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.

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.

Background: In Sweden, dental care for children and adolescents, including specialist orthodontic treatment, is publicly funded. This study aims to analyze the impact of sociodemographic factors on the distribution of publicly funded specialist orthodontic treatment in a mid-sized Swedish region. Methods: A registry-based cohort study was conducted in Region Östergötland, including individuals born between 2000 and 2003. Sociodemographic data were obtained from Statistics Sweden (SCB), while dental health information was sourced from The Swedish Quality Registry for Caries and Periodontal Disease (SKaPa). The primary outcome variable was initiation of specialist orthodontic treatment, extracted from dental records. Statistical analysis was performed using Stata v.18.1. Results: The cohort comprised 16 893 individuals, with 51.5% males and 48.5% females. Specialist orthodontic treatment was initiated for 25.7% of the population (n = 4 342), with most treatments involving fixed appliances. Several sociodemographic factors were significantly associated with the likelihood of receiving orthodontic treatment. Females had 1.74 times higher odds (95% CI: 1.63–1.87) of receiving treatment compared to males. Individuals born in Sweden had 1.42 times greater odds (95% CI: 1.18–1.72) of receiving treatment compared to those born abroad. Similarly, children with Swedish-born parents had 1.16 times increased odds (95% CI: 1.04–1.30) compared to children with foreign-born parents. Children of mothers with university/college education had an OR of 1.29 (95% CI: 1.12–1.48), while those whose fathers had a university/college education had an OR of 1.19 (95% CI: 1.05–1.34), compared to parents with primary/lower secondary education. Conclusions: Males, individuals born outside Sweden, those with foreign born parents, and whose parents had lower educational levels were less likely to receive orthodontic treatment within the publicly funded dental health services in Region Östergötland. These findings suggest that sociodemographic factors influenced the distribution of orthodontic care, though the role of treatment demand requires further investigation.

OBJECTIVE: To investigate changes to the composition of a panel of extracellular matrix (ECM) proteins in the temporomandibular joint (TMJ) posterior disc attachment in relation to the diagnoses disc displacement with/without reduction (DDwR, DDwoR).

DESIGN: Patients scheduled for arthroscopy or open joint surgery due to DDwR or DDwoR were eligible for inclusion. During surgery biopsies of the posterior disc attachment were harvested. Proteins were extracted from the biopsies and screened using multiplex bead analysis for 23 different ECM proteins. Patients with DDwR served as controls to DDwoR. The variables gender, age, symptom duration, previous trauma, and Wilkes criteria were assessed in relation to the protein concentrations with a quantile regression model. Significance was set at p < 0.05.

RESULTS: DDwoR patients had smaller preoperative mouth opening capacity (p < 0.001) and shorter symptom duration (p = 0.007) compared to DDwR. Patients with a sudden onset of DDwoR more often had trauma to the jaws as an inciting event compared to delayed onset DDwoR (p = 0.014). In the adjusted analyses, ADAMTS13 (p = 0.000), aggrecan (p = 0.012), collagen IVα1 (p = 0.001), Lumican (p = 0.008), MMP-7 (p = 0.000), MMP-10 (p = 0.043), NCAM-1 (p = 0.006), Tenascin C (p = 0.030), TIMP-2 (p = 0.000), and TIMP-3 (p = 0.027) had significantly higher concentrations in DDwoR. MMP-9 (p = 0.019) and syndecan-4 (p = 0.002) demonstrated a positive strong correlation to female gender. A higher Wilkes criteria corresponded to a higher protein composition similarly to how protein composition increased in DDwoR compared to DDwR.

CONCLUSION: ECM protein composition changes with TMJ diagnoses and Wilkes criteria suggesting degenerative changes as a main factor. Gender seems to marginally affect the ECM.

Background: This study evaluates whether exposure to dental X-ray examinations in childhood and adolescence results in negative health effects.

Material and methods: This systematic review includes both primary studies and systematic reviews available in Medline, Embase, and Web of Science databases. Six reviewers read the full text of the selected studies.

Results: The literature search resulted in 10,949 publications. After title and abstract screening, 55 publications were selected for full text reading, resulting in a total of 18 reports, 7 systematic reviews, and 11 primary studies for quality assessment.

Conclusion: None of the selected studies passed the quality assessment due to high or very high risk of bias. There is a gap of knowledge regarding negative effects of dental X-rays and a need for more accurate and updated studies.

Objectives: Children in out-of-home care (OHC) are at greater risk of ill health than other children in the community. The aim of this registry-based cohort study was to compare the oral health and dental care needs of children in OHC with those of other children in Sweden, by merging data from different Swedish registries. A further aim was to analyse whether children in OHC received more dental examinations after 2017, following implementation of a law requiring mandatory health evaluations prior to placement.

Methods: We identified an exposed cohort of Swedish children and young people, 0–19 years old, who had been placed in OHC 2010–2018 ( N  = 50,878), and an unexposed cohort, five times larger, matched for age, sex and county of residence ( N  = 254,380). During the study period, children in OHC received relatively fewer regular, scheduled dental examinations (4.21 vs. 4.88; p  < 0.0001). More children entering OHC in 2018 received dental examinations (81.7%) compared with 2016 (76.6%) ( p  < 0.0001), but this was still lower than the proportion of controls. Moreover, during the study period, dental caries affected more teeth in children in OHC than in the controls (dft 6-year-olds 1.56 vs. 0.74; p  < 0.0001, and DFT 12-year-olds 1.18 vs. 0.65; p  < 0.0001), and they had more extractions and more emergency dental appointments than children who had never been in OHC.

Conclusion: Not only do children in OHC have poorer oral health than other children, they also receive less support from the dental health services. It seems that society has failed in its mission to ensure that children in OHC are not disadvantaged with respect to health and access to comprehensive healthcare. Thus, there is an urgent need for reappraisal of guidelines, legislation, and organizational models for providing dental care to children and adolescents in OHC.

Background: Antibiotic prophylaxis in dental implant surgery remains a contentious topic, with varying guidelines and clinical practices worldwide.

Aim: Report how Swedish dentists use antibiotic prophylaxis during dental implant surgery, based in a review of patient records.

Method: This retrospective, cross-sectional study evaluated the antibiotic prophylaxis habits of Swedish dentists, focusing on the relationship between surgical complexity and antibiotic use.

Results: Data from 450 patient records with registered implant surgeries at two major dental care providers, one public and one private, were analysed. Thirty-seven clinics provided the data, and 109 dentists performed the surgeries. Findings revealed that 72.2% of implant surgeries were straightforward procedures, with no administration of antibiotic prophylaxis in 70.5% of these. Conversely, 90% of bone augmentation cases involved antibiotic use, particularly in complex protocols utilizing synthetic materials and membranes. Overall, 54.4% of patients in the study population received no antibiotic prophylaxis at all. Surgical complexity was a significant predictor for antibiotic administration, while patient-specific factors, such as age, chronic diseases, and tobacco use, had limited influence.

Conclusion: Restrained antibiotic use in implant surgery in Sweden reflects alignment with current stewardship goals, particularly in straight forward procedures. However, continued administration in some uncomplicated cases and frequent use in complex surgeries highlight the need for clearer, evidence-based guidelines and standardized antibiotic protocols.

Aim: Periodontitis proxy variables enable an expansion of periodontal research. The study aimed to estimate the validity of questionnaire items and registry data in relation to Stage III–IV periodontitis and having 50% bone loss.

Methods: Malmö Offspring Dental Study (MODS) participants (995) filled out questionnaires and underwent periodontal and panoramic radiography examinations. The questionnaire items, number of periodontal treatment procedures (PTP) in the Dental Health Register (DHR), and number of teeth with ≥ 6 mm probing depth in the Swedish Quality Register for Caries and Periodontal Disease (SKaPa) were evaluated as proxies for severe periodontitis. Stage III–IV periodontitis was the primary reference standard.

Results: For PTP‐based severe periodontitis proxy in DHR, positive predictive value (PPV) was 88% and negative predictive value (NPV) 87% for Stage III–IV. The SKaPa‐based proxy showed poor positive predictive values (PPVs, < 70%), but similar area under the curve (AUC), 0.74, compared with the DHR data (AUC 0.76). Sensitivity was < 70%, and specificity > 90% for the DHR and SKaPa proxies. Identification of cases with periodontitis by questionnaire combined with the demographic variables age, sex, smoking habits and education yielded good discriminatory ability (AUC > 0.75).

Conclusion: Register‐based data can effectively identify individuals with severe periodontitis in large cohort studies, thereby advancing periodontal research.