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Axtelius, Björn
Publications (10 of 45) Show all publications
Franzon, B., Moutakis, M., Axtelius, B., Åkerman, S. & Klinge, B. (2024). The relationship between practice ownership and follow-up of comprehensive dental care. A Swedish register study.. Acta Odontologica Scandinavica, 83, 151-159
Open this publication in new window or tab >>The relationship between practice ownership and follow-up of comprehensive dental care. A Swedish register study.
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2024 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, p. 151-159Article in journal (Refereed) Published
Abstract [en]

AIMS: The aims of this register study were:

  1. To study whether the type of ownership of the dental practice was correlated with the type of dental care provided, that is public versus private ownership and professional (dentist or dental hygienist) versus non-professional ownership.
  2. To study the extent of follow-up of patients who have undergone two types of treatments. 

MATERIAL & METHODS: Two types of dental care were defined in the two groups studied, periodontitis/peri-implantitis and comprehensive restorative/rehabilitation. All relevant treatment codes that fall under these definitions are noted when they are performed. Also, the follow-up of each treatment code is noted. Differences in dental and socioeconomic status over time and between regions were adjusted for. A drop-out analysis was performed.  Results: Dental practices owned by dentists or dental hygienists schedule follow-up appointments for patients who have undergone comprehensive restorative or rehabilitation dentistry more often than practices with other types of ownership. Dental practices owned by dentists or dental hygienists follow up patients with periodontitis and peri-implantitis less frequently.

CONCLUSION: Type of ownership of a dental business influences the extent to which periodontal, and comprehensive restorative or rehabilitation dentistry were followed up.

Place, publisher, year, edition, pages
Medical Journals Sweden, 2024
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66940 (URN)10.2340/aos.v83.40277 (DOI)38623771 (PubMedID)
Available from: 2024-04-26 Created: 2024-04-26 Last updated: 2024-04-26Bibliographically approved
Shmarina, E., Ericson, D., Åkerman, S. & Axtelius, B. (2022). Exploring salutogenic factors supporting oral health in the elderly. Acta Odontologica Scandinavica, 80(4), 241-251
Open this publication in new window or tab >>Exploring salutogenic factors supporting oral health in the elderly
2022 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, no 4, p. 241-251Article in journal (Refereed) Published
Abstract [en]

Aim To explore associations between salutogenic factors and selected clinical outcome variables of oral health in the elderly, combining Antonovsky's salutogenic theory and the Lalonde Health Field concept. Methods The subjects comprised 146 individuals, aged 60 years and older, who had participated in a population-based epidemiological study in Sweden, 2011-2012, using questionnaire and oral examination data. A cross-sectional analysis used the selected outcome variables, such as number of remaining teeth, DMFT-index and risk assessment, and salutogenic factors from the questionnaire, clustered into domains and health fields, as artifactual-material, cognitive-emotional and valuative-attitudinal. This selection was based on findings from our previous analysis using a framework cross-tabulating two health models. The purpose was to facilitate analysis of associations not previously addressed in the literature on oral health. Bivariate and Multiple Linear Regression analyses were used. Results Numerous salutogenic factors were identified. Significant associations between outcome variables and salutogenic factors previously unreported could be added. Regression analysis identified three contributing independent factors for 'low DMFT'. Conclusions This study supports the usefulness of a salutogenic approach for analysing oral health outcomes, identifying university education, the importance of dental health organization recall system and close social network, as important salutogenic factors. The large number of salutogenic factors found supporting oral health among the elderly indicates the complexity of salutogenesis and the need for robust analysing tools. Combining two current health models was considered useful for exploring these covariations. These findings have implications for future investigations, identifying important research questions to be explored in qualitative analyses.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Oral health, salutogenesis, observational study, social determinants of health, elderly
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-46767 (URN)10.1080/00016357.2021.1990995 (DOI)000710378500001 ()34693858 (PubMedID)2-s2.0-85118111543 (Scopus ID)
Available from: 2021-11-09 Created: 2021-11-09 Last updated: 2024-02-08Bibliographically approved
Sharma, S., Lövgren, A., Åkerman, S., Nilsson, P. M., Axtelius, B., List, T. & Häggman-Henrikson, B. (2021). Prevalence of Facial Pain and Headache in Sweden. The Journal of Oral & Facial Pain and Headache, 35(2), 139-+
Open this publication in new window or tab >>Prevalence of Facial Pain and Headache in Sweden
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2021 (English)In: The Journal of Oral & Facial Pain and Headache, ISSN 2333-0384 , E-ISSN 2333-0376 , Vol. 35, no 2, p. 139-+Article in journal (Refereed) Published
Abstract [en]

Aims: To compare the prevalence of facial pain and headache across various regions in Sweden. Methods: This study involved a comparison of cross-sectional questionnaire studies over a period of 10 years including 128,193 individuals and assessed facial pain, pain on function, and headache. Participants included (1) all Public Dental Service patients aged 16 to 90 years in Vasterbotten (n = 57,283) and Gavleborg (n = 60,900); and (2) random samples of residents in Kalmar (n = 3,560) and Skane (n = 6,450). Facial pain and pain on function were assessed for all participants, and headache was also assessed for participants in Kalmar and Skane. Descriptive statistics were used to estimate unadjusted prevalence estimates and demographic characteristics. Prevalence estimates were adjusted for age and sex using weighted distributions from the 2015 data in the Swedish population registry before comparisons across the regions. Results: Overall, the prevalence of facial pain and headache were significantly higher in female than in male participants (P<.01). The standardized prevalence of facial pain was 4.9% in Vasterbotten, 1.4% in Gavleborg, 4.6% in Kalmar, and 7.6% in Skane. For headache, the standardized prevalence was 18.9% in Kalmar and 21.3% in Skane. In Skane, individuals with facial pain had a 15-fold higher odds of headache than those without. Conclusion: In the present Swedish epidemiologic study, the prevalence of facial pain ranged from 1.4% in Gavleborg to 7.6% in Skane. Besides different sampling frames and other population characteristics, the presence of a high number of immigrants in Skane may account for some differences in pain prevalence across the Swedish regions.

Place, publisher, year, edition, pages
Quintessence, 2021
Keywords
facial pain, headache, prevalence, survey, temporomandibular disorders
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-44588 (URN)10.11607/ofph.2645 (DOI)000661872600007 ()34129659 (PubMedID)2-s2.0-85108247703 (Scopus ID)
Available from: 2021-07-07 Created: 2021-07-07 Last updated: 2024-02-05Bibliographically approved
Shmarina, E., Ericson, D., Åkerman, S. & Axtelius, B. (2021). Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde. Acta Odontologica Scandinavica, 79(3), 218-231
Open this publication in new window or tab >>Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde
2021 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, no 3, p. 218-231Article in journal (Refereed) Published
Abstract [en]

Objective The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde. Material and methods This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated. Results The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m(2)' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors. Conclusions The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Health field concept, oral health, oral health-related quality of life, salutogenesis
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-41095 (URN)10.1080/00016357.2020.1849790 (DOI)000619032000001 ()33596156 (PubMedID)2-s2.0-85101048255 (Scopus ID)
Available from: 2021-03-09 Created: 2021-03-09 Last updated: 2024-02-08Bibliographically approved
Gullberg, J., Lindh, C., Axtelius, B., Horner, K., Devlin, H. & Povlsen, L. (2020). Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists. Gerodontology, 37(2), 208-216
Open this publication in new window or tab >>Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists
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2020 (English)In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 37, no 2, p. 208-216Article in journal (Refereed) Published
Abstract [en]

Objective To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. Background Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. Materials and methods A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. Results From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. Conclusion Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
osteoporosis, primary dental care, qualitative study, risk assessment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:mau:diva-13809 (URN)10.1111/ger.12462 (DOI)000510949300001 ()32022322 (PubMedID)2-s2.0-85079056377 (Scopus ID)
Available from: 2020-03-18 Created: 2020-03-18 Last updated: 2024-06-17Bibliographically approved
Lira-Junior, R., Holmström, S. B., Clark, R., Zwicker, S., Majster, M., Johannsen, G., . . . Boström, E. A. (2020). S100A12 Expression Is Modulated During Monocyte Differentiation and Reflects Periodontitis Severity. Frontiers in Immunology, 11, Article ID 86.
Open this publication in new window or tab >>S100A12 Expression Is Modulated During Monocyte Differentiation and Reflects Periodontitis Severity
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2020 (English)In: Frontiers in Immunology, E-ISSN 1664-3224, Vol. 11, article id 86Article in journal (Refereed) Published
Abstract [en]

S100A12 is a calcium-binding protein of the S100 subfamily of myeloid-related proteins that acts as an alarmin to induce a pro-inflammatory innate immune response. It has been linked to several chronic inflammatory diseases, however its role in the common oral immunopathology periodontitis is largely unknown. Previous in vitro monoculture experiments indicate that S100A12 production decreases during monocyte differentiation stages, while the regulation within tissue is poorly defined. This study evaluated S100A12 expression in monocyte subsets, during monocyte-to-macrophage differentiation and following polarization, both in monoculture and in a tissue context, utilizing a three-dimensional co-culture oral tissue model. Further, we explored the involvement of S100A12 in periodontitis by analyzing its expression in peripheral circulation and gingival tissue, as well as in saliva. We found that S100A12 expression was higher in classical than in non-classical monocytes. S100A12 expression and protein secretion declined significantly during monocyte-to-macrophage differentiation, while polarization of monocyte-derived macrophages had no effect on either. Peripheral monocytes from periodontitis patients had higher S100A12 expression than monocytes from controls, a difference particularly observed in the intermediate and non-classical monocyte subsets. Further, monocytes from periodontitis patients displayed an increased secretion of S100A12 compared with monocytes from controls. In oral tissue cultures, monocyte differentiation resulted in increased S100A12 secretion over time, which further increased after inflammatory stimuli. Likewise, S100A12 expression was higher in gingival tissue from periodontitis patients where monocyte-derived cells exhibited higher expression of S100A12 in comparison to non-periodontitis tissue. In line with our findings, patients with severe periodontitis had significantly higher levels of S100A12 in saliva compared to non-periodontitis patients, and the levels correlated to clinical periodontal parameters. Taken together, S100A12 is predominantly secreted by monocytes rather than by monocyte-derived cells. Moreover, S100A12 is increased in inflamed tissue cultures, potentially as a result of enhanced production by monocyte-derived cells. This study implicates the involvement of S100A12 in periodontitis pathogenesis, as evidenced by increased S100A12 expression in inflamed gingival tissue, which may be due to altered circulatory monocytes in periodontitis.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2020
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-13820 (URN)10.3389/fimmu.2020.00086 (DOI)000512767600001 ()32082330 (PubMedID)2-s2.0-85079500771 (Scopus ID)
Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2024-06-17Bibliographically approved
Senneby, A., Neilands, J., Svensäter, G., Axtelius, B. & Rohlin, M. (2019). Threshold values affect predictive accuracy of caries risk assessment (ed.). Acta Odontologica Scandinavica, 77(4), 315-327
Open this publication in new window or tab >>Threshold values affect predictive accuracy of caries risk assessment
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2019 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 4, p. 315-327Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment. Material and methods: Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists’ risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds. Results: Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk. Conclusions: As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Acid tolerance, caries increment, likelihood ratios, microbiology, predictive accuracy
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15576 (URN)10.1080/00016357.2018.1564838 (DOI)000463338500001 ()30727798 (PubMedID)2-s2.0-85061086639 (Scopus ID)28590 (Local ID)28590 (Archive number)28590 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
Franzon, B., Englander, M., Axtelius, B. & Klinge, B. (2018). Dentistry as a free market in the context of leading policymaking (ed.). International Journal of Qualitative Studies on Health and Well-being, 13(1), Article ID 1484218.
Open this publication in new window or tab >>Dentistry as a free market in the context of leading policymaking
2018 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, article id 1484218Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to disclose the psychological meaning structure of dentistry as a free market within the context of leading Swedish policymaking. Following the criteria for the descriptive phenomenological psychological method data was collected from leading policy makers about the experiential aspects of dentistry as a free market within the context of a welfare state. The analysis showed that dentistry as a free market was experienced as a complex business relationship between buyers and sellers that transcended the traditional dentist and patient roles. The lived experience of the proposed business transaction was based on two inherently conflicting views: the belief in the individual's ability to make a free choice versus the understanding that all individuals in a society do not have the ability or the means necessary to make a free choice. Dentistry as a free market within a welfare state, such as Sweden, can thus be seen as a persistent attempt to hold on to a compromise between two very distinctive political ideologies.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
National Category
Dentistry
Research subject
Health and society; Health and society
Identifiers
urn:nbn:se:mau:diva-6904 (URN)10.1080/17482631.2018.1484218 (DOI)000435684100001 ()29912654 (PubMedID)2-s2.0-85056382732 (Scopus ID)26220 (Local ID)26220 (Archive number)26220 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-06-17Bibliographically approved
Franzon, B., Axtelius, B., Åkerman, S. & Klinge, B. (2017). Dental politics and subsidy systems for adults in Sweden from 1974 until 2016 (ed.). BDJ Open, 3(17007)
Open this publication in new window or tab >>Dental politics and subsidy systems for adults in Sweden from 1974 until 2016
2017 (English)In: BDJ Open, E-ISSN 2056-807X, Vol. 3, no 17007Article in journal (Refereed) Published
Abstract [en]

Aims: The dental health sector, as part of the Swedish welfare system, originated in 1974. Since then, the dental insurance has undergone three major changes. The aim of this archive study was to study where in the legislative process the dental politics concerning national dental insurance and subsidies were formed. Materials and Methods: The material, such as Commission of inquiry proposals and Government Bills from four major dental reforms, was collected from the library at the Sveriges Riksdag (Swedish Parliament) and was analysed and structured using a modified version of the Health Field Model. Results: The views on the fundamental ideas, such as the connection between general and dental health, preventive dentistry, rehabilitation of the mouth and promotion of dental health, were the same over the years. The views on dentistry as a market, when it comes to freedom of prices, have undergone a major change since 1974, but the view on the welfare state remains the same. Conclusions: The Swedish dental subsidy systems and how dentistry has been treated politically are the results of a chain of events ranging from care for the population's dental health, political doctrines, ‘zeitgeist‚, dental policy, to state finances.

Place, publisher, year, edition, pages
Nature Publishing Group, 2017
Keywords
Health care
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-5872 (URN)10.1038/bdjopen.2017.7 (DOI)29607078 (PubMedID)23697 (Local ID)23697 (Archive number)23697 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
Östergård, G.-B., Englander, M. & Axtelius, B. (2016). A salutogenic patient-centred perspective of improved oral health behaviour: a descriptive phenomenological interview study (ed.). International Journal of Dental Hygiene, 14(2), 142-150
Open this publication in new window or tab >>A salutogenic patient-centred perspective of improved oral health behaviour: a descriptive phenomenological interview study
2016 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 14, no 2, p. 142-150Article in journal (Refereed) Published
Abstract [en]

A salutogenic perspective was applied in the study when investigating the patient's perspective of what it means to move in the direction towards health in the treatment of periodontitis. Objectives The study aimed at describing the lived experience of improved oral health-related behaviour. Method The descriptive phenomenological method was chosen for collection and analysis of data. Patients were selected from a private general dental clinic. Results The results described the patient-centred perspective in the general structure held together by eight constituents: (i) change is increased successively, (ii) a changed view on self-care at the start of change, (iii) improved self-care includes understanding and automatic routine, (iv) motivating challenges and feedback are perceived as strengthening, (v) having good thoughts and being satisfied with one's own capacity, (vi) experiencing trust and participation along with an expert, (vii) negative experiences and limitations precedes the change and (viii) relating yourself to past time, present time, future and other people. Conclusion The complex pattern of interconnected external and internal components in the results calls for the need of a holistic perspective of the change process and for the clinician to practise flexibility.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
health promotion, oral health behaviour, patient's perspective, phenomenology, psychology, qualitative methods
National Category
Dentistry
Research subject
Health and society
Identifiers
urn:nbn:se:mau:diva-4523 (URN)10.1111/idh.12153 (DOI)000374351500009 ()26053305 (PubMedID)2-s2.0-84930608146 (Scopus ID)19510 (Local ID)19510 (Archive number)19510 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
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