OBJECTIVES The aim was to assess the association between the presence of site-specific subgingival micro-organisms and the levels of matrix metalloproteinases-8 and matrix metalloproteinases-9 (MMP-8 and MMP-9) in gingival crevicular fluid (GCF). MATERIALS AND METHODS The patient group consisted of 56 subjects with periodontitis and the control group of 43 subjects without periodontitis. GCF samples from four test sites for each subject were collected. Polymerase chain reaction was used to detect the presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola. MMP-8 concentrations were analyzed by a time-resolved immunofluorometric assay, and MMP-9 levels were determined by enzyme-linked immunosorbent assay. Student's unpaired t-test, chi-square test, and Fisher's exact P-value were calculated. RESULTS The presence of T. denticola in the test sites was significantly higher in the patient group than in the control group. The presence of T. forsythia and T. denticola was associated with increased levels of MMP-8 in the test sites. Respectively, site-specific presence of T. denticola was associated with an increase in MMP-9 levels in three of the four test sites. CONCLUSIONS The presence of subgingival micro-organisms in GCF, particularly T. denticola, appeared to induce a host response with an increased release of MMP-8 and MMP-9 in the test sites.

Background and Objective: Oral microorganisms may be involved in the development of cardiovascular diseases, and Porphyromonas gingivalis is one of the periodontal microorganisms that has been found in carotid atheroma. The aim of this work was to study subgingival microorganisms and early carotid lesions in subjects with and without periodontitis.Material and Methods: Eighty-eight subjects with periodontitis and 40 subjects without periodontitis underwent dental examinations in 2003. The presence of the periodontal microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Tannerella forsythia was analyzed from subgingival plaque using PCR amplification. The common carotid artery was scanned using ultrasound and the calculated intima-media area (cIMA) was measured. The association between periodontitis, the cIMA value and the presence of periodontal microorganisms, together with several confounders, was studied in a multiple logistic regression model.Results: Smoking [odds ratio (OR) = 5.64; p = 0.001), level of education (OR = 5.02; p < 0.05) and the presence of P. gingivalis (OR = 6.50; p < 0.05) were associated with periodontitis. Explanatory factors for the increased cIMA were periodontitis (OR = 4.22; p < 0.05), hypertension (OR = 4.81; p < 0.05), high body mass index (OR = 5.78; p < 0.01), male gender (OR = 3.30; p < 0.05) and poor socioeconomic status (OR = 4.34; p < 0.05). P. nigrescens (OR 4.08; p < 0.05) and P. gingivalis (OR 7.63; p < 0.01) also appeared as explanatory variables associated with increased cIMA values.Conclusion: This cross-sectional study showed that P. nigrescens and P. gingivalis were significantly associated with increased cIMA values.

OBJECTIVE:The purpose of this project was to create a modified CBT model to determine the impact on increased adherence to oral hygiene instructions. In a pilot study test, this model was compared with traditional instructions.METHOD:Tools developed and tested in this pilot study were a self-reporting questionnaire, a visual information consisting of pictures and a diary to document according to a modified CBT method. Four participants were divided into two groups, control group and CBT group. At the first visit, all participants answered a self-reporting questionnaire. The clinical examination consisted of measuring the PI, GI and GBI. The same information and instructions were given. All received toothbrushes, dental floss and professional tooth cleaning. The CBT group was instructed to document their feelings and thoughts in a diary. After 3 weeks, the participants answered the same questionnaire, and the same clinical measurements were conducted at the re-examination. The CBT group brought their diaries for evaluation.RESULT:At the end of the study, there was a difference in PI, GI and GBI between the groups. The levels of PI, GI and GBI had decreased more in the CBT group than in the control group. The questionnaire also showed that the CBT group had increased their knowledge and awareness about oral health.CONCLUSION:This pilot study shows that using a modified model of CBT, by keeping a diary, resulted in increased adherence to oral hygiene and knowledge about gingivitis, compared with traditional instructions.

BACKGROUND AND OBJECTIVE An association has been found between periodontal disease and the development of atherosclerosis. We investigated the hypothesis that periodontal disease triggers the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in blood. Increased levels of these parameters might then indicate early atherosclerosis. MATERIAL AND METHODS In this cross-sectional study, the material comprised 80 subjects with chronic periodontitis and 31 subjects with no periodontal disease. Sixteen years after diagnosis of periodontal disease ultrasonography revealed a statistically significant difference (p < 0.001) of carotid intima-media thickness between the subjects with chronic periodontitis and the periodontally healthy subjects. Matrix metalloproteinase-9 and TIMP-1 were analyzed from blood as periodontal and systemic inflammatory markers. The relationship between MMP-9, TIMP-1 and MMP-9/TIMP-1 as dependent variables and several independent variables (age, sex, smoking, education, body mass index, hypertension, periodontal disease and cholesterol) were analyzed in multiple logistic regression models to assess the value of the inflammatory markers in predicting carotid atherosclerosis. RESULTS Matrix metalloproteinase-9 and TIMP-1 were significantly higher in plasma from subjects with periodontal disease and atherosclerosis. Periodontal disease was identified as the principal independent predictor both for atherosclerosis (odds ratio 3.89 for increase in bilateral carotid intima-media thickness) and for increased MMP-9, TIMP-1 and MMP-9/TIMP-1 (odds ratio 2.58, 5.53 and 3.41, respectively). Classical atherosclerosis risk factors, such as increased total cholesterol, age and sex (women), were significant predictors in the model. CONCLUSION Matrix metalloproteinase-9, TIMP-1 and MMP-9/TIMP-1 in blood from subjects with periodontal disease could be useful laboratory markers for increased carotid artery intima-media thickness.

BACKGROUND AND OBJECTIVE Growing experimental evidence implicates chronic inflammation/infection due to periodontal diseases as a risk factor for death. The objective was to evaluate the role of periodontitis in premature death in a prospective study. METHODS The causes of death in 3273 randomly-selected subjects, aged 30-40 years, from 1985 to 2001 were registered. At baseline, 1676 individuals underwent a clinical oral examination (Group A) and 1597 did not (Group B). Mortality and causes of death from 1985 to 2001 were recorded according to ICD-9-10. RESULTS In Groups A (clinically examined group) and B, a total of 110 subjects had died: 40 subjects in Group A, and 70 in Group B. In Group A significant differences were present at baseline between survivors and persons who later died, with respect to dental plaque, calculus, gingival inflammation and number of missing molars in subjects with periodontitis (p < 0.001). The multiple logistic regression analysis results of the relationship between being dead (dependent variable) and several independent variables identified periodontitis with any missing molars as a principal independent predictor of death. CONCLUSIONS Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems.

INTRODUCTION:Chronic infection and inflammation are considered to be risk factors in the development of cardiovascular diseases; the chronic inflammatory and microbial burden caused by the dental plaque in these individuals may predispose them to atherosclerotic process.AIMS:The aims were to study the involvement of a high level of dental plaque, severe gingival inflammation and periodontitis in the development of early atherosclerotic process in women.METHODS:Forty-six randomly chosen women with periodontitis and 21 periodontally healthy women were subjected to a comprehensive clinical oral examination, including oral hygiene status and level of gingival inflammation. Atherosclerotic risk factor analysis and carotid ultrasonography were performed. Common carotid artery intima-media thickness (IMT) and lumen diameter were measured and intima-media area (cIMA) was calculated. The following statistical methods were used: analysis of variance, chi-squared tests and multiple logistic regression analysis.RESULTS:There were highly significant differences between the patients and controls in the amount of dental plaque, gingival inflammation as well as bleeding on probing and pocket depth. The mean values of IMT and cIMA were significantly higher in women with periodontal disease than in controls. Multiple logistic regression analysis identified periodontitis as a principal-independent predictor of both the common carotid artery cIMA and IMT.CONCLUSIONS:The present results indicate that a high amount of dental plaque, severe gingival inflammation as well as periodontitis seem to be associated with the development of atherosclerotic lesions in women already at its early and subclinical stages.

OBJECTIVES To study self-reported oral problems in relation to periodontal clinical findings in an epidemiological investigation. MATERIALS AND METHODS 1676 individuals, 828 men and 848 women, participated. The clinical examination comprised the number of remaining teeth excluding third molars, plaque index (PLI), gingival index (GI), bleeding on probing (BOP%), calculus index (CI) and the number of teeth with pocket depth (PD) > or =5 mm. Participants answered a questionnaire concerning smoking and snuffing habits and described in their own words any oral problems present. Analysis of variance (anova), unpaired t-test and chi-squared test were the statistical methods used. RESULTS The questionnaire was completed by 99.4% of participants. Problems of the teeth and mouth were reported by 28.9% of respondents comprising 31.8% females and 26.2% males. The difference between the sexes was statistically significant (P < 0.05). Of the reported oral problems, 57.4% was of periodontal origin. The differences between subjects with and without self-reported mobile teeth showed significant clinical outcome in PLI (P < 0.001), CI (P < 0.01), GI (P < 0.001), BOP% (P < 0.01), the number of teeth with PD > or = 5 mm (P < 0.001) and the number of remaining teeth (P < 0.001). The differences between subjects with and without self-reported periodontal disease and with and without bleeding gingiva also showed significant differences in CI (P < 0.05), GI (P < 0.05) and the number of teeth with PD > or = 5 mm (P < 0.05) and in PLI (0.001), CI (P < 0.01), GI (P < 0.001) and BOP% (P < 0.001) respectively. CONCLUSIONS Present study clearly shows that self-reported periodontal problems were confirmed by clinical assessments.

BACKGROUND AND OBJECTIVES:To investigate the levels of matrix metalloproteinase (MMP) -8 and -9 with the simultaneous presence of periodontal pathogens in gingival crevicular fluid (GCF) as well as MMP-9 and cholesterol in blood. Although bacterial pathogens are required to initiate the periodontal disease process, in some individuals the reaction to bacteria may lead to an excessive host response, resulting in a general inflammatory response.METHODS:MMP-9 and lipids were analyzed from the blood samples of 33 subjects with a 16-year history and oral health records of periodontal disease as well as from 31 periodontally healthy controls. Information was obtained on education, body mass index, and family history of atherosclerosis. GCF was taken to determine MMP-8 and MMP-9 levels, and bacterial samples were simultaneously collected for polymerase chain reaction assessment of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Tannerella forsythia, and Treponema denticola. Analysis of variance, chi-squared test, and multiple logistic regression analysis were used to analyze the results.RESULTS:Demographic data showed significant differences between patients and controls in smoking (P < 0.01), body mass index (P < 0.05), family history of atherosclerotic disease (P < 0.01), and education (P < 0.01). Significant differences were also observed in oral health data, in the detection of P. gingivalis (P < 0.001), P. intermedia (P < 0.01), P. nigrescens (P < 0.001), and T. forsythia (P < 0.001) and in the levels of MMP-8 and MMP-9 in GCF between patients and controls. T. forsythia[odds ratio(OR) 10.1; P = 0.001] and age (OR 5.54; P = 0.008) appeared to be the main independent predictors for high MMP-8 in GCF. Patients had significantly higher total cholesterol (P < 0.01), low-density lipoprotein cholesterol (P = 0.05), and triglycerides (P < = 0.01) than controls. Plasma levels of MMP-9 were significantly higher in patients than in controls (P = 0.001).CONCLUSIONS:Specific periodontal microorganisms appeared to induce host response, with increased release of MMP-8 and MMP-9 in gingival pockets as well as of MMP-9 in plasma, possibly triggering its up-regulation in blood.

International Journal of Dental HygieneVolume 4, Issue s1 p. 22-25 Dental plaque as a possible risk factor for general disease – results from longitudinal studies B Söder, B Söder Birgitta Söder, Institute of Odontology, Karolinska Institutet, Huddinge, SwedenSearch for more papers by this author B Söder, B Söder Birgitta Söder, Institute of Odontology, Karolinska Institutet, Huddinge, SwedenSearch for more papers by this author First published: 01 September 2006 https://doi.org/10.1111/j.1601-5037.2006.00198.xCitations: 5 Birgitta Söder Institute of OdontologyKarolinska InstitutetHuddingeSwedenTel.: +46 8 524 800 00E-mail: birgitta.soder@ofa.ki.se Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume4, Issues1September 2006Pages 22-25 RelatedInformation

Objectives: The aim of the present study was to investigate the influence of anxiety, measured by one single question, on gingival inflammation and periodontal disease in non-smokers and smokers.Material and Methods: The participants were 144 subjects with untreated periodontal disease 30-40 years of age, and 26 healthy controls, 30-40 years of age. All subjects were clinically examined and answered an uncomplicated question regarding anxiety in every day life, as well as smoking habits. The periodontitis subjects were divided into; an aggressive periodontitis (AP)-group and a chronic periodontitis (CP)-group. Fisher's exact probability t-test, analysis of variance (ANOVA), Mann-Whitney U-test and analysis of covariance (ANOVA) were used as statistical methods.Results: Anxious subjects had a significantly higher gingival index than non-anxious subjects, when controlling for smoking (p < 0.01). The healthy anxious non-smokers had an average score of GI 1.6 (+/- 0.4 SD) compared with 1.2 (+/- 0.4 SD), p < 0.05 for the non-anxious non-smokers. Anxious smokers with periodontits (AP-/CP-group) had significantly more sites with pockets >= 5 mm, compared with non-anxious smokers, (p < 0.05).Conclusions: The results of the present study, suggest that self-reported anxiety was associated with an adverse affect on the gingiva. Anxiety seemed to be associated with increased severity of periodontal disease in smokers.

Objective: The aim of this study was to analyse changes in bone height after 17 years in smokers and non-smokers with periodontal disease, and to compare these with clinical assessment outcome.Material and Methods: Participants comprised 50 adults with periodontitis and 18 healthy controls from a randomly selected epidemiological sample. Their mean age at the end of the study was 54.2 (SD +/- 3.09) years. The study included radiographic analysis compared with clinical data.Results: The periodontitis group had significantly (p < 0.001) higher values than their healthy counterparts for plaque index (PLI), gingival index (GI), calculus index (CI), and bleeding on probing (BOP) at baseline and after 17 years. At the end of the follow-up, never-smokers with periodontitis had higher values for PLI (p < 0.05) and ex-smokers and smokers had higher GI and BOP (p < 0.001) than the controls. In all individuals with periodontitis, maxillary molars were most affected. Smokers had more severe marginal bone loss over time. Vertical bone defects were more often seen on the mesial side of teeth (p < 0.05).Conclusion: Marginal bone level in this prospective study did reveal tooth groups at higher risk for progression of periodontal disease.

BACKGROUND AND PURPOSE:There is growing experimental evidence implicating chronic inflammation/infection as an atherosclerotic risk factor. In this study, the involvement of periodontal disease in the development of early atherosclerotic vascular lesions has been evaluated.METHODS:In randomly chosen 82 patients with periodontal disease and 31 periodontally healthy individuals subjected to a clinical oral examination in 1985, atherosclerotic risk factor analysis and carotid ultrasonography was performed during reexamination 16 years later. Common carotid artery intima-media thickness (IMT) and lumen diameter were measured and intima-media area (cIMA) was calculated. The relationship between IMT and cIMA as dependent variables and periodontal disease, age, gender, body mass index, heredity for atherosclerosis, diabetes mellitus, hypertension, plasma cholesterol, smoking, and education as independent variables was evaluated in a multiple logistic regression model.RESULTS:The mean values of IMT and cIMA were significantly higher in patients with periodontal disease than in controls, both at the right (P<0.01 and P<0.001, respectively) and left side (P<0.001 for both variables). When the means of the bilateral measurements of these 2 ultrasonographic variables were tested, multiple logistic regression analysis identified periodontal disease as a principal independent predictor of the common carotid artery cIMA (odds ratio [OR], 5.20; P=0.003) and IMT (OR, 4.64; P=0.004).CONCLUSIONS:The present results indicate that periodontal disease is associated with the development of early atherosclerotic carotid lesions.

Bad breath usually originates within the oral cavity and is believed to be associated with periodontal disease. The over all aim of the present thesis was to study periodontal conditions in subjects with bad breath as well as the prevalence of bad breath in subjects with periodontal disease. Paper I was designed to study the relationships between foetor ex ore, halitophobia, oral hygiene and periodontal disease. The aim of Paper II was to study periodontal conditions the presence of certain microorganisms, and inflammatory mediators, in subjects with bad breath. Our hypothesis was that the periodontal condition of patients with bad breath was worse than in subjects without this symptom. In Paper I, of 840 men [mean age = 35.7 years (±2.8 SD)] and 841 woman [mean age = 35.7 years (±2.9 SD)] who participated in an epidemiological study of periodontal health that was started in 1985, 2.4 % were found to exhibit foetor ex ore and 1 % were diagnosed as having halitophobia. Subjects with both periodontal disease and bad breath demonstrated a higher percentage of teeth with pockets ≥5 mm than did individuals without bad breath (p<0.001). Moreover subjects with foetor ex ore showed significantly higher levels of plaque and calculus values than did those without this symptom (p< 0.01and p<0.001 respectively).Of the 28 participants described in Paper II, [mean age = 54.4 (±3.5 SD) years] selected from the same group of patients described in Paper I, 8 still had bad breath, 10 suffered from periodontal disease without bad breath and 10 were periodontally healthy nonsmokers. Subjects with bad breath had more teeth with pocket depths ≥5 mm or ≥8-mm, than did subjects with periodontal disease but without bad breath. In the subjects with bad breath, all of the micro-organisms analysed by the PCR method, were detected and a significantly larger number of subjects with than without bad breath were colonized by P.g. (p< 0.01). Conclusions: Paper I: Foetor ex ore is caused by poor oral hygiene, reflected by the amount of calculus and plaque present and visits to the dentist. In subjects with periodontitis, foetor ex ore may be a useful indicator of the severity of the disease. Halitophobia correlated with the presence of a relatively large amount of calculus on the teeth and occurs independently of foetor ex ore.Paper II: Subjects with both bad breath and periodontal disease exhibited higher levels of plaque, more gingival inflammation, more severe periodontal disease, and higher levels of PGE2 and elastase in their gingival crevicular fluid than did periodontal patients without bad breath. More subjects with bad breath harboured A.a. and P.g. than those without this symptom. In particular P.g was significantly more often detected in the group with bad breath. General conclusions: The subjects with bad breath and periodontal disease exhibited the same levels of plaque throughout the 18-year study period. Bad breath, which could be a sign of active periodontal disease, does not seem to be influenced by smoking

The aim of this study was to compare the prevalence of periodontal disease in different groups of tobacco users. Participants (n = 1674) were selected from an initial random sample of residents in the Stockholm region. Socio-demographic characteristics and life-time history of tobacco use were registered in a self-completed questionnaire, followed by a clinical examination. Cumulative life-time tobacco use was analyzed in pack-years and can-years as the exposure of interest. Among participants, 50.8% were females and 49.2% were males. Life-time tobacco use was categorized into four mutually exclusive categories. Approximately, two-thirds of snuff users had combined snuff use with cigarette smoking during their life. Tobacco users had a higher prevalence of periodontal disease compared to never users. Exclusive smokers and mixed users presented the less favorable situation. Unhealthy periodontal conditions increased with increasing exposure to smoking, most evidently at the level of 15 or more pack-years. There was a significant positive association between current or former smoking and periodontal disease (OR = 2.7, Cl = 1.7-4.3 and OR = 2.0, Cl = 1.2-3.3, respectively) even after adjustment for plaque level. An indication of association was also apparent with former snuff use. Plaque was independently associated with periodontal disease, with a dose gradient. Smoking is associated with periodontal disease independently of plaque. Combining cigarette smoking and snuff use during life does not convey a decreased probability of being diagnosed with periodontal disease compared to smoking exclusively.

The aim of this paper was systematically to evaluate the caries-preventive effect of professional fluoride varnish treatments. A search of the literature for articles published between 1966 and August 2003 was carried out in electronic databases, reference lists of articles, and selected textbooks in accordance with the strategy of the Swedish Council on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized and controlled clinical trials comparing fluoride varnish with placebo, no active treatment or other fluoride preventive regimens of at least 2 years' study duration were included. The trials that met the inclusion criteria were assessed independently and systematically by at least two reviewers and scored from A to C according to predetermined criteria for methodology and performance. The main outcome measure was the preventive fraction expressed as a percentage. The results displayed limited evidence (evidence level 3) for the caries preventive effect of topical applications of fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0-69%) when compared with untreated controls. Inconclusive evidence (evidence level 4) was found for fluoride varnish treatment in the primary dentition and in adults. This systematic review reinforces the need for future dinical research of high quality, incorporating modern concepts of dinical performance and evaluation to assess dental caries control using professional fluoride varnish.

The aim of this study was to determine whether there is an association between self-reporting of periodontal diseases and outcome in a clinical examination, and whether any difference is present in awareness of periodontal status between smokers and non-smokers. Participants comprised 1676 adults (838 M and 838 F aged between 31 and 40 years), 564 of whom reported being smokers. Subjects were asked via questionnaire whether they thought they had periodontal disease and why. A total of 1655 subjects answered the questionnaire and were subsequently divided into those who suspected having periodontal disease (Yes-group) and those who did not (No-group). A full-mouth clinical examination was carried out in all subjects. Female smokers in the Yes-group had a significantly higher number of teeth with pockets > or = 5 mm (P < 0.001) and a higher calculus index (CI-S, P < 0.01) than female smokers in the No-group. Male smokers in the Yes-group had significantly less remaining teeth (P < 0.01), more teeth with pockets > or = 5 mm (P < 0.001), and a higher CI-S (P < 0.05) than their counterparts in the No-group. For smokers, multivariate logistic regression analysis yielded an odds ratio (OR 3.21 [95% CI 1.73 5.74]) of self-reported periodontal disease to periodontitis outcome which was significant (P < 0.001). This association remained significant (P < 0.01) after adjustment for confounding factors. Subjects who reported having periodontal disease, especially those who also reported having movable teeth, were confirmed to have the disease. Smokers were more aware of their periodontal status than non-smokers.

The Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on different caries-preventive methods. The aim of this article was to report the findings concerning the caries-preventive effect of fluoride mouthrinses (FMRs) in various age groups, with special reference to background fluorides. A systematic search in electronic databases for literature published between 1966 and August 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years' follow-up, and caries increment in the permanent dentition (DeltaDMFS/T) as endpoint. Out of 174 articles originally identified, 62 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF) expressed as percent. The level of evidence was based on 25 articles. The results revealed limited evidence (evidence level 3) for the caries-preventive effect (PF 29%) of daily or weekly sodium fluoride rinses compared with placebo in permanent teeth of schoolchildren and adolescents with no additional fluoride exposure and for a caries-preventive effect on root caries in older adults. Inconclusive evidence (evidence level 4) was found regarding the effect of FMRs in schoolchildren and adolescents exposed to additional fluoride sources such as daily use of fluoride toothpaste. No firm support for the use of FMRs was disclosed in a small number of studies designed for patients at caries risk. Furthermore, no association between the frequency of the rinses and prevented fraction or saved surfaces per year was found. In conclusion, this systematic review suggests that sodium fluoride mouthrinses may have an anti-caries effect in children with limited background of fluoride exposure, while its additional effect in children with daily use of fluoride toothpaste could be questioned. The need for further clinical trials to elucidate the effect of FMRs in risk patients and older adults is emphasized.

OBJECTIVES:The use of oral moist snuff (snus) is widespread among Swedish men, but little is known about the use in adolescents. The aim of this study was to describe patterns of snuff dipping, smoking and alcohol drinking in a sample (n = 6287) of 9th grade male students participating in a census survey in the Stockholm region.RESULTS:About 20% of the sample reported use of snus, and more than two-thirds of snus users were also cigarette smokers. Among current nonusers of tobacco (66% of the sample), 14% reported frequent binge drinking, in contrast to 49% among current exclusive cigarette smokers, 60% among exclusive snus users and 69% among users of both cigarettes and snus. The estimated mean annual consumption of alcohol was 5-10 times higher among tobacco users than among nonusers, with users of snus consuming more alcohol than smokers. Compared to non- or minimal drinkers, heavy alcohol drinkers had a disproportionately higher risk to report snus use, after adjustment for smoking behaviour (OR = 16.7, 95% CI 12.9-21.7). When the analysis was restricted to users of only one type of tobacco, heavy drinkers were twice as likely to report snus, rather than cigarette, use.CONCLUSIONS:Both tobacco use and alcohol drinking have been independently associated with a variety of pathological oral conditions in adults. These behaviours coexist in early adolescence. Their effect on oral health need to be investigated in prospective studies and should be of concern to the dental professionals.

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non-supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow-up and caries increment in the permanent (DeltaDMFS/T) or primary (Deltadmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non-supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long-term studies in age groups other than children and adolescents are still lacking.