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A visit to the dental clinic may be challenging for a child with Down syndrome due to medical and oral health problems as well as communication problems. The aim of the present study was to explore how parents of children with Down syndrome describe their child's needs in the dental health care setting. In a survey concerning parental experiences with dental health care in Sweden, free comments were analysed with content analysis and resulted in five categories: “Need for continuity of care in dental health care”; “Need for dental health care professionals to have knowledge and expertise in caring for children with Down syndrome and other disabilities”; “Need for dental health care professionals to use a caring approach with children with Down syndrome”; “Need for the child with Down syndrome to be prepared to participate in their dental health care visit” and “Need for the child with Down syndrome to be given the same rights as typically developing children”. To support children with Down syndrome in an optimal way, dental health care needs to be tailored to meet the child's unique needs. In addition, dental health care professionals need knowledge of and expertise in the care of children with Down syndrome.

Background Healthcare professionals’ attitudes to and knowledge of oral health are fundamental to providing good oral health care to older adults. One instrument that assesses healthcare professionals’ attitudes to and knowledge of oral health in a Swedish context is the “Attitudes to and Knowledge of Oral health” (AKO) questionnaire. Two of the three item-groups of the AKO have previously been validated in a Swedish context. However, it is crucial that all three item-groups are validated, and beneficial to design a shorter, easy-to-use questionnaire for healthcare professionals while maintaining adequate integrity of its reliability and validity. Therefore, the present study aims to develop a short-form version of AKO and to secure its psychometric properties. Methods Psychometric evaluation with Classical Test Theory and Item Response Theory to validate and shorten AKO with 611 healthcare professionals from a population of 1159 working in a municipality in an urban area in western Sweden. Results Of the original 16 items in the AKO, 13 were shown to warrant retention in the abbreviated/shortened form. These showed acceptable validity and reliability for assessing healthcare professionals’ attitudes to and knowledge of oral health. Conclusion This validated short-form version of AKO shows acceptable validity and reliability after being reduced to 13 items, structured in a 3-part scale. The items are consistent with the total scale, indicating that the internal consistency is acceptable. Future studies should be performed to evaluate AKO in other groups of healthcare professionals, across cultures, languages, and so on, to investigate its use and strengthen its validity and reliability. CC BY 4.0© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.© 2022 BioMed Central Ltd unless otherwise stated. Part of Springer Nature.Correspondence: maria.snogren@his.seOpen access funding provided by University of Skövde. This research received funding from the Skaraborg Institute for Research and Development, Skövde, Sweden, and from the School of Health Sciences University of Skövde, Skövde, Sweden.

Background Xerostomia and changes in saliva characteristics are common side-effects in patients with head and neck cancer (HNC) undergoing radiotherapy, which negatively impact their oral health. However, there are no consensus standards for intervention to manage these problems. The aim of this study was to determine the effect of an integrated supportive program on xerostomia and saliva characteristics at a 1-year follow-up of patients with HNC radiated with a low dose to the major salivary glands. Methods The CONSORT guidelines for a randomized controlled trial were used. Participants with a low overall dose to major salivary glands were randomly allocated to an intervention group (n = 47) or a control group (n = 45). The intervention group received usual care and an integrated supportive program, which included three steps: face-to-face education; face-to-face coaching at 1 month post-radiotherapy; and four telephone coaching sessions at 2, 3, 6, and 9 months post-radiotherapy. The face-to-face education consisted of oral hygiene instruction, oral self-care strategies, facial and tongue muscle exercises, and salivary gland massage. Adherence to the intervention was evaluated using a questionnaire completed during the 9 months follow-up. The control group received usual care. The unstimulated saliva flow rate and xerostomia were assessed in both groups. Results A total of 79 participants (40 in the intervention group and 39 in the control group) completed the 12 months follow-up. The intervention group achieved significantly greater relief from xerostomia than the control group after 3 months (intervention group: 35.1 ± 5.9 versus control group: 38.0 ± 5.9, P = 0.027) and 12 months follow-up (intervention group: 18.5 ± 4.1 versus control group: 22.8 ± 4.3, P P = 0.035). Adherence to the intervention was generally good. Conclusion This integrated supportive program with good adherence relieved xerostomia and had a positive effect on unstimulated saliva flow rate among patients with HNC radiated with a low dose to the major salivary glands during the 12 months of follow-up. Trial registration: Chinese Clinical Trial Registry ChiCTR2100051876 (08/10/2021), retrospectively registered.

Supragingival dental plaque samples were collected from 40 Swedish adolescents, including 20 with caries lesions (CAR) and 20 caries-free (CF). Fresh plaque samples were subjected to an ex vivo acid tolerance (AT) test where the proportion of bacteria resistant to an acid shock was evaluated through confocal microscopy and live/dead staining, and the metabolites produced were quantified by 1H Nuclear Magnetic Resonance (1H NMR). In addition, DNA was extracted and the 16S rRNA gene was sequenced by Illumina sequencing, in order to characterize bacterial composition in the same samples. There were no significant differences in AT scores between CAR and CF individuals. However, 7 out of the 10 individuals with highest AT scores belonged to the CAR group. Regarding bacterial composition, Abiotrophia, Prevotella and Veillonella were found at significantly higher levels in CAR individuals (p=0.0085, 0.026 and 0.04 respectively) and Rothia and Corynebacterium at significantly higher levels in CF individuals (p=0.026 and 0.003). The caries pathogen Streptococcus mutans was found at low frequencies and was absent in 60% of CAR individuals. Random-forest predictive models indicate that at least 4 bacterial species or 9 genera are needed to distinguish CAR from CF adolescents. The metabolomic profile obtained by NMR showed a significant clustering of organic acids with specific bacteria in CAR and/or high AT individuals, being Scardovia wiggsiae the species with strongest associations. A significant clustering of ethanol and isopropanol with health-associated bacteria such as Rothia or Corynebacterium was also found. Accordingly, several relationships involving these compounds like the Ethanol : Lactate or Succinate : Lactate ratios were significantly associated to acid tolerance and could be of predictive value for caries risk. We therefore propose that future caries risk studies would benefit from considering not only the use of multiple organisms as potential microbial biomarkers, but also their functional adaptation and metabolic output.

Aim To describe parental perceptions of general health, oral health and received dental health care in Swedish children with Down syndrome (DS). Methods Online questionnaire, quantitative data analysis (Chi-square test). Results Parents of 101 children with DS (52 boys, 49 girls, mean age: 9.6 years) participated. Seventy percent rated their child's general health and 74% their child's oral health as good or very good. Parents, who rated their child's oral health as poor (8%), also reported that dental procedures were difficult. Children received dental care at general (55%) and specialist clinics (53%). Ninety-four percent of parents of children receiving specialist dental health care were satisfied compared to 70% of parents with children in general clinics. The parents most valued characteristics of dental professionals were patience (63%) and their ability to engage the child (68%). Parents wanted multidisciplinary collaboration. Conclusion Most parents rated their child's general and oral health as good or very good. Children with poor oral health were also reported to have difficulties coping with dental procedures. Parents wanted dental care to be tailored to meet their child's unique needs. They wanted dental professionals to have knowledge about children with a need for special care. Lastly, they requested multidisciplinary collaboration.

Introduction The Convention on the Rights of the Child will be absorbed into Swedish law by 2020, which highlights the need to promote equality in communication between health care professionals and communicatively vulnerable children. In this regard, participation and person-centredness is important in the interaction with each child to provide adequate information on the peri-radiographic process in a way that the child can understand. Hence, the aim was to develop communication support for interaction with children during acute radiographic procedures. Method The study has a qualitative design adapting a multiphase structure. A participatory design was used which included four phases conducted in succession to each other. Interviews were conducted with children from Elementary School and Special School. Questionnaires were collected from their parents and from radiographers in four different Radiology Departments. Results The analysis of the data highlighted the need for information in the peri-radiographic process. Parents and children wanted material that is easy to use and could be adapted in a person-centred way. Conclusion A prototype of the ICIR (interactive communication support in radiology settings), with illustrations and accompanying text was developed that can be useful as information sharing in interaction between children, parents and health care professionals in the radiographic context. Implications for practice The ICIR can be a usable tool for information sharing in the interaction between children, parents and health care professionals during radiographic procedures.

The aim was to examine the caries incidence in adolescents using the Public Dental Service (PDS) during a 5-year period in relation to their caries experience at baseline and risk classification.A 5-year retrospective cohort study based of the dental records from 17 PDS clinics in south-eastern Sweden was conducted; 159 individuals born in 1997 were included, and their caries risk was classified at 12 and 17 years of age. Caries prevalence and documented risk groups were assessed at baseline and after 5 years.The increment of caries (both initial and manifest caries) was higher, to a statistically significant degree, after 5 years in adolescents who were recorded as caries-free at baseline compared to individuals with caries at baseline (P .001). In individuals with caries at baseline, the greatest increment of caries was found at approximal sites (P .001). At baseline, individuals were classified as low (94%), medium (6%) and high risk (0%). After 5 years, the figures were 74%, 20% and 6%, respectively. Although classified in a low-caries risk group, 9% had ≥6 decayed or filled surfaces at baseline, and 23% did after 5 years. Approximately 62% of individuals were registered as caries-free at baseline, and 45% were after 5 years.There was an increase in caries over 5 years, especially among adolescents without caries experience at baseline. The majority of adolescents had the same risk classification after 5 years. Further research with a larger sample size is needed to evaluate risk assessment for caries.

Information on how the oral microbiome develops during early childhood and how external factors influence this ecological process is scarce. We used high-throughput sequencing to characterize bacterial composition in saliva samples collected at 3, 6, 12, 24 months and 7 years of age in 90 longitudinally followed children, for whom clinical, dietary and health data were collected. Bacterial composition patterns changed through time, starting with “early colonizers”, including Streptococcus and Veillonella; other bacterial genera such as Neisseria settled after 1 or 2 years of age. Dental caries development was associated with diverging microbial composition through time. Streptococcus cristatus appeared to be associated with increased risk of developing tooth decay and its role as potential biomarker of the disease should be studied with species-specific probes. Infants born by C-section had initially skewed bacterial content compared with vaginally delivered infants, but this was recovered with age. Shorter breastfeeding habits and antibiotic treatment during the first 2 years of age were associated with a distinct bacterial composition at later age. The findings presented describe oral microbiota development as an ecological succession where altered colonization pattern during the first year of life may have long-term consequences for child´s oral and systemic health., A.M.: Spanish Ministry of Economy and Competitiveness (grant no. BIO2015-68711-R). M.S.: The Research Council for the South-East Sweden (grant no: 79001). M.C.J.: The Swedish Research Council (2016-01698); the Swedish Heart and Lung Foundation (20140321); the Medical Research Council of Southeast Sweden (FORSS-573471); the Cancer and Allergy Foundation. M.C.C.: European Research Council (ERC-starting grant 639226).

The aim of the present case-control study was to investigate dental caries, various caries-related factors as well as gingival condition, in 12- to 16-year-olds with long-term asthma (n = 20) and a matched healthy control group (n = 20). Data on dietary and oral hygiene habits, numbers of mutans streptococci and lactobacilli in saliva were also obtained. The plaque pH drop after a sucrose rinse was measured up to 40 min at 2 approximal tooth sites. A lower salivary flow rate was found in the asthma group compared to the control group (p < 0.05). The mean (± SD) of DFS, including manifest and initial caries, was 4.9 ± 5.5 in the asthma and 1.4 ± 2.3 (p < 0.01) in the control group. Only 1 adolescent in the asthma group was caries free compared to 13 in the control group. Concerning pH in plaque, adolescents with asthma had a lower initial value (p < 0.01) and final pH (p < 0.05) than the control group. The Cariogram data showed that 55% of the subjects in the control group had ‘a high chance of avoiding caries’ compared to 10% in the asthma group (p < 0.01). The asthmatic adolescents had higher numbers of sites with gingival bleeding (p < 0.01). To conclude, adolescents with long-term asthma had a higher total DFS and caries risk (according to Cariogram), decreased salivary rate, more gingival bleeding and lower plaque pH than adolescents without asthma.

Objective. The aim of this study was to investigate oral health and its determinants in 3-year-old and 6-year-old children with asthma. Methods and subjects. Caries and gingivitis were examined in 127 asthmatic (all children with asthma in a selected area and born during a specific time period) and 117 matched, healthy control children.The parents were interviewed regarding various oral-health-related factors. Results. The mean dfs (± standard deviation) in the 3-year-old with asthma was 1.4 ± 3.2 compared with 0.5 ± 1.2 in the controls (P

Objective. To study oral health in young adults with long-term, controlled asthma. Material and methods. Twenty 18- to 24-year-olds with a mean duration of asthma of 13.5 [standard deviation (SD) 5.4] years and 20 matched healthy controls were included. A clinical examination was performed and the prevalences of caries, erosions, gingival inflammation, cervicular fluid and periodontal pockets and the plaque formation rate were registered. The salivary flow rate and the numbers of mutans Streptococci and Lactobacilli in saliva were determined. Plaque pH was measured after a sucrose rinse for up to 40 min at two approximal sites. The participants were interviewed regarding dietary and oral hygiene habits. Results. The mean (SD) DFS, including manifest and initial caries, was 8.6 (10.6) in the asthma group and 4.0 (5.2) in the control group (P = 0.09). Initial caries lesions were more common in the asthma group than in the control group: 6.0 (8.1) and 1.3 (2.0), respectively (P = 0.02). The asthma group had more gingivitis (P = 0.01) and a lower stimulated salivary secretion rate than the controls (P = 0.01). The asthmatics also had a somewhat, although not statistically significant, lower initial pH value in plaque and a more pronounced pH drop compared with the controls. In the asthma group, 65% reported frequent mouthbreathing, compared with 10% of the controls (P = 0.01). No differences were found in tooth-brushing or dietary habits between the groups. Conclusion. Young adults with long-term, controlled asthma had more initial caries, more gingival inflammation and a lower stimulated salivary secretion rate than individuals without asthma.

OBJECTIVE: The aim of this study was to investigate caries and its determinants in preschool children with and without asthma, followed from 3 to 6 years. METHODS AND SUBJECTS: Caries, plaque, and gingivitis were examined at 3 and 6 years of age in 64 asthmatic children and 50 matched, healthy control children. Furthermore, at 6 years radiographic examination and saliva sampling were conducted. The parents were interviewed about various oral health-related factors. RESULTS: Initial caries increment between 3 and 6 years of age was statistically significant higher for children with asthma compared with children without asthma (P < 0.05). Asthmatic children had more bleeding gingivitis and a higher consumption of sugary drinks than healthy children at 3 years of age (P < 0.05). At both 3 and 6 years of age, the asthmatic children were more frequently mouth breathers than healthy children, only statistically significant for 6-year olds (P < 0.05). CONCLUSION: Preschool children with asthma at 3 years of age run a higher risk of developing caries lesions until 6 years of age compared with children without asthma. Children with asthma have a higher prevalence of bleeding gingivitis, a higher intake of sugary drinks and are more frequently mouth breathers than preschool children without asthma.