Aron Naimi-Akbar

Objective: The Swedish Quality Register for Caries and Periodontal Disease (SKaPa) is a national registry providing oral health data for children and adolescents. Since no validation has been performed on adolescents with permanent dentitions, the aim of this study was to evaluate SKaPa data for dental caries in 19-year-olds. Material and Methods: This diagnostic accuracy study included a random sample of 19-year-olds (N = 250) examined in 2014 in the Public Dental Service, Region Värmland. Clinical records served as the reference standard and SKaPa variables as the index test. Number of decayed and filled teeth (DFT), number of decayed, missing, and filled teeth (DMFT), missing teeth due to caries (MTC), missing teeth due to any reason (MTA), number of decayed teeth (DT), and number of filled teeth (FT) were evaluated. Agreement was evaluated using exact agreement, Cohen’s kappa, and intraclass correlation coefficients. Results: Data showed high agreement for DFT, DMFT, MTA, DT, and FT (kappa between 0.82 and 0.90; ICC 0.93–0.96). SKaPa underestimated caries by 6–7%. Among 155 participants with DFT/DMFT ≥1, only three had MTC, limiting evaluation. Conclusions: SKaPa caries data demonstrate high accuracy. However, as MTC could not be evaluated, DMFT should be used with caution in research at this point. Researchers should instead use DFT but be observant of the risk of an underdiagnosis of dental caries in SKaPa for 19-year-olds.

Introduction: Inequalities in oral health persist, particularly in highly developed countries, where socioeconomic status is an important explanatory factor. Previous analyses identified immigrant background as a determinant of dental caries development. The present study further explored this association by investigating the influence of home language and the income classification of the country or region of origin on caries development. Methods: This prospective longitudinal cohort study followed 3,402 children who lived in 23 socioeconomically disadvantaged areas in Stockholm, Sweden, from ages 1 to 3 years. Caries was assessed using the International Caries Detection and Assessment System (ICDAS II) criteria. Primary outcome measures were number of tooth surfaces with dental caries (ICDAS ≥ 1 and ICDAS ≥ 3). Longitudinal data were collected through annual clinical examinations that included questionnaires at ages 1, 2, and 3 years. Immigrant background was defined by the languages spoken at home, which were linked to the income classification of the country or region of origin and categorized as low-, middle-, or high-income European or non-European countries or regions. These factors, home language and income classification, served as exposure variables in the analysis. Results: The study identified 83 home languages. The reference group, the Swedish language group, had the lowest caries count at all time points and showed the smallest increase in caries development. The Mixed language group (Swedish and one or more foreign home languages) had a caries risk between the reference group (Swedish language) and the non-Swedish language group (no Swedish was spoken at home). Higher caries development was found among some immigrant groups, particularly those from middle-income European countries and non-European countries or regions. Conclusion: Immigrant background emerged as a sociodemographic determinant, with evident variation in caries outcomes across different groups. Preventive efforts should continue, but further development to better address the specific needs of multicultural, low-socioeconomic communities. Measures such as use of interpreters, multilingual materials, and establishment of community outreach programs could be beneficial. Trial registration: ISRCTN35086887. Registered 16 December 2013.

Conventional Swedish snus is used by millions in Scandinavia and increasingly worldwide, yet its cardiovascular effects remain poorly characterized. The emergence of nicotine pouches—commonly referred to as ‘white snus’ in Sweden—that deliver comparable nicotine without tobacco constituents adds complexity to a heterogeneous landscape and raises questions about whether cardiovascular risk follows nicotine exposure regardless of product type. We explore epidemiological and mechanistic evidence on snus and cardiovascular disease, the contributions of nicotine versus tobacco‐specific nitrosamines (TSNAs) to risks, and identify knowledge gaps, with focus on novel nicotine products and the research opportunity offered by the Swedish Tobacco Cohort (SWETOC). Epidemiological evidence suggests elevated cardiovascular disease (CVD) mortality among snus users, with the most consistent signals for fatal myocardial infarction and heart failure. Associations with incident atherosclerotic events are more heterogeneous. Mechanistic evidence points to nicotine‐mediated pathways, including sympathetic activation, endothelial dysfunction and increased arterial stiffness, whereas evidence for TSNA‐driven CVD risk remains sparse, and declining TSNA levels in modern Swedish snus make that path less likely and harder to study. Nicotine pouches deliver comparable or higher systemic nicotine than conventional snus but lack long‐term cardiovascular outcome data. Real‐world cessation data from Denmark suggest structured programmes can achieve 6‐month abstinence rates of approximately 53% among non‐smoking nicotine users. The evidence supports nicotine as the primary driver of snus‐associated CVD risk, with important implications for the cardiovascular safety of novel nicotine products. Evidence is needed to inform public health guidance, clinical advice and regulatory decisions. SWETOC represents a unique infrastructure to generate this evidence.

Aim: This study aimed to examine associations between separate malocclusion traits and oral health-related quality of life (OHRQoL) among adolescents with malocclusion. It also aimed to assess sex differences in OHRQoL and whether sex modified the associations between malocclusion traits and OHRQoL. Methods: We conducted a multicenter cross-sectional study among adolescents aged 12–19 years. Two groups were recruited: a no malocclusion group from general dentistry clinics and a malocclusion group from specialist orthodontic clinics. The participants completed two OHRQoL instruments—the generic Child Perceptions Questionnaire (CPQ11–14 short form) and the orthodontic-specific Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Malocclusion was assessed based on intraoral photographs. Sociodemographic data were obtained from Statistics Sweden, and caries data from the national caries registry (SKaPa). Associations between malocclusion traits and OHRQoL were examined using linear regression models adjusted for confounders, with additional analyses of sex differences in OHRQoL and effect modification by sex. Results: The final sample included 103 without malocclusion and 541 with malocclusion. After adjustment, anterior crowding was associated with poorer OHRQoL compared with other malocclusion traits in both instruments. Among those with malocclusion, females reported poorer OHRQoL than males, whereas no sex differences were observed in the no malocclusion group. In the sex-stratified analyses, associations between separate malocclusion traits and OHRQoL were largely similar across sexes. Conclusions: Anterior crowding shows the strongest association with poorer OHRQoL. Females with malocclusion report poorer OHRQoL than males, but there is limited evidence of sex modifying associations between separate malocclusion traits and OHRQoL. Registration: ClinicalTrials.gov on 02 Sept 2021 (registration number: NCT05038865).

This meta-review evaluated the possibility of more specified recommendations in antibiotic treatment through a narrowed focus on facial trauma. The aim was to analyze the effect of different regimens of antibiotic in treatment of skeletal trauma to the face. The knowledge mapping was based on existing systematic reviews (SRs) on trials specified in a PICO: Participants (P): Adults and children, diagnosed with fractures to the facial skeleton. Interventions (I): Antibiotic intervention. Comparator (C): Placebo, no antibiotics. Outcomes (O): Postoperative infection, pain, re-operation, other complications, healing deficiencies, (Oral) Health related Quality of Life, removal of osteosynthesis, adverse reactions. The literature search in PubMed, The Cochrane Library, and Web of Science according to PRISMA resulted in 1487 records. A COVIDENCE selection process resulted in 29 articles retrieved and read in full text revealing 10 articles eligible for evaluated according to ROBIS. Three SRs were considered to have low risk of bias and constituted the final evidence evaluation. The meta-review of these SRs did not provide sufficient support for prolonged antibiotic treatment after surgical intervention of midfacial fractures in comparison with antibiotics only the first day postoperatively. No support for antibiotic treatment for conservatively managed fractures alone was found. This review is limited by a relatively low number of included SRs. However, tendencies in outcomes suggests a restricted duration of antibiotics in treatment of facial fractures.

Objectives: Children in out-of-home care (OHC) are at greater risk of ill health than other children in the community. The aim of this registry-based cohort study was to compare the oral health and dental care needs of children in OHC with those of other children in Sweden, by merging data from different Swedish registries. A further aim was to analyse whether children in OHC received more dental examinations after 2017, following implementation of a law requiring mandatory health evaluations prior to placement. Methods: We identified an exposed cohort of Swedish children and young people, 0–19 years old, who had been placed in OHC 2010–2018 (N = 50,878), and an unexposed cohort, five times larger, matched for age, sex and county of residence (N = 254,380). During the study period, children in OHC received relatively fewer regular, scheduled dental examinations (4.21 vs. 4.88; p < 0.0001). More children entering OHC in 2018 received dental examinations (81.7%) compared with 2016 (76.6%) (p < 0.0001), but this was still lower than the proportion of controls. Moreover, during the study period, dental caries affected more teeth in children in OHC than in the controls (dft 6-year-olds 1.56 vs. 0.74; p < 0.0001, and DFT 12-year-olds 1.18 vs. 0.65; p < 0.0001), and they had more extractions and more emergency dental appointments than children who had never been in OHC. Conclusion: Not only do children in OHC have poorer oral health than other children, they also receive less support from the dental health services. It seems that society has failed in its mission to ensure that children in OHC are not disadvantaged with respect to health and access to comprehensive healthcare. Thus, there is an urgent need for reappraisal of guidelines, legislation, and organizational models for providing dental care to children and adolescents in OHC.

This study evaluates the agreement of data on dental caries between electronic dental records and data retrieved from the national SKaPa-registry (Swedish Quality Registry for caries and periodontal disease), with special reference to e/M in deft/DMFT. In a random sample of 500 6- and 12-year-old children having received dental care in 2014 in the county region of Värmland, Sweden, the diagnostic accuracy of data in electronic dental records with corresponding data obtained from the SKaPa-registry was compared by using Cohen's Kappa and Intraclass correlation coefficient (ICC). For dft/DFT the Kappa was 0.95, and ICC 0.98 (total population). For deft/DMFT in the total population the Kappa was 0.80 and ICC 0.96. For 6-year-olds (deft) the Kappa was 0.89 and ICC 0.99 and for 12-year-olds (DMFT) the Kappa was 0.70, and ICC 0.83. The corresponding figures for Kappa and ICC when excluding individuals without caries (deft/DMFT = 0) were: Total population 0.63 and 0.94; 6-year-olds 0.79 and 0.99; 12-year-olds 0.42 and 0.68. Agreement between data in the dental records and SKaPa was very high for dft/DFT confirming that transfer from the dental records to the SKaPa-registry is safe and correct. As the accuracy of deft/DMFT was considerably lower than for dft/DFT we advise against using deft/DMFT data from SKaPa for research purposes at this point.

Background: Temporomandibular disorders (TMD) are associated with musculoskeletal diseases (MSD), mental and behavioural disorders (MBD), and patients with TMD have been shown to have 2–3 times more days of sick leave (SL) and disability pension (DP) than the general population. MSD and MBD are two of the most common causes for SL and DP, and the association between TMD and the influence of comorbidities on the need for SL and DP among TMD patients need further clarification. This study investigates the impact of MSD and MBD comorbidity on SL and DP among TMD patients diagnosed in a hospital setting and/or surgically treated. Methods: All incident TMD patients diagnosed or treated in a hospital setting between 1998 and 2016 and aged 23–59 were included. A non-exposed comparison cohort was collected from the general population. The cohorts were grouped based on the presence of comorbidity: No comorbidity (Group I); MSD comorbidity (Group II); MBD comorbidity (Group III); and combined MSD and MBD comorbidity (Group IV). Main outcomes were mean annual days of SL and DP, and statistical analysis was conducted using generalized estimated equations. Results: TMD subjects with no comorbidities (Group I) and with MSD/MBD comorbidity (Group II and III) were 2–3 times more often on SL and DP than the corresponding groups from the general population. However, in the group with both MSD and MBD comorbidity (Group IV), the difference between the TMD subjects and the general population was diminishing, suggesting an additive effect. Conclusion: TMD patients are more dependent on SL and DP benefits compared to general population and the difference remains even after considering MSD and MBD comorbidity. In individuals with combined MSD and MBD comorbidity, concurrent TMD has less impact on the need for social insurance benefits. The results accentuate the impact TMD has on the patients’ impaired ability to return to work and why TMD should be recognized as having a substantial impact on individual and economic suffering as well as on societal costs, with emphasis on the influence of comorbidities on patient suffering.