Role of oral pathogens in the pathogenesis of intracranial aneurysm: review of existing evidence and potential mechanisms.

Degeneration of intracranial aneurysm wall is under active research and recent studies indicate an increased risk of rupture of intracranial aneurysm among patients with periodontal diseases. In addition, oral bacterial DNA has been identified from wall samples of ruptured and unruptured aneurysms. These novel findings led us to evaluate if oral diseases could predispose to pathological changes seen on intracranial aneurysm walls eventually leading to subarachnoid hemorrhage. The aim of this review is to consider mechanisms on the relationship between periodontitis and aneurysm rupture, focusing on recent evidence.

Long-term patient satisfaction and the sense of coherence - a longitudinal study 10-15 years after orthognathic surgery.

OBJECTIVE: This study focuses on evaluating the long-term treatment outcome (10-15 years) and patient satisfaction after orthognathic treatment with bisagittal split osteotomy (BSSO). Furthermore, the aim was to evaluate whether the psychosocial factor, sense of coherence (SOC) associates with long-term patient satisfaction. MATERIALS AND METHODS: Study sample consisted of 57 patients who had orthognathic treatment with BSSO. Self-completion questionnaires were distributed approximately 1.8 years and 10-15 years after surgery to evaluate treatment outcome. SOC was evaluated with a 12-scale questionnaire 10-15 years after the surgery. RESULTS: After 10-15 years following BSSO, 96% of patients were highly or moderately satisfied with the treatment outcome and none expressed dissatisfaction. Less educated patients were more satisfied with the treatment outcome than those with a higher educational level. Patients who felt clear improvement in their facial appearance expressed higher satisfaction than those experiencing only minor facial improvement. Furthermore, patients with improvement in orofacial pains and headaches more often expressed high satisfaction than those without improvement of these symptoms. Patients with strong SOC seemed to have somewhat higher scores for functional aspects of long-term treatment outcome. CONCLUSIONS: Post-treatment satisfaction with orthognathic treatment appears to be long-lasting. Psychosocial factors may play a role in long-term post-treatment satisfaction. Our study strongly suggests that psychosocial factors should be taken into account in the treatment planning of orthognathic patients.

Periodontitis and gingival bleeding associate with intracranial aneurysms and risk of aneurysmal subarachnoid hemorrhage.

Oral bacteria DNA has been found in intracranial aneurysms (IA) and a high prevalence of periodontitis was reported in IA patients. We investigated whether periodontitis associates with IA formation and aneurysmal subarachnoid hemorrhage (aSAH). First, we compared in a case-control setting the prevalence of periodontal disease in IA patients (42 unruptured IA, 34 ruptured IA) and in age- and gender-matched controls (n = 70) from the same geographical area (Health 2000 Survey, BRIF8901). Next, we investigated whether periodontitis at baseline associated with aSAH in a 13-year follow-up study of 5170 Health 2000 Survey participants. Follow-up data was obtained from national hospital discharge and cause of death registries. Univariate analysis, logistic regression, and Cox-regression were used. Periodontitis (≥ 4mm gingival pocket) and severe periodontitis (≥ 6mm gingival pocket) were found in 92% and 49% of IA patients respectively and associated with IAs (OR 5.3, 95%CI 1.1-25.9, p < 0.000 and OR 6.3, 95%CI 1.3-31.4, p < 0.001, respectively). Gingival bleeding had an even stronger association, especially if detected in 4-6 teeth sextants (OR 34.4, 95%CI 4.2-281.3). Severe periodontitis in ≥ 3 teeth or gingival bleeding in 4-6 teeth sextants at baseline increased the risk of aSAH during follow-up (HR 22.5, 95%CI 3.6-139.5, p = 0.001 and HR 8.3, 95%CI 1.5-46.1, p = 0.015, respectively). Association of periodontitis and gingival bleeding with risk of IA development and aSAH was independent of gender, smoking status, hypertension, or alcohol abuse. Periodontitis and gingival bleeding associate with increased risk for IA formation and eventual aSAH. Further epidemiological and mechanistic studies are indicated.

Changes in posterior airway space and hyoid bone position after surgical mandibular advancement.

OBJECTIVE: To evaluate cephalometric changes in posterior airway space (PAS) and in hyoid bone distance to mandibular plane (MP) 1-3 years after bilateral sagittal split osteotomy (BSSO). MATERIAL AND METHODS: The sample consisted of 36 females and 16 males who underwent mandibular advancement by BSSO. To observe sagittal changes in PAS and in hyoid bone distance to MP both pre- and postoperative cephalograms were analyzed using WinCeph® 8.0 software. For the statistical analyses paired T-test and multivariate logistic regression models were used. RESULTS: By the surgical-orthognathic treatment the sagittal dimension of PAS showed variable changes but it mainly diminished when the mandibular advancement exceeded 6 mm. In most cases the hyoid bone moved superiorly by BSSO. Logistic regression models showed that males, patients with narrow PAS at the baseline, and those with counterclockwise rotation of the mandible by the treatment gained more increase in PAS. However, an increase in sagittal PAS dimension tended to relapse over time. Concerning the movement of the hyoid it was found that the more PAS increased the less hyoid moved superiorly. In males the change in hyoid position was more obvious than in females. CONCLUSION: Males, patients with narrow PAS at the baseline, and those whose mandible moved in the counterclockwise direction with moderate advancement gained more retrolingual airway patency by BSSO.

The relationship among sense of coherence, socio-economic status, and oral health-related behaviours among Finnish dentate adults.

This study assessed the independent and interactive associations between sense of coherence (SOC) and socio-economic status (SES) with oral health-related behaviours. Data from 5,399 dentate adults regarding their demographic characteristics, years of education, SOC score, and oral health-related behaviours were analysed. Household income was obtained from tax authorities. Logistic regression was used to test the adjusted association of SOC with each behaviour and to test the statistical interaction between each SES indicator and the SOC score. Subjects were 1.20 [95% confidence interval (95% CI): 1.11-1.28] and 1.22 (95% CI: 1.12-1.32) times more likely to visit dentists regularly for check-ups and to brush their teeth twice daily or more often, respectively, and were 1.11 (95% CI: 1.03-1.20) and 1.21 (95% CI: 1.12-1.32) times less likely to be daily smokers and to consume sugar-added products on a daily basis, respectively, for every unit increase in SOC score. The findings provide strong support for an association between higher levels of SOC and more favourable oral health-related behaviours, independently of current SES and demographic characteristics of the participants and across the four behaviours assessed. By contrast, the findings give limited support for the moderating role of SOC on the relationship between SES and oral health-related behaviours.

Sense of coherence as a determinant of toothbrushing frequency and level of oral hygiene.

BACKGROUND: Antonovsky's salutogenic theory seeks to find general health-promoting factors in individuals as distinct from characteristics that function as risks for specific diseases. A central construct of the theory is sense of coherence (SOC). Individuals with a strong SOC have the ability to define events as less stressful (because of comprehensibility); to mobilize resources to deal with encountered stressors (manageability); and to possess the motivation, desire, and commitment to cope (meaningfulness). Our aim is to investigate whether SOC, self-reported toothbrushing frequency, and objectively assessed levels of oral hygiene are related. METHODS: The sample of the present study consisted of 4,131 30- to 64-year-old dentate Finns belonging to a large nationally representative sample. The questionnaire and home interview included information about socioeconomic and demographic factors, behavioral variables, such as oral health behaviors (toothbrushing frequency), and a 12-item SOC scale, used here as a unidimensional measure categorized into quintiles. The level of oral hygiene was measured during clinical oral examination. Chi-square test, ordinal, and ordinary logistic regression analyses were used. RESULTS: Subjects belonging to the strongest SOC quintile were found to be significantly more often two, or more, times a day brushers compared to those with less strong SOC. After controlling for toothbrushing frequency, sociodemographic and socioeconomic factors, smoking habits, and number of teeth, both strong and moderate levels of SOCs were also found to be related to a good level of oral hygiene compared with moderate and poor levels of oral hygiene. Furthermore, subjects within the weakest SOC quintile were found to have significantly more often than others poor levels of oral hygiene. CONCLUSIONS: Our results suggest that a weak sense of coherence increases both the probability of having a poor level of oral hygiene and a frequency of toothbrushing of less than once a day. This and the theory concerning the development of SOC suggest that sense of coherence may be taken as a determinant of both the frequency and the quality of toothbrushing.

A strong sense of coherence promotes regular dental attendance in adults.

OBJECTIVE: To investigate the relationship between the sense of coherence (SOC) and dental attendance pattern. It was hypothesised that the subjects with a stronger SOC have a more regular dental attendance. BASIC RESEARCH DESIGN: In the nationally representative sample including 8,028 persons aged 30, or more, 88% were surveyed. The questionnaire and home interview included information about socio-economic and demographic factors, behavioural and attitudinal variables, such as oral health behaviours (i.e. dental attendance pattern), and the SOC scale (12-item). Chi-square test, unadjusted and adjusted logistic regression models were used in the data analysis. PARTICIPANTS: The sample for this study consisted of 4,263, 30- to 64-year-old dentate, adults. RESULTS: Regular dental attendance was more common among those with a stronger SOC. Gender, education, family income and marital status, but not age, were related with dental attendance. The gender- and age-adjusted associations between the SOC and dental attendance pattern were found to be significantly stronger among those having high-, or middle level of education compared with those having a low education level. CONCLUSION: A stronger SOC is associated with regular dental attendance. This raises the possibility of achieving long-term positive effects on dental attendance in adulthood, if the SOC could be strengthened during adolescence.

The influence of sense of coherence on the relationship between childhood socioeconomic status and adult oral health-related behaviours.

OBJECTIVES: To assess the role of adulthood socioeconomic status (SES) and sense of coherence (SOC) in the relationship between childhood SES and adult oral health-related behaviours. METHODS: This study analysed responses of 5318 dentate subjects aged 30 years and over who participated in the Finnish Health 2000 Survey. Participants provided information on their demographic characteristics (sex, age, marital status and urbanization), childhood SES (parental education), adulthood SES (years of education and household income), the SOC scale and four oral health-related behaviours (dental attendance, toothbrushing frequency, sugar intake frequency and daily smoking). Structural equation modelling was used to test a model including adult SES and SOC as mediating factors of the relationship between childhood SES and adult oral health-related behaviours. Multi-group comparison was conducted to test the model within each sex and age group. RESULTS: Childhood SES was related to adult oral health-related behaviours (P < 0.001) but only indirectly, via adulthood SES (P < 0.001) and adult SOC (P = 0.001). However, the relationship via adulthood SES was much stronger than that via SOC (standardized path coefficients were 0.24 and 0.01 respectively). In the multi-group comparison, the model was invariant across sex and age groups. CONCLUSIONS: The relationship between childhood SES and adult oral health-related behaviours was mainly mediated by adulthood SES, and to a much less extent by SOC. A stronger SOC was significantly associated with better adult oral health-related behaviours, after controlling for the effect of adulthood SES and demographic characteristics of the participants.

Sense of coherence as a determinant of the oral health-related quality of life: a national study in Finnish adults.

Our aim was to investigate the relationship among the oral health-related quality of life, the sense of coherence (SOC), and socio-economic and demographic factors, oral behavioural variables and oral health variables. The sample of this study consisted of 4,039, 30-64-yr-old dentate adults (1,899 men and 2,140 women). The questionnaire and home interview included information about socio-economic and demographic factors, behavioural and attitudinal variables (such as oral health behaviours and oral health variables), the SOC (12-item) and the Oral Health Impact Profile scales (OHIP-14). Subjects with a strong or moderate SOC were found to have significantly fewer problems attributed to oral conditions (OHIP) than those with a weak SOC. The SOC was also associated with all of the subscales of the OHIP, and the association was most evident in psychological discomfort, psychological disability and handicap subscales. The SOC appears to be a determinant of the OHIP, independently of oral health, oral health behaviour and socio-economic factors. A psycho-social aspect is strongly embodied in the oral health-related quality of life of individuals.