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  • 1.
    Aboulaich, Nabila
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Expanding role of caveolae in control of adipocyte metabolism: proteomics of caveolae2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The primary function of adipose tissue is to store energy in the form of triacylglycerol, which is hydrolyzed to fatty acids to supply other tissues with energy. While insulin promotes the storage of triacylglycerol, catecholamines stimulate its hydrolysis. The development of type II diabetes is strongly associated with obesity, indicating a role of triacylglycerol metabolism in the pathogenesis of diabetes. Caveolae are plasma membrane invaginations found in most cells but are highly abundant in adipocytes. Insulin receptors are localized in caveolae and their function depends on intact caveolae structures. In the present thesis work, mass spectrometry-based methodology allowed identification of a number of new proteins and their posttranslational modifications in caveolae of human adipocytes. Variable N-terminal acetylation and phosphorylation of caveolin-1α and caveolin-1β were identified, which might regulate the function of caveolae. The transcription regulator protein PTRF was identified as the major caveolae associated protein. Specific proteolytic modifications of PTRF at the cytosolic surface of caveolae and phosphorylation on nine serine and one threonine residues were identified. Moreover, insulin induced translocation of PTRF from the plasma membrane to the nucleus. PTRF was previously shown to regulate the activity of both RNA polymerase I and polymerase II, thus a role of PTRF in mediating the anabolic action of insulin on protein synthesis and gene transcription is proposed.

    PTRF was also involved in an extranuclear function in the hormonal regulation of triacylglycerol metabolism in caveolae. PTRF was colocalized with the triacylglycerol regulator proteins perilipin and hormone-sensitive lipase (HSL) in the triacylglycerol-synthesizing caveolae subclass. We showed that, while perilipin was translocated to the plasma membrane, both PTRF and HSL were translocated from the plasma membrane to the cytosol as a complex in response to insulin. The perilipin recruited to the plasma membrane was highly threonine phosphorylated. By mass spectrometry, three phosphorylated threonine residues were identified and were located in an acidic domain in the lipid droplet targeting domain of perilipin. The insulin-induced recruitment of perilipin to the plasma membrane might, therefore be phosphorylation-dependent. Isoproterenol, which stimulates hydrolysis of triacylglycerol, induced a complete depletion of perilipin B from the plasma membrane, suggesting a function of perilipin B to protect newly synthesized triacylglycerol in caveolae from being hydrolyzed by HSL. The location of PTRF and HSL was not affected by isoproterenol, indicating that insulin is acting against a default presence of PTRF and HSL in caveolae.

    Taken together, this thesis expands our knowledge about caveolae and provided valuable information about their involvement in novel roles, particularly in the hormonal regulation of triacylglycerol metabolism.

    List of papers
    1. Vectorial proteomics reveal targeting, phosphorylation and specific fragmentation of polymerase I and transcript release factor (PTRF) at the surface of caveolae in human adipocytes
    Open this publication in new window or tab >>Vectorial proteomics reveal targeting, phosphorylation and specific fragmentation of polymerase I and transcript release factor (PTRF) at the surface of caveolae in human adipocytes
    2004 (English)In: The Biochemical journal, ISSN 1470-8728, Vol. 383, no Pt 2, p. 237-248Article in journal (Refereed) Published
    Abstract [en]

    Caveolae, the specialized invaginations of plasma membranes, formed sealed vesicles with outwards-orientated cytosolic surface after isolation from primary human adipocytes. This morphology allowed differential, vectorial identification of proteins at the opposite membrane surfaces by proteolysis and MS. Extracellular-exposed caveolae-specific proteins CD36 and copper-containing amine oxidase were concealed inside the vesicles and resisted trypsin treatment. The cytosol-orientated caveolins were efficiently digested by trypsin, producing peptides amenable to direct MS sequencing. Isolation of peripheral proteins associated with the cytosolic surface of caveolae revealed a set of proteins that contained nuclear localization signals, leucine-zipper domains and PEST (amino acid sequence enriched in proline, glutamic acid, serine and threonine) domains implicated in regulation by proteolysis. In particular, PTRF (polymerase I and transcript release factor) was found as a major caveolae-associated protein and its co-localization with caveolin was confirmed by immunofluorescence confocal microscopy. PTRF was present at the surface of caveolae in the intact form and in five different truncated forms. Peptides (44 and 45 amino acids long) comprising both the PEST domains were sequenced by nanospray-quadrupole-time-of-flight MS from the full-length PTRF, but were not found in the truncated forms of the protein. Two endogenous cleavage sites corresponding to calpain specificity were identified in PTRF; one of them was in a PEST domain. Both cleavage sites were flanked by mono- or diphosphorylated sequences. The phosphorylation sites were localized to Ser-36, Ser-40, Ser-365 and Ser-366 in PTRF. Caveolae of human adipocytes are proposed to function in targeting, relocation and proteolytic control of PTRF and other PEST-domain-containing signalling proteins.

    Keywords
    Caveolae, human adipocyte, MS, PEST sequence, polymerase I and transcript release factor (PTRF), proteolysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19145 (URN)10.1042/BJ20040647 (DOI)15242332 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2009-06-12Bibliographically approved
    2. N-terminal processing and modifications of caveolin-1 in caveolae from human adipocytes
    Open this publication in new window or tab >>N-terminal processing and modifications of caveolin-1 in caveolae from human adipocytes
    Show others...
    2004 (English)In: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, E-ISSN 1090-2104, Vol. 320, no 2, p. 480-486Article in journal (Refereed) Published
    Abstract [en]

    Caveolin, the principal structural protein of caveolae membrane domains, has a cytosol-exposed N-terminal part that was cleaved off by trypsin treatment of caveolae vesicles isolated from primary human adipocytes. Sequencing of the released tryptic peptides by nanospray quadrupole time-of-flight mass spectrometry revealed that both caveolin-1alpha and caveolin-1beta were processed by excision of the starting methionines. The N-terminus of the mature caveolin-1alpha was acetylated, while caveolin-1beta was found in acetylated as well as in non-acetylated forms. Fractional phosphorylation of serine-36 in the mature caveolin-1alpha and of the homologous serine-5 in caveolin-1beta was identified. This is the first experimental evidence for in vivo phosphorylation of caveolin-1 at the consensus site for phosphorylation by protein kinase C. The phosphorylation was found in both the acetylated and non-acetylated variants of caveolin-1beta. This variability in modifications is consistent with critical involvement of the N-terminal domain of caveolin in the regulation of caveolae.

    Keywords
    Human adipocyte, Caveolin-1; Caveolae, Protein phosphorylation, N-terminal acetylation, Mass spectrometry
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19146 (URN)10.1016/j.bbrc.2004.05.196 (DOI)15219854 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2017-12-13Bibliographically approved
    3. Hormonal control of reversible translocation of perilipin B to the plasma membrane in primary human adipocytes
    Open this publication in new window or tab >>Hormonal control of reversible translocation of perilipin B to the plasma membrane in primary human adipocytes
    2006 (English)In: Journal of Biological Chemistry, ISSN 0021-9258, E-ISSN 1083-351X, Vol. 281, no 17, p. 11446-11449Article in journal (Refereed) Published
    Abstract [en]

    In adipocytes, perilipin coats and protects the central lipid droplet, which stores triacylglycerol. Alternative mRNA splicing gives rise to perilipin A and B. Hormones such as catecholamines and insulin regulate triacylglycerol metabolism through reversible serine phosphorylation of perilipin A. It was recently shown that perilipin was also located in triacylglycerol-synthesizing caveolae of the plasma membrane. We now report that perilipin at the plasma membrane of primary human adipocytes was phosphorylated on a cluster of threonine residues (299, 301, and 306) within an acidic domain that forms part of the lipid targeting domain. Perilipin B comprised <10% of total perilipin but was the major isoform associated with the plasma membrane of human adipocytes. This association was controlled by insulin and catecholamine: perilipin B was specifically depleted from the plasma membrane in response to the catecholamine isoproterenol, while insulin increased the amount of threonine phosphorylated perilipin at the plasma membrane. The reversible translocation of perilipin B to and from the plasma membrane in response to insulin and isoproterenol, respectively, suggests a specific function for perilipin B to protect newly synthesized triacylglycerol in the plasma membrane.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19147 (URN)10.1074/jbc.C500461200 (DOI)16527823 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2017-12-13Bibliographically approved
    4. Association and insulin regulated translocation of hormone-sensitive lipase with PTRF
    Open this publication in new window or tab >>Association and insulin regulated translocation of hormone-sensitive lipase with PTRF
    2006 (English)In: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, E-ISSN 1090-2104, Vol. 350, no 3, p. 657-661Article in journal (Refereed) Published
    Abstract [en]

    Polymerase I and transcript release factor (PTRF) is in human adipocytes mainly localized at the plasma membrane. This localization was under control of insulin, which translocated PTRF to the cytosol and nucleus, indicating a novel role for PTRF in insulin transcriptional control. In the plasma membrane PTRF was specifically bound to a triacylglycerol-metabolizing subclass of caveolae containing hormone-sensitive lipase (HSL). In response to insulin PTRF was translocated to the cytosol in parallel with HSL. PTRF and HSL were quantitatively immunoprecipitated from the cytosol by antibodies against either PTRF or HSL. The findings indicate also a novel extranuclear function for PTRF in the control of lipolysis.

    Keywords
    Hormone-sensitive lipase, Polymerase I and transcript release factor, Adipocyte, Human, Insulin, Translocation, Protein complex, Caveolae, Lipid metabolism, Transcriptional control
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19148 (URN)10.1016/j.bbrc.2006.09.094 (DOI)17026959 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2017-12-13Bibliographically approved
  • 2.
    Abtahi, Jahan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Henefalk, G.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Randomised trial of bisphosphonate-coated dental implants: Radiographic follow-up after five years of loading2016In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 45, no 12, p. 1564-1569Article in journal (Refereed)
    Abstract [en]

    The results of a randomised trial with bisphosphonate-coated dental implants have been reported previously. Each patient received one coated and one uncoated implant in a double-blind split-mouth design study. After 6 months of osseointegration, resonance frequency analysis indicated better fixation of the coated implants. Reduced marginal bone resorption was also shown. However, it was not known whether the advantage of the bisphosphonate coating would persist over time. The radiographic results at 5 years after implant installation are reported herein. A blinded investigator measured marginal resorption on fresh radiographs obtained for 14 of the 16 patients (two had died) and compared these with the post-implantation images. Non-parametric statistics were used. All implants functioned well. The median marginal bone loss for control implants was found to be 0.70 mm, which is less than usually reported in the literature. The bisphosphonate-coated implants showed even less resorption (median 0.20 mm). The median difference within each pair of implants after 5 years of use was 0.34 mm (95% confidence interval 0.00-0.75 mm; P = 0.04). The present data suggest that bisphosphonate-coated implants enable prolonged preservation of the marginal bone.

  • 3.
    Asplund, Tobias
    et al.
    Linköping University, Department of Biomedical Engineering.
    Hellerfelt, Rikard
    Linköping University, Department of Biomedical Engineering.
    Det trådlösa stetoskopet: kardiovaskulär data över GPRS2004Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Inom området för telemedicin efterfrågas praktiska sätt för läkare att snabbt och tillförlitligt kunna ställa preliminära diagnoser. Genom att använda GPRS kan stetoskopljud överföras över långa avstånd. På så vis kan en patient bli undersökt utan att behöva träffa sin läkare. Den här rapporten förklarar arbetet med att konstruera ett trådlöst stetoskop som använder sig av GPRS. In the area of telemedicine practical methods are wantedfor a doctor to quickly and reliably be able to set a preliminary diagnose. By using GPRS stethoscope sound can be sent over long distances. In that way a patient can be examined without having to meet his or her doctor. This report explains the work of constructing a wireless stethoscope using GPRS.

  • 4.
    Astrom, A. N.
    et al.
    University of Bergen, Norway.
    Gulcan, F.
    University of Bergen, Norway.
    Ekback, G.
    Örebro County Council, Sweden; University of Örebro, Sweden.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care. Linköping University.
    Long-term healthy lifestyle patterns and tooth loss studied in a Swedish cohort of middle-aged and older people2015In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 13, no 4, p. 292-300Article in journal (Refereed)
    Abstract [en]

    The promotion of a healthy lifestyle has become an issue of public health importance in the context of ageing populations and increasing prevalence of chronic diseases. Objective(i) To estimate changes in use of fluoridated tooth paste, use of tooth picks, smoking and alcohol consumption and (ii) to examine whether experience with incident or prevalent tooth loss predict healthy lifestyle transitions from age 50 to 70. MethodIn 1992, 6346 individuals born in 1942 agreed to participate in a prospective cohort study and 3585 completed follow-up questionnaires in 1997, 2002, 2007 and 2012. Statistical analyses were conducted by chi-square statistics, Cochrans Q and logistic regression. ResultsIn total, 15.7% and 74.0% reported incident (tooth loss only in 2012) and prevalent tooth loss (tooth loss in 1992 and 2012). Significant differences occurred between the 1992 and 2012 prevalence of using toothpicks (from 48.3% to 69.1%), smoking (from 26.9% to 10.1%) and alcohol consumption (from 41.5% to 50.5%), 29% and 15.6% increased use of toothpicks and alcohol consumption, whereas 15.5% stopped daily smoking. Increased use of fluoridated tooth paste, smoking cessation and failure to increase use of toothpicks was associated with prevalent tooth loss between age 50 and 70. ConclusionThis study revealed positive and negative trends in oral health behaviours over a 20-year period in persons aged 50 at baseline. Mixed support was obtained for the assumption that oral health promoting lifestyle transitions follow experience with tooth loss. Older people with tooth loss experience could benefit from targeted counselling aimed at coping with oral diseases.

  • 5.
    Astrom, Anne N.
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, NorwayM Anne Nordrehaug Åstrøm, Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Lie, Stein A.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekback, Gunnar
    Örebro County Council, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Gulcan, Ferda
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care.
    Self-reported dry mouth among ageing people: a longitudinal, cross-national study2019In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 127, no 2, p. 130-138Article in journal (Refereed)
    Abstract [en]

    Focusing on Swedish and Norwegian cohorts of community-dwelling older adults between age 65 and 70, this study aimed to identify predictors of the prevalence and incident cases of daytime and night-time xerostomia. It was hypothesized that the prevalence increases with increasing age and is higher in women than in men and that the prevalence of persistent xerostomia and the 5-yr-incident cases are higher in people with consistent use of medication and need for health care. Of the Norwegian participants who completed the 2007 survey (age 65 yr), 70% (n = 2,947) participated in 2012. Individuals participating in both 2007 and 2012 constituted the Swedish panel (80%, n = 4,862). The prevalence of xerostomia was higher in women than in men and increased from age 65 to age 70, most markedly in the Swedish cohort. The risk of persistent xerostomia was greatest for participants with consistent use of medication (OR = 1.3) and contact with a physician (OR = 2.3). The risk of incident cases of xerostomia during daytime was greatest for participants with recent and consistent use of medication and recent contact with a physician. Dental professionals should identify patients with xerostomia, emphasize early prevention, and alleviate oral symptoms in collaboration with physicians.

  • 6.
    Astvaldsdottir, Alfheiour
    et al.
    Karolinska Institute, Sweden.
    Naimi-Akbar, Aron
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Brolund, Agneta
    Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Lintamo, Laura
    Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Attergren Granath, Anna
    Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Tranaeus, Sofia
    Karolinska Institute, Sweden; Swedish Agency Health Technology Assessment and Assessment, Sweden; Malmt University, Sweden.
    Ostlund, Pernilla
    Swedish Agency Health Technology Assessment and Assessment, Sweden; Malmt University, Sweden.
    Arginine and Caries Prevention: A Systematic Review2016In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 50, no 4, p. 383-393Article, review/survey (Refereed)
    Abstract [en]

    Objectives: To evaluate the available evidence that the use of arginine-containing dental care products prevents the development of new caries lesions and the progression of existing lesions. Search Methods: We performed a systematic literature search of databases including PubMed, the Cochrane Library and EMBASE. Selection Criteria: We selected randomized controlled trials of treatment with arginine in fluoride-containing dental products measuring dental caries incidence or progression in children, adults and elderly subjects. Data Collection and Analysis: Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE classification. Main Results: Due to conflicts of interest and weak transferability to Swedish conditions, no conclusions can be drawn from studies on the effects of arginine-fluoride toothpaste in children. Arginine-containing toothpaste costs about 40% more than basic fluoride toothpaste; to determine whether it is more cost-effective, the higher cost must be considered in relation to any additional caries-preventive effect. The literature review also disclosed some questionable research ethics: in several of the studies, the children in the control group used non-fluoride toothpaste. Toothpaste without fluoride is not as effective against dental caries as the standard treatment - fluoride toothpaste - which has a well -documented effect. This contravenes the fundamental principles of research ethics. Conclusion: At present there is insufficient evidence in support of a caries-preventive effect for the inclusion of arginine in toothpastes. More rigorous studies, and studies which are less dependent on commercial interests, are required. (C) 2016 S. Karger AG, Basel

  • 7.
    Bakke, Merete
    et al.
    Köpenhamns Universitet.
    Bergendal, Birgitta
    Jönköping.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine.
    Sjogreen, L.
    Göteborg University.
    Asten, P.
    Lovisenberg Diakonale Hospital.
    Development and evaluation of a comprehensive screening for orofacial dysfunction.2007In: Swedish Dental Journal, ISSN 0347-9994, Vol. 31, no 2, p. 75-84Article in journal (Refereed)
    Abstract [en]

    The aim was to develop a comprehensive screening instrument for evaluation of orofacial dysfunction that was easy to perform for different health professionals without special equipment. The Nordic Orofacial Test - Screening (NOT-S), consisting of a structured interview and clinical examination, was developed with a picture manual illustrating the different tasks in the examination. It was first tested in a Swedish version, and later translated to other Nordic languages, and to English.

             The interview reflected six domains, (I) Sensory function, (II) Breathing, (III) Habits, (IV) Chewing and swallowing, (V) Drooling, and (VI) Dryness of the mouth, and the examination included six domains representing (1) The face at rest, and tasks regarding (2) Nose breathing, (3) Facial expression, (4) Masticatory muscle and jaw function, (5) Oral motor function, and (6) Speech. One or more “yes” for impairment in a domain resulted in one point (maximum NOT-S score 12 points).

             The mean NOT-S score (±SD) in 120 patients (3-86 yr), referred to five centers for specialized dental care or speech and language pathology in Sweden, Norway and Denmark, was 4.1±2.6, and 0.4±0.6 in 60 control subjects (3-78 yr). The screening was easy to administer and the time spent 5-13 min. The scores from the clinic-referred sample differed significantly from the controls, and the sensitivity of the screening was 0.96 and specificity 0.63. Repeated evaluations of videotapes of 20 patients by 3 examiners, speech-language pathologists and dentists, with at least two-week intervals, showed inter- and intraexaminer agreement on the points given in the domains at respectively 83% and 92-95% which increased after recalibration to 85% and 95-99%. Kappa values for interexaminer agreement on the NOT-S scores were 0.42-0.44 (i.e. fair), and the method error was 5.3%. To conclude, NOT-S gave a reliable and valid screening for orofacial dysfunction.

  • 8.
    Bengtsson, Martin
    et al.
    Univ Hosp Skane, Sweden.
    Wall, Gert
    Univ Hosp Skane, Sweden.
    Larsson, Pernilla
    Region Östergötland, Public Dental Health Care. Malmo Univ, Sweden.
    Becktor, Jonas P.
    Malmo Univ, Sweden.
    Rasmusson, Lars
    Gothenburg Univ, Sweden.
    Treatment outcomes and patient-reported quality of life after orthognathic surgery with computer-assisted 2-or 3-dimensional planning: A randomized double-blind active-controlled clinical trial2018In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 153, no 6, p. 786-796Article in journal (Refereed)
    Abstract [en]

    Introduction: Thorough treatment planning is essential for a good clinical outcome in orthognathic treatment. The planning is often digital. Both 2-dimensional (2D) and 3-dimensional (3D) software options are available. The aim of this randomized 2-arm parallel double-blinded active-controlled clinical trial was to comprae the outcomes of computer-based 2D and 3D planning techniques according to patient-reported health related quality of life. The hypothesis was that a 3D technique would give a better treatment outcome compared with a 2D technique. Methods: Orthognathic treatment for 62 subjects, aged 18 to 28 years, with severe Class III malocclusion was planned with both 2D and 3D techniques. After treatment planning but before surgery, the patients were randomly allocated via blind collection of 1 enveloped card for each subject in a 1:1 ratio to the test (3D) or the control (2D) group. Thus, the intervention was according to which planning technique was used. The primary outcome was patient-reported outcome measures. The secondary outcome was relationship between patient-reported outcome measures and cephalometric accuracy. Questionnaires on the patients health-related quality of life (HRQoL) were distributed preoperatively and 12 months after surgical treatment. The questionnaires were coded, meaning blinding throughout the analysis. Differences between groups were tested with the Fisher permutation test. The HRQoL was also compared with measurements of cephalometric accuracy for the 2 groups. Reslts: Three subjects were lost to clinical follow-up leaving 57 included. Of these, 55 subjects completed the questionnaires, 28 in the 2D and 27 in the 3D groups. No statistically significant difference regarding HRQoL was found between the studied planning techniques: the Oral Health Impact Profile total showed -3.69 (95% confidence interval, -19.68 to 12.30). Consistent results on HRQoL and cephalometric accuracy showed a difference between pretreatment and postreatment that increased in both groups but to a higher level in the 3D group. A difference between pretreatment and posttreatment HRQoL was shown for both groups, indicating increased quality of life after treatment. This supports recent findings comparing 3D and 2D planning techniques. No serious harm was observed during the study. Conclusions: Improvemens of HRQoL were shown after treatment independent of which planning technique, 2D or 3D, was used. No statisticaly significant difference was found between the planning techniqes. Registration: This trial was not registered. Protocol: The protocol was not published before trial commencement.

  • 9.
    Bergstrom, Eva-Karin
    et al.
    Vastra Gotaland Reg, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Moberg Sköld, Ulla
    Univ Gothenburg, Sweden.
    Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12-to 15-Year-Olds in Sweden2019In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 53, no 3, p. 339-346Article in journal (Refereed)
    Abstract [en]

    Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Vastra Gotaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the "low" subgroup, those with 1-3 into the "moderate" subgroup and those with amp;gt;= 4 into the "high" subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12. (C) 2019 S. Karger AG, Basel

  • 10.
    Broden, Josephine
    et al.
    Malmo Univ, Sweden; Swedish Publ Dent Serv, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Fransson, Helena
    Malmo Univ, Sweden.
    Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 4, p. 275-281Article in journal (Refereed)
    Abstract [en]

    Objective: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries. Material and methods: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices. Results: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment. Conclusions: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.

  • 11.
    Bågesund, Mats
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Public Dental Health Care. Linköping University, Faculty of Medicine and Health Sciences. TakoCentre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway.
    Shafiee, Z.
    TakoCentre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway.
    Drivdal, M.
    Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway.
    Berden, J.
    TakoCentre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway.
    Storhaug, K.
    TakoCentre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway.
    Dental care and oral health in Aagenaes syndrome/lymphedema cholestasis syndrome 12015In: Special Care in Dentistry, ISSN 0275-1879, Vol. 35, no 2, p. 83-89Article in journal (Refereed)
    Abstract [en]

    Aagenaes syndrome/lymphedema cholestasis syndrome 1 (LCS1) is a rare genetic disorder characterized by neonatal cholestasis and lymphedema. The aim was to assess dental care and oral health in adults with LCS1. Fifteen (9M, 6F) individuals diagnosed with LCS1, aged 19-59 years participated. The study evaluated salivary secretion rate, dental radiographs, intraoral photos and included a questionnaire. Eight (53%) had regular dental checkups. Three had received subsidized dental care. Seven (47%) had two or more subjective symptoms of xerostomia. Three (20%) had a decreased stimulated salivary secretion rate below 0.7 mL/minute. Seven (47%) had dentin caries. Marginal periodontitis was found in all six patients above 35 years of age, but not before that age. Thirteen (87%) had tooth discoloration, which was extensive in three (20%). Conclusion. Several patients with LCS1 have problems with periodontitis and tooth discoloration. Frequent dental checkups are therefore recommended. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.

  • 12.
    Caban, Janusz
    et al.
    Vastervik Hospital, Sweden.
    Fermergard, Robert
    Vastervik Hospital, Sweden.
    Abtahi, Jahan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Long-term evaluation of osteotome sinus floor elevation and simultaneous placement of implants without bone grafts: 10-Year radiographic and clinical follow-up2017In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 19, no 6, p. 1023-1033Article in journal (Refereed)
    Abstract [en]

    BackgroundInsertion of an implant in the edentulous posterior maxilla is a challenging procedure because of poor bone quality and increased pneumatization of the maxillary sinus after tooth extraction. To increase the amount of bone, several surgical bone grafting techniques have been used?with considerable morbidity for patients. Osteotome sinus floor elevation (OSFE) is a less invasive technique. The clinical and radiographic outcome of 53 implants placed with this technique without bone graft has been reported previously. PurposeHere we report the clinical and radiographic findings after 10 years of implant load bearing. Material and methodsIn a retrospective study, 34 Astra implants in 25 patients were subjected to 10-year follow-up radiologically and clinically. Each patient received 1 or 2 conical Astra implants. The level of the marginal bone and the height of the residual peri-implant alveolar bone (RPAB) for each implant were measured from digital intra-oral radiographs. ResultsTwo implants in edentulous patients were lost at the 1-year follow-up, and 1 more at the 3-year examination. There was no loss between 3-year and 10-year follow-up. At 10-year follow-up 36 implants were included. Implants used in single-tooth replacements and in partially edentulous cases had a 100% survival rate. The mean marginal bone loss was 0.60.8 mm. The bone height at the time of implant insertion ranged from 1.8 to 6.9 mm, with a mean value of 4.3 +/- 1.0 mm. At 10-year follow-up the mean gain in bone at the implant sites for all implants was 2.6 +/- 1.2 mm. ConclusionsThe OSFE technique is a reliable method for rehabilitation of patients with atrophied posterior maxilla. However, the success of this method is associated with the amount of the residual bone. In the present study, this surgical approach without bone graft showed reliable long-term results with Astra implants.

  • 13.
    Cardemil, Carina
    et al.
    Department of Oral Maxillofacial Surgery, NÄL Medical Centre Hospital, Trollhättan, Sweden; Department of Oral & Maxillofacial Surgery, The Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden.
    Ristevski, Zoran
    Department of Oral Maxillofacial Surgery, NÄL Medical Centre Hospital, Trollhättan, Sweden, and Department of Oral; Maxillofacial Surgery, Head & Neck Oncology Center, University Hospital Örebro, Örebro, Sweden.
    Alsén, Bengt
    Department of Oral Maxillofacial Surgery, NÄL Medical Centre Hospital, Trollhättan, Sweden.
    Dahlin, Christer
    Department of Oral Maxillofacial Surgery, NÄL Medical Centre Hospital, Trollhättan, Sweden; Department of Biomaterials Science, Institute for Surgical Sciences, The Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden.
    Influence of different operatory setups on implant survival rate: a retrospective clinical study2009In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 11, no 4, p. 288-291Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Surgery performed under sterile operating conditions, as well as atraumatic surgery, has been stated to be among the most important requirements for successful osseointegration. However, there are few reports concerning the sterile surgical technique in association with implant placement, and the appropriate level of operatory setup is not fully known.

    PURPOSE: The purpose of this study was to analyze implant survival rate using a simplified surgical operatory setup compared with the use of the original Brånemark System (Nobel Biocare AB, Göteborg, Sweden) protocol.

    MATERIALS AND METHODS: A total of 1,285 consecutively treated patients were included in the study. Four thousand implants were placed during the period of 1985 to 2003. Group A (using the Brånemark System protocol) comprised of 654 patients and 2,414 implants. Group B (using a simplified operatory setup) comprised of 631 patients and 1,586 implants. Healing was evaluated after 6 months of clinical function. Failure was defined as the removal of implants because of nonosseointegration. Statistic analysis was performed using t-test for paired data. The level of significance was set at 5% for comparison of data.

    RESULTS: No significant difference with regard to complications and implant survival rate was found in the study.

    CONCLUSION: The result from the present study suggests that a simplified operatory setup does not affect the survival rate of oral implant treatment.

  • 14.
    Carlsson, Gunnar E.
    et al.
    University of Gothenburg, Sweden.
    Ekbäck, Gunnar
    Örebro University, Sweden; Örebro County Council, Sweden.
    Johansson, Anders
    University of Bergen, Norway.
    Ordell, Sven
    Östergötlands Läns Landsting, Public Dental Health Care.
    Unell, Lennart
    Örebro University, Sweden; Örebro County Council, Sweden.
    Is there a trend of decreasing prevalence of TMD-related symptoms with ageing among the elderly?2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 714-720Article in journal (Refereed)
    Abstract [en]

    Objective. Older adults have not been studied as much as younger ones regarding prevalence of TMD-related symptoms. The aim was to assess the prevalence of TMD-related symptoms in two population samples, 70 and 80 years old. Materials and methods. Identical questionnaires were in 2012 sent to all subjects born in 1932 and 1942 living in two Swedish counties. The response rate was 70.1%, resulting in samples of 5697 70-and 2922 80-year-old subjects. The questionnaire comprised 53 questions. Answers to questions on problems regarding TMD-related symptoms and awareness of bruxism were analysed. Results. Twelve per cent of the women and 7% of the men in the 70-year-old group reported some, rather great or severe problems regarding TMD pain. In the 80-year-olds the prevalence was 8% and 7%, respectively. Subjects who had problems with TMJ sounds reported difficulty to open the jaw wide 6-times and TMJ pain 10-13-times more frequently than subjects without such problems. Changes of taste and awareness of bruxism were the only variables significantly associated with TMD symptoms in both age groups. Number of teeth was not significantly associated with any of the TMD-related symptoms. Conclusions. Most of the elderly subjects had no severe problems with TMD-related symptoms, but 12% of the 70-year-old women reported some, rather great or severe problems. The marked gender difference at age 70 had disappeared in the 80-year-old group. The prevalence was lower among the 80-compared with the 70-year-old subjects of both sexes. The results support the comorbidity between TMD-related symptoms and general health problems.

  • 15.
    Ek, Fredrik
    Linköping University, Department of Biomedical Engineering.
    Undersökning och utformning av ett generellt datainsamlingssystem i LabVIEW2005Independent thesis Basic level (professional degree)Student thesis
    Abstract [sv]

    This report is the result of a diploma work made at IMT at US in Linköping. The purpose of this piece of work is to investigate the possibility to design a general program for data-acquisition using LabVIEW, suiting different hardwares and connections. Great importance has been attached to communication with serialport, using bluetooth, because different wireless PPG-instruments has been developed parallel to this project. These PPG-circuits uses this type of serialcommunication. Communication with USB, GPIB and analog connection has also been examined and analog communication has been tested practically. But any serious implementation of these types in the LabVIEW-program has not been made.The paper starts with theory where LabVIEW, bluetooth, PPG, different connections and the different PPG-sensors is described concisely. Theory is followed by a"performance-part"where the course of action and the LabVIEW- program is described.The result of the work is an application in LabVIEW for communication with different PPG-sensors, where interface, protocol and file-standard/format has been designed. The program is adapted to prolonged measurements with full duplex. Measurements can be saved into ascii- or binary format, and signals can be studied carefully in graphs.Since only one PPG-sensor is fully made, a test in measurement and acquisition has been made with that sensor only. Ragarding the other PPG-instruments, the communication has been tested in hyperterminal.

  • 16.
    Ekback, Gunnar
    et al.
    Örebro County Council, Sweden; University of Örebro, Sweden.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care. Malmö University, Sweden.
    Does different wording of a global oral health question provide different results?2015In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, no 4, p. 250-257Article in journal (Refereed)
    Abstract [en]

    Objective. Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions. Background. It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the global oral health question is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is. Materials and methods. In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Orebro (T) and Ostergotland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression. Results. The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR = 5.6 and 5.2), chewing capacity (OR = 6.9 and 4.2), satisfaction with dental appearance (OR = 19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR = 3.5 and 3.9). Conclusion. Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants.

  • 17.
    Ekback, Gunnar
    et al.
    Regional Örebro County, Sweden; Örebro University, Sweden.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care. Malmö University, Sweden.
    Self-perceived taste disturbance: a 20-year prospective study of a Swedish 1942 birth cohort2017In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 34, no 2, p. 180-186Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to assess the impact of dental care factors, general health factors and socio-economic factors on perceived taste disturbance (PTD) over time and to assess the stability of or change in PTD in a panel of individuals as they progressed from middle age (50 years) to early old age (70 years). Materials and methods: Data collection was conducted from a cohort study beginning in 1992, when the participants were 50 years old, and again 5, 10, 15 and 20 years later. Stability and change in PTD were described using cross-tabulation. Perceived taste disturbance over the 20-year survey period was modelled using the generalised estimating equation (GEE). Results: The prevalence of PTD during a 5-year period found in this study ranged from 2.4 to 2.9%, the latter in individuals between 60 and 70 years of age. Women generally had PTD more often than men. The longitudinal analysis showed that problems with bad breath (OR = 3.6), blisters (OR = 3.4), burning mouth (OR = 3.4) and self-perceived health (OR = 2.7) were the most important factors explaining PTD. Conclusions: This study showed that PTD does not increase between 50 and 70 years of age in ordinary community-living individuals. There were no long-term impacts on PTD over time from socio-economic factors, and over time, there were a limited number of factors contributing to the effect. Bad breath, blisters, burning mouth and self-perceived health are important factors for the dentist to discuss with the patient in the case of PTD.

  • 18.
    Ekback, Gunnar
    et al.
    Regional Örebro County, Sweden; University of Örebro, Sweden.
    Ordell, Sven
    Östergötlands Läns Landsting, Public Dental Health Care. Malmö University, Sweden.
    Stahlnacke, Katri
    Regional Örebro County, Sweden.
    Satisfaction with dental care and life-course predictors: A 20-year prospective study of a Swedish 1942 birth cohort?2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 3, p. 194-201Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to assess the impact of care experience, health factors and socioeconomic factors on satisfaction with dental care across time and to assess the stability or change in levels of self-reported satisfaction with dental care in individuals as they progress from middle age to early old age.Materials and methods: The present work is based on five separate data collections from a cohort study with 3585 individuals responding in all years of the survey. Data collection was conducted in 1992 when the subjects were 50 years of age and again 5, 10, 15 and 20 years later. Absolute stability in satisfaction with dental care was assessed by calculating the proportion of individuals who maintained their position in the same category from one survey period to another. Changes across time were tested using Cochrans Q test. Satisfaction with dental care across the 20-year survey period was modeled using the generalized estimating equation (GEE).Results and conclusion: The result showed that 85% of women and 83% of men remained satisfied with dental care. Binomial GEE revealed no statistical significant change in satisfaction with dental care between 1992-2012. In sum, this study has shown that this age group, born in 1942, was stably satisfied with dental care between age 50 and age 70, despite all changes during this time period. Females are more satisfied than men and the most important factors are the experience of attention during the last visit, satisfaction with dental appearance and good chewing capability.

  • 19.
    Ekbäck, Gunnar
    et al.
    Örebro County Council, Sweden; University of Örebro, Sweden; Örebro University Hospital, Sweden.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care. Malmö University, Sweden.
    Palmetun-Ekbäck, Maria
    Örebro University Hospital, Sweden; Örebro County Council, Sweden.
    Ekbäck, Gustav
    Örebro County Council, Sweden; University of Örebro, Sweden; Örebro University Hospital, Sweden.
    Unell, Lennart
    Malmö University, Sweden; Örebro County Council, Sweden.
    Johansson, Ann-Katrin
    University of Bergen, Norway.
    Reporting dental caries disease in longitudinal studies - a suggestion2016In: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, no 2, p. 173-179Article in journal (Refereed)
    Abstract [en]

    In general, most infectious and/or lifestyle-related diseases are defined as being present when sufficient signs or symptoms occurs in an individual. The term "sufficient" is a relative concept and a disease can therefore be measured with different degrees of certainty. These symptoms are commonly defined in such a way that it is possible to determine the incidence and prevalence of the disease and also the proportion of individuals that are cured from the disease. If dental caries is an individual disease which can be compared to other diseases regarding incidence and prevalence, it is important to determine for how long an individual must be free from new signs of the disease before being considered cured or free from the disease and to define the "sufficient" signs or symptoms needed for a diagnose. Based on these thoughts, the purpose of this study was to calculate caries incidence and prevalence in a group of adolescents from a definition of dental caries based on ICD-10. This study included all 12 year olds in 1990 who attended a clinical dental examination in 1990-1995 in Orebro County, Orebro, Sweden, yearly during these six years. Dental caries disease at the individual level was defined as Ko2.1 (dentinal caries) according to ICD-bo while freedom of caries was defined as the absence of Ko2.1 during a three-year period. In this study the yearly prevalence was 12%, the three year cumulative incidence was 18% and the incidence rate 13%. Results of this study highlight the poor outcomes in curing caries disease in this age-group, according to the criteria in this study, as only 17% of the children with caries at the outset of the study were free from the disease three years later. Defining both a practical level to measure signs of dental caries, and the period an individual must be free from them to be classified as cured from the disease create new opportunities to compare and communicate the disease of dental caries with other diseases. This way of registration is also of advantage for planning purposes as there the centre of interest must be the individual patient and not the tooth or surface.

  • 20.
    Gudmundsson, Jens Kristjan
    et al.
    Eskilstuna Hospital, Sweden.
    Ajan, Aida
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Abtahi, Jahan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses: a clinicopathological study of 114 patients2016In: Journal of Applied Oral Science, ISSN 1678-7757, E-ISSN 1678-7765, Vol. 24, no 6, p. 561-567Article in journal (Refereed)
    Abstract [en]

    Objective: Fine-needle aspiration cytology is a valuable method for preoperative assessment of head and neck tumors. However, its accuracy in detection of salivary gland masses is controversial compared with other methods. The aim of this work was to evaluate the effectiveness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses. Material and Methods: Over a 10-year period, 126 parotid gland masses were resected. Retrospective chart reviews of 114 patients were performed. The results of FNAC and final histological diagnosis were compared and the accuracy of FNAC was determined. Results: Final histological evaluation revealed 11 malignant tumors and 103 benign lesions. Pleomorphic adenoma was the most common neoplasm (63%), followed by Warthins tumor (17.5%). The sensitivity of FNAC in detecting malignant tumors was 73% and the specificity was 97%. Positive predictive value (PPV) was 73% and negative predictive value (NPV) was 97%. The overall accuracy of FNAC in detecting parotid masses was 95%. False-negative diagnosis was found in mucoepidermoid carcinoma, acinic cell carcinoma, and epithelial-myoepithelial carcinoma whereas there was false-positive diagnosis in cases of pleomorphic adenoma and normal parotid gland tissue. Conclusion: FNAC is a reliable minimally invasive diagnostic method with a high sensitivity in diagnosis of lesions in parotid glands. The sensitivity of detection of malignant tumors in parotid glands was low due to the biopsy technique used, and depended on tumor location. Postoperative complications decreased after superficial parotidectomy.

  • 21.
    Gulcan, Ferda
    et al.
    University of Bergen, Norway.
    Ekback, Gunnar
    Örebro County Council, Sweden; University of Örebro, Sweden.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care. Dental Commissioning Unit, Östergötland County Council, Linköping University, Sweden .
    Atle Lie, Stein
    University of Bergen, Norway.
    Nordrehaug Astrom, Anne
    University of Bergen, Norway.
    Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden2015In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 15, no 20Article in journal (Refereed)
    Abstract [en]

    Background: A life course perspective recognizes influences of socially patterned exposures on oral health across the life span. This study assessed the influence of early and later life social conditions on tooth loss and oral impacts on daily performances (OIDP) of people aged 65 and 70 years. Whether social inequalities in oral health changed after the usual age of retirement was also examined. In accordance with "the latent effect life course model", it was hypothesized that adverse early-life social conditions increase the risk of subsequent tooth loss and impaired OIDP, independent of later-life social conditions. Methods: Data were obtained from two cohorts studies conducted in Sweden and Norway. The 2007 and 2012 waves of the surveys were used for the present study. Early-life social conditions were measured in terms of gender, education and country of birth, and later-life social conditions were assessed by working status, marital status and size of social network. Logistic regression and Generalized Estimating Equations (GEE) were used to analyse the data. Inverse probability weighting (IPW) was used to adjust estimates for missing responses and loss to follow-up. Results: Early-life social conditions contributed to tooth loss and OIDP in each survey year and both countries independent of later-life social conditions. Lower education correlated positively with tooth loss, but did not influence OIDP. Foreign country of birth correlated positively with oral impacts in Sweden only. Later-life social conditions were the strongest predictors of tooth loss and OIDP across survey years and countries. GEE revealed significant interactions between social network and survey year, and between marital status and survey year on tooth loss. Conclusion: The results confirmed the latent effect life course model in that early and later life social conditions had independent effects on tooth loss and OIDP among the elderly in Norway and Sweden. Between age 65 and 70, inequalities tooth loss related to marital status declined, and inequalities related to social network increased.

  • 22.
    Gulcan, Ferda
    et al.
    University of Bergen, Norway .
    Nasir, Elwalid
    University of Bergen, Norway .
    Ekbäck, Gunnar
    Örebro County Council and University of Örebro, Sweden .
    Ordell, Sven
    Östergötlands Läns Landsting, Public Dental Health Care.
    Nordrehaug Åstrøm, Anne
    University of Bergen, Norway .
    Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden2014In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 14, no 59Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.

    METHODS:

    In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.

    RESULTS:

    Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p < 0.05). Stratified analysis revealed that the mean OIDP frequency score worsened in participants who became dissatisfied- and improved in participants who became satisfied with oral health. Compared to participants who maintained all teeth, those who lost teeth were more likely to experience improvement and worsening of OIDP across both countries. The two-way interaction between country and tooth loss was not statistically significant.

    CONCLUSIONS:

    Changes in OIDP at the individual level were more pronounced than the percentage distribution of OIDP at each point in time would suggest. The OIDP frequency score showed promising evaluative properties in terms of acceptable longitudinal validity, responsiveness and reproducibility among older people in Norway and Sweden. This suggests that the OIDP instrument is able to detect change in the oral health status that occurred over the 5 year period investigated. Norwegian elderly were more likely to report worsening in OIDP than their Swedish counterparts. Disease prevention should be at focus when formulating the health policy for older people.

  • 23.
    Göranson, Emma
    et al.
    Östergötlands Läns Landsting, Public Dental Health Care.
    Lundström, Fredrik
    Östergötlands Läns Landsting, Public Dental Health Care.
    Bågesund, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Public Dental Health Care.
    Outcome of orthodontic care and residual treatment need in Swedish 19-year-olds2014In: Swedish Dental Journal, ISSN 0347-9994, Vol. 38, no 3, p. 133-142Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to assess the outcome of orthodontic care in Linkoping, Sweden. The dental records of 207 (107 M,100 F) 19-year-olds registered at one public dental health clinic were studied. A clinical examination was performed where malocclusions were registered, where after residual orthodontic treatment need was measured using the Index of Complexity, Outcome and Need (ICON). The 19-year-olds also filled in a questionnaire regarding residual subjective orthodontic treatment demand. Differences between genders were analysed. One hundred and ten (47 M, 63 F) individuals (53.1%) had partaken in orthodontic consultations. Orthodontic appliance treatment had been received by 86 (38 M, 48 F) individuals (41.6%). A residual orthodontic treatment need was registered in 28 (22 M, 6 F) individuals (13.5%). Residual subjective orthodontic treatment demand was expressed by 9 (3 M, 6 F) individuals (4.3%). Eight (2 M, 6 F) of those had no residual treatment need. A higher (p=0.006) rate of females (63.0%) than males (44.0%) had participated in orthodontic consultations. The proportion of males (35.5%) who had experienced orthodontic treatment was not significantly lower (p=0.069) than among the females (48.0%). However, a lower (p=0.009) proportion of treated males (55.3%; n=21 out of 38) than of treated females (81.3%; n=39 out of 48) had received their treatment by orthodontic specialists. At 19 years of age, the proportion of males with residual treatment need (20.6%) was higher (p=0.002) than among the females (6.0%). Every patient with orthodontic treatment need and -demand at 19 years of age had previously been offered orthodontic treatment. The conclusion was drawn that the orthodontic care scheme had successfully diagnosed and treated orthodontic problems in the population. However, notable differences between genders regarding treatment modalities and the amount of residual treatment need at age 19 were found.

  • 24.
    Halling Linder, Cecilia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Enander, Karin
    Linköping University, Department of Physics, Chemistry and Biology, Molecular Physics. Linköping University, Faculty of Science & Engineering.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Glycation Contributes to Interaction Between Human Bone Alkaline Phosphatase and Collagen Type I2016In: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 98, no 3, p. 284-293Article in journal (Refereed)
    Abstract [en]

    Bone is a biological composite material comprised primarily of collagen type I and mineral crystals of calcium and phosphate in the form of hydroxyapatite (HA), which together provide its mechanical properties. Bone alkaline phosphatase (ALP), produced by osteoblasts, plays a pivotal role in the mineralization process. Affinity contacts between collagen, mainly type II, and the crown domain of various ALP isozymes were reported in a few in vitro studies in the 1980s and 1990s, but have not attracted much attention since, although such interactions may have important implications for the bone mineralization process. The objective of this study was to investigate the binding properties of human collagen type I to human bone ALP, including the two bone ALP isoforms B1 and B2. ALP from human liver, human placenta and E. coli were also studied. A surface plasmon resonance-based analysis, supported by electrophoresis and blotting, showed that bone ALP binds stronger to collagen type I in comparison with ALPs expressed in non-mineralizing tissues. Further, the B2 isoform binds significantly stronger to collagen type I in comparison with the B1 isoform. Human bone and liver ALP (with identical amino acid composition) displayed pronounced differences in binding, revealing that post-translational glycosylation properties govern these interactions to a large extent. In conclusion, this study presents the first evidence that glycosylation differences in human ALPs are of crucial importance for protein–protein interactions with collagen type I, although the presence of the ALP crown domain may also be necessary. Different binding affinities among the bone ALP isoforms may influence the mineral-collagen interface, mineralization kinetics, and degree of bone matrix mineralization, which are important factors determining the material properties of bone.

  • 25.
    Hjelm-Andersson, Alexander
    Linköping University, Department of Biomedical Engineering.
    En kombination av Bluetooth och LabVIEW för ett universellt mätdatorsystem inom medicinsk teknik2004Independent thesis Basic level (professional degree)Student thesis
    Abstract [sv]

    Examensarbetet är utfört på Linköpings Universitet, Institutionen för Medicinsk Teknik och bygger på att undersöka möjligheterna för trådlös överföring av mätvärden via Bluetooth. Mätningarna gäller två olika hårdvaror som med metoden PPG mäter blodflöde, en ny förenklad hårdvara och en mer avancerad och tidigare utvecklad hårdvara. Arbetet är tvådelat, under första delen upprättades en kommunikation med Bluetooth och två metoder för överföring av data undersöktes. Under andra delen togs ett gränssnitt fram i utvecklingsmiljön LabVIEW för styrning av hårdvarorna samt för åskådliggörandet av mätdata. Metoderna som undersöktes för dataöverföring är att antingen kontinuerligt skicka samplat data direkt från en AD-omvandlare eller att fylla bluetoothmodulens minne för att därefter skicka samtliga värden samtidigt. För utvärdering av vilken metod som passar bäst för ändamålet diskuteras för- och nackdelar, samplingshastigheter undersöks och redovisas med hjälp av tabeller och grafer. Examensarbetet har resulterat i en grund för fortsatt utveckling av trådlös anpassning av mättekniska ändamålinom medicinsk teknik.

  • 26.
    Hongxing, L.
    et al.
    Department of Clinical Dentistry - Prosthodontics, University of Bergen, Bergen, Norway.
    Astrøm, A. N.
    Department of Clinical Dentistry - Community Dentistry, University of Bergen, Bergen, Norway.
    List, T.
    Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
    Nilsson, Ing-Marie
    Region Östergötland, Public Dental Health Care.
    Johansson, A.
    Department of Clinical Dentistry - Prosthodontics, University of Bergen, Bergen, Norway.
    Prevalence of temporomandibular disorder pain in Chinese adolescents compared to an age-matched Swedish population.2016In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 43, no 4, p. 241-8Article in journal (Refereed)
    Abstract [en]

    This study aimed to (i) assess the prevalence and perceived need for treatment of TMD pain, and its association with socio-economic factors and gender, in adolescents in Xi᾽an, Shaanxi Province, China, and (ii) compare the prevalence and association with gender of TMD pain in Xi᾽an to an age-matched Swedish population. We surveyed Chinese adolescents aged 15 to 19 years in Xi'an, China (n = 5524), using a questionnaire with two-stage stratified sampling and the school as the sampling unit. The study included second-year students at selected high schools. It also included an age-matched Swedish population (n = 17,015) surveyed using the same diagnostic criteria for TMD pain as that used in the Chinese sample. The survey found TMD pain in 14·8% (n = 817) of the Chinese sample and 5·1% (n = 871) of the Swedish sample (P < 0·0001). Girls had significantly more TMD pain than boys in both the Chinese (P < 0·05) and Swedish (P < 0·001) samples. TMD pain increased with age in the Chinese population. Of the Chinese adolescents with TMD pain, 47% reported that they felt a need for treatment. Rural schools, low paternal education levels, poverty, living outside the home, poor general and oral health, and dissatisfaction with teeth all showed significant positive correlations with TMD pain. Prevalence of TMD pain in Chinese adolescents was significantly higher than in the Swedish sample.

  • 27.
    Hongxing, Li
    et al.
    Department of Clinical Dentistry – Prosthodontics, University of Bergen, Bergen, Norway.
    List, Thomas
    Orofacial pain and Jaw Function, Malmö University, Malmö, Sweden.
    Nilsson, Ing-Marie
    Specialist Center for Oral Rehabilitation, Norrköping, Sweden .
    Johansson, Anders
    Department of Clinical Dentistry – Prosthodontics, University of Bergen, Bergen, Norway.
    Nordrehaug Astrom, Anne
    Department of Clinical Dentistry – Community Dentistry, University of Bergen, Bergen, Norway.
    Validity and reliability of OIDP and OHIP-14: a survey of Chinese high school students2014In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 14, no 158, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: To determine the impact of oral diseases on everyday life, measures of oral quality of life are needed. In complementing traditional disease-based measures, they assess the need for oral care to evaluate oral health care programs and management of treatment. To assess the reliability and validity of the Oral Impact of Daily Performance (OIDP) and the short-form Oral Health Impact Profile (OHIP-14) among high school students in Xian, the capital of Shanxi province, China. Methods: Cross-sectional one-stage stratified random cluster sample using high schools as the primary sampling unit. Students completed self-administered questionnaires at school. The survey included the OHIP-14 and OIDP inventories, translated and culturally adapted for China, and global oral health and socio-behavioral measures. Results: A total of 5,608 students participated in the study, with a 93% response rate (mean age 17.2, SD 0.8, 52% females, 45.3% urban residents). The proportion experiencing at least one impact (at any frequency) during the previous six months was 62.9% for the OHIP-14 and 45.8% for the OIDP. Cronbachs alpha measured internal consistency at 0.85 for OHIP-14 and 0.75 for OIDP while Cohens kappa varied between 0.27 and 0.58 for OHIP-14 items and between 0.23 and 0.65 for OIDP items. Kappa scores for the OHIP-14 and OIDP additive scores were 0.52 and 0.66, respectively. Both measures varied systematically and in the expected direction, with global oral health measures showing criterion validity. The correlation between OIDP and OHIP-14 was r(s) + 0.65. That both measures varied systematically with socio-behavioral factors indicates construct validity. Conclusion: Both the OIDP and OHIP-14 inventories had reasonable reliability and construct validity in relation to subjective global oral health indicators among adolescents attending high schools in China and thus appear to be useful oral health -related quality of life measures in this context. Overall, the OHIP-14 and OIDP performed equally well, although OHIP-14 had superior content validity due to its sensitivity towards less severe impacts.

  • 28.
    Häggman-Henrikson, B.
    et al.
    Malmö University, Sweden; Umeå University, Sweden; Malmö University, Sweden.
    Alstergren, P.
    Malmö University, Sweden; SCON, Sweden; Skåne University Hospital, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Malmö University, Sweden.
    Hogestatt, E. D.
    Lund University, Sweden.
    Ostlund, P.
    Umeå University, Sweden; Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Tranaeus, S.
    Umeå University, Sweden; Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Vitols, S.
    Swedish Agency Health Technology Assessment and Assessment, Sweden; Karolinska Institute, Sweden.
    List, T.
    Malmö University, Sweden; SCON, Sweden; Skåne University Hospital, Sweden.
    Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis2017In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 44, no 10, p. 800-826Article, review/survey (Refereed)
    Abstract [en]

    This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients amp;gt;= 18 years with chronic (amp;gt;= 3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [ temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

  • 29.
    Höglund, Markus
    et al.
    Region Östergötland, Public Dental Health Care, Orofacial Medicine/Hospital Dentistry Linköping. Karolinska Inst, Sweden.
    Bågesund, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Shahnavaz, Shervin
    Karolinska Inst, Sweden.
    Wardh, Inger
    Karolinska Inst, Sweden; Acad Ctr Geriatr Dent, Sweden.
    Evaluation of the ability of dental clinicians to rate dental anxietyIn: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of ostergotland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients levels of dental anxiety on a Visual Analogue Scale. The correlation (r(s)) between the clinicians and patients ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians and patients ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians confidence and their ability to rate a patients dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.

  • 30.
    Ingemansson Hultquist, Ann
    et al.
    Västervik Public Dental Service, Kalmar County Council, Sweden.
    Bågesund, Mats
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Dentin caries risk indicators in 1-year-olds. A two year follow-up study2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 8, p. 613-619Article in journal (Refereed)
    Abstract [en]

    Background: Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.Aim: Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.Design: Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.Results: An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR=6.5, p=.002). Multiple regression analysis found the variables Beverages other than water (OR=7.1, pamp;lt;0.001), Caries in sibling (OR=4.8, p=.002), High level of MS (score 2-3) (OR=3.4, p=.03) and Night meal (OR=3.0, p=.03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.Conclusions: Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.

  • 31.
    Ingemansson Hultquist, Ann
    et al.
    Östergötlands Läns Landsting, Public Dental Health Care. Folktandvården, Västervik, Sweden.
    Lingström, Peter
    Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Bågesund, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Public Dental Health Care.
    Risk factors for early colonization of mutans streptococci - a multiple logistic regression analysis in Swedish 1-year-olds2014In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 14, no 147Article in journal (Refereed)
    Abstract [en]

    Background: Mutans streptococci (MS) are closely related to the development of dental caries and are usually established in the oral cavity during early childhood. The aim of the study was to identify factors associated with the presence of MS in Swedish 1-year-olds. Methods: Parents completed a questionnaire on different caries-associated factors and an oral bacterial sample was collected from 1,050 (526 boys, 524 girls) 1-year-olds. Multiple logistic regression analyses were performed to identify risk factors for colonization with MS. Results: MS were found in 27% of the 1-year-olds with teeth. High or very high MS scores (2-3) were found in 72 (7%) of the children. MS score was correlated to the number of erupted teeth (p less than 0.001). No difference due to gender was found. Multiple logistic regression analysis showed that presence of bacteria was associated with: caries in a sibling, other beverages than water between meals, and more than 8 erupted teeth. High or very high MS scores (2-3) were associated with other beverages than water between meals, and more than 8 erupted teeth. Conclusions: Number of teeth present, diet and family aspects were factors associated with presence of MS in 1-year-olds. To develop high or very high MS scores, the number of erupted teeth and dietary habits are important.

  • 32.
    Isaksson, Helen
    et al.
    Inst Postgrad Dent Educ, Sweden.
    Koch, Goran
    Inst Postgrad Dent Educ, Sweden.
    Alm, Anita
    Publ Dent Hlth Serv, Sweden.
    Nilsson, Mats
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Futurum, Sweden.
    Wendt, Lill-Kari
    Jonkoping Univ, Sweden.
    Birkhed, Dowen
    Fersens Vag 14B, Sweden.
    Parental factors in early childhood are associated with approximal caries experience in young adults-A longitudinal study2019In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 47, no 1, p. 49-57Article in journal (Refereed)
    Abstract [en]

    Objectives To test the hypothesis that parental factors in early childhood influence approximal caries experience in young adults. Methods A cohort of 494 individuals was followed longitudinally from 1 to 20 years of age. Data were retrieved from parental interviews and questionnaires when the child was 1 and 3 years of age. At age 20, the participants underwent bitewing radiographic examination. Based on the number of approximal caries lesions (Da), stratified into initial (D-i) or manifest caries (D-m) and approximal fillings (Fa), the participants were divided into two main groups: those with: (a) 0 D(im)Fa (n = 244) and (b) amp;gt;0 D(im)Fa (n = 250). A subgroup was also created (amp;gt;= 8 D(im)Fa; n = 33). Results Toothbrushing with fluoride toothpaste at 3 years of age less than twice a day (OR 1.6, 95% CI 1.0-2.6) and the participants mothers self-estimation of their oral health care as "less than optimal" were important risk factors for developing caries (amp;gt;0 D(im)Fa OR 2.0, 95% CI 1.3-3.1). An interaction effect between toothbrushing at 3 years of age less than twice a day and consumption of caries risk products amp;gt; 3 times a day further increased the caries experience in young adults (amp;gt;= 8 D(im)Fa OR 8.3, 95% CI 1.8-37.8) together with maternal anxiety about dental treatment (OR 7.4 95% CI 1.6-34.6). Conclusions Parental factors in early childhood are associated with caries experience at 20 years of age.

  • 33.
    Johansson, Ann-Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Lysosomal Membrane Permeabilization: A Cellular Suicide Stragegy2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In the last decade, a tremendous gain in knowledge concerning the molecular events of apoptosis signaling and execution has been achieved.

    The aim of this thesis was to clarify the role of lysosomal membrane permeabilization and lysosomal proteases, cathepsins, in signaling for apoptosis. We identified cathepsin D as an important factor in staurosporine-induced human fibroblast cell death. After release to the cytosol, cathepsin D promoted mitochondrial release of cytochrome c by proteolytic activation of Bid. Cathepsin D-mediated cleavage of Bid generated two fragments with the apparent molecular mass of 15 and 19 kDa. By sequence analysis, three cathepsin D-specific cleavage sites, Phe24, Trp48, and Phe183, were identified. Moreover, we investigated the mechanism by which cathepsins escape the lysosomal compartment, and found that Bax is translocated from the cytosol to lysosomes upon staurosporine treatment. In agreement with these data, recombinant Bax triggered release of cathepsins from isolated rat liver lysosomes. Conceivably, the Bcl-2 family of proteins may govern release of pro-apoptotic factors from both lysosomes and mitochondria. The importance of lysosomal cathepsins in apoptosis signaling was studied also in oral squamous cell carcinoma cells following exposure to the redox-cycling drug naphthazarin or agonistic anti-Fas antibodies. In this experimental system, cathepsins were released to the cytosol, however, inhibition of neither cathepsin D, nor cysteine cathepsin activity suppressed cell death. Interestingly, cysteine cathepsins still appeared to be involved in activation of the caspase cascade. Cathepsins are often overexpressed and secreted by cancer cells, and it has been reported that extracellular cathepsins promote tumor growth and metastasis. Here, we propose that cathepsin B secreted from cancer cells may suppress cancer cell death by shedding of the Fas death receptor.

    Defects in the regulation of apoptosis contribute to a wide variety of diseases, such as cancer, neurodegeneration and autoimmunity. Increased knowledge of the molecular details of apoptosis could lead to novel, more effective, treatments for these illnesses. This thesis emphasizes the importance of the lysosomal death pathway, which is a promising target for future therapeutic intervention.

    List of papers
    1. Cathepsin D mediates cytochrome c release and caspase activation in human fibroblast apoptosis induced by staurosporine
    Open this publication in new window or tab >>Cathepsin D mediates cytochrome c release and caspase activation in human fibroblast apoptosis induced by staurosporine
    2003 (English)In: Cell Death and Differentiation, ISSN 1350-9047, Vol. 10, no 11, p. 1253-1259Article in journal (Refereed) Published
    Abstract [en]

    There is increasing evidence that proteases other than caspases, for example, the lysosomal cathepsins B, D and L, are involved in apoptotic cell death. In the present study, we present data that suggest a role for cathepsin D in staurosporine-induced apoptosis in human foreskin fibroblasts. Cathepsin D and cytochrome c were detected partially released to the cytosol after exposure to 0.1 µM staurosporine for 1 h. After 4 h, activation of caspase-9 and -3 was initiated and later caspase-8 activation and a decrease in full-length Bid were detected. Pretreatment of cells with the cathepsin D inhibitor, pepstatin A, prevented cytochrome c release and caspase activation, and delayed cell death. These results imply that cytosolic cathepsin D is a key mediator in staurosporine-induced apoptosis. Analysis of the relative sequence of apoptotic events indicates that, in this cell type, cathepsin D acts upstream of cytochrome c release and caspase activation.

    Keywords
    apoptosis, caspases, cathepsin D, cytochrome c, fibroblasts, lysosomes
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13200 (URN)10.1038/sj.cdd.4401290 (DOI)
    Available from: 2008-04-17 Created: 2008-04-17 Last updated: 2017-08-30
    2. Lysosomal membrane permeabilization during apoptosis: Involvement of Bax?
    Open this publication in new window or tab >>Lysosomal membrane permeabilization during apoptosis: Involvement of Bax?
    Show others...
    2005 (English)In: International journal of experimental pathology (Print), ISSN 0959-9673, E-ISSN 1365-2613, Vol. 86, no 5, p. 309-321Article in journal (Refereed) Published
    Abstract [en]

    Bcl-2 family members have long been known to control permeabilization of the mitochondrial membrane during apoptosis, but involvement of these proteins in lysosomal membrane permeabilization (LMP) was not considered until recently. The aim of this study was to investigate the mechanism underlying the release of lysosomal proteases to the cytosol seen during apoptosis, with special emphasis on the role of Bax. In human fibroblasts, exposed to the apoptosis-inducing drug staurosporine (STS), the release of the lysosomal protease cathepsin D to the cytosol was observed by immunocytochemistry. In response to STS treatment, there was a shift in Bax immunostaining from a diffuse to a punctate pattern. Confocal microscopy showed co-localization of Bax with both lysosomes and mitochondria in dying cells. Presence of Bax at the lysosomal membrane was confirmed by immuno-electron microscopy. Furthermore, when recombinant Bax was incubated with pure lysosomal fractions, Bax inserted into the lysosomal membrane and induced the release of lysosomal enzymes. Thus, we suggest that Bax is a mediator of LMP, possibly promoting the release of lysosomal enzymes to the cytosol during apoptosis.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2005
    Keywords
    Bax, cathepsins, lysosomes, lysosomal membrane permeabilization, mitochondria
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13201 (URN)10.1111/j.0959-9673.2005.00442.x (DOI)
    Note

    The previous status of this article was Manuscript and the working title was Insertion of Bax into lysosomal membranes promotes release of lysosomal proteases during apoptosis.

    Available from: 2008-04-17 Created: 2008-04-17 Last updated: 2017-12-13Bibliographically approved
    3. Cathepsin D-mediated processing of Bid at Phe24, Trp48, and Phe183
    Open this publication in new window or tab >>Cathepsin D-mediated processing of Bid at Phe24, Trp48, and Phe183
    Show others...
    2008 (English)In: International Journal of Experimental PathologyArticle in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13202 (URN)
    Available from: 2008-04-17 Created: 2008-04-17 Last updated: 2017-08-30
    4. Role of lysosomal cathepsins in naphthazarin- and Fas-induced apoptosis in oral squamous cell carcinoma cells
    Open this publication in new window or tab >>Role of lysosomal cathepsins in naphthazarin- and Fas-induced apoptosis in oral squamous cell carcinoma cells
    2006 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, Vol. 126, no 1, p. 70-81Article in journal (Refereed) Published
    Abstract [en]

    Conclusion. Intracellular cysteine cathepsins are pro-apoptotic factors involved in activation of caspases in two oral squamous cell carcinoma (SCC) cell lines.

    Objective. To study the possible involvement of lysosomal cathepsins in oral SCC cell apoptosis.

    Material and methods. Apoptosis was induced in the two human oral SCC cell lines UT-SCC-20A and UT-SCC-24A using naphthazarin or anti-Fas antibodies, and was studied by analysis of caspase activity and nuclear morphology. Involvement of lysosomal cathepsins was investigated using the cysteine cathepsin inhibitor z-FA-FMK and the cathepsin D inhibitor pepstatin A. The amounts of cellular and soluble Fas death receptor were determined by ELISA.

    Results. Release of cathepsins from the lysosomes to the cytosol was observed early in apoptosis. Cysteine cathepsins were found to be involved in activation of caspases in response to treatment with naphthazarin or anti-Fas antibodies, but inhibition of cysteine cathepsin activity was not sufficient to prevent cell death. Moreover, inhibition of cysteine cathepsin activity resulted in increased expression of the Fas death receptor, suggesting involvement of extracellular cysteine cathepsins in death receptor shedding.

    Keywords
    Caspases; cathepsin D; cell death; cysteine cathepsins; Fas death receptor; lysosomes; shedding; soluble Fas
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13203 (URN)10.1080/00016480510043422 (DOI)
    Available from: 2008-04-17 Created: 2008-04-17 Last updated: 2009-05-20
  • 34.
    John, M. T.
    et al.
    University of Minnesota, USA.
    Feuerstahler, L.
    University of Minnesota, USA.
    Waller, N.
    University of Minnesota, MN 55455 USA.
    Baba, K.
    Showa University, Japan.
    Larsson, Pernilla
    Centre of Oral Rehabilitation, Prosthetic Dentistry,Norrköping .
    Celebic, A.
    University of Zagreb, Croatia.
    Kende, D.
    University of Pecs, Hungary.
    Rener-Sitar, K.
    University of Ljubljana, Slovenia.
    Reissmann, D. R.
    University of Medical Centre Hamburg Eppendorf, Germany.
    Confirmatory factor analysis of the Oral Health Impact Profile2014In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 9, p. 644-652Article in journal (Refereed)
    Abstract [en]

    Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher-order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health-Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the projects Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four-factor model and a bifactor model that included one general factor and four group factors. Using model-fit criteria and factor interpretability as guides, the four-factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0.05, CFI = 0.99) and interpretability. These results corroborate our previous findings that four highly correlated factors - which we have named Oral Function, Orofacial Pain, Oro-facial Appearance and Psychosocial Impact - can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four-factor solution suggest that OHRQoL can also be sufficiently described with one score.

  • 35.
    John, M. T.
    et al.
    University of Minnesota, USA.
    Reissmann, D. R.
    University of Medical Centre Hamburg Eppendorf, Germany.
    Feuerstahler, L.
    University of Minnesota, USA.
    Waller, N.
    University of Minnesota, USA.
    Baba, K.
    Showa University, Japan.
    Larsson, Pernilla
    Centre of Oral Rehabilitation, Prosthetic Dentistry,Norrköping.
    Celebic, A.
    University of Zagreb, Croatia.
    Szabo, G.
    University of Pecs, Hungary.
    Rener-Sitar, K.
    University of Ljubljana, Slovenia.
    Exploratory factor analysis of the Oral Health Impact Profile2014In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 9, p. 635-643Article in journal (Refereed)
    Abstract [en]

    Although oral health-related quality of life (OHRQoL) as measured by the Oral Health Impact Profile (OHIP) is thought to be multidimensional, the nature of these dimensions is not known. The aim of this report was to explore the dimensionality of the OHIP using the Dimensions of OHRQoL (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the projects Learning Sample (n = 5173), we conducted an exploratory factor analysis on the 46 OHIP items not specifically referring to dentures for 5146 subjects with sufficiently complete data. The first eigenvalue (27.0) of the polychoric correlation matrix was more than ten times larger than the second eigenvalue (2.6), suggesting the presence of a dominant, higher-order general factor. Follow-up analyses with Horns parallel analysis revealed a viable second-order, four-factor solution. An oblique rotation of this solution revealed four highly correlated factors that we named Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact. These four dimensions and the strong general factor are two viable hypotheses for the factor structure of the OHIP.

  • 36.
    John, M. T.
    et al.
    Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA.
    Rener-Sitar, K.
    Department of Prosthodontics, University of Ljubljana, Ljubljana, Slovenia.
    Baba, K.
    Department of Prosthodontics, Showa University, Tokyo, Japan.
    Čelebić, A.
    Department of Prosthodontics, University of Zagreb, Zagreb, Croatia.
    Larsson, Pernilla
    Region Östergötland, Public Dental Health Care.
    Szabo, G.
    Department of Prosthodontics, University of Pécs, Pécs, Hungary.
    Norton, W. E.
    epartment of Health Behavior, University of Alabama, Birmingham, AL, USA.
    Reissmann, D. R.
    Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Patterns of impaired oral health-related quality of life dimensions.2016In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 43, no 7, p. 519-27Article in journal (Refereed)
    Abstract [en]

    How dental patients are affected by oral conditions can be described with the concept of oral health-related quality of life (OHRQoL). This concept intends to make the patient experience measurable. OHRQoL is multidimensional, and Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact were suggested as its four dimensions and consequently four scores are needed for comprehensive OHRQoL assessment. When only the presence of dimensional impact is measured, a pattern of affected OHRQoL dimensions would describe in a simple way how oral conditions influence the individual. By determining which patterns of impact on OHRQoL dimensions exist in prosthodontic patients and general population subjects, we aimed to identify in which combinations oral conditions' functional, painful, aesthetical and psychosocial impact occurs. Data came from the Dimensions of OHRQoL Project with Oral Health Impact Profile (OHIP)-49 data from 6349 general population subjects and 2999 prosthodontic patients in the Learning Sample (N = 5173) and the Validation Sample (N = 5022). We hypothesised that all 16 patterns of OHRQoL dimensions should occur in these individuals who suffered mainly from tooth loss, its causes and consequences. A dimension was considered impaired when at least one item in the dimension was affected frequently. The 16 possible patterns of impaired OHRQoL dimensions were found in patients and general population subjects in both Learning and Validation Samples. In a four-dimensional OHRQoL model consisting Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact, oral conditions' impact can occur in any combination of the OHRQoL dimensions.

  • 37.
    John, Mike T.
    et al.
    University of Minnesota, USA.
    Reissmann, Daniel R.
    University of Medical Centre Hamburg Eppendorf, Germany.
    Feuerstahler, Leah
    University of Minnesota, USA.
    Waller, Niels
    University of Minnesota, USA.
    Baba, Kazuyoshi
    Showa University, Japan.
    Larsson, Pernilla
    Centre of Oral Rehabilitation, Prosthetic Dentistry, Norrköping, Sweden.
    Celebic, Asja
    University of Zagreb, Croatia.
    Szabo, Gyula
    University of Pecs, Hungary.
    Rener-Sitar, Ksenija
    University of Ljubljana, Slovenia.
    Factor analyses of the Oral Health Impact Profile - Overview and studied population2014In: Journal of Prosthodontic Research, ISSN 1883-1958, E-ISSN 2212-4632, Vol. 58, no 1, p. 26-34Article in journal (Refereed)
    Abstract [en]

    Purpose: A desideratum of oral health-related quality of life (OHRQoL) instruments such as the Oral Health Impact Profile (OHIP) is that they accurately reflect the structure of the measured construct(s). With this goal in mind, the Dimensions of Oral Health-Related Quality of Life (DOQ) Project was proposed to investigate the number and nature of OHRQoL dimensions measured by OHIP. In this report, we describe our aggregate data set for the factor analyses in the project, which consists of responses to the 49-item OHIP from general population subjects and prosthodontics patients from 6 countries, including a large age range of adult subjects and both genders. Materials and methods: The DOQ Projects aggregate data set combines data from 35 individual studies conducted in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden. Results: The combined data set includes 10778 OHIPs from 9348 individuals (N = 6349 general population subjects, N = 2999 prosthodontic patients). To elucidate the OHIP latent structure, the aggregated data were split into a Learning Sample (N = 5173) for exploratory analyses and a Validation Sample (N = 5022) for confirmatory analyses. Additional data (N = 583) were assigned to a third data set. Conclusion: The Dimensions of Oral Health-Related Quality of Life Project contains a large amount of international data and is representative of populations where OHIP is intended to be used. It is well-suited to assess the dimensionality of the questionnaire. (C) 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

  • 38.
    John, Mike T.
    et al.
    Department of Diagnostic and Biological Sciences, University of Minnesota, 7-536 Moos Tower 515 Delaware Street SE, Minneapolis, MN 55455, USA.
    Reissmann, Daniel R.
    Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Čelebić, Asja
    Department of Prosthodontics, University of Zagreb, and School of Dental Medicine and Clinical Hospital Centre, Zagreb, Croatia.
    Baba, Kazuyoshi
    Department of Prosthodontics, Showa University, Tokyo, Japan.
    Kende, Dóra
    Department of Prosthodontics, University of Pécs, Pécs, Hungary.
    Larsson, Pernilla
    Region Östergötland, Public Dental Health Care.
    Rener-Sitar, Ksenija
    Department of Prosthodontics, University of Ljubljana, Ljubljana, Slovenia; Department of Prosthodontics, University Dental Clinics, University Medical Center Ljubljana, Ljubljana, Slovenia.
    Integration of oral health-related quality of life instruments.2016In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 53, p. 38-43Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To integrate items from two widely used oral health-related quality of life (OHRQoL) questionnaires, the General Oral Health Assessment Index (GOHAI) and the Oral Impacts on Daily Performances (OIDP), as well as culturally-specific items of the Oral Health Impact Profile (OHIP) into a four-dimensional OHRQoL model consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact.

    METHODS: Subjects came from an ancillary study of the Dimensions of Oral Health-Related Quality of Life Project (N=267 patients, mean age±SD: 54.0±17.2years, 58% women.) Patients filled in the original 49 items of OHIP and 22 additional OHRQoL items in a cross-sectional study. These additional items consisted of 7 culturally specific OHIP items and 15 GOHAI or OIDP items with unique content not covered in OHIP-49. Before data collection, three experts hypothesized to which of the four OHRQoL dimensions these items belong. Hypotheses were tested in correlation analyses between the 22 items and the four dimension scores that were derived from OHIP-49.

    RESULTS: Five of the 22 items did not provide sufficient information to which dimension they belong. In 16 of the remaining 17 items, the pattern of correlation coefficients fitted experts' a priori hypotheses. Acceptance of 16 of the 17 hypotheses was interpreted as evidence that additional (not in OHIP-49 contained) OHRQoL items can be assigned to Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact.

    CONCLUSION: Items of three OHRQoL instruments can be integrated into a dimensional OHRQoL model consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact.

    CLINICAL SIGNIFICANCE: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact can serve as a simple and clinically appealing set of oral health-related quality of life (OHRQoL) dimensions and therefore provide an opportunity for simpler, but psychometrically improved OHRQoL measurement in the future.

  • 39.
    Kallunki, Jenny
    et al.
    Östergötlands Läns Landsting, Public Dental Health Care.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Ericsson, Elisabeth
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Tonsillotomy versus tonsillectomy--a randomized trial regarding dentofacial morphology and post-operative growth in children with tonsillar hypertrophy2014In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 36, no 4, p. 471-478Article in journal (Refereed)
    Abstract [en]

    Objectives:The primary aim of this study was to analyse two different methods of tonsil surgery, tonsillectomy (TE) and tonsillotomy (TT), regarding post-operative dentofacial growth in children with tonsillar hypertrophy. A secondary aim was to analyse these results in relation to cephalometric standards.Material and methods:The study group consisted of 64 subjects (39 boys and 25 girls), mean age 4.8 years ± 4 months. They were randomized to a complete removal of the pharyngeal tonsil, TE, (n = 31) or a partial removal, TT, (n = 33). Pre-operative and 2 years post-operative study material were obtained and analysed. The results were compared with cephalometric standards.Results:Pre-operative, children with hypertrophic tonsils displayed an increased vertical relation (P < 0.05) compared with cephalometric standards. Post-operative, no significant difference could be detected between the two surgical procedures regarding dentofacial growth. Mandibular growth with an anterior inclination was significant (P < 0.001/TE, P < 0.01/TT) for both groups. An increased upper and lower incisor inclination was noted (P < 0.01/TE,TT). The vertical relation decreased (P < 0.001/TE, P < 0.05/TT) as well as the mandibular angle (P < 0.01/TE, P < 0.001/TT). Reduction was also significant for the sagittal intermaxillar (P < 0.001/TE,TT) relation. These post-operative results, together with a more prognatic mandible (P < 0.05/TE,TT) and chin (P < 0.001/TE, P < 0.01/TT), might indicate a more horizontal direction of mandibular growth.Conclusion:TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils. This result should be considered when deciding upon surgical technique.

  • 40.
    Kastenbom, Lisa
    et al.
    Umea Univ, Sweden.
    Falsen, Alexandra
    Umea Univ, Sweden.
    Larsson, Pernilla
    Region Östergötland, Public Dental Health Care. Malmo Univ, Sweden;.
    Sunnegardh-Gronberg, Karin
    Umea Univ, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Costs and health-related quality of life in relation to caries2019In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 19, no 1, article id 187Article in journal (Refereed)
    Abstract [en]

    Background Dental caries remains a common and expensive disease for both society and affected individuals. Furthermore, caries often affect individuals health-related quality of life (HRQoL). Health economic evaluations are needed to understand how to efficiently distribute dental care resources. This study aims to evaluate treatment costs and QALY weights for caries active and inactive adult individuals, and to test whether the generic instrument EQ-5D-5 L can distinguish differences in this population. Methods A total of 1200 randomly selected individuals from dental clinics in Vasterbotten County, Sweden, were invited to participate. Of these, 79 caries active and 179 caries inactive patients agreed to participate (response rate of 21.7%). Inclusion criteria were participants between 20 and 65 years old and same caries risk group categorization in two consecutive check-ups between 2014 and 2017. Results Treatment costs showed to be twice as high in the caries active group compared to the caries inactive group and were three times higher in the caries active age group 20-29 compared to the caries inactive age group 20-29. Differences between the groups was found for number of intact teeth according to age groups. In the EQ-5D-5 L instrument, more problems relating to the dimension anxiety/depression was seen in the caries active group. QALY weights showed tendencies (non-significant) to be lower in the caries active group. Conclusions These findings highlight the need for efficient treatments and prevention strategies as well as adequate money allocation within dentistry. However, further research is needed to assess appropriate instruments for health economic evaluations.

  • 41.
    Klingspor, Lena
    et al.
    Karolinska Inst, Sweden.
    Ullberg, Mans
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Rydberg, Johan
    Dept Clin Microbiol, Sweden.
    Kondori, Nahid
    Univ Gothenburg, Sweden.
    Serrander, Lena
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Microbiology.
    Swanberg, Jonas
    Ryhov Hosp, Sweden.
    Nilsson, Kenneth
    Uppsala Univ, Sweden.
    Bengten, Cecilia Jendle
    Karlstad Cent Hosp, Sweden.
    Johansson, Marcus
    Kalmar Cty Hosp, Sweden.
    Granlund, Margareta
    Umea Univ, Sweden.
    Tornqvist, Eva
    Orebro Univ Hosp, Sweden.
    Nyberg, Anders
    Cty Hosp Sundsvall Harnosand, Sweden.
    Kindlund, Karin
    Hallands Hosp, Sweden.
    Ygge, Minna
    Sunderby Hosp, Sweden.
    Kartout-Boukdir, Dalila
    Unilabs AB, Sweden.
    Toepfer, Michael
    Unilabs AB, Sweden.
    Halldin, Eva
    Vasteras Hosp, Sweden.
    Kahlmeter, Gunnar
    Cent Hosp Vaxjo, Sweden.
    Ozenci, Volkan
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Epidemiology of fungaemia in Sweden: A nationwide retrospective observational survey2018In: Mycoses (Berlin), ISSN 0933-7407, E-ISSN 1439-0507, Vol. 61, no 10, p. 777-785Article in journal (Refereed)
    Abstract [en]

    ObjectivesTo identify the epidemiology and antifungal susceptibilities of Candida spp. among blood culture isolates to identify the epidemiology and antifungal susceptibilities of Candida spp. among blood culture isolates in Sweden. MethodsThe study was a retrospective, observational nationwide laboratory-based surveillance for fungaemia and fungal meningitis and was conducted from September 2015 to August 2016. ResultsIn total, 488 Candida blood culture isolates were obtained from 471 patients (58% males). Compared to our previous study, the incidence of candidaemia has increased from 4.2/100000 (2005-2006) to 4.7/100000 population/year (2015-2016). The three most common Candida spp. isolated from blood cultures were Candida albicans (54.7%), Candida glabrata (19.7%) and species in the Candida parapsilosis complex (9.4%). Candida resistance to fluconazole was 2% in C.albicans and between 0% and 100%, in non-albicans species other than C.glabrata and C.krusei. Resistance to voriconazole was rare, except for C.glabrata, C.krusei and C.tropicalis. Resistance to anidulafungin was 3.8% while no Candida isolate was resistant to amphotericin B. ConclusionsWe report an overall increase in candidaemia but a minor decrease of C.albicans while C.glabrata and C.parapsilosis remain constant over this 10-year period.

  • 42.
    Kvist, Therese
    et al.
    Karolinska Institute, Sweden.
    Cocozza, Madeleine
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Annerbäck, Eva-Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Dahllöf, Goran
    Karolinska Institute, Sweden.
    Child maltreatment - prevalence and characteristics of mandatory reports from dental professionals to the social services2017In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 27, no 1Article in journal (Refereed)
    Abstract [en]

    BackgroundDental professionals are required to report suspicions of child maltreatment to the social services. As yet, no studies assess the prevalence of these mandated reports from dental care services or their content. AimThis study investigates the prevalence and characteristics of mandated reports from dental professionals to the social services. Furthermore, it analyses associations between dental professionals reporting suspicions of maltreatment with such reports from other sources. DesignThe study collected dental mandatory reports from within one municipality of Sweden during 2008-2014. The material consisted of a total of 147 reports by dental professionals regarding 111 children. ResultsThe total prevalence of reports from dental care services to the social services was 1.5 per 1000 children with a significant increase between 2008 and 2011 (P amp;lt; 0.001). The primary cause for a report concerned parental deficiencies in care (n = 93) and secondly, a concern for dental neglect (n = 52) (P amp;lt; 0.001). Among all reports, 86% involved children with prior contacts with the social services. ConclusionReports to the social services from dental care services on suspicions of child maltreatment concern parental deficiencies (failure to attend appointments) and neglect (dental neglect). Mandated reports from dental care services often co-occur with other mandated reports.

  • 43.
    Larsson, Pernilla
    et al.
    Department for Orofacial Pain and Jawfunction, Faculty of Odontology, Malmö University, Malmö, Sweden.
    John, M. T.
    Division of Epidemiology and Community Health, Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, USA.
    Hakeberg, M.
    Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg,.
    Nilner, K.
    Department of Oral Prosthetics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    List, T.
    Department for Orofacial Pain and Jawfunction, Faculty of Odontology, Malmö University, Malmö, Sweden.
    General population norms of the Swedish short forms of Oral Health Impact Profile2014In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 4, p. 275-281Article in journal (Refereed)
    Abstract [en]

    We reported the development and psychometric evaluation of a Swedish 14-item and a five-item short form of the Oral Health Impact Profile. The 14-item version was derived from the English-language short form developed by Slade in1997. The five-item version was derived from the German-language short form developed by John etal. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N=1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N=1309) were on average 50 center dot 1 +/- 17 center dot 4years old, and 54% were women. Short form summary scores correlated highly with the 49-item OHIP-S (r greater than= 0 center dot 97 for OHIP-S14, r greater than= 0 center dot 92 for OHIP-S5) and with self-report of oral health (r greater than= 0 center dot 41). Reliability, measured with Cronbachs alpha (0 center dot 91 for OHIP-S14, 0 center dot 77 for OHIP-S5), was sufficient. In the general population, 50% of the subjects had greater than= 2 OHIP-S14 score points and 10% had greater than= 11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had greater than= 2 OHIP-S14 score points, and 10% had greater than= 11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP-S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14-item and 5-item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies.

  • 44.
    Larsson, Pernilla
    et al.
    Department of Orofacial Pain and Jawfunction, Faculty of Odontology, Malmö University, Malmö, Sweden.
    John, M. T.
    Division of Epidemiology and Community Health and Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, USA.
    Nilner, K.
    Department of Prosthetic Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden.
    List, T.
    Division of Epidemiology and Community Health and Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, USA.
    Normative values for the oro-facial Esthetic Scale in Sweden2014In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 2, p. 148-154Article in journal (Refereed)
    Abstract [en]

    This study reports the findings and challenges of the assessment of oro-facial aesthetics in the Swedish general population and the development of normative values for the self-reporting Orofacial Esthetic Scale (OES). In a Swedish national sample of 1406 adult subjects (response rate: 47%), OES decile norms were established. The influence of sociodemographics (gender, age, and education), oral health status and general health status on OES scores was analysed. Mean +/- standard deviation of OES scores was 503 +/- 156 units (0, worst score; 70, best score); less than1% of the subjects had the minimum score of 0, and 11% had the maximum score of 70 OES units. Orofacial Esthetic Scale score differences were (i) substantial (greater than5 OES units) for subjects with excellent/very good versus good to poor oral or general health status; ii) small (2 units), but statistically significant for gender (P=0.01) and two age groups (P=0.02), and (iii) absent for subjects with college versus no college education (P=0.31) or with and without dentures (P=0.90). To estimate normative values for a self-reporting health status, instrument is considered an important step in standardisation, and the developed norms provide a frame of reference in the general population to interpret the Orofacial Esthetic Scale scores.

  • 45.
    Lundin, Ulrika
    Linköping University, The Department of Physics, Chemistry and Biology.
    Biomarker Discovery in Diabetic Nephropathy by Targeted Metabolomics2008Independent thesis Advanced level (degree of Master (Two Years)), 20 points / 30 hpStudent thesis
    Abstract [en]

    Diabetic nephropathy is a chronic kidney disease and one of the more severe complications from diabetes mellitus type 2. The glomerular and tubular dysfunctions usually lead to end stage renal disease and the treatments of these patients (dialysis, kidney transplants) are a huge economic burden for the society. Due to an epidemiologic increase of type 2 diabetes, conventional diagnostic markers like creatinine and albumin are not sufficient, since they are only able to identify already existing kidney damage. With targeted metabolomics, the analysis of small molecules produced from metabolism, this project aimed at finding novel and more sensitive metabolic biomarkers from several different classes of metabolites. The different assays were performed with flow injection analysis, high performance liquid chromatography, gas chromatography and mass spectrometry, and with principal component analysis and discriminant analysis, up-and down-regulated metabolites could be identified and their respective biochemical pathways, if possible, explained. In diabetics significantly elevated concentrations of very long chain fatty acids (impaired peroxisomal β-oxidation), urinary sugars and acylcarnitines in plasma could be recognized. Markers indicating kidney damage included significantly increased plasma concentrations of asymmetric dimethylarginine (inhibition of nitric oxide synthase resulting in decreased endothelial functionality) and histamine (indication of uremic pruritus). Oxidative stress was also found to be a potential prognostic marker as indicated by the raised methionine-sulfoxide to methionine ratio in nephrotic patients. To summarize, this project succeeded in identifying metabolic biomarkers both for diabetes type 2 and nephropathy, which in the future might become important tools in slowing down progression or diagnosing these diseases.

  • 46.
    Lönn, Johanna
    et al.
    Univ Orebro, Sch Hlth & Med Sci, Div Clin Med, Orebro, Sweden; PEAS Institute, Linköping and Örebro University, Sweden.
    Starkhammar Johansson, Carin
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Public Dental Health Care.
    Nakka, Sravya
    PEAS Institute, Linköping, Sweden.
    Palm, Elenor
    Örebro University, Sweden.
    Bengtsson, Torbjörn
    Örebro University, Sweden.
    Nayeri, Fariba
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases. PEAS Inst, Inst Prot Environm Affin Surveys, Linkoping, Sweden.
    Ravald, Nils
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Public Dental Health Care.
    High Concentration but Low Activity of Hepatocyte Growth Factor in Periodontitis2014In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 85, no 1, p. 113-122Article in journal (Refereed)
    Abstract [en]

    Background: High levels of hepatocyte growth factor (HGF), a healing factor with regenerative and cytoprotective effects, are associated with inflammatory diseases, including periodontitis. HGF biologic activity requires binding to its receptors, the proto-oncogene c-Met and heparan sulfate proteoglycan (HSPG). This study investigates HGF expression and its relationship to subgingival microbiota in medically healthy individuals with and without periodontitis.

    Methods: Saliva, gingival crevicular fluid (GCF), and blood samples from 30 patients with severe periodontitis and 30 healthy controls were analyzed for HGF concentration using enzyme-linked immunosorbent assay and binding affinity for HSPG and c-Met using surface plasmon resonance. The regenerative effects of saliva from three patients and controls were analyzed in an in vitro model of cell injury. Subgingival plaques were analyzed for the presence of 18 bacterial species.

    Results: Patients with periodontitis showed higher HGF concentrations in saliva, GCF, and serum (P <0.001); however, the binding affinities for HSPG and c-Met were reduced in GCF and saliva (P <0.002). In contrast to the controls, saliva from patients showed no significant regenerative effect over time on gingival epithelial cells. Compared with controls, patients had a higher prevalence of periodontally related bacteria.

    Conclusions: Higher circulatory HGF levels indicate a systemic effect of periodontitis. However, the HGF biologic activity at local inflammation sites was reduced, and this effect was associated with the amount of periodontal bacteria. Loss of function of healing factors may be an important mechanism in degenerative processes in periodontally susceptible individuals.

  • 47.
    Nafi Salih, Firas
    et al.
    Public Dent Health Serv, Sweden.
    Lindsten, Rune
    Institute Postgrad Dent Educ, Sweden.
    Bågesund, Mats
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care. Public Dent Health Serv, Sweden.
    Perception of orthodontic treatment need among Swedish children, adolescents and young adults2017In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 75, no 6, p. 407-412Article in journal (Refereed)
    Abstract [en]

    Objective: Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19. Materials and methods: A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo. Results: The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.21.5), than among subjects, age 15 (3.6 +/- 1.2) (p = .0009), and subjects, age 19 (3.5 +/- 1.2) (p = .00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p = .002 and .001, respectively) and (ii) previous orthodontic treatment (p = .005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p = .002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p = .047) than Swedes, age 19. Conclusions: The lower limit for orthodontic treatment need among subjects, age 10, was higher - compared to subjects, ages 15 and 19 - and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.

  • 48.
    Nilsson, Ing-Marie
    et al.
    Region Östergötland, Public Dental Health Care, Center for Oral Rehabilitation Norrköping. Malmo Univ, Sweden.
    Brogardh-Roth, Susanne
    Malmo Univ, Sweden.
    Månsson, Johanna
    Lund Univ, Sweden.
    Ekberg, EwaCarin
    Malmo Univ, Sweden.
    Temporomandibular pain in adolescents with a history of preterm birth2019In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 46, no 7, p. 589-596Article in journal (Refereed)
    Abstract [en]

    Aim

    To evaluate the frequency of temporomandibular disorder (TMD) pain among adolescents with a history of preterm birth compared to a matched control group.

    Methods

    A group of 192 preterm‐born adolescents was followed up at the age of 17‐19 years and compared to matched controls. Self‐report questionnaires included screening questions about TMD pain, chronic diseases, general health, depression, anxiety, anger, antisocial behaviour and self‐concept. TMD pain was defined as answering “yes” to one or both of the following questions: “Do you have pain in the temple, face, temporomandibular joint or jaws once a week or more?” and “Do you have pain when you open your mouth wide or chew once a week or more often?” Data analysis was performed using chi‐square test and logistic regression model with likelihood ratio test.

    Results

    A TMD pain frequency of 23% of preterm‐born adolescents and 26% among the controls was found, with no significant differences between the groups. Neither were there differences regarding anxiety, depression, anger or self‐confidence. Within the preterm group, adolescents with TMD pain registered tension and pain in the body, trouble sleeping, stomach pain and feelings of hopelessness about the future. The controls with TMD pain, more reported having a bad life, feeling like a failure and having bodily pain. Among tested background variables, only TMJ locking or intermittent locking once a week or more was found to explain TMD pain in adolescents.

    Conclusion

    A high frequency of TMD pain was found in both groups, one possible explanation could be TMJ dysfunction.

  • 49.
    Nilsson, Ing-Marie
    et al.
    Region Östergötland, Public Dental Health Care.
    Willman, Ania
    Malmö University, Sweden.
    Treatment Seeking and Self-Constructed Explanations of Pain and Pain Management Strategies Among Adolescents with Temporomandibular Disorder Pain2016In: Journal of Open Archaeology Data, ISSN 2333-0384, E-ISSN 1984-3046, Vol. 30, no 2, p. 127-133Article in journal (Refereed)
    Abstract [en]

    Aims: To explore adolescents explanations of their temporomandibular disorder (TMD) pain, their pain management strategies for TMD pain, and their treatment seeking behavior.

    Methods: One-on-one interviews were conducted with 21 adolescents aged 15 to 19 years who had TMD pain and followed a semi structured interview guide. Subjects were strategically selected from patients referred to an orofacial pain clinic. All participants had been examined and received a pain diagnosis based on the Research Diagnostic Criteria for TMD. The interviews focused on the adolescents experiences of TMD pain, their strategies for handling pain, and how they seek care. The interviews were recorded, transcribed verbatim, and analyzed using qualitative manifest content analysis.

    Results: Qualitative manifest content analysis revealed two categories: (1) self constructed explanations, with three subcategories (situation-based explanatory model, physical/biologic model, and psychological explanatory model); and (2) pain management strategies, with four subcategories (social support, treatment, relaxation/rest, and psychological strategies). Adolescents used physical activities and psychological and pharmacologic treatment to manage pain. Reasons for seeking treatment were to be cured, to obtain an explanation for their pain, and because their symptoms bother others.

    Conclusion: Adolescents living with TMD pain develop self-constructed explanations and pain management strategies. With access to these descriptions, dentists can be better prepared to have a dialogue with their adolescent patients about their own explanations of pain, the nature of pain, and in which situations the pain appears. Dentists can also explore adolescent patients pain management strategies and perhaps also suggest new treatment strategies at an earlier stage.

  • 50.
    Norderyd, Johanna
    et al.
    Institute Postgrad Dent Educ, Sweden; Jonköping University, Sweden.
    Graf, Jonas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Marcusson, Agneta
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Nilsson, Karolina
    Ryhov County Hospital, Sweden.
    Sjöstrand, Eva
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Habilitation.
    Steinwall, Gunilla
    Habilitation Centre, Ryhov County Hospital, Jönköping.
    Ärleskog, Elinor
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Bågesund, Mats
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Sublingual administration of atropine eyedrops in children with excessive drooling - a pilot study2017In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 27, no 1, p. 22-29Article in journal (Refereed)
    Abstract [en]

    BackgroundDrooling can be a severe disability and have high impact on daily life. Reversible treatment is preferable. AimTo analyse whether sublingual administration of atropine eyedrops is a useful reversible treatment option for severe drooling in children with disabilities. DesignThe study had a prospective, single-system research design. The participants served as their own controls. The study period was 3 weeks without treatment, 4 weeks with atropine eyedrop solution 10 mg/mL one drop a day followed by 4 weeks of one drop twice a day. Parents rating of their childs drooling was assessed on a 100-mm VAS, and unstimulated salivary secretion rate measurement was performed together with notations about side effects and practicality. ResultsParents VAS assessment of drooling decreased from a median (range) of 74 (40-98) at baseline to 48 (18-88) (P = 0.05) and 32 (12-85) (P = 0.004) after 4 weeks of atropine once a day and another 4 weeks of atropine twice a day, respectively (n = 11). Unstimulated salivary secretion rates decreased from baseline to end of study (P = 0.032). Several parents complained about difficult administration. No irreversible side effects were noted. ConclusionsSublingual atropine eyedrops may be an alternative for treatment of severe drooling in children with disabilities.

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