Aims: Smoking increases the risk of developing severe diseases. However, the effects of snus are less known. We aimed to create a cohort on tobacco exposure by collecting data from the Swedish Public Dental Service. The cohort will be used to study even rare health outcomes of both smoking and snus.

Methods: In Sweden, 35% (2021) of the adult population and 85% (2021) of all children use the Public Dental Service. The dental practitioner asks about tobacco use and registers replies in patients’ records. We have now assembled a database of all available such data in the country and linked them to other national health and social registers, forming the Swedish Tobacco Cohort (SWETOC). SWETOC is hence a cohort with prospectively designed data collection.

Results: Out of all 21 regions in Sweden, 19 participated, and approximately 5.5 million unique individuals provided tobacco data. Registrations dated from 1994 to 2023. All participating regions provided data from at least 2015 and forward. Overall prevalence for smoking was 12%, and 13% for snus. More men used snus than women, and there were regional differences in tobacco use patterns. Gender distribution was around equal at all age levels. Some regions provided additional tobacco information such as amount and type of product used, willingness for tobacco cessation, and notes in free text.

Conclusions: SWETOC is a novel resource that can be used to close the current and future knowledge gaps regarding the health outcomes of smoked and smokeless tobacco.

Objective: The aim was to investigate associations between dental healthcare utilization and all-cause, cardiovascular (CVD), cancer, and other-cause mortality.

Materials and methods: A postal public health survey was distributed in the autumn of 2008 to a stratified random sample of the population aged 18–80 in Scania, southern Sweden (response rate 54.1%). Baseline survey data were linked to mortality data, creating a prospective cohort study with 8.3-year follow-up. The present study entails 26,115 respondents. Associations between dental healthcare utilization and mortality were investigated in survival analyses and analyses with a nested case–control design.

Results: In all, 68.4% had visited dental healthcare <1 year ago; 19.0%, 1–2 years ago; 6.7%, 3–5 years ago; 5.5%, >5 years ago; and 0.4%, never. The groups that had visited dental healthcare 1–2 years ago, 3–5 years ago, and >5 years ago displayed increased hazard ratios of all-cause mortality throughout the multiple- adjusted survival analyses compared to the <1-year reference group. Conditional logistic regression analyses with a nested case–control design confirmed results with a clearer gradient in all-cause mortality. CVD, cancer, and other-cause mortality showed some significant associations with dental healthcare utilization.

Conclusions: Dental healthcare utilization was associated with all-cause mortality, with a clear gradient in the nested case–control design.

PURPOSE: The aim of the study was to identify patient-specific and/or surgery-specific factors that may predict complications following orthognathic surgery, using data from the Swedish National Register of Orthognathic Surgery (NROK).

METHODS: In this retrospective register-based cohort study, data from NROK (2017-2020) was analyzed to identify risk factors for complications following single-jaw maxilla surgery, mandibular surgery, and bimaxillary surgery. Outcome data on postoperative infection (POI), removal of osteosynthesis material, re-operation, and persistent neurosensory disturbance (NSD) were collected 12-months postoperatively.

RESULTS: Among the 428 patients included in the study, 100 had single-jaw maxilla surgery, 130 had mandible surgery, and 198 had bimaxillary surgery. The site of surgery showed to be the main factor linked to postoperative complications after orthognathic surgery. Mandibular interventions and bimaxillary surgery increased the risk of POI, removal of osteosynthesis material and NSD more than three (3) times compared to maxillary surgery. For re-operation, there was no significant difference between the groups. Other factors associated with increased risk were overweight, age over forty, smoking, and no postoperative antibiotics.

CONCLUSION: Mandibular and bimaxillary procedures are associated with increased postoperative complication rates. Age, BMI, smoking, and antibiotic use should be considered in preoperative planning and postoperative care.

Aim: This study aimed to examine associations between separate malocclusion traits and oral health-related quality of life (OHRQoL) among adolescents with malocclusion. It also aimed to assess sex differences in OHRQoL and whether sex modified the associations between malocclusion traits and OHRQoL.

Methods: We conducted a multicenter cross-sectional study among adolescents aged 12–19 years. Two groups were recruited: a no malocclusion group from general dentistry clinics and a malocclusion group from specialist orthodontic clinics. The participants completed two OHRQoL instruments—the generic Child Perceptions Questionnaire (CPQ11–14 short form) and the orthodontic-specific Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Malocclusion was assessed based on intraoral photographs. Sociodemographic data were obtained from Statistics Sweden, and caries data from the national caries registry (SKaPa). Associations between malocclusion traits and OHRQoL were examined using linear regression models adjusted for confounders, with additional analyses of sex differences in OHRQoL and effect modification by sex.

Results: The final sample included 103 without malocclusion and 541 with malocclusion. After adjustment, anterior crowding was associated with poorer OHRQoL compared with other malocclusion traits in both instruments. Among those with malocclusion, females reported poorer OHRQoL than males, whereas no sex differences were observed in the no malocclusion group. In the sex-stratified analyses, associations between separate malocclusion traits and OHRQoL were largely similar across sexes.

Conclusions: Anterior crowding shows the strongest association with poorer OHRQoL. Females with malocclusion report poorer OHRQoL than males, but there is limited evidence of sex modifying associations between separate malocclusion traits and OHRQoL.

Registration: ClinicalTrials.gov on 02 Sept 2021 (registration number: NCT05038865).

Objectives: The oral fine motor control is compromised in patients with full-arch, bimaxillary bridges compared to those with natural teeth. No previous studies have examined the differences between the prosthetic treatments small anterior bridges and single anterior implants (SI). The aim of the study was to evaluate oral fine motor control in patients with single anterior tooth loss, comparing anterior teeth connected in 3-unit resin bonded bridges (RBB) and free-standing teeth adjacent to single implants (SI). Materials and Methods: A standardized hold-and-split task was performed in 16 patients on two occasions: once, with a RBB in place and once after replacement with a SI. The four conditions connected tooth (CT), pontic (P), free-standing tooth (T), and single implant (SI) were tested. Outcome variables hold force, variability of hold force, split force, and duration of split were analyzed using paired sample t-test or Wilcoxon signed rank test, with a significance level set at p < 0.05. Results: The results showed significant differences between T and SI for all variables (p < 0.05) except for duration of split (p > 0.05), and between CT and P regarding hold force and duration of split. No significant differences were found between CT and T or P and SI for any of the outcome variables (p > 0.05). Conclusions: Oral fine motor control on a SI was compromised compared to a T and comparable to a P of a 3-unit RBB. However, splinting a tooth (CT) in a 3-unit anterior RBB does not seem to compromise the oral fine motor control.

BACKGROUND AND AIMS: In the relationship between periodontitis and coronary heart disease (CHD), the mechanistic role of subclinical atherosclerosis remains incompletely understood. This study examines whether subclinical atherosclerosis mediates the periodontitis-incident CHD association; how a specific periodontitis phenotype modifies subclinical coronary atherosclerosis; and whether periodontitis is associated with epicardial adipose tissue (EAT) attenuation as a marker of inflammation.

METHODS: Data from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were linked to national registers for dental data and CHD incidence. Coronary atherosclerosis was quantified using coronary artery calcium scores (CACS) and segment involvement scores (SIS). EAT characteristics were derived from non-contrast cardiac computed tomography. Associations between severe periodontitis and incident CHD events were examined using multivariable regression models, and mediation by CACS and SIS was explored.

RESULTS: Among 29 056 SCAPIS participants, severe periodontitis was present in 6% (n = 1809) and was associated with severe CACS [≥301, odds ratio (OR) 1.69, 95% confidence interval (CI) 1.39-2.06] and severe SIS (>4 segments, OR 1.40, 95% CI 1.17-1.67), with the strongest associations among individuals without concomitant dental caries. Moreover, periodontitis was associated with lower EAT attenuation (β = -0.27 HU, 95% CI -0.48 to -0.05) and a 42% higher risk of incident CHD events (hazard ratio 1.42, 95% CI 1.03-1.97), which was partially mediated by coronary atherosclerosis.

CONCLUSIONS: Severe periodontitis is positively associated with subclinical coronary atherosclerosis, EAT alterations reflecting inflammatory activity, and CHD event incidence. These results position periodontitis as a marker of increased coronary risk, warranting targeted cardiovascular risk assessment.

Conventional Swedish snus is used by millions in Scandinavia and increasingly worldwide, yet its cardiovascular effects remain poorly characterized. The emergence of nicotine pouches-commonly referred to as 'white snus' in Sweden-that deliver comparable nicotine without tobacco constituents adds complexity to a heterogeneous landscape and raises questions about whether cardiovascular risk follows nicotine exposure regardless of product type. We explore epidemiological and mechanistic evidence on snus and cardiovascular disease, the contributions of nicotine versus tobacco-specific nitrosamines (TSNAs) to risks, and identify knowledge gaps, with focus on novel nicotine products and the research opportunity offered by the Swedish Tobacco Cohort (SWETOC). Epidemiological evidence suggests elevated cardiovascular disease (CVD) mortality among snus users, with the most consistent signals for fatal myocardial infarction and heart failure. Associations with incident atherosclerotic events are more heterogeneous. Mechanistic evidence points to nicotine-mediated pathways, including sympathetic activation, endothelial dysfunction and increased arterial stiffness, whereas evidence for TSNA-driven CVD risk remains sparse, and declining TSNA levels in modern Swedish snus make that path less likely and harder to study. Nicotine pouches deliver comparable or higher systemic nicotine than conventional snus but lack long-term cardiovascular outcome data. Real-world cessation data from Denmark suggest structured programmes can achieve 6-month abstinence rates of approximately 53% among non-smoking nicotine users. The evidence supports nicotine as the primary driver of snus-associated CVD risk, with important implications for the cardiovascular safety of novel nicotine products. Evidence is needed to inform public health guidance, clinical advice and regulatory decisions. SWETOC represents a unique infrastructure to generate this evidence.

BACKGROUND: No consistent approach to the management of direct oral anticoagulants (DOACs) during and after oral surgery has been established. Thus, DOACs may be unnecessarily discontinued, raising the potential risk of life-threatening thromboembolism. To address the inconsistency in this approach, our study assessed the risk of bleeding and other complications in patients who continue to use DOACs during and after simple and surgical tooth extractions.

METHODS: Between May 2016 and December 2023, this prospective study recruited patients aged 18 years or older who were receiving a DOAC or warfarin and were in need of simple or surgical extractions of one or more teeth. Local haemostatic agents were being used to control bleeding. Patients were instructed to manage minor postoperative bleeding at home by biting down on gauze soaked in tranexamic acid for at least 30 min. After surgery, all patients were followed for 7 days. The chi-squared test compared dichotomous variables; the two-sample t-test, continuous variables; logistic regressions, dichotomous outcomes; and linear regressions, continuous outcomes.

RESULTS: In all, 354 teeth were extracted from 160 patients receiving DOACs and 56 patients receiving warfarin. The incidence of any type of postoperative bleeding was 27% in patients receiving DOACs and 37% in those receiving warfarin (OR 0.66, 95% CI: 0.28-1.57; p = 0.35). Most patients were able to manage any bleeding at home themselves. Clinically relevant bleeding necessitating prompt evaluation or a secondary surgical intervention by a dentist or healthcare professional occurred in 3% of patients receiving DOACs and 11% of patients receiving warfarin (OR 0.30, 95% CI: 0.08-1.06; p = 0.06). No reports of major bleeding requiring hospitalization or blood transfusion were found. Perioperative bleeding volume was comparable between the two groups.

CONCLUSIONS: Patients receiving DOACs without interruption during surgery may have a lower risk of bleeding than those on warfarin. Patients may safely continue to use DOACs during and after simple and surgical extractions. This eliminates the potentially higher risk of serious thromboembolic events that are associated with a pause in anticoagulant therapy.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT04662515). Retrospectively registered 4 December 2020.

Although craniomaxillofacial (CMF) trauma is a factor recognized as contributing to the development of temporomandibular joint disorders (TMJD), large population-based research on CMF trauma and subsequent TMJD is lacking. Additionally, it is unknown how previous CMF trauma affects work disability reimbursements for patients with TMJD (pwTMJD). This Swedish registry-based study included 33,315 pwTMJD matched to 333,122 individuals from the general population. Both a case-control design and a cohort design were used in this study to evaluate the association between CMF trauma and TMJD, and to investigate how CMF trauma impacts the number of days on work disability among pwTMJD. The main study finding was that many types of previous CMF trauma were strongly associated with TMJD, with mandibular fractures having the strongest association (adjusted odds ratio 11.4). Furthermore, the strongest association for an increased number of annual days on work disability was found for pwTMJD with a history of CMF trauma. These results suggest that CMF trauma influences the developmental path of TMJD, even in a population-based sample.

OBJECTIVES: This paper studies the treatment effect of total joint replacement (TJR) of the temporomandibular joint (TMJ) with alloplastic joint prosthesis regarding function, symptoms and health-related quality of life compared to other surgical and non-surgical treatments in patients with TMJ disorders.

METHODS: Three databases (PubMed, Cochrane Library and Web of Science) were searched up to 11 March 2025. Studies in which TJR was compared with other surgical or non-surgical methods were searched and analyzed. Data extraction and quality assessments were performed by at least two investigators independently. Risk of bias was assessed with the ROBINS-I-tool. Certainty of evidence was assessed with GRADE.

RESULTS: A total of 2,891 studies were identified in the search. One study met the criteria with comparison of TJR with a control group consisting of patients treated with another surgical method, namely, interpositional arthroplasty. The study investigated the outcome variables such as pain reduction and improvement in mouth opening and had a moderate risk of bias. No significant difference between the groups was found after regression analysis. Quality of life assessment was not the objective of this study. No meta-analysis could be performed from this literature search, for obvious reasons.

CONCLUSION: TMJ reconstruction with alloplastic prostheses is rapidly evolving, with new systems continually entering the market. This review highlights the urgent need for further scientific efforts, including well-designed trials capable of demonstrating the comparative effectiveness of alloplastic TJR against other treatment modalities, ideally randomized trials with controls.