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  • 1.
    Holmer, Helene
    et al.
    Kristianstad Central Hospital.
    Widén, Cecilia
    Kristianstad University, Faculty of Health Science, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, Faculty of Health Science, Avdelningen för oral hälsa.
    Wallin Bengtsson, Viveca
    Kristianstad University, Faculty of Health Science, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, Faculty of Health Science, Avdelningen för oral hälsa.
    Coleman, Michael
    Skåne University Hospital,.
    Wohlfart, Björn
    Lund University.
    Steen, Stig
    Lund University.
    Persson, Rutger G
    Kristianstad University, Faculty of Health Science, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, Faculty of Health Science, Avdelningen för oral hälsa.
    Sjöberg, Klas
    Lund University.
    Improved general and oral health in diabetic patients by an Okinawan-based Nordic diet: a pilot study2018In: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 19, no 7, article id E1949Article in journal (Refereed)
    Abstract [en]

    Periodontal disease, periodontitis as well as the preceding gingivitis, has been associated with both obesity and diabetes. Studies have shown that diet changes can lead to a lower incidence of such inflammation. The aim of the present case series over four weeks was to study the effects on medical and dental conditions in patients with type 2 diabetes of the consumption of the Okinawan-based Nordic Diet (OBND®). Medical and dental examinations were performed to estimate the general health and gingivitis/periodontitis. Serum cytokine levels were assessed using Luminex technology. Eight of ten study participants completed the study. All participants lost weight (p = 0.012). Six out of seven that were treated with insulin could reduce their insulin intake after two weeks with OBND®. The reduction was about 16 units which corresponds to a 34% relative reduction compared to the starting point (range 15⁻63%). Fasting blood glucose values fell (p = 0.035). Hemoglobin A1c (HbA1c) (p = 0.01), triglycerides (p = 0.05), and low-density lipoprotein (LDL) (p = 0.05) were also reduced. Bleeding on probing changed from ~28% before any dietary changes to ~13% after two weeks with OBND® (p = 0.01). The reduction in gingival bleeding was as substantial as might be expected from one session of professional tooth cleaning. Markers of inflammation were also reduced. The OBND® thus showed significant promise in alleviating the impact of diabetes on dental as well as general health.

  • 2.
    Olsson, Viktoria
    et al.
    Kristianstad University, School of Education and Environment, Avdelningen för Mat- och måltidsvetenskap. Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL).
    Larsson, Ewa
    Igelösa Life Science AB, Sweden.
    Wallin Bengtsson, Viveca
    Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap.
    Widén, Cecilia
    Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    Sensory acceptance of a diet designed to counteract obesity, diabetes and periodontaldisease2017Conference paper (Other academic)
    Abstract [en]

    A modified Nordic diet, developed by Igelösa Life Science AB, was tested in a clinical pilot study including ten individuals with type 2 diabetes during two weeks. The diet was based on locally produced, traditional ingredients such as intact grains, vegetables, legumes, root vegetables, fish, poultry, fruit and nuts. The intake of sugar, red meat and dairy products was restricted. One of the aims of the study was to study the sensory acceptance of the diet.

    The study was designed as a case-series. The diet was provided, ready-made and free of charge, to both the experimental subjects (N=10) and their partners (N=5). Two subjects were excluded due to heath implications, not related to the diet. The sensory acceptance was measured through questionnaire data and two focus groups (before and after the 2-week test period, 20 minutes each). Partners were invited to participate in the focus group interviews.

    Data from the questionnaire showed a high degree of liking for most meals. The result of the focus groups indicated the importance of the every-day meal as a social activity. They further expressed satisfaction with sensory properties and the perceived health benefits of the Igelösa diet but also some frustration regarding small portions, too little salt and somewhat unfamiliar ingredients.

    Sensory acceptance for diets nutritionally designed for weight reduction and/or maintenance is  a key factor. Despite the low number of participants, the pilot study indicate that the Igelösa diet is well accepted. An innovation of the study was that both the experimental subjects and their partners received the diet. The participants stated that this was supportive, facilitating adherence and promoting long-term impact on health. Habits, such as poor diet, can only be defeated by a concerted team effort and our work provide a glimpse of the potential benefits   of this shared approach.

  • 3.
    Renvert, Stefan
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life.
    Wallin-Bengtsson, Viveca
    Public Dental Health Services, Kristianstad.
    Berglund, Johan
    Blekinge Institute of Technology.
    Persson, G. Rutger
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life.
    Periodontitis in older Swedish individuals fails to predict mortality2015In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 19, no 2, p. 193-200Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aims to assess mortality risk and its association to health aspects in dentate individuals 60 years of age and older.

    MATERIALS AND METHODS: Medical and periodontal data from 870 dentate individuals (age range 60-96) participating in the Swedish National Study on Aging and Care in Blekinge (SNAC-Blekinge) with survival statistics over 6 years were studied.

    RESULTS: During 6 years of follow-up, 42/474 of the individuals (8.9 %), who at baseline were between age 60 and 75, and 134/396 individuals of the individuals (33.9 %), who at baseline were ≥75 years, died. Surviving dentate individuals had more teeth (mean 19.3, S.D. ± 7.9) than those who died (mean 15.9, S.D. ± 7.3; mean diff 3,3; S.E. mean diff 0.7; 95 % CI 2.0, 4.6; p = 0.001). A self-reported history of high blood pressure (F = 15.0, p < 0.001), heart failure (F = 24.5, p < 0.001, observed power = 0.99), older age (F = 34.7, p < 0.001), male gender (F = 6.3, p < 0.01), serum HbA1c with 6.5 % as cutoff level (F = 9.3, p = 0.002) were factors associated with mortality. A medical diagnosis of heart disease, diabetes, any form of cancer, or periodontitis failed to predict mortality.

    CONCLUSIONS: A self-reported history of angina pectoris, chronic heart failure, elevated serum HbA1c, and few remaining teeth were associated with mortality risk. A professional diagnosis of cardiovascular disease, diabetes, cancer, or periodontitis was not predictive of mortality.

    CLINICAL RELEVANCE: Self-health reports are important to observe in the assessment of disease and survival in older individual.

  • 4.
    Wallin Bengtsson, Viveca
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    Persson, G. Rutger
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    Berglund, Johan
    Institute of Technology, Karlskrona.
    Renvert, Stefan
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    A cross-sectional study of the associations between periodontitis and carotid arterial calcifications in an elderly population2015In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, p. 115-120Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate if the presence of periodontitis is associated with carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population.

    MATERIALS AND METHODS: Study individuals were randomly selected from the Swedish civil registration database representing the aging population (60-96 years) in Karlskrona, Sweden. Bleeding on probing (BOP) and the deepest probing measurement at each tooth were registered. The proportions of teeth with a probing depth ≥5 mm and the proportion of teeth with bleeding on probing were calculated. Analog panoramic radiographs were taken and the proportion of sites with a distance ≥5 mm between the alveolar bone level and the cement-enamel junction (CEJ) were assessed. A diagnosis of periodontitis was declared if a distance between the alveolar bone level and the CEJ ≥5 mm could be identified from the panoramic radiographs at >10% of sites, probing depth of ≥5 mm at one tooth or more and with BOP at >20% of teeth.

    RESULTS: Readable radiographs were obtained from 499 individuals. Carotid calcification was identified in 39.1%. Individuals were diagnosed with periodontitis in 18.4%. Data analysis demonstrated that individuals with periodontitis had a higher prevalence of carotid calcifications (Pearson χ (2) = 4.05 p < 0.05) and with a likelihood of 1.5 (95% CI = 1.0, 2.3, p < 0.05).

    CONCLUSIONS: Data analysis demonstrated a significant association between periodontitis and carotid calcification.

  • 5.
    Wallin Bengtsson, Viveca
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III.
    Persson, G. Rutger
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III. Kristianstad University, Forskningsmiljön Oral Hälsa - Allmänhälsa - Livskvalitet.
    Renvert, Stefan
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap III. Kristianstad University, Forskningsmiljön Oral Hälsa - Allmänhälsa - Livskvalitet.
    Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 6, p. 401-412Article, review/survey (Refereed)
    Abstract [en]

    Objectives. To assess the literature on carotid calcifications defined from panoramic radiographs (PMX) and concurrent diagnosis of stroke and periodontitis.

    Materials and methods. A literature search screening for publications using search terms such as PMX and carotid calcification, stroke and periodontitis was performed in November 2012.

    Results. A total of 189 articles were retrieved, among which 30 were included in the review. The sensitivity for PMX findings of carotid calcifications (CC) compared to a diagnosis by Doppler sonography varied between 31.1–100%. The specificity for PMX findings of carotid calcifications compared to a diagnosis by Doppler sonography varied between 21.4–87.5%. Individuals with CC findings from PMX have more periodontitis and risk for stroke.

    Conclusions. There is a shortage of well-designed studies in older dentate individuals assessing the associations between periodontitis and radiographic evidence of CC and in relation to stroke or other cardiovascular diseases.

    Statement of Clinical Relevance. Carotid calcifications are prevalent in patients with periodontitis and such individuals may have an increased risk for stroke. The absence of signs of carotid calcification on panoramic radiographs is indicative of no calcification of carotid arteries.

  • 6.
    Wallin Bengtsson, Viveca
    et al.
    Kristianstad University, Faculty of Health Science, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, Faculty of Health Science, Avdelningen för oral hälsa.
    Persson, Rutger G
    Kristianstad University, Faculty of Health Science, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, Faculty of Health Science, Avdelningen för oral hälsa. USA.
    Berglund, Johan
    Institute of Technology.
    Renvert, Stefan
    Kristianstad University, Faculty of Health Science, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, Faculty of Health Science, Avdelningen för oral hälsa.
    Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study2019In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 23, no 3, p. 1171-1179Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess if carotid calcifications detected in panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10-13 years in individuals between 60 and 96 years.

    MATERIALS AND METHODS: Baseline (2001-2004) panoramic radiographs were assessed for evidence of carotid calcifications from individuals with no previous history of stroke and/or ischemic heart diseases. A radiopaque nodular mass adjacent to the cervical vertebrae, at or below the intervertebral space C3-C4, was interpreted as carotid calcification. Annual medical records were searched for ICD 10 codes through 2014.

    RESULTS: Signs of carotid calcification was demonstrated in 238/635 (37.5%) of the study individuals. Signs of carotid calcification was associated with future stroke and/or ischemic heart diseases (χ2 = 9.1, OR 1.6, 95% CI 1.2, 2.2, p < 0.002). In individuals 60-72 years, a significant association between radiographic signs of carotid calcification and stroke and/or ischemic heart diseases (χ2 = 12.4, OR 2.4, 95% CI 1.5, 4.0, p < 0.000) (adjusted for high blood pressure, diabetes type 2, BMI; OR 1.9, 95% CI 1.1, 3.5, p = 0.03). Individuals (60-72 years) with radiographic evidence of carotid calcifications had a mean cumulative stroke and/or ischemic heart diseases survival time of 12.1 years compared to those without such evidence (13.0 years) (log rank Mantel-Cox χ2 = 10.7, p = 0.001).

    CONCLUSIONS: Evidence of carotid calcifications in panoramic radiographs is associated with an event of stroke and/or ischemic heart diseases in 60-96-year-old individuals.

    CLINICAL RELEVANCE: Radiographic evidence of carotid calcifications is associated with stroke and/or ischemic heart diseases. Patients with signs of carotid calcifications should therefore be referred for medical examination.

  • 7.
    Wallin Bengtsson, Viveka
    Kristianstad University, Faculty of Health Science, Research environment Oral Health - Public Health - Quality of Life (OHAL). Kristianstad University, Faculty of Health Science, Avdelningen för oral hälsa.
    Periodontitis, carotid calcifications and future cardiovascular diseases in older individuals2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. Periodontitis is a chronic inflammatory disease with a microbiological etiology affecting the supporting tissues of the tooth. The disease affects approximately 50% of the adult population. The prevalence of periodontitis increases with age. The complex bacterial infection, as well as an exaggerated host inflammatory reaction, may trigger subclinical atherosclerosis. Aims. The overall aim of the present thesis was to study the associations between periodontitis, cardiovascular diseases and mortality. The specific aims were: I) to evaluate the use and value of panoramic radiographs in assessing carotid calcifications in relation to other used methods (gold standards) and to assess the literature on carotid calcifications defined from panoramic radiographs and concurrent diagnosis of stroke and periodontitis, II) to evaluate if periodontitis is associated with the presence of carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population, III) to assess if carotid calcifications detected on panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10–13 years in individuals between 60 and 96 years, IV) to assess if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases or are at higher risk of death over a period of 17 years. Methods: A literature review based on peer-reviewed studies was performed evaluating the use of panoramic radiographs in assessing carotid calcifications compared to other methods. In study II, III, IV older individuals, 60 years and older participating in the Swedish National Study of Aging and Care (SNAC) were included in the studies. A dental hygienist performed a dental clinical and radiographic examination. Probing depths (PD) and bleeding on probing (BOP) was registered. From radiographic panoramic images, the distances between the alveolar bone level and the cement enamel junction (CEJ) were measured. In study II, a diagnosis of periodontitis was declared, using a composite definition; if a distance between the alveolar bone level and the CEJ ≥5 mm on panoramic radiographs at >10% of sites and PD ≥5 mm at one or more teeth and with BOP >20% of teeth. In study IV, an indicator of a history of periodontal disease was declared if a distance between the alveolar bone level and the CEJ ≥5 mm on panoramic radiographs at ≥30% of sites. Evidence of a radiopaque nodular mass in the intervertebral space at or below the vertebrae C3-C4 was identified as carotid calcification. In addition, a medical research team performed the medical examinations, and a medical doctor (JB) reviewed all medical records for information about events of stroke and ischemic heart diseases. Stroke and ischemic heart diseases were registered according to the ICD 10 codes: ICD 60-69 for stroke and ICD: 20-25 for ischemic heart diseases. Study I was a review of the literature, in study II, a cross-sectional study design was employed. In studies III and IV, a longitudinal prospective study design was used. Results: On the use of panoramic radiographs in assessing carotid calcifications in relation to other used methods, the sensitivity and specificity varied between studies published. Furthermore, only a small number of studies were found concerning carotid calcifications and stroke. These studies were primarily retrospective. Four studies were found on the association between periodontitis and carotid calcification. Study II identified that older individuals with periodontitis had a significantly higher prevalence of carotid calcifications than individuals who did not have a diagnosis of periodontitis. In study III, a significant association was found between carotid calcifications on panoramic radiographs and 13- year incidence of stroke using a logistic regression analysis adjusted for confounders (BMI, diabetes type 2, hypertension) in the 60-72 years. A statistically significant crude association between radiographic evidence of carotid calcifications and incidence of ischemic heart diseases was found in individuals between 60-72 years. Such an association was, however, not identified among individuals older than 72 years. In study IV, Cox regression analysis was used, adjusted for confounders (age group, BMI >30, diabetes type 2, gender, hypertension, history of AMI, history of stroke, periodontitis, smoking) and with a definition of periodontitis as having a distance between the alveolar bone level and the CEJ ≥5 mm in panoramic radiographs at ≥ 30% of sites. Periodontitis increased the risk for ischemic heart diseases in all individuals, in women and in the 78-96 years age group (OO). Associations between periodontitis, and mortality were found in all individuals, in men and in the 60-72 years age group (YO) in the long term follow-up. Conclusions: 1. 1. Study I identified that there are studies which have assessed the value of panoramic radiographs in relation to other used methods (gold standards). The sensitivity and the specificity varied, with the specificity being more often higher. Few studies have considered the relationship between radiographic evidence of carotid calcifications and stroke. Four studies identified a relationship between a diagnosis of periodontitis and carotid calcifications on panoramic radiographs. 2. Study II identified a significant association between periodontitis and carotid calcification in individuals 60-96 years. 3. Study III identified that signs of carotid calcifications assessed from panoramic radiographs from the 60-96-year-old individuals were consistent with an incident of stroke and/or ischemic heart diseases over 13 years follow-up. 4. Study IV identified that periodontitis was associated with future ischemic heart diseases in all individuals, in women and in the 78- 96 years age group. Periodontitis was associated with mortality in all indviduals, in men and in the 60-72 years age group.

  • 8.
    Widén, Cecilia
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    Erovic Ademovski, Seida
    Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    Karlgren-Andersson, Pernilla
    Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap.
    Sättlin, Susanna
    Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    Wallin Bengtsson, Viveka
    Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).
    Hälsoklinik på Tandhygienistprogrammet2017In: Högskolepedagogisk debatt, ISSN 2000-9216, no 2, p. 29-34Article in journal (Other (popular science, discussion, etc.))
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