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Vollan, M. L., Hasselgren, L. C., Shi, X.-Q. & Jonsson, M. V. (2024). Clinical use of cone-beam computed tomography in Western Norway: a referral-based retrospective study. Acta Odontologica Scandinavica, 83, 537-545
Open this publication in new window or tab >>Clinical use of cone-beam computed tomography in Western Norway: a referral-based retrospective study
2024 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, p. 537-545Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To elucidate cone-beam computed tomography (CBCT) referral profiles in Western Norway.

MATERIALS AND METHODS: In all, 3,031 referrals to oral- and maxillofacial radiologist were reviewed. Patient data were retrieved retrospectively from electronic charts. The patient's age, gender, and perceived clinical indication were noted, as well as relevant medical and dental history and whether the referring clinician was a general dentist or held a clinical dental specialty.

RESULTS: A total of 2,680 referrals fulfilled the inclusion criteria (UiB n = 1,471, and TkVestland, n = 1,209). The female:male ratio was 1,427:1,253. Mean age was 33 years - 35 years for females compared to 31 years for males (p < 0.001). The most common clinical indications were related to impacted teeth (29%), endodontic issues (17%), cleft lip palate (12%), and resorptions (10%). Less common were bone lesions, implant planning, trauma to the teeth or jaws, atypical orofacial pain, and temporo-mandibular joint (TMJ). The patient age-profiles mirrored differences in indications within the cohort. Most referrals were from specialist dentists such as orthodontists, oral surgeons, and endodontists. Interestingly, 543/2,680 (20%) referrals were from general dentists.  Conclusions: Specialist dentists such as orthodontists, oral surgeons, and endodontists refer most patients for clinical indications such as impacted teeth, endodontic issues, and resorptions.

Place, publisher, year, edition, pages
Medical Journals Sweden, 2024
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-71723 (URN)10.2340/aos.v83.41943 (DOI)001333981100008 ()39324573 (PubMedID)2-s2.0-85204941322 (Scopus ID)
Available from: 2024-10-22 Created: 2024-10-22 Last updated: 2024-11-11Bibliographically approved
Chen, Y., Cai, W., Shi, X.-Q., Li, B. & Feng, X. (2024). Impact of palatopharyngeal sizes changing on pharyngeal airflow fluctuation and airway vibration in a pediatric airway. Journal of Biomechanics, 168, 112111-112111, Article ID 112111.
Open this publication in new window or tab >>Impact of palatopharyngeal sizes changing on pharyngeal airflow fluctuation and airway vibration in a pediatric airway
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2024 (English)In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 168, p. 112111-112111, article id 112111Article in journal (Refereed) Published
Abstract [en]

Snoring is common in children and is associated with many adverse consequences. One must study the relationships between pharyngeal morphology and snoring physics to understand snoring progression. Although some model studies have provided fluid–structure interaction dynamic descriptions for the correlation between airway size and snoring physics, the descriptions still need to be further investigated in patient-specific airway models. Fluid-structure interaction studies using patient-specific airway structures complement the above model studies. Based on reported cephalometric measurement methods, this study quantified and preset the size of the palatopharynx airway in a patient-specific airway and investigated how the palatopharynx size affects the pharyngeal airflow fluctuation, soft palate vibration, and glossopharynx vibration with the help of a verified FSI method. The results showed that the stenosis anterior airway of the soft palate increased airway resistance and airway resistance fluctuations, which can lead to increased sleep effort and frequent snoring. Widening of the anterior airway can reduce airflow resistance and avoid obstructing the anterior airway by the soft palate vibration. The pharyngeal airflow resistance, mouth inflow proportion, and soft palate apex displacement have components at the same frequencies in all airway models, and the glossopharynx vibration and instantaneous inflow rate have components at the same frequencies, too. The mechanism of this same frequency fluctuation phenomenon can be explained by the fluid–structure interaction dynamics of an ideal coupled model consisting of a flexible plate model and a collapsible tube model. The results of this study demonstrate the potential of FSI in studying snoring physics and clarify to some degree the mechanism of airway morphology affecting airway vibration physics.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Respiratory Medicine and Allergy Dentistry
Identifiers
urn:nbn:se:mau:diva-69131 (URN)10.1016/j.jbiomech.2024.112111 (DOI)001219239000001 ()38657433 (PubMedID)2-s2.0-85190886935 (Scopus ID)
Available from: 2024-06-18 Created: 2024-06-18 Last updated: 2024-11-11Bibliographically approved
Vicente, A., Cederhag, J., Rashidi, N., Wiedel, A.-P., Becker, M., Brogårdh-Roth, S., . . . Hellén-Halme, K. (2024). Low-Dose Cone-Beam Computed Tomography in Swedish Pediatric Patients With Alveolar Clefts Following Alveolar Bone Grafting-A Clinical Study. Clinical and Experimental Dental Research, 10(6), Article ID e70021.
Open this publication in new window or tab >>Low-Dose Cone-Beam Computed Tomography in Swedish Pediatric Patients With Alveolar Clefts Following Alveolar Bone Grafting-A Clinical Study
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2024 (English)In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 10, no 6, article id e70021Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to investigate whether a low-dose cone-beam computed tomography (CBCT) protocol provides diagnostically acceptable image quality for assessing bone healing after alveolar bone grafting.

MATERIAL AND METHODS: The study cohort comprised 11 patients (aged 7-14 years) with orofacial clefts who had undergone alveolar bone grafting at Skåne University Hospital in Malmö, Sweden. During the postsurgical follow-up at 6 months, each patient was assessed twice: once with a standard-dose CBCT protocol and once with a low-dose CBCT protocol, which in total corresponds to one CBCT examination made with the exposure settings recommended by the manufacturer. Among others, the assessed parameters included subjective image quality, as well as bone graft height, thickness, and integration.

RESULTS: No significant differences were found between the standard- and low-dose protocols for most parameters (p > 0.05). Exceptions included subjective image quality (one observer, p = 0.05) and confidence levels during the assessment (three observers, p = 0.01, 0.01, 0.02).

CONCLUSIONS: The low-dose protocol yielded adequate image quality for postoperative CBCT healing assessment in patients who have undergone alveolar bone grafting. However, the confidence level of observers during the assessment with the low-dose protocol was reduced. This study is registered on ClinicalTrials.gov (NCT06395077).

CLINICAL TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT06395077).

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
alveolar bone grafting, cone‐beam computed tomography, orofacial cleft, radiation
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-72100 (URN)10.1002/cre2.70021 (DOI)001369071800001 ()39497332 (PubMedID)2-s2.0-85208272658 (Scopus ID)
Available from: 2024-11-11 Created: 2024-11-11 Last updated: 2024-12-16Bibliographically approved
Vicente, A., Wiedel, A.-P., Becker, M., Brogårdh-Roth, S., Shi, X.-Q. & Hellén-Halme, K. (2024). Quantitative assessment of cleft volume and evaluation of cleft's impact on adjacent anatomical structures using CBCT imaging. Oral Radiology/Springer, 40(2), 295-303
Open this publication in new window or tab >>Quantitative assessment of cleft volume and evaluation of cleft's impact on adjacent anatomical structures using CBCT imaging
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2024 (English)In: Oral Radiology/Springer, ISSN 0911-6028, E-ISSN 1613-9674, Vol. 40, no 2, p. 295-303Article in journal (Refereed) Published
Abstract [en]

Objectives: To determine pre-operative cleft volume and evaluate cleft´s impact on surrounding anatomical structures in children and adolescents with orofacial clefts using cone bean computed tomography (CBCT) imaging.

Methods: The present retrospective study retrieved CBCT examinations of 68 patients from a previous study. The examinations had been exposed either before (n = 53) or after (n = 15) alveolar bone grafting. Pre-operative volume of cleft was determined, and type and location were evaluated. Morphological changes on the adjacent anatomical structures, including the incisive foramen, the nasal septum and floor, and the inferior turbinate, were assessed.

Results: Mean bilateral cleft volume was 0.76 cm3, while mean unilateral cleft volume was 1.08 cm3; the difference was significant (p < 0.001). Variation in cleft volume, however, was large. The incisive foramen was not visible in the majority of cases with bilateral clefts (71%); the difference was significant (p = 0.001). In cases with unilateral clefts, the nasal septum in 87% was curved towards the cleft or graft side. Also, the mean size of the widest part of the inferior turbinate was 8.8 mm on the cleft or graft side and 10.4 mm on the non-cleft side. The difference was significant (p < 0.001).

Conclusions: When required, CBCT is a feasible method for quantitatively illustrating alveolar clefts and their impact on the morphological development of surrounding structures. Variation in cleft volume was large.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Orofacial cleft, Cone-beam computed tomography, Cleft volume, Alveolar bone grafting
National Category
Surgery
Identifiers
urn:nbn:se:mau:diva-66087 (URN)10.1007/s11282-023-00736-0 (DOI)001154070100001 ()38302684 (PubMedID)2-s2.0-85183926174 (Scopus ID)
Available from: 2024-02-26 Created: 2024-02-26 Last updated: 2024-11-15Bibliographically approved
Augdal, T., Angenete, O., Zadig, P., Lundestad, A., Nordal, E., Shi, X.-Q. & Rosendahl, K. (2024). The assessment of bone health in children with juvenile idiopathic arthritis; comparison of different imaging-based methods. Pediatric Rheumatology, 22(1), Article ID 80.
Open this publication in new window or tab >>The assessment of bone health in children with juvenile idiopathic arthritis; comparison of different imaging-based methods
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2024 (English)In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 22, no 1, article id 80Article in journal (Refereed) Published
Abstract [en]

Background: Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA).

Methods: Data used in the present study was drawn from a large multicentre study including 228 children aged 4-16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested.

Results: One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites. Categorizing BHI SDS and DXA BMD Z-scores on a 0-5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 - 0.5. For cone-beam CT, based on a 1-3 scale, 59 out of 94 left TMJ's were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1).

Conclusions: Categorizing DXA LS and automated radiographic Z-scores on a 0-5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Osteoporosis, Child, Radiography, Cone-beam computed tomography, Dual-energy X-ray absorptiometry
National Category
Pediatrics
Identifiers
urn:nbn:se:mau:diva-71058 (URN)10.1186/s12969-024-01018-7 (DOI)001303630900001 ()39210351 (PubMedID)2-s2.0-85202899854 (Scopus ID)
Available from: 2024-09-13 Created: 2024-09-13 Last updated: 2024-11-11Bibliographically approved
Cederhag, J., Kadesjö, N., Nilsson, M., Alstergren, P., Shi, X.-Q. & Hellén-Halme, K. (2023). Comparison of absorbed doses and organ doses measured with thermoluminescent dosimeters and Gafchromic film for cone beam computed tomography examination of the posterior mandibular region in a head phantom. Oral surgery, oral medicine, oral pathology and oral radiology, 136(6), 769-776
Open this publication in new window or tab >>Comparison of absorbed doses and organ doses measured with thermoluminescent dosimeters and Gafchromic film for cone beam computed tomography examination of the posterior mandibular region in a head phantom
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2023 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 136, no 6, p. 769-776Article in journal (Refereed) Published
Abstract [en]

Objectives: We aimed to map the correlation between thermoluminescent dosimeters (TLDs) and Gafchromic film for measuring absorbed doses and to compare minimum, maximum, and mean absorbed doses over larger regions of interest and at various craniofacial organs and tissues during cone beam computed tomography (CBCT) exposure of the mandibular third molar region.

Study design: We positioned TLDs at 75 measurement points in a head phantom. Gafchromic film was cut to the same shape as the 5 levels of the phantom and was placed on top of the TLDs. Both dosimetry methods thus included the surface of each level simultaneously. CBCT scans were made using a 5 × 5 cm field of view and a rotation angle of 200°. Measurements included absorbed dose distributions, doses at all 75 points, and minimum, maximum, and mean doses within organs and tissues.

Results: The correlation of point-dose measurements at all TLD sites with doses measured on film was strong (R2 = 0.9687), with greatest correlation at lower doses (<2 mGy). Large deviations between TLD and film measurements of minimum and maximum doses and absorbed doses to the organs occurred at all 5 levels. TLD positioning failed to cover several organ sites; for these, only absorbed dose measurements from the film were available.

Conclusions: TLDs were unable to sample dose distributions and gradients accurately. The characteristics of Gafchromic LD-V1 film make it a favorable alternative in dental CBCT dosimetry.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-62210 (URN)10.1016/j.oooo.2023.07.006 (DOI)001133164600001 ()37625926 (PubMedID)2-s2.0-85168847369 (Scopus ID)
Available from: 2023-08-30 Created: 2023-08-30 Last updated: 2024-11-11Bibliographically approved
Chen, Y., Feng, X., Shi, X.-Q., Cai, W., Li, B. & Zhao, Y. (2023). Computational fluid-structure interaction analysis of flapping uvula on aerodynamics and pharyngeal vibration in a pediatric airway. Scientific Reports, 13(1), 2013, Article ID 2013.
Open this publication in new window or tab >>Computational fluid-structure interaction analysis of flapping uvula on aerodynamics and pharyngeal vibration in a pediatric airway
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, p. 2013-, article id 2013Article in journal (Refereed) Published
Abstract [en]

The uvula flapping is one of the most distinctive features of snoring and is critical in affecting airway aerodynamics and vibrations. This study aimed to elucidate the mechanism of pharyngeal vibration and pressure fluctuation due to uvula flapping employing fluid-structure interaction simulations. The followings are the methodology part: we constructed an anatomically accurate pediatric pharynx model and put attention on the oropharynx region where the greatest level of upper airway compliance was reported to occur. The uvula was assumed to be a rigid body with specific flapping frequencies to guarantee proper boundary conditions with as little complexity as possible. The airway tissue was considered to have a uniform thickness. It was found that the flapping frequency had a more significant effect on the airway vibration than the flapping amplitude, as the flapping uvula influenced the pharyngeal aerodynamics by altering the jet flow from the mouth. Breathing only through the mouth could amplify the effect of flapping uvula on aerodynamic changes and result in more significant oropharynx vibration.

Place, publisher, year, edition, pages
Nature Publishing Group, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-58545 (URN)10.1038/s41598-023-28994-2 (DOI)001003435000055 ()36737491 (PubMedID)2-s2.0-85147457896 (Scopus ID)
Available from: 2023-03-03 Created: 2023-03-03 Last updated: 2024-11-11Bibliographically approved
Augdal, T. A., Angenete, O. W., Shi, X.-Q., Sall, M., Fischer, J. M., Nordal, E. & Rosendahl, K. (2023). Cone beam computed tomography in the assessment of TMJ deformity in children with JIA: repeatability of a novel scoring system. BMC Oral Health, 23, 1-15, Article ID 12.
Open this publication in new window or tab >>Cone beam computed tomography in the assessment of TMJ deformity in children with JIA: repeatability of a novel scoring system
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2023 (English)In: BMC Oral Health, E-ISSN 1472-6831, Vol. 23, p. 1-15, article id 12Article in journal (Refereed) Published
Abstract [en]

Background The temporomandibular joint (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA). Diagnostic imaging is necessary to correctly diagnose and evaluate TMJ involvement, however, hitherto little has been published on the accuracy of the applied scoring systems and measurements. The present study aims to investigate the precision of 20 imaging features and five measurements based on cone beam computed tomography (CBCT). Methods Imaging and clinical data from 84 participants in the Norwegian study on juvenile idiopathic arthritis, the NorJIA study, were collected. Altogether 20 imaging features and five measurements were evaluated indepen-dently by three experienced radiologists for intra-and interobserver agreement. Agreement of categorical variables was assessed by Fleiss', Cohen's simple or weighted Kappa as appropriate. Agreement of continuous variables was assessed with 95% limits of agreement as advised by Bland and Altman. Results "Overall impression of TMJ deformity" showed almost perfect intraobserver agreement with a kappa coefficient of 0.81 (95% CI 0.69-0.92), and substantial interobserver agreement (Fleiss' kappa 0.70 (0.61-0.78)). Moreover, both "flattening" and "irregularities" of the eminence/fossa and condyle performed well, with intra-and interobserver agreements of 0.66-0.82 and 0.55-0.76, respectively. "Reduced condylar volume" and "continuity" of the fossa/eminence had moderate intra-and interobserver Kappa values, whereas continuity of the condyle had Kappa values above 0.55. Measurements of distances and angles had limits of agreement of more than 15% of the sample mean. Conclusions We propose a CBCT-based scoring system of nine precise imaging features suggestive of TMJ deformity in JIA. Their clinical validity must be tested.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Arthritis juvenile, Temporomandibular joint, Observer variation, Scoring system, Precision
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-58372 (URN)10.1186/s12903-022-02701-5 (DOI)000911972200001 ()36627622 (PubMedID)2-s2.0-85146100023 (Scopus ID)
Available from: 2023-02-27 Created: 2023-02-27 Last updated: 2024-11-11Bibliographically approved
Ihlis, R. L., Giovanos, C., Liao, H., Ring, I., Malmgren, O., Tsilingaridis, G., . . . Shi, X. Q. (2023). Cone beam computed tomography indications for interdisciplinary therapy planning of impacted canines. Oral surgery, oral medicine, oral pathology and oral radiology, 135(1), e1-e9
Open this publication in new window or tab >>Cone beam computed tomography indications for interdisciplinary therapy planning of impacted canines
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2023 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 135, no 1, p. e1-e9Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate how cone beam computed tomography (CBCT) affects the therapeutic planning of impacted maxillary canines.

Study design: A total of 132 impacted canines from 89 pediatric patients were collected from 3 specialist clinics in Stockholm, Sweden. An interdisciplinary therapy planning team consisting of 5 dental specialists evaluated each case and chose their preferred treatment alternative, initially without and later with CBCT images, to decide whether CBCT was justified for therapy planning. Predefined variables measurable using only 2-dimensional (2D) assessments were analyzed using stepwise logistic regression analyses.

Results: The CBCT was considered indicated in 47% of the cases. Additional information from CBCT led to a treatment decision change in 9.8%. Significant 2D predictors for CBCT justification were horizontal canine angulation compared with vertical angulation (odds ratio [OR] = 10.9), extraction strategy involvement (OR = 6.7), and buccally positioned canines compared with palatal (OR = 5.3), central (OR = 25.0), and distal or uncertain positions (OR = 7.7).

Conclusions: The benefit-risk assessment of CBCT for impacted canines may be reinforced by performing and applying justification decisions for CBCT acquisition at the therapeutic thinking level. If preliminary treatment planning motivates further in-depth investigation of either root status or tooth location, a CBCT is indicated.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-56318 (URN)10.1016/j.oooo.2022.06.013 (DOI)000932745600001 ()36229372 (PubMedID)2-s2.0-85139736403 (Scopus ID)
Available from: 2022-11-30 Created: 2022-11-30 Last updated: 2024-11-11Bibliographically approved
Gil, E. G., Åstrøm, A. N., Lie, S. A., Rygg, M., Fischer, J., Rosén, A., . . . Skeie, M. S. (2023). Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis. Acta Odontologica Scandinavica, 81(1), 50-65
Open this publication in new window or tab >>Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis
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2023 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 81, no 1, p. 50-65Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes.

MATERIAL AND METHODS: In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10-16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual.

RESULTS:  > 0 (OR = 2.33, 95% CI: 1.47 - 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 - 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups.

CONCLUSIONS: Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Adolescent, dental plaque, gingival diseases, juvenile idiopathic arthritis, oral health
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-52204 (URN)10.1080/00016357.2022.2078505 (DOI)000802987900001 ()35635806 (PubMedID)2-s2.0-85131628786 (Scopus ID)
Available from: 2022-06-08 Created: 2022-06-08 Last updated: 2024-11-11Bibliographically approved
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