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  • 1. Devlin, Hugh
    et al.
    Allen, Philip
    Graham, Jim
    Jacobs, Reinhilde
    Nicopoulou-Karayianni, Katy
    Lindh, Christina
    Malmö högskola, Faculty of Odontology (OD).
    Marjanovic, Elizabeth
    Adams, Judith
    Pavitt, Susan
    van der Stelt, Paul F
    Horner, Keith
    The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study2008In: British Dental Journal, ISSN 0007-0610, E-ISSN 1476-5373, Vol. 204, no 10, article id E16Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    OBJECTIVE: To determine if thinning (<3 mm width) of the lower cortical border of the mandible on dental panoramic radiographs, as well as other clinical risk factors, may provide a useful diagnostic test for osteoporosis in young postmenopausal women. DESIGN: Six hundred and fifty-two subjects (age range 45-70 years) were involved in this multi-centre, cross-sectional study. SETTING: Patients were recruited from centres in Leuven (Belgium), Athens (Greece), Manchester (UK), and Malmo (Sweden). SUBJECTS AND METHODS: The subject's age, body weight, whether the patient took hormone replacement therapy or had a history of low trauma fracture were used to form a clinical osteoporosis risk assessment (the OSteoporosis Index of RISk or OSIRIS index). Each patient also received a dental panoramic radiographic examination. RESULTS: One hundred and forty subjects had osteoporosis involving at least one of the measurement sites (lumbar spine, femoral neck or total hip). Those with osteoporosis tended to have a low OSIRIS score and a thinned cortical mandibular border. The area under the ROC curve for using both cortical width and OSIRIS to predict osteoporosis was 0.90 (95% CI = 0.87 to 0.92). There was a significant improvement in the diagnostic ability of the combined OSIRIS and cortical width test over both tests applied separately (p <0.001). The cost effectiveness of the cortical width and OSIRIS model was improved by using a high specificity threshold rather than high sensitivity. However, this analysis ignores the costs associated with missed cases of osteoporosis. CONCLUSION: Dentists have a role to play in the detection and referral of patients at high risk of osteoporosis.

  • 2. Ellervall, Eva
    et al.
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Vinge, Ellen
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Antibiotic prophylaxis in oral healthcare - the agreement between Swedish recommendations and evidence2010In: British Dental Journal, ISSN 0007-0610, E-ISSN 1476-5373, Vol. 208, no 3, article id E5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Almost all (17/20) Swedish counties have pharmaceutical committees that establish recommendations for the use of antibiotic prophylaxis in oral healthcare.Objective To evaluate the evidence for the use of antibiotic prophylaxis in oral healthcare and the agreement between Swedish recommendations and evidence. MATERIAL AND METHODS: We conducted a systematic literature search in PubMed and the Cochrane Controlled Trials Register. The MeSH terms 'antibiotic prophylaxis' and 'dentistry' were used in the database search. Abstracts were reviewed according to specific inclusion and exclusion criteria. A total of 186 articles were read in full text by the four authors independently. Data extraction and interpretation of data was carried out using a pre-defined protocol. In the end, one case-control study was included for evaluation of evidence. RESULTS: The case-control study included patients with specific cardiac conditions. The study reported a 49% protective efficacy (odds ratio: 0.51) of antibiotic prophylaxis for first-time episodes of endocarditis within 30 days of procedure. This result was not statistically significant. The quality of the evidence was low. No studies were evaluated on patients with other medical conditions. The recommendations included several cardiac and other medical conditions for which there is a lack of evidence or no evidence to support the use of antibiotic prophylaxis. CONCLUSIONS: There is a lack of evidence to support the use of antibiotic prophylaxis. To avoid the risk of adverse events from antibiotics and the risk of developing resistant bacterial strains, the use of antibiotic prophylaxis should be minimised and recommendations in Sweden should be revised to be more evidence-based.

  • 3.
    Klingberg, Gunilla
    Malmö högskola, Faculty of Odontology (OD).
    Summary of pain: Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe2008In: British Dental Journal, ISSN 0007-0610, E-ISSN 1476-5373, Vol. 205, no 1, p. 30-31Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Objective To compare the pain and distress response of children receiving a local anesthesia injection using a computerised device (Wand((R))) or a traditional syringe over two consecutive treatment sessions and to study whether the response to the two injection techniques was different for high or low dentally anxious children.Design Randomised controlled trial.Setting Secondary dental care practice specialised in treating children.Subjects and Methods Children were selected and randomly allocated to the Wand((R)) or traditional injection condition. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-ds). Based on video recordings of the injections, for each 15 seconds, the occurrence of five pain related behaviours was registered and a score was given on the Venham distress scale. Children rated their pain after each injection.Intervention Over two consecutive treatment sessions one group received two local anaesthesia injections with the traditional syringe and the other group received two injections with the Wand((R)).Outcome measures The mean number of pain related behaviours, the mean distress scores and the self-reported pain scores were compared. Based on the CFSS-ds subjects were split into highly and low dentally anxious children.Results One hundred and forty-seven subjects participated in the study: aged 4-11 years, 71 girls. Based on the behaviour displayed during the local anaesthesia injection and the self-reported pain after the injection, no difference could be found between an injection with the traditional syringe or the Wand((R)) over the first or second treatment session. However, on the first treatment session, highly anxious children reported more pain (p = 0.001), displayed more pain related behaviour (p = 0.002) and more distress (p <0.001) than low anxious children in reaction to the local anaesthesia injection.Conclusion No clear difference in the response of referred children could be found between an injection with the Wand((R)) or the traditional syringe. Level of dental anxiety was found to be an important factor in the response of children to a local anaesthesia injection.

  • 4.
    Liedholm, Rolf
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Lysell, Leif
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Brickley, Mark
    Shepherd, Jonathan
    Third molar treatment outcome: a comparison of patients' preferences in Sweden and Wales2005In: British Dental Journal, ISSN 0007-0610, E-ISSN 1476-5373, Vol. 199, no 5, p. 287-291Article in journal (Refereed)
    Abstract [en]

    Aim: To elucidate and compare patients’ outcome preferences with regard to removal and retention of mandibular third molars in Sweden and Wales. Subjects and Method: The subjects comprised patients referred for and scheduled for removal of one or both mandibular third molars in both Sweden and Wales. To study patients’ preferences for outcomes of removal and retention of the mandibular third molar, the Multi-attribute utility (MAU) methodology was applied to these patients. Results: Relative weighting of domains was similar in the two countries. “Home and social life” received the highest relative weighting in Sweden and “General health and well-being” in Wales. “Your appearance” received the lowest relative weighting in Sweden and Wales. In both Sweden and Wales operative jaw fracture was considered to be the outcome with most impact and dentigerous cyst and imbricated incisors the least impact. Outcome ranking was similar in the two countries and operative outcomes were considered by patients to be more detrimental to health than retention outcomes. Conclusions: This European comparison showed that patients’ preferences in Sweden and Wales were similar and that the outcomes of surgery were considered worse after third molar removal than retention. Patient-orientated treatment decisions are less subject to variation than clinician-orientated decisions.

  • 5.
    Pälvärinne, Raimo
    et al.
    Malmö University, Faculty of Odontology (OD).
    Widström, E.
    National Institute for Health and Welfare (THL), Helsinki, Finland; Institute of Clinical Dentistry, Arctic University of Norway, Tromsø, Norway.
    Forsberg, B. C.
    Department of Public Health Sciences, Karolinska Institutet, Senior Public Health Physician, Stockholm County Council, Sweden.
    Eaton, K. A.
    University of Leeds; Honourary Professor University of Kent, United Kingdom.
    Birkhed, Dowen
    Professor Emeritus, Malmö, Sweden. Former Head of Department of Cariology, Institute of Odontology, Sahlgrenska Academy at University of Gothenburg, Sweden.
    The healthcare system and the provision of oral healthcare in European Union member states: Part 9: Sweden2018In: British Dental Journal, ISSN 0007-0610, E-ISSN 1476-5373, Vol. 224, no 8, p. 647-651Article in journal (Refereed)
    Abstract [en]

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

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