The Institute for Postgraduate Dental Education

Jönköping, Sweden

The Institute for Postgraduate Dental Education

Jönköping, Sweden
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PubMed | Karolinska Institutet and The Institute for Postgraduate Dental Education
Type: | Journal: Acta odontologica Scandinavica | Year: 2017

The aim was to assess orofacial function and monitor oral care in patients with amyotrophic lateral sclerosis (ALS) to maintain oral comfort and oral health.A case series of 14 patients newly diagnosed with ALS accepted to participate in a quality improvement project. After initial examinations, baseline oral conditions were obtained and the patients were seen every 3 months. Nordic Orofacial Test-Screening (NOT-S) was used for evaluation of orofacial function.Patients were grouped according to initial symptoms in a bulbar group and a spinal group with eight and six patients, respectively. The mean age at diagnosis was 62.8 years. All were dentate with a mean of 26.7 natural teeth. Most patients had very good oral and dental conditions. As expected, orofacial functions were differently affected in the two groups; at initial NOT-S registration, the mean total score was 5.6 (range 3-8 domains) in the bulbar group and 0.7 (0-2 domains) in the spinal group. At final registration, the corresponding figures were 6.1 and 3.2. Oral and dental aids were introduced according to need.In the bulbar group, several orofacial functions became impaired at an early stage of disease development, and at final registrations many vital orofacial functions were severely compromised. The spinal group was less severely affected orally. However, all individuals irrespective of type of initial symptoms needed assistance in performing oral hygiene measures in the latter part of the disease period. Good oral health and oral comfort could be maintained in all participants and no other dental treatment was needed.


Faulks D.,CHU Clermont Ferrand | Faulks D.,Clermont University | Norderyd J.,The Institute for Postgraduate Dental Education | Norderyd J.,University Institute of Health Sciences | And 6 more authors.
PLoS ONE | Year: 2013

Children in dentistry are traditionally described in terms of medical diagnosis and prevalence of oral disease. This approach gives little information regarding a child's capacity to maintain oral health or regarding the social determinants of oral health. The biopsychosocial approach, embodied in the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) (WHO), provides a wider picture of a child's real-life experience, but practical tools for the application of this model are lacking. This article describes the preliminary empirical study necessary for development of such a tool - an ICF-CY Core Set for Oral Health. An ICF-CY questionnaire was used to identify the medical, functional, social and environmental context of 218 children and adolescents referred to special care or paediatric dental services in France, Sweden, Argentina and Ireland (mean age 8 years ±3.6yrs). International Classification of Disease (ICD-10) diagnoses included disorders of the nervous system (26.1%), Down syndrome (22.0%), mental retardation (17.0%), autistic disorders (16.1%), and dental anxiety alone (11.0%). The most frequently impaired items in the ICF Body functions domain were 'Intellectual functions', 'High-level cognitive functions', and 'Attention functions'. In the Activities and Participation domain, participation restriction was frequently reported for 25 items including 'Handling stress', 'Caring for body parts', 'Looking after one's health' and 'Speaking'. In the Environment domain, facilitating items included 'Support of friends', 'Attitude of friends' and 'Support of immediate family'. One item was reported as an environmental barrier - 'Societal attitudes'. The ICF-CY can be used to highlight common profiles of functioning, activities, participation and environment shared by children in relation to oral health, despite widely differing medical, social and geographical contexts. The results of this empirical study might be used to develop an ICF-CY Core Set for Oral Health - a holistic but practical tool for clinical and epidemiological use. © 2013 Faulks et al.


Bergendal B.,The Institute for Postgraduate Dental Education
American Journal of Medical Genetics, Part A | Year: 2014

Oral signs and symptoms are present in most ectodermal dysplasias (EDs). The aim of this article is to summarize some of the literature on current knowledge of oral manifestations and orofacial function in EDs. The review will focus on the most common forms where dental manifestations can be crucial for a differential diagnosis of ED among individuals with hypodontia and oligodontia, and preferably where the investigations included personswhohad a genetically verified diagnosis. Disturbances in tooth development are common and can appear as tooth agenesis, variations in size and shape of teeth, defects in the mineralized tissues, and problems in tooth eruption. Abnormalities in number, size, and shape of teeth, and reduced salivary secretion, present in isolated oligodontia as well as in hypohidrotic ED and incontinentia pigmenti. In some more rare EDs these symptoms appear in combination with clefts of lip and/or palate in some affected individuals. Leukokeratosis in the oral mucosa presents in70%of genetically confirmedcases of pachyonychia congenita. Also, orofacial function is often affected in ED, due to malformations, an incomplete dentition, and low salivary secretion which can compromise chewing, swallowing, and speech. In conclusion, there is a clinical overlap in oral signs and symptoms between isolated oligodontia and the most common EDs. Studies with genetically confirmed diagnoses and larger cohorts, as well as multicenter collaboration and the establishing of international registries, would create a basis for refined diagnostics, where oral examinations should be an integrated part of clinical assessment. © 2014 Wiley Periodicals, Inc.


Josefsson E.,The Institute for Postgraduate Dental Education
Swedish dental journal. Supplement | Year: 2010

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20-year-old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self-perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to "Index of Orthodontic Treatment Need--Dental Health Component" (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 per cent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory "Being under the pressure of social norms" was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.


Bergendal B.,The Institute for Postgraduate Dental Education | Klar J.,Uppsala University | Stecksen-Blicks C.,Umeå University | Norderyd J.,The Institute for Postgraduate Dental Education | Dahl N.,Uppsala University
American Journal of Medical Genetics, Part A | Year: 2011

Oligodontia is defined as the congenital lack of six or more permanent teeth, excluding third molars. Oligodontia as well as hypodontia (lack of one or more permanent teeth) are highly heritable conditions associated with mutations in the AXIN2, MSX1, PAX9, EDA, and EDAR genes. Here we define the prevalence of mutations in the AXIN2, MSX1, PAX9, EDA, and EDAR genes, and the novel candidate gene EDARADD in a cohort of 93 Swedish probands with non-syndromic, isolated oligodontia. Mutation screening was performed using denaturing gradient gel electrophoresis and DNA sequence analysis. Analyses of the coding sequences of the six genes showed sequence alterations predicted to be damaging or potentially damaging in ten of 93 probands (10.8%). Mutations were identified in the EDARADD (n=1), AXIN2 (n=3), MSX1 (n=2), and PAX9 (n=4) genes, respectively. None of the 10 probands with mutations had other self-reported symptoms from ectodermal tissues. The oral parameters were similar when comparing individuals with and without mutations but a family history of oligodontia was three times more frequent for probands with mutations. EDARADD mutations have previously been reported in a few families segregating hypohidrotic ectodermal dysplasia and this is, to our knowledge, the first report of an EDARADD mutation associated with isolated oligodontia. © 2011 Wiley-Liss, Inc.


Lundgren D.,Gothenburg University | Slotte C.,Gothenburg University | Slotte C.,The Institute for Postgraduate Dental Education | Grondahl K.,The Institute for Postgraduate Dental Education
Clinical Implant Dentistry and Related Research | Year: 2013

Background: Alternative implant designs may reduce the need for complicated and costly bone augmentation procedures in situations with limited bone height. Purpose: Wide dental tube implants have been manufactured and tested in three patients and followed for 5 years to evaluate if such implants are capable to support fixed prosthetic constructions with good prognosis in areas with limited bone height. Materials and Methods: Four machined-tube implants with a height of 6mm, an outer diameter of 7.4mm, and an inner diameter of 6.0mm were placed in three patients. After a healing period of 3 months, ceramometal suprastructures were constructed to supply the implants. Annual clinical and radiographical follow-ups were done up to 5 years. At the 5-year follow-up, all three patients were examined with a cone beam computed tomography technique. Results: All implants and the suprastructures were clinically stable after 5 years. In one patient, vertical bone loss and a 6-mm deep pocket appeared after 1 year. The pocket has remained throughout the observation period and has been regularly debrided and kept it free from clinical signs of inflammation. In the other two patients, the soft tissue surrounding the implants was in good health with no or only slight inflammation throughout all observations. Pocket probing revealed no or slight bleeding and pocket depths amounting to less than 3mm. Conclusion: It was shown that this new type of implant will function excellent during follow-up times of several years. Further studies should be done to explore in more detail indications for such implants. © 2011 Wiley Periodicals, Inc.


Falk Kieri C.,Umeå University | Bergendal B.,The Institute for Postgraduate Dental Education | Lind L.K.,Umeå University | Schmitt-Egenolf M.,Umeå University | Stecksen-Blicks C.,Umeå University
BMC Medical Genetics | Year: 2014

Background: Mutations in the EDAR-gene cause hypohidrotic ectodermal dysplasia, however, the oral phenotype has been described in a limited number of cases. The aim of the present study was to clinically describe individuals with the c.1072C > T mutation (p. Arg358X) in the EDAR gene with respect to dental signs and saliva secretion, symptoms from other ectodermal structures and to assess orofacial function.Methods: Individuals in three families living in Sweden, where some members had a known c.1072C > T mutation in the EDAR gene with an autosomal dominant inheritance (AD), were included in a clinical investigation on oral signs and symptoms and self-reported symptoms from other ectodermal structures (n = 37). Confirmation of the c.1072C > T mutation in the EDAR gene were performed by genomic sequencing. Orofacial function was evaluated with NOT-S.Results: The mutation was identified in 17 of 37 family members. The mean number of missing teeth due to agenesis was 10.3 ± 4.1, (range 4-17) in the mutation group and 0.1 ± 0.3, (range 0-1) in the non-mutation group (p < 0.01). All individuals with the mutation were missing the maxillary lateral incisors and one or more of the mandibular incisors; and 81.3% were missing all four. Stimulated saliva secretion was 0.9 ± 0.5 ml/min in the mutation group vs 1.7 ± 0.6 ml/min in the non-mutation group (p < 0.01). Reduced ability to sweat was reported by 82% in the mutation group and by 20% in the non-mutation group (p < 0.01). The mean NOT-S score was 3.0 ± 1.9 (range 0-6) in the mutation group and 1.5 ± 1.1 (range 0-5) in the non-mutation group (p < 0.01). Lisping was present in 56% of individuals in the mutation group.Conclusions: Individuals with a c.1072C > T mutation in the EDAR-gene displayed a typical pattern of congenitally missing teeth in the frontal area with functional consequences. They therefore have a need for special attention in dental care, both with reference to tooth agenesis and low salivary secretion with an increased risk for caries. Sweating problems were the most frequently reported symptom from other ectodermal structures. © 2014 Falk Kieri et al.; licensee BioMed Central Ltd.


Arzoo P.S.,Uppsala University | Klar J.,Uppsala University | Bergendal B.,The Institute for Postgraduate Dental Education | Norderyd J.,The Institute for Postgraduate Dental Education | Dahl N.,Uppsala University
American Journal of Medical Genetics, Part A | Year: 2014

A large proportion (>50%) of patients with isolated oligodontia were recently reported with WNT10A mutations. We have analyzed a population-based cohort of 102 individuals diagnosed with non-syndromic oligodontia and a mean of 8.2 missing teeth. The cohort included 94 families and screening of WNT10A identified that 26 probands (27.7%) had at least one WNT10A variant. When we included the MSX1, PAX9, AXIN2, EDA, EDAR, and EDARADD genes, 38.3% of probands were positive for a mutation. Biallelic WNT10A mutations were strongly associated with a larger number of missing teeth (11.09) when compared to both monoallelic WNT10 mutations (6.82) and the group without mutations in WNT10A, MSX1, PAX9, AXIN2, EDA, EDAR, or EDARADD (7.77). Genotype-phenotype analysis of individuals with WNT10A mutations showed that premolars were the most common missing teeth. Furthermore, biallelic WNT10A mutations were associated with absence of maxillary and mandibular molars as well as mandibular central incisors. Maxillary central incisors were always present. Thus, our study indicates that WNT10A mutations are associated with both the type and numbers of missing teeth. Furthermore, we show that this population-based cohort of isolated oligodontia had a considerably lower frequency of mutated WNT10A alleles and a lower mean number of missing teeth when compared to patients recruited from dental specialist centers. © 2013 Wiley Periodicals, Inc.


PubMed | Gothenburg University and The Institute for Postgraduate Dental Education
Type: Journal Article | Journal: Clinical implant dentistry and related research | Year: 2016

Diverging opinions exist regarding rough surface abutment usage, and abutment exclusion effects are unstudied.The study aims to: (1) assess tissue response to oxidized or machined abutments or no abutment; and (2) evaluate immediate implant-loading effects.In a 2005-2008 parallel-group randomized, clinical trial, 50 partially edentulous subjects received three Brnemark TiUnite (Nobel Biocare, Gothenburg, Sweden) implants. Superstructures were attached via abutments (one with a TiUnite surface - AOX, and one with a machine-milled surface - AM) or directly at implant level (IL). Implants were immediately loaded (test) or unloaded for 3 months (control). Postoperative examinations were done up to 3 years.Forty-seven subjects were reexamined after 3 years. Four and two implants were lost in test and control groups, respectively, during the first year. Thereafter, no implant loss occurred (95.7% survival). After 1 year, mean (SEM) peri-implant marginal bone loss (MBL) was 1.33 (0.08) mm (test) and 1.25 (0.08) mm (control). Between 1 and 3 years, a nonsignificant MBL occurred: 0.36 (0.08) mm (test) and 0.33 (0.06) mm (control). Similar MBL was found at IL (1.81 [0.93] mm) and AOX (1.77 [0.14] mm) after 3 years and was significantly lower at AM (1.42 [0.17] mm) than at IL (groups merged); 42% of the implants displayed mucosal bleeding at 3 years and probing pocket depths varied between 2.13 (0.12) mm and 3.62 (0.15) mm, significantly lower buccally. Bleeding on probing (BoP) in minute amounts was found in 30-45% of the sites and abundant BoP at about 20% of the sites. Soft tissue retracted mostly during year 1 and was more pronounced buccally. Regression analyses revealed significant effects from smoking, periodontal disease, abundant BoP, and a low initial implant stability quotient on MBL.No further significant MBL was found between 1 and 3 years, irrespective of loading protocol. Use of machined abutments may benefit marginal bone stability over time.


PubMed | The Institute for Postgraduate Dental Education
Type: Journal Article | Journal: Acta odontologica Scandinavica | Year: 2016

The purpose of this radiographic study was to evaluate the prevalence of intrabony defects and to study the correlation between these defects and clinical variables in a Swedish adult population. Another aim was to study the combined relationship of intrabony defects and furcation involvement with clinical variables.The present study was performed using bitewing and apical radiographs from 329 subjects. The clinical and radiographic data were collected from the study that was carried out in Jnkping 2003. Intrabony defects were measured from the bottom of the pocket to the highest point of alveolar bone crest. Furcations were considered healthy if the furcation was filled with bone up to the fornix. SPSS was used to analyze the results.2014 molars and 5898 non-molars were included in the study. The prevalence of intrabony defects was 2.2% in the whole population. Multivariate analysis showed that periodontal pockets (p<0.0001), plaque (p<0.001), age (p<0.02) and gender (p<0.03) had a significant relationship with the occurrence of intrabony defects. On the other hand, gingivitis, smoking habits and education level were not associated with intrabony defects. Multivariate analysis showed that the only variable associated with presence of intrabony defects and furcation involvement was presence of periodontal pockets (p<0.0001). Whilst, gingivitis, education level, plaque, gender, age and smoking habits were not associated with the outcome.Mandibular second molars were most likely to display intrabony defects, whilst mandibular incisors were the least likely to do so.

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