Lennart Unell

Infant dental enucleation: A literature review on a traditional remedial practice in East Africa

Abstract Objective. To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa. Materials and methods. Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review. Results. An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined. Conclusions. Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

Associations between social and general health factors and symptoms related to temporomandibular disorders and bruxism in a population of 50 year-old subjects

The aim of this epidemiological study was to examine associations between temporomandibular (TMD)‐related problems and variables from three domains: (1) socio‐economic attributes, (2) general health and health‐related lifestyle, and (3) dental attitudes and behaviors. The overall response rate to a questionnaire mailed to the total population of 50‐year‐old subjects in two Swedish counties (8,888 individuals) was 71%. Among the 53 questions in the questionnaire, those related to social, general health, and health‐related factors were used as independent variables in logistic regression models. Three TMD‐related symptoms and reported bruxism were used as dependent variables. Impaired general health was the strongest risk factor for reported TMD symptoms. Along with female gender and dissatisfaction with dental care, impaired general health was significantly associated with all three TMD symptoms. A few more factors were associated with pain from the TMJ only. In comparison, reported bruxism showed more significant associations with the independent variables. In addition to the variables associated with TMD symptoms, being single, college/university education, and daily tobacco use were also significantly correlated with bruxism. Besides female gender, impaired general health, dissatisfaction with dental care, and a few social and health‐related factors demonstrated significant associations with TMD symptoms and reported bruxism.

Eating disorders and oral health: a matched case–control study

The aim was to compare the oral health status of patients with eating disorders (EDs), with sex- and age-matched controls, with a view to identify self-reported and clinical parameters that might alert the dental healthcare professional to the possibility of EDs. All patients who entered outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of 65 ED patients who started psychiatric/medical treatment, 54 agreed to participate. Eating disorder patients and controls answered a questionnaire and underwent dental clinical examinations. Multivariate analysis identified significantly higher ORs for ED patients to present dental problems (OR = 4.1), burning tongue (OR = 14.2), dry/cracked lips (OR = 9.6), dental erosion (OR = 8.5), and less gingival bleeding (OR = 1.1) compared with healthy controls. Sensitivity and specificity for the correct classification of ED patients and controls using the five variables was 83% and 79%, respectively. The ED patients with vomiting/binge eating behaviors reported worse perceived oral health (OR = 6.0) and had more dental erosion (OR = 5.5) than those without such behavior. In ED patients with longer duration of the disease, dental erosion was significantly more common. In conclusion, oral health problems frequently affect ED patients, and this needs to be considered in patient assessment and treatment decisions.

Explanatory models for clinically determined and symptom-reported caries indicators in an adult population.

The aim of the present study was to analyze possible indicators of: (i) relative number of decayed and filled teeth, (ii) relative number of decayed teeth, (iii) subjectively reported toothache, and (iv) sensitive teeth, and to find explanatory models for these phenomena. Independent variables from three domains were used: (i) socio-economic factors, (ii) general health and health-related lifestyle, and (iii) dental attitudes and behaviors. The study basis was validated questionnaires from all 50-year-olds in 2 Swedish counties (n = 8888), response rate 71% (n = 6343). For a 20% subsample (58% participation) the DFT and DT were determined by calibrated dentists. Analyses were done with logistic and multiple regression. The variables born outside Sweden, gender, education, shift work, satisfaction with dental care, fear and care utilization were associated with DFT/number of teeth. For DT/number of teeth, the direction of association was reversed for the variables born outside Sweden and gender. Social class, education, general health, and use of tobacco were further covariates. Good oral hygiene gave a lower ratio of DT. For the logistic regression model of toothache, residence in cities and satisfaction with dental care had lower probability for toothache reports, while born outside Sweden, mouth dryness, use of pharmaceuticals, tobacco, fear, and high utilization increased this probability. In general, the association pattern was as could be expected: immigrants, working class, low education, smoking, dissatisfaction with dental treatment and low utilization all appeared as risk factors for both the clinically determined caries indicators, but not necessarily for subjective symptom reports. Only fear of dental treatment showed a consistent positive association with all the indicators.

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.

A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects

The aim of this study was to determine the changes in prevalence of xerostomia in subjects from 50 to 65 yr of age. Questionnaires were sent to all subjects who were born in 1942 and were living in two Swedish counties in 1992, 1997, 2002, and 2007. The analyses focused on those who answered the questionnaires both in 1992 and in 2007. The response rate was 71.4% (n = 6,346) in 1992 and 73.1% (n = 6,078) in 2007. Of those who answered the questionnaire in 1992, 74.3% (n = 4,714) also responded in 2007. There was an almost linear increase in the prevalence of xerostomia at the four study time-points (i.e. when the subjects were 50, 55, 60, and 65 yr of age). Xerostomia was more prevalent at night than during the day. The pooled prevalence of night-time and daytime xerostomia was 6% at 50 yr of age and 15% at 65 yr of age, and it was higher in women than in men on both occasions. Logistic regression analyses showed that impaired health and smoking were significantly associated with daytime xerostomia but not with night-time xerostomia. Despite the increase in prevalence of xerostomia from 50 to 65 yr of age, there was considerable variation during the observation period. The incidence rate was 13% (507/4,015) and the disappearance rate was 42% (104/250) (dichotomized answers).

Social inequality in oral health-related quality-of-life, OHRQoL, at early older age: Evidence from a prospective cohort study

Abstract Objectives . This study aimed to assess the long-term effect of socio-behavioral characteristics on oral impacts on daily performances (OIDP) at age 65 and the influence on OIDP at age 65 of changes in socio-behavioral characteristics between age 50 and 65. Methods . In 1992, all 50-year-olds in two counties of Sweden were invited to participate in a longitudinal survey. A total of 6346 responded and, of those, 4143 completed follow-ups at ages 55, 60 and 65 years. Results . At age 65, 26.9% had oral impacts. Subjects being immigrants, being unmarried, reporting economic barriers, bad general health, bad quality dental care, less than annual dental attendance, limited social network and smoking at age 50 experienced oral impacts at age 65 more frequently than their counterparts in the opposite groups. Compared to the stable advantaged groups, stable disadvantaged groups regarding marital status, health status, smoking and reported quality of care had increased ORs for oral impacts. Compared to the stable advantaged groups, those who experienced deterioration with respect to health status, dental attendance and quality of oral health care and those who quitted smoking had increased ORs for oral impacts. Conclusions . Disadvantaged socio-behavioral condition at age 50 had a long lasting detrimental effect on OHRQoL at age 65. Deterioration in socio-behavioral circumstances was associated with increased oral impacts. Early protection against the effect of socio-behavioral adversity by imposing economic barriers, ensure provision of high quality care and by promotion of healthy lifestyles seems to have the potential to reduce oral impacts at older ages.

Use of dental services throughout middle and early old ages: a prospective cohort study

OBJECTIVES Focusing on a Swedish 1942 birth cohort, this study describes the trend of dental health care utilization between age 50 and 65 and identifies major determinants of dental visiting habits using Andersens model as adapted for dentistry as a theoretical framework. METHOD In 1992, a census of 50 year olds in two counties of Sweden was invited to participate in a longitudinal questionnaire survey. Of the total population of 8888 subjects, 6346 responded (71%). Of the 6346 subjects who completed the 1992 survey, 4143 (65%) completed postal follow ups in 1997, 2002 and 2007. RESULTS 83.3% and 3.2% of the cohort remained stable with respect to use and nonuse of regular dental care. Cochrans Q test revealed that the proportions reporting regular use decreased from 93% at age 50-87% at age 65 (P < 0.001). Generalized estimated equations revealed the following covariates; gender (females), country of birth (native born), marital status (married), perceived quality of dental care (good perceptions), dental care utilization as a child, remaining teeth and perceived oral problems. The influence of the variable time, functioning as a measure of period/ageing, maintained a statistically significant relationship with regular utilization after adjusting for all covariates in the model. CONCLUSION Regular use of dental health care services decreased slightly but statistically significantly from age 50 to 65 and was most prevalent in socio-economically advantaged groups, among those with remaining own teeth, subjects who perceived oral problems and reported high quality dental care. The results have implications for planning of elderly dental health care and required dental workforce in Sweden and countries with similar welfare systems.

Differences in four reported symptoms related to temporomandibular disorders in a cohort of 50-year-old subjects followed up after 10 years

Objective. To assess possible changes in the prevalence of four temporomandibular disorder (TMD) symptoms reported by subjects at age 50 and again 10 years later. Material and methods. Identical questionnaires were sent out in 1992 and in 2002 to all subjects born in 1942 and living in two Swedish counties. Of those who answered the four questions on TMD symptoms in 1992, 74% responded in 2002 (n=4639). The response alternatives were dichotomized into two groups: 1) No problems and 2) some, rather severe and severe problems. Results. The mean prevalence of TMD-related symptoms reflected small and mainly non-significant changes, whereas the prevalence of reported bruxism was significantly greater at age 60 than at age 50. Among those with no TMD symptoms at age 50, 5–7% of the men and 8–9% of the women reported symptoms at age 60. Of those reporting one or more TMD symptoms at age 50, 47–65% of the men and 40–48% of the women had no symptoms 10 years later. There was a significant and markedly increased risk of reporting TMD symptoms and bruxism (OR>10) at age 60 among those who had symptoms at age 50. Conclusions. The mean prevalence of reported TMD symptoms was relatively consistent from age 50 to age 60. The group reporting symptoms at the first examination were highly likely still to have the symptoms 10 years later. However, approximately half of the subjects with TMD symptoms at age 50 reported no symptoms at age 60.

Changes in reported orofacial symptoms over a ten-year period as reflected in two cohorts of fifty-year-old subjects

Objective. The study presents changes in reported orofacial symptoms over the course of a 10-year period. It was hypothesized that there was an increase of temporomandibular disorder (TMD) and orofacial pain symptoms during the period concurrent with social and demographic changes. Material and Methods. All 50-year-old subjects living in two Swedish counties were asked to answer a mail questionnaire in 1992 and 2002. In the two cohorts, 6,343 and 5,798, respectively, responded (response rate 71.3% and 70.2%). Results. Striking differences in demographic, occupational, general, and oral health conditions were found. General health was reported to be less good, utilization of dental care decreased, whereas number of teeth increased. The prevalence of a number of intra-oral symptoms and orofacial symptoms increased significantly between 1992 and 2002. Reported bruxism increased from 18% in 1992 to 28% in 2002. Conclusion. The observed increase in reported orofacial pain symptoms during the 10-year period, concurrent with changes in society, deserves further attention by society and the dental community.