It is common knowledge for all dental personnel that root filled teeth can be painful. Earlier studies on this subject are meta-analyses and clinical studies reporting data in relation to the time since treatment was performed, not epidemiological studies reporting on the general population or cohorts who regularly attend dentistry. The studies often report ´all-cause tooth pain´ or´odontogenic´ versus ´non-odontogenic´ tooth pain. These are broad categories with different possibilities for the origins of pain. A better understanding of the possible origins of pain would aid in clinical assessment.

This doctoral thesis is centred around a cross-sectional clinical data collection in general dental practice and follow up of interventions monitored by collecting data from dental records over six years. The aim is to better understand painful root filled teeth better by exploring anamnestic, clinical, and radiographic characteristics at a regular check-up by the regular dentist.

Study I is an observational cross-sectional study. The aim was to investigate the frequency and characteristics of pain and discomfort, irrespective of origin, in a cohort of adult patients regularly attending the Public Dental Service in Sweden. A further aim was to examine whether there was an association between pain symptoms, clinical status and radiological findings. One out of ten participants experienced pain or discomfort from their root filled teeth; the average pain intensity was low. Lower age, tenderness to percussion and apical palpation were associated with painful teeth. Furthermore, 41.9% of the painful teeth had apical radiolucency.

Study II is a case-control study. Cases were participants with at least one painful root filled tooth, and controls were participants with a root filled tooth without pain. The aim was to compare, in detail, painful root filled teeth with root filledteeth without pain matched on age, sex, jaw- and tooth type, with the additional aim to explore patient- and tooth related factors that may explain the pain. It was more common with tenderness to percussion and apical palpation, as well as swelling, pocket depths greater than 6mm and apical radiolucency for the painful teeth. For 60% of the painful teeth, apical periodontitis was the likely origin of pain, marginal periodontitis and TMD were found to contribute in 30%, and for 10%, no obvious clinical or radiological findings could explain the pain.

In Study III, the painful teeth were subdivided into two groups: those with at least one sign of disease and those with no such signs. The aim was to compare painful root filled teeth with and without signs of inflammatory disease, regarding (i) pain characteristics, (ii) impact of pain and (iii) patient characteristics. No differences could be found except for higher pain intensity and no apical palpation of the teeth without signs of disease. The impact of pain was equally low, and there were no differences in patient characteristics.

In Study IV, all the participants from Study I who could be followed for six years were included, and the interventions were followed by collecting data from the dental records. The aim was to explore longitudinally what happens to root filled teeth in terms of interventions, regardless of time since RCT, during six years. A further aim was to explore how the interventions were associated with variables obtained from a standard clinical examination. Regarding the painful teeth, a third were extracted, another third had 'no event' recorded and, in falling order, the rest were 'scheduled for follow-up', had a 'new restoration' or were 'endodontically re- treated'. In comparison, it was more common with extraction and RCT for painful teeth than 'no event', 'scheduled for follow-up' and new restoration.

In conclusion, the findings indicate that pain from root filled teeth is a relatively common problem. Those with pain generally have a low intensity and minimal impact on everyday life. Apical periodontitis is the most common origin of pain, but a few are difficult to diagnose with the common examination modalities. The clinical presentation of teeth with and without signs of inflammation resemble each other, pointing to possible help from other diagnostic modalities. Even though extraction and RCT are more common interventions for painful teeth, not all painful teeth receive an intervention.

Periodontitis and dental caries are two of the most prevalent human diseases, affecting nearly 2 billion worldwide. Persistence is largely attributed to the formation of biofilms (plaque) by oral bacteria, which left undisturbed lead to destruction of surrounding tissues and increase the risk for secondary disease. As current treatments such as mechanical removal and adjunctive therapies can be inadequate, there is a need for new anti-plaque chemical agents. Stabilized hypochlorous acid (sHOCl) has emerged as a potential anti-biofilm agent in areas such as wound therapy but its use in treating oral diseases remains unknown. Therefore, our aim in this thesis was to assess the role of sHOCl as an antimicrobial agent for use in the oral cavity.

We found that at low concentrations, sHOCl was effective in killing bacteria within mixed-species in vitro models resembling periodontitis and dental caries. Moreover,  sHOCl  displayed  higher  antibiofilm  activity  compared  to chlorhexidine, whilst not damaging tested oral surfaces. At sub-lethal levels, sHOCl was observed to target multiple cellular components through oxidative stress in Streptococcus biofilms. Simultaneously, work on our models revealed a possible new application of CFSE-based dyes in microscopy for the live-imaging of biofilms. In particular, multi-dye compatibility opens up the possibilities for future research employing mixed-species biofilms. Finally, our preliminary findings also indicate that sHOCl may permit a selective re-growth of biofilms following exposure.

Taken together, the results of this thesis lay the groundwork for investigations of sHOCl as an antibiofilm agent, and continue to push microbial research towardsmore relevant models.

AimThe aim of this systematic review was to investigate the quality of evidence for methods used to diagnose, restore and prevent dental erosions, by evaluating and summarising clinical controlled studies and in situ studies covering this field.Material and MethodsThree databases, PubMed, Embase and Cochrane database, were searched for studies published until October 2023. Studies fulfilling the selection criteria were selected, and the risk of bias of the included studies was assessed. Two authors independently reviewed the studies, evaluated their risk of bias and extracted data from the included studies. The certainty of evidence of the findings in the studies was determined using GRADE.ResultsThe literature search identified 7176 records. Out of these, 19 studies were included in this review, three revolving diagnostics, three revolving treatment and 13 revolving prevention. However, due to the fact that only few studies with a small number of participants have investigated the same methods on the same outcome, the studies do not constitute any body of evidence.ConclusionThis systematic review highlights the shortage of data on methods used for diagnostics, restorative treatment and prevention of dental erosions. More knowledge is needed to strengthen the scientific evidence regarding methods used for dental erosions.

PURPOSE: This research aimed to investigate potential factors associated with the risk of perforation of the labial bone plate, nasal floor, or maxillary sinus floor during immediate implant placement (IIP) in the maxillary premolar area, utilizing a cone-beam computed tomography (CBCT) virtual study.

METHODS: CBCT exams from 179 eligible participants, encompassing 716 teeth, were included. Implants were virtually positioned in 2 orientations: along the long axis of the tooth (the prosthetically-driven position) and in an optimal position relative to adjacent anatomical structures (the bone-driven position). Binary logistic regression analysis was employed to assess potential associations between perforation or invasion and various covariates, including sex, age, tooth region, the distance from the tooth apex to the nasal floor or maxillary sinus floor, the angle between the prosthetically- and bone-driven positions (implant-line A angle [ILAA]), and the labial concavity angle (LCA).

RESULTS: The mean ILAA was 18.3°±8.0°, and the angle was significantly larger for the second premolar compared to the first premolar. The mean minimum implant length was 13.0±2.1 mm, with a bone anchorage of 4 mm. The incidence of perforation was 84.1% for the prosthetically-driven position and 40.5% for the bone-driven position. Factors associated with a higher risk of cortical bone wall perforation or invasion of the 2-mm safety margin from surrounding anatomical structures (in the bone-driven position) included female sex, older age, shorter distance from the tooth apex to the nasal cavity/maxillary sinus, and smaller LCA.

CONCLUSIONS: A high prevalence of cortical bone wall perforation or invasion of the 2-mm safety margin is anticipated when performing IIP in the maxillary premolar region.

Gender differences in pain reporting and prevalence have been demonstrated. As gender of examiner also affects reporting of pain on palpation, the aim of this study was to evaluate the effects of examiner gender on palpation performance using three different palpation methods. Examiners of both genders were instructed on the correct technique for each palpation method by either a female or male instructor. The target was to achieve a pressure of 100 kPa, corresponding to the 1 kg of force for muscle palpation described in the diagnostic criteria for temporomandibular disorders (DC/TMD). All examiners performed traditional palpation with the index finger, palpation with a palpometer, and a novel bimanual palpation with visual feedback, in a randomized order. The examiner's gender, and its interaction with the gender of the instructor did not significantly affect magnitude, accuracy, or precision of the pressure applied. The method of palpation was the only factor that significantly impacted all metrics. The palpometer achieved the lowest palpation magnitude (mean pressure applied = 113.7  kPa, 95% CI: 109.8-117.6), the highest accuracy (absolute difference = 15.7  kPa, 95% CI: 12.3-19.1), and the highest precision (mean coefficient of variation = 6.8, 95% CI: 6.0-7.6), followed by bimanual palpation and traditional palpation. The results suggest that gender differences in pain reporting in patients are not likely to be a result of the technical aspects associated with the gender of the examiner. Instead, these differences may be attributed to other factors, such as sociocultural influences.

OBJECTIVE: To analyse sex differences in health-related quality of life (HRQL) before, during and up to 3 months posttreatment of head and neck cancer, and to examine the importance of salivary secretion rate for HRQL posttreatment.

METHODS: Patients were recruited before starting curative oncologic treatment. Clinical examinations were performed including determination of the stimulated salivary secretion rate. HRQL (EORTC C30 and HN35) was reported at baseline, weeks 2, 4 and 6 during treatment and 3 months after treatment.

RESULTS: A total of 56 men and 19 women were included. During treatment, men reported more problems with pain and sexuality, a higher use of painkillers and need for nutritional support during oncologic treatment, while women reported more problems with weight loss and dry mouth. At 3 months posttreatment, women reported more problems and symptoms than men with the highest scores noted for dry mouth, weight loss and sticky saliva. Patients with hyposalivation (≤ 0.7 mL/min) posttreatment reported more problems and symptoms compared with those with a secretion rate of > 0.7 mL/min, especially regarding dry mouth, sticky saliva and social eating (p < 0.001 for all three).

CONCLUSION: Problems and symptoms during and postoncologic treatment seem to differ between women and men, which must be taken into consideration by healthcare and dental professionals. Patients with hyposalivation posttreatment have more problems and symptoms and are therefore in greater need of supportive care.

Background: There is limited and conflicting data on the reduction of circulatory inflammatory mediators in patients with apical periodontitis (AP) following endodontic treatment.

Objective: To answer the following research question: in adult healthy patients with AP [Population (P)], is there a difference before [Comparator (C)] and after various endodontic treatments (nonsurgical, surgical or retreatment) [Intervention (I)] on systemic levels of inflammatory biomarkers [Outcome (O)] in the follow-up period [Time (T)]?

Methods: An electronic literature search was conducted in the databases Scopus, PubMed, Clarivate Analytics' Web of Science, Cochrane Database of Systematic Reviews and Grey literature from inception to July 2024 with no language restrictions. Observational studies examining changes in serum levels of inflammatory mediators were included. Two independent reviewers selected studies, extracted data and critically appraised the included studies. Qualitative and quantitative (meta-analysis) data synthesis methods were employed. The Newcastle-Ottawa Scale was used to assess the quality of the included studies.

Results: Sixteen studies met the inclusion criteria, of which six were included in the meta-analysis. These studies were published between 1992 and 2024, involving a total of 596 patients (54% females) aged between 16 and 75 years. The meta-analysis of pooled data showed a significant decrease in high-sensitive C-reactive protein (hs-CRP) levels in the serum of patients with AP 6 months after treatment [2.26 ± 1.76 versus 1.28 ± 1.06 mg/L, (Z = 2.03, p = .04)] and a decrease in interleukin-1β (IL-1β) levels 12 months after treatment [13.01 ± 5.95 versus 10.86 ± 3.52 pg/mL, (Z = 3.72, p < .01)]. One study was assessed as poor quality, while all others were considered high quality.

Discussion: Despite the differences in methodologies across the included studies, it has been established that effective endodontic treatment leads to a reduction in systemic inflammatory biomarkers in the body.

Conclusion: Following effective endodontic treatment in patients with AP, the systemic levels of hs-CRP and IL-1β exhibit a significant reduction at 6 and 12 months, respectively. Further clinical studies should investigate whether effective endodontic treatment and reduced levels of investigated biomarkers may change the clinical presentation of systemic diseases.

Objectives: Posttransplant infections may lead to dire consequences in immunocompromised organ recipients. Oral foci of infection are therefore often eliminated prior to solid organ transplantation to reduce posttransplant morbidity. However, despite increasing numbers of organ transplantations the necessity of pretransplant dental treatment and its effect on transplant outcome remains uncertain. The aim of the present systematic review was to evaluate the impact of oral foci of infection and pretransplant dental treatment on adverse events following solid organ transplantation.

Methods: Studies on adult patients undergoing solid organ transplantation with/without oral infection or with/without pretransplant dental treatment were eligible. An electronic search in PubMed, Scopus, Web of Science, CINAHL and Cochrane was conducted up to June 11, 2024. Screening of eligibility, data extraction and risk-of-bias assessment of the included studies with the Newcastle-Ottawa Scale were done independently by two reviewers. Data were synthesized with a narrative approach.

Results: In total, 4035 unique publications were identified. After full text assessment of 75 studies nine cohort studies on liver, kidney, heart and/or lung transplantation based on 727 patients were included. Two studies based on 161 patients found a significant increase of infectious complications after liver transplantation when no dental treatment was performed. Presence of oral foci increased the risk of hospitalization after kidney transplantation in one study but was associated with lower infection rate after lung transplantation in another study. No studies found significant impact on mortality or on organ rejection. Overall, the quality of the included studies was good with low or medium risk-of-bias.

Conclusion: To our knowledge, this is the first systematic review on the impact of oral infection on organ transplantation. The results suggest a possible link between persisting oral infection and posttransplant infectious complications, thus lending support to the elimination of oral infectious foci before solid organ transplantation.

Background: The aim of this study was to investigate how different scanning protocols affect the accuracy (truenessand precision) of intraoral scanning of complete arches with implant cylinders.Material and Methods: A master model was designed with five cylinders. One scanner, TRIOS2 (3shape), was usedto scan the model with four different scan protocols: ROCK (wavelike scanning in a pendulum movement), ZIG-ZAG (wavelike scanning technique), OBP (occlusal, buccal, and palatal), and OWBP (occlusal, wiggling, buccal,and palatal). A total of 30 scans were performed using each of the four protocols. The master model was digitizedwith an industrial ISO-certified ATOS scanner. GOM inspect software was used to compare the scans to the mastermodel and evaluate any deviation between the scan protocols and the master model. The data was analyzed usingthe One Sample t-test (p=0,05).Results: The precision (standard deviation) ranged from 23-83μm for protocol ROCK, 22-147μm for ZIGZAG,21-170μm for OBP, and 23-116μm for OWBP. The trueness (mean deviation from master model) was 5-41μm forROCK, 7-97μm for ZIGZAG, -21-29μm for OBP, and 1-24μm for OWBP. All protocols showed statistically signi-ficant differences to the master model in multiple distances, except OWBP, which had a single significant differencein comparison to the master model.Conclusions: Protocol OWBP has a higher trueness than other tested protocols. All tested protocols have highertrueness and precision when scanning smaller distances than inter-arch measurement. Clinical significance;Thetrueness and precision of intraoral scanning is generally better in smaller spans due to less deviation. The protocolOWBP, that is recommended by the manufacturer, has the least deviating trueness in comparison to the mastermodel.

Purpose: Marginal bone resorption (MBR) around dental implants may sometimes be a self-limiting condition due to balancing immunologic reactions against utilized materials rather than a progressive bacterial infection. Contrary to previous assumptions from ligature-induced experimental peri-implantitis studies, a recent 8-week experiment by the present authors showed that marginal ligatures trigger an inflammatory immune response, resulting in bone resorption around implants in the absence of plaque. The present study aimed to investigate whether this inflammatory/immunologic reaction attenuates or progresses toward implant failure after a longer healing time (12 weeks).

Materials and methods: Sterile silk ligatures were placed around the top of titanium (Ti) implants and compressed against the femoral cortical bone plate of six rabbits. A nonligated implant was used as a control. After 12 weeks of submerged healing, ground sections of implants and surrounding tissues were investigated with light microscopy. The marginal soft tissues were also analyzed using selected quantitative polymerase chain reaction (qPCR) markers.

Results: Histologically, the ligatures were outlined by immune cells, including multinucleated giant cells (MNGCs), with adjacent fibrous encapsulation and resorbed peripheral bone that contrasted from the osseointegrated nonligated control implants. The difference in expression of qPCR markers was not significant, but > two-fold upregulation of markers CD11b, IL1β, ARG1, NCF1, and CD4 and > twofold downregulation of CD8 indicated a mild, focal inflammatory/immune response against the ligatures compared to controls, with upregulation of M1 and M2 macrophages, neutrophils, and helper T-cells as well as downregulation of killer T cells. Further, the bone formation markers OC and ALPL were > two-fold downregulated (consistent with the lack of osseointegration of the ligatures) compared to control implants.

Conclusions: Marginal silk ligatures trigger an inflammatory/immune response and aseptic bone resorption around implants. Compared to the previous 8-week study, the inflammatory reaction against the silk appears to attenuate with time, with only a mild persisting inflammation that may block osseointegration; instead, a fibrous tissue encapsulation-type reaction is maintained. This may explain why traditional ligature experiments have required regular exchange of ligatures for the bone resorption to progress.

AIMS: To investigate the effect of a lingual nerve block on spontaneous pain in patients with burning mouth syndrome (BMS) and to estimate associated somatosensory abnormalities by quantitative sensory testing (QST).

PROTOCOL AND METHODS: A standardised QST battery including cold detection threshold (CDT), warmth detection threshold (WDT), thermal sensory limen (TSL), paradoxical heat sensation (PHS), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR) and pressure pain threshold (PPT) was performed at the oral mucosa of the most painful site and intraoral control site in 20 BMS patients, and at the tongue and cheek mucosa in 22 age- and gender-matched healthy controls. The effect of a lingual nerve block on spontaneous burning pain reported by the BMS patients on a 0-10 cm visual analogue scale (VAS) was investigated in a randomised double-blind crossover design using (1 mL) lidocaine (lido) or saline (sal) with an interval of 1 week. The BMS patients were grouped into 'central' and 'peripheral' mechanisms based on the effect of the lingual nerve injections. For each BMS patient, Z-scores and Loss/Gain scores were computed. Differences among groups and sites were analysed using a two-way ANOVA. Differences within group were assessed by paired t-test.

RESULTS: The 20 BMS patients were characterised on the basis of VAS changes (ΔLido-ΔSal) as a peripheral BMS subgroup (n = 9) with pain relief more than 1 cm on the VAS and a central BMS subgroup (n = 11) with pain relief less than 1 cm. BMS patients (n = 20) had lower sensitivity to thermal stimuli (i.e., CDT, WDT, TSL, CPT, HPT and PPT) and higher sensitivity to mechanical stimuli (i.e., PPT) compared with controls (p ≤ 0.007). Based on Loss/Gain coding, L1G0 (loss of thermal somatosensory function with no somatosensory gain, 55.0%) was the most frequent coding in the BMS group, which was higher than 11.4% in the control group (p < 0.001). Surprisingly, there was no significant difference between the peripheral and central BMS subgroups with regard to the Z-scores of any of the nine QST parameters (p > 0.097).

CONCLUSIONS: The results of the lingual nerve blocks demonstrated two distinct phenotypes with either peripheral or central mechanisms but no direct impact on somatosensory function. Overall, somatosensory function in BMS patients seems abnormal in the painful areas compared to matched controls with a conspicuous loss of thermosensory function.

AIM: To evaluate conditioned pain modulation (CPM) in burning mouth syndrome (BMS) patients with different pain mechanisms.

MATERIALS AND METHODS: Twenty BMS patients (52.0 ± 6.8 years, 17 women and 3 men) and age- and gender-matched 22 healthy controls were enrolled in this randomised controlled trial. The patients received an active lingual nerve block (lidocaine) and a placebo injection (saline) randomly with an interval of 1 week in a double-blinded manner. Patients evaluated their pain intensity on a 0- to 10-cm visual analogue scale (VAS) before and after each injection, with or without CPM. Based on the anaesthesia effect, BMS patients were divided into two groups with presumed different pain mechanisms; a 'central subgroup (n = 11)' with pain relief less than 1 cm and 'peripheral subgroup (n = 9)' with pain relief more than 1 cm on the VAS. Mechanical pain threshold (MPT) and wind-up ratio (WUR) were investigated at two oral mucosa regions: the region with most intense symptoms and a control region for the patient group; tongue and buccal region for the control group. CPM was induced by immersing the left hand into cold water. A moderate level of pain (around five on the VAS) was obtained by adjusting the water temperature. MPT and WUR were measured twice for all the participants with and without CPM, which was analysed and presented as relative change in MPT and WUR. Differences between groups were analysed using two-way ANOVA. Differences within group between tests were assessed by paired t-test.

RESULTS: At baseline, there were no significant group differences for MPT or WUR between BMS patients and healthy controls (p ≥ 0.156). The mean bath temperature to evoke moderate pain for the BMS group was significantly lower than that for the healthy control group (8.9°C vs. 11.9°C, p = 0.003). The CPM evoked an inhibitory modulation in 18.2%-44.4% of BMS patients, while for the healthy group, the ratio was 68.2%-81.8%. Central BMS patients had smaller CPM effects than healthy participants at the painful site and control site, which indicated a decreased CPM function (p ≤ 0.034). Peripheral BMS patients had lower CPM effects than healthy participants only at the painful site (p = 0.037).

CONCLUSIONS: The present findings documented impairment of central nociceptive inhibition processing in BMS patients which was more extensive in central BMS than peripheral BMS. These findings add to the suggestion that BMS may a heterogeneous pain condition with at least two different phenotypes.

OBJECTIVES: Fusobacterium can contribute to oral diseases, but also pose as a systemic risk factor. This genus, and especially F. nucleatum, can be found in colorectal cancer (CRC) tissue and is involved in multiple aspects of this type of cancer. Previous studies indicated a possible oral origin of these bacteria; however, stronger evidence is needed to reach a definitive conclusion. This pilot study aimed to establish a method to successfully compare, at the strain level, fusobacteria from the oral cavity and CRC resection material for future cohort studies of CRC patients.

MATERIAL AND METHODS: In a first cohort of eight periodontitis patients, gingival crevicular fluid and saliva were collected. Fusobacterium was isolated on two different media. In a second cohort, saliva and CRC resection material were collected from ten CRC patients. These samples were used for screening of Fusobacterium with culturing, 16S rRNA gene profiling and a PCR-based approach.

RESULTS: In the first cohort, different Fusobacterium species were identified in GCF and saliva samples. However, as the total yield of Fusobacterium seemed slightly higher in saliva samples, it was therefore preferred for subsequent sample collection. Thus, in the second cohort, patient-matched saliva and CRC resection material were screened for Fusobacterium and this showed that nine patients were culture-positive in the saliva samples; however, no Fusobacterium could be isolated from the resection material. On the other hand, 16S rRNA gene profiling of the resection material indicated that eight CRC patients were positive for Fusobacterium. All eight of these patients carried Fusobacterium in their saliva, indicated by both marker gene PCR and culture-based screening.

CONCLUSIONS: These pilot results are compatible with data from previous studies, indicating a possible link between oral and CRC-associated Fusobacterium, and a more in-depth analysis of specific strains and their characteristics in a larger cohort is justified.

TRIAL REGISTRATION: The protocol was registered at clinicaltrials.gov (NCT05945082).

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).

Licensure exams play a crucial role in ensuring the competence of individuals entering a profession, thereby safeguarding the public and maintaining the quality and integrity of the profession. In Sweden, dentists educated outside the European Union seeking to practise dentistry must undergoa re-certification process. The re-certification process includes a theoretical examination where pass marks are set using a three-level Angoff method. This study aimed to determine the consistency of the Angoff ratings using independent panels at two Swedish universities. Two cohorts of panellists were included in the study: one reference and one external. The reference panel was responsible for rating the upcoming theoretical examinations in the proficiency test, which were used to set the pass mark. The external panel, recruited from a dental school at a university in another region in Sweden, provided ratings after the examinations. Three examinations during 2019–2020 were included in this study (267 items in total). There was a strong correlation (ρ ≥ 0.70, p < .001) between the ratings of the two independent panels, with no significant differences in item ratings across the full exams, dental disciplines, and professional qualifications analysed. This suggests that the three-level Angoff method reliably produces similar standards for assessing the competence of the minimally qualified dentist across different institutions. The expectations of the minimally qualified but still acceptable dentist were comparable between the two independent panels across the three theoretical examinations explored. The alignment between the panels indicates valid, reliable standards across institutions, despite the independent syllabi of the two study programmes. However, while there is an alignment, differences in ratings remain. Consequently, involving multiple institutions in future standard-setting processes could help ensure that the standards reflect a broader range of educational practices, supporting the credibility of licensure examinations.

OBJECTIVE: To explore experiences of caries prevention in adult patients with recurrent cavities among experienced dentists.  Method: Five focus group discussions consisting of seven men and nine women, 38-61 years of age, and with working experience as dentists between 5 and 35 years, were conducted. The participants represented Public Dental Health Service clinics and private practitioners. Qualitative content analysis was used to analyze data.  Results: The participants emphasized the importance of effective communication and patient engagement in caries prevention. They described their experiences as an endless trail, making fillings. They expressed their inability to take necessary responsibility and being stuck in the dental care system due to various circumstances. The understanding of caries was contradictory, and an inadequate mandate to control time to fulfill their preventive work was evident. They felt responsible to do the best for their patients, but how to share responsibility with colleagues and patients and having enough time for this seemed difficult and unclear. These problems did not motivate to further education in cariology.

CONCLUSION: The findings underscore the urgent need for improvement in preventive caries treatment and the necessity of allocating sufficient time for dentists to engage in this crucial aspect of their work.

Objectives: The objectives were to: (i) assess the accuracy of dental data for adults obtained from the Swedish Quality Register on Caries and Periodontitis (SKaPa); (ii) explore whether Latent Class Analysis (LCA) can identify groups of people based on caries data; and (iii) characterise the dental, medical and behavioural characteristics of people in the LCA- derived classes. Methods: Caries data from the SKaPa register were compared with clinical data collected by five experienced dentists in a nested subgroup of the Malm & ouml; Offspring Study (MOS), namely the Malm & ouml; Offspring Dental Study (MODS) (n = 724) for validation. Dental data from SKaPa were then used to classify 61 984 adult participants of the V & auml;sterbotten Intervention Programme (VIP) into five classes using LCA and DMFS- based quintile ranking, respectively. Dental status (including caries progression over 5 years), medical, anthropometric and behavioural characteristics were compared between the groups. Analyses were replicated in 2767 adults in the MOS. Results: DMFSscores and number of teeth recorded within - 2 to +2 years showed excellent agreement between the SKaPa and reference data with intra- class correlations > 0.90. The five LCA classes differed in mean DMFS from 10.0 to 94.4. There were strong associations between LCA class and health, and health and behavioural measures respectively, including some associations that were not detected using DMFSranked quintile groups. LCA class was associated with incremental change in DMFS, DFS, and number of teeth. The results in the MOS cohort were consistent with the results in the VIP cohort. Conclusions: Dental data for adults from the SKaPa registry were considered accurate within 2 years of recording. The LCA approach can classify participants into caries subtypes based on dental charting. These groups differ in health and behavioural characteristics and future caries increment. The LCA approach may capture some information that is missing from DMFSranked quintile groups, but is also heavily influenced by total DMFS, meaning that applying LCA in cumulative, highly age- determined diseases, such as caries, is a challenge.

Aim: To (i) evaluate structured postgraduate part-time programs in periodontology, including those addressing peri-implant diseases, among members of the European Federation of Periodontology (EFP), (ii) the impact of the 2018 classification scheme and EFP clinical practice guidelines and (iii) propose a framework for periodontal vocational education and training.

Materials and methods: A summary of relevant European guidelines for vocational education and training was compiled. In a survey and in a systematic review, current part-time programs in continuing professional education in periodontology as well as in prevention and management of peri-implant diseases were examined. The implementation and dissemination of the 2018 classification scheme and the EFP clinical practice guidelines were assessed by literature analysis. Based on these findings, a framework for periodontal vocational education and training was generated.

Results: Part-time programs for professional development in periodontology are established in nine EFP member countries. The systematic review identified lack of knowledge in prevention and management of peri-implant diseases among dental practitioners and hygienists. Continuing professional development was found to be important for education in prevention, classification and management of periodontal as well as peri-implant diseases. The proposed European framework consists of an escalator model with three levels (certificate, diploma and master).

Discussion: Considering the identified variation in the national programs, there is a need to improve education in periodontal and peri-implant diseases. The proposed frameworkmay will help harmonize the national structures.

Conclusion: The proposed framework for part-time professional development is expected to enhance professional qualification.

Objectives: to compare saliva proteome of patients before treatment of head and neck cancer and six months post-treatment with controls.

Design: Five dentate patients and five age and gender-matched controls were included. The stimulated salivary secretion rate was determined, and saliva was stored at −80 °C. After thawing, 30 mg of each sample and a reference (aliqouts of all samples) was trypsin digested. The digested peptides were analyzed by mass spectrometry. The relative abundances were transformed to log2 and significant differences determined. Relative abundances of mucins were compared with patient's problems with dry mouth, sticky saliva and swallowing. Data are available via ProteomeXchange with identifier PXD047500.

Results: 966 proteins with ≥2 unique peptides were found. Compared with controls, 30 proteins were found in significantly lower relative abundances and 65 in higher at pre-treatment and 38 proteins in significantly lower relative abundances and 34 proteins in higher post-treatment. Regarding proteins from the salivary glands, a significantly lower relative abundance of Cystatins was detected pre-treatment and significantly lower relative abundances of Cystatin, Cysteine-rich secretory protein 3, Lactoperoxidase, Prolactin-inducible protein and Proline-rich protein 4 post-treatment. No clear relation between relative abundance of mucins and dry mouth, sticky saliva and problems with swallowing was detected.

Conclusion: Decreases in several salivary gland proteins post cancer treatment might lead to a reduced defense against oral disorders. Knowledge about changes in saliva proteins in connection with oral cancer treatment is important for planning dental care for these patients.

Avhandlingen undersöker orala biofilmers syratolerans (AT) och hur denna egenskap påverkas av ändringar i den omgivande miljön. Detta för att närmare första de fenotypiska förändringar som de orala bakterierna genomgår under kariesutveckling.

I delarbete I analyseras hur växt i biofilm och närvaro av salivproteiner påverkar 5 orala bakteriearters AT samt deras förmåga att utveckla en ATR. Resultaten av studien visar att adhesion till en yta, närvaro av salivprotein och pH-förändringar i den omgivande miljön kan bidra till höga nivåer av syratolerans hos orala bakterier.

I delarbete II undersöks kliniska plackprover från barn med hög kariesaktivitet med plackprover från barn utan tecken på kariesaktivitet, vad gäller bakteriernas AT, kolhydratmetabolism och inbördes komposition. Skillnader i produktionen av organiska syror och bakteriell komposition kunde ses mellan de två grupperna och signifikant högre nivåer av AT visades i plackprover från barnen med hög kariesaktivitet.

I delarbete III, undersöktes effekten av probiotiska bakterier på orala arters AT. Resultaten av studien visar att närvaro av den probiotiska arten L. reuteri PTA5289 inhiberade utvecklingen av en ATR hos de orala arterna och ledde till en nedreglering av tre gener involverade i ATR.

Resultaten i denna avhandling indikerar att många orala arter kan uppnå höga nivåer av syratolerans och att denna egenskap kan påverkas av signaler i den omgivande miljön. AT hos orala biofilmer kan därför vara ett framtida fokusområde vid utvecklingen av nya prediktiva biomarkörer och terapeutiska interventioner för karies.

Aim: To explore the context in which general dental practitioners (GDPs) decide to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with persistent asymptomatic apical periodontitis (PAAP).

Methodology: Fifteen GDPs were strategically selected for in-depth interviews. The informants were encouraged to describe in their own words and in as much detail as possible, the three most recent patient cases of PAAP of a root canal filled tooth, in which they decided to refrain from further treatment. The interviews were recorded digitally and transcribed verbatim. The collected material was analysed according to Qualitative Content Analysis with an inductive approach.

Results: A pattern of varying degrees of uncertainty associated with the decision process was identified. The motives to refrain intervention had great diversity. The result from analysis of the qualitative data was formulated in an overall theme 'Between doubt and certainty in a complex clinical context' covering the latent content. The first main category covering the manifest content was 'The continuum of confidence' with three subcategories 'Experienced uncertainty', 'Reluctant approval' and 'At ease with refraining' illustrating the feelings and attitudes experienced by the informants. The second category was 'In support of acceptance' with three subcategories 'Patient's autonomy, risks and cost-benefits', 'Emotional aspects' and 'Relieving measures' representing the reasons for refraining from intervention.

Conclusions: The decision to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with PAAP was made with some measure of confidence, combined with compensatory strategies to support the decision, taking into account not only values beneficial to the patient and awareness of limited external resources, but also factors related to the informants' personal preferences, convenience, concerns, ambition and emotions.

Introduction: During development of dental caries, oral biofilms undergo changes in microbial composition and phenotypical traits. The aim of this study was to compare the acid tolerance (AT) of plaque from two groups of children: one with severe caries (CA) and one with no caries experience (CF) and to correlate this to the microbial composition and metabolic profile of the biofilms.

Methods: Dental plaque samples from 20 children (2–5 years) in each group were studied. The AT was analyzed by viability assessment after exposure to an acid challenge (pH 3.5), using LIVE/DEAD® BacLight™ stain and confocal microscopy. Levels of acid tolerance (AT) were evaluated using a scoring system ranging from 1 (no/low AT), to 5 (high/all AT). Metabolic profiles were investigated following a 20 mM glucose pulse for one hour through Nuclear Magnetic Resonance (NMR). Microbial composition was characterized by 16S rRNA Illumina sequencing.

Results: The mean AT score of the CA group (4.1) was significantly higher than that of the CF group (2.6, p < 0.05). When comparing the end-products of glucose metabolism detected after a glucose-pulse, the CA samples showed a significantly higher lactate to acetate, lactate to formate, lactate to succinate and lactate to ethanol ratio than the CF samples (p < 0.05). The bacterial characterization of the samples revealed 25 species significantly more abundant in the CA samples, including species of Streptococcus, Prevotella, Leptotrichia and Veillonella (p < 0.05).

Discussion: Our results show that AT in pooled plaque from the oral cavity of children with severe caries is increased compared to that in healthy subjects and that this can be related to differences in the metabolic activity and microbial composition of the biofilms. Thus, the overall phenotype of dental plaque appears to be a promising indicator of the caries status of individuals. However, longitudinal studies investigating how the AT changes over time in relation to caries development are needed before plaque AT could be considered as a prediction method for the development of dental caries.

Objectives The aim of this cross-sectional survey was to assess oral health, including prevalence of periodontitis and rate of tooth loss, in a Swedish cohort of patients with inflammatory bowel disease (IBD). Methods A questionnaire on general anamnestic and socio-economic aspects, IBD diagnosis, and various oral health aspects was distributed online. The analyses focused on the comparison between patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) as well as on factors associated with self-reported severe periodontitis and tooth loss. Results Analyses were based on answers from 786 patients; 415 with UC, 371 with CD, 74% female. In both disease entities, high prevalence of severe periodontitis (i.e., 38.5%) was reported, and about 19% of the population had less than 20 remaining teeth and 6.5% a poor oral health-related quality of life. CD patients tended to be more severely affected than UC patients (p > 0.05 in the adjusted analysis). Almost 90% of CD patients were aware of being entitled to a bi-annual governmental financial support for dental care due to IBD; however, 1 out of 4 UC patients did not. Furthermore, IBD patients largely believe that the interest of their physicians in any oral lesions due to IBD diagnosis is low. Conclusions Severe periodontitis and high rate of tooth loss are frequent in Swedish IBD patients. Clinical relevanceEven though IBD patients receive bi-annually some special financial support for dental care, it seems this is still not sufficient and more preventive measures appear necessary.

Magnesium (Mg) - based alloys are becoming attractive materials for medical applications as temporary bone implants for support of fracture healing, e.g. as a suture anchor. Due to their mechanical properties and biocompatibility, they may replace titanium or stainless-steel implants, commonly used in orthopedic field. Nevertheless, patient safety has to be assured by finding a long-term balance between metal degradation, osseointegration, bone ultrastructure adaptation and element distribution in organs. In order to determine the implant behavior and its influence on bone and tissues, we investigated two Mg alloys with gadolinium contents of 5 and 10 wt percent in comparison to permanent materials titanium and polyether ether ketone. The implants were present in rat tibia for 10, 20 and 32 weeks before sacrifice of the animal. Synchrotron radiation-based micro computed tomography enables the distinction of features like residual metal, degradation layer and bone structure. Additionally, X-ray diffraction and X-ray fluorescence yield information on parameters describing the bone ultrastructure and elemental composition at the bone-to-implant interface. Finally, with element specific mass spectrometry, the elements and their accumulation in the main organs and tissues are traced. The results show that Mg-xGd implants degrade in vivo under the formation of a stable degradation layer with bone remodeling similar to that of Ti after 10 weeks. No accumulation of Mg and Gd was observed in selected organs, except for the interfacial bone after 8 months of healing. Thus, we confirm that Mg-5Gd and Mg-10Gd are suitable material choices for bone implants.

BackgroundEvidence on how persons with and in remission from an eating disorder experience their oral health is limited. Dental treatment in Sweden today is often postponed until medical rehabilitation has been completed, but this carries risks. For the patient, the risk is severely impaired oral health and additional suffering, and for both society and the patient, higher costs than might have been necessary.MethodsTen female informants aged 21-51 years (mean age = 36.7, standard deviation 12.7) in remission from an eating disorder with a median duration of 12.5 (range 4-25) years of illness, were questioned in semi-structured interviews about their perceptions of oral health. All participants had been referred to a specialist dental clinic and needed oral rehabilitation. 10% of the patients had been diagnosed with anorexia nervosa and 90% with bulimia nervosa. All had been in remission from the eating disorder for at least one year. Transcripts of the interviews were analyzed with thematic analysis using an inductive approach.ResultsOne overarching theme emerged from the analysis: dental damage persisted as a visible, lingering scar during remission of the eating disorder, reminiscent of the disease and its consequences. The three major themes identified were (1) Physical impact, (2) Psychological impact, and (3) Impact on daily living. The first major theme included erosive tooth wear and impaired oral function and aesthetics. Interviewees described the second as feelings of stigma, guilt, shame, anxiety, and worry, in particular concerning self-inflicted dental damage through self-induced vomiting. The last major theme covered avoidance strategies such as limiting smiling and laughing and minimizing social situations such as eating with others, pursuing a wanted career, and meeting a partner.ConclusionsThe participants in this study expressed a profound negative impact on daily life and a two-fold burden of stigma of having suffered from both an eating disorder and poor oral health. Research has established a link between eating disorders and poor oral health, such as erosive tooth wear. One knowledge gap, however, is how patients with and after recovery from an eating disorder experience their oral health. In Sweden, dental treatment is often postponed until after medical rehabilitation, but this carries risks. For the patient, the risk is severely impaired oral health and additional suffering, and for both society and the patient, higher costs than might have been necessary. The self-reports of the patients in their interviews witnessed to their suffering from two sources: the diagnosis of a mental disorder and poor oral health. Many reported feelings of stigma, shame, and guilt over, for example, self-induced vomiting, which was a predominant factor in dental damage. Tooth damage emerged as a visible, lingering scar that reminded the patient of the disease long after remission.

This paper presents a novel approach to predict caries development in dental patients by analyzing event interval sequences extracted from electronic health records (EHRs). Leveraging a subset of the SKaPa dataset, comprising 1,500 patients aged 30 to 70, and encompassing 14,870 tooth-wise event interval sequences, our method surpasses baseline models and state-of-the-art deep learning approaches. By assessing temporal relations between event intervals and utilizing interpretable classification models such as decision trees (DTs) and random forests (RFs), our approach achieves higher recall rates and area under the precision-recall curve (AUPRC) scores in identifying cases of caries development. Notably, our methods demonstrate superior performance in learning the minority class (i.e., caries development), underscoring the effectiveness of the event interval representation in capturing predictive features. These findings underscore the potential of our approach to improve caries prognosis and enable targeted interventions in dental healthcare.

This commentary introduces the new Graduating European Dentist Curriculum Domain V-'Research', and outlines the international multi-stakeholder development and consultation process that was undertaken in order to develop the new Domain.

OBJECTIVE: This study investigated oral health status in 60-year-old individuals over 12 years.

MATERIALS AND METHODS: Data were obtained from The Swedish National Study on Aging and Care (SNAC). One hundred nineteen 60-year-old individuals (48% females) underwent a clinical and radiographic baseline examination (2001-2003) and follow-up examination in 2013-2015. For statistical analyses, paired t-tests and McNemar's test were performed. Statistical significance was determined at p < 0.05.

RESULTS: At the 12-year follow-up, the mean number of teeth and the proportion of individuals having ≥ 20 teeth decreased (p < 0.001). The mean number of teeth with buccal/lingual and approximal caries lesions increased (p < 0.029 and p < 0.031). Individuals with a distance from the cement-enamel junction to the bone of ≥ 5 mm increased in total (p < 0.002) and in males (p < 0.006). The prevalence of gingivitis increased in total (p < 0.001). The prevalence of periodontitis showed a significant increase in total (p < 0.043) and in females (p < 0.039).

CONCLUSION: The present study indicates that oral health status in 60-year-old individuals deteriorates over 12 years. However, the deteriorations were minor in terms of tooth loss, caries lesions, and changes in periodontal status.

Medication can affect the gut microbiota composition and function. The aim of this study was to investigate connections between use of common non-antibiotic medicines and the gut microbiota composition and function in a large Swedish cohort (N = 2223). Use of 67 medications and polypharmacy (≥ 5 medications), based on self-reported and prescription registry data, were associated with the relative abundance of 881 gut metagenomic species (> 5% prevalence) and 103 gut metabolic modules (GMMs). Altogether, 97 associations of 26 medications with 40 species and of four medications with five GMMs were observed (false discovery rate < 5%). Several earlier findings were replicated like the positive associations of proton pump inhibitors (PPIs) with numerous oral species, and those of metformin with Escherichia species and with lactate consumption I and arginine degradation II. Several new associations were observed between, among others, use of antidepressants, beta-blockers, nonsteroidal anti-inflammatory drugs and calcium channel blockers, and specific species. Polypharmacy was positively associated with Enterococcus faecalis, Bacteroides uniformis, Rothia mucilaginosa, Escherichia coli and Limosilactobacillus vaginalis, and with 13 GMMs. We confirmed several previous findings and identified numerous new associations between use of medications/polypharmacy and the gut microbiota composition and functional potential. Further studies are needed to confirm the new findings.

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.

Background: Neuroplasticity induced by mandibular advancement appliance (MAD) in patients with obstructive sleep apnoea (OSA) is poorly documented.

Objective: This randomised placebo-controlled crossover mechanistic study assessed the effects of short-term use of a MAD on corticomotor excitability of the masseter and tongue in patients with OSA.

Methods: Adults (n = 28) with mild or moderate OSA were randomly allocated to sleep with a MAD for 2-weeks with 40% of the maximal protrusion (MAD active position) and without any jaw protrusion (MAD placebo position). The outcomes were assessed at baseline, and after 2 and 6 weeks, with a 2-week washout period. The primary outcome was the amplitude of motor evoked potential (MEP) assessed on the right masseter, right side of tongue and right first dorsal interosseous with transcranial magnetic stimulation. Corticomotor map volume of the same muscles was also assessed. Repeated-measures ANOVAs followed by Tukey test were applied to the data (p < .050).

Results: There was a significant increase in the MEP amplitude of the masseter and tongue following the MAD active position compared with the baseline and MAD placebo (Tukey: p < .001). There were no significant MEP amplitude differences between the baseline and placebo positions (p > .050). Moreover, there was a significant increase in corticomotor map volume for the masseter and tongue muscles following the MAD active position compared with baseline and MAD placebo (Tukey: p < .003).

Conclusion: Excitability of the masseter and tongue motor pathways is, at least transiently, increased in patients with OSA following a short-term use of MAD. This novel finding of MAD-induced neuroplasticity in corticomotor pathways may contribute to a further understanding of the mechanisms of oral appliances for treating OSA.

Background/aim: Alveolar bone process fractures in preschool children are not well documented in the literature. Alveolar process fractures are located very close to primary teeth and permanent tooth germs. This study investigates the risk of healing complications following alveolar process fractures in the primary dentition and potential sequelae in the permanent dentition.

Materials and methods: A retrospective cohort study was conducted involving 21 patients with 49 primary teeth involved in an alveolar fracture. The follow-up protocol included clinical and radiographic examinations at specified intervals up to the age of 6 years. Healing complications in the primary teeth such as pulp necrosis, pulp canal obliteration, ankylosis, infection-related resorption and premature tooth loss were examined. Sequelae in the permanent dentition was also registered when the permanent incisors had erupted.

Results: Over a 3-year follow-up, the incidence of premature tooth loss was 51.2% [95% CI: 34.1%-68.4%], pulp canal obliteration was 42.5% [95% CI: 27.1%-57.8%], and pulp necrosis was 8.9% [95% CI: 0.6%-17.3%] following an alveolar process fracture. No cases of ankylosis were observed. Sequelae in the permanent dentition primarily included demarcated opacities and hypoplasia with a risk estimated at 24% [95% CI: 13%-39%] and 9% [95% CI: 2%-21%] respectively.

Conclusion: Alveolar process fractures in primary dentition are associated with several healing complications in the primary teeth. Although the likelihood of severe complications in the permanent dentition is low, young children are still susceptible to developing sequelae in their permanent teeth. These results highlight the importance of awareness of dental injuries following alveolar process bone fractures in the primary dentition.

The Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) 2024 guidelines are based on the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines and the Clinical and Laboratory Images in Publications (CLIP) principles, with the addition of items specifically related to endodontics. The use of the PRIDASE 2024 guidelines by authors and their application by journals during the peer review process will reduce the possibility of bias and enhance the quality of future diagnostic accuracy studies. The PRIDASE 2024 guidelines consist of a checklist containing 11 domains and 66 individual items. The purpose of the current document is to provide an explanation for each item on the PRIDASE 2024 checklist, along with examples from the literature to help readers understand their importance and offer advice to those developing manuscripts. A link to the PRIDASE 2024 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (https://pride-endodonticguidelines.org/pridase/) and on the International Endodontic Journal website (https://onlinelibrary.wiley.com/page/journal/13652591/homepage/pride-guidelines.htm).

INTRODUCTION: Prospective studies assessing the relation between endodontic inflammatory disease and subsequent cardiovascular events are few. The present aim was to explore associations between endodontic variables and future cardiovascular events in patients with myocardial infarction and matched controls participating in the PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study.

METHODS: Eight-hundred five patients hospitalized for a first myocardial infarction and 805 controls were recruited between 2010 and 2014. Signs of endodontic inflammatory disease were assessed in panoramic radiographs taken at baseline. Mortality and morbidity data during the approximately 8 years of follow up were obtained from national registries. The risk for future cardiovascular events (first of mortality and nonfatal myocardial infarction, stroke, or hospitalization for heart failure) was analyzed with the log-rank test and Cox proportional hazards regression adjusted for the following confounders: sex, age, smoking, myocardial infarction, diabetes, education, marital status, family history of cardiovascular disease, and marginal periodontitis.

RESULTS: In total, 285 future events were observed during the follow-up period. Unadjusted analyses revealed that ≥1 root-filled tooth increased the risk of a future event. After adjustment, the number of remaining teeth and non-root-filled teeth decreased the risk of future events, whereas a higher Decayed, Missing and Filled Teeth score increased the risk and ≥1 primary apical periodontitis decreased the risk of suffering cardiovascular events. A higher Decayed, Missing and Filled Teeth score and decayed teeth increased the risk of all-cause mortality.

CONCLUSIONS: Tooth loss is a strong indicator of an increased risk for future cardiovascular events. Root-filled teeth seem of limited value as a risk indicator when accounting for other risk factors. The potential effect of dental interventions on future events should be assessed in future research.

Objective: To present a list of key points for good Temporomandibular Disorders (TMDs) clinicalpractice on behalf of the International Network for Orofacial Pain and Related DisordersMethodology (INfORM) group of the International Association for Dental, Oral and CraniofacialResearch (IADR).Methods: An open working group discussion was held at the IADR General Session in New Orleans(March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points.Results: The key points covered knowledge on the etiology, diagnosis, and treatment. Theyrepresent a summary of the current standard of care for management of TMD patients. They arein line with the current need to assist general dental practitioners advance their understanding andprevent inappropriate treatment.Conclusions: The key points can be viewed as a guiding template for other national and interna-tional associations to prepare guidelines and recommendations on management of TMDs adaptedto the different cultural, social, educational, and healthcare requirements.

BackgroundLarge variation in the prevalence of ankylosis and replacement resorption (ARR) is reported in the literature and most studies have relatively small patient numbers. The present retrospective study aimed to provide an overview on prevalence, location of, and associated risk factors with ARR based on a large sample of computed tomography (CT) / cone beam computed tomography (CBCT) scans of impacted teeth. The results should allow clinicians to better estimate the risk of ARR at impacted teeth.MethodsThe CT/CBCT scans of 5764 patients of a single center in Central Europe were screened with predefined eligibility criteria. The following parameters were recorded for the finally included population: gender, age, tooth type/position, number of impacted teeth per patient, and presence/absence of ARR. For teeth with ARR the tooth location in reference to the dental arch, tooth angulation, and part of the tooth affected by ARR were additionally registered.ResultsAltogether, 4142 patients with 7170 impacted teeth were included. ARR was diagnosed at 187 impacted teeth (2.6%) of 157 patients (3.7%); 58% of these patients were female and the number of teeth with ARR per patient ranged from 1 to 10. Depending on the tooth type the prevalence ranged from 0 (upper first premolars, lower central and lateral incisors) to 41.2% (upper first molars). ARR was detected at the crown (57.2%), root (32.1%), or at both (10.7%). After correcting for confounders, the odds for ARR significantly increased with higher age; further, incisors and first/second molars had the highest odds for ARR, while wisdom teeth had the lowest. More specifically, for 20-year-old patients the risk for ARR at impacted incisors and first/second molars ranged from 7.7 to 10.8%, but it approximately tripled to 27.3-35.5% for 40-year-old patients. In addition, female patients had significantly less often ARR at the root, while with increasing age the root was significantly more often affected by ARR than the crown.ConclusionARR at impacted teeth is indeed a rare event, i.e., only 2.6% of 7170 impacted teeth were ankylosed with signs of replacement resorption. On the patient level, higher age significantly increased the odds for ARR and on the tooth level, incisors and first/second molars had the highest odds for ARR, while wisdom teeth had the lowest.

Introduction: Streptococcus pneumoniae (the pneumococcus) effectively colonizes the human nasopharynx, but can migrate to other host sites, causing infections such as pneumonia and sepsis. Previous studies indicate that pneumococci grown as biofilms have phenotypes of bacteria associated with colonization whereas bacteria released from biofilms in response to changes in the local environment (i.e., dispersed bacteria) represent populations with phenotypes associated with disease. How these niche-adapted populations interact with immune cells upon reaching the vascular compartment has not previously been studied. Here, we investigated neutrophil, monocyte, and platelet activation using ex vivo stimulation of whole blood and platelet-rich plasma with pneumococcal populations representing distinct stages of the infectious process (biofilm bacteria and dispersed bacteria) as well as conventional broth-grown culture (planktonic bacteria). Methods: Flow cytometry and ELISA were used to assess surface and soluble activation markers for neutrophil and monocyte activation, platelet-neutrophil complex and platelet-monocyte complex formation, and platelet activation and responsiveness. Results: Overall, we found that biofilm-derived bacteria (biofilm bacteria and dispersed bacteria) induced significant activation of neutrophils, monocytes, and platelets. In contrast, little to no activation was induced by planktonic bacteria. Platelets remained functional after stimulation with bacterial populations and the degree of responsiveness was inversely related to initial activation. Bacterial association with immune cells followed a similar pattern as activation. Discussion: Differences in activation of and association with immune cells by biofilm-derived populations could be an important consideration for other pathogens that have a biofilm state. Gaining insight into how these bacterial populations interact with the host immune response may reveal immunomodulatory targets to interfere with disease development.

BACKGROUND AND AIM: The study 'Periodontitis and Its Relation to Coronary Artery Disease' (PAROKRANK) reported an association between periodontitis (PD) and the first myocardial infarction (MI). This follow-up study aims to test the hypothesis that those with PD-compared to periodontally healthy individuals-are at increased risk for cardiovascular (CV) events and death.

METHODS: A total of 1587 participants (age <75 years; females 19%) had a dental examination including panoramic radiographs between 2010 and 2014. PD was categorized as healthy (≥80% alveolar bone height), mild/moderate (79%-66%) or severe (<66%). A composite CV event (first of all-cause death, non-fatal MI or stroke and hospitalization following to heart failure) was investigated during a mean follow-up period of 9.9 years (range 0.2-12.5 years). Participants were divided into two groups: those with and without PD. The primary event rate, stratified by periodontal status at baseline, was calculated using the Kaplan-Meier method and Cox regression.

RESULTS: The number of events was 187 in the 985 periodontally healthy participants (19%) and 174 in the 602 participants with PD (29%; p < 0.0001). Those with PD had a higher likelihood for a future event (hazard ratio [HR] = 1.26; 95% CI: 1.01-1.57; p = 0.038), following adjustment for age, smoking and diabetes.

CONCLUSION: The PAROKRANK follow-up revealed that CV events were more common among participants with PD, which supports the assumption that there might be a direct relation between PD and CV disease.

Introduction: Widening participation in education by including students from underrepresented groups has been recognized as important for the last decade. During the recent pandemic, the interest in how to make students from different backgrounds feel part of the university, and connected to their studies and peers, has become an even more widespread concern and therefore important to explore further.

The aim of our study was to develop a conceptual model for educational design to support student engagement and participation, by exploring pedagogical aspects recognized as being valuable during widening participation initiatives.

Methods: We used meta-ethnography following the recommended seven steps: getting started, developing a search strategy, reading and assessing the quality of the papers, analyzing how the different studies related to each other based on the interpretation of quotations of the informants (first order) and the researchers of the articles (second order), translating the meaning of the studies, developing a line of argument, and finally developing a conceptual model to express the synthesis. Three databases we used: PubMed, ERIC, and Scopus; the PRISMA workflow was used.

Results: Six articles with a qualitative approach were included. A conceptual model was developed with the theme ‘Scaffolding Strategies’ and four sub-themes: Academic Support, Social Interaction, Processing Expectations and Clarifying Learning Progress.

Conclusion: We developed a conceptual model from previous studies that entailed aspects of particular importance to support widening participation. By using scaffolding strategies in course design, teachers and students may collectively improve the learning environment to promote widening participation, through clear instructions and frequent interaction, communication and calibration of expectations, clarification of learning processes and progress, and support for academic-skills development. Furthermore, the importance of using academic support and social interaction between students and teachers early on, to encourage students to explore how to become an independent learner, is highlighted.

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.

Objective: This study aimed to evaluate the effect of orthognathic surgery on quality of life among Swedish patients. Materials and Methods: Patients subjected to orthognathic surgery due to dentofacial deformity (DFD) and registered in the National Register of Orthognathic Surgery (NROK) in Sweden between 2017 and 2020 were eligible for inclusion in this study. The Swedish-validated Orthognathic Quality of Life Questionnaire (S-OQLQ) was used to evaluate patient quality of life before and after surgery. The S-OQLQ measured each patient's subjective experience regarding social aspects. Results: Eighty-four participants were included in this cohort study, including 45 men (mean age 24.7 years), 48 women (mean age 23.4 years), and eight patients who stated no gender. Women generally graded several aspects of the S-OQLQ higher than men, including facial aesthetics p = 0.029), oral function (p < 0.001), and awareness of facial deformity (p = 0.0054). For all domains of the questionnaire (social, facial aesthetics, function, and awareness), a significant improvement was seen 6-24 months after surgery (p < 0.001). Women rated improvement of function and awareness of facial deformity higher than men (p < 0.001 and p = 0.039, respectively). Conclusion: Quality of life aspects of orthognathic surgery have a strong impact on the treatment outcome. Although functional impairment is often considered a major indication for surgery, the social and aesthetic influence of DFD is highly rated by patients, whereas pain is not an issue before or after treatment.

Malocclusion is a common condition in children and adolescents with a worldwide prevalence of 56%. It is estimated that approximately 30% of Swedish children and adolescents undergo orthodontic treatment at specialist clinics under Sweden’s free comprehensive dental care for children and young patients, with crowded and displaced teeth being one of the main reasons. One of the treatments used to align teeth is placing fixed appliances with brackets on the teeth. The beneficial effects of the treatment include well-aligned teeth and healthy, stable occlusion. However, every orthodontic treatment entails a risk of adverse effects such as external root resorption and pain. In recent decades, a technique that uses passive self-ligating brackets has gained in popularity. This technique is said to generate less frictional resistance, more physiological tissue response and reduced adverse effects compared to conventional techniques. According to a Cochrane report from 2021, the current evidence is sparse regarding fixed appliance treatment in general, and specifically for the treatment effect of passive self-ligating brackets compared to conventional bracket systems in the treatment of crowded teeth in children. 

Radiographic examinations before, during and after the treatment are recommended to monitor the risk of severe external root resorption. The recommendations given in textbooks and scientific articles are contradictive as different check-up intervals and radiographic modalities are recommended. Moreover, the grounds for the recommendations are weak, and due to radiation doses and the ALADA (“as low as diagnostically acceptable”) principle, it may not be justifiable for all patients. 

The CROWDIT (Crowded Displaced Teeth) project was started to decrease knowledge gaps concerning fixed appliance treatment of adolescents with crowded and displaced teeth, from the perspective of patients, clinicians and society. The overall aim of this thesis was to present a systematic, comprehensive evaluation of external apical root resorption and pain levels across various treatment phases during the orthodontic treatment of adolescents with crowded and displaced teeth. These evaluations were based on an RCT (Randomized Clinical Trial) consisting of treatments performed without extractions using either passive self-ligating or conventional bracket systems. 

The first study of the thesis was a systematic review aimed at evaluating the scientific evidence and identifying knowledge gaps concerning external root resorption. During the preparatory work for the systematic review, no appropriate tool was found to assess the risk of bias in studies of adverse effects associated with orthodontic treatment. For this reason, a tool was designed to assess that risk of bias.

The tool and its application in a systematic review identified knowledge gaps and highlighted issues concerning the planning, conducting and reporting of studies. Based on this new knowledge, a methodological study was carried out of reliability and agreement in root length measurements, and two randomized controlled trials were conducted investigating external apical root resorption and pain.

We expect that the outcomes of this thesis and the further studies planned as part of the CROWDIT project will decrease the knowledge gaps and that the results will be integrated into the national guidelines for orthodontic treatment. We anticipate that the outcomes will thereby influence future oral healthcare so that the treatment of adolescents with crowded and displaced teeth using fixed appliances will be supported by scientific evidence.

This thesis was thus based on the following studies:

Paper I: Development of a tool for assessing the risk of bias was developed and applied in a systematic review to answer the following questions:

·          What frequencies and severities of external root resorption have been reported?

·          Is frequency and severity of external root resorption related to the patient’s age, sex, malocclusion or type of appliance?

Paper II: A methodological study that aimed to investigate:

·          The inter-rater and intra-rater reliability and agreement for measurements of the root length of all teeth from incisors to molars using multiplanar reconstruction in CBCT examinations during different phases of orthodontic treatment in adolescents with fixed appliances.

Paper III: Originated from a multi-centre RCT that aimed to investigate: 

·          The frequency and severity of external apical root resorption identified through CBCT examinations obtained before treatment, after levelling of the teeth and insertion of the first 0.019 x 0.025 stainless steel archwire, and after treatment using either passive self-ligating or conventional fixed appliance systems. A further aim was to assess the results in relation to the most affected tooth groups, the time required for levelling, the duration of the 0.019 x 0.025 stainless steel archwire, total treatment time, differences in sex and initial irregularity of teeth.

·          The relevance of intermediate radiography for the early detection of severe or extreme external apical root resorption. 

Paper IV: Originated from a multi-centre RCT that aimed to investigate:

·          Self-reported pain levels across various treatment phases for patients using passive self-ligating or conventional bracket systems.

·          Pain levels in relation to sex, initial archwire dimension, intake of analgesics, degree of displacement of the anterior teeth and impact on everyday activities.

Key findings of Paper I:

·          External root resorption of ≥ 2 mm varied across studies by between 10% and 29% for maxillary incisors. 

·          Data concerning external root resorption as related to patients’ age sex, malocclusion, and type of treatment was contradictory

·          The quality of the evidence, evaluated according to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, was low due to study limitations, imprecision and inconsistency of study results.

Key findings of Paper II

·          CBCT using MPR is a reproducible method for measuring root length during different phases of orthodontic treatment. 

·          Root shortening of ≤ 2 mm measured by CBCT using MPR, for clinical or research purposes, should be interpreted with caution as it may represent a measurement error.

Key findings of Paper III

·          The mean external apical root resorption in mm for upper incisors was 0.20 in the passive self-ligating group and 0.51 in the conventional group, while the corresponding proportion of roots with clinically relevant EARR (≥ 2 mm) was 5.0% and 7.2% respectively.

·          None of the variables treatment time, sex or initial irregularity of teeth could significantly predict the mean external apical root resorption of the upper incisors.

·          It would appear that the relevance of intermediate radiographic examination is negligible for the early detection of severe external apical root resorption.

Key findings of Paper IV

·          Pain levels of 9 to 10 on a 10-point scale were reported from 21.8% of patients in the passive self-ligating group and 30.3% in the conventional group on the most painful day (NS). 

·          Statistically significant, lower mean pain scores and a lower intake of analgesics were reported in the passive self-ligating group than in the conventional group on the first days after bonding in both arches. 

·          After the insertion of the full-size stainless steel archwire, 40% of patients reported taking analgesics.

·          It was found that girls reported lower pain scores compared to boys.

Conclusions and clinical implications:There is a low quality of scientific evidence regarding external root resorption associated with orthodontic treatment with fixed appliances. 

Measurement of root length in CBCT images ia a reproducible method for measuring root length but measured values below 2 mm should be interpreted with caution as they may contain measurement errors.

The frequency and severity of external apical root resorption was generally low and similar for patients treated with passive self-ligating and conventional bracket systems.

Intermediate radiography may be avoided in an adolescent population with crowded teeth treated without extraction, which aligns with the ALADA principle and underlines the importance of individual indications for radiographic examinations and the minimization of radiation doses.

Patients treated with passive self-ligating brackets report lower pain levels and intake of analgesics compared to those treated with conventional bracket systems after treatment initiation. In general girls reported lower pain scores compared to boys.

It is important to inform the patients and their parents before treatment that pain levels are generally substantially high after bonding as well as after insertion of a full-size stainless steel archwire.