Kristin S. Klock

Socio-economic inequality in the self-reported number of natural teeth among Norwegian adults--an analytical study.

OBJECTIVE To assess inequality in dental status associated with educational level, gross personal and family income among Norwegian adults. METHODS Data were collected by Norways Central Bureau of Statistics in November-December 2003. A two-stage, proportional random sample comprising 2000 persons aged 16-79 years was drawn from the national population register. Information became available for 1309 subjects by interview. The present analyses pertain to 1092 subjects aged 25-79 years (response rate 66%, mean age 47.9 years). RESULTS Of the respondents, 3% were edentulous and 9% had fewer than 20 teeth. The mean number of teeth was 27.1 (SD 7.0). In multiple logistic regression analysis, low gross personal and adjusted family income were associated with increased likelihood of having fewer than 20 natural teeth (OR = 2.84, 95% CI 1.58, 5.10; OR = 3.63, 95% CI 1.99, 6.62, respectively). Educational level was significantly associated with dental status in bivariate but not in multivariate analyses, except once among males. The predictors of socio-economic inequality in dental status accounted for a limited proportion of explained variance (Nagelkerkes R(2)) when controlling for age, place of residence, perceived oral health compared with others, perceived importance of oral health, dental attendance and smoking. CONCLUSION Socio-economic inequality in dental status persists among Norwegians aged 25-79 years but absolute differences have decreased during the last 30 years. The findings are encouraging but challenging as far as choice of strategy for further reduction of differences in tooth loss.

Dental fluorosis among persons exposed to high- and low-fluoride drinking water in western Norway

The aim of this project was to study the prevalence and severity of dental fluorosis among persons exposed to moderate- to high- or low-fluoride drinking water in western Norway, and to assess the risk factors involved. Subjects aged 5 to 18 years who had been lifelong consumers of moderate- to high-fluoride groundwater (> or = 0.50 mg F/L) were selected for the study (n = 113). A comparison group (n = 105) was chosen among consumers of low-fluoride surface water (approximately 0.10 mg F/L) in the same district. The Thylstrup-Fejerskov (TF) Index was used to score dental fluorosis. A questionnaire was used to obtain information on fluoride exposure and other relevant factors. Among the consumers of low-fluoride water 14.3% showed dental fluorosis (TF score 1-2) as compared to 78.8% in the group consuming moderate- to high-fluoride water (TF scores 1-7). Premolars were most frequently affected, but severe cases (TF scores 3-7) were equally prevalent in maxillary central incisors and first molars. In logistic regression analysis with TF score 0 or TF score > or = 1 as the dependent variable, only fluoride concentration in the drinking water was associated with a statistically increased risk of dental fluorosis (odds ratio: 18.9; 95% CI: 8.85-40.44). In the study area, which was characterised by multiple fluoride sources, uncontrolled groundwater with moderate to high fluoride content was the most important factor in the development of dental fluorosis. In order to prevent dental fluorosis, groundwater wells should routinely be analysed for fluoride.

Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corahs Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for nonattendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (≤0.26), but high negative predictive values (≥0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point ≥13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was ≥15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.

Trends in reasons for tooth extractions in Norway from 1968 to 1998.

The aims of this study were (i) to determine the reasons for extraction of permanent teeth in Norway in 1998 and (ii) to describe changes in reasons for extraction in time-trend and quasi-longitudinal perspectives over 30 years based on three cross-sectional studies. The 1998 data were obtained from questionnaires distributed to a national random sample of 1,500 dentists, of whom 1,008 responded (67%). A total of 1,495 teeth were extracted for 1,164 patients (age 10±92 years) during a period of 2 weeks. Caries accounted for 40% of the extractions and periodontal diseases for 24%. Caries was the primary reason in patients 10±45 years old, while periodontal diseases dominated among adults >45 years old. In a time-trend perspective, among patients ≤21 years, a significant decrease in the proportion of extractions because of caries was observed between 1968 and 1988, while non-significant changes were found between 1988 and 1998. Extractions because of periodontal disease accounted for about 26% in all surveys. Followed longitudinally, the three cohorts born 1923±32, 1933±42, 1943±52 showed a decrease in the proportion of extractions due to caries, and an increase in the proportion of periodontal extractions during the period, more so between 1968 and 1988 than between 1988 and 1998. The three cohorts showed a variable trend of change, which may indicate that period and age effects do not necessarily operate in the same direction.

Variation in subjective oral health indicators of 65-year-olds in Norway and Sweden

Objective. Guided by the conceptual framework of Gilbert and co-workers, this study assesses satisfaction with oral health as reported by 65-year-olds in Sweden and Norway, the relationship of socio-demographic factors, clinical and subjective oral health indicators with satisfaction of oral health, and the consistency of those relationships across countries. Material and methods. In 2007, standardized questionnaires were mailed to all the residents in two counties in Sweden and three in Norway who were born in 1942. Response rates were 73.1% (n=6078) in Sweden and 56.0% (n=4062) in Norway. Results. Totals of 76.8% of the Swedish and 76.5% of the Norwegian participants reported satisfaction with oral health. Corresponding figures for toothache were 48.1% (Sweden) versus 51.5% (Norway), and for temporomandibular joint symptoms, 10.9% (Sweden) versus 15.1% (Norway). Multiple logistic regression analysis revealed that subjects who perceived they had bad health, smoked daily, had missing teeth, experienced toothache, had problems with chewing, bad breath, and oral impacts were less likely than their counterparts in the opposite groups to be satisfied with their oral health status. The corresponding odds ratios (ORs) ranged from 0.08 (problems chewing) to 0.2 (oral impact). No statistically significant two-way interactions occurred and the model explained 46% of the variance in satisfaction with oral health across the two countries (45% in Sweden and 47% in Norway). Conclusions. The oral condition of 65-year-olds in Norway and Sweden produced impacts in oral symptoms, functional limitations, and problems with daily activities that varied to some extent. Satisfaction with oral health varied by socio-demographic factors and subjective oral health indicators. A full understanding of the oral health and treatment needs of 65-year-olds cannot be captured by clinical measures alone.

Direct evidence concerning the 'major role' of fluoride dentifrices in the caries decline. A 6-year analytical cohort study.

The role of fluoride (F) dentifrices in caries decline was investigated by assessing the effect of variation in their use on caries scores among teenagers. The material comprised 211 subjects aged about 11 years at base line and 18 years at the last examination. Pairs of posterior bitewing radiographs were assessed by one examiner. Information concerning dental health behavior was collected by questionnaire and about treatment received from dental records. A reversal of the traditional DFS gender difference occurred during teenage years. Multivariate regression analyses showed an inverse relationship between variation in F dentifrice use and current decay (D1S) at age 18 years (P < 0.04) and with caries incidence per year (D1FS) during the whole observation period (P < 0.02). Total explained variance in 6-year deltaD1FS scores was 29.8%, of which variation in toothbrushing behavior contributed 1.8 percentage points. While confirming the multifactorial nature of dental caries, these results also provided quantitative evidence for the role of variation in F dentifrice use in caries incidence and decline.

A biobank of primary teeth within the Norwegian Mother and Child Cohort Study (MoBa): a resource for the future.

The Norwegian Mother and Child Cohort Study (MoBa) is a prospective population-based cohort study including >100 000 pregnancies and following the children through childhood, using questionnaires and collecting biological samples. The aim of MoBa is to test specific aetiological hypotheses by estimating the association between exposure and disease, aiming at prevention. A biobank for exfoliated primary teeth collected from the children participating in MoBa has been established (MoBaTooth Biobank). Samples of tooth tissues from the primary dentition can give information about exposure to toxic and essential elements during fetal life and early infancy. Prenatally and postnatally formed tooth tissues permanently document early exposures unlike other biomarkers, as teeth form incrementally at a known rate. Results from tooth analyses will be coupled with corresponding information in the multiple questionnaires and data from analysis of other biological samples collected by MoBa. Invitations to donate one or more teeth are sent to all mothers/children in the period 2008-2016, when the child is 6.75 years old. By August 2011, 7400 participants had been recorded into the MoBaTooth database donating altogether 9798 teeth (1.3 teeth per child). The response rate was 24%, but there is a lag of >1 year in the response. Data from the tooth biobank can supply MoBa with important additional information on the uptake of trace elements during fetal life and early infancy. This information can illuminate possible causal factors of health and disease in the future.

Scandinavian systems monitoring the oral health in children and adolescents; an evaluation of their quality and utility in the light of modern perspectives of caries management

BackgroundRecording reliable oral health data is a challenge. The aims were a) to outline different Scandinavian systems of oral health monitoring, b) to evaluate the quality and utility of the collected data in the light of modern concepts of disease management and to suggest improvements.Material and methodsThe information for in this study was related to (a) children and adolescents, (b) oral health data and (c) routines for monitoring such data. This meant information available in the official web sites of the “KOSTRA-data” (Municipality-State-Report) in Norway, the Swedish National Board of Health and Welfare (“Socialstyrelsen”) and Oral Health Register (the SCOR system, National Board of Health) in Denmark.ResultsA potential for increasing the reliability and validity of the data existed. Routines for monitoring other oral diseases than caries were limited. Compared with the other Scandinavian countries, the data collection system in Denmark appeared more functional and had adopted more modern concepts of disease management than other systems. In the light of modern concepts of caries management, data collected elsewhere had limited utility.ConclusionsThe Scandinavian systems of health reporting had much in common, but some essential differences existed. If the quality of epidemiological data were enhanced, it would be possible to use the data for planning oral health care. Routines and procedures should be improved and updated in accordance with the modern ideas about caries prevention and therapy. For appropriate oral health planning in an organised dental service, reporting of enamel caries is essential.

Dental caries prevention strategies among children and adolescents with immigrant - or low socioeconomic backgrounds- do they work? A systematic review

BackgroundThis systematic review was designed to uncover the most reliable evidence about the effects of caries preventive strategies in children and adolescents of immigrant or low socioeconomic backgrounds.MethodsAccording to pre-determined inclusion and exclusion criteria, relevant articles focusing on underprivileged groups were electronically selected between January1995 and October 2015. The literature search was conducted in five databases; PubMed, Embase, CINAHL, SweMed+ and Cochrane Library. Accepted languages for included articles were English, German and Scandinavian languages. Abstracts and selected articles in full text were read and assessed independently by two review authors. Systematic reviews and meta-analyses were not included. Also articles with topics of water fluoridation and fluoride toothpaste were excluded, this due to all existing evidence of anti-caries effect for disadvantaged groups. The key data about the main characteristics of the study were compiled in tables and a quality grading was performed.ResultsThirty-seven articles were selected for further evaluation. Supervised toothbrushing for 5-year-old school children was found to be an effective prevention technique for use in underprivileged groups. Also a child/mother approach, targeting nutrition and broad oral health education of mothers showed effectiveness. For older children, a slow-release fluoride device and application of acidulated phosphate fluoride (APF) gel showed to be effective.ConclusionOn the basis of this review, we maintain that in addition to studies of water fluoridation and fluoride toothpaste, there are other preventive intervention studies providing scientific evidence for caries reduction among children and adolescents with immigrant or low socioeconomic backgrounds.

Oral health of 65-year olds in Sweden and Norway: A global question and ICF, the latest conceptual model from WHO

Abstract Objective. The aims of this study were to identify explanatory factors of satisfaction with oral health among Norwegian and Swedish 65 year olds in terms of items from four different domains of ICF and to compare the strengths of the various ICF domains in explaining satisfaction with oral health. Further it was to assess whether the explanatory factors of ICF domains vary between Norway and Sweden. Materials and methods. In 2007, standardized questionnaires were mailed to all the residents in certain counties of Sweden and Norway who were born in 1942. Response rates were 73.1% (n = 6078) in Sweden and 56.0% (n = 4062) in Norway. Results. In total, 33 questions based on four different ICF domains were chosen to explain satisfaction with oral health. Logistic regression showed that four different ICF domains in terms of body function, body structure, activity/participation and environmental factors explained, respectively, 53%, 31%, 12% and 34% of the explanatory variance in the satisfaction with oral health. In the final analysis, only nine items were statistically significant (p < 0.05). Conclusion. This study indicates that ICF as a conceptual model could cover a broad spectrum of factors embedded in OHRQoL measured by a global question in Sweden and Norway. Nine items, representing four ICF domains, were important in the final model for explaining satisfaction with oral health.