Search

BackgroundStress in patients with Juvenile Idiopathic Arthritis (JIA) has been found to be associated with orofacial pain, psychological distress, jaw dysfunction and loss of daily activities in a cross-sectional study. The aim of this study was to investigate the relations between stress and change of stress over time versus changes in orofacial pain, psychosocial factors and jaw function over a two-year period in patients with JIA.MethodsThis is a two-year prospective follow-up study involving 40 JIA patients. At baseline (2015) the median age was 12 years and at two-year follow up (2018) 14 years. The JIA patients were examined clinically and with questionnaires at baseline and follow-up with the diagnostic criteria for temporomandibular disorders (DC/TMD) and completed the same set of DC/TMD questionnaires regarding orofacial pain symptoms and psychosocial factors.ResultsChange in stress was associated with change in catastrophizing, psychological distress as well as limitation in general function and jaw function.ConclusionsThis study emphasizes the importance of maintaining a low stress level in patients with JIA since an increase in stress level over a two-year period seems to impair jaw function as well as psychological distress and catastrophizing.

Prolonged use of antibacterial mouthwash is linked to an increased risk of systemic disease. We aimed to investigate if disturbing the oral microbiota would impact the lower gut microbiome with functional effects in diet-induced obesity. Mice were exposed to oral chlorhexidine and fed a Western diet (WD). Food intake and weight gain were monitored, and metabolic function, blood pressure, and microbiota were analyzed. Chlorhexidine reduced the number of viable bacteria in the mouth and lowered species richness in the gut but with proportional enrichment of some bacteria linked to metabolic pathways. In mice fed a Western diet, chlorhexidine reduced weight gain, body fat, steatosis, and plasma insulin without changing caloric intake, while increasing colon triglycerides and proteins, suggesting reduced absorption of these nutrients. The mechanisms behind these effects as well as the link between the oral microbiome and small intestinal function need to be pinpointed. While the short-term effects of chlorhexidine in this model appear beneficial, potential long-term disruptions in the oral and gut microbiota and possible malabsorption should be considered.

Aim: To evaluate the protein profiles in gingival crevicular fluid (GCF) in relation to clinical outcomes after periodontal surgery and examine if any selected proteins affect the mRNA expression of pro-inflammatory cytokines in human gingival fibroblasts. Materials and Methods: This exploratory study included 21 consecutive patients with periodontitis. GCF was collected, and the protein pattern (n = 92) and clinical parameters were evaluated prior to surgery and 3, 6 and 12 months after surgery. Fibroblastic gene expression was analysed by real-time quantitative polymerase chain reaction. Results: Surgical treatment reduced periodontal pocket depth (PPD) and changed the GCF protein pattern. Twelve months after surgery, 17% of the pockets showed an increase in PPD. Levels of a number of proteins in the GCF decreased after surgical treatment but increased with early signs of tissue destruction, with LIGHT being one of the proteins that showed the strongest association. Furthermore, LIGHT up-regulated the mRNA expression of pro-inflammatory cytokines interleukin (IL)-6, IL-8 and MMP9 in human gingival fibroblasts. Conclusions: LIGHT can potentially detect subjects at high risk of periodontitis recurrence after surgical treatment. Moreover, LIGHT induces the expression of inflammatory cytokines and tissue-degrading enzymes in gingival fibroblasts.

The aim of this study was to assess the received TMD treatment modalities and the perceived outcome among the frequent types of EDS. A digital questionnaire was sent to the member of the National Swedish EDS Association during January-March 2022. The subsamples of hypermobile and classical EDS were constructed. Almost 90% reported TMD symptoms. Bite splint therapy, counselling, jaw training and occlusal adjustment were reported as the most common treatments with no statistically significant difference in terms of good effect between the two subsamples. Hypermobile and classical EDS might consider as an entity with regards to TMD.

Oral health care is essential, and digital training may influence healthcare professionals' attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals' experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals' attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

OBJECTIVES: To explore predictive factors for the development and maintenance of jaw pain over a 2-year period. METHODS: One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18-70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with "yes" or "no." A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years. RESULTS: Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53-7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08-67.67) and female gender (OR 4.89, 95% CI 1.09-22.02) did increase the odds for jaw pain after 2 years. CONCLUSION: The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms. CLINICAL RELEVANCE: The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.

AIM: To investigate gingival inflammation and prevalence of four specific periodontal associated pathogens in Juvenile idiopathic arthritis (JIA) in relation to orofacial pain, jaw function and systemic inflammatory activity in JIA. METHODS: Forty-five children with JIA and 16 healthy children as controls, were enrolled. Subjects were examined and classified according to the diagnostic criteria for temporomandibular disorders (DC/TMD). Pain, pain-related disability and jaw function were also assessed. A clinical periodontal examination was performed. Subgingival plaque samples were collected and analyzed for semiquantitative levels of the following periodontal pathogens; Aggregatibacter actinomycetemcomintans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. RESULTS: No significant difference between JIA and healthy individuals was observed regarding the clinical periodontal variables plaque, gingivitis, probing pocket depth or the investigated periodontal pathogens. P. gingivalis and T. forsythia were detected in both groups. In the group with JIA, no significant correlation was found between orofacial pain, jaw function, systemic inflammatory activity and periodontal disease, including levels of P. gingivalis and T. forsythia. CONCLUSION: This study suggests that the periodontal disease-associated bacteria P. gingivalis and T. forsythia do not contribute to neither periodontal disease, systemic inflammatory activity nor orofacial pain and jaw dysfunction, including TMJ arthritis, in JIA patients in Sweden.

BACKGROUND: Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%. OBJECTIVES: This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number/percentage of individuals/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results. RESULTS: The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated. LIMITATIONS: Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data. CONCLUSION: The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite

BACKGROUND: It is well documented that smokers suffer increased risk of postoperative complications after medical surgery, for example delayed healing and increased risk of infection. It is also known that preoperative smoking cessation can reduce the risk of these complications. Because of this there are guidelines regarding preoperative smoking cessation in non-oral medical surgery. There are however no specific guidelines regarding oral surgical procedures, such as surgical extractions, dentoalveolar surgery, periodontal surgery, or dental implantation. Nevertheless, it is common that dentists and oral surgeons recommend smoking cessation pre to oral surgical procedures. The aim with this systematic review was to see if there are any evidence in the literature, supporting preoperative smoking cessation in oral surgical procedures. METHODS: A systematic search of the electronic databases PubMed, Scopus, Web of Science, and Cochrane was conducted to identify studies addressing the effect of preoperative smoking cessation in oral surgical procedures. Included publications were subjected to preidentified inclusion criterion. Six examiners performed the eligibility and quality assessment of relevant studies. Risk of bias was assessed using ROBINS-I and RoB 2. Certainty assessment was carried out using GRADE. RESULTS: The initial search resulted in 2255 records, and after removal of 148 duplicates, 16 articles met an acceptable level of relevance. These were read in full text, whereof 12 articles were excluded, due to different intervention, outcome, or study design than stated in the review protocol. One study remained with moderate risk of bias and three were excluded due to high risk of bias. CONCLUSION: This systematic review could not determine the effect of smoking cessation pre to oral surgical procedures, in smokers. This indicates lack of knowledge in the effects of smoking cessation. We also conclude a lack of knowledge in how to design smoking cessation in t

Background: Lifestyle- and sucrose-dependent polymicrobial ecological shifts are a primary cause of caries in populations with high caries prevalence. In populations with low prevalence, PRH1, PRH2 susceptibility and resistance phenotypes may interact with the Streptococcus mutans adhesin cariogenicity phenotype to affect caries progression, but studies are lacking on how these factors affect the microbial profile of caries. Methods: We analysed how the residency and infection profiles of S. mutans adhesin (SpaP A/B/C and Cnm/Cbm) phenotypes and commensal streptococci and lactobacilli influenced caries progression in a prospective case–referent sample of 452 Swedish adolescents with high (P4a), moderate (P6), and low (P1) caries PRH1, PRH2 phenotypes. Isolates of S. mutans from participants were analysed for adhesin expression and glycosylation and in vitro and in situ mechanisms related to caries activity. Findings: Among adolescents with the resistant (P1) phenotype, infection with S. mutans high-virulence phenotypes was required for caries progression. In contrast, with highly (P4a) or moderately (P6) susceptible phenotypes, caries developed from a broader polymicrobial flora that included moderately cariogenic oral commensal streptococci and lactobacilli and S. mutans phenotypes. High virulence involved unstable residency and fluctuating SpaP ABC, B-1, or Cnm expression/glycosylation phenotypes, whereas low/moderate virulence involved SpaP A phenotypes with stable residency. Adhesin phenotypes did not display changes in individual host residency but were paired within individuals and geographic regions. Interpretation: These results suggest that receptor PRH1, PRH2 susceptibility and resistance and S. mutans adhesin virulence phenotypes specify different microbial profiles in caries. Funding: Swedish Research Council and funding bodies listed in the acknowledgement section.

Objectives Quantitative sensory testing (QST) provides an assessment of cutaneous and deep tissue sensitivity and pain perception under normal and pathological settings. Approximately 2–4% of individuals undergoing groin hernia repair (GHR) develop severe persistent postsurgical pain (PPSP). The aims of this systematic review of PPSP-patients were (1) to retrieve and methodologically characterize the available QST literature and (2) to explore the role of QST in understanding mechanisms underlying PPSP following GHR. Methods A systematic literature search was conducted from JAN-1992 to SEP-2022 in PubMed, EMBASE, and Google Scholar. For inclusion, studies had to report at least one QST-modality in patients with PPSP. Risk of bias assessment of the studies was conducted utilizing the Newcastle Ottawa Scale and Cochrane’s Risk of Bias assessment tool 2.0. The review provided both a qualitative and quantitative analysis of the results. A random effects model was used for meta-analysis. Results Twenty-five studies were included (5 randomized controlled trials, 20 non-randomized controlled trials). Overall, risk of bias was low. Compared with the contralateral side or controls, there were significant alterations in somatosensory function of the surgical site in PPSP-patients. Following thresholds were significantly increased: mechanical detection thresholds for punctate stimuli (mean difference (95% CI) 3.3 (1.6, 6.9) mN (P = 0.002)), warmth detection thresholds (3.2 (1.6, 4.7) °C (P = 0.0001)), cool detection thresholds (-3.2 (-4.9, -1.6) °C (P = 0.0001)), and heat pain thresholds (1.9 (1.1, 2.7) °C (P = 0.00001)). However, the pressure pain thresholds were significantly decreased (-76 (-123, -30) kPa (P = 0.001)). Conclusion Our review demonstrates a plethora of methods used regarding outcome assessments, data processing, and data interpretation. From a pathophysiological perspective, the most consistent findings were postsurgical cutaneous deafferentation and developm

Background: To describe the frequency and impact of oral lesions and professional dental care costs in patients with inflammatory bowel disease (IBD) (i.e., Crohn disease [CD] or ulcerative colitis [UC]) compared to matched controls). Methods: IBD patients and matched controls were surveyed on general anamnestic information, eating and drinking habits, and oral health- and dental care-related questions; IBD patients were additionally surveyed on oral lesions. Problems related to oral lesions and the amount of money spent for professional dental care in the past 12 months were defined as primary outcome parameters. Results: Answers from 1108 IBD patients and 3429 controls were analyzed. About 30% of the patients indicated having had problems with oral lesions, with CD patients having 46% higher odds and having them more often in a generalized form compared to UC patients. Further, self-reported severe periodontitis increased the odds of having oral lesions by almost 2.3-times. However, only about 12.5% of IBD patients were informed by their physician about oral lesions and about 10% indicated receiving treatment for them. Compared to controls, IBD patients required more often dental treatment and spent more money; specifically, UC and CD patients had 27 and 89% higher odds, respectively, for having spent ≥3000 DKK (ca. 440 USD) at the dentist compared to controls. Conclusions: IBD patients have more often oral health problems and higher expenses for professional dental care compared to matched controls. This included problems with IBD-related oral lesions, but these are rarely addressed by the medical or dental team.Keywords: Crohn disease; case-control studies; colitis; dental care; inflammatory bowel diseases; surveys and questionnaires; ulcerative.

Objectives: In this study, the aim was to investigate the medium- to long-term impact of peri-implantitis treatment upon clinical parameters and implant stability quotient values and to ascertain if magnetic resonance frequency analysis can be used as a diagnostic tool to demonstrate postoperative healing following treatment of peri-implantitis. Materials and Methods: A total of n = 26 patients (n = 86 implants) diagnosed with peri-implantitis were recruited for this prospective cohort study and four different treatment modalities were used. Baseline measurements of a number of clinical parameters as well as implant stability measurements in the form of ISQ were recorded. These measurements were repeated at 6, 12, and 24–36 months following treatment. Analysis of variance was performed for all implants treated as well as separately for each treatment modality. A regression model was also used to determine factors affecting ISQ measurements over time. Results: Treatment of peri-implantitis resulted in significant improvements of both average PPDs and BOP (p <.0001 and p <.01). ISQ values marginally improved initially for all treatment modalities, but improvement was only maintained for 2–3 years in treatment modalities I (+1.28), III (+1.49), and IV (+2.92). There was a statistically significant negative linear correlation between average PPD and the ISQ values recorded both at baseline (r = −.618, p < 0.0001) and at 2/3 years (r = −.604, p < 0.0001). Conclusion: Over the 2–3-year follow-up period, all four treatment modalities led to improved clinical and radiographic peri-implant parameters but implant stability posttreatment, as indicated by the fact that the recorded ISQ scores remained stable. As a result, use of MRFA as an adjunct to the traditionally used periodontal and radiographic tools for the evaluation of postoperative implant stability following the treatment of peri-implant disease cannot be recommended. © 2023 The Authors. Clinical and Exp

Introduction: Polymethyl methacrylate is a polymer commonly used in clinicaldentistry, including denture bases, occlusal splints and orthodontic retainers. Methods: To augment the polymethyl methacrylate-based dental appliances incounteracting dental caries, we designed a polymer blend film composed ofpolymethyl methacrylate and polyethylene oxide by solution casting and addedsodium fluoride. Results: Polyethylene oxide facilitated the dispersion of sodium fluoride,decreased the surface average roughness, and positively influenced thehydrophilicity of the films. The blend film made of polymethyl methacrylate,polyethylene oxide and NaF with a mass ratio of 10: 1: 0.3 showed sustainedrelease of fluoride ions and acceptable cytotoxicity. Antibacterial activity of all thefilms to Streptococcus mutans was negligible. Discussion: This study demonstrated that the polymer blends of polyethyleneoxide and polymethyl methacrylate could realize the relatively steady release offluoride ions with high biocompatibility. This strategy has promising potential toendow dental appliances with anti-cariogenicity.

PURPOSE: The aim of the present systematic review was to investigate the influence of hypertension on the dental implant failure rate. METHODS: An electronic search was undertaken in four databases, plus a manual search of journals. The I2 statistic was used to check heterogeneity and the inverse-variance method was used for the meta-analysis. The estimate of relative effect for dichotomous outcome was expressed as an odds ratio (OR). RESULTS: The review included 24 publications. There were 4874 implants (257 failures) placed in hypertensive patients and 16,192 implants (809 failures) placed in normotensive patients. A pairwise meta-analysis showed that implants in hypertensive patients did not have a higher risk of failure than implants placed in normotensive patients (OR 1.100, p = 0.671). The log OR of implant failure between hypertensive and normotensive patients did not significantly change with the follow-up time (p = 0.824). CONCLUSIONS: This review suggests that implants in hypertensive patients do not present higher odds of failure in comparison to normotensive patients. However, further research on this topic, with the use of more rigorous criteria to diagnose patients as being hypertensive, as well as clearer information about the pharmacological management of the condition in the patients, is recommended.

Objective: The objective of the present study was to investigate oral health status, oral health related quality of life, and identify risk factors associated with invasive dental treatment and medication related osteonecrosis of the jaw in patients with multiple myeloma. Material and methods: Patients newly diagnosed with multiple myeloma (n = 144) referred between January 2015 and September 2022 were retrospectively included. The patients underwent a thorough clinical and radiological oral examination and odontogenic infections were treated before the start of bisphosphonate treatment. The patients were followed annually, including clinical and radiological examinations. The oral health related quality of life was investigated by the OHIP-14 questionnaire. Results: Dental treatment (RR = 7.75), receiving combination antineoplastic therapy≥3 (RR =4.13), periodontitis (RR = 4.21), and reduced number of teeth (RR = 2.87) were associated with an increased risk of medication related osteonecrosis of the jaw. The response rate of the OHIP-14 questionnaire was 70.2%. Oral pain or discomfort in the mouth related to the medical treatment was reported by 30.5%. Conclusion: Dental screening and treatment planning in patients with Multiple Myeloma may result in fewer oral infections and fewer interruptions of the medical treatment of myeloma.

Oral biofilms, comprising hundreds of bacteria and other microorganisms on oral mucosal and dental surfaces, play a central role in oral health and disease dynamics. Streptococcus oralis, a key constituent of these biofilms, contributes significantly to the formation of which, serving as an early colonizer and microcolony scaffold. The interaction between S. oralis and the orally predominant mucin, MUC5B, is pivotal in biofilm development, yet the mechanism underlying MUC5B degradation remains poorly understood. This study introduces MdpS (Mucin Degrading Protease from Streptococcus oralis), a protease that extensively hydrolyses MUC5B and offers an insight into its evolutionary conservation, physicochemical properties, and substrate- and amino acid specificity. MdpS exhibits high sequence conservation within the species and also explicitly among early biofilm colonizing streptococci. It is a calcium or magnesium dependent serine protease with strict physicochemical preferences, including narrow pH and temperature tolerance, and high sensitivity to increasing concentrations of sodium chloride and reducing agents. Furthermore, MdpS primarily hydrolyzes proteins with O-glycans, but also shows activity toward immunoglobulins IgA1/2 and IgM, suggesting potential immunomodulatory effects. Significantly, MdpS extensively degrades MUC5B in the N- and C-terminal domains, emphasizing its role in mucin degradation, with implications for carbon and nitrogen sequestration for S. oralis or oral biofilm cross-feeding. Moreover, depending on substrate glycosylation, the amino acids serine, threonine or cysteine triggers the enzymatic action. Understanding the interplay between S. oralis and MUC5B, facilitated by MdpS, has significant implications for the management of a healthy eubiotic oral microenvironment, offering potential targets for interventions aimed at modulating oral biofilm composition and succession. Additionally, since MdpS does not rely on O-glycan removal prior to

Objectives: To analyze the accumulated fees connected with root filling, permanent coronal restoration and follow-on treatment charged by Swedish dentists over a 10-11-year follow-up period. Furthermore, analyzing these fees with reference to the type of restoration, tooth group, and the root-filled teeth which survived compared to those requiring extraction. Material and methods: In 2009, the data register of the Swedish Social Insurance Agency recorded a total of 215,611 teeth as root-filled. The accumulated fees for each tooth encompassed the following interventions: initial root filling, coronal restorations, and follow-up treatments during the designated period. The outcomes were analyzed using descriptive and analytic statistics, including t tests and one-way analysis of variance. The fees are presented in Euros (€1 = SEK 8.94). Results: The total accumulated fees for root fillings amounted to 72 million Euros: the mean fee per root filled tooth was €333.6. The total mean fee over a 10-11-year period, comprising root canal treatment, coronal restorations, and any follow-up treatments, was €923.4. Root-filled teeth with indirect restorations presented a higher mean fee (€1 279.3) compared to those with direct restorations (€829.4) or those without specified restorations (€832.7; p < .001). Moreover, molars presented a significantly higher mean fee (€966.4) compared to premolars (€882.8) and anterior teeth (€891.3; p < .001). Lastly, the mean fee for extracted teeth was €1225.3, which was higher compared to those who survived the follow-up period (€848.0; p < .001). Conclusions: Fees charged by general dental practitioners for root-filled teeth accumulate over time, probably due to the need for further treatment of the tooth. The total mean fee was significantly higher for molars and root-filled teeth with indirect restorations. However, an analysis of the total costs would require prospective clinical cost-effectiveness studies.

Objectives: To investigate the impact of a Ti-Sr-O technology, applied to either a turned surface or an SLA surface, on the mechanical robustness of osseointegration, benchmarked against the SLActive surface. Material and methods: Ti discs (6.25-mm-diameter and 2-mm-thick) with three different surfaces were inserted on the proximal-anterior part of the tibial plateau of adult Swedish loop rabbits: (I) turned surface modified with Ti-Sr-O (turned + Ti-Sr-O), (II) SLA surface modified with Ti-Sr-O (SLA + Ti-Sr-O), and (III) SLActive surface (SLActive). Following a healing period of 2 weeks and 4 weeks, the pull-out (PO) force needed to detach the discs from the bone was assessed, as a surrogate of osseointegration. Results: The SLActive surface exhibited statistically significant higher median PO forces, compared with the SLA + Ti-Sr-O surfaces at both 2- and 4 weeks post-op (p > .05). In this study, no single turned + Ti-Sr-O surface disk was integrated. Conclusions: The tested Ti-Sr-O technology failed to enhance osseointegration; however, this finding may be related to the inappropriateness of the rabbit tibia plateau model for assessing third-generation implant surface technologies, due to the limited diffusion and clearance at the disk-bone interface.

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.

AIM: The aim of the study was to evaluate the 5 years clinical outcomes associated with implant-level connection (IL) versus abutment-level connection (AL) for implants with an internal conical connection (ICC) supporting a screw-retained fixed partial denture. MATERIALS AND METHODS: Fifty patients with 119 implants were randomly allocated to either the AL or IL group. Radiographic (Marginal bone loss) and clinical outcomes (Bleeding on Probing, probing pocket depth, plaque accumulation, incidence of peri-implantitis and peri-implant mucositis as well as prosthetic complications) were collected and compared at 1, 2, 3, and 5 years. A linear mixed model was used to evaluate the differences between groups. RESULTS: Five years after treatment, the MBL change was not significantly different between the groups at any point. The MBL was 0.23 ± 0.64 mm (AL) and 0.23 ± 0.29 mm (IL). The bleeding on Probing was 44% (AL) and 45% (IL) (p = .89). The mean probing depth was 2.91 ± 1.01 mm (AL) and 3.51 ± 0.67 mm (IL). This difference between the groups was statistically significant but clinical insignificant. Presence of plaque was slightly higher (p = .06) in the IL group (34.4%) compared with the AL group (26.3%). The overall technical, biological, and prosthetic complication rates were similar between groups. None of the implants developed peri-implantitis during the entire follow-up period. CONCLUSION: The results of this clinical trial indicated that all clinical and radiographical parameters were clinically comparable between the study groups.

Enterococcus faecalis, a leading multi-resistant nosocomial pathogen, is also the most frequently retrieved species from persistently infected dental root canals, suggesting that the oral cavity is a possible reservoir for resistant strains. However, antimicrobial susceptibility testing (AST) for oral enterococci remains scarce. Here, we examined the AST profiles of 37 E. faecalis strains, including thirty-four endodontic isolates, two vanA-type vancomycin-resistant isolates, and the reference strain ATCC-29212. Using Etest gradient strips and established EUCAST standards, we determined minimum inhibitory concentrations (MICs) for amoxicillin, vancomycin, clindamycin, tigecycline, linezolid, and daptomycin. Results revealed that most endodontic isolates were susceptible to amoxicillin and vancomycin, with varying levels of intrinsic resistance to clindamycin. Isolates exceeding the clindamycin MIC of the ATCC-29212 strain were further tested against last-resort antibiotics, with 7/27 exhibiting MICs matching the susceptibility breakpoint for tigecycline, and 1/27 reaching that of linezolid. Both vanA isolates confirmed vancomycin resistance and demonstrated resistance to tigecycline. In conclusion, while most endodontic isolates remained susceptible to first-line antibiotics, several displayed marked intrinsic clindamycin resistance, and MICs matched tigecycline’s breakpoint. The discovery of tigecycline resistance in vanA isolates highlights the propensity of clinical clone clusters to acquire multidrug resistance. Our results emphasize the importance of implementing AST strategies in dental practices for continued resistance surveillance.

Background: Despite the high prevalence of oral dryness and awareness of its complications, there is limited research on the clinical management of patients with oral dryness in general dental care. Purpose: To (1) describe and compare awareness among dental care professionals regarding saliva functions, potential causes and complications of oral dryness, and patient management (2) Investigate if the length of professional experience influences these aspects. Methods: A digital self-administrated survey was sent to 2668 dental care professionals working in the general dental care, Public Dental Service, in Sweden. Twelve dental care professionals reviewed the questionnaire prior to its distribution. The questionnaire comprised 32 questions about patient management, awareness of saliva functions, causes and complications of oral dryness, and self-assessment queries. Results: The response rate was 18.6% (241 dentists and 257 dental hygienists). Older adults (65+) were asked more often about dry mouth (93.0%) compared to those aged 18-23 years (50.0%) and those under 18 years (24.9%). Dental hygienists encountered individuals with oral dryness more frequently (61.1%) than dentists (48.5%) (p < 0.01), and more often asked individuals in the age groups 18-23 years (p = 0.003), 24-40 years (p = 0.045), and 41-65 years (p = 0.031) about dry mouth. A higher proportion of dental hygienists (88.3%) than dentists (51.0%) had measured salivary secretion rate, (p < 0.001) and more often suggested preventive dental care 3-4 times a year, (42.5% vs. 30.5%) (p < 0.007). Dentists had a higher awareness of saliva functions, while dental hygienists had a higher awareness about causes and complications of oral dryness. Higher proportions of dentists and dental hygienists with over 10 years of professional experience had measured salivary secretion rate (69.1% vs. 95.7%) compared to their counterparts with less than 10 years of professional experience (35.9% vs. 79.5%) (p

Aim: To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields. Methodology: The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant. Results: Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001). Conclusions: According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered.

Objectives: The aim of this study was to monitor changes in Osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa ligand (RANKL) levels in the saliva during orthodontic tooth movement (OTM). Materials and Methods: Nine healthy females (15-20 y of age) with four pre-molar extractions and fixed appliance were included. In total, 134 stimulated and 134 unstimulated saliva samples were collected: at baseline and then every 6-8 weeks at follow-up appointments during the whole orthodontic treatment. Twelve age-matched females with no active orthodontic treatment served as a control group. Saliva samples were analysed by enzyme-linked immunosorbent assay (Elisa). The mean levels of OPG and RANKL were calculated according to the different orthodontic treatment stages: alignment, space closure and finishing. A mixed model analysis was used to compare the means of treatment stages. Baseline OPG levels were compared with the control group using an independent t-test. OPG levels were measured in stimulated saliva due to low levels in unstimulated saliva. Results: No significant difference was observed between baseline OPG values and the control group. OPG increased significantly at all treatment stages: alignment, space closure and finishing compared with baseline (P = 0.002, P = 0.039, P = 0.001, respectively). The salivary levels of OPG increased gradually, except during space closure, reaching peak levels at finishing. RANKL was undetectable in stimulated and unstimulated saliva by sandwich Elisa during OTM. Conclusions: This novel approach shows the changes in the levels of OPG in OTM and indicates how and when to sample saliva during orthodontic treatment to analyse bone remodelling.

OBJECTIVE: In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, i.e. better assessment and more efficient management. METHODS: We summarised current strategies for AB assessment and proposed a research route for improving its metrics. RESULTS: Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity. CONCLUSIONS: Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally-based and subject-based information must be gathered in a universally accepted standardized approach.

Background: Overload from bruxism may affect survival of dental implants. Objectives: To evaluate implant failure and marginal bone loss (MBL) in patients presenting with probable bruxism compared to non-bruxers. The study was registered in PROSPERO (CRD42021238397). Methods: An electronic search September 2022 in PubMed/Medline, Web of Science and Science Direct was combined with a hand search. Two independent reviewers carried out abstract screening, full-text assessment, quality assessment (National Institutes of Health tool) and data extraction. Only studies that provided information on self-report and clinical examination needed for the diagnosis of at least 'probable' bruxism were included. A pairwise random-effect meta-analysis was carried out. Results: In total 1338 studies were identified, and after screening and full-text assessment 27 studies that presented data on 2105 implants in probable bruxers and 10 264 implants in non-bruxers were included, with 138 and 352 implant failures in respective groups. the meta-analysis showed that implants placed in probable bruxers had a higher risk of failure than in non-bruxers (OR 2.189; 95% CI 1.337, 3.583, p = .002). A meta-regression showed that follow-up time did not affect this OR. Eighteen studies provided general data on MBL but did not report results separated between bruxers and non-bruxers. Therefore, an analysis of MBL was not possible. Conclusion: The results of the present systematic review show that implants placed in probable bruxers present a significantly higher risk of failure than implants placed in non-bruxers. This should be considered in treatment planning and management of implant patients.

This paper summarises the background reasoning and work that led to the selection of the items included in the Standardised Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on-field comprehension. The underlying premise is that the different motor activities included in the bruxism spectrum (e.g. clenching vs. grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different aetiology, comorbidities and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity and duration. The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject-based), from the clinical assessment performed by an examiner (clinically based) or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e. status, comorbid conditions, aetiology and consequences). The STAB will help gathering information on many aspects, factors and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self-reported information on bruxism status and potential consequences (subject-based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes.

Background: Excessive jaw muscle activity is a frequent complication after acquired brain injury (ABI). Objective: The study aimed to identify the occurrence and severity of jaw muscle activity and its association with altered state of consciousness in patients with ABI. Methods: A total of 14 severe ABI patients with varied altered state of consciousness were recruited. A single-channel electromyographic (EMG) device was used to assess the jaw muscle activity for three consecutive nights during Week 1 and Week 4 following admission. Differences in number of EMG episodes/h between Week 1 and 4 were analysed using non-parametric tests and association between the EMG activity and altered state of consciousness were analysed using Spearman's correlation test. Results: Nine of fourteen (64%) patients showed indications of bruxism (cutoff: >15 EMG episodes/h). The average EMG episodes/h at admission were 44.5 ± 13.6 with no significant changes after Week 4 of admission (43 ± 12.9; p = .917). The EMG episodes/h ranged from 2 to 184 during Week 1 and 4-154 during Week 4. There were no significant correlations between the number of EMG episodes/h during the three nights and the individuals altered state of consciousness during Week 1 and Week 4. Conclusion: Patients with ABI had a conspicuously high but variable level of jaw muscle activity at admission and it tend to remain high after 4 week of hospitalisation which could potentially lead to adverse effects such as excessive tooth wear, headaches and pain in jaw muscles. The lack of associations between individuals altered level of consciousness and EMG activity could be due to low sample size and further studies are clearly warranted in this patient group with special needs. Single-channel EMG devices can record jaw muscle activity early in the hospitalisation period and might be a helpful tools for early detection of bruxism in ABI patients.

Objectives: The study aimed to investigate how the objective use of a powered toothbrush in frequency and duration affects plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm in elderly individuals with MCI. A second aim was to compare the objective results with the participants’ self-estimated brush use. Materials and methods: Objective brush usage data was extracted from the participants’ powered toothbrushes and related to the oral health variables plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm. Furthermore, the objective usage data was compared with the participants’ self-reported brush usage reported in a questionnaire at baseline and 6- and 12-month examination. Results: Out of a screened sample of 213 individuals, 170 fulfilled the 12-month visit. The principal findings are that despite the objective values registered for frequency and duration being lower than the recommended and less than the instructed, using powered toothbrushes after instruction and information led to improved values for PI, BOP, and PPD ≥ 4 mm in the group of elderly with MIC. Conclusions: Despite lower brush frequency and duration than the generally recommended, using a powered toothbrush improved oral health. The objective brush data recorded from the powered toothbrush correlates poorly with the self-estimated brush use. Clinical relevance: Using objective brush data can become one of the factors in the collaboration to preserve and improve oral health in older people with mild cognitive impairment. Trial registration: ClinicalTrials.gov Identifier: NCT05941611, retrospectively registered 11/07/2023., CC BY 4.0 DEED© 2023, The Author(s)Correspondence Address: J. Flyborg; Department of Health, Blekinge Institute of Technology, Karlskrona, 37179, Sweden; email: johan.flyborg@bth.se

Aim: To investigate the association between periodontitis and lung function in the Malmo Offspring Dental Study.Materials and Methods: In all 1001 individuals (49.9% female, mean age: 44.6) from Malmo Offspring Dental Study were included. Periodontitis was assessed by a full-mouth examination protocol including bleeding on probing and classified according to the American Academy of Periodontology/Center for Disease Control definitions. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were expressed as absolute values and %predicted according to Global Lung Function Initiative reference values. FEV1, FVC and FEV1/FVC were analysed in relation to periodontal status using linear regression.Results:Severe periodontitis was found in 7% of the population. Adjusted regression models showed significant associations between lung function and severe periodontitis with 2.1 unit lower FEV1/FVC ratio (95% CI: -3.91, -0.23) and odds ratio (adjusted) of 2.56 (95% CI: 1.40, 4.75, p = .003) for airflow obstruction (FEV1/FVC less than the lower limit of normal) if having severe periodontitis. Lower values of %predicted FEV1 and %predicted FVC, but not FEV1/FVC, were found in individuals with >25% bleeding on probing.Conclusions: Severe periodontitis was associated with lower FEV1/FVC ratio and airflow obstruction in the present cohort. More large-scale prospective studies and intervention studies are required for a comprehensive evaluation.

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.

Introduktion: Individer med Downs syndrom (DS) har en ökad benägenhet att drabbas av oral ohälsa. Studier visar att det finns en osäkerhet hos tandvårdspersonal i hur man bäst bemöter och behandlar personer med DS. Syfte: Syftet med studien är att beskriva tandhygienisters kunskaper och erfarenheter i mötet med barn och unga med DS i tandvårdssituationen. Metod: Webbenkätstudie med 20 frågor. Deskriptiv statistik användes. Analyserades med chi-två test. Resultat: 92 tandhygienister deltog i studien där majoriteten har i sin yrkesroll mött barn och unga med DS. Respondenterna har önskemål om vidareutbildning, mer samarbete med andra instanser och mer stöd från ledningen. Konklusion: Resultatet indikerar att det finns behov av vidareutbildning, bättre samarbete mellan olika yrkesgrupper, mer tid för behandling, stöd från ledningen och inom organisationen för att öka tandhygienisters möjlighet att hantera komplexiteten i omhändertagandet av barn och unga med DS. Implikationer: Det är nödvändigt att öka medvetenheten om implementering av riktlinjer som framhäver behovet av individanpassad behandlingsplan. Tandhygienister bör använda alternativa kommunikationsstöd i mötet med barn och unga med funktionsnedsättning såsom DS samt stödja deras föräldrarna, anhöriga och assistenter, vilket kan leda till ett bättre omhändertagande av dessa patienter.

Background: Temporomandibular disorders (TMD) are the most common reason for chronic pain in the orofacial area and significantly impact the lives of those affected. The role of lifestyle factors in TMD, however, remains less explored. This cohort study aims to estimate TMD prevalence by addressing potential selection biases and to evaluate the association between TMD and lifestyle factors with a specific focus on sick leave and health related quality of life. Methods: By linking data on TMD in the general population in Västerbotten, northern Sweden (n = 180,000) to health survey data (n = 120,000), information on sociodemographic factors and quality of life was available for 52,961 individuals (50.6% women) with a mean age of 53 years. We applied inverse probability weighting to adjust for selection bias and Poisson regression to explore associations with TMD. Results: TMD prevalence was 9.2% during the study period, being higher in women (12.9%) than men (5.4%). Weighting for varying visiting frequencies did not affect TMD prevalence (average difference 0.4% points). Individuals with TMD, especially women, reported more sick leave and use of pain medication, with a significant association between TMD and increased sick leave (prevalence ratio 1.89, 95% CI: 1.78–2.01) among both women and men. In addition, TMD was associated with a lower health related quality of life (p < 0.001). Conclusion: The association of TMD with sick leave highlights the condition's profound impact on the lives of affected individuals. These findings underscore the influence of TMD on work life and the burden of TMD on the societal level. Significance Statement: The findings provide insight into how TMD affect individuals, by incorporating lifestyle factors, social determinants and the impact of sick leave at a population level. By incorporating these areas into the study of TMD, we can deepen our understanding of how TMD affects individuals' lives. This approach may also create opportun

This paper aims to investigate the presence of Aggregatibacter actinomycetemcomitans and to assess potential indicators of the risk of severe form(s) of periodontitis. A descriptive cross-sectional study of 156 consecutive patients with periodontitis was conducted. Subgingival plaque samples were collected from the participants. The identification of A. actinomycetemcomitans was performed using quantitative polymerase chain reaction. A descriptive analysis, a chi-square test, and a binary logistic regression statistical evaluation were performed. The prevalence of A. actinomycetemcomitans in this population of 156 participants was 17.30% (27 patients). The prevalence of stage-III periodontitis was 75.6% and greater in older men, while the prevalence of stage-IV periodontitis was 22.4% and greater in younger women. We observed a significant relation between the risk of severe periodontitis (stage-IV) and poor oral hygiene (p = 0.006), attendance at dental appointments (p ≤ 0.001), and familial history of periodontitis (p = 0.032). In conclusion, twenty-seven individuals were positive for A. actinomycetemcomitans. Poor oral hygiene, family history of periodontitis, and irregular attendance at dental appointments were identified as potential risk factors for severe periodontitis in this cohort., Oral Microbiome and Human Systemic Health

Background: Magnetic resonance imaging (MRI) of the brain is frequently performed on patients with neurofibromatosis type 1 (NF1), to detect and follow-up intracranial findings. In addition, NF1-related pathologies can appear in the jaws. This case study investigates if it is advantageous to assess the depicted parts of the jaws in the imaging of NF1 patients with intracranial findings, thereby detecting jaw pathologies in their initial stages. Case presentation: We report on the 3-year management with clinical and radiological follow-ups of a central giant cell granuloma and a neurofibroma in the mandible of a patient with NF1 who underwent examinations with brain MRIs. A review of the mandible in the patient’s MRIs disclosed lesions with clear differences in progression rates. Conclusion: NF1-related jaw pathologies may be detected in the early stages if the depicted parts of the jaws are included in the assessment of the imaging of NF1 patients with intracranial findings. This could impact the treatment of eventual pathologies before lesion progression and further damage to the vicinity.

Aggressive forms of periodontitis, especially in young patients, are often associated with an increased proportion of the Gram-negative bacterium Aggregatibacter actinomycetemcomitans of the microbiota of the affected periodontal sites. One of the virulence factors of A. actinomycetemcomitans is a leukotoxin (LtxA) that induces a pro-inflammatory cell death process in leukocytes. A. actinomycetemcomitans exhibits a large genetic diversity and different genotypes vary in LtxA production capacity. The genotype JP2 is a heavy LtxA producer due to a 530-base pair deletion in the promoter for the toxin genes, and this trait has been associated with an increased pathogenic potential. The present study focused on the production and release of LtxA by different A. actinomycetemcomitans genotypes and serotypes under various growth conditions. Four different strains of this bacterium were cultured in two different culture broths, and the amount of LtxA bound to the bacterial surface or released into the broths was determined. The cultures were examined during the logarithmic and the early stationary phases of growth. The JP2 genotype exhibited the highest LtxA production among the strains tested, and production was not affected by the growth phase. The opposite was observed with the other strains. The composition of the culture broth had no effect on the growth pattern of the tested strains. However, the abundant release of LtxA from the bacterial surface into the culture broth was found in the presence of horse serum. Besides confirming the enhanced leucotoxicity of the JP2 genotype, the study provides new data on LtxA production in the logarithmic and stationary phases of growth and the effect of media composition on the release of the toxin from the bacterial membrane.

Objective: Temporomandibular disorders (TMD) may develop, especially among girls, during the adolescence period. The aim of this study was to study if information and advice in a school setting could prevent development of TMD symptoms and headaches during the early teenage period. Methods: Thirteen-year-old girls, at 19 upper elementary schools were invited to participate in a study with structured information about the jaw system, TMD symptoms and risk factors, as well as advice how to manage risk factor and TMD. Six hundred and fifty-one girls enrolled, of which 507 girls were followed for 2–2.5 years. Half received information on three occasions (cases), and the other half served as controls. Included in the analysis of incidence of TMD symptoms were those without frequently occurring TMD symptoms (not including headaches) at baseline (n = 396) and included in the analysis of incidence of headaches were those without frequent headaches at baseline (n = 297). Result: The 2-year incidence of TMD symptoms was significantly lower in the information cohort (19%) compared to the controls (28%) (p =.03). The 2-year incidence of headaches was lower among those who were allocated to information (30%) compared to controls (40%), but the difference was not statistically significant (p =.099). Cases who had headaches at baseline reported a significantly lower prevalence at follow-up compared to controls (p =.03). Conclusion: Standardized information in school settings can prevent development of TMD symptoms and headaches among young girls.

Objective: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. Method: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. Results: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. Conclusion: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

Objectives: To investigate the relationship between malnutrition and potential contributing factors such as poor oral health, dysphagia and mortality among older people in short-term care. Methods: This cross-sectional study is a part of the multidisciplinary multicentre project SOFIA (Swallowing function, Oral health and Food Intake in old Age), which includes older people (≥65 years) in 36 short-term care units in five regions of Sweden. Nutritional status was measured with version II of the Minimal Eating Observation and Nutrition Form (MEONF-II), oral health with the Revised Oral Assessment Guide (ROAG), dysphagia with a water swallow test, and the mortality rate was followed for 1 year. Data were analysed using descriptive analysis and logistic regression models to calculate odds ratios for the association between malnutrition and these factors. Results: Among the 391 participants, the median age was 84 years and 53.3% were women. Mortality rate was 25.1% within 1 year in the total group, and was higher among malnourished participants than among their well-nourished counterparts. Severe dysphagia (OR: 6.51, 95% CI: 2.40–17.68), poor oral health (OR: 5.73, 95% CI: 2.33–14.09) and female gender (OR: 2.2, 95% CI: 1.24–3.93) were independently associated with malnutrition. Conclusion: Mortality rate was higher among malnourished people than those who were well nourished. Severe dysphagia, poor oral health and female gender was predictors of malnutrition among older people in short-term care. These health risks should be given more attention in short-term care with early identification.

Background/Aim: To evaluate the long-term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA-apical plug) and to identify major factors affecting the survival of these teeth. Materials and Methods: Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time-point for tooth loss, and overall survival time in years. Kaplan–Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI). Results: The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA-apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3–5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1–2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3–5, and 5.6 times higher in avulsions. Conclusions: Calcium hydroxide apexification, avulsion, and postoperative PAI 3–5 were identified as prognostic variab

Aggregatibacter actinomycetemcomitans is an opportunistic Gram-negative periodontopathogen strongly associated with periodontitis and infective endocarditis. Recent evidence suggests that periodontopathogens can influence the initiation and progression of oral squamous cell carcinoma (OSCC). Herein we aimed to investigate the effect of A. actinomycetemcomitans-derived extracellular vesicles (EVs) on OSCC cell behavior compared with EVs from periodontopathogens known to associate with carcinogenesis. EVs were isolated from: A. actinomycetemcomitans and its mutant strains lacking the cytolethal distending toxin (CDT) or lipopolysaccharide (LPS) O-antigen; Porphyromonas gingivalis; Fusobacterium nucleatum; and Parvimonas micra. The effect of EVs on primary and metastatic OSCC cells was assessed using cell proliferation, apoptosis, migration, invasion, and tubulogenesis assays. A. actinomycetemcomitans-derived EVs reduced the metastatic cancer cell proliferation, invasion, tubulogenesis, and increased apoptosis, mostly in CDT- and LPS O-antigen-dependent manner. EVs from F. nucleatum impaired the metastatic cancer cell proliferation and induced the apoptosis rates in all OSCC cell lines. EVs enhanced cancer cell migration regardless of bacterial species. In sum, this is the first study demonstrating the influence of A. actinomycetemcomitans-derived EVs on oral cancer in comparison with other periodontopathogens. Our findings revealed a potential antitumorigenic effect of these EVs on metastatic OSCC cells, which warrants further in vivo investigations.

Dette speciale undersøger den øgede sundhedsrisiko forbundet med optagelse af dentale røntgenbilleder, en meget nyttig men potentiel skadelig praksis i tandplejen. Ved at bruge en omfattende litteraturgennemgang og simpel statistisk modellering undersøger specialet sammenhængen mellem strålingseksponering fra dentale røntgenbilleder og forekomsten af sundhedspåvirkninger, primært fokuseret på kræftrisici i hoved- og halsområdet. På trods af de lave doser, der er typiske ved dental røntgenfotografering, forbliver der bekymringer på grund af den stokastiske natur af strålingsinducerede effekter, hvor der ikke findes en klar nedre tærskelværdi for skader. Forskningen syntetiserede fund fra forskellige højkvalitetsstudier, justeret for potentielle forstyrrende faktorer såsom erhvervsmæssige og livsstilsfaktorer. Analysen afslører, at selvom individuelle risici ved et enkelt dentalrøntgenbillede er minimale, kan kumulative effekter på tværs af en befolkning føre til reelle stigninger i kræfttilfælde. Dette understreger nødvendigheden af streng overholdelse af kliniske retningslinjer, der anbefaler røntgenfotografier kun, når det er på klar klinisk indikation. Desuden undersøges ioniserende strålers påvirkning på udvikling af grå stær, og der fremhæves behovet for yderligere forskning inden for dette område., This thesis investigates the increased health risks associated with the use of dental X-rays, a very useful but potentially harmful practice in dental care. By conducting a comprehensive literature review and simple statistical modeling, the thesis examines the relationship between radiation exposure from dental X-rays and the occurrence of health effects, primarily focusing on cancer risks in the head and neck area. Despite the low doses typical of dental radiography, concerns remain due to the stochastic nature of radiation-induced effects, where no clear lower threshold for harm exists. The research synthesizes findings from various high-quality studies, adjusted for potential confounding factors such as occupational and lifestyle factors. The analysis reveals that although individual risks from a single dental X-ray are minimal, cumulative effects across a population can lead to real increases in cancer cases. This underscores the necessity of strictly adhering to clinical guidelines that recommend X-rays only when there is a clear clinical indication. Furthermore, the impact of ionizing radiation on the development of cataracts is examined, highlighting the need for further research in this area.

Pulp therapy has been emerged as a one of the efficient therapies in the field of endodontics. Among different types of new endodontic materials, pulpotec has been materialized as a recognized material for vital pulp therapy. However, its efficacy has been challenged due to lack of information about its cellular biocompatibility. This study evaluates the mechanistic biocompatibility of pulpotec cement with macrophage cells (RAW 264.7) at cellular and molecular level. The biocompatibility was evaluated using experimental and computational techniques like MTT assay, oxidative stress analysis and apoptosis analysis through flow cytometry and fluorescent microscopy. The results showed concentration-dependent cytotoxicity of pulpotec cement extract to RAW 264.7 cells with an LC 50 of X/10 -X/20. The computational analysis depicted the molecular interaction of pulpotec cement extract components with metabolic proteins like Sod1 and p53. The study revealed the effects of Pulpotec cement's extract, showing a concentration-dependent induction of oxidative stress and apoptosis. These effects were due to influential structural and functional abnormalities in the Sod1 and p53 proteins, caused by their molecular interaction with internalized components of Pulpotec cement. The study provided a detailed view on the utility of Pulpotec in endodontic applications, highlighting its biomedical aspects.

Objectives: This study aims to address the critical gap of unavailability of publicly accessible oral cavity image datasets for developing machine learning (ML) and artificial intelligence (AI) technologies for the diagnosis and prognosis of oral cancer (OCA) and oral potentially malignant disorders (OPMD), with a particular focus on the high prevalence and delayed diagnosis in Asia. Materials and methods: Following ethical approval and informed written consent, images of the oral cavity were obtained from mobile phone cameras and clinical data was extracted from hospital records from patients attending to the Dental Teaching Hospital, Peradeniya, Sri Lanka. After data management and hosting, image categorization and annotations were done by clinicians using a custom-made software tool developed by the research team. Results: A dataset comprising 3000 high-quality, anonymized images obtained from 714 patients were classified into four distinct categories: healthy, benign, OPMD, and OCA. Images were annotated with polygonal shaped oral cavity and lesion boundaries. Each image is accompanied by patient metadata, including age, sex, diagnosis, and risk factor profiles such as smoking, alcohol, and betel chewing habits. Conclusion: Researchers can utilize the annotated images in the COCO format, along with the patients' metadata, to enhance ML and AI algorithm development.

BACKGROUND: Green leafy vegetables (GLV) contain inorganic nitrate, an anion with potential prebiotic effects on the oral microbiome. However, it remains unclear whether GLV and pharmacological supplementation [potassium nitrate (PN)] with a nitrate salt induce similar effects on the oral microbiome. OBJECTIVES: This study aimed to compare the effect of GLV with PN supplementation on the oral microbiome composition and salivary biomarkers in individuals with high blood pressure. METHODS: Seventy individuals were randomly allocated to 3 different groups to follow a 5-wk dietary intervention. Group 1 consumed 300 mg/d of nitrate in form of GLV. Group 2 consumed pills with 300 mg/d of PN and low-nitrate vegetables. Group 3 consumed pills with potassium chloride (placebo: PLAC) and low-nitrate vegetables. The oral microbiome composition and salivary biomarkers of oral health were analyzed before and after the dietary intervention. RESULTS: The GLV and PN groups showed similar microbial changes, probably nitrate-dependent, including an increase in the abundance of Neisseria, Capnocytophaga, Campylobacter species, and a decrease in Veillonella, Megasphaera, Actinomyces, and Eubacterium species after the treatment. Increased abundance of Rothia species, and reduced abundance of Streptococcus, Prevotella, Actinomyces, and Mogibacterium species were observed in the GLV group, which could be nitrate-independent. GLV and PN treatments increased salivary pH, but only GLV treatment showed an increase in the salivary buffering capacity and a reduction of lactate. CONCLUSION: The combination of nitrate-dependent and nitrate-independent microbial changes in the GLV group has a stronger effect to potentially improve oral health biomarkers compared with PN.

The integration of Artificial Intelligence (AI) in dental radiography not only presents an opportunity but also holds immense potential to enhance diagnostic accuracy and efficiency. This study addresses the exciting challenge of leveraging AI, specifically a generative pre-trained transformer model, to interpret dental panoramic X-rays, a task traditionally reliant on human expertise. The central purpose of the study is to evaluate the diagnostic capabilities of this AI model compared to professional dental evaluations, focusing on its accuracy and consistency, thereby paving the way for a promising future in dental diagnostics. The research involved a sample of 35 dental panoramic X-rays obtained from Flexident AB, anonymized and annotated by a panel of dental professionals. The study was conducted in two stages: Stage One tested the AI model in three different methods: 1- without any annotations, 2- with numbered teeth, and 3- with colored circles highlighting areas of interest. Stage Two involved training a specialized GPT model with domain-specific knowledge. Key findings indicate that the AI model, when provided with detailed visual annotations, achieved diagnostic accuracy comparable to that of dental professionals, as statistical analysis showed no significant differences between the golden standard (dentist group) and the visually annotated group (P>0.05). However, the model struggled with unannotated images, highlighting the importance of structured input. The research underscores the potential of language-based AI in medical imaging while emphasizing the need for detailed input to optimize performance. This study is pioneering in applying a generative pre-trained transformer model for dental diagnostics, opening new avenues for AI integration in healthcare., Integrationen av artificiell intelligens (AI) inom tandradiografi innebär inte bara en möjlighet utan har också en enorm potential att förbättra diagnostisk noggrannhet och effektivitet. Denna studie tar upp den spännande utmaningen att utnyttja AI, specifikt en generativ förtränad transformer-modell, för att tolka panoramaröntgenbilder av tänder, en uppgift som traditionellt är beroende av mänsklig expertis. Studiens centrala syfte är att utvärdera de diagnostiska förmågorna hos denna AI-modell jämfört med professionella tandläkarbedömningar, med fokus på dess noggrannhet och konsekvens, vilket banar väg för en lovande framtid inom tanddiagnostik. Forskningen omfattade ett urval av 35 panoramaröntgenbilder av tänder erhållna från Flexident AB, anonymiserade och annoterade av en panel av tandläkare. Studien genomfördes i två steg: Steg ett testade AI-modellen på tre olika sätt: 1- utan några annoteringar, 2- med numrerade tänder och 3- med färgade cirklar som markerade intressanta områden. Steg två involverade träning av en specialiserad GPT-modell med domänspecifik kunskap. Nyckelresultat visar att AI-modellen, när den tillhandahölls detaljerade visuella annotationer, uppnådde en diagnostisk noggrannhet jämförbar med professionella tandläkare, då statistisk analys visade inga signifikanta skillnader mellan guldstandarden (tandläkargruppen) och den visuellt annoterade gruppen (P>0,05). Modellen hade dock svårigheter med icke-annoterade bilder, vilket understryker vikten av strukturerad inmatning. Forskningen betonar potentialen hos språkbaserad AI inom medicinsk avbildning och behovet av detaljerad inmatning för att optimera prestanda. Denna studie är banbrytande i sin tillämpning av en generativ förtränad transformer-modell för tanddiagnostik, vilket öppnar nya möjligheter för AI-integrering inom sjukvården.

Malocclusion is a common condition in children and adolescents with a worldwide prevalence of 56%. It is estimated that approximately 30% of Swedish children and adolescents undergo orthodontic treatment at specialist clinics under Sweden’s free comprehensive dental care for children and young patients, with crowded and displaced teeth being one of the main reasons. One of the treatments used to align teeth is placing fixed appliances with brackets on the teeth. The beneficial effects of the treatment include well-aligned teeth and healthy, stable occlusion. However, every orthodontic treatment entails a risk of adverse effects such as external root resorption and pain. In recent decades, a technique that uses passive self-ligating brackets has gained in popularity. This technique is said to generate less frictional resistance, more physiological tissue response and reduced adverse effects compared to conventional techniques. According to a Cochrane report from 2021, the current evidence is sparse regarding fixed appliance treatment in general, and specifically for the treatment effect of passive self-ligating brackets compared to conventional bracket systems in the treatment of crowded teeth in children. Radiographic examinations before, during and after the treatment are recommended to monitor the risk of severe external root resorption. The recommendations given in textbooks and scientific articles are contradictive as different check-up intervals and radiographic modalities are recommended. Moreover, the grounds for the recommendations are weak, and due to radiation doses and the ALADA (“as low as diagnostically acceptable”) principle, it may not be justifiable for all patients. The CROWDIT (Crowded Displaced Teeth) project was started to decrease knowledge gaps concerning fixed appliance treatment of adolescents with crowded and displaced teeth, from the perspective of patients, clinicians and society. The overall aim of this thesis was to present a systemati, Paper III in dissertation as manuscript

In recent decades, progress has been made in preventive dentistry. However, a significant part of the population still needs dental restorations. Dental ceramics, especially zirconia, are increasingly used as restorative materials. The advantages of using a metal-free restorative material are primarily due to their aesthetics and biocompatibility. Clinical reports on zirconia restorations indicate reliable results and that patients are generally satisfied with them. Nevertheless, they are not entirely free from complications, with loss of retention being a commonly reported problem. This issue may be attributed to the cement systems used to retain zirconia to the tooth, which can be technique sensitive. This doctoral thesis comprises four studies with the overall aim of evaluating factors that can affect the adhesion between zirconia and the tooth surface, thereby enhancing the longevity of zirconia-based restorations. Study I was a laboratory study where the surface structure and bond strength of an adhesive cement to different types of zirconia were evaluated after various surface pretreatments. The mechanical method, alumina particle air abrasion, resulted in a rougher surface and increased bond strength between zirconia and cement compared to other surface pretreatments, regardless of the type of zirconia. In Study II, a systematic review and meta-analysis were conducted to analyse how the type of cement affects the survival of tooth-supported single crowns made of zirconia in posterior dentitions. The meta-analysis demonstrated excellent survival rates for these restorations over a three-year period. Few complications occurred, and there was no significant difference between the various types of cement, such as resin cement, glass ionomer cement, and resinmodified glass ionomer cement. Study III is a three-year follow-up of a randomized clinical trial where general practitioners performed three types of all-ceramic posterior tooth-supported single crowns. The r, De senaste årtiondena har det gjorts stora framsteg inom förebyggande tandvård. Trots detta behöver fortfarande en betydande del av befolkningen tandersättningar. Dentala keramer, särskilt zirkonia, används allt oftare som tandersättningsmaterial. Fördelarna med att undvika metaller är förbättrad estetik och vävnadsvänlighet. Kliniska studier visar att tandersättningar av zirkonia håller över tid och patienter är nöjda. Trots detta är de inte helt problemfria, och en vanlig komplikation är att de kan lossna. Detta kan bero på att cementen som används för att fästa zirkonia till tandytan är mer teknikkänsliga. Denna avhandling består av fyra studier vars övergripande mål är att utvärdera faktorer som kan påverka cementens vidhäftning mellan zirkonia och tandytan, och därmed kan förbättra överlevnaden för tandersättningar av zirkonia. Studie I var en laboratoriestudie där ytstrukturen och bindningsstyrkan till adhesivt cement för olika typer av zirkonia utvärderades efter olika ytbehandlingar. Den mekaniska metoden, luftblästring med aluminiumpartiklar, resulterade i en råare yta och ökad bindningsstyrka mellan zirkonia och cement jämfört med andra ytbehandlingar, oavsett typ av zirkonia. I Studie II genomfördes en systematisk översikt och en meta-analys för att analysera hur typen av cement påverkar överlevnaden för tandstödda singelkronor av zirkonia på kindtänder. Meta-analysen visade en utmärkt överlevnad för dessa konstruktioner över en treårsperiod. Det förekom få komplikationer, och ingen signifikant skillnad mellan de olika typerna av cement, såsom resincement, glasjonomercement och resinmodifierat glasjonomercement. Studie III var en treårsuppföljning av en randomiserad klinisk studie där allmänpraktiserande tandläkare utförde tre typer av tandstödda helkeramiska kronor på kindtänder. Resultaten visade en jämförbar överlevnad mellan litiumdisilikat glaskeram och zirkonia kronor. Dessutom var det få komplikationer, och både patienter och tandläkare var nöjda, Paper II in dissertation as manuscript.Paper II and III is not included in the fulltext online

SAMMANFATTNING Syfte: Syftet med studien var att undersöka de faktorer som möjligen kan leda till en ökad risk för perforation av kortikalt ben, sinusgolv eller näshålan vid direktinstallation av implantat (IIP) i premolar området i maxillan. Material och metod: Då denna studie utgår från virtuell installation av implantat så samlades 179 CBCT undersökningar (innehöll totalt 716 premolarer). Vid varje premolar installerades ett implantat virtuellt i två olika positioner; 1) Protetiskt-driven position, som placeras i samma vinkel som premolarens längdaxel 2) Ben-driven position, där implantatet installeras i den vinkel med mest benvolym. Följande variabler granskades: Patientens ålder, patientens kön, vilken tand det är (1:a eller 2:a premolar), avståndet mellan sinus/näshålan och rotspetsen samt vinkeln mellan de olika positionerna (ILAA) och vinkeln på labiala konkaviteten (LLC). Resultat: Vid IIP i premolarsregionen var prevalensen av perforation 84,1% i den protetiskt drivna positionen och 40,5% i den ben-drivna. Medelvärdet för (ILAA) var 18,3 ± 8,0 grader och visade sig vara högre i andra premolarsregionen. Minsta möjliga implantat längden med 4 mm benförankring apikalt, hade ett medelvärde på 13,0 ± 2,1 mm. De variabler som ansågs ha en koppling till en ökad risk av perforation var: Det kvinnliga könet, hög ålder, ett mindre avstånd mellan rotspets och sinus/näshåla samt en mindre labial concavity angle (LCA). Slutsats: Noggrann planering och patientselektion krävs innan påbörjad behandling. Den begränsade mängden benvolym ger en stor risk för perforation av kortikalt ben och gör det utmanande att hålla ett säkert avstånd till närliggande anatomiska strukturer. Nyckelord: Dentala implantat; direkt installation; maxillära premolarer; Datortomografi (CBCT), Purpose: The aim of this study is to assess the risk of perforation when performing immediate implant installation in the premolar maxillary area and investigate factors that might increase the risk of perforation of adjacent cortical bone and nearby anatomical structures. Methods: The virtual installment of implants were performed on a total of 179 CBCT exam with 716 premolars. For each premolar, an implant was installed in two different positions; 1) The prosthetically-driven position, in the long axis of the tooth 2) The bone-driven position, in the position with the most available amount of bone. The following factors were investigated: Age, gender, tooth position (1st or 2nd premolar), the distance between the sinus and nasal cavity to the root apex, the angles between the two positions (ILAA) and finally the angle of the labial concavity (LLC). Results: The prevalence of perforation when performing IIP in the maxillary premolar region was 84.1% in the prosthetically-driven position and 40.5% in the bone-driven position. The mean value of ILAA was 18.3 ± 8 degrees. The minimal implant length, with 4 mm of apical bone anchorage, had a mean value of 13.0 ± 2.1 mm. The following variables had a possible correlation to an increased risk of perforation: Gender (higher risk in females), older age, a shorter distance between root apex and sinus/nasal cavity and a smaller LCA. Conclusions: Careful treatment planning and patient selection is required prior to the performing of IIP in the premolar maxillary area, because of the high risk of perforation and invasion of the safe distance. Keywords: Dental implants; immediate placement; maxillary premolars; cone-beam computed tomography (CBCT).