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Objectives: Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the incidence of and risk factors for MRONJ after tooth extractions in cancer patients treated with high-dose bisphosphonate and denosumab (BP and DS). Material and methods: The protocol followed the PRISMA statement list and was registered in PROSPERO. Searches were performed for literature published up to April 2021 in the electronic databases PubMed, Embase, Web of Science and CINAHL, and then supplemented by manual research. Results: The search process resulted in 771 identified articles, of which seven studies fitted the population, intervention, comparison, and outcome (PICO) framework. All were observational studies and four had control groups. A total of 550 patients treated with BP and DS were identified of whom 271 had received tooth extractions after medication onset. Due to significant heterogenicity in the collected data only a qualitative analysis was performed. The MRONJ incidence after tooth extractions varied between 11 and 50% at patient level. MRONJ occurred up to three years after the tooth extraction. Teeth affected by inflammation before the extraction and additional osteotomy during the surgical procedure were identified as risk factors. Conclusion: Reliable methods of diagnosing MRONJ and adequate follow-up period are important factors in obtaining the actual incidence of MRONJ after tooth extractions in patients treated with high-dose BP and DS.

Objective: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. Method: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. Results: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. Conclusion: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did

OBJECTIVES: To examine the current knowledge on oral health status and dental care of older persons through a systematic mapping of systematic reviews of low or moderate risk of bias. BACKGROUND: Geriatric dentistry covers all aspects of oral health and oral care of older persons. Oral health is part of general health and contributes to a person's physical, psychological and social wellbeing. METHODS: A literature search was performed in three different databases (PubMed, The Cochrane Library and Cinahl) within 12 domains: Dental caries, periodontitis, Orofacial pain and temporomandibular joint (TMJ) pain, mucosal lesions, oral motor function, dry mouth, halitosis, interaction between oral status and other medical conditions, ability to interrelate and communicate, quality of life, ethics and organisation of dental care for older persons. Systematic reviews were identified and scrutinised, highlighting scientific knowledge and knowledge gaps. RESULTS: We included 32 systematic reviews of which 14 were judged to be of low/moderate risk of bias. Most of the domains lack systematic reviews with low or moderate risk of bias. In two of the domains evidence was identified; in institutionalised people aged 65 or older, effective oral hygiene can prevent pneumonia. Furthermore, there is an evidence of a relationship between malnutrition (protein energy-related malnutrition, PEM) and poor appetite and edentulousness. CONCLUSIONS: There is an urgent need for further research and evidence-based knowledge within most domains in geriatric dentistry and in other fields related to oral health and dental care for older persons striving for multi-disciplinary research programmes.

Aims: To investigate patients' experiences of therapeutic jaw exercises for treating masticatory myofascial pain. Methods: A total of 10 patients were selected for the interview study. All patients had received treatment with jaw exercises at a specialist clinic. Semi-structured interviews were conducted in a nonclinical environment according to an interview guide with 10 domains. The interviews were transcribed and translated into English. Systematic text condensation (STC) was used to arrange and analyze the text material. Results: In the systematic process of analyzing the qualitative data, four main themes were identified: "Patient Adherence," "Symptoms," "Treatment Effect," and "Participation." Most informants were initially skeptical of the jaw exercises due to their simplicity. Later on, the simplicity of the exercises and the fact that they did not need more advanced treatment were valued most by a majority of patients. Some informants suspected serious disease behind their symptoms. Treatment effects on pain and physical impairment were reported. To do the jaw exercises in conjunction with an already established routine seemed important to enhance adherence. Trust in the caregiver and being able to remedy their pain by themselves were also important to the informants. Conclusion: Jaw exercises are a useful treatment valued by patients due to their simplicity and effectiveness. However, before the treatment, patients should be informed about the cause of the symptoms, and any skepticism should be addressed. Results from this qualitative study cannot be generalized, but the study design and the selected population allow the results to be transferable to similar contexts.

Risken för att drabbas av oral ohälsa ökar med stigande ålder. Mer än hälften av alla personer över 75 år har rotkaries och omkring 25 % har besvär från tandkött (gingivit) och slemhinnor. Orsakerna är en kombination av en minskad salivsekretion, försämrad munhygien, tätare energirika födointag och en förändrad bakterieflora. Merparten av dessa tillstånd går att förebygga och kontrollera med populationsinriktade och individrelaterade insatser utifrån ett helhetsperspektiv. Det vetenskapliga underlaget för äldre bygger på få studier med hög risk för felkällor men viss evidens finns för salivstimulation, mekanisk plackkontroll och ökad fluorexponering. För sekundär prevention av rotkaries finns ett visst stöd för högfluortandkräm och fluorlack medan stödet för kemisk plackkontroll är begränsat. Gingivit och candida-infektioner behandlas i första hand med förbättrade munhygienrutiner. Det finns stora kunskapsluckor rörande tandhälsan hos sköra och sjuka äldre och det behövs mer klinisk behandlingsforskning inom området äldretandvård.

Objective. Dental phobia is prevalent in the general population and can be successfully treated through cognitive behavioural therapy, which results in patients being able to cope with dental treatments. The aim of this study was to increase the understanding of factors of importance for maintaining regular dental care after completion of a cognitive behavioural therapy programme. Material and methods. A qualitative study design was used. Fourteen individuals who had successfully completed the programme and had thereafter been referred to a general dental practitioner were interviewed. An interview guide with open-ended questions was used. The interviews were tape-recorded and transcribed verbatim. The texts were analysed using descriptive and qualitative content analysis ( Grounded Theory). Results. The manifest analysis identified four content areas: experience of dental care, content of the behavioural therapy programme, perception of therapy and impact on quality of life. The latent analysis identified influence on quality of life, security, activity and barriers to dental care as categories. Although all informants had successfully completed the dental fear treatment programme, only a few stated that they had an uncomplicated relation to dental care afterwards. Barriers to dental care were lack of money and fear. A sense of security was conclusive to coping with dental care, and a respectful approach on the part of the dental care personnel was essential to development of this sense. Conclusions. Confidence in one's own ability to cope with dental care and the right to guide the treatment were important. Thus the theme in the present study was self-efficacy and respectful dental care personnel.

Purpose: The objective of the present study was to study the ability to influence young at-risk patients attitudes toward tobacco use through two intervention methods that were performed by dental health professionals. Materials and Methods: Two inteiventions, a brief individual motivational interview and an adapted school lecture, were studied, and both were compared with a control group Before and after interventions, a questionnaire was used Patients born in 1989 and 1992 who were judged by the dental personnel as potentially at risk for dental diseases, a total of 301 individuals, were included. Results: Both before and after interventions, the results showed a generally negative attitude towards tobacco use A majority of the participants were positive towards measures that were taken to control the spread of tobacco use, younger participants (born 1992) to a greater extent (73%) than the older participants (born 1989) (54%) Important factors that kept the participants away from tobacco use were the harmful effects and the approaches of parents and friends The older participants believed to a greater extent that they would try smoking as adults No change in tobacco use was registered after intervention, although the participants reported an increased use among friends Conclusions: The two pedagogical methods that were used in the present study influenced the young people's attitudes towards tobacco use only to a small extent However, the period between 12 and 15 years old seems to provide a good opportunity to influence attitudes towards tobacco. The adolescents' demand for interactive learning and their development of attitudes and tobacco use habits in relation to family and friends provide opportunities to use new pedagogical models

Epidemiological data reveal that the prevalence of dental caries in western countries has decreased in recent decades. The aim of this study was to investigate how dentists and dental hygienists assess dental caries lesions in bite-wing radiographs between 1983 and 2003. All dentists and dental hygienists in Public Dental Health in Uppsala County were offered to take part in the study. The participants assessed manifest and initial caries lesions in eight bite-wing radiographs from three patients individually. An X-ray viewer and binoculars were used. The assessments were repeated in the same radiographs every five years, a total of five times, between 1983 and 2003. In the different test occasions 80-103 dentists and 11-48 dental hygienists participated. The registration of dental caries changed between 1983 and 2003. The number of manifest lesions registered by dentists decreased between 1983 and 1988, but were stable after 1988. Dental hygienists showed no changes in the registration of manifest lesions during the study. Initial lesions registered by dentists and dental hygienists increased between 1988 and 1998. Assessments of initial caries lesions displayed a wider range than manifest lesions. Increasing age and more years in the profession resulted in fewer registered initial caries lesions. Dental hygienists had a tendency to register less caries than dentists. In conclusion, the result of the study indicate that inclusion of initial caries lesions in epidemiological reports should lead to a reduction in reliability. The changes in assessments of manifest caries lesions that took place in the 19805s should be considered when epidemiological data are evaluated.

During the last decades, a new policy involving normalisation, integration, equality and deinstitutionalisation of mentally retarded (MR) individuals has been accepted in Sweden. Consequently, many institutions have been closed and an increased number of people with MR are now integrated into the Swedish community. The general aim of this thesis was to investigate if a greater degree of independence for MR adults influenced the prevalence of oral diseases. Material and methods: The caries incidence and prevalence, number of remaining teeth, incidence of tooth mortality and inter-proximal bone loss were investigated in a group of MR adults, aged 21-40 years, all with protracted, regular preventive dental care. The studied variables were related to living arrangements and degree of MR, and were followed during 8.5 years (Papers I, II and VI). Incidence and reasons for tooth mortality were studied during 10 years in institutionalised MR individuals (Paper III). In connection with the closing-down of an institution for MR adults, the changes of oral hygiene habits, sucrose intake and oral microbiological flora were studied in the new integrated living (Papers IV and V). Results: Less restrictive living arrangements and mild forms of MR were correlated to a high caries prevalence in persons with MR. After 8.5 years, the caries incidence had decreased in all subjects, but persons with mild MR and those who lived integrated still had a higher caries prevalence than other MR adults. With the exception of subjects with Down syndrome, the interproximal bone loss during 8.5 years was similar or lower compared to normal Swedish populations. Institutionalised MR subjects had lost an average of 3.72 teeth during 10 years. Periodontitis was the main reason for tooth mortality. Persons who cooperated well with dental treatment and those who used neuroleptics lost fewer teeth during the 10-year period compared to other MR individuals. The proportion of subjects with high levels of m