterioration after radiotherapy has an impact on functional rehabilitation after tumor treatment.

Cone beam CT (CBCT) is a relatively new imaging modality, which is now widely available to dentists for examining hard tissues in the dental and maxillofacial regions. CBCT gives a three-dimensional depiction of anatomy and pathology, which is similar to medical CT and uses doses generally higher than those used in conventional dental imaging. The European Academy of DentoMaxilloFacial Radiology recognizes that dentists receive training in two-dimensional dental imaging as undergraduates, but most of them have received little or no training in the application and interpretation of cross-sectional three-dimensional imaging. This document identifies the roles of dentists involved in the use of CBCT, examines the training requirements for the justification, acquisition and interpretation of CBCT imaging and makes recommendations for further training of dentists in Europe who intend to be involved in any aspect of CBCT imaging. Two levels of training are recognized. Level 1 is intended to train dentists who prescribe CBCT imaging, such that they may request appropriately and understand the resultant reported images. Level 2 is intended to train to a more advanced level and covers the understanding and skills needed to justify, carry out and interpret a CBCT examination. These recommendations are not intended to create specialists in CBCT imaging but to offer guidance on the training of all dentists to enable the safe use of CBCT in the dentoalveolar region.

Introduction: The aim of this study was to investigate how students perceive the benefit of participating in a teacher-organised session providing feedback on exams, termed post-exam feedback, in two dental hygienist programmes.

Methods: The study was based on interviews with 22 participants, including 18 students and 4 faculty teachers. The data were approached on the basis of thematic analysis, allowing us to generate insights on how the participants reflected on their participation in the post-exam feedback sessions and how they perceived this arrangement as learners.

Results: The findings from the study suggest that motivated students consider post-exam feedback to be beneficial in clearing up uncertainties and deepening their understanding of issues not fully understood during the exam, as well as supporting their further learning. Less motivated students mainly consider post-exam feedback to be relevant for students who do not pass the exams.

Conclusions: Organised in a student-centred way and with attentiveness to student learning preferences, the results suggest that post-exam feedback can be valuable for enhancing assessment and supporting student learning related to exams.

BACKGROUND: In odontology, panoramic radiographs (PRs) are regularly performed. PRs depict the teeth and jaws as well as carotid artery calcifications (CACs). Patients with CACs on PRs have an increased risk of vascular events compared to healthy controls without CACs, but this association is often caused by more vascular events and risk factors at baseline. However, the risk of vascular events has only been analyzed based on the presence of CACs, and not their shape. Thus, this study determined if the shape of CACs in PRs affects the risk of future vascular events.

METHODS: The study cohort included 117 consecutive patients with CACs in PRs and 121 age-matched controls without CACs. CAC shape in PRs was dichotomized into bilateral vessel-outlining CACs and other CAC shapes. Participants were followed prospectively for an endpoint of vascular events including myocardial infarction, stroke, and vascular death.

RESULTS: Patients with bilateral vessel-outlining CACs had more previous vascular events than those with other CAC shapes and the healthy controls (p < 0.001, χ²). The mean follow-up duration was 9.5 years. The endpoint was reached in 83 people. Patients with bilateral vessel-outlining CACs had a higher annual risk of vascular events (7.0%) than those with other CAC shapes (4.4%) and the controls (2.6%) (p < 0.001). In multivariate analysis, bilateral vessel-outlining CACs (hazard ratio: 2.2, 95% confidence interval: 1.1-4.5) were independent risk markers for the endpoint.

CONCLUSIONS: Findings of bilateral vessel-outlining CACs in PRs are independent risk markers for future vascular events.

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.

OBJECTIVE: To determine calcium volume in extirpated carotid plaques, analyze correlations between calcium volume and degree of stenosis, and analyze whether calcium volume influences the possibility of detecting stenosis in panoramic radiographs.

STUDY DESIGN: Ninety-seven consecutive patients with ultrasonography-verified carotid stenosis were examined with panoramic radiography before surgery. Extirpated carotid plaques (n = 103) were analyzed for calcium volume by cone beam computed tomography (CBCT). Panoramic radiographs were analyzed for carotid calcifications.

RESULTS: The median calcium volume was 45 mm(3) (first quartile subtracted from the third quartile [IQR], 14-98 mm(3)). We observed no correlation between calcium volume and degree of stenosis. Seventy-eight stenoses were situated within the region included in the panoramic radiographs, and their volumes ranged from 0 to 509 mm(3). Of these, 99% revealed carotid calcifications on panoramic radiographs.

CONCLUSIONS: We found no association between calcium volume and degree of carotid stenosis. Calcium volume did not influence the possibility of detecting carotid calcifications in panoramic radiographs.

OBJECTIVE: Carotid stenoses ≥50% are associated with increased risk for stroke that can be reduced by prophylactic carotid endarterectomy (CEA). Calcifications in arteries can be detected in panoramic radiographs (PRs). In a cross-sectional study, we analyzed (1) extirpated plaques for calcification, (2) how often PRs disclosed calcified plaques, (3) how often patients with stenoses ≥50% presented calcifications in PRs, and (4) the additional value of frontal radiographs (FRs).

STUDY DESIGN: Patients (n = 100) with carotid stenosis ≥50% were examined with PRs and FRs before CEA. Extirpated carotid plaques were radiographically examined (n = 101).

RESULTS: It was found that 100 of 101 (99%) extirpated plaques were calcified, of which 75 of 100 (75%) were detected in PRs; 84 of 100 (84%) patients presented carotid calcifications in the PRs, in 9.5% contralateral to the stenosis ≥50%.

CONCLUSIONS: Carotid calcifications are seen in PRs in 84% of patients with carotid stenosis ≥50%, independent of gender. FRs do not contribute significantly to this identification.

Objective. The aim of this case-control study was to investigate whether patients with a first myocardial infarction (MI) had a higher prevalence of calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs) than age-, gender-, and residential area-matched controls without MI. Study Design. Six hundred ninety-six cases with a first MI and 696 controls were included in this substudy of the Swedish multicentre PAROKRANK study. All participants underwent panoramic radiography, and the PRs were evaluated for CCAAs. Results. The prevalence of CCAAs detected by PR was 33.8% (235 of 696) in cases and 27.6% (192 of 696) in controls (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.44; P = .012). Among males, 32.7% of cases (184 of 562) and 26.5% of controls (149 of 562) displayed CCAAs on PRs (OR 1.24; 95% CI 1.03-1.48; P = .022). Among both genders, bilateral CCAAs were significantly more common among cases than among controls (P = .002). Conclusions. Cases with recent MIs had a significantly higher prevalence of CCAAs on PRs compared with controls without MIs. This difference between groups was more pronounced for bilateral CCAAs. These findings supported the hypothesis that CCAA detection could serve as a risk indicator for future MIs.

PURPOSE: To study general dental practitioners (GDPs) ability to detect calcified carotid artery atheromas (CCAAs) in panoramic radiographs (PRs) and if their diagnostic accuracy in long term is improved after a short training programme.

METHODS: Fourteen GDPs had their diagnostic accuracy regarding CCAA in PR assessed at baseline, 2 weeks and 1 year after training. Comparison was made with a reference standard based on consensus results from two experienced oral and maxillofacial radiologists. At each session, 100 radiographs were assessed individually by the GDPs. After the baseline assessment, the GDPs participated in a 2-hour training programme comprising a lecture and diagnostic training by calibration. The GDPs results before and after training were compared, as well as between follow-up sessions.

RESULTS: A significant improvement in diagnostic accuracy was observed with increased sensitivity (from 41.8% to 55.7%, P = 0.02) without a significant decrease in specificity (from 87.2% to 86.7%, P = 0.87). The Kappa values also increased (from 0.66 to 0.71, P = 0.04). At 1-year follow-up, the improvement compared to baseline remained significant. There were no significant changes between the 2-week and 1-year follow-up assessment.

CONCLUSION: A short training programme can significantly and sustainable improve GDPs diagnostic accuracy regarding CCAA.

Objective: To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI). Methods: The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined. Results: CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P = .04) and patients (P = .001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P = .07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments. Conclusions: Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.

Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area-matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA-particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.

Objectives/Hypothesis To study whether tonsillectomy is effective on obstructive sleep apnea (OSA) in adults with large tonsils. Study Design A multicenter prospective interventional study. Methods The study comprised 28 patients with OSA, an apnea-hypopnea index of > 10, large tonsils (Friedman tonsil size 3 and 4), and age 18 to 59 years. They were derived from 41 consecutive males and females with large tonsils referred for a suspicion of sleep apnea to the ear, nose, and throat departments in Umea, Skelleftea, and Sunderbyn in northern Sweden. The primary outcome was the apnea-hypopnea index, measured with polygraphic sleep apnea recordings 6 months after surgery. Secondary outcomes included daytime sleepiness, as measured with the Epworth Sleepiness Scale, and swallowing function, using video-fluoroscopy. Results The apnea-hypopnea index was reduced from a mean of 40 units per hour (95% confidence interval [CI] 28-51) to seven units per hour (95% CI 3-11), P < 0.001, at the 6-month follow-up after surgery. The apnea-hypopnea index was reduced in all patients and 18 (64%) were cured. The Epworth Sleepiness Scale was reduced from a mean of 11 (95% CI 8-13) to 6.0 (95% CI 4-7), P < 0.001. A swallowing dysfunction was found in seven of eight investigated patients before surgery. Of those, swallowing function improved in five patients after surgery, whereas no one deteriorated. Conclusion Tonsillectomy may be effective treatment for adult patients with OSA and large tonsils. Tonsillectomy may be suggested for adults with OSA and large tonsils. Level of Evidence 4.

Objectives/Hypothesis: To evaluate the effect of radiofrequency surgery of the soft palate on daytime sleepiness in snoring men with mild or no sleep apnea Study design: Randomized controlled trial Methods: Thirty-five men were recruited from consecutive patients referred to the Ear, Nose and Throat Clinic due to snoring and complaints of daytime sleepiness. The inclusion criteria were an apnea-hypopnea index of ≤ 15, male gender and age 18-65 years. Patients were randomized to either radiofrequency or sham surgery of the soft palate. All but one chose and received the option of three treatments. All patients participated in a follow-up including an overnight sleep apnea recording and questionnaires 12 months after the last treatment. The primary outcome was daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) and other questionnaires. Secondary outcomes were effects on the apnea-hypopnea index and subjective snoring. Results: Thirty-two of 35 patients, 19 of 20 in the radiofrequency surgery group and 13 of 15 in the sham surgery group, completed the study. No differences between the two groups in relation to the ESS or apnea-hypopnea index were found at follow-up. Conclusion: Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no sleep apnea, one year after surgery.

BACKGROUND: Swallowing dysfunction and risk of undernutrition increase the risk of pneumonia, morbidity, and mortality. Short-term care is an unexplored care context, where many older people stay yearly.

AIM: This cross-sectional study aimed to describe and analyze the relationship between swallowing dysfunction and risk of undernutrition among older people in short-term care, including potential gender-related differences.

METHODS: In total, 391 people (209 women), aged ≥ 65 years (median age 84 years) and admitted to short-term care in five Swedish counties participated. They went through a timed water swallow test to assess swallowing dysfunction, including abnormal swallowing capacity and signs of aspiration (i.e., cough and voice change). Risk for undernutrition was assessed using the Minimal Eating Observation and Nutrition Form-version II.

RESULTS: Swallowing dysfunction was observed in 248 of 385 (63%) participants, including abnormal swallowing capacity in 213 of 385 (55%) and aspiration signs in 127 of 377 (34%). Abnormal swallowing capacity was more frequent among women (p = 0.030), whereas men with normal swallowing capacity exhibited signs of aspiration more frequently (cough p = 0.038, voice change p = 0.004). Risk of undernutrition was found in 91 of 390 (23%) participants, more frequently among women (p = 0.007). A logistic regression model revealed an increased risk of undernutrition among older people with abnormal swallowing capacity (OR 1.74, 95% CI 1.04-2.92, p = 0.034).

CONCLUSIONS: The high prevalence of swallowing dysfunction and risk of undernutrition highlight the need for a systematic screening program and feasible treatment to improve swallowing function for adequate and safe food intake among older people in short-term care.

CLINICAL TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov on July 4, 2016, under NCT02825927.

Background: Oral and pharyngeal swallowing dysfunction are common complications in acute stroke patients. This primary aim of this study was to determine whether oral neuromuscular training improves swallowing function in participants with swallowing dysfunction after stroke. A secondary aim was to assess how well results of the timed water-swallow test (TWST) correspond with swallowing dysfunction diagnosed by videofluoroscopy (VFS).

Methods: This was an intention-to-treat two-centre prospective randomized open-label study with blinded-evaluators (PROBE) design. At 4 weeks after stroke onset, participants with swallowing dysfunction were randomized to 5 weeks of continued orofacial sensory-vibration stimulation with an electric toothbrush or additional oral neuromuscular training with an oral device (Muppy®). Participants were examined with TWST, a lip-force test, and VFS before (baseline), after 5 weeks’ treatment (the end-of-treatment), and 12 months after treatment (follow-up). The baseline VFS results were compared with the TWST results. The primary endpoint was changes in swallowing rate assessed using TWST, from baseline to the end of training and from baseline to follow-up based on intention-to-treat analyses. The secondary endpoint was the corresponding changes in lip-force between baseline, the end of treatment, and follow-up.

Results: The participants were randomly assigned as controls (n = 20) or for intervention with oral neuromuscular training (n = 20). After treatment, both groups had improved significantly (intervention, P < 0.001; controls, P = 0.001) in TWST but there was no significant between-group difference in swallowing rate. At the 12-month follow-up, the intervention group had improved further whereas the controls had deteriorated, and there were significant between-group differences in swallowing rate (P = 0.032) and lip force (P = 0.001). A TWST < 10 mL/sec at baseline corresponded to VFS-verified swallowing dysfunction in all assessed participants.

Conclusion: The 5-week oral neuromuscular training improved swallowing function in participants with post-stroke dysphagia compared with the controls 12 months after intervention, but there was no between-group difference in improvement immediately after treatment. TWST results corresponded with VFS results, making TWST a feasible method for identifying persons with swallowing dysfunction after stroke. Larger randomized controlled trials are required to confirm our preliminary positive long-term results.

Trial registration: Retrospectively registered at ClinicalTrials.gov: NCT04164420. Registered on 15 November 2019.

Objectives: this prospective, cluster randomised, controlled trial investigated the effect of oral neuromuscular training among older people in intermediate care with impaired swallowing.

Methods: older people (≥65 years) with swallowing dysfunction were cluster randomised according to care units for 5 weeks of neuromuscular training of the orofacial and pharyngeal muscles or usual care. The primary endpoint was the change in swallowing rate (assessed with a timed water swallow test) from baseline to the end-of-treatment and 6 months post-treatment. The secondary endpoints were changes in signs of aspiration during the water swallow test, and swallowing-related quality of life (QOL). An intention-to-treat principle was followed, and mixed-effects models were used for data analysis with the clustered study design as a random factor.

Results: in total, 385 participants from 36 intermediate care units were screened, and 116 participants were randomly assigned to oral neuromuscular training (intervention; n = 49) or usual care (controls; n = 67). At the end of treatment, the geometric mean of the swallowing rate in the intervention group had significantly improved 60% more than that of controls (P = 0.007). At 6 months post-treatment, the swallowing rate of the intervention group remained significantly better (P = 0.031). Signs of aspiration also significantly reduced in the intervention group compared with controls (P = 0.01). No significant between-group differences were found for swallowing-related QOL.

Conclusions: oral neuromuscular training is a new promising swallowing rehabilitation method among older people in intermediate care with impaired swallowing.

Trial registration: ClinicalTrials.gov: NCT02825927.

Objectives: We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.

Methods: This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95% confidence intervals (CI).

Results: The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3% were females. Mortality within one year was 25.1%. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95% CI 1.02‐2.75; P = .041 and aHR: 1.98, 95% CI 1.07‐3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0%) and 2.6 (95% CI 1.15‐5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0%).

Conclusions: Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations.

In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

BACKGROUND AND AIM: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT).

METHODS: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3) was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations.

RESULTS: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: <8; 8-35; 36-70 and >70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients.

CONCLUSION: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification.

Objective. The aim of this study was to determine whether people with calcifications in the area of the carotid arteries on panoramic radiographs (CALPANs) have an increased prevalence of vascular risk factors or an increased risk of future vascular events. Materials and Methods. We included 113 consecutive patients with CALPANs and 116 gender- and age-matched controls without CALPANs. Vascular risk factors were generally known in the study population, since it was recorded in a population-based community-screening program. Results. Patients with CALPANs had a higher prevalence of vascular risk factors than controls independent of previous vascular events. During the 5.4-year follow-up, patients with CALPANs had a higher risk of a combined endpoint of vascular events (5.6%/yr) compared with the controls (2.4%/yr) (P = .004 by log rank test; unadjusted hazard ratio (HR) 2.4; 95% CI 1.3-4.3). This difference was not significant when previous vascular events and risk factors were taken into account (adjusted HR; 1.2; 95% CI 0.6-2.3; P = .62; Cox regression). Conclusions. People with CALPANs are very likely to have vascular risk factors, but these factors might be unknown when CALPANs are detected. Accordingly, patients with CALPANs should be advised to have their vascular risk factors regularly checked in order to receive advice on preventive lifestyle modifications and medical treatment when indicated. However, it remains unknown whether CALPANs add information about the independent risk of future vascular events. Therefore, further studies are warranted to investigate whether the detection of CALPANs indicates a need for additional or more intense vascular treatment.

Background: Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications. Methods: This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy. Results: Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis - not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95% CI 4.2-20.8%) had carotid stenosis - significantly over the 5% pre-specified threshold (p = 0.014, Binomial test). Conclusions: The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy.

Objective: The aim of this case-control study was to investigate whether cognitively impaired individuals have a higher burden of calcified carotid artery atheroma (CCAA) than controls without cognitive impairment.

Material and methods: The study included 154 cases with Alzheimer’s disease (n = 52), mild cognitive impairment (n = 51), or subjective cognitive decline (n = 51) diagnosed at a university memory clinic. Seventy-six cognitively healthy controls were sampled through the Swedish population register. All participants underwent clinical oral and panoramic radiographic examinations. Two oral and maxillofacial radiologists performed blinded analyses of the panoramic radiographs for signs of CCAA, which was registered as absent or present and, if present, unilateral or bilateral. Consensus assessment was used for all statistical analyses.

Results: CCAA was common (40%) in this middle-aged and older Swedish population. We found no differences in the prevalence of CCAA between cases and controls (40% vs. 42%).

Conclusion: Cognitively impaired patients do not have a higher burden of CCAA than matched controls without cognitive impairment.

OBJECTIVE: To test the hypothesis that preoperative asymptomatic pharyngeal swallowing dysfunction predisposes for the development of symptoms of dysphagia after uvulopalatopharyngoplasty (UPPP) and uvulopalatoplasty (UPP). MATERIAL AND METHODS: A total of 42 patients who snored were scheduled to undergo UPPP (n = 20) or UPP (n = 22). UPP was performed using either a CO2 laser or a conventional steel scalpel. Preoperatively and 1 year postoperatively all patients were examined videoradiographically to assess pharyngeal swallowing function. They also completed a questionnaire pre- and postoperatively concerning their snoring problems and swallowing function as well as the outcome of surgery. RESULTS: Preoperatively, 7 (17%) patients reported dysphagia. Pharyngeal swallowing dysfunction was demonstrated in 6/7 patients with preoperative dysphagia while pharyngeal swallowing dysfunction was evident preoperatively in 18/35 non-dysphagic patients. Of the 35 patients without preoperative dysphagia, 10 (29%/) developed dysphagia after surgery. There was no significant risk of development of postoperative dysphagia for patients with compared to patients without preoperative pharyngeal swallowing dysfunction. Only one of the seven patients with preoperative dysphagia experienced worsening of the problem. A total of 93% of the patients reported a decrease in snoring and 95% reported a decrease in daytime sleepiness. CONCLUSIONS: Preoperative pharyngeal swallowing dysfunction was not proven to predict the development of dysphagia after UPPP or UPP. The surgical method did not influence the frequency of postoperatively acquired dysphagia. The results do not indicate that patients with preoperative dysphagia should be excluded from treatment with UPPP or UPP.

Att ha ett svårförståeligt tal är ett socialt handikapp som kan misstolkas som att individen har en intellektuell funktionsnedsättning. Sväljningssvårigheter som aspiration med hosta och risk för kvävning, kan i värsta fall vara livshotande men också socialt och fysiskt handikappande eftersom måltiden är viktig såväl i det sociala umgänget som för nutrition.

Svalget (farynx) utgör förbindelsen mellan näsa och mun till struphuvudet (larynx) och matstrupen (esofagus). Farynx är därmed delaktig i de livsuppehållande funktionerna andning och sväljning samt under tal, hostning, kräkning och kväljning. Farynxdysfunktion kan ge  avvikande tal, sväljningssvårigheter, snarkning, sömnapné och kan i värsta fall leda till kvävning.

Videoradiografisk undersökning är en viktig del vid bedömning av avvikelser i farynx funktion under tal och sväljning samt som underlag för val av behandlingsstrategi. Bariumsulfatbaserad kontrastmedel används vid undersökningarna för att visualisera mjukvävnaderna i farynx under tal samt som bolus vid bedömning av tugg- och sväljningsfunktion.

The aim of this chapter is to describe arthrography as method for diagnosing soft tissue derangements of the temporomandibular joint (TMJ) as well as a tool for guided administration of corticosteroids. The chapter includes numerous illustrations and five videos explaining the methods of arthrography, arthrotomography and contrast-guided administration of corticosteroids. MRI is the most common method for diagnosing soft tissue derangements of the TMJ. Yet, there are situations when arthrography is useful and superior to MRI, e.g. when the patient suffers from claustrophobia, has loose ferromagnetic objects in the body or metal objects in the head and neck region causing disturbances in the images (e.g. orthodontic devices). Arthrography is also useful if there is call for diagnosing soft tissue perforations in the disc or the posterior attachment, or adherences between the disc or the posterior attachment and the bony components that can be revealed during the real-time dynamic assessment. Filling the joint compartments can contribute to loosening of adherences and the anaesthesia preceding injection of contrast media constitutes a diagnostic tool by confirming origin of pain. Follow-up of splint therapy can be included in the examination. Finally, arthrography can be used as guidance for intervention with, e.g. corticosteroids.

Arthrography is an alternative technique for diagnosing soft tissue derangements of the temporomandibular joint (TMJ) when magnetic resonance imaging (MRI) is not an option. This can be due to contraindications to perform a MRI on a specific patient or when MRI is not applicable for specific diagnoses of soft tissue derangements of the TMJ. It is an invasive method and can be used not only for diagnostics but also for therapeutic injections e.g. administration of corticosteroids

Biopsy studies of the soft palatal and oropharyngeal tissues in habitual snorers and patients suffering from obstructive sleep apnoea have shown signs of neurogenic lesions. These lesions might affect the pharyngeal swallowing function, which is dependent on adequate sensitivity. The objective of the present study was to test the hypothesis that snoring is associated with aberrant pharyngeal swallowing function. Forty-one consecutive patients without dysphagia, seeking medical attention because of heavy snoring and various degrees of daytime sleepiness, were prospectively selected. Fifteen non-snoring volunteers without dysphagia served as controls. Patients and volunteers were videoradiographically examined in lateral and posteroanterior views during the oral and pharyngeal phases of swallowing. The hypothesis was verified. Snoring patients demonstrated deviant pharyngeal swallowing function seven times more frequently than did the non-snoring volunteers. Deviant pharyngeal swallowing function was observed in 22 (54%) of the snorers compared with 1 (7%) of the non-snoring volunteers. Impaired bolus control with premature leakage of bolus into the pharynx and a delayed evocation of the swallowing reflex was the most common finding, followed by bolus residual in the pharynx and laryngeal penetration. The conclusion was that snoring is associated with subclinical pharyngeal swallowing dysfunction.

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

Introduction: A combination of summative assessments and post-exam feedback can create a formative environment to support student learning. It remains unknown to what extent feedback sessions are conducted after exams in oral radiology courses for dental and dental hygienist students in Europe. This survey study aimed to explore whether post-exam feedback sessions were conducted, and if so, in what format.

Materials and Methods: A questionnaire was distributed to 76 dental schools in 26 countries and 34 dental hygienist schools in 14 countries in Europe. The questions addressed whether feedback was provided after exams in oral radiology, the feedback format, and whether feedback sessions were formalised or performed for other reasons.

Results: Questionnaire responses were received from 33 dental schools in 18 countries, and 20 dental hygienist schools in 11 countries. Information about grades was provided in 23–30% of the schools. Post-exam feedback sessions including opportunities for discussion was provided at 39% of the schools, all with guidelines stating that these sessions should be carried out. The remaining schools provided feedback either on request by individual students or as written examples of correct answers.

Conclusion: Almost one third of the dental schools announced grades without providing any post-exam feedback that could support learning. Two fifth utilised feedback sessions to assist students in gaining knowledge and sorting out misconceptions, all according to guidelines. Given the possible learning potential in post-exam feedback with opportunity to discuss, further studies of this format would be valuable, including the role and use of feedback guidelines.

OBJECTIVES: Snoring is associated with subclinical pharyngeal swallowing dysfunction, probably owing to vibration trauma to the pharyngeal tissues caused by snoring. Negative intrathoracic pressure during apnoea causes stretching of the velum and pharynx. The aim of this study was to investigate whether patients with severe sleep apnoea have an increased frequency of videoradiographically diagnosed subclinical pharyngeal swallowing dysfunction compared with snoring patients with or without mild sleep apnoea as well as with non-snoring controls. METHODS: Eighty consecutive patients referred for sleep apnoea recordings because of snoring were examined. Fourteen of these patients were excluded because they suffered from dysphagia. Fifteen non-snoring, non-dysphagic volunteers served as controls. Videoradiography was performed to examine the oral and pharyngeal swallowing function in patients and controls. Overnight sleep apnoea recordings were used to evaluate the apnoea-hypopnoea index (AHI). RESULTS: Pharyngeal swallowing dysfunction was observed in 34/66 (52%) of the snoring patients and in 1/15 (7%) of the non-snoring controls. Pharyngeal swallowing dysfunction was observed in 50% of patients with an AHI of >or=30, in 61% of patients with an AHI of 5-29 and in 43% of patients with an AHI of <5. There was no significant difference in the frequency of pharyngeal swallowing dysfunction between snoring patients with different AHIs. CONCLUSION: Snoring patients run an increased risk of developing subclinical pharyngeal swallowing dysfunction independent of concomitant sleep apnoea.

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.

Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. MATERIAL AND METHODS: Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC H&N35 Quality of Life questionnaire. The TheraBite(®) range of motion scale was used to measure maximal interincisal distance. The dose-response relationship for structures important for mastication and the temporomandibular joints was investigated by normal tissue complication probability modelling. RESULTS: No significant differences in patient-reported trismus or maximal interincisal distance were found between the two trial arms. Patient-reported moderate to high scores regarding trismus increased from 3% at the start of radiation therapy to 25% at the long-term follow-up. Maximal interincisal distance correlated significantly with patient-reported scores of trismus. The best dose-response fit to the endpoint data was found for the dose to the ipsilateral masseter. CONCLUSIONS: Trismus is a persistent complication after radiotherapy with 3D-conformal radiation therapy. We found no difference between the severity and prevalence of trismus between conventional and accelerated fractionation, but a significant correlation between the absorbed dose to the mastication structures and opening of the mouth. Further prospective studies may determine whether a reduced dose to structures important for mastication using intensity-modulated radiation therapy will reduce problems with trismus.

Conclusion Neck dissection after radiotherapy increased the risk of aspiration as a late effect in a sub-sample of patients treated for head and neck cancer in the ARTSCAN study. Patients treated with accelerated fractionation (AF) developed aspiration, with or without coughing, more frequently than patients treated with conventional fractionation (CF). Objectives A long-term follow-up study was conducted to determine the frequency of aspiration as a late effect in patients with head and neck cancer treated with AF or CF. Method One-hundred and eight patients were recruited from two centres of the Swedish multi-centre study, ARTSCAN, where AF and CF were compared. Patients with positive lymph nodes were treated with neck dissection after completing radiotherapy. The follow-up was performed at a median of 65 months after initiation of radiotherapy and included an ENT and a videofluoroscopic examination. Results Aspiration was found in 51/108 (47%) and silent aspiration in 34/96 (35%) patients. Neck dissection (n = 47 patients) was significantly associated with both aspiration and silent aspiration. Aspiration was more common among patients treated with AF (34/61; 56%) compared to CF (17/47; 36%; p = 0.053). Silent aspiration was also more common after AF (24/54; 44%) than after CF (10/42; 24%; p = 0.052).

Purpose: The aim was to assess skeletal stability after maxillary advancement using either distraction osteogenesis (DO) or conventional Le Fort I osteotomy (CO) in patients with cleft lip and palate (CLP) or cleft palate (CP) utilising a new superimposition-based cephalometric method.

Method: This retrospective study included patients who were treated with DO (N = 12) or CO (N = 9). Sagittal and vertical changes after surgery, and skeletal stability at 18 months post-operatively were assessed with superimposition-based cephalometry, comparing lateral cephalograms performed pre-operatively (T0), post-operatively after CO or immediately after completed distraction in DO (T1), and at 18 months of follow-up (T2).

Results: The mean sagittal movements from T0 to T2 in the DO and CO groups were 5.9 mm and 2.2 mm, respectively, with a skeletal relapse rate of 16% in the DO group and 15% in the CO group between T1 and T2. The vertical mean movement from T0 to T2 in the DO and CO groups was 2.8 mm and 2.0 mm, respectively, and the skeletal relapse rate between T1 and T2 was 36% in the DO group and 32% in the CO group.

Conclusion: Sagittal advancement of the maxilla was stable, in contrast to the vertical downward movement, which showed more-extensive relapse in both groups. Despite more-extensive maxillary advancement in the DO group, the rates of skeletal relapse were similar.

Objective: To evaluate the outcome of secondary alveolar bone grafting (SABG) in patients with cleft lip and palate at 16 years of age and to identify predictors associated with surgical failure.

Study Design: This retrospective follow-up included 91 patients with 100 cleft palates treated with SABG at a mean age of 9.2 years. The possible predictors for surgical failure analyzed were sex, dental development stadium, type of cleft, side, tooth erupting into the graft, cortical boundary, presence of a lateral incisor, extraction, preoperative expansion, oral hygiene, retention device, and age. The outcome variable for surgical success was Bergland score I and II. Surgical outcome was analyzed at 16 years of age based on intraoral radiographs, according to the Bergland index. Statistical analyses included estimation of odds ratios for predictor variables.

Results: The post-SABG success rate was 91% (Bergland score I and II) with a mean follow-up of 7.2 years. Surgical failure was significantly associated with poor oral hygiene.

Conclusions: This study revealed a high success rate (91%) at a mean of 7.2 years post-SABG. Poor oral hygiene significantly increased the risk of surgical failure. This suggests that increased perioperative measures to maintain good oral health could reduce surgical failure.

Background and Aim: The study ‘Periodontitis and Its Relation to Coronary Artery Disease’ (PAROKRANK) reported an association between periodontitis (PD) and the first myocardial infarction (MI). This follow-up study aims to test the hypothesis that those with PD—compared to periodontally healthy individuals—are at increased risk for cardiovascular (CV) events and death.

Methods: A total of 1587 participants (age <75 years; females 19%) had a dental examination including panoramic radiographs between 2010 and 2014. PD was categorized as healthy (≥80% alveolar bone height), mild/moderate (79%–66%) or severe (<66%). A composite CV event (first of all-cause death, non-fatal MI or stroke and hospitalization following to heart failure) was investigated during a mean follow-up period of 9.9 years (range 0.2–12.5 years). Participants were divided into two groups: those with and without PD. The primary event rate, stratified by periodontal status at baseline, was calculated using the Kaplan–Meier method and Cox regression.

Results: The number of events was 187 in the 985 periodontally healthy participants (19%) and 174 in the 602 participants with PD (29%; p < 0.0001). Those with PD had a higher likelihood for a future event (hazard ratio [HR] = 1.26; 95% CI: 1.01–1.57; p = 0.038), following adjustment for age, smoking and diabetes.

Conclusion: The PAROKRANK follow-up revealed that CV events were more common among participants with PD, which supports the assumption that there might be a direct relation between PD and CV disease.

PURPOSE: Persistent severe swallowing dysfunction with aspiration is a common and sometimes overlooked sequelae after treatment for squamous cell carcinoma of the head and neck (SCCHN) and may impact food intake and nutritional status. More knowledge is needed to increase the understanding of severe swallowing dysfunction as a risk factor for persistent nutritional deteriorations in SCCHN survivors. The purpose of the study was to investigate weight loss and body mass index (BMI) in relation to pharyngeal swallowing function in a long-term perspective in patients after SCCHN treatment.

METHODS: Data from 101 patients were available for the analyses. Swallowing function was assessed by videofluoroscopy at a mean of 71.6 months after the start of radiotherapy (RT). Percent weight change (calculated with weight at the start of RT as the reference) and BMI at follow-up were the primary nutritional measures.

RESULTS: Aspiration was present in 48 of 101 patients (48 %). Patients with aspiration had a significantly higher mean weight loss and a lower BMI (-10.9 % and 23.1, respectively) at follow-up compared with patients without aspiration (-2.8 % and 26.0, respectively). Patients with aspiration were unable to gain weight after 23 months. Only ten of 101 patients (10 %) were underweight at follow-up.

CONCLUSIONS: Swallowing dysfunction with aspiration was related to long-term weight loss and reduced BMI. Few patients were underweight despite the high prevalence of swallowing dysfunction.

The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96 h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29–93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78–0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.