Tobacco use habits among Swedish female youth athletes and the influence of the social environment.

AIM: This study examined the prevalence of tobacco habits and the influence of the social environment among Swedish female athletes representing both individual and team sports in Sweden. MATERIAL AND METHOD: A self-reported cross-sectional survey was performed with 791 female athletes 15-24 years old representing ten of the most common sports in Sweden. The questions related to the participants' involvement in sports and their tobacco habits. RESULTS: Findings revealed that a large proportion of the female athletes had never smoked (65%) or used snus (74%). However, a considerable portion of the participants had tried smoking (27%) or using snus (20%), especially those involved in team sports. Results also showed statistically significant associations between female athletes' smoking habits and those of both their mothers and their peers, but not with the tobacco habits of their coaches, indicating that coaches do not influence the female athletes' use of tobacco. CONCLUSION: In conclusion, this study indicated that the vast majority of female athletes did not use tobacco. A significant portion had sometimes tried tobacco, especially members of team sports, but this behaviour did not seem to be influenced by the tobacco habits of their coaches.

Sense of coherence and its relationship with oral health-related behaviour and knowledge of and attitudes towards oral health.

OBJECTIVE: To investigate the relationship between sense of coherence (SOC), oral health-related behaviour, knowledge of and attitudes towards oral health in an adult Swedish population. METHODS: A cross-sectional design with a stratified random sample of 910 individuals aged 20, 30, 40, 50, 60, 70 and 80 years were invited to the study, from Jönköping, Sweden. The investigation used the Swedish short version of the SOC questionnaire comprising 13 items and self-reported questions about oral health habits and knowledge of and attitudes towards oral health. In addition, a self-report questionnaire to elicit demographic information was included. RESULTS: A total of 525 individuals, 261 men and 264 women, answered all the 13-item SOC questions, which constituted the final number of the participants. After adjustment for all the sociodemographic factors included in the analysis, individuals with a stronger SOC had twice as high a chance of having healthier behaviour, including a lower frequency of snacks and drinks between meals, as well as a more positive attitude, such as the importance of having one's own teeth as one gets older, satisfaction with their own teeth, perceiving their teeth as good and no feeling of dental fear, compared with individuals with a poorer SOC. Moreover, SOC and a good knowledge of caries were significantly associated after adjustment for age and gender. CONCLUSIONS: SOC was significantly associated with several oral health-related behaviours, attitudes towards oral health and knowledge of dental caries. When working with oral health promotion, SOC could be a way for promoting a better understanding of the behaviour and attitudes of individuals and for enabling dental personals to use that knowledge for the guidance of the individual.

Oral health in young individuals with foreign and Swedish backgrounds--a ten-year perspective.

AIM: To investigate oral health status and coherent determinants in children with foreign backgrounds compared with children with a Swedish background, during a ten year period. DESIGN AND METHODS: In 1993 and 2003, cross-sectional studies with random samples of individuals in the age groups 3, 5, 10 and 15 years were performed in Jönköping, Sweden. All the individuals were personally invited to a clinical and radiographic examination of their oral health status. They were also asked about their attitudes to and knowledge of teeth and oral health care habits. The final study sample comprised 739 children and adolescents, 154 with a foreign background (F cohort) and 585 with a Swedish background (S cohort). RESULTS: In both 1993 and 2003, more 3- and 5 year olds in the S cohort were caries-free compared with the F cohort. In 1993, dfs was higher among 3- and 5 year olds in the F cohort (p<0.01) compared with the S cohort. In 2003, dfs/DFS was statistically significantly higher in all age groups among children and adolescents in the F cohort compared with the S cohort. When it came to proximal tooth surfaces, the percentages of individuals who were caries-free, with initial carious lesions, with manifest carious lesions and with restorations among 10-year-olds in the F cohort were 55%, 23%, 4% and 18% in 1993. The corresponding figures for the S cohort were 69%, 20%, 6% and 5% respectively. In 2003, the values for the F cohort were 54%, 29%, 4% and 13% compared with 82%, 12%, 1% and 5% in the S cohort. In 2003, the odds of being exposed to dental caries among 10- and 15-yearolds in the F cohort, adjusted for gender and age, were more than six times higher (OR=6.3, 95% CI:2.51-15.61; p<0.001) compared with the S cohort. CONCLUSIONS: There has been a decline in caries prevalence between 1993 and 2003 in all age groups apart from 3-year-olds. However, the improvement in dfs/DFS was greater in the S cohort compared with the F cohort in all age groups. The difference between the F and S cohorts in terms of dfs/ DFS was larger in 2003 compared with 10 years earlier. In 2003, the odds ratio for being exposed to dental caries was almost six times higher for 10- and 15-year-olds with two foreign-born parents compared with their Swedish counterparts.

Prevalence of symptoms and signs indicative of temporomandibular disorders in children and adolescents. A cross-sectional epidemiological investigation covering two decades.

AIMS: These were to 1) estimate the prevalence of subjective symptoms and clinical signs of temporomandibular disorders (TMD) in children and adolescents in the city of Jönköping, Sweden, 2) follow possible variations in TMD signs and symptoms over a 20-year period, and 3) study possible associations between TMD symptoms and signs and factors of interest. DESIGN: About 100 individuals in the age groups of 3, 5, 10 and 15 years participated in cross-sectional stratified epidemiological investigations in 1983, 1993 and 2003. METHODS: All participants were asked to fill in a questionnaire including questions on general and oral health, dental care habits and some socio-demographic issues. More specific questions recorded the presence or absence of subjective symptoms: tiredness in the jaws on awakening or during chewing; clicking sounds or crepitations from the temporomandibular joints (TMJs); locking/ catching of the mandible; luxation of the mandible; reduced jaw movement capacity; pain during jaw movements; other pain conditions in the jaws or in the TMJ regions. Subjects were examined clinically at each time period for; jaw mobility (maximum jaw opening including vertical overbite, maximum laterotrusion to the right and to the left, maximum protrusion); TMJ function (normal function, deflection on jaw opening of >2 mm, TMJ clicking or crepitations, TMJ locking, TMJ luxation); pain on jaw movement (no pain on movements, pain on one movement, pain on more than one movement); muscle pain (no muscle pain, pain on palpation in 1-3 sites, pain on palpation in >3 sites); TMJ pain (no joint pain, pain on lateral palpation of one or both joints, pain on posterior palpation of one or both joints). No functional examination of the masticatory system was performed in children aged 3 and 5 years. RESULTS: TMD-related symptoms were very rare in 3- and 5-year-olds. In the age groups of 10- and 15-year olds, 5-9% of the participants reported more severe symptoms, up to 50% showed one or more TMD signs, while it was estimated that 1-2% were in need of TMD treatment. Several symptoms and signs increased with age. No gender differences, with the exception of recurrent headache, were noted. Oral parafunctions were reported by 11-47%. Apart from a few variables, no statistically significant changes in the prevalence of TMD symptoms and signs were observed over the 20-year period. Clenching/grinding of teeth and general health factors were found to be associated with TMD symptoms and signs. CONCLUSIONS: The prevalence of more severe TMD symptoms and signs in children and adolescents was generally low in all three examinations and did not change significantly during the 20-year period. Increasing age, general health factors and oral parafunctions were associated with TMD symptoms and signs in 10- and 15-year-olds.

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.

Technical quality of root fillings and periapical status in root filled teeth in Jönköping, Sweden.

AIM: To study changes in technical quality of root fillings and periapical status in root filled teeth in random samples of 20 to 70 year-olds between 1973 and 2003. METHODOLOGY: Data from dentate subjects aged 20-70 years from examinations conducted in 1973 (n = 498), 1983 (n = 530), 1993 (n = 547) and 2003 (n = 491) were used for the analysis. Length of root fillings were measured on radiographs to the nearest 0.1 mm. Adequate seal was defined as a root filling without lateral and/or apical voids. Periapical status was assessed according to the periapical index. All observations were made by one calibrated observer registered from full mouth radiographic examinations. Teeth with root fillings ending within the canal without lateral or apical voids were considered adequate. The association between root filling quality and periapical status was analysed by means of the Chi-squared test and a multilevel logistic regression analysis. RESULTS: Adequately root filled teeth had a significantly lower frequency of apical periodontitis than inadequately root filled teeth (11.8% vs. 22.8%). The frequency of technically adequate root fillings increased statistically significant from 1973 (23.7%) to 2003 (36.4%) without a concomitant improvement of the periapical status in root filled teeth over time (24.5% vs. 24.6%). CONCLUSIONS: This study reports on an improving technical quality of root fillings over time, without a concomitant improvement of the periapical status in root filled teeth. A larger proportion of treated molars over time may be of importance for the result.

A global perspective on changes in the burden of caries and periodontitis: implications for dentistry.

The structure and contents of most oral health care systems and the contents of dental curricula reflect a deep-rooted tradition for attempting to cure oral diseases by refined technological means. However, better oral health conditions for the world's populations necessitate the application of up-to-date scientific knowledge to control the major oral diseases. This review points out that not only should the structure and contents of oral health care delivery systems be based on state-of-the-art knowledge about the biology of the oral diseases; they must also take into account the trends for change in caries and periodontal diseases within and between populations, and acknowledge the impact of changes in treatment philosophies for these trends. The oral disease profiles for populations in low- and high-income countries are briefly described, and it is concluded that the rapidly changing disease profiles observed in high-income countries necessitate re-thinking of the future role and organization of dentistry in such countries. The priorities for low- and middle-income countries must be to avoid repeating the mistakes made in the high-income countries. Instead, these societies might take advantage of setting priorities based on a population-based common risk factor approach. If such an approach is adopted, the training of personnel with oral health care competence must be rethought. The authors suggest three different cadres of dental care providers to be considered for an approach that allows health care planners in different populations around the world to prioritize appropriate oral health care with due respect for the socio-economic conditions prevailing.

The relationship of some negative events and psychological factors to periodontal disease in an adult Swedish population 50 to 80 years of age.

BACKGROUND: Clinical observations and epidemiological studies suggest that experiences of negative life events, especially those manifested as depression, may contribute to an increased susceptibility to periodontal disease. OBJECTIVE: In the present study, the prevalence of some negative life events and psychological factors and their relation to periodontal disease were investigated. The sample consisted of individuals 50-80 years of age from an extensive cross-sectional epidemiological study performed in 1993 in the city of Jönköping, Sweden. METHOD: 298 dentate individuals from the Jönköping study were randomly selected. Clinical and radiographic examinations included registration of the number of existing teeth, plaque index, gingival index, pocket depth, and alveolar bone loss. In addition, a questionnaire about socioeconomic status, life events, and psychological and stress-related factors was used. RESULTS: The results revealed that, in addition to the well-documented periodontal disease risk factors such as increased age, oral hygiene status, and smoking, the loss of a spouse (being a widow or widower) and the personality trait of exercising extreme external control were also associated with severe periodontal disease. CONCLUSION: The findings support recent studies suggesting that traumatic life events such as the loss of a spouse may increase the risk for periodontal disease. Above all, the present results indicate that an individual's ability to cope with stressful stimuli (coping behavior), as measured by the beliefs of locus of control of reinforcements may play a role in the progression of periodontal disease.

Factors associated with snuffing habits among ice-hockey-playing boys.

The aim of the present investigation was to study differences in background factors between ice-hockey-playing boys who used snuff, who had tried using snuff, and who had never used snuff. The background factors studied were the socio-economic conditions of the boys' parents; the tobacco habits of the boys' parents, siblings, and friends; the boys' choice of theoretical or practical upper secondary school programme; knowledge of the harmful effects of tobacco as well as participation in a sport other than ice hockey. Data were collected usinG a questionnaire. Of 249 boys in the age group 12-19 years who participated in the study, 13% used snuff, 34% had tried using snuff, and 53% had never used snuff. The factors knowledge of the harmful effects of tobacco and choice of theoretical or practical upper secondary school programme had no significant association with the boys' snuffing habits. This was also true for the parents' tobacco habits unless their habits were analysed separate from each other, where "mother smoked" showed an association with boys who used snuff. The study also showed a significant difference between boys who used snuff and boys who had never used snuff and between boys who had tried using snuff and boys who had never used snuff; boys who used snuff tended to have siblings who used snuff. Of boys who used snuff, 77% reported that their friends' use of snuff had influenced them to start using snuff. A significant difference could also be shown between boys who used snuff, had tried using snuff and never-users depending on whether the boys participated in a sport other than ice hockey. Snuff usage was not as widespread among boys who participated in other sport activities. This was verified by the multivariate logistic regression analysis where "taking part in other sports than ice hockey" was the explanatory variable that showed the strongest association with the dependent variable. An active participation in ice hockey and the environment, in which this sport is practised, would consequently be a strong influencing factor to start using snuff.

Fixed prosthodontics in adults in Jönköping, Sweden in 1983 and 1993. An epidemiological study of prevalence and choice of material.

The aim of the study was to assess the prevalence of fixed prostheses, i.e. single crowns and fixed partial dentures, in adults 20-80 years old in two cross-sectional studies carried out in 1983 and 1993 and to analyse whether the choice of material for fixed prostheses had changed during this time period. The material comprised 586 and 593 individuals. A descriptive analysis of number of individuals with fixed prostheses was made concerning the number of crowns and pontics, the distribution in the jaws, and the materials used. The prevalence of individuals with fixed prostheses was shown to increase with age both in 1983 and 1993. In 1993 the number of individuals with fixed prostheses was slightly lower than in 1983 (44 and 48 percent respectively). There was no difference according to gender. The proportion of individuals with fixed prostheses was lower or almost unchanged in the 20-, 30-, 40-, 50-, 60-, and 80-year-olds in 1993 compared to 1983. In the 70-year-olds, however, the proportion of individuals with fixed prostheses was considerably higher in 1993 compared to 1983. Most individuals with fixed prostheses had a small number of crowned teeth, and about half of the individuals had not more than four crowned teeth. Likewise most individuals with pontics had a small number of pontics. The distributions of crowned teeth and pontics in the jaws were similar in 1983 and 1993. Pontics and crowns were more frequent in the upper than in the lower jaw. Crowns made of porcelain or metal ceramic had increased by 1993 in the 30-80 year age groups, and the study thus confirms general clinical experience that porcelain and metal ceramic are more often the materials of choice in fixed prosthodontics in adults today.

A prospective longitudinal study on periodontal bone height changes in a Swedish population.

BACKGROUND, AIMS: This investigation was performed to assess longitudinal changes in periodontal bone height in an adult population over a period of 17 years. METHODS: In 1973, a random sample of 1000 individuals aged 3-70 years in the city of Jönköping, Sweden, was examined clinically and radiographically to assess dental status and treatment needs. Out of the 574 dentate individuals 15-60 years, 433 accepted the invitation and were re-examined in 1989-91, 4 were edentulous and the study therefore finally included 429 dentate individuals. The examination included full mouth plaque and gingivitis scores and bone height measurements on full mouth intra-oral radiographs. All age groups except the youngest had very good oral hygiene with 50% or more having plaque and gingivitis scores below 20%. RESULTS: From the age of 20, there was a general pattern of bone height reduction over time corresponding to an annual loss of around 0.1 mm. From the age of 30 years, about 80% of the population had one or more sites with bone loss of 10% or more. Very few individuals, about 5%, exhibited an individual mean bone loss of 2 mm or more. 17% had > or =6 such sites indicating destructive periodontal disease. These individuals and sites could not be identified in advance based only on previous disease experience.

Possible sites for cylinder implants in Swedish individuals aged 20-70 years. A comparative radiological inventory in 1983 and 1993.

UNLABELLED: The aim of this study was to evaluate the number of possible sites for cylinder implants in an epidemiological sample of adult individuals and to compare these results with those from a similar inventory performed 10 years earlier. This study, which comprised individuals 20-70 years old, is part of two larger epidemiological dental studies of individuals from the community of Jönköping, Sweden, performed in 1983 and 1993. Random samples of 579 and 575 individuals respectively were examined and classified according to the Eichner index. The radiographic examination included an orthopantomogram and a full-mouth intra-oral examination. Only existing spaces anterior to the second molars were considered as possible implant sites. Cylinder implants with a diameter of 3.75 mm and a length between 7 and 20 mm were plotted on the radiographs. RESULT: The most striking result from this study was the reduction by almost a half of the total number of possible implant sites between 1983 and 1993. A certain proportion of existing tooth gaps had been treated with conventional fixed prostheses, usually in small tooth gaps, and this tendency had increased between 1983 and 1993. The need for implants in the anterior frontal region was small but constant (less than 1%) in 1983 and 1993. In the future, implants will be a treatment option in young individuals, most likely in cases of trauma and tooth agenesis. Further it may be assumed that implant treatment in edentulous jaws will continue to increase in relative terms, i.e. the percentage of edentulous jaws that have been treated with implants will increase. In absolute terms, however, the frequency of the treatment will decrease because fewer individuals will be edentulous. Instead, the proportion of partially dentate subjects treated with implants will increase.

Knowledge and habits of tobacco among ice-hockey-playing boys. An intervention study.

The aim of this study was to investigate tobacco habits among ice-hockey-playing boys in three clubs in the County of Värmland, Sweden and to analyse whether health information about the harmful effects of tobacco could change the players' tobacco habits. In addition, the issue of whether there is any correlation between knowledge of tobacco and its harmful effects with tobacco habits was studied. Ice-hockey-players from three ice-hockey clubs were represented and one of the clubs acted as a control group. A total of 252 male ice-hockey-players, 12-19 years old participated. A specially designed questionnaire containing 33 questions on background, socioeconomics, behaviour, and knowledge was used. The boys answered the questionnaire on three occasions. The first and second examinations took place on the same occasion with the intervention occurring between the examinations. The third examination was carried out after 3-5 weeks. The study showed that the use of snuff played a more important role among the ice-hockey-players than did smoking and that they had tried using snuff at the age of 12. The baseline investigation showed that there were no significant differences between the clubs in tobacco habits and knowledge of the harmful effects of tobacco. After the health information, the boys' knowledge of tobacco and its harmful effects increased significantly (p<0.001), but regardless, no change in their use of tobacco was found after 3-5 weeks. Knowledge also increased significantly among the boys in the control group (p<0.001), but no change in the use of tobacco was found here either. No significant difference could be demonstrated between the group of boys who used snuff and the non-users with regard to their knowledge of the harmful effects of tobacco.

Healing following GTR treatment of bone defects distal to mandibular 2nd molars after surgical removal of impacted 3rd molars.

AIM: The purpose of this study was to study the healing, following guided tissue regeneration (GTR) treatment, of bone defects distal to mandibular 2nd molars (M2s) after surgical removal of impacted mesioangularly or horizontally inclined third molars (M3s) in patients > or = 25 years. METHOD: 20 patients with bilateral soft tissue impacted M3s were included in the split-mouth study. The 2 sites to be treated in each patient were randomised before the 1st operation as to which would undergo the test procedure and which would be the control site. After surgical removal of M3 at test sites, a resorbable polylactic acid (PLA) barrier was attached to M2 to cover the post-surgical bone defect. The flap was then replaced and sutured to cover the barrier. Control sites underwent the same procedure, as did the test sites, with the exception that no barrier was placed. The clinical examinations performed were oral hygiene pre- and 12 months postoperatively and probing pocket depth 12 months postoperatively. The alveolar bone level (ABL) at the distal surface of the M2, as determined from radiographs taken at suture removal and 12 months postsurgery, was chosen to be the primary response variable. RESULTS: Most bone defects showed healing up to 10%-20% of the tooth length at both test and control sites. 2 test and 2 control sites showed no improvement in the bone level. The mean values of bone healing registered in mm from the cemento-enamel junction (CEJ) were 2.6 +/- 2.19 SD and 3.0 +/- 2.20 SD for test and control sites, respectively. Different factors affecting the healing result are discussed.

Healing following GTR treatment of intrabony defects distal to mandibular 2nd molars using resorbable and non-resorbable barriers.

AIMS: The objectives of the present, randomised clinical trial were (i) to evaluate the healing of periodontal intrabony defects at the distal aspect of mandibular 2nd molars using a resorbable polylactic acid (PLA) barrier and a non-resorbable polytetrafluoroethylene (e-PTFE) barrier and (ii) to compare the therapeutic effect of the bioresorbable versus the non-resorbable barrier. METHOD: 19 patients with intrabony defects distal to mandibular 2nd molars > or = 4 mm (on radiographs) were included in the study. The defects all remained 5 years after surgical removal of impacted 3rd molars. Following flap elevation and defect debridement, the defects were randomly covered with, either a resorbable PLA or a non-resorbable e-PTFE barrier. Flaps were repositioned and sutured to completely cover the barriers. Treatment was evaluated clinically after 1 year by measurements of probing depth (PD), probing attachment level (PAL), and probing bone level (PBL) and radiographically by measurements of bone levels on computer digitised images of radiographs taken immediately before and 1 year postsurgery. RESULTS: Both treatments resulted in significant PD reduction, PAL gain, and bone fill. The total PD reduction was 5.3 +/- 1.9 mm for the PLA treated sites and 3.7 +/- 1.7 mm for the e-PTFE treated sites (p<0.05). The corresponding values for PAL gain were 4.7 +/- 0.7 mm and 3.6 +/- 1.7 mm (p<0.05) and for PBL gain 5.1 +/- 1.2 and 3.3 +/- 2.0 mm (p<0.05). Radiographic bone fill averaged 3.4 +/- 1.2 for the PLA and 2.0 +/- 1.6 mm for the e-PTFE barriers (p<0.05). Radiographic bone level measurements were significantly smaller than the corresponding clinical measurements, indicating that radiographs tend to underestimate bone fill. CONCLUSIONS: GTR treatment of deep intrabony defects distal to mandibular second molars using resorbable PLA barriers resulted in significant PD reduction, PAL gain and bone fill at least equivalent to the results obtained using non-resorbable e-PTFE barriers.

Caries prevalence and distribution in 3-20-year-olds in Jönköping, Sweden, in 1973, 1978, 1983, and 1993.

Four cross-sectional studies were carried out in 1973, 1978, 1983, and 1993 to collect clinical and radiographic epidemiological data on the dental health status of the inhabitants of Jönköping, Sweden. The aim of the present paper was to use these data to analyze trends in the development of caries among children and adolescents between 1973 and 1993. Approximately 500 randomly selected individuals evenly distributed among the age groups 3, 5, 10, 15, and 20 years participated in each study. The main results show that the numbers of caries-free individuals increased in all age groups. In 1993, the mean number of decayed and filled tooth surfaces in the primary (dfs) and the permanent (DFS) dentition in all age groups was less than half of that found in 1973. Most of this decrease took place during the first 5 years, i.e., between 1973 and 1978. Between 1978 and 1983, only minor changes were observed. There was a further reduction of approximately 30%-50% in dfs/DFS between 1983 and 1993 in 3-, 5-, 10-, and 20-year-olds. The frequency distributions of dfs/DFS for 5- and 15-year-olds revealed an increasing skewness over time: in 1993, a large majority of the children and adolescents had a low or moderate caries severity while only a small group had high scores of dfs/DFS.

Caries prevalence and distribution in 20-80-year-olds in Jönköping, Sweden, in 1973, 1983, and 1993.

In 1973, a cross-sectional study on oral health status was performed on 1000 individuals in the age groups 3-70 years in Jönköping, Sweden. In 1983 and 1993, new cross-sectional studies were carried out in the age groups 3-80 years. The aim of the present study was to analyze caries prevalence and distribution in the three investigations 1973, 1983, and 1993 in the age groups 20-80 years. In the younger age groups (20-40 years), a larger proportion of individuals with good oral health was found in 1993 than in 1973 or 1983. A steady increase in the number of teeth in the age groups 40-80 years could be found, which was also reflected in the increasing number of decayed and filled tooth surfaces (DFS) in the same age groups. A marked decrease in proximal DFS in 20-50-year-olds in 1993 compared to 1973 and 1983 was found. However, a rather large and unchanging group of individuals suffering from severe caries was also observed. This situation demands an individualized caries treatment strategy based on risk assessment.

Risk of severe periodontal disease in a Swedish adult population. A longitudinal study.

The aim of this study was to identify risk factors for severe periodontal disease progression in a Swedish adult population between the years 1973 and 1988-91. In 1973, a random sample of 474 dentate adults living in Jönköping County was examined clinically and radiographically. A questionnaire on demographic and socio-economic status, general health, and dental care habits was also used. During the years 1988-1991, 361 of the individuals examined in 1973 were re-examined. A total of 506 (6%) teeth or in average 1.4 teeth per subject were lost between the 2 examinations. 4 subjects had become completely edentulous. The mean loss of teeth in the different age groups 20-60 years was 0.2, 0.9, 1.4, 2.3, and 2.6, respectively. The periodontal bone level decreased by age both in 1973 and in 1988 91. The mean annual progression rate was 0.06 mm for all 357 individuals and varied between 0.04 and 0.07 mm per subject in the different age groups. The presence of periodontal disease progression was defined as bone loss of >20% at a proximal site between the 2 examinations. The most prevalent tooth types with bone loss of >20% at proximal sites were the maxillary and mandibular 2nd molars and the 1st maxillary molar, representing a % of 18.0, 12.8, and 13.5, respectively. The degree of association between severe periodontal disease progression and explanatory variables was investigated using logistic regression models. The dependent variable was no progression of periodontal disease or severe periodontal disease progression, i.e., subjects with periodontal bone loss >20% at > or =6 sites. Age was found to be correlated with severe periodontal disease progression by an odds ratio of 1.05 (CI: 1.02-1.07). The frequency of females in the group with severe bone loss was 58% and higher than in the non-progressing group, 50%. Only 9% in the group with no bone loss smoked as compared to 38% in the group of individuals with severe periodontal bone loss. % supragingival plaque, gingival inflammation, and deepened periodontal pockets (> or =4 mm) at baseline were related to severe periodontal disease progression by odds ratios of 1.03 (CI: 1.02-1.05), 1.01 (1.00-1.03), and 1.03 (1.00-1.05), respectively. In the multivariate logistic regression model, age (odds ratio 1.13 (CI: 1.06-1.19)), smoking (odds ratio 20.25 (5.07-80.83)), and % pockets > or =4 mm (odds ratio 1.15 (1.04-1.27)) remained significantly associated with severe disease progression. Furthermore, female gender and differences in income level appeared in the multivariate analysis to be related with severe bone loss, with odds ratios of 3.19 (CI: 1.02-9.97) and 8.46 (CI: 1.97-36.37), respectively.

Tooth loss and periodontal bone level in individuals of Jönköping County. A comparison between two adult populations living in the city and in the surrounding area.

Cross-sectional and longitudinal studies were performed in the community (in this paper changed to city) of Jönköping, Sweden, over a period of 20 years to follow changes in oral health and oral health behaviour. To widen our knowledge about dental health and dental care among the adult population, we expanded the study in 1993 to cover the whole county. The specific aim of the present study was to describe tooth loss (excluding third molars) and periodontal bone level in adult residents of Jönköping County and to compare these two parameters in adults living in the city of Jönköping with the same in adults living in the rest of the county. Random samples of individuals 30, 40, 50, 60, and 70 years old were selected. A total of 484 persons from the city and 1219 subjects from the rest of the county were examined. A total of 32 (7%) and 27 (2%) persons were completely edentulous in the examined populations from the city and from the rest of the county, respectively. A majority belonged to the older age groups, 60 and 70 years, with 17% of the subjects in the city being edentulous compared with 13% in the rest of the county. The mean number of missing teeth in subjects in the city versus subjects in the rest of the county was 0.75/0.95, 1.37/1.60, 3.34/2.43, 6.34/7.40, and 9.95/10.26 in 30-, 40-, 50-, 60-, and 70-year-olds, respectively. Of all the different tooth types, the average number of molars per person decreased the most with increasing age from an average of 7.79/7.83 (city/county) to 3.06/3.09 (city/county) for 30- and 70-year-olds, respectively. The proportion of subjects without molars was higher in the older age groups in both the city and the rest of the county with 4.8/10.7% and 15.6/22.0% of the 60- and 70-year-olds, respectively, lacking molars. In both populations, the mean periodontal bone level decreased with age. It was concluded that no important differences in tooth loss and periodontal health could be seen between the two populations. When organising dental care, dental health administrators could apply the findings from the population in the city to the entire county.

Risk of severe periodontal disease in a Swedish adult population. A cross-sectional study.

In this study, potential risk factors for severe periodontal disease were identified in a cross-sectional sample from the county of Jonkoping, Sweden. 547 adults 20-70 years of age were categorised clinically and radiographically by level of periodontal disease experience. These levels were used to divide the sample into groups--individuals without any reduction in periodontal bone level (60%) and those with severe periodontal bone loss (13%)--which were then used in univariate and multivariate logistic regression analyses as dependent variable. Demographic, socio-economic, general health, smoking habits, clinical, and dental care variables were used in the different regression analyses. In the univariate model, age (20-70 years) was found to be correlated with more severe periodontal disease experience (odds ratio: 1.13; 95% CI: 1.10-1.17). The association with periodontal disease was more pronounced for the older age groups (50, 60, and 70 years). A negative financial situation was also related to severe periodontal bone loss when regressed univariately (odds ratio 2.20 [95%: 1.04-4.68]). Moderate-heavy smoking (> or =10 cigarettes/day) appeared to be associated with severe periodontal destruction with an odds ratio of 9.78 (95% CI: 3.62-36.42). Of the clinical variables in the univariate model, higher mean levels of supragingival dental plaque and the presence of subgingival calculus were related to more severe periodontal disease with odds ratios of 1.02 (95%: 1.01-1.03) and 2.96 (95%: 1.50-5.88), respectively. When the same variables were regressed multivariately, age (continuous) (odds ratio 1.17 [95% CI: 1.12-1.22]), moderate-heavy smoking (odds ratio 11.84 [95% CI: 4.19-33.50]), and higher mean levels of plaque (odds ratio 1.02 [95% CI: 1.00-1.03]) remained significant. Light smoking (1-9 cigarettes/day) was not significantly associated with severe periodontal disease in the 2 regression models. The present study demonstrated that smoking, greater age, and higher mean levels of plaque are potential risk factors for severe periodontal disease in this specific population.