Tor Österberg

Trends and prognoses of dental status in the Swedish population: analysis based on interviews in 1975 to 1997 by Statistics Sweden

The aims of this study were to describe changes in dental status over the 22-year period from 1975 to 1997, and to make a prognosis of dental status based on these data for the years 2005 and 2015. The study is based on regular investigations of the living conditions performed by Statistics Sweden of samples varying between 11,582 and 14,964 participants and a response rate from 78% to 86%. The questions of the interview used in this study were focused on dental status and utilization of dental services. The prevalence of edentulism in the age group 25-74 years decreased from 19% in 1975 to 3% in 1996/97. The proportion of dentate persons increased from 75% in 1975 to 97% in 1996/97 in age group 45-64 years with similar trends in the other age groups. In 1996/97, 2.1% of the whole sample (16-84 years) reported that they had received implant-supported restorations. The rate was higher among the elderly and the edentulous subjects. The great regional differences in dental status found in the first part of the observation period remained only in the oldest age group in 1996/97. The prognosis predicts that 95% of the subjects in age group 65-74 years and 90% in age group 75-84 years will be dentate in the year 2015. The substantial increase of dentate subjects among the elderly that has occurred during the past few decades and its expected continuation in the coming years implies a great change in need and demand for dental care services.

Utilization of dental services in relation to socioeconomic and health factors in the middle-aged and elderly Swedish population

The aims of this study were to describe the change in reported time since the latest visit to a dentist between the years 1980/81 and 1988/89 and the reported use of dental services in relation to age, dental state, and socioeconomic and health characteristics in a sample of the Swedish population in 1988/89. The studies are based on interviews by Statistics Sweden about the living conditions. In the investigations in 1980/81, 14,964 inhabitants between 16 and 84 years of age participated, and in 1988/89, 13,309 inhabitants. In all age groups there was a significantly higher frequency of reported visits to a dentist last year in 1988/89 than in 1980/81. In the age group 50-64 years old this figure increased from 54% to 75%, and in the age group 65-84 years old it increased from 26% to 39%. In the investigation in 1988/89 about 75% of the dentulous women in all age groups up to 75 years reported visiting a dentist last year. The relative risk for not visiting a dentist last year, adjusted for age, gender, and dental state, was higher in dentulous subjects with low income and education, not married, not native-born, living in rural areas, smoking, and low social and physical activity. The results of the logistic regression analysis showed that, among the elderly, functional ability and general health factors have lower significance for time since last visit to a dentist than socioeconomic, social support, and life-style factors.

Number of teeth – a predictor of mortality in 70-year-old subjects

OBJECTIVES To investigate whether the number of teeth at age 70 is an independent predictor of mortality. METHODS Within the gerontological population studies in Göteborg, Sweden, four birth cohorts born in 1901/1902, 1906/1907, 1911/1912 and 1922 were examined cross-sectionally at 70 years of age. The total number of participants in the odontological cohorts was 1803. Mortality data were collected from the national Swedish health registers. Cox regression models were used to measure the association between mortality and the number of teeth with adjustment for covariates such as health factors, socio-economic and lifestyle factors. RESULTS The prevalence of edentulism showed a marked change from 51% in the first cohort to 16% in the last cohort. The 7-year mortality rate was 14% in women and 28% in men, and the highest in edentulous men in the last two cohorts (42% and 47% respectively). The 7-year mortality including all four cohorts showed a hazard ratio of 0.96 (95% CI 0.94-0.98; P < 0.001) for the number of teeth with adjustment for cohort. The corresponding 18-year mortality including the three first cohorts showed a hazard ratio of 0.98 for women and 0.97 for men. The number of teeth was an independent statistically significant predictor of 7-year mortality in both genders and of 18-year mortality in men. CONCLUSIONS The result showed that each remaining tooth at age 70 decreased the 7-year mortality risk by 4%. The difference between edentulous subjects and dentate subjects with >or=20 teeth regarding 7-year mortality was significantly higher in the last compared to the first cohort. The number of teeth was a significant predictor of mortality independent of health factors, socio-economic status and lifestyle.

Edentulism associated with obesity: a study of four national surveys of 16 416 Swedes aged 55–84 years

Abstract Objective. To investigate the association between edentulism and obesity in the Swedish population aged 55–84 years over a 22-year period as a result of changes in health and socio-economic factors. Material and methods. Subjects aged 55–84 years (n = 16 416) were randomly sampled from the Swedish population by Statistics Sweden on four occasions (1980–81, 1988–89, 1996–97 and 2002). Trained interviewers collected information about dental status and anthropometric, demographic, socio-economic, lifestyle and health-related factors. Statistical analyses were based on logistic regression models. Results. Edentulism decreased from 43% to 14% in the age group 55–84 years from 1980 to 2002, and the proportion of subjects with removable dentures decreased from 68% to 33%. In the age group 55–74 years, the proportion of subjects with low education decreased from 60% to 28%, and the proportion of obese subjects (body mass index ≥30 kg/m2) increased from 9% to 15%. In women aged 55–74 years, the association between obesity and edentulism, adjusted for health, lifestyle and socioeconomic factors, was significant in all surveys, and the odds ratio for obesity changed from 1.64 (95% confidence interval 1.18–2.27) in 1980 to 3.17 (95% confidence interval 1.69–6.18) in 2002. In men, the association was weaker and was significant only in the sample that combined all surveys and included individuals aged 55–84 years. Conclusion. The study indicated an association between edentulism and obesity, which was most obvious in women aged 55–74 years.

Number of teeth – a predictor of mortality in the elderly? A population study in three Nordic localities

Objective. Although associations between number of teeth and mortality have been found in some studies, the results have not been conclusive. The aim of this study was to determine whether dental status at age 75 is an independent predictor of survival in three Nordic populations. Material and Methods. The baseline study was conducted as part of a comparative Nordic investigation of systematic samples of 75-year-old men and women born in the period 1914–16 (n=1004) and living independently in three Nordic localities: Glostrup in Denmark, Jyväskylä in Finland, and Göteborg in Sweden. Performed in 1989–91, the study included a home interview, a health questionnaire, and a laboratory examination. For the present study, the mortality data of all participants up to age 82 were collected from official registers in 1999. Results. Lower mortality during 7 years was associated with higher number of remaining teeth at age 75. In Jyväskylä and Göteborg, but not in Glostrup, the association between number of teeth and mortality was statistically significant. For all three samples pooled and adjusted for sex and location, this association was significant (odds ratio 0.86; p<0.001). Conclusions. Number of teeth is a significant predictor of 7-year mortality in 75-year-old women independently of a number of factors related to lifestyle, disease, and reduced functional capacity.

Dental caries and related factors in 88- and 92-year-olds. Cross-sectional and longitudinal comparisons.

Our aim was to compare two groups of 88- and 92-year-olds (n = 92 and n = 40), respectively, with regard to teeth, caries, and salivary and microbial conditions. Oral variables were analyzed in relation to functional capacity and use of cardiovascular agents and psychoactive drugs. Untreated root caries, plaque score, and counts of lactobacilli increased between the ages of 88 and 92 years (P < 0.01). Nine of the 24 longitudinally followed up subjects had lost 1-5 teeth over 4 years, and 17 subjects had developed new caries (DFS). The mean caries increment over 4 years was 1.3 coronal and 3.6 root surfaces, and new DFS per 100 surfaces at risk was 4.3 coronal and 17.5 root surfaces. Plaque score and final pH of buffer capacity increased (P < 0.05 and 0.01, respectively), whereas saliva flow, independent of gender, was unchanged. Use of cardiovascular agents and psychoactive drugs was associated with a deteriorated dental status.

Utilization of dental care after the introduction of the Swedish dental health insurance

The dental care utilization rate in an urban Swedish population over an 11-year period was studied, starting at the time of the introduction of a national dental health insurance. The systematically selected samples comprised, for each calendar year of the period, approximately 11,000 inhabitants more than 20 years of age in the city of Göteborg. In 1976 and 1984 information on utilization was coupled to information about various demographic, socioeconomic, and disablement factors. In addition, a longitudinal study was performed of 8012 people who resided in Göteborg in 1976 and 1984, correlating dental attendance rates with the same factors. The results showed that dental care utilization increased among both men and women, mostly in age groups more than 65 years of age. Utilization rate in 1976 and in 1984 was independently associated with age, sex, income, marital status, disablement, and regions of the city, and it is concluded that the goal of the dental insurance act, which was, among other things, to contribute to a more equitable distribution of dental care, in many respects has not been achieved. Early identification of people with low utilization may provide a means to obtain the most pronounced improvement in dental health.

Caries prevalence and salivary and microbial conditions in 88-year-old Swedish dentate people

As part of a comprehensive investigation of 88-year-old people, caries prevalence, stimulated salivary secretion rate, buffer capacity, and the prevalence of lactobacilli and mutans streptococci were studied in a subsample of 92 dentate subjects. The mean number of remaining teeth was 14.1 +/- 7.3. The DMFT was 25.2 +/- 3.0, and DF surfaces 38.3 +/- 22.7. Root caries experience was found in 85% of the subjects, with a mean root caries index of 36.6 +/- 28.5%. The men had significantly higher mean values of salivary secretion rate (2.0 +/- 1.3 ml/min) than the women (1.1 +/- 0.6 ml/min) (p < 0.001). The mean final pH of buffer capacity was 6.3 +/- 1.3. High counts of lactobacilli (> 10(5)) and mutans streptococci (> 10(6)) were found in 49% and 55% of the subjects, respectively, of whom most were denture wearers. The mean number of total mutans streptococci was higher in persons harboring both Streptococcus mutans and S. sobrinus than in subjects with only S. mutans.

Root Caries and Some Related Factors in 88-Year-Old Carriers and Non-Carriers of Streptococcus sobrinus in Saliva

The prevalence of caries on exposed root surfaces in 88-year-old subjects with and without salivary levels of Streptococcus sobrinus was studied. Ninety-two individuals were examined with regard to root caries lesions and fillings. The root caries index (RCI) was calculated and related to salivary flow rate and buffer capacity, plaque score and salivary counts of Streptococcus mutans, S. sobrinus and lactobacilli. In 89 subjects with exposed root surfaces, all but 2 harbored mutans streptococci; 51 subjects carried S. mutans only, 35 both S. sobrinus and S. mutans, and 1 S. sobrinus only. The RCI was significantly higher in persons with than those without S. sobrinus (p < 0.05). Subjects with both S. sobrinus and S. mutans had higher counts of total mutans streptococci and lactobacilli than subjects with only S. mutans (p < 0.05). The RCI was significantly correlated to S. sobrinus and S. mutans (p < 0.05). The positive correlation between the RCI and S. sobrinus was still significant when the other tested variables were kept constant, whereas the correlation between the RCI and S. mutans was weaker when S. sobrinus and lactobacilli were kept constant. The D-component of the RCI (DSr%) was significantly correlated to S. sobrinus, S. mutans and lactobacilli, whereas the F-component of the RCI showed no significant correlation to any of the tested variables. A stepwise multiple correlation showed that the variance of DSr% was best explained in the S. sobrinus carriers by S. sobrinus and the salivary buffer effect, and in the non-carriers by S. mutans.

Prevalence and incidence of dental caries and related risk factors in 70- to 76-year-olds

Objective. The prevalence of caries and various risk factors was studied cross-sectionally in two cohorts of 72-year-olds over the course of 20 years. Incidence was also studied over a period of 6 years. Material and Methods. Samples of two dentate subjects from cohorts of 70 to 72-year-olds were included; cohort III (n=135), born 1911–12, and cohort VI (n=139), born 1930. Cohort III was also examined at 70 years of age and re-examined after 6 years. An interview and clinical examination, including DMFS, plaque and gingival bleeding indices, pocket depth, and secretion rate for stimulated whole saliva, were carried out. Results. The mean numbers of teeth in cohorts III and VI were 14 and 21, respectively. On average, 2.1 tooth surfaces were decayed (DS) in cohort III compared with 1.3 in cohort VI (p<0.05). 49% of the individuals in cohort III did not develop any new DS, while 19% developed ≥3 DS during the 6-year follow-up period. The prevalence of caries was related to plaque and gingival bleeding indices, as well as a pocket depth of ≥4 mm, at ages 70 and 72. Moreover, the incidence of caries was related to the same factors. Conclusions. The numbers of remaining teeth increased and the prevalence of caries decreased over the 20-year period. The incidence of caries over the follow-up period of 6 years was moderate. The results indicate that the prevalence of plaque, gingival bleeding, and a pocket depth of ≥4 mm are predictive factors for both prevalence and incidence of caries.