Prevalence and progression of erosive tooth wear among children and adolescents in a Swedish county, as diagnosed by general practitioners during routine dental practice.

OBJECTIVES: To investigate the prevalence and four-year progression of erosive tooth wear (ETW) recorded in general dental practice, and to evaluate the usefulness of a simplified grading scale. METHODS: Four cohorts (aged 3, 7, 11 and 15 years at baseline; n = 735) were followed from 2008 to 2012 during their routine dental examinations. Grading of ETW was performed on permanent upper incisors and first molars, using the scales of Johansson et al. 1996 and Hasselkvist & Johansson 2010. RESULTS: Valid data were available for 641 individuals, 7-19-years of age, of whom 326 had data allowing analyses of progression. The prevalence of ETW increased with age, although at a lower level than in comparable studies. Progression was found in one-third of the subjects, with higher proportions and higher grades noted among the older cohorts. The simplified scale, that graded only four surfaces, resulted in just a few missed, mainly mild, cases of ETW. CONCLUSIONS: Clinically significant signs of ETW and patterns of progression can be reliably detected if the erosion index used includes a few selected surfaces of permanent teeth as part of the routine dental examination. Early signs of ETW, however, seem to be more difficult to detect and evaluate. CLINICAL SIGNIFICANCE: It is both possible and beneficial to introduce the diagnosing of ETW in routine dental examinations. To reduce the time involved in grading every patient, the simplified 4-surface application, seems to be a useful tool, but which is to be augmented with more extensive grading in individuals considered to be at risk.

Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial.

OBJECTIVES: To compare treatment time, patients' perceptions during orthodontic treatment, dental fear and side effects, between open and closed surgical exposures in patients with palatally displaced canines (PDCs). TRIAL DESIGN: Multicentre, randomized controlled trial, with random 1:1 allocation of two parallel groups. MATERIALS AND METHODS: One hundred and twenty patients from three different orthodontic centres were randomized into one of the two intervention arms, open or closed surgical exposure. Both techniques had mucoperiosteal flaps raised and bone removed above the PDCs. In open exposure, tissue was removed above the canine, and glass ionomer - reaching above soft tissue - was built on the crown. The canine was then left to erupt spontaneously, prior to orthodontic alignment. At closed exposure, a chain was bonded to the canine and orthodontic traction was applied under the mucosa until eruption. Orthodontic alignment of the canines was undertaken after eruption into the oral cavity, with fixed appliances in both groups. All participants were treated according to intention to treat (ITT). BLINDING: Due to the nature of this trial, only outcome assessors could be blinded to the intervention group. RESULTS: One hundred and seventeen patients completed the trial. All PDCs were successfully aligned. Total treatment time was equal in the two techniques, mean difference -0.1 months (95% CI -3.2 to 2.9, P = 0.93). The closed group experienced more pain and discomfort during the active orthodontic traction. Dental fear, root resorption and periodontal status did not show any clinically significant differences between the groups. GENERALIZABILITY: Results of this randomized controlled trial (RCT) can be generalized only to a similar population aged 9-16 years, if exclusion criteria are met. CONCLUSION: The closed exposure group experienced more pain and discomfort mostly during active orthodontic traction. All other studied outcomes were similar between the two exposure groups. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

Barriers and facilitators for adolescent girls to take on adult responsibility for dental care - a qualitative study.

Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county. Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis. Results: The study findings could be summed into the theme "Triggers for adolescent girls to take on or not take on adult responsibility for dental care". The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories. Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

Validity and reliability of the Swedish versions of the short-form Child Perceptions Questionnaire 11-14 and Parental Perceptions Questionnaire.

Objective: To examine the validity and reliability of the Swedish versions of the short-form Child Perceptions Questionnaire 11-14 (CPQ11-14) and Parental Perceptions Questionnaire (P-CPQ) for measuring children's oral health-related quality of life (OHRQoL). Material and methods: The sample comprised 247 children and parents. OHRQoL was assessed by asking each child and their accompanying parent to complete the relevant questionnaire. To allow test-retest analysis, 30 children and 32 parents were asked to complete the instrument a second time within 2-4 weeks. Results: In terms of construct validity, significant correlations were observed between CPQ scale scores and the global ratings of oral health and overall well-being for both the CPQ11-14 and the P-CPQ. Regarding internal consistency, Cronbach's alphas for the total scales were 0.81 and 0.77, respectively, indicating good reliability, and internal consistency for the subscales (two or four dimensions) was acceptable. Test-retest reliability was good for the CPQ11-14 total scale (ICC 0.77) and acceptable for the P-CPQ total scale (ICC 0.63). Conclusions: The Swedish versions of the short-form CPQ11-14 and P-CPQ are both valid and reliable, and can be recommended for use among Swedish children aged 11-14 years for evaluation of OHRQoL.

Experiences and perceptions of infant dental enucleation among Somali immigrants in Sweden: a phenomenographic study.

Objective: The aim of this study was to explore and describe ways of experiencing and perceiving the Eastern African practice of infant dental enucleation (IDE) among immigrants of Somali origin living in Sweden. Material and methods: Six informants, three men and three women aged 26-54 years, were recruited for semi-structured individual interviews. Phenomenographic analysis of the interview transcripts was performed. Findings: Informants described four ways of experiencing and perceiving IDE: as an effective, necessary treatment; as a disputed tradition; as an alternative to failure; and as a desperate measure. The experiences and perceptions were highly influenced by the contexts the informants had been in, namely, communities in which traditional treatments were used frequently, in which other people were influential over their daily lives, and in which negative experiences of formal health care were common, as well as other difficult circumstances beyond the informants' individual control. Conclusions: The findings contribute to deepened understanding of IDE and the importance of context to the practice of it. Further, the findings deepen understanding of the decision to have the practice performed on infants, which may help dental and health care personnel to adequately communicate with individuals of Somali origin about the harmfulness of IDE.

Agreement between children and parents in rating oral health-related quality of life using the Swedish versions of the short-form Child Perceptions Questionnaire 11-14 and Parental Perceptions Questionnaire.

Objective: To explore the agreement between children and parents on children's oral health-related quality of life (OHRQoL) when using the Swedish short forms of CPQ11-14 and P-CPQ, and to evaluate the impact on agreement of oral health including malocclusion and background characteristics (dental fear, family situation, gender of informant). Material and methods: A total of 257 children and their accompanying parents were asked to fill in the Swedish versions of the short-form CPQ11-14 and P-CPQ separately in connection with a clinical examination. Results: The participants comprised 247 child-parent pairs: 116 (47%) boys, 131 (53%) girls, 166 (67%) mothers and 81 (33%) fathers. The agreement between the child and parental ratings of the children's OHRQoL was low, with an ICC of 0.22 (95% CI: 0.04-0.37) for the total scale. Conclusions: There was a low agreement between children's and parents' answers. For best care, it is advisable to consider perceptions of both children and parents because they can complement each other in estimating the child's OHRQoL.

A 3-year study of patients with tinnitus and jaw muscle tenderness.

Objective: This study evaluated three-year results of treatment with an interocclusal appliance in 89 tinnitus patients with jaw muscle tenderness. Methods: Subjective tinnitus severity was recorded using a visual analog scale (VAS). The number of tender muscles was registered. The patients were followed annually. After three years, 64 patients were examined (72%). Results: Tinnitus severity at baseline was high (mean VAS value 68.3). After one year, the VAS values were substantially lower (mean 37.4; p < 0.001). During the following two years, there were no significant changes in VAS values. The mean number of tender muscles decreased from seven to two after one year and remained at this number for up to three years. Conclusion: In many tinnitus patients with signs of temporomandibular disorders (TMDs), intraoral splint therapy reduced tinnitus severity and jaw muscle symptoms. The favorable results after one year remained for up to three years without significant changes.

Dental avoidance among adolescents - a retrospective case -control study based on dental records in the public dental service in a Swedish county.

Objective: This study aimed to investigate the occurrence of missed dental appointments among 16-19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009-2012.Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents' individual situation and be observant of early signs of avoidance.

Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions: a multicentre, randomized, controlled trial.

Background: Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials. Objectives: To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs. Trial design: The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio. Material and methods: Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery. Blinding: It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group. Results: Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group. Conclusion: There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group. Trial registration: Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

Nocturnal enuresis impaired children's quality of life and friendships.

AIM: There have not been any continence-specific measurement tools in Swedish that have allowed clinicians to investigate the quality of life (QoL) in children with bladder dysfunction. This study evaluated the QoL in Swedish children with nocturnal enuresis and tested the reliability of a Swedish translation of the Paediatric Incontinence Questionnaire (PinQ). METHODS: This prospective study comprised 46 children aged six to 18 years with nocturnal enuresis, who completed the PinQ after it was translated into Swedish. It was completed twice by 33 patients, and these responses were included in the test-retest evaluation. RESULTS: The self-reported mean sum score for the whole group was 26.3 ± 13.37 (range: 5-58), and the most affected domains were social relations with peers and self-esteem. The highest individual scores were four, three or two for 71.7%, 17.4% and 10.9% of the study population, respectively. Cronbach's alpha was 0.87 for the whole questionnaire, indicating good internal consistency. The test-retest stability was excellent, with an intra-class correlation coefficient of 0.76. CONCLUSION: Children with nocturnal enuresis had impaired self-esteem, and their impaired QoL affected their relationships with friends. The Swedish version of the PinQ proved to be a reliable tool that will be used in further studies.

A retrospective multicenter study comparing metal-ceramic and composite single crowns performed in public general dentistry: 5-year results.

Objective The aim of this study was to evaluate and compare the 5-year survival and complication rate of metal-ceramic (MC) and composite single crowns performed within Public Dental Service, general dentistry, in three Swedish counties and with patients' gender, tooth position, root canal treatment and the presence of a post-and-core taken into account. Methods Data were collected from dental records of 600 patients who had received either an MC (n = 300) or a composite (n = 300) crown on a premolar or molar tooth in the year 2005 and where 5 years of follow-up data were available. Status at treatment completion and at follow-up was recorded, together with any history of intervention during the follow-up period. Results The 5-year survival rate for MC crowns was higher than for composite crowns (93% versus 70%; p < 0.001). This difference was stable, irrespective of the county, patients' gender or tooth position. No gender difference in survival rate was seen for MC crowns, while the survival of composite crowns was significantly higher among women than among men (75% versus 65%; p < 0.05). For MC crowns, there was a tendency toward a lower survival rate for endodontically treated teeth without a post-and-core (83%) as compared to those provided with a post-and-core (93%) and to vital teeth (94%). Surviving composite crowns had recordings of significantly more complications than MC crowns (p < 0.001). Conclusion On premolars and molars, MC crowns have a better medium-term prognosis and fewer complications than composite crowns.

Oral health-related quality-of-life among children in Swedish dental care: The impact from malocclusions or orthodontic treatment need.

OBJECTIVES: To describe oral health-related quality-of-life (OHRQoL) and the impact of malocclusions or orthodontic treatment need in a cohort of children in Swedish dental care, using the Swedish version of the Child Perceptions Questionnaire-Impact Short Form (CPQ11-14-ISF:16). SUBJECTS AND METHODS: Two hundred and fifty-seven children (mean age = 11.5 years, SD = 0.8, range = 9.8-13.5 years) completed the CPQ11-14-ISF:16 in conjunction with a clinical examination. In addition to malocclusions and orthodontic treatment need (based on the Index of Orthodontic Treatment Need-Dental Health Component), possible confounders (caries, enamel defects, dental trauma, headache and socio-economic markers) were recorded. Children also rated their own dental fear on the Children's Fear Survey Schedule-Dental Sub-scale (CFSS-DS). RESULTS: The mean total CPQ11-14-ISF:16 score was 9.31. The logistic regression analyses revealed an impact of orthodontic treatment need on OHRQoL (CPQ), but no clear association between higher severity and higher impact on OHRQoL was seen. Dental fear and headache appeared to discriminate for poorer OHRQoL. No impact from caries, enamel defects, dental trauma, or socio-economic markers was revealed. CONCLUSIONS: This cohort of children reported good self-perceived OHRQoL. Effects on OHRQoL from malocclusions or orthodontic treatment need were limited and inconsistent. Dental fear and headache were found to be more distinct impact factors on OHRQoL than were malocclusions or orthodontic treatment need.

Dental fear among children and adolescents in a multicultural population--a cross-sectional study.

The aim of this study was to explore dental fear in a multicultural population of child and adolescent dental patients, with background, gender, age, and socioeconomic status taken into account. A specific aim was to investigate whether the level of DF differed between patients with a non- Swedish background and patients with a Swedish background. In conjunction with a routine visit to the dental clinic, 301 patients (8-19 years old) assessed their dental fear on the Children's Fear Survey Schedule - Dental Subscale, using self-ratings. Following an interview protocol, patients' and their parents' country of birth, and parents' education and occupation/employment were registered. An interpreter was present when needed. Self-rated dental fear was almost equal among patients coming from a non-Swedish background and patients with a Swedish background. Girls scored higher than boys and younger children scored slightly higher compared to older children, but the pattern of dental fear variation was inconsistent. Socioeconomic status differed between the groups with a non-Swedish vs. a Swedish background, but no impact on dental fear was revealed. When children and adolescents with a non-Swedish vs. a Swedish background were modelled separately, female gender and younger age had an impact on dental fear only in the group with a Swedish background. No differences in dental fear were found between children and adolescents from non-Swedish vs. Swedish backgrounds. Dental fear variations according to gender and age were more pronounced in the group with a Swedish background compared to the group with a non-Swedish background. No impact of socioeconomic status could be revealed.

Prevalence and change of malocclusions from primary to early permanent dentition: a longitudinal study.

OBJECTIVE: To follow a group of children from primary to early permanent dentition and determine the prevalence, self-correction, and new development of malocclusions; the need for orthodontic treatment; and the possible influences of habits, breathing disturbances, and allergies. MATERIALS AND METHODS: Two hundred and seventy-seven children were followed at 3, 7, and 11.5 years of age. Malocclusions and orthodontic treatment need were determined by clinical examinations. Data on sucking habits, breathing disturbances, allergies, dental trauma, and orthodontic treatments were collected from a questionnaire and dental records. RESULTS: Malocclusions were found in 71% of participants at 3 years of age, 56% at 7 years of age, and 71% at 11.5 years of age. Self-correction was noted for anterior open bite, sagittal malocclusions, and posterior crossbite, while deep bite developed. A high number of contact point displacements and spacings contributed to the prevalence of malocclusion rate of 71% at 11.5 years. Severe or extreme orthodontic treatment need was apparent in 22%. Habits, allergies, or breathing disturbances found at 3 years of age had no associations with malocclusions at 11.5 years of age. CONCLUSIONS: This sample revealed a significant percentage of malocclusions and orthodontic treatment need. A substantial number of self-corrections and establishment of new malocclusions occurred during the transition from primary to early permanent dentition.

The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies.

BACKGROUND: Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life. OBJECTIVES: To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents. MATERIALS AND METHODS: Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low. RESULTS: The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL. CONCLUSION: The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

Implant-Supported Single Crowns Replacing Congenitally Missing Maxillary Lateral Incisors: A 5-Year Follow-Up.

BACKGROUND: Knowledge of the long-term survival of single implants in cases of congenitally missing lateral incisors in the maxilla is limited. PURPOSE: This retrospective study aimed to evaluate the 5-year survival of implants and implant-supported crowns (ISCs) and to assess the functional and aesthetic outcomes from the professional and patient perspectives. MATERIALS AND METHODS: From a total of 46 patients with congenitally missing upper lateral incisors, 36 patients treated with 54 Brånemark® (Nobel Biocare AB, Göteborg, Sweden) implants and ISCs participated in the study. A clinical examination, California Dental Association (CDA) evaluation, and patient questionnaire were used to rate and compare the objective and subjective evaluations of the ISCs. RESULTS: The survival of implants and ISCs was 100%. The CDA ratings were satisfactory for all ISCs, with 70% being rated excellent. The patient rating was also high for the overall satisfaction item, with 21 being completely satisfied and 14 fairly satisfied. However, 12 patients wished for the replacement of their ISCs. Logistic regression analysis indicated that a less optimal embrasure fill was the most discriminating factor though not statistically significant (p = .082). CONCLUSIONS: One-third of the patients wished for the replacement of their ISCs. Soft tissue adaptation seems to be an important factor for overall satisfaction.

Infant dental enucleation: A literature review on a traditional remedial practice in East Africa.

OBJECTIVE: To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa. MATERIALS AND METHODS: Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review. RESULTS: An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined. CONCLUSIONS: Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

Infant dental enucleation in an East African population in Sweden: a cross-sectional study on dental records.

AIM: To examine the prevalence of infant dental enucleation (IDE) of primary canines, an East African traditional remedial procedure, in a multiethnic population of children in Sweden. DESIGN: A cross-sectional study was conducted of dental records of 1133 patients (mean age 4.6 years, SD ± 1.4) attending one public dental service clinic in Sweden. The clinic was located in an area with a large multiethnic community. All were born within the years 2002-2006 and had received a check-up in one of the years 2007-2009. A registry was made of missing primary canines where no reason could be found. In documented cases, information about ethnic origin was extracted. Statistical grouping was made according to known East African ethnicities. RESULTS: At least 36 ethnicities were recorded. Twenty-four (2.1%) patients were missing one or more canines according to the criteria for IDE. Significant difference was seen when comparison was made between patients of known East African ethnicities, of whom 20.8% (21/101) manifested findings consistent with the criteria, and the rest of the population (3/1032; P < 0.001). CONCLUSIONS: Prevalence of cases suggestive of IDE among patients of East African origin points to a need for increased awareness within dental and healthcare communities.

Validating the dental subscale of the children's fear survey schedule using Rasch analysis.

Rasch analysis was used to examine the validity of the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS). Data were collected from parents of children in regular dental care (n = 240) and from parents of children referred to a specialized pediatric dental clinic (n = 200). The Rasch model is a probabilistic model in which estimations are based on the relationship between person ability and item difficulty, and the present study investigated the validity of the CFSS-DS through analysis of person and item fit, dimensionality, ordering of thresholds, local dependency, and differential item functioning. The results show multidimensionality of the original scale, and an adjusted version consisting of six items with good fit to the model is suggested. The adjusted scale makes interval-level analysis possible, and time efficiency and elimination of previously criticized items argue in favor of the adjusted scale.