28 results on '"Øystein Fardal"'
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2. The PTEN hamartoma tumor syndrome: how oral clinicians may save lives
- Author
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Øystein Fardal, Kristian Nevland, Anne Christine Johannessen, and Hildegunn Høberg Vetti
- Subjects
General Engineering ,General Medicine - Published
- 2022
3. Mukogingivale forandringer som følge av bruk av snus – presentasjon av fem kasus
- Author
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Øystein Fardal and Anne Christine Johannessen
- Abstract
Hovedbudskap Bruken av snus er økende i Norge, særlig blant yngre mennesker Kasuspresentasjonene viser mukogingivale forandringer og gingivale retraksjoner som ofte er observert hos pasienter. Det er viktig å være klar over de orale forandringene som kan skje i forbindelse med bruken av snus og anbefale pasientene å slutte.
- Published
- 2022
4. Provision of treatment for periodontitis in Norway in 2013 – a national profile
- Author
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Gunnar Rongen, Peter A. Heasman, Øystein Fardal, Jostein Grytten, and Irene Skau
- Subjects
Male ,medicine.medical_specialty ,Periodontal treatment ,Dentists ,Population ,Dentistry ,Norwegian ,03 medical and health sciences ,Professional Role ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Periodontitis ,Surgical treatment ,education ,General Dentistry ,Periodontal Diseases ,Aged ,education.field_of_study ,Scientific Research Report ,Norway ,business.industry ,Dental health ,030206 dentistry ,medicine.disease ,language.human_language ,Cross-Sectional Studies ,language ,Female ,business - Abstract
Background Epidemiological studies have reported high levels of periodontal diseases worldwide. Over the last 40 years, Norway has introduced several measures including major financial support to reduce periodontal diseases. The aims of this study were to establish the present level of periodontal treatment, the treatment profiles for the nation, and to assess if long-term clinical data support the findings. Materials and methods The database of the Norwegian Health Economic Administration for 2013 was analysed to establish the prevalence of treated periodontitis in a cross-sectional register-based study. Treatment profiles including patients' ages, gender, geographic distributions, treatment types, prosthetic tooth replacements and the treatment distributions between the dental health professionals were assessed. Results 4.4% of the 20 years and older age group was treated for periodontitis. More females (55%) than males (45%) were treated with predominance in the 60-69 year age group. Private general dental practitioners performed 43.8% of the total periodontal treatment, while dental hygienists performed 22.5%. Periodontists performed 32.8% of the non-surgical and 74.6% of the surgical treatment. Tooth replacements for teeth lost due to periodontal diseases were provided for 0.57% of the population. Clinical studies from Norway showed marked improvements in the periodontal parameters examined over the last 40 years. Conclusion The frequency of periodontal treatments in Norway was low, but sufficient to maintain major tooth retention for the population. Long-term external clinical data supported these findings. The treatments were well distributed between private general dental practitioners, hygienists and periodontists.
- Published
- 2020
5. Proposing a model for auditing data quality of long-term periodontal outcome studies
- Author
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Øystein Fardal, Irene Skau, Kristian Nevland, and Jostein Grytten
- Subjects
Tooth Loss ,Outcome Assessment, Health Care ,Humans ,General Medicine ,Longitudinal Studies ,General Dentistry ,Data Accuracy ,Retrospective Studies - Abstract
Objective The assessment of the success of conventional periodontal therapy is based on retrospective studies from private practice and university clinics. Due to their marked heterogeneity, it is difficult to assess the data quality and rate these studies. The aim is to test a model for auditing and rating the data quality of periodontal outcome studies. Methods The method was adapted from the NIH Health Care Systems Collaboratory model, which uses three data quality dimensions: completeness (including all the relevant variables), consistency (ensuring that the same variables are compared) and accuracy (proportion of data in error with a gold standard). The model was applied to studies from a Norwegian specialist practice and data from the Norwegian Health database to test if the auditing process was workable using real world data. Results Forty-seven risk and prognostic factors were included for completeness. Seven variables were specified for consistency: tooth loss, smoking, systemic conditions, oral hygiene, individual tooth prognosis, maintenance profiles and timing of extractions. The factors tested showed a 95.7% completeness and an average accuracy deviation from the gold standard of −2.3% for each of the risk/prognostic factors and an overall study score of 93.3%. Conclusions It was possible to develop a method for auditing and rating the quality of periodontal outcome studies. The model was tested using both real world data including risk and prognostic factors from individual outcome studies and national big data. The application of the model to these sets of data showed a high accuracy of the risk/prognostic factors and a close relationship with national big data.
- Published
- 2022
- Full Text
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6. Familial tendency as a determinant of tooth loss during long-term periodontal therapy
- Author
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Øystein Fardal, Jostein Grytten, and Irene Skau
- Subjects
Pediatrics ,medicine.medical_specialty ,Prognostic factor ,Affect (psychology) ,03 medical and health sciences ,Tooth Loss ,0302 clinical medicine ,Periodontal disease ,medicine ,Tooth loss ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Family history ,Child ,Periodontal Diseases ,A determinant ,Retrospective Studies ,business.industry ,Dental scaling ,030206 dentistry ,Private practice ,Tooth Extraction ,Periodontics ,medicine.symptom ,business - Abstract
Aim Little evidence exists on how familial tendencies affect the long-term success of periodontal therapy. The aim of this study was to compare outcomes for two generations and their control patients treated in the same private practice. Materials/methods Parents and their children were observed for tooth loss between 1986 and 2017. Matching control groups were identified from the same practice, one for the parent and one for the children group. The control patients had no close family members with a history of periodontal diseases. Both the generations and control groups completed a similar course of periodontal therapy. The matching strategy aimed at making the groups as similar as possible with respect to well-known risk and prognostic factors. The data were analysed by multiple regression where the outcome was the number of teeth lost due to periodontal disease. Results A total of 435 patients were identified (148 parents, 154 children and 133 controls). 72 parents and 61 children (133) had more than 5 years follow-up (average 15.5 and 12.9 years, respectively). Balancing tests showed that the matching was successful. 65% of tooth loss was attributable to close family history. The regression showed that the parent generation lost 1.02 more teeth than the controls, while the children lost 0.61 more teeth. Conclusion Having close family members with a history of periodontal diseases is a strong prognostic factor affecting the long-term outcome of periodontal therapy.
- Published
- 2020
7. Adding smoking to the Fardal model of cost-effectiveness for the lifetime treatment of periodontal diseases
- Author
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Øystein Fardal, John A. Martin, Peter A. Heasman, Jostein Grytten, Patrick Fardal, Gerard J. Linden, and Stig Aanerød Ellingsen
- Subjects
0301 basic medicine ,Financial costs ,medicine.medical_specialty ,Periodontal treatment ,Cost effectiveness ,Cost-Benefit Analysis ,03 medical and health sciences ,Tooth Loss ,0302 clinical medicine ,Periodontal disease ,Cigarette smoking ,medicine ,Humans ,In patient ,Intensive care medicine ,Treatment costs ,Dental Care ,health care economics and organizations ,Periodontal Diseases ,business.industry ,Smoking ,030206 dentistry ,030104 developmental biology ,Supportive psychotherapy ,Periodontics ,business - Abstract
Background Little is known about the financial costs that smoking adds to the lifetime treatment of periodontal disease. Methods The total lifetime cost of periodontal treatment was modeled using data from private periodontal practice. The costs of initial and supportive therapy, re‐treatment and tooth replacements (with bridgework or implants) were identified using average dental charges from the American Dental Association survey. Smoking costs at $6 and $10 for 20 cigarettes were compared to the costs of lifetime periodontal treatment for stable and unstable compliant patients. Results Smoking added 8.8% to the financial cost of the lifetime cost of periodontal therapy in stable maintenance patients, 40.1% in patients who needed one extra maintenance visit, and 71.4% in patients who needed two extra maintenance visits per year in addition to added retreatment. The cost of smoking far exceeded the cost of periodontal treatment; For patients who smoked 10 to 40 cigarettes per day at the cost of $6 or $10 a pack, the cost of smoking exceeded the cost of lifetime periodontal treatment by between 2.7 and 17.9 times. Smoking 40 cigarettes at $10 a packet for 3.4 years would pay for the entire lifetime cost of periodontal treatment. Conclusion Smoking adds considerable extra financial costs to the lifetime treatment of periodontal diseases. The cost of smoking itself exceeds the cost of periodontal therapy.
- Published
- 2017
8. Applying quality assurance in real time to compliant long-term periodontal maintenance patients utilizing cost-effectiveness and cost utility
- Author
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Jostein Grytten and Øystein Fardal
- Subjects
Male ,medicine.medical_specialty ,Quality Assurance, Health Care ,Visual Analog Scale ,Cost effectiveness ,Visual analogue scale ,Cost-Benefit Analysis ,Population ,Pain ,Oral Health ,Dental Prosthesis ,Tooth Loss ,Maintenance therapy ,Dental Anxiety ,Humans ,Medicine ,Longitudinal Studies ,Dental Restoration, Permanent ,education ,Periodontal Diseases ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Middle Aged ,Surgery ,Term (time) ,Treatment Outcome ,Patient Satisfaction ,Cost utility ,Physical therapy ,Patient Compliance ,Periodontics ,Anxiety ,Female ,medicine.symptom ,business ,Attitude to Health ,Quality assurance ,Follow-Up Studies - Abstract
Background Little work has been done on quality assurance of long-term maintenance of periodontal therapy Materials/methods A quality assurance model was applied to 80 patients (50 females, 30 males) with an average age of 64.3 years (SD. 8.83, range 45–91) and with 21.6 (SD. 2.65, range 16–26) maintenance years. The main elements were patients' expectations, objectives and patient-based outcomes, human and financial costs and treatment deviations. For cost-effectiveness, this group was compared with a control group of 25 patients with an average of 9.96 years not complying with maintenance therapy. Results The patients' main expectations and reasons for seeking treatment were to save teeth and a desire for better oral health. The patients had a total tooth-year loss of 3.3%. 81.3% reported improved oral health. Total treatment discounted cost was €5842. The cost of buying an extra tooth year was €20.2. Patients reported anxiety of 4.6 (SD10.5, range 0–47) and discomfort of 11.8 (SD13.2 range 0–70) for the maintenance visits on the Visual Analogue Scale (VAS). Treatment deviations showed 3.8% extreme downhill patients, 6.3% with poor oral hygiene, 3.8% reported a worsening of their oral health, 3.8% had high anxiety whereas 5.0% experienced a high level of discomfort. Conclusion It is possible to apply a number of elements of a quality assurance measure to a patient population of compliant maintenance patients in real time. The results obtained compare well with previous internal and external studies. This model should be useful to patients and practitioners as well as for larger population-based studies.
- Published
- 2014
9. The Lifetime Direct Cost of Periodontal Treatment: A Case Study From a Norwegian Specialist Practice
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Gerard J. Linden, Øystein Fardal, Per Gjermo, Ciaran O'Neill, B. Frode Hansen, Leiv Sandvik, and Elizabeth Fardal
- Subjects
Periodontal treatment ,Cost-Benefit Analysis ,Dentistry ,Norwegian ,Tooth Loss ,Humans ,Medicine ,health care economics and organizations ,Cost implications ,Dental Implants ,Cost–benefit analysis ,Norway ,business.industry ,Dental prosthesis ,Health Care Costs ,Direct cost ,medicine.disease ,Chronic periodontitis ,language.human_language ,Quality-adjusted life year ,Chronic Periodontitis ,Organizational Case Studies ,language ,Denture, Partial, Fixed ,Periodontics ,Quality-Adjusted Life Years ,business - Abstract
Successful periodontal treatment requires a commitment to regular lifelong maintenance and may be perceived by patients to be costly. This study calculates the total lifetime cost of periodontal treatment in the setting of a specialist periodontal practice and investigates the cost implications of choosing not to proceed with such treatment.Data from patients treated in a specialist practice in Norway were used to calculate the total lifetime cost of periodontal treatment that included baseline periodontal treatment, regular maintenance, retreatment, and replacing teeth lost during maintenance. Incremental costs for alternative strategies based on opting to forego periodontal treatment or maintenance and to replace any teeth lost with either bridgework or implants were calculated.Patients who completed baseline periodontal treatment but did not have any additional maintenance or retreatment could replace only three teeth with bridgework or two teeth with implants before the cost of replacing additional teeth would exceed the cost of lifetime periodontal treatment. Patients who did not have any periodontal treatment could replace ≤ 4 teeth with bridgework or implants before a replacement strategy became more expensive.Within the limits of the assumptions made, periodontal treatment in a Norwegian specialist periodontal practice is cost-effective when compared to an approach that relies on opting to replace teeth lost as a result of progressive periodontitis with fixed restorations. In particular, patients who have initial comprehensive periodontal treatment but do not subsequently comply with maintenance could, on average, replace ≤ 3 teeth with bridgework or two teeth with implants before this approach would exceed the direct cost of lifetime periodontal treatment in the setting of the specialist practice studied.
- Published
- 2012
10. Impact of Anxiety on Pain Perception Associated With Periodontal and Implant Surgery in a Private Practice
- Author
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Christopher A. McCulloch and Øystein Fardal
- Subjects
Adult ,Male ,Pain Threshold ,Reoperation ,medicine.medical_specialty ,genetic structures ,Visual analogue scale ,medicine.drug_class ,Anesthesia, Dental ,media_common.quotation_subject ,Alveolar Bone Loss ,Specialty ,Dentistry ,Surgical Flaps ,Sex Factors ,Perception ,Dental Anxiety ,medicine ,Humans ,Pain perception ,Anesthetics, Local ,Periodontal Diseases ,Aged ,Pain Measurement ,media_common ,Aged, 80 and over ,Pain, Postoperative ,Local anesthetic ,business.industry ,Furcation Defects ,Dental Implantation, Endosseous ,Middle Aged ,Private practice ,Taste ,Physical therapy ,Periodontics ,Anxiety ,Female ,Implant ,medicine.symptom ,business ,Attitude to Health ,Anesthesia, Local - Abstract
There are limited data on pain perception after periodontal or implant surgery or how pain perception is affected by presurgical anxiety.Presurgical anxiety and surgical pain perceptions were measured by visual analog scale (VAS) scores and by interview of patients (N = 102) undergoing periodontal or implant therapy in a private periodontal specialty practice in Norway.Patients reported that bad taste, receiving the local anesthetic, and excessive fluid in the mouth were the most uncomfortable experiences associated with periodontal or implant surgery. Analysis of identical responses to these questions showed that there was low intrapatient agreement for uncomfortable experiences (κ = 0.18), but there was reasonably good agreement for comfortable experiences (κ = 0.76). There were no significant differences between repeated VAS scores for pain perception (P = 0.91) or anxiety (P = 0.75) from two consecutive surgeries. There were no significant differences of VAS scores for perception of discomfort for periodontal surgery (9.9 ± 17.0) compared to implant surgery (16.7 ± 24.2; P0.2). Presurgical anxiety scores were higher for implant surgery (45.5 ± 33.4) than for periodontal surgery (19.5 ± 28.1; P0.01). Patients with high pretreatment anxiety scores reported that periodontal and implant surgery were more uncomfortable than patients with low anxiety scores (20.5 ± 25.6 versus 0.45 ± 1; P0.001). VAS perception and anxiety scores did not change on first-time through fourth-time surgeries, but retreatment surgery patients recorded higher perception and anxiety VAS scores than patients undergoing surgery for the third or fourth time (P0.01). Females recorded significantly higher anxiety scores than males (P = 0.04).For periodontal surgery and implant treatments pain perception is affected by the level of presurgical anxiety.
- Published
- 2012
11. Tooth loss and implant outcomes in patients refractory to treatment in a periodontal practice
- Author
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Gerard J. Linden and Øystein Fardal
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Dental Plaque ,Dentistry ,Dental plaque ,Oral hygiene ,Tooth Loss ,Refractory ,Recurrence ,Risk Factors ,Stress, Physiological ,Tooth loss ,medicine ,Humans ,Dental Restoration Failure ,Family history ,Periodontal Diseases ,Aged ,Dental Implants ,Periodontitis ,business.industry ,Smoking ,Implant failure ,Middle Aged ,Oral Hygiene ,medicine.disease ,Surgery ,Treatment Outcome ,Case-Control Studies ,Patient Compliance ,Periodontics ,Female ,Implant ,medicine.symptom ,business ,Follow-Up Studies - Abstract
AIM: The aim of this study was to investigate the factors associated with continued significant tooth loss due to periodontal reasons during maintenance following periodontal therapy in a specialist periodontal practice in Norway. MATERIAL AND METHODS: A case-control design was used. Refractory cases were patients who lost multiple teeth during a maintenance period of 13.4 (range 8-19) years following definitive periodontal treatment in a specialist practice. Controls were age- and gender-matched maintenance patients from the same practice. Characteristics and treatment outcomes were assessed, and all teeth classified as being lost due to periodontal disease during follow-up were identified. The use of implants in refractory cases and any complications relating to such a treatment were recorded. RESULTS: Only 27 (2.2%) patients who received periodontal treatment between 1986 and 1998 in a specialist practice met the criteria for inclusion in the refractory to treatment group. Each refractory subject lost 10.4 (range 4-16) teeth, which represented 50% of the teeth present at baseline. The rate of tooth loss in the refractory group was 0.78 teeth per year, which was 35 times greater than that in the control group. Multivariate analysis indicated that being in the refractory group was predicted by heavy smoking (p=0.026), being stressed (p=0.016) or having a family history of periodontitis (p=0.002). Implants were placed in 14 of the refractory patients and nine (64%) of these lost at least one implant. In total, 17 (25%) of the implants placed in the refractory group were lost during the study period. CONCLUSIONS: A small number of periodontal maintenance patients are refractive to treatment and go on to experience significant tooth loss. These subjects also have a high level of implant complications and failure. Heavy smoking, stress and a family history of periodontal disease were identified as factors associated with a refractory outcome.
- Published
- 2008
12. Interviewing Self-Reported Highly Anxious Patients During Periodontal Treatment
- Author
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Øystein Fardal and B. Frode Hansen
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Adult ,Male ,Periodontal treatment ,medicine.medical_specialty ,business.industry ,Toothache ,Middle Aged ,Root Planing ,Interviews as Topic ,Phobic Disorders ,Dental Anxiety ,Anticipatory anxiety ,Dental Scaling ,Humans ,Periodontics ,Medicine ,Anxiety ,Female ,Sex Distribution ,medicine.symptom ,business ,Psychiatry ,Fear of pain ,Periodontal Diseases ,Aged - Abstract
Background: Little information exists on highly anxious patients referred for periodontal therapy. Methods: All patients referred for periodontal therapy between November 1, 2002 and April 1, 2004 were included in this study. Patients who perceived themselves as extremely anxious were interviewed further, and their anxiety levels were observed during the various stages of periodontal therapy. Results: Twenty-one (19 females and two males, average age, 49.76 years) of 176 patients (12.1%) reported extreme anticipatory anxiety. The main reasons for their anxiety were fear of pain and previous bad experience(s). Conclusions: Average anxiety levels decreased with the progress of the periodontal therapy. However, individual responses varied greatly and were unpredictable.
- Published
- 2007
13. Management of periodontal disease in patients using calcium channel blockers - gingival overgrowth, prescribed medications, treatment responses and added treatment costs
- Author
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Henning Lygre and Øystein Fardal
- Subjects
Drug ,Adult ,Male ,medicine.medical_specialty ,Dihydropyridines ,Dose ,media_common.quotation_subject ,Dentistry ,Renin-Angiotensin System ,Tooth Loss ,Maintenance therapy ,Recurrence ,Internal medicine ,Tooth loss ,Medicine ,Humans ,Treatment costs ,media_common ,Aged ,Aged, 80 and over ,business.industry ,Drug Substitution ,Gingival Overgrowth ,Calcium channel ,Dihydropyridine ,Health Care Costs ,Middle Aged ,medicine.disease ,Calcium Channel Blockers ,Oral Hygiene ,Drug Combinations ,Treatment Outcome ,Chronic Periodontitis ,Retreatment ,Periodontics ,Female ,medicine.symptom ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Adverse drug reaction ,medicine.drug ,Follow-Up Studies - Abstract
OBJECTIVES Gingival overgrowth (GO) is an adverse drug reaction in patients using calcium channel blockers (CCBs). Little is known about the effects of CCBs on the management of periodontal diseases. The aim of this study was to assess how the use of CCBs affects the long-term supportive treatment and outcomes in patients undergoing periodontal therapy. METHODS All patients using CCBs during the initial treatment and/or the supportive periodontal therapy (SPT) were selected from a periodontal practice. Patients were scored using a Gingival Overgrowth Index (GOI). The effects of CCB types and dosages were assessed in terms of the frequency and the severity of GO, treatment responses, substitutions and extra treatment costs. Mean values, Standard Deviation (SD) and range were calculated. The Mann-Whitney test was used to assess statistically significant differences (p < 0.05) for GO between patients with good and poor oral hygiene, differences between before and after terminating or replacing the CCBs, possible differences between drug dosages (Dihydropyridine 5 mg and 10 mg) and differences between three drug combinations (CCB and inhibitors of the renin-angiotensin system (IRAS), CCB and non-IRAS, CCB and statins). RESULTS One hundred and twenty-four patients (58 females, 66 males, 4.6% of the patient population) were using CCBs. 103 patients were assessed. Average age was 66.53 years (SD. 9.89, range 42-88) and the observation time was 11.30 years (SD 8.06, range 1-27). Eighty-nine patients had GO, 75 of these required treatment for GO. Terminating or replacing with alternatives to CCBs resulted in significant decreases in GO (p = 0.00016, p = 0.00068) respectively. No differences were found between good and poor oral hygiene (p = 0.074), drug dosages or the various drug combinations. Surgical treatment was more effective than non-surgical treatment in controlling the GO. Long-term tooth loss was 0.11 teeth per patient per year. Forty-two patients needed re-treatments for GO, resulting in an extra life cost per patient of €13471 (discounted €4177). CONCLUSION The majority of patients (86.4%) using CCBs experienced GO. 47.2% of these experienced recurrence(s) of GO during the SPT and needed re-treatments with resulting added costs. The long-term tooth loss was considerably higher for patients using CCBs than for other patients groups from the same practice setting.
- Published
- 2015
14. Interviews and assessments of returning non-compliant periodontal maintenance patients
- Author
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Øystein Fardal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health Status ,Dentists ,MEDLINE ,Dentistry ,Interviews as Topic ,Treatment Refusal ,Tooth Loss ,Periodontal disease ,Maintenance therapy ,Tooth loss ,medicine ,Humans ,Referral and Consultation ,Periodontal maintenance ,Periodontal Diseases ,Aged ,Aged, 80 and over ,Motivation ,business.industry ,Age Factors ,Dental scaling ,Periodontology ,Middle Aged ,Disease Progression ,Physical therapy ,Dental Scaling ,Periodontics ,Female ,medicine.symptom ,business ,Attitude to Health - Abstract
Background: Periodontal therapy without a maintenance programme has been shown to be of doubtful value. Most studies show a low-level of compliance with periodontal maintenance therapy. Many suggestions as to the reasons for this have been put forward, but it has been difficult to confirm these, as the patients are not available to be interviewed. Aim: To identify, interview and assess returning non-compliant periodontal maintenance patients. Method: All patients who had undergone periodontal therapy between 1986 and 2004 but not complied with the maintenance therapy were interviewed and assessed when they later returned to the specialist office for treatment. Results: Sixty-one patients with an average age of 56.4 years (SD 11,1) were studied. There were 18 males and 43 females. The patients were compliant for 3.4 years (SD 3.2) before leaving and returning after 5.5 years (SD 3.3) of non-compliance. Average tooth loss while non-compliant was 1.6 teeth (SD 2.8). The interviews revealed that 37 patients attended their own dentist's office exclusively for maintenance therapy, eight patients gave health reasons and seven patients lack of motivation or failure to cooperate. Thirty-six patients were re-referred by their own dentist, 13 changed dentist and were referred by this dentist, while 12 patients contacted the specialist office directly. Fifty-three patients claimed to have been fully compliant with their own dentist while non-compliant with the specialist office. Conclusion: The main reason for non-compliance was that the patients did attend their own dentist exclusively for maintenance therapy. Tooth loss and periodontal deterioration was more marked in this group than patients who in addition attended the specialist office for maintenance therapy.
- Published
- 2006
15. Re-treatment profiles during long-term maintenance therapy in a periodontal practice in Norway
- Author
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Øystein Fardal and Gerard J. Linden
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Adult ,Male ,Poor prognosis ,Periodontal treatment ,Periodontal surgery ,Dentistry ,Logistic regression ,Periodontal disease ,Secondary Prevention ,Humans ,Medicine ,Longitudinal Studies ,Family history ,Periodontal Diseases ,Aged ,Aged, 80 and over ,Postoperative Care ,Norway ,business.industry ,Dental Prophylaxis ,Long term maintenance ,Middle Aged ,Logistic Models ,Retreatment ,Patient Compliance ,Periodontics ,Female ,Periodontal Index ,business - Abstract
Background: Periodontal therapy coupled with active maintenance has been shown to be effective in maintaining periodontal health, however, the question of re-treatment is rarely alluded to in the literature. Aim: To quantify the type and extent of re-treatment in a group of patients who had completed a definitive course of periodontal treatment in a Norwegian specialist periodontal practice. The study also investigated factors associated with the provision of periodontal surgery as a re-treatment modality. Methods: A consecutive group of patients who had comprehensive periodontal treatment, which included periodontal surgery, and were subsequently maintained for between 10 and 17 years were studied. Results: One hundred and one patients with an average age at reassessment of 59.4 (standard deviation (SD) 9.0) years were studied. The average length of the review period was 13.1 (SD 1.9) years. In addition to routine maintenance, 50 patients had further re-treatment and 40 of those who were re-treated had periodontal surgery in the study period. Logistic regression showed that independent predictors of surgical re-treatment, with the effects adjusted for other variables in the model, were uncertain or poor prognosis at baseline, erratic or poor post baseline compliance and a family history of periodontal disease. Conclusion: Considerable amounts of re-treatment, including in many cases extensive non-surgical treatment or periodontal surgery, were provided for patients who had surgical periodontal treatment and were subsequently maintained for least 10 years in a specialist periodontal practice.
- Published
- 2005
16. Gingivo-mucosal and cutaneous reactions to amalgam fillings
- Author
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Tore Morken, Øystein Fardal, and Anne Christine Johannessen
- Subjects
Male ,Allergy ,medicine.medical_specialty ,Dentistry ,Hand Dermatoses ,Oral cavity ,Dental Amalgam ,Buccal mucosa ,stomatognathic system ,Tongue ,Hypersensitivity ,medicine ,Humans ,Aged ,Stomatitis ,Mercury allergy ,business.industry ,Mouth Mucosa ,Mercury ,Patch Tests ,medicine.disease ,Dermatology ,stomatognathic diseases ,medicine.anatomical_structure ,Retreatment ,Periodontics ,business ,Skin lesion - Abstract
Background: A number of reports exist on the side effects of materials used to restore teeth. Most of the cases involve local allergy reactions, but also skin lesions are described. Few cases are described where both local effects on the mucosa and skin lesions distant to the oral cavity are caused by amalgam. Result: The case presented indicates that the release of mercury from amalgam fillings is able to induce hypersensitivity reactions resulting in soft-tissue changes in the gingiva, buccal mucosa, tongue and on the skin of the back of the hands.
- Published
- 2005
17. Research in a Dental Practice Setting
- Author
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Øystein Fardal
- Subjects
Male ,Dental practice ,Protocol (science) ,Research design ,medicine.medical_specialty ,Medical education ,business.industry ,Dental research ,Dental Research ,Alternative medicine ,Dentistry ,Economic shortage ,stomatognathic diseases ,Dental Offices ,stomatognathic system ,Research Design ,Data Interpretation, Statistical ,medicine ,Humans ,Child ,Journalism, Dental ,business ,General Dentistry ,Reliability (statistics) - Abstract
There is a shortage of research from dental practice. The aim of this article is to stimulate more interest in dental research. This is done by explaining the basic principles of doing research in a dental practice setting. Examples are taken from the author's own practice. Emphasis is placed on the following points: how to develop and research ideas; factors specific to dental practice; how articles and journals are rated; making a protocol for the study; examiners' reliability and statistical analysis.
- Published
- 2004
18. Tooth loss during maintenance following periodontal treatment in a periodontal practice in Norway
- Author
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Øystein Fardal, Gerard J. Linden, and Anne Christine Johannessen
- Subjects
Adult ,Male ,Quality Control ,Dentistry ,Logistic regression ,Tooth Loss ,Sex Factors ,stomatognathic system ,Odds Ratio ,Tooth loss ,medicine ,Humans ,Periodontitis ,Aged ,Retrospective Studies ,Chi-Square Distribution ,Norway ,business.industry ,Dental Prophylaxis ,Smoking ,Age Factors ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Prognosis ,medicine.disease ,Confidence interval ,stomatognathic diseases ,Logistic Models ,Patient Compliance ,Periodontics ,Female ,medicine.symptom ,business ,Chi-squared distribution - Abstract
Background: Periodontal therapy coupled with careful maintenance has been shown to be effective in maintaining periodontal health; however, a small number of teeth are still lost because of progressive periodontitis. Aim:To investigate factors associated with tooth loss due to periodontal reasons during maintenance following periodontal treatment in patients in a Norwegian specialist periodontal practice. The study also examined how initial prognosis related to actual outcome as measured by periodontal tooth loss. Methods: Hundred consecutive patients (68 females, 32 males) who had comprehensive periodontal treatment and attended for 9.8 (SD: 0.7), range: 9-11 years of maintenance care, were studied. All teeth classified as being lost due to periodontal disease over the period were identified. Results: Only 36 (1.5%) of the 2436 teeth present at baseline were subsequently lost due to periodontal disease. There were 26 patients who lost at least one tooth. Logistic regression analysis showed that tooth loss was significantly related to male gender (p = 0.049; adjusted odds ratio: 2.8; confidence interval (c.i.): 1.0-8.1), older age, i.e.>60 years (p=0.012; adjusted odds ratio: 4.0; c.i.: 1.3-12.0) and smoking (p = 0.019; adjusted odds ratio: 4.2; c.i.: 1.4-13.8). The majority 27 (75%) of the teeth lost due to periodontal disease had been assigned an uncertain, poor or hopeless initial prognosis; however, nine teeth (25%) lost had been assigned a good prognosis at baseline. The prognosis for 202 teeth was judged to have worsened over the period of the study. Conclusion: Compliance with maintenance following periodontal treatment was associated with very low levels of tooth loss in a referral practice in rural Norway. Male gender, older age ( > 60 years) and smoking were predictors of tooth loss due to progressive periodontitis.
- Published
- 2004
19. Pre-treatment conceptions of periodontal disease and treatment in periodontal referrals
- Author
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Øystein Fardal, Anne Christine Johannessen, and Gerard J. Linden
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Pre treatment ,medicine.medical_specialty ,business.industry ,Close relatives ,Norwegian ,Lower risk ,language.human_language ,Tooth mobility ,Periodontal disease ,Internal medicine ,medicine ,language ,Physical therapy ,Periodontics ,Anxiety ,Lack of knowledge ,medicine.symptom ,business - Abstract
Background: Patients preconceptions of periodontal therapy have not been extensively studied and are poorly understood. Aims: To register specific anxieties and preconceptions held by patients referred for specialist periodontal treatment and to investigate the risks such patients were prepared to take of progressive periodontal problems before deciding that periodontal treatment was necessary. Materials and methods: 79 patients referred for specialist treatment completed a structured questionnaire. Participants completed visual analogue scales to quantify the risks which they were prepared to take of various symptoms of periodontal disease before they believed treatment was essential. Results: The majority (71%) had anxieties about pending treatment with the main concern being pain. Those who had sought information prior to treatment mainly did so from close relatives. The majority of patients opted to take no or a very low (
- Published
- 2001
20. Incorporating severity and risk as factors to the Fardal cost-effectiveness model to create a cost-benefit model for periodontal treatment
- Author
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John A. Martin, Raul I. Garcia, Elizabeth Krall Kaye, Øystein Fardal, Carl F. Loeb, Roy C. Page, and Gerard J. Linden
- Subjects
Adult ,Periodontal treatment ,Fees, Dental ,Cost effectiveness ,Cost-Benefit Analysis ,Population ,Alveolar Bone Loss ,Dentistry ,Disease ,Severity of Illness Index ,Root Planing ,Tooth Loss ,Young Adult ,Dental Implants, Single-Tooth ,stomatognathic system ,Risk Factors ,Severity of illness ,medicine ,Tooth loss ,Humans ,Periodontal Pocket ,Young adult ,education ,Periodontitis ,Aged ,Aged, 80 and over ,education.field_of_study ,Crowns ,business.industry ,Health Care Costs ,Middle Aged ,medicine.disease ,Chronic periodontitis ,Gingivitis ,stomatognathic diseases ,Models, Economic ,Chronic Periodontitis ,Periodontics ,Dental Scaling ,Denture, Partial, Fixed ,medicine.symptom ,Periodontal Index ,business - Abstract
A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation.A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk.The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $1,405 to $4,895 for high or moderate risk combined with any severity of CP and was more than $8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $3,416, and the cost of a single-tooth replacement was $4,787.Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.
- Published
- 2013
21. A comparison of teeth and implants during maintenance therapy in terms of the number of disease-free years and costs -- an in vivo internal control study
- Author
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Jostein Grytten and Øystein Fardal
- Subjects
Adult ,Male ,Peri-implantitis ,Cost effectiveness ,Dentistry ,Disease free ,Disease-Free Survival ,Dental Care for Aged ,stomatognathic system ,Maintenance therapy ,Periodontal disease ,Cost of Illness ,medicine ,Humans ,Periodontal Diseases ,Aged ,Retrospective Studies ,Periodontitis ,Orthodontics ,Dental Implants ,business.industry ,Norway ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Peri-Implantitis ,stomatognathic diseases ,Periodontics ,Female ,Implant ,Dental Prosthesis, Implant-Supported ,business - Abstract
BACKGROUND Little is known about the cost minimization and cost effectiveness involved in maintaining teeth and implants for patients treated for periodontal disease. MATERIALS & METHODS A retrospective study was carried out encompassing all patients who had initial periodontal treatment followed by implant placement and maintenance therapy in a specialist practice in Norway. The neighbouring tooth and the contra-lateral tooth were used as controls. The number of disease-free years and the extra cost over and above maintenance treatment for both teeth and implants were recorded. RESULTS The sample consisted of 43 patients with an average age of 67.4 years. The patients had 847 teeth at the initial examination and received 119 implants. Two implants were removed 13 and 22 years after insertion. The prevalence of peri-implantitis was 53.5% at the patient level and 31.1% at the implant level. The prevalence of periodontitis was 53.4% at the patient level and 7.6% at the tooth level. The mean number of disease-free years was: implants: 8.66; neighbouring tooth: 9.08; contra-lateral teeth: 9.93. These mean values were not statistically significantly different from each other. The extra cost of maintaining the implants was about five times higher for implants than for teeth. CONCLUSION The number of disease-free years was the same for neighbouring teeth, contra-lateral teeth and implants. However, due to the high prevalence of peri-implantitis, the cost of maintaining implants was much higher than the cost of maintaining teeth.
- Published
- 2013
22. Periodontal and general health in long-term periodontal maintenance patients treated in a Norwegian private practice: a descriptive report from a compliant and partially compliant survivor population
- Author
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Patrick Fardal, G. Rutger Persson, and Øystein Fardal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health Status ,Population ,Myocardial Infarction ,Dentistry ,Type 2 diabetes ,Overweight ,Risk Assessment ,Dental Prosthesis ,Tooth Loss ,Risk Factors ,Internal medicine ,medicine ,Tooth loss ,Humans ,Longitudinal Studies ,Family history ,education ,Medical History Taking ,Periodontal Diseases ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Oral Hygiene ,Confidence interval ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Private practice ,Cardiovascular Diseases ,Hypertension ,Periodontics ,Patient Compliance ,Female ,medicine.symptom ,Periodontal Index ,business ,Follow-Up Studies - Abstract
There is weak evidence to support the benefit of periodontal maintenance therapy in preventing tooth loss. In addition, the effects of long-term periodontal treatment on general health are unclear.Patients who were compliant and partially compliant (15 to 25 years' follow-up) in private practice were observed for oral and systemic health changes.A total of 219 patients who were compliant (91 males and 128 females) were observed for 19.1 (range 15 to 25; SD ± 2.8) years. Age at reassessment was 64.6 (range: 39 to 84; SD ± 9.0) years. A total of 145 patients were stable (0 to 3 teeth lost), 54 were downhill (4 to 6 teeth lost), and 21 patients extreme downhill (6 teeth lost); 16 patients developed hypertension, 13 developed type 2 diabetes, and 15 suffered myocardial infarcts (MIs). A minority developed other systemic diseases. Risk factors for MI included overweight (odds ratio [OR]: 9.04; 95% confidence interval [CI]: 2.9 to 27.8; P = 0.000), family history with cardiovascular disease (OR: 3.10; 95% CI: 1.07 to 8.94; P = 0.029), type 1 diabetes at baseline (P = 0.02), and developing type 2 diabetes (OR: 7.9; 95% CI: 2.09 to 29.65; P = 0.000). A total of 25 patients who were partially compliant (17 males and eight females) were observed for 19 years. This group had a higher proportion of downhill and extreme downhill cases and MI.Patients who left the maintenance program in a periodontal specialist practice in Norway had a higher rate of tooth loss than patients who were compliant. Patients who were compliant with maintenance in a specialist practice in Norway have a similar risk of developing type 2 diabetes as the general population. A rate of 0.0037 MIs per patient per year was recorded for this group. Due to the lack of external data, it is difficult to assess how this compares with patients who have periodontal disease and are untreated.
- Published
- 2012
23. Periodontal maintenance--overcoming the barriers
- Author
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Øystein Fardal
- Subjects
Periodontal treatment ,medicine.medical_specialty ,business.industry ,Dental Prophylaxis ,Health Behavior ,Models, Psychological ,Oral Hygiene ,Oral hygiene ,Maintenance therapy ,medicine ,Physical therapy ,Humans ,Patient Compliance ,Health behavior ,Intensive care medicine ,Patient compliance ,business ,General Dentistry ,Periodontal maintenance ,Practice Patterns, Dentists' - Abstract
Periodontal maintenance therapy is the most important stage of periodontal treatment, yet compliance is low. Overcoming the barriers associated with the low compliance involves a complex set of problems relating to the patient, the clinician and the interactions between them. It is therefore important to create a periodontal maintenance treatment programme which takes into consideration the needs of each individual patient. In addition, regional variations and differences in practice profiles are also factors to be accommodated in a maintenance programme. Clinical Relevance: Good co-operation between the referring dentist and the specialist is required when recommendations are made to the patient regarding maintenance therapy.
- Published
- 2011
24. Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients--a retrospective study
- Author
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Øystein Fardal and Gerard J. Linden
- Subjects
Adult ,Male ,medicine.medical_treatment ,Abutment ,Alveolar Bone Loss ,Dentistry ,Dental Abutments ,stomatognathic system ,Tooth loss ,medicine ,Humans ,Dental Restoration Failure ,Longitudinal Studies ,Bridge (dentistry) ,Denture Design ,Periodontal Diseases ,Aged ,Dental Implants ,business.industry ,Jaw, Edentulous, Partially ,Dental prosthesis ,Implant failure ,Retrospective cohort study ,Middle Aged ,Denture Retention ,stomatognathic diseases ,Treatment Outcome ,Periodontics ,Denture, Partial, Fixed ,Female ,Implant ,Dental Prosthesis, Implant-Supported ,medicine.symptom ,Tooth Mobility ,business - Abstract
Background: Cross-arch bridges are used to stabilize teeth for patients with reduced periodontal support. Little is known about technical or biological complications, whether teeth and implants can be combined in this type of bridge and the long-term effects on tooth loss. Materials and methods: All patients treated in a specialist periodontal practice who received cross-arch stabilizing bridgework and were subsequently maintained for at least 7 years were included in the study. The patients were selected from all patients who underwent initial periodontal therapy after 1986 in a Norwegian periodontal practice. The bridges were assessed for biological and technical complications. Bridges retained by teeth or by a combination of teeth and implants were included in the study. Results: Ninety-four rigid fixed bridges (77 teeth supported, 17 teeth and implant supported) in 80 patients (46 females, 34 males) were observed for an average of 10 years (range 7―22 years). In four patients, a bridge became loose and had to be re-cemented, and in one case the metal framework of a bridge fractured and the bridge had to be remade. In total, eight abutment teeth were lost from five patients but no implant abutments were lost. Overall, a higher rate of tooth loss was observed for patients provided with stabilizing bridges compared with control maintenance patients not treated with bridgework (p
- Published
- 2010
25. Comprehensive Treatment Planning for the Patient with Oral or Systemic Inflammation
- Author
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Myron Nevins, Gerard J. Linden, Øystein Fardal, David M. Kim, Michael B. Goldberg, Howard C. Tenenbaum, Michael Landzberg, and Michael Glogauer
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,medicine.symptom ,business ,Intensive care medicine ,Radiation treatment planning ,Systemic inflammation ,Surgery - Published
- 2009
26. Perceptions of patients' smiles: a comparison of patients' and dentists' opinions
- Author
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Jannike, Jørnung and Øystein, Fardal
- Subjects
Adult ,Aged, 80 and over ,Male ,Observer Variation ,Attitude of Health Personnel ,Dentists ,Esthetics, Dental ,Middle Aged ,Smiling ,Self Concept ,Patient Satisfaction ,Surveys and Questionnaires ,Gingival Diseases ,Humans ,Tooth Discoloration ,Female ,Aged - Abstract
Little information has been published regarding the difference between how patients perceive their own smiles and how dentists view them.The authors interviewed 78 consecutively seen patients in a general dental practice in Norway about esthetic features of their faces. The patients were not actively seeking esthetic treatment. Patients rated themselves using a 100-point visual analog scale (VAS), and then two dentists (the patients' regular dentist and an independent periodontist), working with photographs of the patients, used the same VAS in rating the patients' smiles.The average age of the patients was 51.2 years (range, 22-84 years). There were 50 women (average age, 51.5 years; range, 22-84 years) and 28 men (average age, 52 years; range, 30-78 years). Patients' satisfaction with their own smiles reached an average of 59.1 (standard deviation [SD], 21.1; range, 5-100) on the VAS. The dentists' scores (38.6 and 40.7) were significantly lower than the patients' scores. The authors observed poor correlation between the periodontist's scores of dentogingival features and the patients' scores. Patients were most satisfied with the gingiva when smiling and least satisfied with tooth shade. Patients younger than 50 years were most satisfied with their smiles. Patients rated teeth and eyes as the most important features in an attractive face. Women gave teeth and hair significantly higher scores and head shape lower scores than did men.Patients' opinions of their own smiles were significantly higher than the two clinicians' assessments of their smiles. Dentists should be aware that patients who seek esthetic services may have different perceptions of their smiles than may patients who do not express such desires.
- Published
- 2007
27. Patient perceptions of periodontal therapy completed in a periodontal practice
- Author
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Gerard J. Linden, Øystein Fardal, and Anne Christine Johannessen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Visual analogue scale ,Anesthesia, Dental ,Oral Surgical Procedures ,Dentistry ,Statistics, Nonparametric ,Sex Factors ,Sex factors ,Upper anterior ,Facial Pain ,Threshold of pain ,medicine ,Humans ,Periodontal Diseases ,Aged ,Pain Measurement ,Aged, 80 and over ,Pain, Postoperative ,Chi-Square Distribution ,business.industry ,Norway ,General Engineering ,Age Factors ,Reproducibility of Results ,Mean age ,Periodontology ,Middle Aged ,Patient perceptions ,Physical therapy ,Dental Scaling ,Periodontics ,Female ,business ,Chi-squared distribution ,Anesthesia, Local - Abstract
The perceptions that patients have of periodontal therapy have not been extensively studied and are not well understood. The purpose of this study was to assess the degree of discomfort associated with periodontal therapy carried out in a specialist practice.A consecutive group of 150 patients (90 females, 60 males; mean age 54.5 years) who had completed periodontal therapy, which included surgery, in a periodontal practice in Norway was studied. The patients indicated the discomfort they had experienced with periodontal therapy on a visual analog scale (VAS). Other factors associated with postoperative discomfort such as the use of analgesics were recorded.The mean VAS scores were low for all procedures investigated. The highest mean score was recorded for anesthesia in the upper anterior region. There were small differences between the levels of discomfort reported by males compared to females. The VAS scores decreased with increasing age for anesthesia in the lower arch (P = 0.004) and surgery in the lower arch (P = 0.003). Virtually all (97%) of the patients perceived periodontal treatment to be associated with no more discomfort than conventional dental treatment.Very low reported levels of discomfort were associated with both non-surgical and surgical periodontal therapy by Norwegian patients treated in a specialist periodontal practice.
- Published
- 2002
28. Rare case of keratin-producing multiple gingival cysts
- Author
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Anne Christine Johannessen and Øystein Fardal
- Subjects
Adult ,Pathology ,medicine.medical_specialty ,Cell of origin ,Pathology and Forensic Medicine ,Odontogenic cyst ,Recurrence ,parasitic diseases ,Periodontal Cyst ,Keratin ,medicine ,Humans ,Mandibular Diseases ,Gingival cysts ,General Dentistry ,chemistry.chemical_classification ,business.industry ,Anatomy ,medicine.disease ,Dental lamina ,chemistry ,Gingival Diseases ,Keratins ,Female ,Stem cell ,business ,Gingival disease - Abstract
A rare case of multiple keratin-containing gingival cysts is presented. It is suggested that either a common dental lamina stem cell with diverging differentiation pathways or another cell of origin may be responsible for the formation of these unique cysts.
- Published
- 1994
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