Summary Importance of communication from a cultural and linguistic perspective in dental care -A literature review The aim of this literary review was to describe dental care situations where communication difficulties arise due to various cultural and linguistic aspects. This was investigated by the following questions: – What cultural aspects need to be taken into account in order to achieve satisfactory communication in healthcare/dental care? –How is healthcare/dental care affected by the use of verbal and non-verbal communication? – What evidence is there of the usage of alternative methods of communication when language barriers exist in dental care situations? Method was screened in the literary study, and was done as a literary review. Scientific articles have been sought out according to a three-step selection process to search for answers to the research questions. The results showed that the availability of a qualified interpreter ensures the establishment of good communication with dental care patients that have language problems. There is evidence of a significant difference in the use of a qualified interpreter and an interpreter without formal training. The creation of good dialogues and true communication is only possible when cultural and language barriers are broken by using a professional interpreter. In summary, dental care staff needs to meet every individual patient with interest and empathy, regardless of background or communicative ability.Keywords: Cultural Barriers, Dental Care, Foreign Background, Non-Verbal Communication.

ABSTRACT Background: The ability to identify individual risk factors for development of caries areimportant parts in the perspective of being able to control and limit caries disease. One suchcomponent is to establish, cut-off values for normal versus not normal values of known andputative risk factors. Aim: The aim was to analyze if individual variations of the amount of stimulated salivasecretion, pH-level and buffer capacity as well as content of S. mutans and A.actinomycetemcomitans could be used to form an alternative method to reach cut-off valuesbased on the natural variation in a population of dental students. Methods: This study was conducted by collecting saliva from 71 dental students at Umeåuniversity. The saliva was collected three times over a period of five weeks. The collection ofsaliva was conducted pair vice by the students themselves. The saliva was analyzed regardingsaliva secretion rate, buffer capacity, pH-level and quantity of S. mutans and A.actinomycetemcomitans. Measured factors were plotted graphically to show their stabilityover time among the participants. Results: Saliva secretion (and buffering, pH) showed a normal distribution that rangedwidely but with stable intra-individual values, the bacterial factors showed a non-parametricdistribution ranging from negative to positive values that varied largely. Conclusions: The normal distribution of salivatory properties makes it possible to calculatecut-off values based on standard deviation. The non-parametric distribution of the microbialfactors suggests cut-off values based on infected versus non-infected and intra-individuallyhigh numerical counts of bacteria on repeated analysis.

Background: Filifactor alocis is a gram positive, obligate anaerobic rod bacterium that has shown correlation to pathogenic events that may be linked to periodontitis. Previous studies have proved the presence of so-called “rtx” toxins in F. alocis that are similar to the leukotoxin of A. actinomycetemcomitans. The relevance of this gene in periodontitis is however unknown. Aim: The primary aim of the study was thereby to investigate whether the occurrence of Filifactor alocis carrying the rtx-gene affects the pathological progression of periodontitis or not. The secondary aim was to observe an eventual correlation between high loads F.alocis and attachment loss. Methods: Altogether 99 clinical samples taken from the gingival pockets of Ghanaian adolescents between the age of 10-19 were scanned by using PCR and gel electrophoresis. Thereafter the correlations were analyzed mainly from the point of view of progression by using Excel and MedCalc. Results: The highest significant value was shown in the group where correlation between the rtx- gene occurrence and clinical attachment loss progression existed (44%, p<0.05). No statistically significant values between the high loads of F.alocis and attachment loss were found. Conclusion: Our findings suggested the possible existence of a correlation between the rtx- gene occurrence and clinical attachment loss progression and thus supported our hypothesis. Thereby the primary null hypothesis was rejected. However, no correlation could be seen between F.alocis and attachment loss, which in turn did not support our secondary hypothesis.

ABSTRACT Background. Three-dimensional (3D) printing is a manufacturing technique, based on building objects layer by layer. It has received more attention lately especially in the medical and dental fields.   Aim: To investigate two mechanical properties of three-dimensionally printed polymer-based materials and compare them with conventionally cured polymer-based material.  Methods: Samples of four 3D-printed polymer-based materials (NextDent C&B MFH; NextDent Denture 3D+; NextDent Ortho Rigid and Freeprint® temp) and a conventionally cured and hand-mixed polymer-based provisional material (Luxatemp star) were investigated. Flexural strength and Vickers hardness were analyzed. Before the tests were carried out, all samples were placed in water in 37°C for at least 24 hours.   Results: The flexural strength results showed that there was statistically significant difference between Luxatemp star, NextDent C&B MFH and Freeprint®temp. Both 3D printed materials had a higher flexural strength than the conventionally cured material (Luxatemp star). At the same time, there was no statistically significant difference between Luxatemp star, NextDent Denture 3D+ and NextDent Ortho Rigid. The hardness values showed no statistically significant difference between the conventionally cured material (Luxatemp star) and the 3D printed materials. Furthermore, no statistically significant differences could be seen between the different 3D printed materials.  Conclusions: NextDent C&B MFH and Freeprint®temp had higher flexural strength than the conventionally cured material. NextDent Ortho Rigid and NextDent Denture 3D+ had a flexural strength comparable to the conventionally cured polymer-based material. 3D printed materials had a hardness comparable to the conventionally cured ones.

ABSTRACT  Background: Three-dimensional (3D) printing is a manufacturing technique, based on building objects layer by layer. It has received more attention lately especially in the medical and dental fields.   Aim: To investigate two mechanical properties of three-dimensionally printed polymer-based materials and compare them with conventionally cured polymer-based material.  Methods: Samples of four 3D-printed polymer-based materials (NextDent C&B MFH; NextDent Denture 3D+; NextDent Ortho Rigid and Freeprint® temp) and a conventionally cured and hand-mixed polymer-based provisional material (Luxatemp star) were investigated. Flexural strength and Vickers hardness were analyzed. Before the tests were carried out, all samples were placed in water in 37°C for at least 24 hours.   Results: The flexural strength results showed that there was statistically significant difference between Luxatemp star, NextDent C&B MFH and Freeprint®temp. Both 3D printed materials had a higher flexural strength than the conventionally cured material (Luxatemp star). At the same time, there was no statistically significant difference between Luxatemp star, NextDent Denture 3D+ and NextDent Ortho Rigid. The hardness values showed no statistically significant difference between the conventionally cured material (Luxatemp star) and the 3D printed materials. Furthermore, no statistically significant differences could be seen between the different 3D printed materials.  Conclusions: NextDent C&B MFH and Freeprint®temp had higher flexural strength than the conventionally cured material. NextDent Ortho Rigid and NextDent Denture 3D+ had a flexural strength comparable to the conventionally cured polymer-based material. 3D printed materials had a hardness comparable to the conventionally cured ones.

Background: Substandard technical quality of root fillings is strongly correlated with apical periodontitis. The introduction of Nickel-Titanium rotary system has improved the technical quality. However, the overall treatment outcome of root canal treatments has not improved. Root canal treatment has been shown to be associated with stress, anxiety and lack of control.  Aim: To investigate the experience of endodontic treatment among general dental practitioners with focus on difficulties and barriers.  Methods: A digital questionnaire survey was sent by email to general dental practitioners (GDPs) in five counties in northern Sweden. The participants were asked questions regarding general information and questions related to their endodontic work divided into three main groups; the patient, education and stress, time and material.  Results: The response rate was 58% (n=96). Sixty percent of the participants had a very or quite positive attitude towards endodontic treatment. Sixty-three percent often or sometimes experience stress when performing root canal treatment. Lack of time was frequently answered as a cause of stress (59%). Most respondents had a good (40%) or quite good (54%) education in endodontics. Twenty-two percent of the GDPs felt very confident and 62% felt quite confident when performing root canal treatment. Conclusion: The participants generally had a positive attitude toward endodontic work. Although, stress was frequently experienced when performing root canal treatment, in many situations due to lack of time. Results from the present study indicates that education is of great value to further develop the dentists’ confidence in endodontics.

ABSTRACT Aim: To understand endodontic infections and their prognosis knowledge of which bacteria are present, viable, and part of perpetuating the late stages of the infection. The aim of this study was to investigate three different methods for mapping the composition of the microbiota in infected root canals. Methods: (i)Culturing on agar discs; (ii)real-time polymerase chain reaction (qPCR) processing; and (iii)qPCR processing of samples pre-treated with propidium monoazide (PMA). Samples were collected from 32 teeth and stored in buffer solution. Culturing was conducted on Fastidious Anaerobe Agar plates using 200 µL sample solution. Another 400 µL was treated with PMA dye and photoactivation prior to qPCR processing, while the remaining 400 µL was processed by qPCR without pretreatment. The sampled diagnoses were asymptomatic apical periodontitis, asymptomatic apical periodontitis with sinus tract, and symptomatic apical periodontitis. Results: The study found no significant difference in amount of bacteria between the three diagnoses, but found that different methods yielded significantly different results when applied to each diagnosis. qPCR detected the highest absolute numbers of bacteria, and qPCR with PMA the lowest. Conclusions: Results indicate that different methods yield different results, but that the diagnoses do not differ much in terms of bacterial load. To confidently conclude whether or not there is a connection between diagnosis and amount of bacteria, a larger sample size is needed. The results in this study are suspected to be skewed by compromised data, and no certain conclusions can be drawn.

Relationship between oral health-related quality of life and teeth whitening Summary Aim: The aim of the study was to study the relationship between oral health-related quality of life and teeth whitening. Method: Literature Study. Scientific articles were searched in databases DOSS, PubMed and Medline with keyword combinations "Oral health-related quality of life" AND "teeth whitening" and "quality of life" AND "teeth whitening". The literature study included 13 quality-reviewed articles. Results: The thematic analysis resulted in three main themes and under each central main theme has several sub-theme identifiers. Main themes showed that there was a connection between oral health-related quality of life and teeth whitening: Aesthetic impact, Psychological impact and Pain impact. Teeth whitening led to reduced aesthetic anxiety, improved aesthetic self-perception, color change, reduced discomfort, improved self-confidence that had a positive effect on the oral health-related quality of life. On the other hand, teeth whitening could cause tooth sensitivity and soft tissue irritation, which had a negative effect on the oral health-related quality of life. Keywords: Bleaching, discolored teeth, quality of life , whiter teeth.

SAMMANFATTNING Vedbildning är en underliggande mekanism för så skilda områden som industri, boende och en hållbar miljö. Vedbildning sker i det vaskulära kambiet där organiserade celldelningar åtföljs av differentiering till specialiserade vedceller. Ved består av sekundärt xylem som är starka, stora celler med tjocka cellväggar som är lignifierade. Dessa celler transporterar vatten och näringsämnen samt ger trädet dess styrka. Grunden för de starka cellerna är en avancerad komposit bestående av cellulosafibrer tvärbundna av hemicellulosa och slutligen ingjutet i lignin. Denna fiberkomposit är den sekundära cellväggen i vedartade växter. Celldelning och differentiering regleras genom att sätta igång och stänga av gener. Proteiner som kodas av dessa gener utför de viktigaste funktionerna i cellerna. De styr hela maskineriet som upprätthåller cellernas struktur och funktion, underhåller tillväxt samt tillverkar nödvändiga produkter såsom cellväggskolhydraterna. Träbioteknologiforskningsgruppen har varit en del av ett kraftfullt åtagande att identifiera de proteiner som är ansvariga för nyckelprocesser i vedbildning. Detta har utförts genom att övervaka genexpressionen vid olika tidpunkter av vedcellsmognad i Populus tremula x tremuloides. Här beskriver vi undersökningen av proteiner som är inblandade i cellexpansion och bildandet av sekundär cellvägg liksom utvecklandet av ett modellsystem som kommer vara en hjälp i den funktionella analysen av cellulosabiosyntes. Expansin är ett protein som verkar i cellexpansionen i alla växtens vävnader. Vi har studerat ett expansin, PttEXPA1, som visat sig vara särskilt närvarande i celler som genomgår vedbildning. Dessutom har vi undersökt glykosyltransferaser som tycks spela en viktig roll i bildandet av sekundär cellvägg. En av dessa, PttGT43A har uttryckts i jästen Pichia pastoris och i baculovirusinfekterade insektsceller. Dessvärre var proteinnivåerna för låga för biokemisk karakterisering. Dessutom har vi demonstrerat att flytande cellkulturer av hybridasp kan användas som ett modellsystem för cellulosabiosyntes. Genom att bemästra proteinerna som är ansvariga för vedbildning får vi verktyg att utveckla skogsproduktsmarknaden. En vision är nya produkter som till exempel träd som växer snabbare, ändrade fiberegenskaper, produktion av vedkolhydrater såväl som utvecklandet av intelligenta material genom biomimetisk ingenjörskonst. / ABSTRACT Wood formation or xylogenesis is a fundamental process for so diverse issues as industry, shelter and a sustainable environment. Xylogenesis originates from the vascular cambium where organised cell divisions are followed by differentiation into specialised wood cells. Wood is comprised of secondary xylem, rigid large cells with thick cell walls that are lignified. These cells transport water and nutrients as well as give the tree its strength. The basis for the sturdy cells is an advanced composite made up of cellulose fibers cross-linked by hemicelluloses and finally embedded in lignin. This fiber-composite is the secondary cell walls of woody plants. Cell division and differentiation is regulated by switching on and off genes. Proteins encoded by these genes execute the major functions in the cells. They steer the entire machinery operating the structure and function of the cells, maintaining growth and synthesising essential products such as the cell wall carbohydrates. The Wood Biotechnology research group has been part of a massive undertaking of identifying proteins responsible for the key processes of xylogenesis. This has been achieved by monitoring the gene expression at different time points of wood cell maturation in Populus tremula x tremuloides. Here we describe investigation of proteins involved in cell expansion and secondary cell wall formation as well as the development of a model system that will aid the functional analysis of cellulose synthesis. Expansin is a protein involved in cell expansion in all tissues of the plant. We have studied one expansin, PttEXPA1, found to be especially abundant in cells undergoing wood formation. Also, we have examined glycosyltransferases that seemingly play a part in secondary cell wall formation. One of these, PttGT43A is expressed in the yeast Pichia pastoris as well as in baculovirus infected insect cells. However, protein levels were too low for biochemical characterisation. We have also demonstrated that hybrid aspen cell suspension cultures can be used as a model system for cellulose synthesis. By mastering proteins involved in xylogenesis we acquire the tools to improve and develop the wood product market. New products envisioned include e.g. faster growing trees, changed fiber characteristics, production of wood carbohydrates as well as invention of intelligent materials by biomimetic engineering. / QC 20101122

Sammanfattning Syfte: Syftet med studien var att undersöka om böjhållfastheten pålitiumdisilikatbaserad glaskeram som har framställts genom pressteknik påverkasav en energidryck (NOCCO) och apelsinjuice motsvarande 13-års förbrukning. Material och metod: Totalt tillverkades 30 provkroppar genom att pressas i IPSe.max Press®. Provkropparna delades in i tre grupper, varav två grupper utsattesför sura drycker (EMA & EMN) och en grupp som kontrollgrupp (EMK). Antaletprovkroppar var 10 i varje grupp med måtten 12 mm i diameter och 1,7 mm itjocklek. Alla grupper bevarades i varsin behållare fylld med respektive dryck.EMA förvarades i 8°C apelsinjuice, EMN förvarades i 8°C NOCCO focus 4legend soda och EMK förvarades i 37°C destillerat vatten. Efter 14 dygn utsattesprovkropparna för biaxialt böjhållfasthetstest och efteråt analyserades resultatetmed One-way ANOVA, Tukey’s test med en signifikansnivå på α= 0,05. Resultat: Resultatet visade att det fanns en signifikant skillnad mellan grupperna.Testet påvisade att EMK hade lägst medelvärde (215 MPa) och EMA hade högstmedelvärde (432 MPa). Gruppen EMK hade en signifikans i jämförelse medsamtliga grupper medan EMN och EMA inte uppvisade signifikant skillnadgentemot varandra. Slutsats: Följande slutsatser i föreliggande invitro studie kan dras; sura dryckerhar ingen påverkan på böjhållfastheten hos litiumdisilikatbaserade glaskeramerframställt genom pressteknik. / Abstract Aim: The aim of the study is to investigate whether the strength of lithiumdisilicate-based glass ceramics that have been produced by pressing technologyare affected by an energy drink (NOCCO) and orange juice after treatmentcorresponding to 13 years of consumption. Material and method: A total of 30 specimens by IPS e.max Press® weremanufactured, then divided into two groups exposed to acidic beverages (EMA &EMN) and one group was assigned as a control group (EMK) with 10 specimensin each group, measuring 12 mm in diameter and 1.7 mm in thickness. EMA waspreserved with 8 °C orange juice, EMN was preserved with 8 °C NOCCO focus 4legend soda and EMK was preserved in 37 °C distilled water. After 14 days, thespecimens were subjected to biaxial flexural strength and subsequently analyzedwith One-way ANOVA, Tukey's test with a significance level of α = 0.05. Result: The results showed that EMK had the lowest mean (215 MPa) and EMAhad the highest mean (432 MPa). It turned out that EMK had a significance incomparison with all groups, while EMN and EMA have no significant differencefrom each other. Conclusion: The following conclusions are drawn from this in vitro study; acidicbeverages have no effect on the flexural strength of lithium disilicate-based glassceramics produced by pressing technology.