BACKGROUND: Most patients who undergo esophagectomy for esophageal cancer develop tumor recurrence and die within 5 years of surgery. An impact of preoperative dental status on survival in this patient group has been suggested but remains uncertain.

METHODS: This national Swedish cohort study included 871 patients who underwent esophagectomy for esophageal cancer (adenocarcinoma or squamous cell carcinoma) between 2011 and 2020 and were followed up until 2024. The exposure was the number of remaining teeth, based on dentist visits within 5 years before the esophagectomy, categorized into five (quintiles) and 10 (deciles) groups. The main outcome was all-cause 5-year mortality. Data were retrieved from medical records and national complete registries. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, tumor histology, neoadjuvant therapy, education level, and pathological tumor stage.

RESULTS: There were no statistically significant associations between the number of remaining teeth and the risk of all-cause 5-year mortality, independent of the categorization of the number of teeth. The HR was 1.13 (95% CI 0.85-1.51) comparing the lowest quintile of remaining teeth (n = 0-19) with the highest quintile (n = 29-32), and the HR was 0.98 (95% CI 0.64-1.52) comparing the lowest decile of remaining teeth (n = 0-10) with the highest decile (n = 31-32). There were no statistically significant associations in any of the subgroup analyses of age, comorbidity, or education.

CONCLUSION: This study did not identify any association between the number of remaining teeth and the risk of 5 year mortality in patients who underwent esophagectomy for esophageal cancer.

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 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.

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.

OBJECTIVE: The aim was to optimize diagnostics for carotid artery calcifications (CACs) on panoramic radiographs (PRs) to identify cardiovascular disease (CVD) by investigating how 4 defined CAC shapes are associated with ultrasound (US) findings indicating CVD.

STUDY DESIGN: The study included 414 participants (802 neck sides) from the Malmö Offspring Dental Study, examined with PRs. The PRs were assessed for CAC shapes stratified into 4 categories: single, scattered, vessel-width defining, and vessel-outlining. The carotid arteries were examined with US for signs of CVD: the presence of plaques, largest individual area of a plaque, number of plaques, and percentage reduction of the lumen. Associations between the different CAC categories and US characteristics were analyzed.

RESULTS: All categories of CAC were significantly associated with a higher degree of US findings indicating CVD compared with no CAC (P < .001). The most significant differences were found for vessel-outlining CAC, with the mean of the largest individual plaque area of 17.9 vs 2.3 mm², mean number of plaques 1.6 vs 0.2, and mean percentage reduction of the lumen 24.1% vs 3.5% (all P < .001).

CONCLUSIONS: Independent of shape, CACs detected on PRs were associated with a higher degree of US findings of CVD. This was most pronounced for vessel-outlining CAC. With refined differential diagnostics of CACs in PRs, dentists may contribute to improved identification of patients in need of cardiovascular prevention.

BACKGROUND: It is well documented that smokers suffer increased risk of postoperative complications after medical surgery, for example delayed healing and increased risk of infection. It is also known that preoperative smoking cessation can reduce the risk of these complications. Because of this there are guidelines regarding preoperative smoking cessation in non-oral medical surgery. There are however no specific guidelines regarding oral surgical procedures, such as surgical extractions, dentoalveolar surgery, periodontal surgery, or dental implantation. Nevertheless, it is common that dentists and oral surgeons recommend smoking cessation pre to oral surgical procedures. The aim with this systematic review was to see if there are any evidence in the literature, supporting preoperative smoking cessation in oral surgical procedures.

METHODS: A systematic search of the electronic databases PubMed, Scopus, Web of Science, and Cochrane was conducted to identify studies addressing the effect of preoperative smoking cessation in oral surgical procedures. Included publications were subjected to preidentified inclusion criterion. Six examiners performed the eligibility and quality assessment of relevant studies. Risk of bias was assessed using ROBINS-I and RoB 2. Certainty assessment was carried out using GRADE.

RESULTS: The initial search resulted in 2255 records, and after removal of 148 duplicates, 16 articles met an acceptable level of relevance. These were read in full text, whereof 12 articles were excluded, due to different intervention, outcome, or study design than stated in the review protocol. One study remained with moderate risk of bias and three were excluded due to high risk of bias.

CONCLUSION: This systematic review could not determine the effect of smoking cessation pre to oral surgical procedures, in smokers. This indicates lack of knowledge in the effects of smoking cessation. We also conclude a lack of knowledge in how to design smoking cessation in the most effective way.

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.

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.

Periodontitis - an often neglected risk factor for several other diseases

Periodontitis is a chronic inflammatory disease that degrades dental supporting tissues, including the alveolar bone. The global prevalence is 19%, in Sweden it is 11%. Left untreated, periodontitis can cause loss of teeth. The initial clinical manifestations of periodontitis usually start between 35 and 45 years of age. The underlying pathological mechanism is an aberrant inflammatory response to the bacteria colonizing the gingival crevice. Periodontitis has been associated with several other diseases, most prominently diabetes. The relation between periodontitis and diabetes is bidirectional in the sense that diabetes increases the risk for periodontitis and vice versa. Periodontitis also increases the risk for cardiovascular disease and cancer.