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Hänsel Petersson, Gunnel
Publications (10 of 27) Show all publications
Nordström, M., Lager, A., Hänsel Petersson, G. & Ericson, D. (2024). Karies: världens vanligaste icke smittsamma sjukdom. Läkartidningen, 121, Article ID 23127.
Open this publication in new window or tab >>Karies: världens vanligaste icke smittsamma sjukdom
2024 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 121, article id 23127Article in journal (Refereed) Published
Abstract [en]

More than 2.8 billion individuals worldwide suffer from untreated caries. Over ninety-five percent of all 50-year-olds in Sweden have caries experience. Caries is the most common cause of dental restorations and tooth loss. Tooth loss is associated with cardiovascular diseases, dementia, and death. Periapical tooth infections caused by caries can spread and cause severe infection, however rarely with lethal outcome. Sugars are a common risk factor for caries and other noncommunicable diseases such as cardiovascular diseases, diabetes, and obesity.  Caries is a consequence of sugar-provoked acid production and dysbiosis in the tooth biofilm (dental plaque). There are several conditions which may increase the risk for dental caries, such as different medical conditions and medications which may cause dry mouth. Treatment costs for caries are high.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66561 (URN)38470274 (PubMedID)
Available from: 2024-03-28 Created: 2024-03-28 Last updated: 2024-03-28Bibliographically approved
Nordström, M., Carlsson, P., Ericson, D., Lager, A., Jansson, H., Wolf, E. & Hänsel Petersson, G. (2024). Some young adults can maintain good oral health despite socioeconomic challenges. European Journal of Oral Sciences, Article ID e12985.
Open this publication in new window or tab >>Some young adults can maintain good oral health despite socioeconomic challenges
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2024 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, article id e12985Article in journal (Refereed) Epub ahead of print
Abstract [en]

The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19–23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was ‘Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health’, comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2024
Keywords
salutogenesis, health promotion, dental caries, young adults, socioeconomy, resilience, family support, health behaviour, psychology
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66678 (URN)10.1111/eos.12985 (DOI)001189369500001 ()38520668 (PubMedID)
Available from: 2024-04-11 Created: 2024-04-11 Last updated: 2024-04-23Bibliographically approved
Nordström, M., Carlsson, P., Ericson, D., Hedenbjörk-Lager, A. & Hänsel Petersson, G. (2023). Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review. Acta Odontologica Scandinavica, 81(3), 176-185
Open this publication in new window or tab >>Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review
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2023 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 81, no 3, p. 176-185Article, review/survey (Refereed) Published
Abstract [en]

Objective: To identify common resilience factors against non-communicable diseases (dental caries, diabetes type II, obesity and cardiovascular disease) among healthy individuals exposed to chronic adversity.

Materials and methods: The databases MEDLINE (via PubMed), Scopus and CINAHL were searched. Observational studies in English assessing resilience factors among populations living in chronic adversity were included. Intervention studies, systematic reviews, non-original articles and qualitative studies were excluded. There were no restrictions regarding publication year or age. No meta-analysis could be done. Quality assessments were made with the Newcastle-Ottawa scale (NOS).

Results: A final total of 41 studies were included in this systematic review. The investigated health resilience factors were divided into the following domains: environmental (community and family) and individual (behavioural and psychosocial). A narrative synthesis of the results was made according to the domains.

Conclusions: Individual psychosocial, family and environmental factors play a role as health resilience factors in populations living in chronic adversity. However, the inconclusive results suggest that these factors do not act in isolation but interplay in a complex manner and that their interaction may vary during the life course, in different contexts, and over time.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Dental caries, common risk approach, salutogenesis, resilience, systematic review
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-54102 (URN)10.1080/00016357.2022.2095021 (DOI)000825783700001 ()35811490 (PubMedID)2-s2.0-85133691731 (Scopus ID)
Available from: 2022-08-02 Created: 2022-08-02 Last updated: 2023-08-22Bibliographically approved
Havsed, K., Hänsel Petersson, G., Isberg, P.-E., Pigg, M., Svensäter, G. & Rohlin, M. (2023). Multivariable prediction models of caries increment: a systematic review and critical appraisal.. Systematic Reviews, 12(1), Article ID 202.
Open this publication in new window or tab >>Multivariable prediction models of caries increment: a systematic review and critical appraisal.
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2023 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, no 1, article id 202Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment.

METHODS: Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR -) based on sensitivity and specificity presented in the studies included.

RESULTS: Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR - ranges of 0.78-10.3 and 0.0-1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall.

CONCLUSIONS: The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models' usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties.

TRIAL REGISTRATION: PROSPERO CRD#152,467 April 28, 2020.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
CHARMS, Dental caries, Likelihood ratio, PROBAST, Prediction models
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-63663 (URN)10.1186/s13643-023-02298-y (DOI)001089824700001 ()37904228 (PubMedID)2-s2.0-85175349690 (Scopus ID)
Available from: 2023-11-13 Created: 2023-11-13 Last updated: 2023-12-04Bibliographically approved
Hänsel Petersson, G. & Twetman, S. (2019). Tobacco use and caries increment in young adults: a prospective observational study. (ed.). BMC Research Notes, 12(1), Article ID 218.
Open this publication in new window or tab >>Tobacco use and caries increment in young adults: a prospective observational study.
2019 (English)In: BMC Research Notes, E-ISSN 1756-0500, Vol. 12, no 1, article id 218Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Tobacco use has a negative influence on general and oral health but data concerning caries are mainly derived from epidemiological and cross-sectional studies. The aim of this study was to investigate smoking and use of smokeless tobacco (Swedish snus) as determinants of dental caries increment in young adults over 3 years. The baseline cohort consisted of 1295 19-year-olds registered at eight Public Dental Clinics representing socioeconomic strata. After 3 years, 982 of the patients could be reexamined (drop-out rate 24.2%). Caries was scored as decayed and filled surfaces according the WHO criteria and the individual caries increment was recorded by counting the number of surfaces that changed from "sound" to "decayed/filled" over the study period. Information on habitual tobacco use (smoking, snuffing) was collected from a structured questionnaire at baseline. RESULTS: The baseline prevalence of smoking and use of Swedish snus was 22.3% and 6.3% respectively. Smoking, but not snuffing, displayed a statistically significant relationship with caries increment over 3 years. For smoking, the relative risk was 1.5 (95% CI 1.2-1.7) and the number needed to harm 6.8 (95% CI 4.5-14.2). Thus, habitual smoking is a risk factor for caries in young adults and the findings reinforce arguments that dental health professionals should incorporate anti-smoking activities in their preventive strategies.

Place, publisher, year, edition, pages
BioMed Central, 2019
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6352 (URN)10.1186/s13104-019-4253-9 (DOI)000464884700001 ()30971314 (PubMedID)2-s2.0-85064203314 (Scopus ID)29509 (Local ID)29509 (Archive number)29509 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
Hänsel Petersson, G. & Twetman, S. (2017). Relationship between risk assessment and payment models in Swedish Public Dental Service: a prospective study (ed.). BMC Oral Health, 17(1), Article ID 40.
Open this publication in new window or tab >>Relationship between risk assessment and payment models in Swedish Public Dental Service: a prospective study
2017 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, no 1, article id 40Article in journal (Refereed)
Abstract [en]

Background: To a) compare risk categories in patients selecting a capitation payment (CP) model with those in fee-for-service (FFS), b) determine the 3-year caries increment in the two groups, and c) compare the amount of delivered preventive care in the two groups. Methods: A comprehensive risk assessment was carried out in 1295 young adults attending eight Public Dental Clinics in the Scania region and 75% could be re-examined after 3 years; 615 had selected the CP model and 310 the traditional FFS. Caries was scored according to WHO and data concerning preventive care was extracted from the dental records. Results: More patients in the low risk category preferred the CP model (74% vs. 26%) while > 80% with high risk selected FFS. The baseline caries level was significantly higher in the FFS group as well as the 3-year caries increment (1.6 vs. 0.8 DFS: p < 0.05). The amount of additional preventive care delivered to each patient was generally lower in the FFS model; it was most frequent among patients with "some" risk in the CP model (83.8%) while the lowest delivery rates were found among low risk patients in the FFS system (32.4%). Conclusions: Young adults in public dental care with low risk preferred the prepaid model while those in the higher risk categories selected fee-for-service. As more additional preventive care was delivered to patients in the subscribed care, oral health planners and decision makers should be aware of the fact that capitation payment models may enhance inequalities in dental health over time.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Caries prevention, Dental care models, Risk assessment, Young adults, Sweden
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7112 (URN)10.1186/s12903-016-0327-4 (DOI)000392016000001 ()28077122 (PubMedID)2-s2.0-85009957899 (Scopus ID)23347 (Local ID)23347 (Archive number)23347 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
Hänsel Petersson, G., Åkerman, S., Isberg, P.-E. & Ericson, D. (2016). Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need (ed.). BMC Oral Health, 17(1), Article ID 13.
Open this publication in new window or tab >>Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need
2016 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, no 1, article id 13Article in journal (Refereed)
Abstract [en]

BACKGROUND: Predicting future risk for oral diseases, treatment need and prognosis are tasks performed daily in clinical practice. A large variety of methods have been reported, ranging from clinical judgement or "gut feeling" or even patient interviewing, to complex assessments of combinations of known risk factors. In clinical practice, there is an ongoing continuous search for less complicated and more valid tools for risk assessment. There is also a lack of knowledge how different common methods relates to one another. The aim of this study was to investigate if caries risk assessment (CRA) based on clinical judgement and the Cariogram model give similar results. In addition, to assess which factors from clinical status and history agree best with the CRA based on clinical judgement and how the patient's own perception of future oral treatment need correspond with the sum of examiners risk score. METHODS: Clinical examinations were performed on randomly selected individuals 20-89 years old living in Skåne, Sweden. In total, 451 individuals were examined, 51 % women. The clinical examination included caries detection, saliva samples and radiographic examination together with history and a questionnaire. The examiners made a risk classification and the authors made a second risk calculation according to the Cariogram. RESULTS: For those assessed as low risk using the Cariogram 69 % also were assessed as low risk based on clinical judgement. For the other risk groups the agreement was lower. Clinical variables that significantly related to CRA based on clinical judgement were DS (decayed surfaces) and combining DS and incipient lesions, DMFT (decayed, missed, filled teeth), plaque amount, history and soft drink intake. Patients' perception of future oral treatment need correlated to some extent with the sum of examiners risk score. CONCLUSIONS: The main finding was that CRA based on clinical judgement and the Cariogram model gave similar results for the groups that were predicted at low level of future disease, but not so well for the other groups. CRA based on clinical judgement agreed best with the number of DS plus incipient lesions.

Place, publisher, year, edition, pages
BioMed Central, 2016
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6274 (URN)10.1186/s12903-016-0238-4 (DOI)000379721100006 ()27430746 (PubMedID)2-s2.0-84978401540 (Scopus ID)21698 (Local ID)21698 (Archive number)21698 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
Hänsel Petersson, G., Ericson, E. & Twetman, S. (2016). Preventive care delivered within Public Dental Service after caries risk assessment of young adults (ed.). International Journal of Dental Hygiene, 14(3), 215-219
Open this publication in new window or tab >>Preventive care delivered within Public Dental Service after caries risk assessment of young adults
2016 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 14, no 3, p. 215-219Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study preventive care provided to young adults in relation to their estimated risk category over a 3-year period. METHODS: The amount and type of preventive treatment during 3 years was extracted from the digital dental records of 982 patients attending eight public dental clinics. The baseline caries risk assessment was carried out by the patient's regular team in four classes according to a predetermined model, and the team was responsible for all treatment decisions. Based on the variables 'oral health information', 'additional fluoride' and 'professional tooth cleaning', a cumulative score was constructed and dichotomized to 'basic prevention' and 'additional prevention'. RESULTS: More additional preventive care was provided to the patients in the 'low-risk' and 'some risk' categories than to those classified as 'high' or 'very high' risk (OR = 2.0, 95% CI 1.4-3.0; P < 0.05). Professional tooth cleaning and additional fluorides were most frequently employed in the 'low-risk' and 'some risk' categories, respectively. Around 15% of the patients in the high-risk categories did not receive additional preventive measures over the 3-year period. There was an insignificant tendency that patients with additional prevention developed less caries than those that received basic prevention in all risk categories except for the 'very high-risk' group. CONCLUSION: The caries risk assessment process was not accompanied by a corresponding targeted individual preventive care in a cohort of young adults attending public dental service. Further research is needed how to reach those with the greatest need of primary and secondary prevention.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15591 (URN)10.1111/idh.12135 (DOI)000379948100008 ()25727487 (PubMedID)2-s2.0-84923677380 (Scopus ID)21693 (Local ID)21693 (Archive number)21693 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-04-04Bibliographically approved
Hänsel Petersson, G. & Twetman, S. (2015). Caries risk assessment in young adults: a 3 year validation of the Cariogram model (ed.). BMC Oral Health, 15(17), Article ID 17.
Open this publication in new window or tab >>Caries risk assessment in young adults: a 3 year validation of the Cariogram model
2015 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 15, no 17, article id 17Article in journal (Refereed) Published
Abstract [en]

Background: To validate baseline caries risk classifications according to the Cariogram model with the actual caries development over a 3-year period in a group of young adults living in Sweden. Methods: The study group consisted of 1,295 19-year-old patients that completed a comprehensive clinical baseline examination, including radiographs and salivary tests. An individual caries risk profile was computed and the patient was placed in one of five risk categories. After 3 years, 982 patients (75.8%) were re-examined and caries increment for each patient was calculated. The outcome was expressed as sensitivity, specificity and predictive values and compared with a risk assessment scheme used in Public Dental Service. Results: The drop-outs displayed more risk factors and a significantly higher caries burden at baseline compared with those that remained in the project (p < 0.05). There was a strong association between the Cariogram risk categories and the 3-year caries increment on cavity level but the predictive values were modest. The high or very high caries risk categories yielded high specificities (>90%) but poor sensitivities. The low risk groups displayed higher sensitivities on expense of impaired specificities. No combinations proved clinically useful values according to Yuoden's index. Conclusions: Within the limitations of the present study, the computer-based Cariogram did not perform better than a caries risk assessment scheme based on past caries experience and caries progression, over a 3-year period in young adults.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Lactobacilli, Mutans streptococci, Risk factors, Saliva
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6660 (URN)10.1186/1472-6831-15-17 (DOI)000349042200001 ()25627618 (PubMedID)2-s2.0-84924125740 (Scopus ID)19771 (Local ID)19771 (Archive number)19771 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
Hänsel Petersson, G., Ericson, E., Isberg, P.-E. & Twetman, S. (2013). Caries risk assessment in young adults: A 3-year validation of clinical guidelines used in Public Dental Service (ed.). Acta Odontologica Scandinavica, 71(6), 1645-1650
Open this publication in new window or tab >>Caries risk assessment in young adults: A 3-year validation of clinical guidelines used in Public Dental Service
2013 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 71, no 6, p. 1645-1650Article in journal (Refereed)
Abstract [en]

Abstract Objectives. To validate a risk classification model according to the Public Dental Service (PDS) guidelines with the actual 3-year caries outcome in terms of predictive values. Materials and methods. All 19-year-old patients registered at eight public dental clinics in Skåne, Sweden were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects, representing 10% of the age group attending the public dental care in the region. A risk classification of each patient in four categories was made by the patient's regular team according to the guidelines. At the follow-up 3 years later, 75.8% were accessible. The final examinations included bitewing radiographs and the actual caries increment for 982 patients was calculated. Results. At baseline, 11.9% were assessed as being at 'high' or 'very high' risk. The dropouts had significantly more caries than the remaining patients (p < 0.05). The general disease activity was low, but those grouped into the two highest risk groups displayed significantly more new caries than those at lower risk (p < 0.05). With a cut-off value ΔDFS > 0 vs DFS = 0, the sensitivity was 81% and the specificity 56% for 'low' risk vs any risk. By combining the 'low' and 'some' risk categories, the PDS model generated an improved specificity (94%). Conclusions. The risk assessment scheme used by the Public Dental Service for young adults relied basically on past and current caries activity and 65-70% of the patients were correctly classified. The model was most effective to screen out patients with low caries risk.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
risk classification, guidelines, risk model
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6680 (URN)10.3109/00016357.2013.788734 (DOI)000326678700043 ()23834530 (PubMedID)2-s2.0-84887218403 (Scopus ID)15840 (Local ID)15840 (Archive number)15840 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
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