Risto Tuominen

Oral Health Indicators Poorly Predict Coronary Heart Disease Deaths

Several earlier studies have suggested that development of coronary heart disease (CHD) is causally related to oral infections. The aim of this study was to investigate the association between oral health indicators and CHD deaths. Out of a nationally representative sample, 6527 men and women aged 30–69 years participated in the health examination with a dental check. Detailed oral health data included caries, periodontal and dental plaque status, presence of remaining teeth, and various types of dentures. Over a mean 12-year follow-up, persons dying of CHD were older and more often smoked, had hypertension, hypercholesterolemia, diabetes, and only a basic education compared with other persons. In univariate analyses, several oral health indicators were associated with CHD deaths. Adjustment for the established CHD risk factors reduced all these associations to statistical non-significance. The associations between oral health indicators and CHD are mostly explained by confounding factors, particularly those relating to health behavior.

Factors associated with subjective need for orthodontic treatment among Finnish university applicants

Subjective orthodontic treatment need and associated factors were studied in a sample of 226 young Finnish adults. The subjects, applicants to enter the University of Helsinki, were interviewed immediately after their entrance examination. A need for treatment was felt by 14% of the subjects. For 47% of those expressing such a need their reason was appearance only, and for 25% it was both appearance and their ability to chew. Among subjects who reported a visible dental irregularity, 38% were dissatisfied with their dental appearance, and 25% felt the need for orthodontic treatment. Women were more often dissatisfied with their dentition than men. Subjective need for treatment was significantly associated with perceived visible dental irregularity and infrequent socializing but not with orthodontic treatment in childhood, pattern of dental attendance, or district of residence. Of various perceptions of anterior teeth, irregularly and wrongly positioned teeth were most often connected with treatment need.

The cost-effectiveness of nationwide breast carcinoma screening in Finland, 1987–1992

The aim of this study was to evaluate the cost‐effectiveness, from a societal perspective, of the Finnish nationwide breast carcinoma screening program.

Periodontal status among male industrial workers in southern Finland with or without access to subsidized dental care.

The association between subsidized dental care and periodontal status was studied in male industrial workers in southern Finland in 1994. Clinical examinations and a multiple-choice questionnaire were completed for 325 workers (age, 38-65 years) with access to subsidized dental care and 174 controls without access. The CPITN scores based on full-mouth recordings were analyzed, using both the individual and sextant as units of analysis. Overall, 6% of the subsidized group and 2% of the control group had no periodontal treatment need (p < 0.05). Deep pockets > or = 6 mm were found in 5% of the subsidized workers and 11% of the controls (p < 0.05). In the logistic regression analyses the probability of calculus was negatively associated with access to subsidized dental care. Smoking was the strongest independent factor affecting periodontal status. Our findings show a positive relationship between access to subsidized dental care and periodontal status.

Incremental cost‐effectiveness of double‐reading mammograms

Background. Double reading is a widely used criterion standard in breast cancer screening despite a lack of evidence of the cost‐effectiveness of the second reading. This study evaluates the incremental cost‐effectiveness of such a strategy.Design. Cost‐effectiveness analysis: Nationwide population‐based semi‐annual screening program for women aged 50–59 in Finland. Participation rate was 91%. All mammograms (95,423) performed during 1990–1995 in three screening centers of the Finnish Cancer Society were read by two radiologists with gradings recorded. The effectiveness of the double reading was the difference in cancers detected in the double compared to that of the single reading. Incremental costs of the double reading for the health care and non‐health care and the time costs were estimated. The main outcome measure was the incremental cost per additional cancer found as a result of the double‐reading strategy.Results. The total number of cancers detected with the double and single reading were 290 and 261, respectively. A significantly higher ratio of carcinoma in situ was the causative pathology in cancers detected only by the second reader. The cost per cancer detected with a single reading was US

Smoking and Periodontal Disease in the Finnish Population Aged 30 Years and Over

18,340. The incremental cost of any additional cancer found was US

Exploring the determinants of periodontal treatment costs: A special focus on cigarette smoking

25,523, that is, a 39% higher cost per additional cancer found by double reading.Conclusions. The additional cost per cancer detected by double reading is not drastically higher than with single reading. However, the additional cost per life year saved may be much higher.

Economic evaluation of cataract surgery: A comparison between IOL and non‐IOL techniques

The aim of this study, which was part of the Mini-Finland Oral Health Survey, was to evaluate the effect of smoking on periodontal condition in the Finnish adult population. A representative sample was drawn from the population aged 30 years and over. The total number of subjects was 8000, 90% of whom participated in the clinical examination. Periodontal diagnoses were made according to the modified Periodontal Treatment Need System (PTNS). Information about age, toothbrushing, and smoking habits was collected by personal interviews. When the sample was divided into two groups (with and without periodontal pockets), the overall risk ratio (RR) was 1.39 and was slightly higher for men than for women. A log-linear model was used to study simultaneous associations and interactions between smoking, periodontal disease, and some background factors. In this model, smoking had not significantly affected the periodontal condition.

Oral mucosal changes and associated factors among male industrial workers with or without access to subsidized dental care

Determinants of periodontal treatment costs are explored by constructing and estimating a recursive multi-equation model. The costs are based on treatment needs defined by the conventional concept of periodontal disease. Special attention is paid to the effect of cigarette smoking on the costs. The model is based on the health production theory and the findings of earlier studies of factors affecting periodontal disease. The model was estimated by Lisrel by using the ML method. The data were based on a clinical examination and interview of a representative sample (n = 4771) of the dentulous Finnish population aged 30 years and over (The Mini-Finland Oral Health Survey). Most of the predictions of the model were confirmed by the empirical testing. In terms of direct effects, there seems to be four significant explanatory factors to the total costs: the number of remaining natural teeth, age, caries status and smoking in that order. The elasticity of costs with respect to the number of cigarettes per day was 0.072 for men and 0.021 for women. Moreover, the model revealed other interesting connections between oral health variables, oral hygiene and health care habits and the exogenous variables of age, education and income. Implications of new concepts of periodontal disease on results are also discussed.

Dental students' knowledge of AIDS and HIV infection in Helsinki, Finland, and in Dar es Salaam, Tanzania

Abstract Using a sample of 116 patients, 53 of whom had undergone cataract extraction without IOL implantation, and 63 of whom had been treated by IOL implantation, a retrospective evaluation of differences in economic effects was performed. The use of non‐IOL technique was cheaper for the hospital, but the overall costs for society were soon higher, mainly as a result of the significantly higher costs of obtaining contact lenses and spectacles in the non‐IOL group. The longer we expect cataract surgery patients to live post‐operatively the greater will be the difference in favour of using the IOL technique. The estimated annual savings to society for every 875 patients operated would be from FIM 5 million to FIM 26.5 million if non‐IOL technique was used and from FIM 10.5 million to FIM 28.5 million with IOL surgery. Cataract surgery, and especially with IOL technique, seems to be an operation resulting in substantial savings to society.