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  • 1.
    Adern, Bengt
    et al.
    Department of Stomatognathic Physiology , Specialist Dental Care Center The Mälar Hospital , Eskilstuna , Sweden.
    Minston, Ava
    Postgraduate Dental Education Center, Orofacial Pain and Jaw Function , Örebro , Sweden; Department of Stomatognathic Physiology , Institute of Odontology , Jönköping , Sweden.
    Nohlert, Eva
    Centre for Clinical Research Västerås, Uppsala University , Västerås , Sweden.
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Postgraduate Dental Education Center, Orofacial Pain and Jaw Function , Örebro , Sweden; Centre for Clinical Research Västerås, Uppsala University , Västerås , Sweden.
    Self-reportance of temporomandibular disorders in adult patients attending general dental practice in Sweden from 2011 to 20132018Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, nr 7, s. 530-534Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) and acceptance or nonacceptance of such disorders in adult patients attending all public dental health services in the County of Sormland, Sweden, during a 3-year period, 2011-2013. Methods: Two questions were asked about TMD and the voluntary mouth-opening capacity was measured. The results were registered in a score 0-3. The registration was completed with a question about each patient's acceptance or nonacceptance of their condition. Results: More than 73,000 registrations of the TMD condition were performed in general dental clinics from 2011 to 2013. The mean prevalence of a TMD score of 1-3 was 5% and was consistent over these years. Seventy percent of these patients were women. The peak prevalence of TMD was registered in patients aged 30-45years (38%), and the frequency declined in older age groups. Reduced voluntary mouth-opening capacity (<= 35 mm) was found in less than 2% of the participants. About one-fifth of the patients with a TMD-score of 1-3 did not accept their condition and wanted professional care. The frequency of nonacceptance of the condition increased with the severity of symptom score: 15%, 27%, and 49% for scores 1, 2, and 3, respectively. Conclusions: This study shows that the prevalence of self-reported TMD in adult patients was consistent from 2011 to 2013 and should be considered as a public health issue in Sweden. Patients with more severe TMD pain symptoms wanted care more frequent. The annual clinical calibrations should be continued to achieve an acceptable level of registration.

  • 2. Adern, Bengt
    et al.
    Stenvinkel, Christer
    Sahlqvist, Lotta
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Prevalence of temporomandibular dysfunction and pain in adult general practice patients2014Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, nr 8, s. 585-590Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To analyse the prevalence of temporomandibular disorders and related pain (TMD-pain) among adult recall patients in general dental practice. Materials and methods. From November 2006 to September 2008, all adults attending a Swedish Public Dental Service (PDS) clinic for recall examination were asked two standardized questions about temporomandibular pain and dysfunction. Mouth-opening capacity was measured. The responses to the questions and mouth-opening capacity were combined to give a TMD-pain score, on a scale of 0-3. The patients' acceptance of their TMD condition was also noted. Results. The subjects comprised 2837 adults (53% females, 47% men). Of the total sample, 4.9% reported a TMD-pain score of 1-3. The gender difference was significant: women predominated (p < 0.003). Forty-three per cent of those with TMD-pain scores of 1-3 (36% men, 47% women) considered that the condition warranted treatment, especially those registering a pain score (significant difference between pain and dysfunction groups, p < 0.000). Conclusions. The TMD-pain score shows promise as a useful instrument for detecting and recording TMD-pain. The prevalence of TMD disclosed in the study is high enough to be considered a public health concern. Most of the subjects with lower scores on the TMD-pain scale accepted their condition as not severe enough to require treatment.

  • 3. Adèrn, Bengt
    et al.
    List, Thomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Nebeska, Marie
    Öster, Aanders
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Orsaker till remisser till bettfysiolog: en jämförelse mellan fyra specialistkliniker2003Ingår i: Tandläkartidningen, ISSN 0039-6982, Vol. 95, nr 10, s. 50-55Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    Specialistinstanser i bettfysiologi möter i huvudsak patienter som har en långvarig och svårt smärtproblematik. Under 1900-talet har dock även behandling av obstruktiv sömnapné tillkommit. Ofta är det en läkare som remitterat patienten till den bettfysiologiska kliniken. Denna studie visar att bettfysiologen är en viktig länk mellan tandvården och sjukvården vid utredning och behandling av orofacial smärta. Syf-tet med studien var att jämföra orsakerna till remisser till bettfysiologi. En jämförelse gjordes mellan fyra specialistkliniker i bettfysiologi un-der en 4-månadersperiod år 2001. De flesta remitterade patienter var kvinnor i åldern 20 år och uppåt. Bland de remitterade kvinnorna var smärta den dominerande orsaken medan männen lika ofta remittera-des för sömnstörning som för smärta. 86 procent av patienterna som remitterats för smärta värderade smärtans intensitet som måttlig till väldigt svår. Hos 80 procent av dessa patienter var smärtan långvarig.

  • 4. Andrén, Ann
    et al.
    Hedberg, Pär
    Walker-Engström, Marie-Louise
    Wahlén, Petra
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 2, s. 705-712Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Methods Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Results Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP >135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) ≤15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. Conclusions In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI ≤15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.

  • 5. Andrén, Ann
    et al.
    Sjöquist, M
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance - a three-year follow-up2009Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 36, s. 719-725Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder; it affects 4% of males and 2% of females. Hypertension has been shown to occur in 28-57% of OSA patients. There is a steady increase in evidence linking OSA to long-term cardiovascular morbidity including hypertension. The purpose of this study was to investigate whether mandibular advancement oral appliance (OA) treatment of OSA affects the patient's blood pressure (BP) in a 3-month and a 3-year perspective. Twenty-nine consecutive patients, with verified OSA defined as apnoea index (AI) >5 per hour and/or apnoea/hypopnoea index (AHI) > or =10 per hour, received an OA as treatment. BP was measured on three occasions; before treatment, after 3 months of treatment, and after 3 years of treatment. BP was measured with an electronic blood pressure monitor. The treatment effect of OA was measured after 3 months by repeated somnographic registration while the patient was wearing the OA. A treatment response was defined as AHI < 10; this was achieved in 25 of 29 patients (86%) at the 3-month evaluation. Significant reductions in blood pressure were attained between baseline and the 3-month evaluation (P < 0.001) and these changes remained at the 3-year follow-up in both systolic BP of -15.4 +/- 18.7 mm Hg and diastolic BP of -10.3 +/- 10.0 mm Hg. OA therapy reduced blood pressure in both a 3-month and a 3-year perspective in patients with OSA.

  • 6.
    Bondemark, Lars
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    List, Thomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Ekberg, EwaCarin
    Malmö högskola, Odontologiska fakulteten (OD).
    Eriksson, Lars
    Malmö högskola, Odontologiska fakulteten (OD).
    Nilner, Maria
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Arne
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Wolf, Eva
    Malmö högskola, Odontologiska fakulteten (OD).
    Funktionsstörningar och smärta2008Ingår i: Tandläkartidningen, ISSN 0039-6982, Vol. 100, nr 9-10, s. 64-68Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Orofaciala funktionsstörningar och smärta är en sammanfattning av kliniska problem och sjukdomar som involverar bett, käkar, tuggmuskulatur, käkleder och omgivande strukturer. Orsakerna är oftast multifaktoriella för de barn, ungdomar och vuxna som drabbas.

  • 7.
    Eriksson, Lars B
    et al.
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;Centre for Clinical Research, Uppsala University, Falun, Sweden.
    Gordh, Torsten
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;Multidisciplinary Pain Centre, Uppsala University, Uppsala, Sweden.
    Karlsten, Rolf
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;Multidisciplinary Pain Centre, Uppsala University, Uppsala, Sweden.
    LoMartire, Riccardo
    Centre for Clinical Research, Uppsala University, Falun, Sweden.
    Thor, Andreas
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;Plastic & Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden.
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Intravenous S-ketamine’s analgesic efficacy in third molar surgery: A randomized placebo-controlled double-blind clinical trial2024Ingår i: British Journal of Pain, ISSN 2049-4637, Vol. 18, nr 2, s. 197-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred.

    Methods: The study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline).

    Results: A primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group.

    Conclusions: Pre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.

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  • 8.
    Eriksson, Lars
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery2012Ingår i: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 17, nr 3, s. 193-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics. Material and methods In a randomized, controlled, single-blinded procedure, 87 men and women aged 18–44 years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery. Results Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M + S group (193 min) and the C group (110 min) (p = 0.001) as well as the M + T group (157 min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation. Discussion and conclusion The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies.

  • 9. Eriksson, LB
    et al.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Safety of adjunct pre-emptive intravenous tramadol with midazolam sedation for third molar surgery2015Ingår i: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 19, nr 4, s. 353-359Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The purpose of this study was to evaluate patient safety, in terms of adverse events, alterations in blood pressure or oxygen saturation (SpO2) in two routine sedation procedures, with and without intravenous analgesia. METHODS: Patients referred for surgical removal of mandibular third molars were treated in a randomized, controlled, single-blinded procedure. Eighty-seven men and women, aged 18 to 44 years, were allotted to either of two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S) or to a control group (C), given no sedation. RESULTS: Tramadol at 1 mg/kg body weight resulted in a higher frequency of oxygen desaturation (SpO2 < 90 %) than a placebo (p = 0.002) but had no effect on mean SpO2 at the end point or at the end of surgery. In both the test groups, there was a significant decrease in diastolic blood pressure (p < 0.001) from baseline to the end of surgery. CONCLUSION: The results confirm that pre-emptive intravenous tramadol, administered at 1 mg/kg body weight as an adjunct to midazolam sedation for third molar surgery, offers a safe method. But, it should be noted that our previous study shows that it is not a particularly effective analgesic. Further testing is therefore warranted, using other doses or other drugs, to find a better intravenous protocol for postoperative analgesia, with maximum effect and minimal risk, in outpatient oral and maxillofacial surgery procedures.

  • 10.
    Feldman, Inna
    et al.
    Department of Public Health and Caring Science, Uppsala Universitet, Uppsala, Sweden.
    Helgason, Asgeir Runar
    Department of Public Health Sciences, Social Medicine, Karolinska Institutet, Stockholm, Sweden; Reykjavik University and Icelandic Cancer Society, Reykjavik University, Reykjavik, Iceland.
    Johansson, Pia
    Public Health and Economics, Stockholm, Sweden.
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Centre for Clinical Research, Uppsala University, Hospital of Vastmanland, Västerås, Sweden.
    Nohlert, Eva
    Centre for Clinical Research, Uppsala University and Region Vastmanland, Västerås, Sweden.
    Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up2019Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 9, nr 8, s. 1-8, artikel-id e030934Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up. DESIGN AND OUTCOME MEASURES: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (euro) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio. SETTING: The study was conducted in dental clinics in Sweden. PARTICIPANTS: 294 smokers aged 19-71 years were included in the study. INTERVENTIONS: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT). RESULTS: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to euro918 and euro3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden. CONCLUSION: CEA favours the more costly HIT if decision makers are willing to spend at least euro4000/QALY for tobacco cessation treatment.

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  • 11.
    Flink, Håkan
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Uppsala Univ, Vastmanland Hosp Västerås, Ctr Clin Res, Reg Vastmanland, Västerås, Sweden..
    Hedenbjörk-Lager, Anders
    Malmö universitet, Odontologiska fakulteten (OD).
    Liljeström, Simon
    Uppsala Univ, Vastmanland Hosp Västerås, Ctr Clin Res, Reg Vastmanland, Västerås, Sweden..
    Nohlert, Eva
    Uppsala Univ, Vastmanland Hosp Västerås, Ctr Clin Res, Reg Vastmanland, Västerås, Sweden..
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Uppsala Univ, Vastmanland Hosp Västerås, Ctr Clin Res, Reg Vastmanland, Västerås, Sweden..
    Identification of caries-active individuals in longitudinal data a methodological study using a national registry2023Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, s. 1-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveThe aim was to identify caries active individuals among adults by using a trajectory model of longitudinal data from the Swedish national registry (SKaPa) and comparing them with published data from the Dunedin cohort.Materials and methodsData from two different age groups (30- and 40-year-olds) followed for 10 years were retrieved from SKaPa and were compared with published longitudinal birth-cohort data from the Dunedin study. Using the trajectory model, the subjects were divided into three different trajectories according to their caries development over time (i.e. high, 15%; moderate, 45%; low, 40%).ResultsCaries experience, as measured by mean decayed, missing, and filled surfaces (DMFS) index, revealed significant differences among the three trajectories in both age groups. The patterns were similar to those observed in the Dunedin cohort. The mean increase in DMFS during the 10-year follow-up period from SKaPa was significantly higher for the high trajectories in both age groups compared with the moderate and low trajectories.ConclusionsThe method using three trajectories for presentation of caries experience over time, may be a useful tool to identify subjects with different disease activities. Identification of subjects in the high caries experience trajectory may increase the possibility to explore and evaluate more effective caries prevention for this group in the future.

  • 12.
    Flink, Håkan
    et al.
    Centre for Clinical Research, Uppsala University, Västmanland County, Västerås, Sweden; Public Dental Clinic, Public Dental Health Västmanland, Sala, Sweden.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD). Centre for Clinical Research, Uppsala University, Västmanland County, Västerås, Sweden; Postgraduate Dental Education Center, Public Dental Service, Örebro, Sweden.
    Arnetz, Judith E.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
    Birkhed, Dowen
    Fersens väg, Malmö, Sweden.
    Patient-reported negative experiences related to caries and its treatment among Swedish adult patients2017Ingår i: BMC Oral Health, E-ISSN 1472-6831, Vol. 17, nr 1, artikel-id 95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment. Methods: A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients' dental records. Exploratory factor analysis was conducted on items related to patients' perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared. Results: The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients. Conclusions: Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.

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  • 13.
    Flink, Håkan
    et al.
    Centre for Clinical Research, Uppsala University, Västerås, Sweden; Public Dental Clinic Sala, Public Dental Health Västmanland, Sala, Sweden.
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Arnetz, Judith E
    Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States.
    Birkhed, Dowen
    Fersens Väg, Malmö, Sweden.
    Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults.2020Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 78, nr 3, s. 229-235Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.

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  • 14. Flink, Håkan
    et al.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Arnetz, Judy
    Birkhed, Dowen
    Correlation between perceived experience of caries disease and recorded caries activity among adult patients at a Swedish Public Dental Clinic: A longitudinal study2013Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 71, nr 6, s. 1486-1492Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Objective. To compare patients' perceived experiences of caries activity with recorded longitudinal caries prevalence, consequences of caries and length of recall intervals. Materials and methods. A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients at a Swedish Public Dental Clinic. The overall response rate was 69%. The questionnaire included items regarding perceived caries activity, general health, dietary and oral hygiene habits, level of education and socioeconomic status. Questionnaire responses were studied for their association to clinical data extracted from patient dental records. Results. There was a correlation between patient-perceived and documented caries activity for all respondents (rho = 0.65; p < 0.001). CA patients had significantly more perceived caries activity (p < 0.001), decayed teeth (p < 0.001), root fillings (p = 0.001) and extractions (p < 0.001) than CI patients. The mean recall interval was 1.5 years for CA and 2.1 years for CI (p < 0.001). In multiple logistic regression analysis, CA patients were at increased risk for xerostomia (OR = 22.66, p = 0.003), sleep disturbances (OR = 4.36, p = 0.04) and more frequent use of daily extra fluoride (OR = 3.58, p = 0.03). Conclusions. Patient-perceived experience of caries correlated well with recorded caries activity in this group of middle-aged Swedish adults. Individuals with active caries were aware of their disease and made more frequent attempts to reduce caries activity by use of daily extra fluoride. Individual risk-based recall intervals did not seem to eliminate consequences of disease activity such as root fillings and extractions during the follow-up period.

  • 15.
    Flink, Håkan
    et al.
    Publ Dent Hlth Vastmanland, Publ Dent Clin Sala, Vasteras, Sweden; Uppsala Univ, Vastmanland Cty Hosp, Clin Res Ctr, Vasteras, Sweden.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD). Uppsala Univ, Vastmanland Cty Hosp, Clin Res Ctr, Vasteras, Sweden.
    Arnetz, Judy
    Michigan State Univ, Dept Family Med, E Lansing, MI 48824 USA; Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Birkhed, Dowen
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Cariol, Gothenburg, Sweden.
    Patient-reported outcomes of caries prophylaxis among Swedish caries active adults in a long-term perspective2016Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, nr 1, s. 101-110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to measure patient-reported outcomes of caries prophylaxis and to compare them with previously documented efforts in dental offices. A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The overall response rate was 69%. The questionnaire included items regarding patient perceived caries prophylaxis in relation to: 1) treatment and recommendations given by the dental personnel, 2) performed self-care and 3) perceived and expected effects.The responses were studied for their association to clinical data, extracted retrospectively from the patients' dental records.The mean follow up time was > 16 years. Information about caries prophylaxis (p = 0.01) and recommendations for self-care (p = 0.04) were given more often to the CA group than to the CI group. Supplementary examinations and recommendations of self-care risk treatments were more frequent in the CA group (p < 0.001). CA patients also made more frequent extra efforts at home to avoid caries by changing their eating habits (p < 0.001), improving their oral hygiene (p = 0.04) and using extra fluoride (p = 0.001). In the CA group, 60% did not considerthat the extra prophylaxis efforts had made them caries inactive, and 40% were not satisfied with the outcome. Most patients (> 90%) hoped that the outcome of caries prophylactics would be a reduced number of cavities.The patient-perceived experiences of caries prophylaxis-were in concordance with dental records. Both the dentists and the caries active middle-aged Swedish adults were aware of the need for extra prophylaxis.The caries active patients perceived having made extra home care efforts, but had not experienced that they had become free from caries

  • 16.
    Hedberg, Pär
    et al.
    Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden; Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Nohlert, Eva
    Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Effects of oral appliance treatment on inflammatory biomarkers in obstructive sleep apnea: A randomised controlled trial2021Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 30, nr 4, artikel-id e13253Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Obstructive sleep apnea (OSA) may lead to increased circulating concentrations of inflammatory biomarkers and treatment may change these. We aimed to assess the effect of oral appliance (OA) therapy on inflammatory biomarkers in a randomised controlled pilot trial. A total of 71 patients with OSA and systemic hypertension were randomly allocated to an active, mandible protruded (OAa) or a passive, mandible non-protruded device (OAp) treatment. Serum concentrations of the inflammatory biomarkers white blood cells, high-sensitivity C-reactive protein, interleukin 6, interleukin 10, and tumour necrosis factor-α were measured at baseline and after 3 months of OA treatment. The differences between treatment groups in biomarker concentration change during the treatment were presented as the Vargha and Delaney effect size and evaluated with the Wilcoxon-Mann-Whitney test. This effect size expresses the probability of a higher value in a random participant from one group compared with a random patient from the other group, and a value of 0.5 means stochastically equal groups. After 3 months of treatment, there was a significant reduction of the apnea-hypopnea index in the OAa group compared with the OAp group (effect size 0.258, 95% confidence interval 0.146-0.386, p < .001). There were no significant differences between the groups in any of the inflammatory markers' concentration changes during the treatment period (effect sizes between 0.488 and 0.524; all p values ≥.737). Thus, OA treatment for 3 months did not affect circulating concentrations of some common inflammatory markers in patients with OSA and systemic hypertension.

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  • 17.
    Isacsson, G.
    et al.
    Uppsala Univ, Ctr Clin Res, Vasteras, Sweden; Vastmanland Cty Hosp, Orofacial Pain & Jaw Funct, Vasteras, Sweden.
    Nohlert, E.
    Uppsala Univ, Ctr Clin Res, Vasteras, Sweden.
    Fransson, A.
    Postgrad Dent Educ Ctr Orebro, Dent Sleep Med Clin, Orebro, Sweden.
    WimanEriksson, E.
    Postgrad Dent Educ Ctr Orebro, Dent Sleep Med Clin, Orebro, Sweden.
    Ortlieb, E.
    Postgrad Dent Educ Ctr Orebro, Dent Sleep Med Clin, Orebro, Sweden.
    Fodor, C.
    Vastmanland Cty Hosp, Orofacial Pain & Jaw Funct, Vasteras, Sweden.
    Schumann, M.
    Vastmanland Cty Hosp, Orofacial Pain & Jaw Funct, Vasteras, Sweden.
    Sturebrand, M.
    Vastmanland Cty Hosp, Orofacial Pain & Jaw Funct, Vasteras, Sweden.
    Trepp, L.
    Postgrad Dent Educ Ctr Orebro, Dent Sleep Med Clin, Orebro, Sweden.
    Avdelius, Anna
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD). Postgrad Dent Educ Ctr Orebro, Dept Orthodont, Orebro, Sweden.
    Bornefalk-Hermansson, A.
    Uppsala Clin Res Ctr, Uppsala, Sweden.
    Bibloc and Monobloc Oral appliances in the Treatment of Obstructive Sleep apnoea: a Multicenter, Randomized, Blinded, Parallel-Group Trial2017Ingår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, nr Suppl 1, s. E142-E143Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: The clinical benefit of bibloc over monobloc appliances has not been established in randomized trials treating obstructive sleep apnoea (OSA). We hypothesized that the two types of appliances are equally effective in treating moderate to severe OSA. Materials and methods: We performed a blinded, multicenter, randomized, controlled, prospective, parallel-group trial including patients aged 18 years or older who had moderate-to-severe OSA. Patients were randomly assigned to receive either a bibloc or a monobloc appliance with the intention to protrude the mandible 75% of the individual maximal protrusion capacity. At baseline a one-night respiratory polygraphy was done without any respiratory support. The polygraphy was iterated with the appliance in place at a 6-week follow-up. The primary outcome was the absolute change in the apnoea-hypopnea-index (AHI) from baseline to the 6-week follow-up, analysed in the per-protocol population. All patients who received an appliance were included in the safety analysis. This trial is registered with ClinicalTrials.gov, number NCT02148510, and approved by Uppsala Regional Ethical Review Board, Sweden (#2014/021). Results: We recruited patients from three dental specialist clinics in Sweden; enrolment of 302 patients was done between March 2014 and April 2016; 146 randomized to bibloc and 156 to monobloc appliance. Twenty-three patients in the bibloc group and 17 in the monobloc group were withdrawn due to reasons like appliance could not be fitted, lack of compliance, adverse events or non-valid follow-up polygraphy i.e. a per-protocol group of 123 bibloc and 139 monobloc treated patients. The mean change of AHI from baseline to 6 weeks of treatment was -13.8 (95% CI -16.1 to -11.5; p < 0.001) in the bibloc group and -12.5 (95% CI -14.8 to -10.3; p < 0.001) in the monobloc group. The mean difference was not significant between the groups (-1.3 (95% CI -4.5 to 1.9). The most common adverse event in the orofacial region was upper airway infection followed by complains from various parts of the mouth, jaws and teeth. Conclusions: Bibloc and monobloc appliance treatment was equal in their effects in treating OSA as measured by at home polygraphic respiratory measures and the appliances were associated with a similar degree of adverse events. Acknowledgements: Funding from Uppsala-Örebro Regional Research Council and Vastmanland County Council, Sweden.

  • 18.
    Isacsson, Göran
    et al.
    Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden.
    Nohlert, Eva
    Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Fransson, Anette M C
    Department of Orthodontics, Dental Research, Public Dental Service, Region Örebro County and Faculty of Medicine and Health, Örebro University, Sweden; Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden.
    Bornefalk-Hermansson, Anna
    UCR Uppsala Clinical Research Center, Uppsala University, Sweden.
    Wiman Eriksson, Eva
    Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden.
    Ortlieb, Eva
    Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden.
    Trepp, Livia
    Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden.
    Avdelius, Anna
    Malmö universitet, Odontologiska fakulteten (OD).
    Sturebrand, Magnus
    Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden.
    Fodor, Clara
    Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden.
    List, Thomas
    Malmö universitet, Odontologiska fakulteten (OD).
    Schumann, Mohamad
    Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden.
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden.
    Use of bibloc and monobloc oral appliances in obstructive sleep apnoea: a multicentre, randomized, blinded, parallel-group equivalence trial.2019Ingår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, nr 1, s. 80-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The clinical benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that the two types of appliances are equally effective in treating OSA. Objective: To compare the efficacy of monobloc versus bibloc appliances in a short-term perspective. Patients and methods: In this multicentre, randomized, blinded, controlled, parallel-group equivalence trial, patients with OSA were randomly assigned to use either a bibloc or a monobloc appliance. One-night respiratory polygraphy without respiratory support was performed at baseline, and participants were re-examined with the appliance in place at short-term follow-up. The primary outcome was the change in the apnoea-hypopnea index (AHI). An independent person prepared a randomization list and sealed envelopes. Evaluating dentist and the biomedical analysts who evaluated the polygraphy were blinded to the choice of therapy. Results: Of 302 patients, 146 were randomly assigned to use the bibloc and 156 the monobloc device; 123 and 139 patients, respectively, were analysed as per protocol. The mean changes in AHI were -13.8 (95% confidence interval -16.1 to -11.5) in the bibloc group and -12.5 (-14.8 to -10.3) in the monobloc group. The difference of -1.3 (-4.5 to 1.9) was significant within the equivalence interval (P = 0.011; the greater of the two P values) and was confirmed by the intention-to-treat analysis (P = 0.001). The adverse events were of mild character and were experienced by similar percentages of patients in both groups (39 and 40 per cent for the bibloc and monobloc group, respectively). Limitations: The study shows short-term results with a median time from commencing treatment to the evaluation visit of 56 days and long-term data on efficacy and harm are needed to be fully conclusive. Conclusion: In a short-term perspective, both appliances were equivalent in terms of their positive effects for treating OSA and caused adverse events of similar magnitude. Trial registration: Registered with ClinicalTrials.gov (#NCT02148510).

  • 19.
    Isacsson, Göran
    et al.
    Department of Orofacial Pain and Jaw Function, Västmanland County Hospital, Västerås, Sweden.
    Schumann, Mohamad
    Department of Orofacial Pain and Jaw Function, Västmanland County Hospital, Västerås, Sweden.
    Nohlert, Eva
    Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Mejersjö, Christina
    Clinic of Orofacial Pain, Sahlgrenska Academy and Public Dental Health, Gothenburg, Sweden.
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD). Department of Orofacial Pain and Jaw Function, Postgraduate Dental Education Center, Örebro, Sweden.
    Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia - A multicentre randomised controlled trial.2019Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 46, nr 1, s. 5-13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Temporomandibular joint (TMJ) arthralgia is a painful condition assumed to be associated with local inflammation. OBJECTIVE: The objective of the present study was to determine the efficacy for reducing pain of a single-dose intra-articular (IA) injection of methylprednisolone to the TMJ. The hypothesis was that methylprednisolone would effectively reduce TMJ pain. METHODS: This randomised, double-blind, parallel-group, multicentre, controlled study included visits for enrolment, treatment and 4-week follow-up. The study included patients 18 years and older who had been diagnosed with unilateral TMJ arthralgia. All participants were randomly assigned to receive 1 mL IA injections of methylprednisolone or saline. The primary outcome was change in recorded pain intensity on a visual analogue scale (VAS) at maximum jaw opening, analysed in the per protocol population. RESULTS: In total, 54 patients were randomly assigned to single-dose IA injections with methylprednisolone (n = 27) or saline (n = 27). Between baseline and the 4-week follow-up, VAS-rated pain intensity at maximum jaw opening decreased from a mean of 61.0 (95% confidence interval [CI]: 50.1; 70.7) to 33.9 (95% CI: 21.6; 46.2) in the methylprednisolone group and from 59.6 (95% CI: 50.7; 65.9) to 33.9 (95% CI: 23.8; 43.9) in the saline group. The between-group difference was not significant (P = 0.812). Treatment-related adverse events were doubled in the methylprednisolone group. CONCLUSION: Methylprednisolone provided no additional benefit for reducing pain, but caused more harm compared with saline following a single-dose IA injection in patients with TMJ arthralgia.

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  • 20. Johansson, Ann-Katrin
    et al.
    Johansson, Anders
    Nohlert, Eva
    Norring, Claes
    Åstrom, Anne Nordrehaug
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Eating disorders - knowledge, attitudes, management and clinical experience of Norwegian dentists2015Ingår i: BMC Oral Health, E-ISSN 1472-6831, Vol. 15, nr 124, artikel-id 124Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The purpose of this study was to investigate knowledge, attitudes and clinical experience with regard to patients with eating disorders (ED) among Norwegian dentists. METHODS: In 2010, a questionnaire was sent to all dentists in Norway (N = 4282) comprising 33 questions related to demographics of the participating dentists, their knowledge of ED (general and oral health aspects), clinical experience, attitudes and perceived management preferences. RESULTS: The participation rate was 40 % (47 % women and 53 % men). Their knowledge about ED was often retrieved from common media sources and the greater part of the participants reported they had seen very few patients with ED during their professional career. Female dentists reported superior knowledge about ED compared to males, but the former experienced greater difficulties to inform about the condition. Referrals of the patient to other health facilities were significantly more common among female compared to male dentists. The majority of dentists (76 %) reported a need of more education related to ED management. CONCLUSIONS: The Norwegian dentists in this study reported limited clinical experience and insufficient knowledge regarding ED. There is therefore a need to increase both undergraduate and continuing education in this field, which can improve preventive and management measures that a dentist can provide for ED patients.

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  • 21.
    Johansson, Ann-Katrin
    et al.
    Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Nohlert, Eva
    Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Johansson, Anders
    Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Norring, Claes
    Stockholm Center for Eating Disorders, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD). Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Dentists and eating disorders: knowledge, attitudes, management and experience2009Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 33, nr 1, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aims of the present study were to explore the level of knowledge and attitudes among dentists in relation to patients with eating disorders (ED) and evaluate the extent to which patients with ED are identified and/or treated in the dental setting. A postal questionnaire was constructed and sent to all dentists (n = 367) in two Swedish counties during November 2005. The questionnaire comprised 29 questions or statements in the following categories: demographics, general knowledge of ED and its oral consequences, experience of and attitudes towards patients with ED and interaction within the health care system, for example, referrals and treatment options regarding this patient group. The response rate was 70% (n = 258). Perceived knowledge about ED was most commonly obtained from media sources, namely newspapers, television, etc. Few dentists knew that there existed specialized referral units for ED patients in their county. The majority of dentists stated that they had seen only a few such patients during their practice. Even though the perceived level of general knowledge about ED among female dentists appeared to be better than among male dentists, they also found it more difficult to inform the patient/relatives about their suspicion of the condition. Female dentists referred to specialists significantly more frequently than did males. Eighty-six percent of responders reported that they needed more training in dental management of patients with ED. Knowledge and clinical experience of dentists as regards patients with ED were found to be low. The level of education in this area needs to be improved, which would have the potential to encourage dentists to become more involved in secondary and tertiary prevention and management of ED.

  • 22.
    Koch, Margaretha
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Englander, Magnus
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för socialt arbete (SA).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Wolf, Eva
    Malmö högskola, Odontologiska fakulteten (OD).
    Successful clinical and organisational change in endodontic practice: a qualitative study2014Ingår i: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 18, nr 3, s. 121-127Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process.

  • 23. Koch, Margaretha
    et al.
    Eriksson, Hans G
    Axelsson, Susanna
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Effect of educational intervention on adoption of new endodontic technology by general dental practitioners: a questionnaire survey2009Ingår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 42, nr 4, s. 313-321Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To survey the clinical endodontic protocols of general dental practitioners (GDPs) in public dental clinics and to assess the effect of an educational intervention on the adoption of a nickel-titanium (Ni-Ti) rotary system. METHODS: General dental practitioners in a Swedish Intervention County (IC), underwent an educational programme in endodontics. A follow-up questionnaire was posted to 98 GDPs in the IC and to 97 GDPs in a Control County (CC), where no specific training had been provided. The questionnaire concerned demographics, clinical endodontic protocols and instrumentation techniques. RESULTS: The response rate to the questionnaire was 87%. More than 90% of all GDPs reported they always or generally used rubber dam, determined working length, used the canal irrigant 0.5% buffered NaOCl and calcium hydroxide as an interappointment dressing. Two of three GDPs reported, they generally or always informed the patient of the prognosis. Every second GDP reported routines for postoperative recall and follow-up. The Ni-Ti rotary technique was reported to be completely adopted by 77% of the GDPs in the IC, significantly higher than in the CC (6%), P < 0.001. In the IC 79% of the GDPs reported they completed instrumentation in one treatment session, compared with only 32% in the CC, P < 0.001. The 'single-cone' mode of canal filling was reported to be significantly more frequent amongst GDPs in the IC, P < 0.001. CONCLUSIONS: General dental practitioners in both counties reported using contemporary clinical endodontic protocols. GDPs who had undergone an educational programme in Ni-Ti rotary instrumentation reported they had successfully integrated the technique into daily clinical practice.

  • 24.
    Koch, Margaretha
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Eckerlund, Ingemar
    Axelsson, Susanna
    A cost-minimization analysis of root canal treatment before and after education in nickel-titanium rotary technique in general practice2012Ingår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 45, nr 7, s. 633-641Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden. METHODOLOGY: Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA. RESULTS: Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P < 0.001). Thus, on average, for every second root canal treatment performed after the education, one instrumentation session was saved. Root canal treatments in teeth with one canal, and three or more canals, were completed in significantly fewer instrumentation sessions after the education (P < 0.001). Direct costs of instrumentation sessions were SEK 2587 (USD 411) for group A and SEK 2851 (USD 453) for group B, for teeth with one canal, and SEK 2946 (USD 468) for group A and SEK 3510 (USD 558) for group B, for teeth with three or more canals (year 2011). Root canal treatments of teeth with two canals showed no significant difference with respect to number of instrumentation sessions and costs. CONCLUSIONS: Significantly fewer instrumentation sessions were required in group A, and root canal instrumentation therefore costs less than in group B. On the assumption that treatment outcome is identical in group A and B, root canal instrumentation performed after the education was more cost-effective.

  • 25.
    Koch, Margaretha
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Wolf, Eva
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Effect of education intervention on the quality and long-term outcomes of root canal treatment in general practice2015Ingår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 48, nr 7, s. 680-689Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim To compare the technical quality and long-term outcomes of root canal treatment by general practitioners of a Swedish Public Dental Service, before and after an endodontic education including Ni-Ti rotary technique (NiTiR). Methodology A random sample was compiled, comprising one root filled tooth from each of 830 patients, treated by 69 general practitioners participating in the education: 414 teeth root filled in 2002, pre-education, using primarily stainless steel instrumentation and filling by lateral compaction, and 416 teeth root filled post-education (2005), using mainly NiTiR and single-cone obturation. Follow-up radiographs taken in 2009 were evaluated alongside immediate post-filling radiographs from 2002 to 2005. The density and length of the root fillings were registered. Periapical status was assessed by the Periapical Index (PAI), using two definitions of disease: apical periodontitis (AP) (PAI 3 + 4 + 5) and definite AP (PAI 4 + 5). Tooth survival was registered. Root fillings pre- and post-education were compared using chi-square and Fisher's exact tests. Crude extraction rates per 100 years were calculated for comparison of tooth survival. Explanatory variables (type of tooth, root filling quality, periapical status, marginal bone loss, type and quality of coronal restoration) in relation to the dependent variable (AP at follow-up) were analysed by multivariable logistic regression. Results Follow-up data were available for 229 (55%) of teeth treated pre-and 288 (69%) treated post-education: both tooth survival (P < 0.001) and root filling quality were significantly higher (P < 0.001) in the latter. However, there was no corresponding improvement in periapical status. Both preand post-education, root fillings with definite AP on completion of treatment had significantly higher odds of AP or definite AP at follow-up. For teeth treated post-education, inadequate root filling quality was significantly associated with AP at follow-up. Conclusions Despite a higher tooth survival rate and a significant improvement in technical quality of root fillings after the education, there was no corresponding improvement in periapical status.

  • 26.
    Lindfors, Erik
    et al.
    Department of Stomatognathic Physiology , Public Dental Health Service , Uppsala , Sweden; Department of Dental Medicine , Karolinska Institutet, Scandinavian Center for Orofacial Neuroscience (SCON) , Huddinge , Sweden.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD). Clinical Centre of Research , Uppsala University , Västerås , Sweden; Postgraduate Education Dental Center , Örebro, Sweden.
    Magnusson, Tomas
    School of Health and Welfare , Jönköping University , Jönköping , Sweden.
    Ernberg, Malin
    Department of Dental Medicine , Karolinska Institutet, Scandinavian Center for Orofacial Neuroscience (SCON) , Huddinge , Sweden.
    Treatment of temporomandibular disorders - knowledge, attitudes and clinical experience among general practising dentists in Sweden.2016Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, nr 6, s. 460-465Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs). MATERIAL AND METHODS: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n = 128) and 2014 (n = 113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001. RESULTS: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines. CONCLUSIONS: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD.

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  • 27.
    List, Thomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Bettfysiologi i Sverige: vilkor och ramar2005Ingår i: Tandlægebladet, ISSN 0039-9353, Vol. 109, nr 4, s. 308-313Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Svensk bettfysiologi är framgångsrik sett med internationella glasögon. Denna framgång har uppnåtts genom den omfattande forskning som bedrivits. Ämnets status höjdes genom att bli godkänd specialitet i 1993.

  • 28.
    List, Thomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Orofacial smärta2010Ingår i: Smärta och smärtbehandling / [ed] Mads Werner, Ido Leden, Liber, 2010, s. 556-564Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 29.
    List, Thomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Temporomandibulär dysfunktion hos barn och tonåringar2009Ingår i: Migrän och spänningshuvudvärk hos barn och tonåringar / [ed] Bo Larsson, Studentlitteratur AB, 2009Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 30. Molarius, Anu
    et al.
    Engström, Sevek
    Flink, Håkan
    Simonsson, Bo
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Socioeconomic differences in self-rated oral health and dental care utilisation after the dental care reform in 2008 in Sweden2014Ingår i: BMC Oral Health, E-ISSN 1472-6831, Vol. 14, artikel-id 134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aims of this study were to determine self-rated oral health and dental attendance habits among Swedish adults, with special reference to the role of social inequalities, after the Swedish dental care reform in 2008. Methods: The study is based on a survey questionnaire, sent to 12,235 residents of a Swedish county, in 2012. The age group was 16-84 years: 5,999 (49%) responded. Using chi-square statistics, differences in prevalence of self-rated oral health and regular dental attendance were analysed with respect to gender, age, educational level, family status, employment status and country of birth. Self-rated poor oral health was analysed by multivarite logistic regression adjusting for the different socio-demographic factors, financial security and having refrained from dental treatment for financial reasons. Results: Three out of four respondents (75%) reported fairly good or very good oral health. Almost 90% claimed to be regular dental attenders. Those who were financially secure reported better oral health. The differences in oral health between those with a cash margin and those without were large whereas the differences between age groups were rather small. About 8% reported that they had refrained from dental treatment for financial reasons during the last three months. Self-rated poor oral health was most common among the unemployed, those on disability pension or on long-term sick leave, those born outside the Nordic countries and those with no cash margin (odds ratios ranging from 2.4 to 4.4). The most important factor contributing to these differences was having refrained from dental treatment for financial reasons. Conclusion: The results are relevant to strategies intended to reduce social inequalities in oral health, affirming the importance of the provision of equitable access to dental care.

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  • 31. Nohler, Eva
    et al.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Tillgren, Per
    Johansson, Pia
    Rosenblad, Andreas
    Helgason, Ásgeir R
    Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden: a randomized trial2009Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 9, s. 121-131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting. METHODS: 300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (> or = 183 days) at the 12-month follow-up. RESULTS: Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support. CONCLUSION: Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support. TRIAL REGISTRATION: Trial registration number: NCT00670514.

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  • 32. Nohlert, Eva
    et al.
    Helgason, Ásgeir R.
    Tillgren, Per
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Johansson, Pia
    Comparison of the Cost-Effectiveness of a High- and a Low-Intensity Smoking Cessation Intervention in Sweden: A Randomized Trial2013Ingår i: Nicotine & tobacco research, ISSN 1462-2203, E-ISSN 1469-994X, Vol. 15, nr 9, s. 1519-1527Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To assess the relative cost-effectiveness of a high-intensity treatment (HIT) and a low-intensity treatment (LIT) for smoking cessation. Methods: The societal and health care perspective economic evaluation was based on the reported number of quitters at 12-month follow-up (point prevalence) from a randomized controlled trial of 2 smoking cessation programs in Sweden. Future disease-related costs (in Swedish kronor [SEK] 2004; SEK7.35 = USD1) and health effects (in quality-adjusted life-years [QALYs]) were estimated via a Markov model comprising lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease including stroke with costs and QALYs discounted 3% annually. Results: HIT was more effective than LIT (23% vs. 16% quitters), but at a considerably higher intervention cost: SEK26,100 versus 9,100 per quitter. The model-estimated societal costs avoided did not balance the higher intervention costs, so the incremental cost-effectiveness ratio (ICER) amounted to SEK100,000 per QALY for HIT versus LIT. All sensitivity analyses indicated an ICER below SEK300,000 and that HIT is the preferred option if the decision maker willingness-to-pay exceeds SEK50,000 per QALY. Compared with no intervention, LIT was cost saving, whereas HIT was estimated at SEK8,400 per QALY. Conclusions: Compared with no smoking cessation program, it is a societal waste not to implement the LIT as it is estimated to result in lower societal costs. The incremental cost per QALY gained of SEK100,000 for HIT is considered very cost-effective in Sweden. Thus, if smoking cessation programs are judged in the same manner as other Swedish health care measures, the high-intensity program should be chosen before the low-cost program.

  • 33. Nohlert, Eva
    et al.
    Öhrvik, John
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Tillgren, Per
    Helgason, Ásgeir R
    Long-term follow-up of a high- and a low-intensity smoking cessation intervention in a dental setting: a randomized trial2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, artikel-id 592Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Achieving lifelong tobacco abstinence is an important public health goal. Most studies use 1-year follow-ups, but little is known about how good these are as proxies for long-term and life-long abstinence. Also, intervention intensity is an important issue for development of efficient and cost-effective cessation treatment protocols.The study aims were to assess the long-term effectiveness of a high- and a low-intensity treatment (HIT and LIT) for smoking cessation and to analyze to what extent 12-month abstinence predicted long-term abstinence. METHODS: 300 smokers attending dental or general health care were randomly assigned to HIT or LIT at the public dental clinic. Main outcome measures were self-reported point prevalence, continuous abstinence (>=6 months), and sustained abstinence. The study was a follow-up after 5--8 years of a previously performed 12-month follow-up, both by postal questionnaires. RESULTS: Response rate was 85% (n=241) of those still alive and living in Sweden. Abstinence rates were 8% higher in both programs at the long-term than at the 12-month follow-up. The difference of 7% between HIT and LIT had not change, being 31% vs. 24% for point prevalence and 26% vs. 19% for 6-month continuous abstinence, respectively. Significantly more participants in HIT (12%) than in LIT (5%) had been sustained abstinent (p=0.03). Logistic regression analyses showed that abstinence at 12-month follow-up was a strong predictor for abstinence at long-term follow-up. CONCLUSIONS: Abstinence at 12-month follow-up is a good predictor for long-term abstinence. The difference in outcome between HIT and LIT for smoking cessation remains at least 5--8 years after the intervention.Trial registration number: NCT00670514.

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  • 34.
    Nordin, Erik
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Stenberg, Madelené
    Centre of Clinical Research, Uppsala university, Västerås, Sweden.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD). Centre of Clinical Research, Uppsala university, Västerås, Sweden; Postgraduate Dental Education Center, Public Dental Service, Örebro, Sweden.
    Obstructive sleep apnoea: patients' experiences of oral appliance treatment2016Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 43, nr 6, s. 435-442Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Over the past few decades, there has been a pronounced increase in the number of patients being treated by general dental practitioners for obstructive sleep apnoea (OSA). The purpose of this study was to survey the care and patient experiences and the self-reported effectiveness of OSA treatment with an oral appliance (OA) incorporating mandibular advancement. The design was a retrospective, cross-sectional study, with follow-up between 6 months to 1 year after commencement of treatment. A survey form was posted to 1150 subjects, identified in the regional register over a 1-year period as having been treated with an OA for OSA. The questionnaire comprised 70 questions and assertions in various domains, such as general health/lifestyle, changes in symptoms/quality of life and sleep-related experiences, daytime sleepiness, changes in life situation, evaluation of treatment and the value of treatment. The overall response rate was 64% (n = 738). Treatment with OA gave relief of symptoms in 83% of the respondents. Quality of life, somatic and cognitive symptoms improved significantly in patients who used the appliance frequently (P < 0·001). Daytime sleepiness decreased significantly (P < 0·001). Treatment satisfaction and willingness to recommend the similar treatment to a friend were high (>85%). OA treatment of OSA by general dental practitioners is a safe procedure. Most of the survey respondents experienced relief of symptoms. Those who used their appliance frequently reported improvement in quality of life, somatic and cognitive symptoms. Excessive daytime sleepiness was reduced in the majority of the patients under treatment.

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  • 35. Petersson-Skantz, Helen
    et al.
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Oral apparatur värdefull vid sömnapnébehandling2010Ingår i: Tandläkartidningen, ISSN 0039-6982, nr 5, s. 64-69Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    Studien omfattar en prospektiv konsekutiv serie av 60 vuxna patienter som behandlats för obstruktiv sömnapné (osa) hos allmäntandläkare med intraoral mandibelframdragande apparatur (oral apparatur, oa). Syftet var att kvalitetsutvärdera behandlingseffekter och eventuella biverkningar av oa-behandling. Patienterna besvarade enkäter före behandlingsstart och efter en respektive sex månaders behandling. 55 av de ursprungliga 60 patienterna svarade på samtliga enkäter, varav 41 var män och 19 var kvinnor med en medelålder på 54 år. Efter sex månaders behandling rapporterade 47 procent att deras allmänna välbefinnande var mycket bättre, 65 procent att deras sömnkvalitet blivit mycket bättre och hos 74 procent hade snarkningsbesvären minskat mycket. Andelen personer som uppgav att de aldrig hade huvudvärk var före behandling 23 procent som ökade till 75 procent efter behandling. Hos två av tre patienter förelåg ingen trötthets-/stelhetskänsla i käksystemet och detta förändrades inte under behandlingstiden. De som intermittent upplevde trötthets-/stelhetskänsla vid käkfunktion ökade från 18 procent till 27 procent efter behandlingen. Rörelsesmärtan vid käkfunktion ökade något efter oa-användning, men denna biverkning var låg (5 procent). Majoriteten av patienterna (67 procent) upplevde inga bettförändringar i samband med behandling, dock uppgav 4 procent att de fått en stor bettförändring i och med användandet av oa. Sammanfattningsvis kan sägas att oral apparatur är en värdefull behandlingsmetod vid lätt till måttligt osa med få biverkningar av oftast mindre omfattning avseende käkfunktionen eller andra komplikationer.

  • 36.
    Tegelberg, Åke
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Andrén, A
    Effects on blood pressure after treatment of obstructive sleep apnea with an oral appliance with mandibular advancement, a 3 year follow-up2007Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    The study purpose was to investigate if rduction of obstructive sleep apnea with oral appliance therapy (AO)affects blood pressure (BP) in hypertensive patients in a short-term and long-term perspective. Material and methods: Twenty-nine consecutive patients with verified obstructive sleep apnea (OSA);defined as apnea index (AI)

  • 37.
    Tegelberg, Åke
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Andrén, A
    Effects on hypertension after treatment of obstructive sleep apnea with mandibular advancement device2007Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 38.
    Tegelberg, Åke
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Flink, H
    Bergdahl, M
    Karlsson, A
    Lagerlöf, Folke
    Hyposalivation - vanligt hos äldre, men inte ovanligt hos yngre vuxna.2007Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 39.
    Tegelberg, Åke
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Nohlert, E.
    Bergman, LE
    Andrén, A.
    Bed partners' and patients' experiences after treatment of obstructive sleep apnoea with an oral appliance2012Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 36, nr 1, s. 35-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the study was to evaluate bed-partners' and patients' self-reports of general well-being, physical strength and mental energy after treatment for obstructive sleep apnoea (OSA) with a mandibular advancement oral appliance (OA). Patients (N = 134) referred from medical physicians diagnosed with true OSA, i.e. an apnoea-hypopnoea index of > 10, were treated with an OA for more than one year. The somnographic evaluations were undertaken in a patient's home before the start of, and six months after, treatment. An individually designed monobloc OA was manufactured by a dental technician for nightly use. After one year of treatment, a follow-up questionnaire was sent to patients whose sleep disorder was reduced > 50% from baseline values and to their bed partners. The questionnaire consisted of 15 questions or statements with multi-answer alternatives concerning well-being, physical strength, mental energy, sleep, day and night symptoms, and the Epworth Sleepiness Scale (ESS: eight questions). The questionnaire was answered by 82% (110/134) of the patients and 85 bed partners. Both patients and bed partners reported improvement in general well-being, physical strength and mental energy, between 70-80% for patients and 55-68% for bed partners sharing the same bed-room. Similar results were found for concentration ability, joyfulness and strength of effort in social intercourse, as well as decreased daytime sleepiness, improvement in the feeling of getting enough sleep and reduced nocturia. Conclusions: In all dimensions, the treatment effect had a great influence, not only on patients but on bed partners as well.

  • 40.
    Tegelberg, Åke
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Nohlert, E.
    Uppsala Univ, Ctr Clin Res, Vasteras, Sweden.
    Bornefalk-Hermansson, A.
    Uppsala Univ, Uppsala Clin Res, Uppsala, Sweden.
    Fransson, A.
    Orebro Univ, Fac Med & Hlth, Orebro, Sweden; Orebro Univ, Postgrad Dent Educ Ctr, Orebro, Sweden.
    Isacsson, G.
    Uppsala Univ, Orofacial Pain Clin, Vasteras, Sweden; Uppsala Univ, Ctr Clin Res, Vasteras, Sweden.
    Respiratory Outcome After One-year Treatment Of Obstructive Sleep Apnea With Bibloc Versus Monobloc Oral Appliances: a Multicenter, Randomized Equivalence Trial2019Ingår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 64, nr Suppl. 1, s. S378-S378Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The benefit of bibloc over monobloc appliances in one-year obstructive sleep apnea (OSA) has not been evaluated in randomized trials. We hypothesized that these types of appliances are equally effective.

    Methods: In this multicenter, randomized equivalence trial patients with OSA were assigned to either bibloc or monobloc appliance treatment. At baseline a one-night home respiratory polygraphy was done without respiratory support, and at one-year follow-up examination iterated with the appliance in place. The outcome was the change in the apnea-hypopnea-index (AHI) and the equivalence limits were set at ±5.

    Results: Out of 302 patients 146 were randomly assigned to bibloc and 156 to monobloc. In 88 and 104 patients, respectively, were analysed per-protocol with a significant reduction of AHI with a mean change -16.7 (95% CI -19.4 to -14.1) in the bibloc and -11.8 (-14.9 to -8.7) in the monobloc and not significantly equivalent. The proportion of responders defined as AHI < 10 at the follow-up was 68% and 65% for bibloc and monobloc, respectively. Treatment related adverse events were generally mild and transient and occurred similar in frequencies between groups.

    Conclusions: Bibloc and monobloc appliance treatment gave a significant positive effect in treating OSA. The treatment modalities were not statistically equivalent, with a numerically greater reduction with bibloc, and, were associated with a similar degree of adverse events.

  • 41.
    Tegelberg, Åke
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Nohlert, Eva
    Uppsala University.
    Bornefalk-Hermansson, Anna
    Uppsala University.
    Fransson, Anette
    Örebro University.
    Isacsson, Göran
    Västmanland County Hospital, Västerås.
    Respiratory outcomes after a 1-year treatment of obstructive sleep apnoea with bibloc versus monobloc oral appliances: a multicentre, randomized equivalence trial2020Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 78, nr 6, s. 401-408Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that these types of appliances would be equally effective.

    Material and methods: In this multicentre, randomized equivalence trial, patients with OSA received one type of bibloc or one type of monobloc treatment. At baseline, a 1-night polygraphy study was done, and this was repeated after 1 year. The outcome was any change in the apnoea–hypopnoea index (AHI) and the limits of equivalence between the two devices were set at ±5 AHI units.

    Results: Of 302 patients, 146 were randomly assigned to bibloc and 156 to monobloc appliances. In 88 and 104 patients, respectively, there were significant reductions in the AHI (p < .001) with a mean change of −16.7 (95% CI −19.4 to −14.1) in the bibloc and −11.8 (−14.9 to −8.7) in the monobloc groups. The proportions of responders defined as having an AHI <10 were 68% and 65% for the bibloc and monobloc groups, respectively. Treatment-related adverse events were mild, transient and the dropouts were more frequent in the bibloc group.

    Conclusions: Both types of treatments positively and significantly reduced respiratory disturbances, but at the 1-year follow-up, they were not significantly different in treating OSA, with a numerically greater reduction of the AHI value with the bibloc appliance. However, the higher proportion of treatment-related adverse events and higher proportion of dropouts among bibloc users should be balanced against the advantage of a greater reduction in the AHI.

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  • 42.
    Tegelberg, Åke
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden.
    Nohlert, Eva
    Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden.
    List, Thomas
    Malmö universitet, Odontologiska fakulteten (OD).
    Isacsson, Göran
    Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden; Orofacial pain and jaw function Clinic, Department of Specialist Dental Care, Västmanland Hospital, Västerås, Sweden.
    Oral appliance influence on jaw function in obstructive sleep apnea2023Ingår i: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 164, nr 5, s. 682-689, artikel-id S0889-5406(23)00302-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Oral appliance (OA) therapy in obstructive sleep apnea (OSA) could be a risk factor for normal jaw function, given the prolonged effect of an OA in keeping the mandible in a protruded position away from a normal position. This study aimed to assess changes in symptoms and clinical findings related to jaw function after 1 year of treating OSA with an OA.

    METHODS: In this follow-up clinical trial, 302 patients with OSA were assigned to treatment with either monobloc or bibloc OA. Baseline and 1-year follow-up assessment included using the Jaw Functional Limitation Scale, self-reported symptoms and signs related to jaw function. The clinical examination of jaw function included mandibular mobility, dental occlusion, and tenderness in the temporomandibular joints and masticatory muscles. Descriptive analyses of variables are presented for the per-protocol population. To evaluate differences between the baseline and the 1-year follow-up, paired Student t tests and the McNemar change test was used.

    RESULTS: One-hundred and ninety-two patients completed the 1-year follow-up (male 73%, mean aged 55 ± 11 years). There was no change in the Jaw Functional Limitation Scale score at the follow-up (nonsignificant). The patients described no change in symptoms at the follow-up, except for improvements in morning headache (P <0.001) and increased frequency of difficulties in opening the mouth or chewing on awakening (P = 0.002). Subjectively reported changes in dental occlusion during biting/chewing increased significantly at the follow-up (P = 0.009).

    CONCLUSIONS: No changes in measurements of jaw mobility, dental occlusion, or pain on palpation of the temporomandibular joints or masticatory muscles were seen at the follow-up. Thus, using an OA in treating OSA had limited influence on jaw functions and related symptoms. Moreover, the risk of developing pain and functional impairment in the masticatory system was infrequent, indicating that this treatment is safe and can be recommended.

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  • 43.
    Tegelberg, Åke
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Wenneberg, Bengt
    List, Thomas
    Malmö högskola, Odontologiska fakulteten (OD).
    General practice dentists' knowledge of temporomandibular disorders in children and adolescents2007Ingår i: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 11, nr 4, s. 216-221Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of the study was to map general practice dentists' (GPDs) knowledge of temporomandibular disorders (TMD) in children and adolescents. Materials and methods: A questionnaire was mailed to 286 Swedish dentists in the Public Dental Service and 17 TMD specialists with documented research experience. The questionnaire contained 37 statements on aetiology, diagnostics, classification, chronic pain and pain behaviour, treatment, and prognosis. Each statement was judged on a 0-10 point scale with the endpoint definitions agree or disagree. Results: The overall response rate to the questionnaire was 87%. In 28 of all 37 statements, the TMD specialists endorsed a consensus, i.e. >75% of the specialists had the same opinion about the statement. TMD specialists differed most in opinion in the domain diagnostics and classification. In 65% of the statements, differences in knowledge between GPDs and TMD specialists were non-significant. The greatest number of significant between-group differences was found in the domain treatment and prognosis. Most of these statements were related to morphological factors. Conclusion: There is a high degree of consensus in TMD knowledge amongst the TMD specialists and a high degree of agreement in knowledge between GPDs and TMD specialists. In some areas, however, TMD specialists still need to reach a consensus which is founded on evidence-based TMD knowledge in children and adolescents and that can be used in undergraduate teaching. It is therefore important to develop and strengthen the undergraduate dental teaching in TMD and orofacial pain.

  • 44.
    Tegelberg, Åke
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Wilhelmsson, Bo
    Erixon-Lindroth, Nina
    Lindström, Leif H
    Improved cognitive functions after treatment with an oral appliance in obstructive sleep apnea2012Ingår i: Nature and Science of Sleep, ISSN 1179-1608, Vol. 4, s. 89-96Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The objective of this study was to evaluate the effect of oral appliance (OA) treatment on cognitive functions in patients with obstructive sleep apnea (OSA).

    MATERIALS AND METHODS: In a prospective study, 50 male patients with verified moderate-to-severe OSA received an OA with mandibular advancement. The cognitive functions assessed included working memory, vigilance, executive functioning, and mental pace, measured before as well as after 6 months of treatment. Somnography was used to measure physiological treatment effects. Forty-three patients completed the 6-month follow-up study.

    RESULTS: All domains of cognitive functioning measured improved after 6 months of treatment with an OA (P <; 0.001). The apnea/hypopnea- and oxygen desaturation-indices decreased significantly after treatment (P <; 0.01). An obvious treatment response was reached in 60% of the patients, and 54% of the patients had recovered ie, had normalized breathing during sleep.

    CONCLUSION: OA with mandibular advancement is a treatment modality for the physiological symptoms of OSA, and may have a positive impact on cognitive functions, after only 6 months of treatment.

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  • 45. Tillgren, P
    et al.
    Nohlert, E
    Johansson, P
    Helgason, A
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Att sluta röka - en effektstudie av två rökavvänjningsprogram utförda inom Folktandvården, Landstinget Västmanland2007Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund och syfte med studien. Landstinget Västmanland har i sitt tobaksförebyggande arbete utvecklat och tillämpat flera olika metoder för att stödja befolkningen att sluta röka och snusa. En av dessa metoder är NIX rökslutsprogram som utvecklats av Folktandvården i samarbete med ett privat företag. Metodens långtidseffekter har dock inte utvärderats efter vetenskapliga principer som förordas av bland annat Statens beredning för medicinsk utvärdering, SBU. Syftet med denna utvärdering var att utvärdera rökslutsprogrammet NIX Individ jämfört med självhjälpsprogrammet Fimpa dig fri, avseende andel rökfria 12 månader efter planerat rökstopp samt metodernas kostnadseffektivitet. Material och metod. Studiedesignen är en randomiserad kontrollerad studie (RCT) där deltagarna slumpmässigt lottats till antingen rökslutsprogrammet NIX Individ (interventionsgrupp) eller självhjälpsprogrammet Fimpa dig fri (kontrollgrupp). Målgruppen för studien var vuxna dagligrökare (20 år och äldre) som hade en önskan att sluta röka. Deltagarna skulle kunna läsa och förstå det material som ingick i de båda rökslutsprogrammen på svenska språket. Deltagarna rekryterades främst via tandvården, hälso- och sjukvården och några större arbetsplatser i Västerås, men också av rökande som själva kontaktade studien. Interventionsprogrammet NIC Individ pågick under ca fyra månader och omfattade åtta träffar med ca 30 minuter per träff hos en rökslutsutbildad tandhygienist. Efter ett personlighetstest utformas interventionen utifrån de fyra personlighetstyper som programmet baseras på. Programmet Fimpa dig fri är ett självhjälpsmaterial som består av ett tryckt häfte på 48 sidor om att sluta röka. Deltagarna i detta program träffade initialt vid ett tillfälle en rökslutsutbildad tandhygienist under ca 30 minuter, för att gå igenom innehållet och arbetsuppgifterna i självhjälpsprogrammet som skulle genomföras under cirka åtta veckor. Totalt kom 294 (N) personer att ingå i studien varav 146 i NIX Individ-programmet och 148 i Fimpa dig fri. Alla deltagare fick besvara en baslinjeenkät före programstarten. Enkäten besvarades av 98% av de 300 inkluderade deltagarna en uppföljningsenkät med den tidigare enkätens frågor och nya frågor om bland annat hälsa sändes per post till deltagarna 12 månader efter deras planerade rökstopp. I denna uppföljning efter 12 månader medverkade 252 deltagare (86%) i studien användes definitionen rökfri om en deltagare som vid utvärderingstillfället uppgett att de inte rökt under den senaste veckan (punkprevalens). För att definieras som att vara i vidmakthållande steget skulle deltagaren ha varit rökfri i minst 6 månader. Den ekonomiska utvärderingen baserades på kostnaderna för att bedriva rökslusinsatserna, antalet personer som var rökfria efter 12 månader samt en tidigare framtagen skattning av de hälsomässiga och samhällsekonomiska effekterna av rökslut. I en kostnadseffektivitetsanalys jämfördes därefter kostnaderna för att bedriva insatserna (interventionskostnaderna) med insatsernas samhällsekonomiska och hälsomässiga effekter. Resultat rökfria efter 12 månader. Efter 12 månader var 23 % (59 av de 252 deltagarna) rökfria varav 27 % (35/131) för deltagarna i NIX Individ och 20% (24/121) i Fimpa dig fri. Ytterligare 11 respektive 6 % av deltagarna rökte men inte dagligen. Tolv personer (5%) hade använt snus under den senaste veckan före uppföljningen, varav 6 dagligen. 16% (40/252) av deltagarna hade varit rökfria i mer än 6 månader och det fanns en signifikant skillnad (p<0,05) mellan de båda programmen, 21% (27/131) för NIX Individ jämfört med 11% (13/121) för Fimpa dig fri. Vid uppföljningen rökte männen signifikant fler cigaretter än kvinnorna (p<0,05). Det var färre rökfria bland dem som hade en kortare utbildning jämfört med dem som hade gymnasie- eller högskoleutbildning. Bland dem som var rökfria var det signifikant fler som fått undervisning om rökningens hälsorisker under sin skolgång jämfört med dem som inte slutat röka (p<0,05). 52% av deltagarna hade använt sig av nikotinersättningsmedel NRT, i NIX Individ 54% och i Fimpa dig fri 52%. Det var lika stor andel rökfria vid uppföljningen bland dem som använt NRT som bland dem som inte gjort det. I NIX Individ var andelen rökfria 32% bland dem som använt NRT jämfört med 40% bland dem som inte använt sådana medel. Motsvarande siffror för Fimpa dig fri var 24% rökfria bland dem som använt NRT och 17% bland dem som inte använt NRT (ej signifikant). De som var rökfria hade i högre grad, utöver stödet av programmet, även stöttats i sitt rökslutsförsök av sin nära omgivning som familj, vän och/eller arbetskamrat (p<0,05). Kvinnorna hade varit signifikant mer ovanligt nedstämda under någon period efter första kontakten med programmet än männen (p<0,01). Motsvarande könsskillnader gällde också om att något annat (än att de försökt sluta röka) hänt i deras liv som kan ha orsakat deras stress eller nedstämdhet (p=0,01). Det var nästan statistiskt säkerställt (p=0,052) att kvinnorna fått mer stöd av vän/vänner än vad män fått. 33% av deltagarna hade, när det gällde förändringsstegen, inte förflyttat sig från där de befann sig före programstarten. Bland de 193 personer som rökte vid uppföljningen och som var stegklassificerade var det 74% som hade för avsikt att senast inom ett halvår göra ett nytt rökslutsförsök. För deltagare som initialt var i steget övervägande (contemplation) eller steget förberedelse (preparation) var det en större andel av NIX Individ jämfört med Fimpa dig fri-deltagarna som uppnått minst 6 månaders rökfrihet, medan däremot flera deltagare i NIX Individ gjorde det (p<0,05). Bland dem som haft socialt stöd var det också säkerställt fler i NIX Individ som varit rökfria sex månader jämfört med Fimpa dig fri (p<0,05). Insatsernas kostnadseffektivitet. Den totala kostnaden för att genomföra de två insatserna uppgick till ca1,84 miljoner kronor. De gemensamma kostnaderna för projektledning och rekrytering samt uppföljning av deltagare, uppgick till ca 700 000 kronor. Kostnaderna per deltagare i Fimpa dig fri var 956 kronor och för NIX Individ och till ca 500 000 kronor för Fimpa dig fri. De hälsomässiga effekterna av rökslut beräknades för NIX Individ uppgå till knappt 14 QALYs, och till knappt 10QALYs för Fimpa dig fri. Fimpa dig fri-programmet beräknades i kostnadseffektivitets-analyserna leda till minskade kostnader för samhället i stort, och mycket låga nettokostnader för hälso- och sjukvården. Detta resultat uppstår eftersom de besparade samhällskostnaderna var större och de besparade hälso- och sjukvårdskostnaderna var nästan lika stora som interventionskostnaderna. I jämförelse med Fimpa dig fri beräknades den ökande (inkrementella) kostnaden per QALY för NIX Individ uppgå till ca 96 000 kronor per QALY. Dessa kostnader måste jämföras med vad samhället och landstinget är villiga att betala för en ökad hälsa. Kostnaden 96 000 kronor per QALY för NIX Individ ligger under den gräns som Socialstyrelsen anser vara väl kostnadseffektiv. Båda metoderna bör därför införas inom hälso- och sjukvården. Fimpa dig fri om man önskar minska de samhällsekonomiska kostnaderna och NIX Individ om man är villig att betala mer för att uppnå ytterligare hälsa. Slutsatser. Studien visar på att NIX Individ och Fimpa dig fri är effektiva rökslutsprogram vad avser rökfria efter 12 månader. NIX Individ svarar för en högre andel rökfria än Fimpa dig fri programmet, men denna skillnad är inte signifikant och resultatet är jämförbart med andra program med motsvarande studiedesign och intensitet. För personer som varit rökfria i mer än sex månader är det däremot en säkerställd skillnad mellan NIX Individ och Fimpa dig fri. Ingen av deltagarna i Fimpa dig fri lyckades nå denna längre rökfrihet utan omgivningsstöd eller professionella krafter. Den ekonomiska utvärderingen ger samma resultat som tidigare genomförda ekonomiska studier av rökslutsprogram i Sverige, både NIX Individ och Fimpa dig fri är kostnadseffektiva program. Fimpa dig fri bör rekommenderas i första hand inom hälso- och sjukvården, då programmet medför ytterst små extra kostnader. NIX Individs kostnad per hälsoeffekt ligger under den gräns som Socialstyrelsen anser vara väl kostnadseffektivt, och ger därför tillräckligt mycket mer hälsa för att vara värd att införa inom hälso- och sjukvården. Studien visar också att det inom tandvården, sjukvården och via större arbetsplatser är möjligt att rekrytera deltagare till rökslutsprogram och att tandhygienister med utbildning i rökslutstöd och med tandvården som arena kan genomföra effektiva, mera intensiva program än bara några minuters rökslutsrådgivning i samband med ordinarie besök.

  • 46.
    Wolf, Eva
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Leonard, Kerstin
    Malmö universitet, Odontologiska fakulteten (OD).
    Vidigsson, My
    Malmö universitet, Odontologiska fakulteten (OD).
    Tegelberg, Åke
    Malmö universitet, Odontologiska fakulteten (OD).
    Koch, Margaretha
    Malmö universitet, Odontologiska fakulteten (OD).
    Adoption of change in endodontic practice after an educational program: A qualitative study2022Ingår i: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 8, nr 3, s. 781-792Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim was to define the characteristics of successful implementation of new clinical endodontic routines within a public dental health organization, following an educational program. Materials and Methods: Fifteen staff members were strategically selected for the interview. All had completed a theoretical educational intervention including a complementary endodontic treatment strategy and, for the dentists, comprising training in the nickel-titanium-rotary-technique. All experienced the successful acceptance of new clinical routines. Two thematic in-depth audiotaped interviews were conducted, wherein the informants described the implementation process in their own words. The interviews were transcribed verbatim and analyzed according to Qualitative Content Analysis. Results: A theme was identified: A multiple flexible process with governance support and gradual reinforcement of motivation, with the following main categories: Firstly, contextual facilitation, with two subcategories (i) a multifaceted organizational foundation and (ii) a tolerance of flexibility. Secondly, emotional facilitation, with two subcategories (i) an experience of simplification and (ii) an experience of improvement. Conclusion: The results improve the understanding of a multifaceted process underlying the acceptance of changes to clinical endodontic procedures by dentists in a public dental health organization. Important contributing factors identified were governance support, a committed resource person with contextual knowledge, tolerance of flexibility in implementation, and permissive informal communication channels within the local workplace. These findings might be a valuable contribution to an evidence base, facilitating the selection of the most appropriate educational strategy and structure for a specified purpose.

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  • 47. Wårdh, Inger
    et al.
    Axelsson, Susanna
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Which evidence has an impact on dentists' willingness to change their behavior?2009Ingår i: Journal of Evidence-Based Dental Practice, ISSN 1532-3382, E-ISSN 1532-3390, Vol. 9, nr 4, s. 197-205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is some literature on how to find the best evidence for clinical practice but little is known about which evidence clinicians actually seek when they look for scientific support in changing behavior. The aim of this study was to explore which evidence has an impact on dentists' willingness to change their behavior by investigating the requirements for seeking and understanding new knowledge, as well as perceived barriers or motives for doing this. A postal questionnaire was analyzed according to demographic information, access to and use of a personal computer, postgraduate education activity, knowledge about evidence-based medicine and scientific terms, and seeking and grasping new and actual knowledge from 177 dentists. Fifteen of these dentists formed 3 focus groups that were interviewed about the areas in the questionnaire. First-order information, that was required in a short time, was sought by the nearest colleagues. Literature and Internet-based technology were second-order information, mainly sought by younger dentists. The people that were interviewed claimed that the real point of issue was to find new knowledge that could be transferred into practice. Many studies pointing to sometimes diverging results only seem to create confused professionals. To include some qualitative aspects in evidence-based reports could be a way of improving understanding and changing behavior in a favorable direction and perhaps also increase interest for new knowledge.

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