Plan for the abolition of dental amalgam by 2030 : National plan required by an EU regulation

Mercury is a contaminant, one of the leading sources of which in Europe is dental amalgam. The aim of the Minamata Convention’s Regulation on Mercury (EU 2017/852), which was implemented in the EU, is to minimise and, where feasible, entirely eliminate global anthropogenic mercury releases by the year 2030. The Regulation is to be regarded as directly applicable legislation in Finland. Each EU country must publish a national plan for the abolition of dental amalgam and the collection of accumulated dental amalgam waste by 1 July 2019. In Finland, the use of dental amalgam has decreased from year to year to a level where it only constitutes clearly less than 1% of all dental fillings produced. Even though the majority of Finnish dentists have abandoned dental amalgam, it still has a user base. In fact, there are some indications that fillings made from amalgam would appear to be more durable and affordable than other filling materials. Many Finns still have old amalgam fillings in their teeth due to their longevity. In Finland, the collection of waste generated from the removal of amalgam fillings has been handled appropriately, but more detailed instructions are required for the recycling of secondary waste that has been contaminated with mercury. Although very little amalgam is used in Finland, its full abolition requires comprehensive cooperation with regard to material development, communications and education, among other things. This document presents the national action plan for abolishing amalgam in Finland by the year 2030

Suunnitelma hammasamalgaamin käytöstä luopumiseksi vuoteen 2030 mennessä : EU-asetuksen edellyttämä kansallinen suunnitelma

Elohopea on ympäristömyrkky, jonka suurimpia lähteitä Euroopassa on hammasamalgaami. EU:ssa toimeenpannun Minamatan yleissopimuksen niin sanotun elohopea-asetuksen (eu 2017/852) tavoitteena on minimoida ja mahdollisuuksien mukaan poistaa kokonaan ihmisen aiheuttamat maailmanlaajuiset elohopeapäästöt vuoteen 2030 mennessä. Asetus on sellaisenaan sovellettavaa lainsäädäntöä Suomessa. Jokaisen EU maan tulee julkaista kansallinen suunnitelma hammasamalgaamista luopumiseksi ja siitä kertyneiden jätteiden keräämiseksi 1.7.2019 mennessä. Suomessa hammasamalgaamin käyttö on vähentynyt vuosi vuodelta niin, että sitä tällä hetkellä käytetään vain selvästi alle yhdessä prosentissa kaikista valmistettavista hammastäytteistä. Vaikka suurin osa suomalaista hammaslääkäreistä ei amalgaamia käytä, on sille olemassa edelleen oma käyttäjäkuntansa. Amalgaamilla onkin joitain indikaatioita, joissa siitä valmistetut täytteet vaikuttavat olevan muita täytemateriaaleja kestävämpiä ja edullisempia. Vanhoja amalgaamitäytteitä on suomalaisten hampaissa vielä runsaasti niiden pitkäikäisyyden vuoksi. Amalgaamitäytteiden purkamisesta syntyvän jätteen keräys on Suomessa hoidettu asianmukaisesti, mutta elohopealla kontaminoituneen sekundäärijätteen kierrätys vaatii vielä tarkempaa ohjeistusta. Vaikka amalgaamin käyttö on Suomessa vähäistä, siitä kokonaan luopuminen vaatii monitahoista yhteistyötä muun muassa materiaalikehityksessä, viestinnässä ja koulutuksessa. Tässä dokumentissa esitetään kansallinen toimintasuunnitelma amalgaamista luopumiseksi Suomessa vuoteen 2030 mennessä

Kirjaamisopas : Suun terveydenhuolto

Julkaisun sähköinen versio: https://yhteistyotilat.fi/wiki08/display/JULSUTE Suun terveydenhuollon kirjaamisopas kuuluu THL:n kirjaamis-oppaiden sarjaan, jonka tarkoitus on ohjata sosiaali- ja terveydenhuollon ammattihenkilöitä kansallisesti potilastiedon yhdenmukaisiin rakenteisiin kirjaamiskäytäntöihin, mikä parantaa tietojen yhteiskäytettävyyttä eri organisaatioiden ja ammattihenkilöiden välillä ja mahdollistaa tietojen hyödyntämistä myös tiedon toissijaisessa käytössä. Suun terveydenhuollon rakenteisen kirjaamisen opas julkaistiin ensimmäisen kerran vuonna 2016. Opas on nyt päivitetty vastaamaan tarkentuneita Suun terveydenhuollon toiminnallisia määrityksiä. Tarkista voimassa olevat versiot osoitteesta https://thl.fi/fi/web/tiedonhallinta-sosiaali-ja-terveysalalla/kirjaaminen/terveydenhuollon-kirjaamisohjeet/suun-terveydenhuolto1.

Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population

A novel qualitative point-of-care test of activated matrix metalloproteinase-8 (aMMP-8) using noninvasive oral rinse sampling procedures has been developed for the early detection of collagen breakdown indicating periodontal tissue destruction. The main object of this study was to assess the reliability of the test in a low-income setting to identify participants with history of periodontal destruction detected as alveolar bone loss (ABL) in radiographs. This cross-sectional study included 486 women who had recently delivered in rural Malawi. The aMMP-8 test and dental panoramic radiographs were taken within 48 h of delivery. The performance of the test in comparison to radiological examinations was tested by following the standards for reporting of diagnostic accuracy studies protocol (STARD) with respective statistical measures and 95% confidence intervals. From the 486 eligible participants, 461 mothers with complete data, aged from 15 to 46 years (mean 24.8, SD 6.0) were included in the analysis. ABL was identified in 116 of 461 participants. There was 56% agreement between the aMMP-8 test results and detected ABL (yes or no) in radiographs. Calculated sensitivity of the test was 80% (72–87%), specificity 48% (43–54%), positive predictive value 34% (31–37%), negative predictive value 88% (83–91%), positive likelihood ratio 1.55 (1.35–1.77), and negative likelihood ratio 0.41(0.28–0.60). The aMMP-8 test sensitivity and negative predictive value to identify the ABL cases were relatively high, but there was additionally a high rate of test-positive results in participants without ABL, especially in young mothers, leading to low overall agreement between the test results and radiological bone loss. Further longitudinal studies are needed to examine if the test positive subjects are in risk of future bone loss before the detectable signs of periodontitis in radiographs.Peer reviewe

Bacterial communities found in placental tissues are associated with severe chorioamnionitis and adverse birth outcomes

Preterm birth is a major cause of neonatal mortality and morbidity worldwide. Bacterial infection and the subsequent inflammatory response are recognised as an important cause of preterm birth. It is hypothesised that these organisms ascend the cervical canal, colonise placental tissues, cause chorioamnionitis and in severe cases infect amniotic fluid and the foetus. However, the presence of bacteria within the intrauterine cavity does not always precede chorioamnionitis or preterm birth. Whereas previous studies observing the types of bacteria present have been limited in size and the specificity of a few predetermined organisms, in this study we characterised bacteria found in placental tissues from a cohort of 1391 women in rural Malawi using 16S ribosomal RNA gene sequencing. We found that specific bacteria found concurrently on placental tissues associate with chorioamnionitis and delivery of a smaller newborn. Severe chorioamnionitis was associated with a distinct difference in community members, a higher bacterial load and lower species richness. Furthermore, Sneathia sanguinengens and Peptostreptococcus anaerobius found in both matched participant vaginal and placental samples were associated with a lower newborn length-for-age Z-score. This is the largest study to date to examine the placental microbiome and its impact of birth outcomes. Our results provide data on the role of the vaginal microbiome as a source of placental infection as well as the possibility of therapeutic interventions against targeted organisms during pregnancy

Distinguishing the Signals of Gingivitis and Periodontitis in Supragingival Plaque: a Cross-Sectional Cohort Study in Malawi.

UNLABELLED: Periodontal disease ranges from gingival inflammation (gingivitis) to the inflammation and loss of tooth-supporting tissues (periodontitis). Previous research has focused mainly on subgingival plaque, but supragingival plaque composition is also known to be associated with disease. Quantitative modeling of bacterial abundances across the natural range of periodontal severities can distinguish which features of disease are associated with particular changes in composition. We assessed a cross-sectional cohort of 962 Malawian women for periodontal disease and used 16S rRNA gene amplicon sequencing (V5 to V7 region) to characterize the bacterial compositions of supragingival plaque samples. Associations between bacterial relative abundances and gingivitis/periodontitis were investigated by using negative binomial models, adjusting for epidemiological factors. We also examined bacterial cooccurrence networks to assess community structure. The main differences in supragingival plaque compositions were associated more with gingivitis than periodontitis, including higher bacterial diversity and a greater abundance of particular species. However, even after controlling for gingivitis, the presence of subgingival periodontitis was associated with an altered supragingival plaque. A small number of species were associated with periodontitis but not gingivitis, including members of Prevotella, Treponema, and Selenomonas, supporting a more complex disease model than a linear progression following gingivitis. Cooccurrence networks of periodontitis-associated taxa clustered according to periodontitis across all gingivitis severities. Species including Filifactor alocis and Fusobacterium nucleatum were central to this network, which supports their role in the coaggregation of periodontal biofilms during disease progression. Our findings confirm that periodontitis cannot be considered simply an advanced stage of gingivitis even when only considering supragingival plaque. IMPORTANCE: Periodontal disease is a major public health problem associated with oral bacteria. While earlier studies focused on a small number of periodontal pathogens, it is now accepted that the whole bacterial community may be important. However, previous high-throughput marker gene sequencing studies of supragingival plaque have largely focused on high-income populations with good oral hygiene without including a range of periodontal disease severities. Our study includes a large number of low-income participants with poor oral hygiene and a wide range of severities, and we were therefore able to quantitatively model bacterial abundances as functions of both gingivitis and periodontitis. A signal associated with periodontitis remains after controlling for gingivitis severity, which supports the concept that, even when only considering supragingival plaque, periodontitis is not simply an advanced stage of gingivitis. This suggests the future possibility of diagnosing periodontitis based on bacterial occurrences in supragingival plaque

Co-causation of reduced newborn size by maternal undernutrition, infections, and inflammation.

More than 20 million babies are born with low birthweight annually. Small newborns have an increased risk for mortality, growth failure, and other adverse outcomes. Numerous antenatal risk factors for small newborn size have been identified, but individual interventions addressing them have not markedly improved the health outcomes of interest. We tested a hypothesis that in low-income settings, newborn size is influenced jointly by multiple maternal exposures and characterized pathways associating these exposures with newborn size. This was a prospective cohort study of pregnant women and their offspring nested in an intervention trial in rural Malawi. We collected information on maternal and placental characteristics and used regression analyses, structural equation modelling, and random forest models to build pathway maps for direct and indirect associations between these characteristics and newborn weight-for-age Z-score and length-for-age Z-score. We used multiple imputation to infer values for any missing data. Among 1,179 pregnant women and their babies, newborn weight-for-age Z-score was directly predicted by maternal primiparity, body mass index, and plasma alpha-1-acid glycoprotein concentration before 20 weeks of gestation, gestational weight gain, duration of pregnancy, placental weight, and newborn length-for-age Z-score (p < .05). The latter 5 variables were interconnected and were predicted by several more distal determinants. In low-income conditions like rural Malawi, maternal infections, inflammation, nutrition, and certain constitutional factors jointly influence newborn size. Because of this complex network, comprehensive interventions that concurrently address multiple adverse exposures are more likely to increase mean newborn size than focused interventions targeting only maternal nutrition or specific infections

Fit to WHO weight standard of European infants over time

OBJECTIVES: The 2006 WHO growth charts were created to provide an international standard for optimal growth, based on healthy, breastfed populations, but it has been suggested that Northern European children fit them poorly. This study uses infant weight data spanning 50 years to determine how well-nourished preschool children from different eras fit the WHO standard, and discuss the implications of deviations. DESIGN: Four longitudinal datasets from the UK and one from Finland were used comprising over 8000 children born between1959 and 2003. Weights from birth to 2 years were converted to age-sex-adjusted Z scores using the WHO standard and summarised using Generalized Additive Models for Location, Scale and Shape. RESULTS: Weights showed a variable fit to the WHO standard. Mean weights for all cohorts were above the WHO median at birth, but dipped by up to 0.5 SD to a nadir at 8 weeks before rising again. Birth weights increased in successive cohorts and the initial dip became slightly shallower. By age 1 year, cohorts were up to 0.75 SD above the WHO median, but there was no consistent pattern by era. CONCLUSIONS: The WHO standard shows an acceptable, but variable fit for Northern European infants. While birth weights increased over time, there was, unexpectedly, no consistent variation by cohort beyond this initial period. Discrepancies in weight from the standard may reflect differences in measurement protocol and trends in infant feeding practice

The utilization of registry data in oral health care

eHealth2023 International Conference, The 28th Finnish National Conference on Telemedicine and eHealth: “Human oriented approach in eHealth and digital services”, 12.-13.10.202