Syftet med studien var att kartlägga kostvanor och munhygienvanor samt uppfattning av den egna munhälsan hos skiftarbetare. Studien har utförts som en kvantitativ tvärsnittsstudie med användning av enkät. Undersökningsgruppen bestod av sammanlagt 100 skiftarbetare från industri- och vård- och omsorgssektorn i Skåne. Det insamlade materialet analyserades i statistikprogrammet Statistical Package for the Social Sciences (SPSS) version 23.0. Resultatet av studien visade att skiftarbetarnas kostvanor påverkades negativt av skiftarbete genom ökat småätande, intag av sötad dryck och oregelbundna måltider på grund av varierande arbetstider.  När det gäller munhygienvanor påverkades inte tandborstningen på samma sätt, däremot rengöringen mellan tänderna utförs inte regelmässigt. Studiens slutsats visade att skiftarbetarna hade goda munhygienvanor när det gäller tandborstning och fluoranvändning dock med mindre regelbunden rengöring mellan tänderna. Kostvanorna var bristfälliga med ökat småätande och sötade drycker mellan måltiderna.

Bakgrund: MI är en metod för rådgivning och för att hjälpa individen att hitta och bibehålla motivation till förändrat beteende. På senare år har metoden börjat användas även inom tandvården. Syfte: Syftet med studien var att genom en litteraturöversikt sammanställa effekten av MI på parodontala sjukdomar och karies hos barn, ungdomar och vuxna. Metod: Studien består av en litteraturöversikt där vetenskapliga artiklar har tagits fram genom sökningar i databaserna PUBMED, DOSS, Medline, Psychinfo och CINAHL som sedan granskats och sammanställts. Sjutton artiklar har utvalts utifrån de inklusion/exklusion kriterier som fanns. De studierna som blev inkluderade i resultatet har blivit granskade med hjälp av en mall för att kunna identifiera studiernas värde för litteraturstudien. Resultat: De utvalda artiklarna var från Frankrike, Kanada, Kina, Tyskland, Iran, Indien, Serbien, Spanien, Sverige och USA. Ungefär hälften av artiklarna påvisade ett positivt resultat för patienter som genomgått MI-samtal i kombination med vanlig behandling jämfört med kontrollgrupper. Den andra hälften såg inga dylika resultat. Slutsats: Metoden tycks ha effekt i vissa sammanhang men inte i andra. En faktor som inte visade någon påverkan på effektiviteten av MI var patienternas ålder. Ytterligare forskning krävs för att fastställa vilka faktorer som påverkar resultatet vid användning av MI inom tandvården. / Background: MI is a method for counseling and for helping individuals find and maintain motivation for change of behavior. In later years the method has also seen some use in dental care.   Aim: To study the effect of MI on parodontal diseases and caries in children, adolescents and adults.   Method: The study design was a literature review where scientific articles were gathered by searching through databases like for example PUBMED, DOSS, Medline, Psychinfo and CINAHL and then scrutinized and summarized. Seventeen articles were selected according to existing inclusion-/exclusion criteria. The included studies were reviewed with a modified review template to present studies of strong/moderate value.     Result: The selected articles were from Canada, China, France, Germany, Iran, India, Serbia, Spain, Sweden and USA. About 50% of the articles indicated a positive result for patients who undertook MI-sessions in combination with regular treatment, compared to control groups. The other half could see no such results.   Conclusion: The method seems to have effect in some instances but not in others. A factor that showed no alteration of MI effectiveness was the patients’ age. Further research is required to determine what factors might influence the outcome of using MI in dental care.

Bakgrund: År 2016 var det över en halv miljon barn inskrivna på förskola i Sverige. Barnen har bl.a. förskolepersonal som förebilder vad gäller kost och attityder kring munhygienen. Eftersom barn spenderar en stor del av sin tid på förskola är det av stor vikt att belysa kunskapen om barns munhälsa hos förskollärarstudenter. Syftet med studien var att undersöka förskollärarstudenters kunskap om munhälsa hos barn. Material och metod: Studien var en kvantitativ tvärsnittsstudie med en enkät som mätinstrument. Enkäten bestod av 20 frågor där kunskap och attityder om barns munhälsa och kostvanor mättes. Urvalet baserades på samtliga studenter från termin sex på förskollärarprogrammet i Jönköping University vårterminen 2018, totalt 82 studenter. Det insamlade datamaterialet analyserades med hjälp av datorprogrammen SPSS och Excel. Resultat: Totalt deltog 55 studenter i studien. Majoriteten av deltagarna hade hög kunskap och goda attityder gällande barns munhälsa och kostvanor. Dock var det endast 18 % av deltagarna som svarade rätt på frågan angående upp till vilken åldern barn behöver vuxenhjälp vid tandborstning. Slutsats: Studiens resultat konstaterade att förskollärarstudenter hade hög kunskap om barns munhälsa och kostvanor men att denna kunskap inte kom från utbildningen. / Background: In 2016, there were over half a million children enrolled in preschools in Sweden. Preschool staff are role models concerning diet and attitudes about oral hygiene, for children. Because children spend a lot of time in preschool it is important to highlight the knowledge of preschool students. The aim of this study was to investigate preschool students’ knowledge of oral health in children. Method: The study was a quantitative cross-sectional study with a survey as a measuring instrument. The survey consisted of 20 questions where knowledge and attitudes about children’s oral health and dietary habits were measured. The selection was based on all students from term six at the preschool teacher program at Jönköping University spring term 2018, a total of 82 students. The data collected was analyzed using computer programs SPSS and Excel. Result: A total of 55 students participated in the study. The majority of participants showed high knowledge and good attitudes regarding children’s oral health and dietary habits. However, only 18 % of the participants responded correctly on the question about what age children needed adult care when tooth brushing. Conclusion: The study found that preschool students had high knowledge regarding children’s oral health and dietary habits, but this knowledge did not come from the education.

Restless legs syndrome (RLS) and Obstructive sleep apnoea syndrome (OSAS) are two sleep disorders that affect daily life with symptoms such as sleepiness and fatigue. It was therefore hypothesised that the skeletal muscle could be affected as symptoms from skeletal muscle are common. The overall aim of the thesis was to investigate aerobic capacity and structure of skeletal muscle in patients with OSAS and RLS and an age matched control group to provide information regarding the underlying mechanisms. The specific aims were to investigate muscle fibre composition, capillary network, capillary proliferation and sings of local inflammation in musculus tibialis anterior of RLS and OSAS.OSAS and RLS patients had a significantly lower predicted VO2 max expressed in ml/min/kg compared with the control group and in the OSAS group apnoes-hyponea index (AHI) was inversely correlated to maximal oxygen uptake Fibre type composition and muscle fibre cross sectional area in the tibialis anterior muscle was equal in all groups with a predominant proportion of slow type I fibres and a smaller fibre area in slow type I fibres compared to fast type II fibres. The distribution of fast fibres (I/IIA, IIA) did not differ except for the group IIX and IIA/IIX where OSAS and RLS had a significantly higher percentage. OSAS patients had a significantly higher number of capillaries per fibre (CAF) for slow type I fibres and CAF per fibre area (CAFA) for fast type II fibres. CFPE- index (capillary to fibre perimeter exchange) and LC/PF-index (length of capillary/perimeter of fibre) were higher in both patient groups. Vascular endothelial growth factor (VEGF) and proliferating endothelial cells were analysed by double-immunofluorescence staining and were presented to a greater extent in the patient groups compared with the healthy controls. Based on normal amounts of T-cells and macrophages in the histological picture it was also demonstrated that local inflammation was not present in the tibialis anterior muscle of RLS and OSAS whish was also supported by the absence of expression of major histocompatibility complex class I molecules (MHC class I) on the surface of the tibialis anterior muscle fibres.In conclusion, the low predicted VO2 max together with higher percentage of type IIX and IIA/IIX muscle fibres indicates a low central capacity in the patient groups. The increased capillary network and the absence of inflammation indicate the occurrence of local hypoxia in tibialis anterior muscle in patients OSAS and RLS.

In the last decade, a tremendous gain in knowledge concerning the molecular events of apoptosis signaling and execution has been achieved. The aim of this thesis was to clarify the role of lysosomal membrane permeabilization and lysosomal proteases, cathepsins, in signaling for apoptosis. We identified cathepsin D as an important factor in staurosporine-induced human fibroblast cell death. After release to the cytosol, cathepsin D promoted mitochondrial release of cytochrome c by proteolytic activation of Bid. Cathepsin D-mediated cleavage of Bid generated two fragments with the apparent molecular mass of 15 and 19 kDa. By sequence analysis, three cathepsin D-specific cleavage sites, Phe24, Trp48, and Phe183, were identified. Moreover, we investigated the mechanism by which cathepsins escape the lysosomal compartment, and found that Bax is translocated from the cytosol to lysosomes upon staurosporine treatment. In agreement with these data, recombinant Bax triggered release of cathepsins from isolated rat liver lysosomes. Conceivably, the Bcl-2 family of proteins may govern release of pro-apoptotic factors from both lysosomes and mitochondria. The importance of lysosomal cathepsins in apoptosis signaling was studied also in oral squamous cell carcinoma cells following exposure to the redox-cycling drug naphthazarin or agonistic anti-Fas antibodies. In this experimental system, cathepsins were released to the cytosol, however, inhibition of neither cathepsin D, nor cysteine cathepsin activity suppressed cell death. Interestingly, cysteine cathepsins still appeared to be involved in activation of the caspase cascade. Cathepsins are often overexpressed and secreted by cancer cells, and it has been reported that extracellular cathepsins promote tumor growth and metastasis. Here, we propose that cathepsin B secreted from cancer cells may suppress cancer cell death by shedding of the Fas death receptor. Defects in the regulation of apoptosis contribute to a wide variety of diseases, such as cancer, neurodegeneration and autoimmunity. Increased knowledge of the molecular details of apoptosis could lead to novel, more effective, treatments for these illnesses. This thesis emphasizes the importance of the lysosomal death pathway, which is a promising target for future therapeutic intervention. / In the last decade, a tremendous gain in knowledge concerning the molecular events of apoptosis signaling and execution has been achieved. The aim of this thesis was to clarify the role of lysosomal membrane permeabilization and lysosomal proteases, cathepsins, in signaling for apoptosis. We identified cathepsin D as an important factor in staurosporine-induced human fibroblast cell death. After release to the cytosol, cathepsin D promoted mitochondrial release of cytochrome c by proteolytic activation of Bid. Cathepsin D-mediated cleavage of Bid generated two fragments with the apparent molecular mass of 15 and 19 kDa. By sequence analysis, three cathepsin D-specific cleavage sites, Phe24, Trp48, and Phe183, were identified. Moreover, we investigated the mechanism by which cathepsins escape the lysosomal compartment, and found that Bax is translocated from the cytosol to lysosomes upon staurosporine treatment. In agreement with these data, recombinant Bax triggered release of cathepsins from isolated rat liver lysosomes. Conceivably, the Bcl-2 family of proteins may govern release of pro-apoptotic factors from both lysosomes and mitochondria. The importance of lysosomal cathepsins in apoptosis signaling was studied also in oral squamous cell carcinoma cells following exposure to the redox-cycling drug naphthazarin or agonistic anti-Fas antibodies. In this experimental system, cathepsins were released to the cytosol, however, inhibition of neither cathepsin D, nor cysteine cathepsin activity suppressed cell death. Interestingly, cysteine cathepsins still appeared to be involved in activation of the caspase cascade. Cathepsins are often overexpressed and secreted by cancer cells, and it has been reported that extracellular cathepsins promote tumor growth and metastasis. Here, we propose that cathepsin B secreted from cancer cells may suppress cancer cell death by shedding of the Fas death receptor. Defects in the regulation of apoptosis contribute to a wide variety of diseases, such as cancer, neurodegeneration and autoimmunity. Increased knowledge of the molecular details of apoptosis could lead to novel, more effective, treatments for these illnesses. This thesis emphasizes the importance of the lysosomal death pathway, which is a promising target for future therapeutic intervention.

Tandvårdsmarknaden är unik ur ett hälsoekonomiskt perspektiv. Den finansieras delvis av privata konsumenter och delvis av staten. Produktionen av tandvård är till skillnad från generell vård relativt jämnt uppdelad mellan privat och statlig sektor. Nya aktörer i form av tandvårdskedjor ägda av riskkapitalbolag har på senare år gått in på marknaden. Den här uppsatsen tittar på huruvida nyetableringen av tandvårdskedjor har påverkat utfallet hos medianen av intakta tänder som mått på tandhälsa. Metoden för att finna sambandet mellan den beroende variabeln medianen av intakta tänder och den oberoende variabeln nyetablering av tandvårdskedjor ägda av riskkapitalbolag var fixa effekter. Data samlades in för Sveriges samtliga 290 kommuner under en tidsperiod av 6 år, vilket sammanlagt resulterade i 1740 observationer. Resultatet är att 1 nyetablering av en tandvårdskedjas klinik gav ett positivt utfall i kommun per 100 000 invånare med 0.04 tänder vad gäller variabeln medianen av intakta tänder. Signifikansen var dock högre än 0.1. Slutsatsen i det hela blir därmed att det inte går att finna statistiskt stöd för att nyetableringen av tandvårdskedjor haft en positiv effekt på svensk tandhälsa eller inte. Vi kan därmed inte förkasta att den sanna effekten av privata tandvårdskedjor är lika med noll (eller till och med negativ).

Objective: To evaluate in humans the efficacy of power driven interdental cleaning tools in addition to tooth-brushing compared to tooth-brushing alone or any non-power driven interdental cleaning tool in addition to tooth-brushing on dental plaque removal and prevention of gingivitis.   Introduction: Daily mechanical self-care disruption of dental plaque is considered important for oral health maintenance. Tooth-brushing, which is the most common method for removing dental plaque, has only a marginal effect on the interdental spaces between the teeth. Therefore, special cleaning tools are necessary for plaque removal in these areas. Dental floss has long been considered “the golden standard” of interdental cleaning and is often recommended by dental health professionals. Powered interdental tools are an alternative that in certain studies have proven to be efficient on plaque and bleeding.   Method: Two internet sources (PubMed and Cochrane Central) were searched for studies investigating the efficacy of powered interdental tools on the parameters of plaque, gingivitis and bleeding in comparison to tooth-brushing only or tooth-brushing and any non-powered interdental tool. The PRISMA 2009 protocol was adopted and studies included were analysed for results and homogeneity. Bias across studies was estimated according to a protocol by SBU.   Results: 14 articles were found relevant to the research question and analysed for data on plaque, gingivitis and bleeding. Studies were grouped according to type of device investigated. The groups consisted of oral irrigation with water on patients with natural teeth or undergoing orthodontic treatment plus a group on other interdental tools. The results show that power interdental tools have a significant ability to decrease plaque, gingivitis and bleeding. / Syfte: Syftet med studien var att söka evidens för maskinella interdentala hjälpmedels effekt på plackborttagning, gingivit och blödning och om de har en tilläggseffekt utöver tandborstning jämfört med endast tandborstning eller tandborstning i kombination med manuella interdentala hjälpmedel på människor.   Introduktion: Daglig plackborttagning är viktig för att uppnå god oral hälsa. Tandborstning är den vanligaste metoden för att ta bort plack men har endast en marginell åtkomst till det interdentala utrymmet mellan tänderna, därför behövs specielle hjälpmedel för plackborttagning i dessa utrymmen. Tandtråd har länge betraktats som ”en gyllene standard” för rengöring mellan tänderna och rekommenderas oftast av tandvården. Maskinella hjälpmedel är ett alternativ som i vissa studier har visat sig vara effektiva mot plack och blödning.   Metod: Två databaser genomsöktes (PubMed och Cochrane Central) för studier av maskinella interdentala hjälpmedel och deras effektivitet på plack, gingivit och blödning i jämförelse med tandborstning, eller tandborstning med manuella interdentala hjälpmedel. Ett protokoll för systematiska litteraturstudier (PRISMA 2009) följdes och inkluderade studier bearbetades med avseende på resultat och risk för systematiska fel med hjälp av en mall från SBU.   Resultat: Totalt 14 artiklar som var relevanta för syftet inkluderades i studien och data för plack, gingivit och blödning analyserades. Studierna grupperades i enlighet med vilken typ av hjälpmedel de utgjorde. Grupperna bestod av vattenflossers (oral irrigators) använda av patienter med egna tänder och/eller med fast tandställning samt en grupp övriga maskinella hjälpmedel. Resultatet pekar på att maskinella interdentala hjälpmedel har en signifikant effekt på plack, gingivit och blödning och kan rekommenderas till patienter som alternativ till manuella hjälpmedel.

BACKGROUND: Vietnam, being a developing country does not have the same economic means to put into dental care as a country like Sweden. Knowledge, attitude and behavior are determining factors for oral health. The AIM of this literature study´s was therefore to evaluate knowledge, attitude and behavior regarding oral health among children and adolescents, in Vietnam and Sweden. METHOD:A literature review was made using the databases DOSS, MEDLINE and CINAHL. Twelve articles were included for the review. RESULTS: Bleeding gum was known, by one-third of the Vietnamese children and adolescents, to be a clinical sign of gingivitis. In Sweden the knowledge varied between 75-83%. In both Vietnam and Sweden, shiny and white teeth were mentioned to be important. The frequency of toothbrushing twice a day or more was reported from 40% to 68% among the participants in Vietnam. In Sweden, it varied from 73% to 82%. The highest percentage of children who consumed sweets daily or more frequent was 59,7% in Vietnam respectively 2-6% in Sweden. CONCLUSION: Knowledge about oral health was lacking and behavior could be seen to be inadequate. The attitude towards oral health is more focused on appearance than on the aspect of health. / BAKGRUND: Vietnam, som är ett utvecklingsland, har inte samma ekonomiska resurser att prioritera till tandvården, vilket däremot ett land som Sverige har. Kunskap, attityd och beteende är alla bestämningsfaktorer för oral hälsa. SYFTET med studien var att utvärdera kunskap, attityd och beteende gällande oral hälsa bland barn och ungdomar i Vietnam och Sverige. METOD: En litteraturstudie gjordes med hjälp av databaserna DOSS, MEDLINE och CINAHL. Tolv artiklar inkluderades i studien. RESULTAT: En tredjedel av de vietnamesiska barnen och ungdomarna visste att blödande tandkött var ett kliniskt tecken på gingivit. I Sverige varierade kunskapen mellan 75–83%. I både Vietnam och Sverige var skinande och vita tänder viktigt. Tandborstning två gånger om dagen rapporterades av 40–68% av deltagarna i Vietnam. I Sverige varierade det mellan 73–82%. Den högsta procentsatsen av barn som konsumerade sötsaker dagligen eller mer frekvent i Vietnam var, 59,7%. I Sverige varierade detta mellan 2–6%. SLUTSATS:Kunskapen och beteendet kring oral hälsa var bristfällig. Attityden till oral hälsa var mer fokuserad på utseende snarare än hälsoaspekten.

Syfte: Syftet med litteraturstudien var att studera förekomsten av mineraliseringsstörning, plack och karies hos prematurt födda barn i det primära och permanenta bettet. Metod: Studien var en litteraturstudie. Fyra databaser användes, MEDLINE, DOSS, CINAHL och PubMed, för att söka fram relevanta artiklar till litteraturstudien. Totalt inkluderades 14 artiklar enligt inklusions- och exklusionskriterierna. Resultat: Två av fyra studier visade att prematurt födda barn har en ökad risk att drabbas av fler MIH drabbade tänder än fullgångna barn. Gemensamt visade studierna att större mängd plack hittades hos prematurt födda barn jämfört med kontrollbarnen. Majoriteten av studierna påvisade ingen statistisk signifikant skillnad mellan prematurt födda barn och fullgångna barn gällande kariesförekomst. Slutsats: Prematur födsel kan leda till högre förekomst av plack och mineraliseringsstörningar. En högre förekomst av karies hos prematurt födda barn kunde inte påvisas. Ökad kunskap kring dessa komplikationer är betydelsefulla för att kunna behandla prematurt födda barn på ett professionellt sätt. Mer forskning behövs kring sambandet mellan prematurt födda barn och karies. / Aim: The aim of the literature study was to study the occurrence of dental hypomineralization (MIH), plaque and caries in prematurely born children in the primary and permanent dentition. Method: The study was a literature study. Four databases were used, MEDLINE, DOSS, CINAHL and PubMed, to find relevant articles for the study. A total of 14 articles were included according to the inclusion and exclusion criteria. Results: Two out of four studies showed that prematurely born children have an increased risk for MIH-affected teeth than full-term children. In common, the findings from the studies showed a higher amount of plaque was found in preterm children compared to control groups. The majority of the studies did not find a statistically significant difference between premature children and full-term children in dental caries prevalence. Conclusion: Premature birth can lead to higher incidence of plaque and dental hypomineralization. A higher incidence of caries in preterm children could not be established.  Increased knowledge of these complications is important for being able to treat prematurely born children in a professional manner. More research is needed on the relationship between prematurely born children and caries.

ABSTRACT Background: The most common species associated with dental caries is Streptococcus mutans. Different Streptococcus mutans adhesion biotypes, SpaP A/B/C and Cnm/Cbm, with ability to predict individual caries development have recently been identified. Aim: The aim of the study was to investigate if there was a difference in growth ability of the Streptococcus mutans adhesion biotypes and their relative sensitivity to biocides such as fluoride and chlorhexidine in vitro. We also aim to compare the potency of biocides in vitro to those concentrations used in the clinic. Methods: Culturing of the Streptococcus mutans biotypes in a planktonic solution with and without fluoride and chlorhexidine. Used concentrations: 3.5-4500 parts per million fluoride and 15-500 parts per million chlorhexidine. Optical density was used to measure growth under the different conditions. Results: The tests with fluoride showed a similar dose dependent inhibition of growth for all 6 biotypes of Streptococcus mutans. The tests with chlorhexidine showed a major inhibition of growth for the concentration 62 parts per million which inhibited growth more than 500 parts per million. All biotypes had a similar proliferation pattern without any biocide present. Conclusion: All tested biotypes of Streptococcus mutans had a similar pattern of sensitivity to the different concentrations of biocides and cultivation conditions used.