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  • 1.
    Bergendal, B
    et al.
    National Oral Disability Centre, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Norderyd, J
    National Oral Disability Centre, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bågesund, M
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Holst, A
    Department of Paediatric Dentistry, Kalmar.
    Signs and symptoms from ectodermal organs in young Swedish individuals with oligodontia2006In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 16, no 5, p. 320-326Article in journal (Refereed)
    Abstract [en]

    Objectives. The aim was to assess signs and symptoms from other ectodermal organs in addition to teeth in young individuals with oligodontia and to establish the prevalence of oligodontia Sample and methods. Children born 1981-94 reported by dental teams in the Public Dental Service to have oligodontia were asked to participate in a clinical study. The examinations comprised a structured interview on symptoms from ectodermal organs, and testing of salivary secretion Results. One hundred and sixty-two individuals met the inclusion criteria, and 123 individuals (75.9%) participated in the clinical study. Half of the individuals had one to four signs or symptoms from ectodermal organs beside oligodontia. The most common sign was low salivary secretion. Twelve individuals (9.6%) with isolated oligodontia reported impaired function of the sweat glands, hair, or nails. The prevalence of oligodontia was 0.090% Conclusions. An early identification of individuals with oligodontia can be made in a majority of cases by checking that all permanent incisors have erupted at the age of 8 years. The validity in asking individuals about normal and abnormal function of ectodermal organs was found to be low. This indicates that there is a strong need to establish routine clinical criteria for dysplasia of ectodermal organs

  • 2.
    Bågesund, Mats
    et al.
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Richter, Sven
    Huddinge University Hospital.
    Ringden, Olle
    Huddinge University Hospital.
    Dahllöf, Göran
    Karolinska Institute.
    Longitudinal scintigraphic study of parotid and submandibular gland function after total body irradiation in children and adolescents2007In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 17, no 1, p. 34-40Article in journal (Refereed)
    Abstract [en]

    Objective. Total body irradiation (TBI) and cyclophosphamide (CY) during allogeneic stem cell transplantation (ASCT) cause salivary gland dysfunction in children. The aim of this investigation was to study the scintigraphic functional changes over time of the parotid and submandibular glands in children and young adults one year after treatment with CY and TBI at ASCT Methods. Salivary gland scintigraphy (SGS) was performed before ASCT, and 3-6 months and 12 months after ASCT. The three male patients who fulfilled the scintigraphic study had a mean age (+/- SD) of 17.3 +/- 9.8 years at ASCT Results. The parotid secretion capacity (SPar) was 83.5 +/- 3.2% before ASCT and 48.5 +/- 25.8% during the next 3-6 months (P less than 0.05). The SPar did not increase (48.1 +/- 12.4%) during the rest of the first year after ASCT. The submandibular emptying capacity (SSub) was 91.3 +/- 12.9% before ASCT and 35.4 +/- 2.3% after 3-6 months (P less than 0.05). The SSub was 87.9 +/- 17.9% one year after ASCT Conclusions. The parotid glands were more sensitive to irradiation since they did not recover lost capacity to secrete saliva, while the submandibular glands recovered the secretion capacity at the one year follow-up

  • 3.
    Bågesund, Mats
    et al.
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Tabrizi, Parisa
    Östergötlands Läns Landsting, Public Dental Service.
    Lidocaine 20% patch vs lidocaine 5% gel for topical anaesthesia of oral mucosa2008In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 18, no 6, p. 452-460Article in journal (Refereed)
    Abstract [en]

    Background. Topical anaesthetics are important to provide pain control at dental injection Aim. The aim was to evaluate the effectiveness of the intraoral topical anaesthetics lidocaine 20% patch (DentiPatch (TM)) and lidocaine 5% gel Design. The randomized unblinded cross-over study included 31 patients (ten boys, 21 girls) aged 13.5 +/- 2.5 years. Application of lidocaine patch or gel was randomly used at first and second visit in the upper premolar region. Heart rate was measured before and at each needle insertion after 2.5, 5, and 15 min and at injection after 15 min Discomfort and pain were expressed in visual analogue scales (VAS) Paired t-test and Mann-Whitney U-test were used for statistic analyses Results. Heart rate at buccal injection decreased more when the patch was used (P = 0.0149). Heart rate was lower at the second visit (P = 0.0287). Patients expressed less discomfort when the patch was used on both buccal (P = 0.0150) and palatal (P = 0.0391) site. Boys had lower heart rate and VAS pain scale ratings than girls Conclusions. Good pain control can reduce the patients anxiety level - expressed in heart rate - at the second appointment. The patch and gel seem to provide similar pain reduction at needle stick and injection of local anaesthetics

  • 4.
    Ekback, Gunnar
    et al.
    Orebro County Council.
    Naslund, Ingmar
    Orebro University Hospital.
    Montgomery, Scott M
    Orebro University Hospital.
    Ordell, Sven
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Self-perceived oral health and obesity among 65 years old in two Swedish counties2010In: SWEDISH DENTAL JOURNAL, ISSN 0347-9994, Vol. 34, no 4, p. 207-216Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the association between oral health and obesity. The study was conducted in the spring of 2007 as a postal survey of all inhabitants born in 1942 and living in the two Swedish counties of Orebro and Ostergotland. This questionnaire survey has been conducted every five years since 1992 but has been updated continually with additional questions and for the sweep used here, height and weight data were collected. A total of 8,313 individuals received the questionnaire and 6,078 of those responded (73,1%). The outcome variable oral health was measured using one global question and four detailed questions representing different aspects of oral health. The independent variable Body Mass Index (BMI) was calculated using self-reported height and weight. A difference in oral health between various BMI groups was found. The difference was both statistically significant and of clinical importance, particularly among the group with severe obesity who reported poorer self-perceived chewing capacity, lower satisfaction with dental appearance, increased mouth dryness and fewer teeth and lower overall satisfaction with oral health. In view of the increased risk of poor oral health demonstrated in this study for those with severe obesity, it may be of value to increase cooperation between dental care and primary health care for these patients.

  • 5.
    Ekback, Gunnar
    et al.
    Orebro County Council.
    Nodrehaug-Astrom, Anne
    University Bergen.
    Klock, Kristin
    University Bergen.
    Ordell, Sven
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Unell, Lennart
    Malmö University.
    Satisfaction with teeth and life-course predictors: a prospective study of a Swedish 1942 birth cohort2010In: EUROPEAN JOURNAL OF ORAL SCIENCES, ISSN 0909-8836, Vol. 118, no 1, p. 66-74Article in journal (Refereed)
    Abstract [en]

    This study aimed to assess the stability or change in satisfaction with teeth among Swedish adults between the ages of 50 and 65 yr, and to identify the impact of socio-demographics and of clinical and subjective oral health indicators on participants satisfaction with teeth during that period. Self-administered standardized questionnaires were used as part of a longitudinal study. In 1992, 1997, 2002, and 2007 all residents (born in 1942) of two Swedish counties were invited to participate in the study. A total of 63% women and 66% men reported being satisfied with their teeth between 50 and 65 yr of age. The corresponding figures, with respect to dissatisfaction, were 7% and 6% respectively. Generalized estimated equation models revealed a decline in the odds of being satisfied with advancing age, which was particularly important in subjects with lower education, tooth loss, and smokers. Consolidation in oral health perceptions starts before age 50, suggesting early intervention before that age. Promotion of a healthy adult lifestyle and improved access to quality oral healthcare might increase the likelihood of people being satisfied with their teeth throughout the third age-period in both genders.

  • 6.
    Fagrell, Tobias G
    et al.
    Sahlgrenska University Hospital.
    Dietz, Wolfram
    University of Jena.
    Jälevik, Birgitta
    Östergötlands Läns Landsting, Public Dental Health Care, Centre for Orthodontics and Paediatric Dentistry.
    Noren, Jorgen G
    University of Gothenburg.
    Chemical, mechanical and morphological properties of hypomineralized enamel of permanent first molars2010In: ACTA ODONTOLOGICA SCANDINAVICA, ISSN 0001-6357, Vol. 68, no 4, p. 215-222Article in journal (Refereed)
    Abstract [en]

    Objective. The microstructure of hypomineralized enamel in permanent teeth has been described in several studies as less distinct prism sheaths and disorganized enamel with lack of organization of the enamel crystals. The mechanical properties, hardness and modulus of elasticity of the hypomineralized enamel have lower values compared with normal. The aim of this study was to examine normal and hypomineralized enamel using scanning electron microscopy (SEM), hardness measurements and X-ray microanalysis (XRMA). Material and methods. Four extracted hypomineralized permanent first molars, sectioned and cut in half, were analyzed with SEM, XRMA and hardness measurements. Results. An inverse relation was found between the micro hardness and the Ca:C ratio in hypomineralized and normal enamel. The acid-etched hypomineralized enamel appeared on SEM to be covered with a structureless layer and the prisms appeared disorganized, with thick prism sheaths and loosely packed crystallites. Furthermore, bacteria were found deep in porous hypomineralized enamel close to the enamel-dentin junction. Conclusions. Teeth diagnosed with molar incisor hypomineralization have significantly lower hardness values in the hypomineralized enamel compared with normal enamel. The hardness values vary according to the morphological and chemical properties.

  • 7.
    Johansson, Kristina
    et al.
    Östersund Hospital, Sweden .
    Lundström, Fredrik
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Orthodontic treatment efficiency with self-ligating and conventional edgewise twin brackets: A prospective randomized clinical trial2012In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 82, no 5, p. 929-934Article in journal (Refereed)
    Abstract [en]

    Objective: To conduct a prospective and randomized study of the efficiency of orthodontic treatment with self-ligating edgewise brackets (SL; Time2 brand, American Orthodontics) and conventional edgewise twin brackets (CE; Gemini brand, 3M). less thanbrgreater than less thanbrgreater thanMaterials and Methods: One hundred consecutive patients were randomized to treatment with either SL or CE brackets. The participants were treated by one of three specialists in orthodontics and with continuous instructions alternately by five orthodontic assistants according to our normal treatment routine (ie, modified 0.022 MBT preadjusted edgewise technique). The treatments were evaluated in terms of overall treatment time, number of visits, and treatment outcome using the Index of Complexity, Outcome and Need (ICON). The number of emergency appointments, number of archwires, overjet, relative space, and extractions at treatment start were noted. less thanbrgreater than less thanbrgreater thanResults: After dropouts, the analyzed material consisted of 44 patients treated with SL (mean age 15.3 years, mean ICON 60.7, 70.4 /0 female) and 46 patients treated with CE (mean age 15.0 years, mean ICON 56.5, 71.7/0 female). There were no statistically significant differences between the SL and CE groups in terms of mean treatment time in months (20.4 vs 18.2), mean number of visits (15.5 vs 14.1), mean ICON scores after treatment (13.2 vs 11.9), or mean ICON improvement grade (7.9 vs 9.1). less thanbrgreater than less thanbrgreater thanConclusion: Orthodontic treatment with SL brackets does not reduce treatment time or number of appointments and does not affect posttreatment ICON scores or ICON improvement grade compared with CE brackets. (Angle Orthod. 2012;82:929-934.)

  • 8.
    Mosskull Hjertton, Petra
    et al.
    Östergötlands Läns Landsting, Public Dental Health Care, Centre for Orthodontics and Paediatric Dentistry.
    Bagesund, Mats
    Östergötlands Läns Landsting, Public Dental Health Care, Centre for Orthodontics and Paediatric Dentistry.
    Er:YAG laser or high-speed bur for cavity preparation in adolescents2013In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 71, no 3-4, p. 610-615Article in journal (Refereed)
    Abstract [en]

    Objectives. The aim was to evaluate the effect on cavity preparation time, the pulse changes and the patients subjective experience during removal of healthy tooth substance with high-speed bur and Er:YAG laser. Materials and methods. Thirty-five (13 male, 22 female) 14-18-year-olds participated. After local anaesthesia, Er:YAG laser and high-speed diamond bur were used for a 2 mm deep cavity preparation on the middle of the buccal surface on contra-lateral healthy maxillary first premolars. The cavity preparation time and the pulse were measured during the treatment. Subjective experience was evaluated using a VAS-scale and a questionnaire. Wilcoxon Signed Rank test and Chi-2-test were used for statistical analyses. Results. The mean (SD) cavity preparation time was 3.7-times longer (p andlt; 0.001) for the laser [59 (41) s] than for the high-speed bur [16 (4) s]. The mean pulse change during preparation differed (p andlt; 0.05) between the bur (+2.2%) and laser (-4.4%). The smell was worse when laser was used (p andlt; 0.01); 65.7% expressed less discomfort and 57.1% experienced a lower sound level when laser was used. Laser was preferred for future treatment in 62.9% of the adolescents. Conclusion. Laser ablation caused unpleasant smell and longer cavity preparation time, but was preferred by a majority of the adolescents.

  • 9.
    Nilsson, Ing-Marie
    et al.
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Drangsholt, Mark
    University of Washington.
    List, Thomas
    Malmö University.
    Impact of Temporomandibular Disorder Pain in Adolescents: Differences by Age and Gender2009In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 23, no 2, p. 115-122Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate the impact of temporomandibular disorder (TMD) pain by age and gender in adolescents, with assessments of this impact specifically on school absence, medication consumption, perceived need for treatment, jaw function limitation, depressive symptoms scores and somatic complaints, and graded chronic pain scale. Methods: In a population-based sample, a mailed questionnaire was sent to 350 patients with self-reported TMD pain (group 1) and 350 healthy age- and sex-matched individuals (group 2) aged 12 to 19 years 2 to 4 weeks after their annual dental examination. The groups were divided into younger (age 12 to 15) and older (age 16 to 19) groups. Descriptive statistics and 95% confidence intervals were used, and chi-square and t-tests were calculated for analyzing group differences. Odds ratios were estimated using logistic regression. Results: As expected, groups I and 2 differed significantly in most variables related to psychosocial and behavioral factors. For adolescents reporting TMD pain once a week or more, no gender or age differences in pain intensity were seen. Jaw function limitation, depressive symptoms scores, somatic complaints, graded chronic pain, and perceived need for TMD treatment were all significantly higher in girls than in boys. Older girls reported higher analgesic consumption and school absences than older boys. Conclusion: Girls reporting TMD pain had significantly greater impact on behavioral and psychosocial factors than boys. Almost one third of older girls, compared to one out of 10 older boys, reported school absences and analgesic consumption because of their TMD pain. J OROFAC PAIN 2009;23; 115-122

  • 10.
    Ordell, Sven
    et al.
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Soderfeldt, Bjorn
    Malmö University.
    Management structures and beliefs in a professional organisation. An example from Swedish Public Dental Health Services2010In: SWEDISH DENTAL JOURNAL, ISSN 0347-9994, Vol. 34, no 3, p. 167-176Article in journal (Refereed)
    Abstract [en]

    Work as a dentist is stressful and demanding. In the Public Dental Health Service (PDHS) the heads of clinics have a great influence on the work environment. In turn the heads have to adapt to the overarching policies on management in each County, which create the environment for the clinics. The aims of this paper were to describe the management structure of the PDHS as described by their Chief Dental Officers (CDOs), and to test hypotheses that the management systems had "a logical administrative structure" A postal questionnaire was mailed to all 21 CDOs, who all responded. Context analysis and bivariate correlations were used The PDHS employed on average 60% of all dentists in a county. The numbers of clinics for general dentistry in Sweden was 698, and for specialist care 144 The heads of clinics were dentists in 92%. Four hypotheses were tested 1/ A separate political board did not lead to closer governance of the PDHS. 2/ There was more emphasis on measurable than on qualitative objectives and follow-up 3/ There was only partial correlation between a larger county and a more formalized management. 4/ There was no correlation between size of county and beliefs on advantages of scale There was a widespread belief in advantages with larger clinics both from administrative, and rather surprisingly, from clinical aspects. Two of the four hypotheses could not be corroborated which indicates that the management structures were more,formed by county specific principles. The four hypotheses on administrative behaviour were only partially corroborated. The implications for delivery of care to-sparsely populated areas need to be monitored in view of the beliefs in larger clinics. The limits for decisions by management and for professional discretion must be monitored closely considering their effects on work environment and on the quality of care the professionals are able to deliver

  • 11.
    Slavnic, Snjezana
    et al.
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Marcusson, Agneta
    Linköping University, Department of Neuroscience and Locomotion, Dental Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Oral Surgery.
    Duration of orthodontic treatment in conjunction with orthognathic surgery2010In: SWEDISH DENTAL JOURNAL, ISSN 0347-9994, Vol. 34, no 3, p. 159-166Article in journal (Refereed)
    Abstract [en]

    Patients considering undergoing combined orthodontic-orthognathic treatment for correction of malocclusion require appropriate information, particularly with respect to duration of treatment The primary aim of this study was to determine the duration of orthodontic treatment carried out in conjunction with orthognathic surgery and to analyze the influence of selected explanatory variables. A further aim was to compare the duration of orthodontic treatment in patients treated by orthodontists at Linkoping University hospital orthodontic clinic and six regional orthodontic clinics This is a retrospective study, based on data from the orthodontic records of patients who had undergone orthognathic surgery at the University Hospital Maxillofacial Unit in Linkoping, Sweden, from 2000 to 2005 The subjects comprised 207 out of 233 patients (107 women and 100 men), aged 15 8 - 56.9 years, median 24.2 years at the time of surgery 26 patients were excluded, either diagnosed with a syndrome, or because it was impossible to follow up the entire treatment. 59 subjects had undergone orthodontic treatment at the University hospital orthodontic clinic and 148 at the 6 regional orthodontic clinics. The variables recorded were gender, malocclusion, the number of appointments (scheduled and emergency) and treatment setting The median value for pre-operative orthodontic treatment time was 19.2 months (range 2.4 - 68.4); for postoperative orthodontic treatment 4 6 months (range 0 - 18 8) and for total orthodontic treatment 278 months (range 5.9 - 79 1). For the University hospital orthodontic clinic, pre-operative (16.7 months) and total orthodontic treatment times (25 months) were significantly shorter than for the regional clinics; the duration of postoperative treatment was significantly longer (4.1 months). No other explanatory variables had a significant influence on the duration of orthodontic treatment. Compared with the regional orthodontic clinics, there were significantly fewer scheduled appointments at the University hospital orthodontic clinic, but no significant difference in emergency attendance.

  • 12.
    Ståhlnacke, Katri
    et al.
    Community Dental Office, Örebro County Council.
    Unell, L.
    Community Dental Office, Örebro County Council.
    Söderfeldt, B.
    Malmö University.
    Ekbäck, G.
    Community Dental Office, Örebro County Council.
    Ordell, Sven
    Östergötlands Läns Landsting, Public Dental Service, Centre for Orthodontics and Paediatric Dentistry.
    Self-perceived oral health among 65 and 75 years old in two Swedish counties2010In: Swedish Dental Journal, ISSN 0347-9994, Vol. 34, no 2, p. 107-119Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate self-perceived oral health in two elderly populations, ages 65 and 75 years, and its relation to background factors, socioeconomic, individual, and dental health service system factors. Another purpose was to investigate if there were any differences in these respects, between the two age groups, born in 1932 or 1942. In two counties in Sweden, Örebro and Östergötland, all persons born in 1942 have been surveyed by mail every fifth year since 1992. In the year 2007 all persons born in 1932 were also surveyed using the same questionnaire. Those born in 1932 consisted of 3735 persons and those born in 1942 6078 persons. From an outline of a general model of inequalities in oral health data were analyzed with descriptive statistics and contingency tables with ?2 analysis. Multivariable analysis was performed by using multiple regression analysis. Factors related to self-perceived oral health were age group, social network, ethnicity, education, general health, tobacco habits, oral hygiene routines, dental visit habits and cost for care. The self-perceived oral health was overall rather high, especially in view of the studied ages, although it was worse for those of age 75. Socio-economic factors, dental health service system as well as individual lifestyle factors affected self-perceived oral health. To have a satisfying dental appearance, in the aspect of how you are judged by other people, was important for these age groups.This presents a challenge for dental health planners especially since the proportion of older age groups are growing.

  • 13.
    Wahlberg, Jeanette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Ledin, Torbjön
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Bågesund, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Public Dental Health Care, Centre for Orthodontics and Paediatric Dentistry.
    Ekman, Bertil
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Impaired Postural Balance in Turner Syndrom2013In: Hormone and Metabolic Research, ISSN 0018-5043, E-ISSN 1439-4286, Vol. 45, no 7, p. 537-540Article in journal (Refereed)
    Abstract [en]

    An impaired body balance has been found in Turner syndrome (TS) in clinical tests like Rombergs’s test and walking on a balance beam. The aim of the study was to assess postural balance in TS subjects with specific balance testing using dynamic posturography and relate to body composition. Nineteen TS subjects (20–57 years) were included. Balance was measured with dynamic posturography (Equitest) and compared with 19 sex and age-matched controls (22–59 years). Equitest, visual, vestibular, and somatosensory systems were provoked with increasing difficulty (6 tests, SO1–SO6) and body sway was measured with a dual forceplate. Body composition was measured with DXA. No difference was found between the TS subjects and the controls on fixed platform with open eyes (SO1), with closed eyes (SO2), with stable platform and visual disorientation (SO3), or on unstable platform with open eyes (SO4). In the difficult tests on unstable platform the TS subjects did worse compared with controls both in the test with eyes closed (SO5), p<0.01, and in the test with visual disorientation (SO6), p<0.05. Composite (a merge of all six recordings) was significantly lower in the TS-group, p<0.05. In the TS group high total body weight was related to worse outcome on tests SO5, SO6, and composite, while total bone mass, age, height, or waist showed no significant association with balance scores. Our findings indicate that TS could have an increased risk for falling due to impaired ability to manage complex coordination tasks.

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