Comparison of biochemical markers of bone metabolism between conventional labial and lingual fixed orthodontic appliances.

OBJECTIVES: The applied orthodontic force causes remodeling of the periodontium through the selective release of cytokines causing resorption of bone, enabling controlled movement of the tooth. This study compared the cytokine profile between patients treated with conventional labial and lingual fixed orthodontic appliances. PATIENTS AND METHODS: The study included 80 patients in need of orthodontic treatment, out of which 40 patients were treated by the labial fixed appliance and 40 by the lingual fixed appliance. Gingival crevicular fluid (GCF) specimens were gathered from both the groups using a microcapillary pipette. The samples were collected at the beginning of the treatment and after 21 days. Enzyme-linked immunosorbent assay was performed to evaluate the cytokine levels. RESULTS: Interleukin (IL)-1α, 1ß, 2, 8, and tumor necrosis factor-alpha (TNF-α) levels were significantly high (P < 0.001) in GCF of participants treated with conventional labial fixed appliance. IL-1α, 1ß, 2, 6, 8, and TNF-α levels were significantly high (P < 0.001) in GCF of participants treated by the lingual fixed appliance. The concentrations of TNF-α and IL-1ß were increased higher than other cytokines in both the treatment groups. CONCLUSION: Overall, the lingual fixed appliance had higher cytokine levels than a labial fixed appliance. Analyzing the GCF cytokine levels during orthodontic treatment could provide an ideal platform for monitoring the progress of the treatment.

The healthcare system and the provision of oral healthcare in European Union member states. Part 9: Sweden.

Equally accessible and affordable dental services for all population groups have been a political goal in Sweden for almost a century. All political parties have shared the idea that a person's social background should not have consequences for his or her dental status. Strategic tools to achieve this ambitious goal have been the wide use of publicly provided oral healthcare services, covering even sparsely populated areas, focusing on preventive care and significant subsidies for necessary treatments. Besides free care for children and young adults, oral healthcare is reimbursed from public funds. The public subsidy was particularly generous in 1975-1999 when a 'full clearance' of adults' dentitions was undertaken both by the public and private providers under fixed prices and high reimbursement levels for all treatment measures. Today, preventive oral healthcare for the elderly is given higher priority as most Swedes have been able to keep their natural teeth.

Tobacco use in relation to socioeconomic factors and dental care habits among Swedish individuals 15-70 years of age, 1983-2003.

OBJECTIVES: The aim of this study was to describe the use of tobacco and changes in its use over time among individuals living in Jönköping, Sweden, and to analyse tobacco habits in relation to socioeconomic conditions, personality aspects and dental care habits. METHODS: This study comprised three epidemiological cross-sectional studies, involving a random selection of individuals aged between 15 and 70 years, and was conducted in 1983, 1993 and 2003. The participants were asked to complete a questionnaire. RESULTS: The results revealed a statistically significant reduction from 34% tobacco users in 1983 to 27% in 1993 and 28% in 2003. The main decrease was seen among smokers. At the same time, the number of users of snuff increased in all the age groups between 20 and 60 years of age. The use of tobacco was therefore largely unchanged in 1993 and 2003. In 2003, there was a statistically significant difference between users and non-tobacco users when it came to the frequency of dental visits; more tobacco users than non-tobacco users did not visit a dentist at all or did not visit a dentist regularly. In 1993, non-tobacco users brushed their teeth more frequently than tobacco users and this difference was statistically significant. CONCLUSIONS: During the 20-year study, there was a reduction in the number of smokers and an increase in the number of snuff users. There was a difference between tobacco users and non-tobacco users when it came to the frequency of dental visits and oral hygiene habits.

Explanatory models for clinical and subjective indicators of periodontal disease in an adult population.

BACKGROUND: The aim of this study was to analyze indicators of periodontal disease using: (1) community periodontal index of treatment needs (CPITN), (2) subjectively reported change of front teeth position, and 3) subjectively reported gingival bleeding. METHOD: These 3 indicators were used in models with explanatory variables from 4 domains: (A) socio-economic attributes, (B) general health and health-related lifestyle, (C) dental attitudes and behaviors, and (D) dental status expressed as (number of teeth and DFT) for the clinically-determined dependent variables. In 1992, the study was carried out cross-sectionally in all 50-year olds in 2 Swedish counties using a questionnaire (n=6343) and clinical investigation of a 20 % sub-sample (n= 1040). RESULTS: Multiple and logistic regression analysis showed that explanatory patterns varied for the clinical and subjective indicators. Use of tobacco had strong effects in all models as did high care utilization. There were few associations with socio-economic attributes. The 2 subjective indicators "changed front position" and "gingival bleeding" associated with attitudes, behaviors and subjective health. Number of teeth and DFT covaried with clinical indicators. CONCLUSIONS: The main conclusions from this study are: (1) that it is possible to find multivariate models with acceptable goodness of fit for prediction of occurrence of periodontal indicators, and (2) that the lack of relation between social attributes and the disease gives arguments for a biological provenance of periodontitis.

Explanatory models for clinically determined and symptom-reported caries indicators in an adult population.

The aim of the present study was to analyze possible indicators of: (i) relative number of decayed and filled teeth, (ii) relative number of decayed teeth, (iii) subjectively reported toothache, and (iv) sensitive teeth, and to find explanatory models for these phenomena. Independent variables from three domains were used: (i) socio-economic factors, (ii) general health and health-related lifestyle, and (iii) dental attitudes and behaviors. The study basis was validated questionnaires from all 50-year-olds in 2 Swedish counties (n = 8888), response rate 71% (n = 6343). For a 20% subsample (58% participation) the DFT and DT were determined by calibrated dentists. Analyses were done with logistic and multiple regression. The variables born outside Sweden, gender, education, shift work, satisfaction with dental care, fear and care utilization were associated with DFT/number of teeth. For DT/number of teeth, the direction of association was reversed for the variables born outside Sweden and gender. Social class, education, general health, and use of tobacco were further covariates. Good oral hygiene gave a lower ratio of DT. For the logistic regression model of toothache, residence in cities and satisfaction with dental care had lower probability for toothache reports, while born outside Sweden, mouth dryness, use of pharmaceuticals, tobacco, fear, and high utilization increased this probability. In general, the association pattern was as could be expected: immigrants, working class, low education, smoking, dissatisfaction with dental treatment and low utilization all appeared as risk factors for both the clinically determined caries indicators, but not necessarily for subjective symptom reports. Only fear of dental treatment showed a consistent positive association with all the indicators.

Attitudes to and experience of dental care among 50-year-olds in two Swedish counties.

The aim of this study was to investigate attitudes to and experiences of dental care in a population, born 1942. The following items were studied: opinions of general and oral health, attitudes to and experiences of dental care, dental care habits, experiences of latest visit to a dentist, tobacco habits and use of various dental hygiene articles. A cross-sectional mail questionnaire was sent in 1992 to all 50-year-olds in two Swedish counties, Orebro and Ostergotland, totally 8888 persons; the response rate was 71%. Of the population 89%, indicated good health. Satisfaction with dental care was high, 94%. 26% stated attendance to a dentist twice or more per year, and 64% at least once a year. As to expenses, 78% paid less than 1000 SEK the last year. Concerning the latest visit, 38% reported painless treatment, 37% no inconvenience, and 55% good care. The duration of the latest visit included on an average 27 min in travel time, 7 min in waiting time and 27 min in treatment time. Information about oral hygiene was given to 29% and about cost for treatment to 47% of the interviewed. There were 28% daily smokers. Snuff was daily used by 10% of the males. Toothbrushing twice a day with fluoride toothpaste seemed to be the standard oral hygiene procedure and was reported by 80% of the respondents.

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.

Explanatory models for oral health expressed as number of remaining teeth in an adult population.

OBJECTIVE: To develop explanatory models for oral health expressed as the number of remaining teeth. METHOD: Socio-economic attributes, health factors, dental attitudes and behaviours were used as explanatory variables in a logistic regression. Cross-sectional validated questionnaire data from all 50-year-old residents in two Swedish counties were collected from 8,888 persons, a response rate of 71.4% (n = 6,343). Adjusted number of teeth and three dichotomies of edentulousness and remaining teeth in various combinations were used as the dependent variables. RESULTS: Social class was unrelated to edentulousness, while individual and health factors were covariants. Individuals with < or = 8 teeth had a social class and education gradient, while those with > or = 25 teeth had class and education gradients as well as a relation to dental care utilisation. There were only three variables showing a consistent and stable relation to the various dependent variables, these were use of tobacco, having only junior high school education and satisfaction with dental care. The multiple and logistic regression models revealed different results. CONCLUSIONS: The main conclusions from this study were, first, that there were different mechanisms for different states of the dentition, interpreted as signs of disease and signs of health, corresponding to the ideas of patho- and salutogenesis, and secondly, that number of teeth present is not usable as a continuous variable, since it does not reflect the same mechanisms across the whole scale.

Saliva composition in children and young adults with Papillon-Lefèvre syndrome.

The aim of the present study was to evaluate the salivary secretion rate and composition in a group of 16 children and young adults (6-27 years) with Papillon-Lefèvre Syndrome (PLS), and to compare the findings with a group (n = 16) of healthy controls. Unstimulated and stimulated whole saliva was collected at least 2 h after meals and the secretion rate determined. The stimulated saliva was assessed for buffer capacity, total protein, peroxidase and hexosamine, while the unstimulated samples were evaluated for total protein, lysozyme, thiocyanate, lactoferrin and salivary IgA. Both the unstimulated (p < 0.01) and stimulated (p < 0.05) saliva secretion rates were significantly lower among the PLS patients compared with the controls. Furthermore salivary buffer capacity was significantly (p < 0.01) lower in the PLS patients. The total protein content in saliva was comparatively high in the study group, while the concentrations of immunoglobulins and non-immunoglobulins were within normal ranges. When calculating the output of the assessed antimicrobial factors, the mean peroxidase level in stimulated whole saliva was found to be significantly (p < 0.01) lower in the PLS patients than in the healthy controls. In conclusion, the present study indicates an impaired water secretion and a somewhat altered saliva gland function in children and young adults with PLS.

Studies on human minor salivary gland secretions using the Periotron method.

Secretions from minor salivary glands were estimated in 127 individuals by the Periotron method of measuring fluid output from different mucosal sites, and outputs were related to different variables. Large intra- and interindividual variations in secretions (expressed as microliter/cm2 per min) were observed, with means of 0.9 for the palatal, 4.8 for the labial and 16.0 for the buccal mucosal sites. Age had no influence on the secretion rate, but women had 10-20% lower values from all three sites than men (p < 0.05). Individuals wearing upper dentures or using tobacco had 300 and 27% increased palatal secretion rates, respectively (p < 0.001, p < 0.05). In addition, those being treated with diuretics had 15% lower rates of secretion from buccal mucosal glands (p < 0.05), and those complaining of oral dryness had 21% lower fluid output from the labial mucosa (p < 0.05). These results support the use of minor salivary glands in combination with the Periotron method to study mucosal secretions and functions.

Impact of medical and life-style factors on number of teeth in 68-year-old men in southern Sweden.

The aim of the present study was to investigate the impact of general health and life-style factors on the number of remaining teeth in 68-year-old men living in the city of Malmö, Sweden. The study included 483 men (participation rate, 78%). Poor self-assessed health, frequent medical attendance, diabetes, and oral dryness were related to fewer remaining teeth. Number of teeth was negatively correlated to concentrations of triglycerides and alkaline phosphatases in serum and to glucose in blood but positively correlated to serum urea. Various dietary variables including consumption of sucrose-containing products and nutritional quality were not related either to number of teeth or to prevalence of edentulousness. Smoking and high consumption of coffee or alcohol were associated with fewer remaining teeth. Multiple logistic regression analyses showed that social class, frequency of dental attendance, smoking, and serum concentrations of triglycerides and urea had an independent effect on number of teeth.

Effect of a long-term change from a mixed to a lactovegetarian diet on human saliva.

The effects of this long-term dietary change on secretion rate, buffer capacity, concentration of sodium and potassium and amylase activity of stimulated parotid and whole saliva was studied in 20 healthy, normal-weight, non-smoking omnivores. Salivary counts of mutans streptococci and lactobacilli were also made. Dietary surveys were carried out and saliva samples collected before (baseline) and 3, 6 and 12 months after the dietary change as well as 3 yr after the end of the lactovegetarian diet period. The dietary data showed an increase in the consumption of fruits, vegetables and dairy products and a decrease in meat, fish, eggs, sweets and biscuits. These changes led to an increased intake of carbohydrates, fibre and water. After 12 months on the vegetarian diet, the secretion rate, buffer capacity and sodium concentration of whole saliva and the secretion rate of parotid saliva had increased significantly. At the 3-yr follow-up, the buffer capacity and sodium concentration were still elevated, while the secretion rate had almost returned to the baseline values. The potassium content of whole saliva showed a tendency to increase during the vegetarian diet period, but had decreased again at the 3-yr follow-up.

Salivary antimicrobial proteins in patients with Crohn's disease.

The aim was to study the level of salivary proteins with antimicrobial properties in persons with Crohn's disease. Twenty-five patients were recruited, 13 with ongoing symptoms (acute group) and 12 free of clinical signs of the disease at the time of the investigation (nonacute group). A control group matched to the nonacute group was also included in the study. Unstimulated and stimulated whole saliva samples were collected, and the secretion rates estimated. Unstimulated saliva was analyzed for concentrations of total protein, peroxidase, thiocyanate, slgA, lactoferrin, lysozyme, and for specific bacteria aggregation ability. Numbers of mutans streptococci and lactobacilli in saliva were determined, and dental caries status was examined. No differences were found among the groups regarding salivary flow rate, total protein, or any of the antimicrobial proteins. However, three patients with Crohn's disease had no detectable slgA in saliva compared with none in the control group. The lactobacillus count and the number of decayed tooth surfaces were higher in the nonacute group than in the control group.

On the relations between dietary habits, nutrients, and oral health in women at the age of retirement.

Intake of energy, nutrients, food items, and various oral health-related factors were studied in 116 women about 5 months before the age of their occupational retirement. The results were analyzed with oral health aspects as both independent and dependent variables. Edentulous women had higher intake of fat and higher coffee consumption than dentate ones, and dentate subjects with 1-20 teeth had higher body mass index than those with > or = 21 remaining teeth. Individuals with high intake of energy and carbohydrates had more decayed tooth surfaces than those with low, but different intakes of other nutrients were not reflected in the studied tooth variables. Daily consumers of sweet beverages and sugar in coffee/tea had more decayed tooth surfaces than non-consumers. Nineteen of the 116 women with 'inadequate' diet did not differ from the others with regard to any of the studied tooth variables. Women with self-assessed chronic oral dryness had higher intake of energy, protein, iron, thiamine, and vitamin D than those without this problem. Smoking habits were reflected in the DMFS index but not in any of the other studied oral health-related variables. It was concluded that intake of energy- and sugar-rich products, frequencies of intakes, and oral dryness seem to be of greater importance for oral health than intake of specific nutrients, at least in this specific cohort.

Root caries susceptibility in periodontally treated patients. Results after 12 years.

The aim of the investigation was to study the individual susceptibility to root caries in periodontally treated patients in a long-term follow-up of 12 years. Age, plaque score, salivary counts of lactobacilli and mutans streptococci, salivary secretion rate and buffer effect, oral sugar clearance time and dietary habit index were tested as possible predictors for root caries incidence. During the whole observation period of 12 years, new root caries lesions were recorded in 24 of a total of 27 patients. In 8 of these, the root caries incidence was between 1 and 5, in 7 between 6 and 9 and in 9, 12 or more new DFS. However, the annual mean number of new DFS was rather low. 13 patients with > 5 new DFS% during the 3rd 4-year period (years 9-12) differed significantly from 14 patients with < or = 5 new DFS% in salivary mutans streptococcus counts (p < 0.01), plaque scores (p < 0.001) and new DFS% during the 2nd 4-year period (years 5-8) (p < 0.001). Simultaneously, risk values among the variables tested at the 8-year examination were about 3 x more prevalent in patients that developed > 5 new DFS% in years 9-12 than in those with < or = 5 new DFS%. During the whole 12-year observation period, smokers had significantly more root caries than non-smokers (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Prediction of root caries in periodontally treated patients maintained with different fluoride programmes.

The aims of the investigation were to evaluate the effect of different fluoride programmes, as adjuncts to professional plaque control every 3-4 months, on root caries incidence in periodontally treated patients and to identify risk factors for root caries development. Ninety-nine individuals, 33-76 years old, who had been treated for periodontal disease were subjected to one of three fluoride programmes during a 2-year period: (1) professional application, 3-4 times/year, of Duraphat (n = 34) or (2) of a 0.4% stannous fluoride gel (n = 33), or (3) daily mouthrinsing with a 0.05% sodium fluoride solution (n = 32). A number of clinical recordings and laboratory tests, used as presumptive risk indicators for root caries, were carried out before and on three different occasions after the periodontal treatment. No statistically significant differences were found between the various fluoride programmes. During the 2-year period, a total of 246 new decayed or filled surfaces (DFS) were recorded, 72 (29.3%) of which were diagnosed as active and 124 (50.4%) as inactive root caries lesions; 50 (20.3%) of the surfaces had been restored. Individuals with > or = 1 new root DFS during the 2 years (n = 50) differed significantly from those with 0 new root DFS (n = 49) as concerns salivary counts of mutans streptococci and lactobacilli, root plaque scores and percentage of exposed root surfaces. Baseline root caries prevalence (r = 0.43) and root plaque scores (r = 0.36) showed the highest correlations with new root DFS.(ABSTRACT TRUNCATED AT 250 WORDS)