Magnus Hakeberg

Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden.

The objective of this study was to evaluate the association between number of missing teeth and all cause, cardiovascular, and cancer mortality as well as morbidity and to explore whether socio-economic factors mediate this association. An ongoing prospective cohort study of 1462 Swedish women included a dental survey in 1968/69 with follow-up until 1992/93. The dental examination included a panoramic radiographic survey and a questionnaire. Number of missing teeth at baseline was analysed in a Cox proportional hazards model to estimate time to mortality and morbidity. Number of missing teeth, independently of socio-economic status variables (the husband’s occupational category, combined income, and education) was associated with increased all cause mortality and cardiovascular disease mortality respectively (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.18–1.58) and (RR: 1.46; 95% CI: 1.15–1.85 per 10 missing teeth), but no associations were found for cancer mortality (RR: 1.18; 95% CI: 0.91–1.52). The relation between poor oral health and future cardiovascular disease could not be explained by measures of socio-economic status in this study.

Prediction of prolonged pain experiences during orthodontic treatment

INTRODUCTION In this study, we investigated prolonged pain reactions in teenage orthodontic patients during a common orthodontic treatment. The aim was to examine factors predicting pain at the end of a follow-up week after placement of elastic separators. METHODS Fifty-five patients (ages, 12-18 years) were included. Baseline assessments were made of perceived intensity of general and dental pain experiences, motivation for treatment, dental anxiety, and personality factors (self-esteem and temperament). Pain intensity was assessed on a visual analog scale, and pain medications were recorded. The patients were separated into pain and no-pain groups according to pain experiences at day 7. RESULTS The pain group (mainly girls) had significantly higher ratings of treatment pain than in the non-pain group at all times measured except for the treatment day. Bivariate and multiple logistic regressions showed significant predictive power from motivation, dental anxiety, activity temperament, and vaccination pain. CONCLUSIONS In this adolescent patient sample, low motivation for orthodontic treatment, high ratings of vaccination pain, elevated dental anxiety level, and low activity temperament characterized patients reporting pain 1 week after the elastic separators were placed.

Technical quality of root fillings and periapical status in root filled teeth in Jönköping, Sweden.

AIM To study changes in technical quality of root fillings and periapical status in root filled teeth in random samples of 20 to 70 year-olds between 1973 and 2003. METHODOLOGY Data from dentate subjects aged 20-70 years from examinations conducted in 1973 (n = 498), 1983 (n = 530), 1993 (n = 547) and 2003 (n = 491) were used for the analysis. Length of root fillings were measured on radiographs to the nearest 0.1 mm. Adequate seal was defined as a root filling without lateral and/or apical voids. Periapical status was assessed according to the periapical index. All observations were made by one calibrated observer registered from full mouth radiographic examinations. Teeth with root fillings ending within the canal without lateral or apical voids were considered adequate. The association between root filling quality and periapical status was analysed by means of the Chi-squared test and a multilevel logistic regression analysis. RESULTS Adequately root filled teeth had a significantly lower frequency of apical periodontitis than inadequately root filled teeth (11.8% vs. 22.8%). The frequency of technically adequate root fillings increased statistically significant from 1973 (23.7%) to 2003 (36.4%) without a concomitant improvement of the periapical status in root filled teeth over time (24.5% vs. 24.6%). CONCLUSIONS This study reports on an improving technical quality of root fillings over time, without a concomitant improvement of the periapical status in root filled teeth. A larger proportion of treated molars over time may be of importance for the result.

Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of Women in Gothenburg.

Objectives. To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968–1969, 1980–1981, 1992–1993 and 2004–2005. Design. Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. Setting. Gothenburg, Sweden with ∼450 000 inhabitants. Subjects. Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59–90%, n =1901). Main outcome measures. Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. Results. There was no significant difference in mean BMI from 1968–1969 versus 2004–2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004–2005 versus 1968–1969. HDL-cholesterol (not measured until 1992–1993), showed a significantly higher mean level in 2004–2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. Conclusions. Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.

Sense of coherence and its relationship with oral health–related behaviour and knowledge of and attitudes towards oral health

OBJECTIVE To investigate the relationship between sense of coherence (SOC), oral health-related behaviour, knowledge of and attitudes towards oral health in an adult Swedish population. METHODS A cross-sectional design with a stratified random sample of 910 individuals aged 20, 30, 40, 50, 60, 70 and 80 years were invited to the study, from Jönköping, Sweden. The investigation used the Swedish short version of the SOC questionnaire comprising 13 items and self-reported questions about oral health habits and knowledge of and attitudes towards oral health. In addition, a self-report questionnaire to elicit demographic information was included. RESULTS A total of 525 individuals, 261 men and 264 women, answered all the 13-item SOC questions, which constituted the final number of the participants. After adjustment for all the sociodemographic factors included in the analysis, individuals with a stronger SOC had twice as high a chance of having healthier behaviour, including a lower frequency of snacks and drinks between meals, as well as a more positive attitude, such as the importance of having ones own teeth as one gets older, satisfaction with their own teeth, perceiving their teeth as good and no feeling of dental fear, compared with individuals with a poorer SOC. Moreover, SOC and a good knowledge of caries were significantly associated after adjustment for age and gender. CONCLUSIONS SOC was significantly associated with several oral health-related behaviours, attitudes towards oral health and knowledge of dental caries. When working with oral health promotion, SOC could be a way for promoting a better understanding of the behaviour and attitudes of individuals and for enabling dental personals to use that knowledge for the guidance of the individual.

Socio-economic risk indicators for apical periodontitis.

Objective. The aim of this study was to reveal possible socio-economic risk indicators for apical periodontitis. Material and Methods. In 1992–93 a representative sample of women in Göteborg, Sweden, aged 38–84 years, participated in a medical and dental survey (n=981) which included dental and medical examinations and dental radiographic examination (OP). The dependent variable was apical periodontitis (AP = 0, AP > 0). The independent variables were age, number of teeth, number of restored teeth, number of root-filled teeth, number of teeth with carious lesions, satisfactory masticatory function, and dental esthetics as crude measures of self-reported dental health, dental anxiety, time elapsed since last visit to a dental office, regular dental visiting habits, smoking, alcohol habits, and marital status. A subjective evaluation of economy, health and life situation (acceptable or poor) was accounted for as socio-economic variables. The oldest age group, women born 1908, and edentulous individuals were omitted, leaving 844 subjects for analysis. Statistical analysis included multivariate logistic regression, chi-squared test, and independent t-test for comparison of group characteristics (AP = 0 vs AP > 0). Results. For socio-economic variables there was a significant association between acceptable health and apical periodontitis (OR = 1.72 (CI = 1.09–2.70)). For oral-related variables, root-filled teeth (OR = 1.17 (CI = 1.10–1.23)) and teeth with carious lesions (OR = 1.48 (CI = 1.19–1.85)) were predictive of apical periodontitis. Conclusions. In the present study, socio-economic variables and dental visiting habits did not appear to have obvious implications for periapical health, whereas root-filled teeth and carious lesions were associated with apical periodontitis.

Dental anxiety and pain related to dental hygienist treatment

Objective. To evaluate different groups of patients’ self-reported assessments of dental anxiety and pain related to various routine dental hygienist treatment procedures, and to investigate the relationship between anxiety concerning dental and dental hygienist treatment. Material and methods. A consecutive sample of 393 patients participated in the study (59.7% F, age range 20 to 85 years, mean 47.6 years). Periodontology (PC), oral medicine (OM), student and general practice (GP) clinics were included. Each patient was asked to answer a questionnaire which included different demographic information, self-reported levels of dental anxiety, and experience of pain in relation to different dental hygienist treatments. Results. Higher dental anxiety was found in relation to gender (women), dentist treatment, and PC and OM patients. Experiences of high or extreme pain were reported by between 7.1% and 9.7% of participants for all dental hygienist procedures except polishing (0.8%). There were significant correlations between dental hygienist fear levels and reported extreme pain experiences among all five treatment procedures. Patients treated at the PC clinic scored significantly higher on pain compared with patients at the other clinics, with the exception of the OM clinic. Conclusions. Patients reported higher dental anxiety levels for dentist treatment as compared with dental hygienist treatment. Moreover, dental anxiety was significantly associated with perceived pain related to different dental hygienist treatment procedures.

Dental anxiety and symptoms of general anxiety and depression in 15-year-olds

OBJECTIVES The objective of the study was to analyse the relationship between dental anxiety and symptoms of general anxiety and depression among 15-year-old individuals. METHODS The sample analysed included 221 randomly selected 15-year-old individuals living in the city of Jönköping, Sweden. One questionnaire captured sociodemography and dental history, while dental anxiety was assessed by the Dental Fear Survey (DFS) and symptoms of general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). RESULTS About 6% of the adolescents were classified as dentally anxious. Symptoms of general anxiety and depression were significantly correlated with dental anxiety in both the bivariate and multivariate analyses. The latter analyses were adjusted for gender and previous painful experiences of dental care. Individuals with high dental anxiety showed general anxiety scores on a clinical level (mean=9.8, SD=4.3). CONCLUSIONS Symptoms of general anxiety and depression were shown to be significantly correlated with dental anxiety among 15-year-old individuals.

Oral health, sense of coherence and dental anxiety among middle-aged women.

AIMS The specific aims of this investigation were to analyze the relationship between sense of coherence (SOC), dental anxiety (DA) and oral health status among middle-aged women, measured both subjectively and objectively and adjusted for socioeconomic status (SES). MATERIALS AND METHODS Randomly selected women, 38 (n = 206) and 50 (n = 287) years of age, were included in a cross-sectional health examination. The participants underwent a series of examination stages, including a clinical and dental radiographic examination. The women responded to questionnaires concerning SES, oral health, DA and SOC. RESULTS The number of teeth was significantly related to SOC, where more missing teeth revealed a lower SOC level among 50-year-olds. The variables of caries, apical periodontitis and filled surfaces were not statistically significantly associated with SOC. However, the self-reported measure of oral health was associated with SOC in both age groups. High DA was significantly related to self-perceived poor oral health regardless of age. Individuals with high DA also had fewer teeth, more filled surfaces and more approximal caries. The multivariate models showed that higher SOC levels were associated with better oral health, as estimated by objective or subjective measures, while the inverse results were seen for DA. Thus, individuals reporting high DA were more likely to have fewer teeth and poor perceived oral health, taking SES into account. CONCLUSIONS Sense of coherence and dental anxiety are psychological aspects with respect to health- and risk-factors of oral health.