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  • 1. Bratthall, Douglas
    et al.
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Caries risk assessment: a comparison between the computer program 'Cariogram', dental hygienists and dentists2000In: Swedish Dental Journal, ISSN 0347-9994, Vol. 24, no 4, p. 129-137Article in journal (Refereed)
    Abstract [en]

    The 'Cariogram', which is an interactive PC-program for caries risk evaluation, illustrates the interaction between caries related factors and expresses the caries risk graphically. It also demonstrates a weighted impact of the different etiological factors on the risk. The aim of this paper was to use the Cariogram program on a set of patients, and to compare the outcome of its risk evaluation with those made by dental hygienists and dentists. A questionnaire, containing the descriptions of five patients with detailed information on nine factors generally associated with caries, was given to the participants. They were asked to rank the patients according to their 'chance to avoid dental caries' during the coming year. The results were compared with the assessments obtained from the Cariogram. Results: 73.5% of the dental hygienists and 78.5% of the dentists ranked the patients for caries risk either identically or with only one deviation when compared to the Cariogram. It was concluded that the 'opinion' of the Cariogram on caries risk was in agreement with that of the majority of the participants. In addition, the Cariogram program induced discussions about the relative impact of etiological factors of caries. It is envisaged that the Cariogram can serve as one further tool in the teaching of caries risk.

  • 2. Bratthall, Douglas
    et al.
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Cariogram - a multifactorial risk assessment model for a multifactorial disease2005In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 33, no 4, p. 256-264Article in journal (Other academic)
    Abstract [en]

    This paper reviews some common methods for the assessment of caries risk. It also describes a new way of illustrating the caries risk profile of an individual, the Cariogram. Past caries experience and socioeconomic factors are often used for prediction of caries. As prediction models, the methods are simple, inexpensive and fast. However, they are not risk models, as they do not specify which particular risk factors are operating. Various biological factors can be used for risk assessment. Common ones are bacteria, diet and host factors. Taken separately, these biological factors often have limited predictive values. Socioeconomic factors often have a heavy impact on the biological factors as they can explain why an individual, for example, has a cariogenic diet or neglects oral hygiene. The biological factors are the immediate cause of the cavities. Caries experience is an illustration of how the host copes up with the biological activity. To facilitate the interpretation of biological data, the Cariogram was developed. It is a computer program showing a graphical picture that illustrates a possible overall caries risk scenario. The program contains an algorithm that presents a 'weighted' analysis of the input data, mainly biological factors. It expresses as to what extent different etiological factors of caries affect caries risk. The Cariogram identifies the caries risk factors for the individual and provides examples of preventive and treatment strategies to the clinician.

  • 3. Bratthall, Douglas
    et al.
    Stjernswärd, Jayanthi
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Assessment of Caries Risk in the Clinic: a Modern Approach2001In: Advances in Operative Dentistry, Challenges of the Future: Vol. 2, Quintessence Publishing Co , 2001, p. 61-72Chapter in book (Other academic)
  • 4.
    Havsed, Kristian
    et al.
    Malmö University, Faculty of Odontology (OD). Department of Pediatric Dentistry, Institute for Postgraduate Dental Education, Jönköping, Sweden; Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Hänsel Petersson, Gunnel
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University, Lund, Sweden.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Svensäter, Gunnel
    Malmö University, Faculty of Odontology (OD).
    Rohlin, Madeleine
    Malmö University, Faculty of Odontology (OD).
    Multivariable prediction models of caries increment: a systematic review and critical appraisal.2023In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, no 1, article id 202Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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  • 5.
    Hellén-Halme, Kristina
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Influence of education level and experience on detection of approximal caries in digital dental radiographs. An in vitro study2010In: Swedish Dental Journal, ISSN 0347-9994, Vol. 34, no 2, p. 63-69Article in journal (Refereed)
    Abstract [en]

    This study evaluated whether variations in education level and experience among dental staff influence the diagnostic accuracy of carious lesions on digital radiographs. Three student groups and a fourth group of general practitioners (Dentists) with more than five years of clinical experience participated in this study.The student groups were (i) dental students in their final (tenth) semester (DS-10), (ii) dental students in the sixth semester (DS-6) who just finished dental radiology training, and (iii) dental hygiene students (DHS) in their final (fourth) semester. Seven observers from each group participated. Standard radiographs of 100 extracted teeth (premolars and molars) were taken. The 28 observers evaluated the images for approximal carious lesions on a standard monitor. All evaluations were made in ambient light below 50 lux. Receiver operating characteristic curves were plotted to assess results. The standard criterion for healthy or carious lesions was a histological examination of sliced teeth. Kappa statistics evaluated intra-observer agreement. For carious lesions that had extended into the dentine, significant differences were found between (i) Dentists and all other groups, (ii) Dentists and DS-10 (p < 0.01), and (iii) Dentists and DS-6 and DHS (p < 0.001). Differences between DS-10 and DHS (p < or = 0.05) were also significant. In this study, education level and experience clearly influenced the diagnostic accuracy of approximal carious lesions that had extended into the dentine on digital radiographs.

  • 6.
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Assessing caries risk: using the cariogram model2003Doctoral thesis, comprehensive summary (Other academic)
  • 7.
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    The management of dental caries: risk assessment and decision-making2007In: Minimally invasive dentistry: The management of dental caries, Quintessence , 2007, p. 47-60Chapter in book (Other academic)
  • 8.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Bratthall, Douglas
    Avaliação do risco de cárie: uma abordagem atual2000In: Promocão de Saúde bucal na clinica odôntológica / [ed] Yvonne De Paiva Buischi, Artes Medicas , 2000, p. 149-168Chapter in book (Other academic)
  • 9.
    Hänsel Petersson, Gunnel
    et al.
    Department of Cariology, Faculty of Odontology, Lund University, Sweden.
    Carlsson, P.
    Department of Cariology, Faculty of Odontology, Lund University, Sweden.
    Bratthall, D.
    Department of Cariology, Faculty of Odontology, Lund University, Sweden.
    Caries risk assessment: a comparison between the computer program ‘Cariogram’, dental students and dental instructors1998In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 2, no 4, p. 184-190Article in journal (Refereed)
    Abstract [en]

    An interactive educational PC-program for caries risk evaluation, the ‘Cariogram’, was developed. It illustrates the interaction between caries related factors and expresses the caries risk graphically. It also expresses a weighted impact of different aetiological factors on the risk. The aim of this paper was to use the Cariogram program on a set of patients, and to compare the outcome of its risk evaluation with those made by dental students and faculty teachers. A questionnaire was given to the participants, containing descriptions of 5 patients with detailed information on 9 factors generally associated with caries. The participants were asked to rank the patients according to their ‘chance to avoid dental caries’ during the coming year. The results were compared with the assessments obtained from the Cariogram and the similarity calculated by group average cluster analysis. Results: 86% of the respondents ranked the patients for caries risk either identical or with only 1 deviation compared to the program. No difference was seen between students and teachers. The cluster analysis identified 5 distinct patterns of ranking the patients with a maximum distance of 0.6 compared to the program. It was concluded that the ‘opinion’ on caries risk of the Cariogram was in agreement with that of the majority of the responders. In addition, the use of the program induced discussions about the relative impact of caries aetiological factors, and it is believed that the Cariogram can serve as one further option in the teaching of caries risk.  

  • 10.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ericson, Ewa
    Isberg, Per-Erik
    Twetman, Svante
    Caries risk assessment in young adults: A 3-year validation of clinical guidelines used in Public Dental Service2013In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 71, no 6, p. 1645-1650Article in journal (Refereed)
    Abstract [en]

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

  • 11.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ericson, Ewa
    Isberg, Per-Erik
    Twetman, Svante
    Caries risk assessment in young adults using Public Dental Service guidelines and the Cariogram-a comparative study2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 71, no 3-4, p. 534-540Article in journal (Refereed)
    Abstract [en]

    Abstract Objectives. To investigate the caries risk profiles in young adults and to compare the risk classification using the Public Dental Service (PDS) guidelines with a risk assessment program, the Cariogram. Materials and methods. All 19-year-old patients registered at eight public dental clinics were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects representing 10% of all 19 year-olds attending dental care at the PDS in Skåne, Sweden. A risk classification of each patient was made by the patient's regular team according to the PDS guidelines. A research team collected whole saliva samples and information from a questionnaire and a structured interview in order to calculate risk according to the Cariogram model. Results. The mean DFS value was 4.9 and 23% of the patients were registered as caries-free (DFS = 0). The PDS risk classification was predominantly based on past caries and/or present caries activity. The majority was classified as 'some risk', while 16.7% were assessed as being of 'high' or 'very high risk'. The corresponding value for the two highest risk groups in the Cariogram model was 17.4%. The agreement between the two models was found acceptable (77.5%) for those assessed as low risk, while discrepancies were disclosed among those classified with higher risks. Conclusions. Although the proportion of subjects assessed with high or very high risk was similar using the PDS guidelines and the Cariogram model, the agreement between the models was fair. An acceptable agreement was only disclosed for the low risk category.

  • 12.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ericson, Ewa
    Public Dental Service, Region Skåne, Malmö, Sweden.
    Twetman, Svante
    Department of Cariology, Endodontics, Pediatric Dentistry and Clinical Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, Maxillofacial Unit, Halland Hospital, Halmstad, Sweden.
    Preventive care delivered within Public Dental Service after caries risk assessment of young adults2016In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 14, no 3, p. 215-219Article in journal (Refereed)
    Abstract [en]

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

  • 13.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Fure, Solveig
    Bratthall, Douglas
    Evaluation of a computer based caries risk assessment program in an elderly group of individuals2003In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 61, no 3, p. 164-171Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate a caries risk assessment computer program, the Cariogram, by comparing the risk assessment of the program with the actual caries increment in a group of elderly individuals over a period of 5 years. The participants were examined and interviewed at baseline about their general health and dietary habits. Data on oral hygiene and use of fluoride were obtained and saliva analyses included mutans streptococci, lactobacilli, buffering capacity, and secretion rate. Based on the baseline recordings, the individuals were divided into 4 risk groups according to the Cariogram. Where the program predicted 0% 20% (high risk), 21%-40%, 41%-60%, and 61%- 100% (low/rather low risk) "chance of avoiding caries", 13, 32, 23, and 48% respectively, had no new DFS over 5 years and 18, 40, 72, and 84%, respectively, had no new lesions at the 5th year. The mean DMFS increment over 5 years was 12.8 in the high/rather high risk group (0% 40% "chance of avoiding caries"), which included 43% of the individuals. In the low/rather low risk group (61%-100% "chance of avoiding caries"), the corresponding value was 5.2%, and 21% of the participants were sorted to this group. The mean DMFS increment for the whole group of elderly individuals was 9.5. In this particular study the Cariogram was able to sort the elderly individuals into risk groups that reflected the actual caries outcome.

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  • 14.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Fure, Solveig
    Twetman, Svante
    Bratthall, Douglas
    Comparing Caries Risk Factors and Risk Profiles between Children and Elderly2004In: Swedish Dental Journal, ISSN 0347-9994, Vol. 28, no 3, p. 119-128Article in journal (Other academic)
    Abstract [en]

    The aim of this study was to compare the caries risk profiles of children and elderly, the actual annual caries increment and the impact of some selected caries related factors.The risk profiles were created by a computerised risk assessment program, the Cariogram, which evaluates data and presents the weighted and summarized result as one figure, illustrating the 'percent chance of avoiding caries' in the future. The data used originated from two separate longitudinal studies illustrating the Cariogram's capacity to assess caries risk. One study comprised about 400 children; the other included about 150 elderly. At baseline, information on past caries experience, diet, oral hygiene and use of fluoride was obtained. Saliva analyses included mutans streptococci and lactobacilli, buffering capacity and secretion rate. The caries risk was assessed and after two and five years, respectively, caries was re-evaluated and the incidence was compared with the predictions. Fifty percent of the children, but only two percent of the elderly appeared in the lowest caries risk group. Of the elderly, 26% belonged to the highest caries risk group versus 3 % of the children.The mean DFS increment per year for the total group of children was 0.4 +/- 0.8 (SD) and 1.2 +/- 1.9 for the elderly. Individual factors contributing significantly to the higher risk profiles for the adults were higher plaque scores, higher counts of mutans streptococci and lower buffering capacity. Over all, the risk for caries, as assessed by the Cariogram, was twice as high for the elderly.

  • 15.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Isberg, Per Erik
    Twetman, Svante
    Caries risk assessment in schoolchildren using a reduced Cariogram model2010In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 10, article id 5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To investigate the caries predictive ability of a reduced Cariogram model without salivary tests in schoolchildren. METHODS: The study group consisted of 392 school children, 10-11 years of age, who volunteered after informed consent. A caries risk assessment was made at baseline with aid of the computer-based Cariogram model and expressed as "the chance of avoiding caries" and the children were divided into five risk groups. The caries increment (DeltaDMFS) was extracted from the dental records and bitewing radiographs after 2 years. The reduced Cariogram was processed by omitting the variables "salivary mutans streptococci", "secretion rate" and "buffer capacity" one by one and finally all three. Differences between the total and reduced models were expressed as area under the ROC-curve. RESULTS: The baseline caries prevalence in the study population was 40% (mean DMFS 0.87 +/- 1.35) and the mean 2-year caries increment was 0.51 +/- 1.06. Both Cariogram models displayed a statistically relationship with caries development (p < 0.05); more caries was found among those assessed with high risk compared to those with low risk. The combined sensitivity and specificity decreased after exclusion of the salivary tests and a statistically significant reduction of the area under the ROC-curve was displayed compared with the total Cariogram (p < 0.05). Among the salivary variables, omission of the mutans streptococci enumeration impaired the predictive ability the most. CONCLUSIONS: The accuracy of caries prediction in school children was significantly impaired when the Cariogram model was applied without enumeration of salivary tests.

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  • 16.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Twetman, Svante
    Caries risk profiles in schoolchildren over 2 years assessed by Cariogram2010In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 20, no 5, p. 341-346Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Caries risk assessment is an important tool in clinical decision making. AIM: To evaluate longitudinal changes in caries risk profiles in a group of schoolchildren in relation to caries development. DESIGN: The Cariogram model was used to create caries risk profiles and to identify risk factors in 438 children being 10-11 years at baseline. The assessment was repeated after 2 years and the caries increment was recorded. The frequency of unfavourable risk factors were compared between those considered at the lowest and the highest risk. RESULTS: Fifty percent of the children remained in the same risk category after 2 years. One third of the children were assessed in a higher-risk category while 18.4% showed a lower risk. Those with increased risk compared with baseline developed significantly more caries than those with an unchanged risk category. The most frequent unfavourable risk factors among those with high risk at baseline were high-salivary mutans streptococci and lactobacilli counts as well as frequent meals. CONCLUSION: Half of the children showed a changed risk category after 2 years, for better or for worse, which suggests that regular risk assessments are needed in order to make appropriate decisions on targeted preventive care and recall intervals.

  • 17.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Twetman, Svante
    Caries risk assessment in young adults: a 3 year validation of the Cariogram model2015In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 15, no 17, article id 17Article in journal (Refereed)
    Abstract [en]

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

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  • 18.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Twetman, Svante
    Relationship between risk assessment and payment models in Swedish Public Dental Service: a prospective study2017In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, no 1, article id 40Article in journal (Refereed)
    Abstract [en]

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

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  • 19.
    Hänsel Petersson, Gunnel
    et al.
    Malmö University, Faculty of Odontology (OD).
    Twetman, Svante
    Tobacco use and caries increment in young adults: a prospective observational study.2019In: BMC Research Notes, E-ISSN 1756-0500, Vol. 12, no 1, article id 218Article in journal (Refereed)
    Abstract [en]

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

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  • 20.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Twetman, Svante
    Bratthall, Douglas
    Evaluation of a computer program for caries risk assessment in schoolchildren2002In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 36, no 5, p. 327-340Article in journal (Refereed)
    Abstract [en]

    The 'Cariogram' is an interactive PC program for caries risk evaluation. It takes into account the interactions between caries-related factors and expresses a graphic assessment of the risk. The aim of this study was to assess the caries risk in schoolchildren using the Cariogram and to evaluate the program by comparing the caries risk assessments with the actual change in DMF. A 2-year prospective study on 446 schoolchildren, 10-11 years old, was conducted. At baseline, data on general health, diet, oral hygiene and use of fluoride were obtained. Saliva analyses included mutans streptococci and lactobacilli counts, buffer capacity and secretion rate. DMFT and DMFS were calculated from records and bitewing radiographs. Scores were entered and caries risk was assessed. Re-examination for caries was done after 2 years. The children were divided into 5 groups according to the assessed caries risk at baseline. Where the Cariogram predicted a 0-20% (high risk), 21-40%, 41-60%, 61-80% and 81-100% (low risk) chance of avoiding new lesions, 8, 35, 42, 73 and 83%, respectively, had no new lesions 2 years later. Logistic regression analyses were carried out. When the Cariogram was included, only two factors, the Cariogram (p < 0.001) and the DMFS at baseline, i.e. past caries experience (p = 0.001), turned out to be significantly associated with caries increment. The Cariogram was the most powerful explanatory variable. When the Cariogram was excluded, lactobacillus count, mutans streptococci, diet intake frequency and DMFS at baseline were significantly associated with caries increment. The Cariogram predicted caries increment more accurately than any included single-factor model. How this finding can be translated into daily practice in the best and most practical way is a matter for future research.

  • 21.
    Hänsel Petersson, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Åkerman, Sigvard
    Malmö högskola, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Ericson, Dan
    Malmö högskola, Faculty of Odontology (OD).
    Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need2016In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, no 1, article id 13Article in journal (Refereed)
    Abstract [en]

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

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  • 22.
    Nordström, Marie
    et al.
    Malmö University, Faculty of Odontology (OD).
    Carlsson, Peter
    Malmö University, Faculty of Odontology (OD).
    Ericson, Dan
    Malmö University, Faculty of Odontology (OD).
    Hedenbjörk-Lager, Anders
    Malmö University, Faculty of Odontology (OD).
    Hänsel Petersson, Gunnel
    Malmö University, Faculty of Odontology (OD).
    Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review2023In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 81, no 3, p. 176-185Article, review/survey (Refereed)
    Abstract [en]

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

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

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

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

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  • 23.
    Nordström, Marie
    et al.
    Malmö University, Faculty of Odontology (OD).
    Carlsson, Peter
    Malmö University, Faculty of Odontology (OD).
    Ericson, Dan
    Malmö University, Faculty of Odontology (OD).
    Lager, Anders
    Malmö University, Faculty of Odontology (OD).
    Jansson, Henrik
    Folktandvården Skåne Lund Sweden.
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Hänsel Petersson, Gunnel
    Malmö University, Faculty of Odontology (OD).
    Some young adults can maintain good oral health despite socioeconomic challenges2024In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, article id e12985Article in journal (Refereed)
    Abstract [en]

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

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  • 24.
    Nordström, Marie
    et al.
    Malmö University, Faculty of Odontology (OD).
    Lager, Anders
    Malmö University, Faculty of Odontology (OD).
    Hänsel Petersson, Gunnel
    Malmö University, Faculty of Odontology (OD).
    Ericson, Dan
    Malmö University, Faculty of Odontology (OD).
    Karies: världens vanligaste icke smittsamma sjukdom2024In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 121, article id 23127Article in journal (Refereed)
    Abstract [en]

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

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  • 25.
    Svensäter, Gunnel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Davies, Julia
    Malmö högskola, Faculty of Odontology (OD).
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Neilands, Jessica
    Malmö högskola, Faculty of Odontology (OD).
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Mejàre, Ingegerd
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Lars G
    Sahlin, Nils-Eeic
    Carlén, Annette
    Dahlén, Gunnar
    Risk, riskbedömning och prevention2008In: Tandläkartidningen, ISSN 0039-6982, Vol. 100, no 9-10, p. 70-76Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Biologiska markörer som baserar sig på egenskaper och aktivitet hos bakterier i dentala biofilmer skulle kunna användas för att identifiera patienter med hög risk för karies och parodontit. Genom att studera hur tandläkare gör riskbedömningar och tar beslut om åtgärder kan man få ett bra underlag för att förbättra praxis.

  • 26. Tayanin, Gisela Ladda
    et al.
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Bratthall, Douglas
    Caries risk profiles of 12-13-year-old children in Laos and Sweden2005In: Oral Health & Preventive Dentistry, ISSN 1602-1622, E-ISSN 1757-9996, Vol. 3, no 1, p. 15-23Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To analyse caries risk factors of 12-13-year-old children living in Laos, using the computer program Cariogram to illustrate the caries risk profile. In addition, to compare the results with a study performed in Sweden. MATERIALS AND METHODS: One hundred Laotian and 392 Swedish children were included. Interviews were performed to obtain information on diet intake and fluoride use. Saliva was analysed for mutans streptococci, lactobacilli and secretion rate/buffering capacity. Oral hygiene was assessed using the Silness and Löe criteria. Caries prevalence was recorded according to WHO. The data were entered into the Cariogram to determine each child's caries risk, expressed as 'the chance of avoiding caries'. The children were divided into five risk groups. RESULTS: Mean DMFT level of the Laotian children was 4.61 +/- 2.95 and 1.38 +/- 1.97 in the Swedish group. For the risk factors plaque amount, frequency of food intake, saliva secretion rate, buffering capacity and fluoride, the Laotian children had significantly less favourable values compared to the Swedes. Only 6% of Laotian children belonged to the Cariogram low risk group versus 40% of the Swedish children. The mean DMFT for the five Cariogram groups was (from low to high risk) 0.00, 3.00, 3.56, 5.66, 6.11 for the Lao children and 0.31, 1.39, 2.56, 3.03, 2.91 for the Swedish ones. The mean chance of avoiding caries was 37.3% for the Laotians and 69.2% for the Swedish children (p < 0.001). CONCLUSION: According to the 'opinion' of the Cariogram, the Laotian children demonstrated significantly higher caries risk than Swedish children.

  • 27. Twetman, Svante
    et al.
    Hänsel Petersson, Gunnel
    Malmö högskola, Faculty of Odontology (OD).
    Bratthall, Douglas
    Caries risk assessment as predictor of metabolic control in young type 1 diabetics2005In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 22, no 1, p. 312-315Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate the relationship between caries risk and glucosy-lated haemoglobin and to evaluate the use of a computerized caries risk assessment program as a predictor of metabolic control in school-children with Type 1 diabetes mellitus. METHODS: The material con-sisted of 64 young Type 1 diabetes mellitus patients (8-16 years) at-tending an outpatient paediatric clinic. Within 2 weeks after the onset of diabetes, a caries risk assessment was carried out with the aid of a computer-based program (Cariogram) and data on the level of meta-bolic control were collected from the medical records at the 3-year check-up. Caries increment was registered at recall clinical examina-tions. RESULTS: A statistically significant positive relationship be-tween caries risk and metabolic control was found (r = 0.51; P < 0.01), with a sevenfold increased risk of impaired metabolic control after 3 years in those assessed with high caries risk at onset (OR 7.3; P < 0.01). When the Cariogram was used as a predictor for the metabolic state of the disease, the sensitivity and specificity was 75% and 71%, respectively. The negative predictive value was 91%. CONCLU-SIONS: Our data suggested that a caries risk assessment at the diagno-sis of diabetes mellitus in children may be a good indicator of overall health care that can provide useful prognostic information on the level of metabolic control after 3 years.

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