Periodontal health and disease in two adult populations in Sweden

This thesis deals with epidemiological data regarding periodontal disease from two different Swedish populations (Jönköping and Skåne). Background The studies focus on periodontal disease, a disease affecting a large part of the adult population. Periodontitis is a complex inflammatory disease, often chronic, which affects the tissues supporting the teeth – the periodontium. The biofilm that adheres to the hard surfaces of the teeth initiate an inflammation in the supporting tissues. In susceptible individuals, the inflammation may cause the destruction of the periodontium (periodontitis). Individuals with severe periodontitis – between 5-15% in different populations – show a range of clinical signs and symptoms, such as bleeding gums, mobile and drifting teeth, the loss of interdental papillae, and eventually the loss of teeth. This may affect the function of the dentition and the aesthetic appearance of the individual. Despite this, the disease is often considered to be silent. Aims The overall aim was to study periodontitis prevalence and severity in two Swedish adult populations, and to describe the changes over time. Further aims were to examine the effect of an individual’s sense of coherence on periodontitis and to analyse the impact of periodontitis on oral health-related quality of life. In order to examine this, a series of four different studies were performed with the following specific aims: I) to investigate the prevalence, severity, extent of marginal bone loss and subject characteristics in the adult population in the county of Skåne, Sweden; II) to assess trends over 40 years regarding the prevalence and severity of periodontitis in an adult Swedish population; III) to investigate the impact of periodontal disease experience on quality of life, in an adult Swedish population, using the OHIP-14 questionnaire; and finally IV). To investigate how an individual’s level of sense of coherence correlates with their periodontitis experience, in two different random samples, ten years apart. Methods One cross-sectional clinical study in Skåne and five cross-sectional clinical studies in Jönköping, repeated every ten years, were performed with random samples of the adult populations. Both study protocols included questionnaires regarding demographic as well as health and oral health-related factors, as well as patient-related outcome measures, such as oral health related quality of life and sense of coherence. Results The prevalence of severe periodontitis experience was eleven percent across the two study populations. There was no difference in periodontitis prevalence according to gender. It was also shown that subjects with severe periodontitis suffered from worse quality of life compared to subjects without periodontitis. Regarding the sense of coherence, no difference could be observed between the different degrees of periodontitis experience. Conclusion The main findings over time were the increase of periodontally healthy individuals and the retention of more teeth among subjects with severe periodontal disease. Also, individuals with advanced periodontitis experience worse quality of life compared to periodontally healthy individuals

Barn tillägnar sig matematiska begrepp

Validerat; 20101217 (root

The effect of Swedish and American smokeless tobacco extract on periodontal ligament fibroblasts in vitro

Use of moist snuff is widespread in Sweden. In 2004 approximately 8oo,ooo Swedes were daily users which corresponds to 22% of the male population and 3% of the female population. The aim of the present study was to evaluate the effect of Swedish moist snuff extract on PDLfibroblast growth and hard tissue production and compare with moist snuff extract from USA. Periodontal ligament cells (PDL-cells) were obtained from 3 healthy subjects (1 female 14 years, 2 males 14 and 17 years) from the root surface of premolars extracted for orthodontic reasons. The cells were isolated from explants and grown in Dulbecco's Modified Eagle's Medium (DMEM) supplemented with 10% fetal calf serum (FBS) and cultivated in 37 degrees C with 5% CO2 in air. Snuff extract in concentrations 0.3%, 1% and 3% (in DMEM with 1% FBS) was tested. Cells from each individual were tested three times, each time in triplicate. Photographs were taken at o and 24 hours with a digital camera and analysed in terms of growth and morphology. Then the cell suspension was frozen and later thawed for examination of the production of alkaline phosphatase after exposure to different snuff concentrations. This in vitro study has shown that PDL cells from 3 different subjects demonstrated a reduced number of cells at exposure to 3% of both Swedish and American snuff extract.The production of alkaline phosphatase after 2 hours was similarly reduced from cells exposed to 3% snuff extract. Further studies have to be made to understand the effect of smokeless tobacco on periodontal tissues. However, from this study can be concluded that smokeless tobacco has biological effects in terms of reduced PDL cell growth and production of alkaline phosphatas

Secular trends over 40 years of periodontal health and disease in individuals aged 20-80 years in Jonkoping, Sweden : Repeated cross-sectional studies

AimTo assess trends over 40years regarding prevalence and severity of periodontitis in a Swedish adult population. Materials and methodsCross-sectional examinations using the same clinical protocol have been repeated every 10years (1973-2013) in a Swedish city with focus on periodontal disease in adults. Periodontal recordings included all teeth, excluding 3rd molars. Periodontal disease experience was classified (no/minor, moderate and severe). ResultsThe no/minor group increased from 43% in 1983 to 60% in 2013. There was a non-significant trend for a decrease of the severe group. Over the 40-year period, the number of teeth increased significantly and at the examination 2013, the severe group accounted for this increase. More than 60% of the study population in 2013 had no periodontal pockets (PD) 6mm. The number of PD 4mm and 6mm were unaltered between 2003 and 2013 in all age groups, except for the 20-year old individuals. This group showed a statistically significant increase of 4mm PD. ConclusionsThe periodontal health has improved in the population over the 40 years. The number of teeth increased significantly in the population, and in 2013, this increase occurred entirely in the severe group. Finally, there was a trend toward diminished prevalence of severe periodontitis

Marginal bone loss in the adult population in the county of Skane, Sweden

The aim of this study was to investigate the prevalence and extent of periodontal disease registered as marginal bone loss and subject characteristics in the adult population in the county of Skåne in Sweden. One thousand individuals, 20-89 years old, were randomly selected and 451 subjects agreed to participate in the study. They answered a questionnaire and in conjunction with the clinical and radiological examination the subjects answered questions about their medical history. The examiners were co-ordinated regarding the diagnostic criteria through comprehensive written instructions, practice and discussions of clinical cases. One observer estimated marginal bone loss around the teeth on digital panoramic radiographs and bitewings. The individuals were classified regarding periodontal disease experience according to the following criteria: PD- = loss of supporting bone tissue or = 1/3 of the root length in or = 1/3 the root length in > or = 30% of the teeth. Subjects with no or minor bone loss, i.e. PD- constituted 69% of the population. Twenty percent of the study population had marginal bone loss corresponding to localised periodontal disease (PD) and 11% exhibited generalised periodontal bone loss (PD+). The periodontal treatment need, defined as probing pocket depth > or = 6 mm and bleeding on probing > or = 20%, was 53% in the PD+ group. An interesting result was that there were no differences in periodontal disease experience between the genders. Conclusions: The prevalence and extent of periodontal disease in this study correlates well with recent other studies. Eleven percent of the population has experienced generalised periodontal disease, and 53% of them have a periodontal treatment need defined as 1 or more site with PPD > or = 6 mm and BoP > or = 20%

Prognostic significance of high hyperdiploid and tri-/tetraploid adult acute myeloid leukemia.

Purpose To ascertain the clinical implications of high hyperdiploid (HH; 49-65 chromosomes) and tri-/tetraploid (TT; >65 chromosomes) adult acute myeloid leukemia (AML), all such cases were retrieved from the Swedish AML Registry. Results Of the 3,654 cytogenetically informative cases diagnosed between January 1997 and May 2014, 68 (1.9%) were HH (n=50)/TT (n=18). Patients with HH/TT were older than those with intermediate risk (IR) AML (median 71 years versus 67 years; P = 0.042) and less often had de novo AML (63% versus 79%; P = 0.004); no such differences were observed between HH/TT and complex karyotype (CK) AML. The overall survival (OS) was similar between patients with HH/TT and CK AML (median 0.9 years versus 0.6 years; P = 0.082), whereas OS was significantly longer (median 1.6 years; P = 0.028) for IR AML. The OS was shorter for cases with HH than with TT (median 0.6 years versus 1.4 years; P = 0.032) and for HH/TT AMLs with adverse abnormalities (median 0.8 years versus 1.1 years; P = 0.044). Conclusions In conclusion, HH/TT AML is associated with a poor outcome, but chromosome numbers >65 and absence of adverse aberrations seem to translate into a more favorable prognosis. Thus, HH/TT AMLs are clinically heterogeneous and should not automatically be grouped as high risk. This article is protected by copyright. All rights reserved

Incidence and prognostic significance of isolated trisomies in adult acute myeloid leukemia : A population-based study from the Swedish AML registry

OBJECTIVES AND METHODS: To ascertain the incidence/clinical implications of isolated autosomal trisomies in adult acute myeloid leukemia (AML), all such cases were retrieved from the Swedish AML Registry.RESULTS: Of the 3179 cytogenetically informative AMLs diagnosed January 1997-May 2015, 246 (7.7%) had isolated trisomies. The frequency increased by age (2.4% at age 18-60 years vs. 23% at >60 years; P<.0001); the median age was 69 years. The five most common were +8 (4.0%), +13 (0.9%), +11 (0.8%), +21 (0.7%), and +4 (0.5%). Age and gender, types of AML and treatment, and complete remission and early death rates did not differ between the single trisomy and the intermediate risk (IR) groups or among cases with isolated gains of chromosomes 4, 8, 11, 13, or 21. The overall survival (OS) was similar in the single trisomy (median 1.6 years) and IR groups (1.7 years; P=.251). The OS differed among the most frequent isolated trisomies; the median OS was 2.5 years for +4, 1.9 years for +21, 1.5 years for +8, 1.1 years for +11, and 0.8 years for +13 (P=.013).CONCLUSION: AML with single trisomies, with the exception of +13, should be grouped as IR

Impact of Periodontal Disease Experience on Oral Health-Related Quality of Life

Background: Periodontal research has traditionally focused on the site level, regarding etiology, pathogenesis, and treatment outcome. Recently, some studies have indicated that the presence of periodontal disease is associated with reduced quality of life. The aim of this study is to investigate the impact of periodontal disease experience on the quality of life. Methods: This cross-sectional study includes 443 individuals. Clinical and radiographic examinations were performed; in conjunction, the oral health-related quality of life of all participants was assessed using the Swedish short-form version of the Oral Health Impact Profile (OHIP-14). Based on marginal bone loss, measured on radiographs, three different groups were identified: participants with loss of supporting bone tissue of less than one third of the root length (BL-), loss of supporting bone tissue of one third or more of the root length in < 30% of teeth (BL), or loss of supporting bone tissue of one third or more of the root length in 30% of teeth (BL+). Results: The effect of periodontal disease experience on quality of life was considerable. For the BL-group, the mean OHIP-14 score was 3.91 (SD: 5.39). The corresponding mean values were 3.81 (SD: 5.29) for the BL group and 8.47 (SD: 10.38) for the BL+ group. The difference among all groups was statistically significant (P < 0.001). A comparison among the mean OHIP-14 scores in the different groups (BL-, BL, and BL+) revealed significant differences in six of seven conceptual domains. Conclusions: The BL+ individuals experienced reduced quality of life, expressed as the OHIP-14 score, compared with the BL and BL-participants