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Biomedical subjects

Vibeke Baelum

Publications and source records attributed to Vibeke Baelum.

At least 19 recordsLinked to original sources
PubMed2006

Spanish version of the Oral Health Impact Profile (OHIP-Sp).

BACKGROUND: The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aims of this study were to develop a Spanish version (OHIP-Sp) of the Oral Health Impact Profile and to evaluate its convergent and discriminative validity, and its internal consistency. METHODS: The original 49-items OHIP was translated to Spanish, revised for understanding and semantics by two independent dentists, and then translated back to English by an independent bilingual dentist. The data originated in a cross sectional study conducted among high school students from the Province of Santiago, Chile. The study group was sampled using a multistage random cluster procedure yielding 9,203 students aged 12-21 years. All selected students were invited to participate and all filled a questionnaire with information on socio-demographic factors; oral health related behaviors; and self-reported oral health status (good, fair or poor). From this group, 9,163 students also accepted to fill a detailed questionnaire on socio-economic indicators and to receive a clinical examination comprising direct recordings of clinical attachment levels (CAL) in molars and incisors, tooth loss, and the presence of necrotizing ulcerative gingival lesions. RESULTS: The participation rate and the questionnaire completeness were high with OHIP-Sp total scores being computed for 9,133 subjects. Self-perceived oral health status was associated with the total OHIP-Sp score and all its domains (Spearman rank correlation). The OHIP-Sp total score was also directly associated with the 4 dental outcomes investigated (Mann-Whitney test) and the largest impact was found for the outcomes, 'tooth loss' with a mean OHIP-Sp score = 13.5 and 'CAL > or = 3 mm' with a mean OHIP-Sp score = 13.0. CONCLUSION: The OHIP-Sp revealed suitable convergent and discriminative validity and appropriate internal consistency (Cronbach's alpha). Further studies on OHIP-Sp warrant the inclusion of populations with a higher disease burden; and the use of test-retest reliability exercises to evaluate the stability of the test.

Journal Article↗
PubMed2006

[Social inequities and diabetes among adolescents].

BACKGROUND: Diseases are not randomly distributed across society. Although the results of several studies consistently report higher occurrence of diabetes among disadvantaged groups in adult populations, rather sparse and contradictory findings have been reported for the young. AIM: To explore whether the distribution of self reported diabetes among high school students from the Province of Santiago is associated to their socioeconomic position. MATERIAL AND METHODS: Data originated from a randomly selected sample of 9,203 Chilean high school students. Students answered questionnaires on demographic variables; self reported diabetes status; and several dimensions of social position. We used logistic regression analyses to study the association between diabetic status and the variables 'number of cars owned by the family'; 'paternal income' (in Chilean pesos); and 'maternal' and 'paternal achieved education'. RESULTS: Univariate analyses suggest the existence of social gradients for the variables number of cars owned and parental education. Multivariable [corrected] analyses indicate that paternal achieved education is the most influential variable. Students coming from families in which the father has only primary school education, are significantly more likely to report having diabetes (odds ratio=2.03 confidence intervals 1.02-4.04). CONCLUSIONS: In this adolescent population, there is a positive association between several indicators of socioeconomic position and reported diabetes.

Adolescent↗
PubMed2006

Gender differences in tooth loss among Chilean adolescents: socio-economic and behavioral correlates.

OBJECTIVE: To investigate gender differences in tooth loss among Chilean adolescents and its association with selected socio-economic indicators and oral-health-related behaviors. MATERIAL AND METHODS: Data on 9,163 Chilean adolescents obtained using multistage random cluster procedures. Clinical recordings included information on missing teeth and the participants provided information on socio-demographic factors and oral-related behaviors. Two eruption-time-adjusted logistic regression analyses were used to investigate the associations between gender, tooth loss and socio-economic position/oral-health-related behaviors. RESULTS: The association between gender and tooth loss remained after adjusting for age, eruption times in both the socio-economic position regression model and the oral-health-related behaviors model. Tooth loss followed social gradients for the variables paternal income and achieved parental education, with students reporting a paternal income < 100,000 US dollars (OR = 2.0), and having a father (OR = 1.8) and a mother (OR = 2.0) who achieved only primary school education being more likely to experience tooth loss. The adjusted regression model for behavioral indicators revealed that students who reported brushing their teeth once a day (OR = 1.6) were more likely to have experienced tooth loss than those who reported more frequent toothbrushing. Students who visited a dentist rarely (OR = 0.8) or never (OR = 0.5) were less likely to have lost first molars and/or incisors. CONCLUSIONS: The results demonstrate that gender differences in tooth loss among young Chileans are related to socio-economic position; and selected oral-health-related behaviors after adjusting for eruption time variation.

Adolescent↗
PubMed2006

Non-grafted sinus implants in periodontally compromised patients: a time-to-event analysis.

This study reports the results of implant therapy involving a sinus membrane lift and of conventional implant therapy in 68 periodontally compromised patients treated between June 1990 and June 2002. Patients had at least two implants inserted, one of which was placed in the maxillary sinus region following fenestration of the lateral sinus wall and lifting of the sinus membrane. Two implant systems were used: a two-stage system (Astra) and a one-stage system (ITI). Annual follow-up visits included recording of plaque, probing pocket depth and measurement of the radiographic distance in millimeter from the implant shoulder to the alveolar crest. Survival analysis showed that the proportion of implants that had not been explanted after 5 years ranged between 88.7% for ITI sinus implants and 97% for ASTRA conventional implants. After 10 years, the proportion of implants remaining in situ ranged between 59% for ITI conventional implants and 97% for ASTRA conventional implants. Cox regression analyses showed that the factors influential for implant explantation were implant type (HR(ITI) = 2.8), implant length (HR(< or = 10 mm) = 3.1), patient being a smoker (HR(smoking) = 2.2) and patient having at least 20 natural teeth (HR(> or = 20 teeth) = 3.8). Our results demonstrate that sinus implants may be inserted with the same success as conventional implants in periodontally compromised patients.

Adult↗
PubMed2006

Social gradients in periodontal diseases among adolescents.

OBJECTIVE: To investigate the association between socioeconomic position and periodontal diseases among adolescents. METHODS: Data were obtained from 9203 Chilean high school students. Clinical examinations included direct recordings of clinical attachment level and the necrotizing ulcerative gingival lesions. Students answered a questionnaire on various dimensions of socioeconomic position. Seven periodontal outcomes were analyzed. Logistic regression analyses were used to identify socioeconomic variables associated with the periodontal outcomes. RESULTS: The occurrence of all periodontal outcomes investigated followed social gradients, and paternal income and parental education were the most influential variables. CONCLUSIONS: The study demonstrates the existence of significant social gradients in periodontal diseases already among adolescents. This is worrying, and indicates a new potential for further insight into the mechanisms of periodontal disease causation.

Adolescent↗
PubMed2006

Dental caries paradigms in diagnosis and diagnostic research.

In this article, the fundamentals of caries diagnosis are reviewed from the three component perspectives, namely the strategy, the logics, and the tactics. Strategy concerns the objectives of the diagnostic process (i.e. why we diagnose caries). The logics describe how we assemble and evaluate the information collected and how this leads to an assessment of diagnostic value. Finally, tactics are about how we collect the information necessary to arrive at a correct diagnosis. We argue that the hitherto-dominant essentialistic caries paradigm should be replaced by a nominalistic caries concept. This allows us to circumvent the problem of a lack of a caries gold standard and to proceed in caries-diagnostic research to find the diagnostic methods that result in the best health outcomes for our patients. We also demonstrate the limitations of the medical model when attempting to understand caries diagnosis, and adhere to the Bader & Shugars caries script model. It is concluded that the current caries profile, characterized by lower prevalence and extent, and slower progression, has increased the need for an academic strengthening of the dental curriculum with respect to diagnostic reasoning and clinical decision-making processes.

Decision Making↗
PubMed2005

The problem of analysing the relationship between change and initial value in oral health research.

The relationship between initial disease status and subsequent change following treatment has attracted great interest in dental research. However, medical statisticians have repeatedly warned against correlating/regressing change with baseline because of two methodological concerns known as mathematical coupling and regression to the mean. In general, mathematical coupling occurs when one variable directly or indirectly contains the whole or part of another, and the two variables are then analyzed by using correlation or regression. Consequently, the statistical procedure of testing the null hypothesis - that the coefficient of correlation or the slope of regression is zero - may become inappropriate. Regression to the mean occurs with any variable that fluctuates within an individual or a population, either owing to measurement error and/or to physiological variation. The aim of this article was to clarify the conceptual confusion around mathematical coupling and regression to the mean within the statistical literature, and to correct a popular misconception about the correct analysis of the relationship between change and initial value. As examples that use inappropriate methods to analyze the relationship between change and baseline are still found in leading dental journals, this article seeks to help oral health researchers understand these problems and explain how to overcome them.

Algorithms↗
PubMed2005

The relationship between baseline value and its change: problems in categorization and the proposal of a new method.

Oral health researchers have shown great interest in the relationship between the initial status of diseases and subsequent changes following treatment. Two main approaches have been adopted to provide evidence of a positive association between baseline values and their changes following treatment. One approach is to use correlation or regression to test the relationship between baseline measurements and subsequent change (correlation/regression approach). The second approach is to categorize the lesions into subgroups, according to threshold values, and subsequently compare the treatment effects across the two (or more) subgroups (categorization approach). However, the correlation/regression approach suffers a methodological weakness known as mathematical coupling. Consequently, the statistical procedure of testing the null hypothesis becomes inappropriate. Categorization seems to avoid the problem of mathematical coupling, although it still suffers regression to the mean. We show, first, how the appropriate null hypothesis may be established to analyze the relationship between baseline values and change in the correlation approach and, second, we use computer simulations to investigate the impact of regression to the mean on the significance testing of the differences in the average treatment effects (or average baseline values) in the categorization approach. Data available from previous literature are reanalyzed by testing the appropriate null hypotheses and the results are compared to those from testing the usual (incorrect) null hypothesis. The results indicate that both the correlation and categorization approaches can give rise to misleading conclusions and that more appropriate methods, such as Oldham's method and our new approach of deriving the correct null hypothesis, should be adopted.

Algorithms↗
PubMed2004

Necrotizing ulcerative gingival lesions and clinical attachment loss.

This paper describes the association between the occurrence of necrotizing ulcerative gingival lesions and clinical attachment loss using multivariable logistic regression methods and data originating in an epidemiological study conducted among a random sample of adolescents (n = 9203). Results show that the presence of necrotizing ulcerative gingival lesions is strongly associated with the occurrence of clinical attachment loss, whether defined as the presence of clinical attachment loss > or= 1 mm in at least two teeth or as the presence of clinical attachment loss > or = 3 mm in at least one tooth. This contribution of necrotizing ulcerative gingival lesions appeared to occur independently of the contribution from known common risk factors. Our findings suggest that there are causes of necrotizing ulcerative gingival lesions, yet to be identified, which have a substantial impact on the occurrence of clinical attachment loss.

Adolescent↗
PubMed2004

Periodontal epidemiology: towards social science or molecular biology?

Terms such as 'molecular epidemiology' and 'genetic epidemiology' have been coined to depict the change from 'traditional epidemiology', concerned with disease determinants at the community or society level, over to 'modern epidemiology', which is concerned with determinants operating at the individual level or even below, i.e. at the organ, tissue, cell, or molecular level. In this commentary, we point out to the limitations of this development and suggest that more emphasis is placed on making the presumed causal disease models explicit, when investigating the relationship between putative determinants and disease. Understanding the disease processes at the micro-level is insufficient for understanding disease at the individual level; and disease patterns at the population level cannot be understood unless it is realized that individuals exist in a variety of contexts that cannot be reduced to individual attributes.

Causality↗
PubMed2004

Implant survival in periodontally compromised patients.

BACKGROUND: Relatively little is known on the long-term prognosis of implants inserted in partially edentulous, periodontally compromised patients. METHODS: A total of 258 conventional implants, 57 two-stage and 201 one-stage implants, which were inserted in 32 and 108 patients, respectively, between June 1988 and June 2002 were followed with respect to their survival, as well as the periodontal parameters bone loss, probing depth, and bleeding on probing. All patients were periodontally compromised who had undergone periodontal surgery and were considered able to maintain a high standard of oral hygiene. RESULTS: The 5-year survival rates were 97% and 94%, respectively, for the two- and the one-stage implants. The 10-year survival rate remained high at 97% for the two-stage implants, but had dropped to 78% for the one-stage implants. Smoking, short implant length, and insertion during the later period (1995-2002) were found to be associated with an increased failure rate. CONCLUSIONS: Implants placed in patients with a history of periodontitis have a 5-year survival similar to that observed for implants installed in non-diseased persons. Although the 10-year survival of the one-stage implants was somewhat lower than has been observed for non-diseased patients, implant placement remains a good treatment alternative also for periodontally compromised patients.

Adult↗
PubMed2003

Classifying periodontitis among adolescents: implications for epidemiological research.

OBJECTIVES: To evaluate the performance of four clinical classification systems proposed for periodontitis in young subjects when applied to epidemiological data on clinical attachment loss. We assess the extent to which the use of different case definition systems may influence the outcome of descriptive and analytical epidemiological studies. METHODS: The data originate in a screening examination for periodontitis carried out among 9162 high school students. Each of four previously published classification systems was applied to the data. The prevalence of cases according to each system was estimated and the association between case status, as defined by each system, and a set of candidate determinant variables was assessed using multivariable logistic regression analyses. RESULTS: The four classification systems yielded rather different prevalence estimates. For localized periodontitis the estimates varied by a factor of 10, and for generalized periodontitis, these varied by a factor of 30. The results of the logistic regression analyses using the different case-definitions essentially confirmed the results of a population-based analysis. However, the precision of the estimates decreased with decreasing numbers of cases identified by the classification systems. CONCLUSIONS: From an epidemiological point of view there is little justification for the use of the complicated classification systems. An approach based on the simple definition of a case as a person with clinical attachment loss, e.g. >/=3 mm, is preferable.

Adolescent↗
PubMed2003

Application of survival analysis to carious lesion transitions in intervention trials.

OBJECTIVE: To demonstrate the usefulness of a survival-time regression model for the analysis of data from two 3-year trials of the caries-preventive effect of sugar-substituted chewing gums and fluoride toothpaste, carried out among 892 Lithuanian children. METHODS: A caries onset was defined as a transition from sound to carious and a caries recovery was defined as a transition from carious to sound. The time at risk for each type of transition was calculated. Using an exponential survival-time regression model, the hazard ratios for the covariates experimental group (control, sugar substitute, fluoride), age, gender, surface type and posteruptive surface age was estimated. This analysis was repeated using two alternative definitions of the caries transitions. RESULTS: The analyses confirmed that caries rates are higher in occlusal surfaces, and that posteruptive surface age influences caries rates. Moreover, it also confirmed that fluoride affects the outcome of ongoing caries activity more than the initiation of caries. CONCLUSIONS: Survival-time analysis of caries transitions allows for the extraction of much more information from caries trials than does the traditional DMF-based analysis, and traditional DMF incremental values may easily be derived from the models.

Age Factors↗
PubMed2003

Defining and classifying periodontitis: need for a paradigm shift?

The past two decades have witnessed a large number of proposals for the classification of periodontitis. These proposals are all founded in an essentialistic disease concept, according to which periodontitis is a link between the causes and the signs and symptoms of periodontitis. Essentialistic definitions are necessarily rather imprecise and thereby subject to multiple interpretations. Consequently, it remains unknown to what extent current knowledge regarding 'different' forms of periodontitis is based on the 'same' type of patients. However, periodontitis is a syndrome, the clinical manifestations of which may come in all sizes. Thereby, periodontitis has no diagnostic truth, just as there is no natural basis for a sharp distinction between health and disease or between 'different' forms of periodontitis. Recognition of these facts and adoption of a nominalistic approach to the definition of periodontitis is needed to provide a rational framework for the development of a classification system that meets the needs of both clinicians and scientists.

Acute Disease↗
PubMed2003

Reliability of clinical attachment level recordings: effects on prevalence, extent, and severity estimates.

BACKGROUND: Although unreliability of periodontal measurements is considered mainly to concern attempts to detect true changes in longitudinal studies, it is also a source of variability that may substantially decrease the precision of estimates obtained in cross-sectional studies. This study assessed the effects of measurement errors on estimates of prevalence, extent, and severity of clinical attachment loss. METHODS: Four examiners performed repeat attachment level recordings in 128, 122, 134, and 133 adolescents, respectively, who participated in a study of clinical attachment loss among 9,162 high school students from Santiago, Chile. A total of 48,954 duplicate recordings were made. Two examiner teams carried out repeat examinations among 292 and 254 subjects, respectively, corresponding to a total number of 51,600 duplicate recordings for interexaminer reliability assessment. RESULTS: A sizeable imprecision was noted regarding prevalence estimates, particularly at the > or = 1 mm level, whereas examiners were reasonably consistent in the assessment of the number of sites with clinical attachment loss. Ninety-five percent of the differences regarding the number of sites with clinical attachment loss > or = 1 mm were in the range from -5 to 5 sites for intraexaminer comparisons, and from -9 to 8 sites for interexaminer comparisons. These differences should be seen in light of the number of sites affected, which ranged from 0 to 85 sites. CONCLUSIONS: Examiner variation may preclude comparisons of prevalence estimates between studies. Valid comparisons may be made between studies of extent estimates provided that uniform parameters are used to express the extent of periodontal breakdown.

Adolescent↗
PubMed2002

Coronary heart disease and periodontitis -- a case control study in Chilean adults.

OBJECTIVES: To investigate the association between periodontal disease parameters and coronary ischemic disease among 30-50-year-old Chileans. MATERIAL AND METHODS: Cases were 30-50-year-olds who were hospitalized in one of four Cardiologic Units in Santiago, Chile, for acute myocardial infarction, unstable angina or angina pectoris. Controls had undergone surgery due to gall bladder stones or abdominal hernia. Information on blood pressure, serum cholesterol, body weight and height, age, occupation, smoking, diabetes and use of antidepressants was obtained. A total of 86 persons participated based on informed consent, but the analysis is based on 61 persons, for whom a complete set of data was obtained. Cases and controls were given a clinical periodontal examination comprising assessment of number of teeth present, periodontal pocket depth and clinical attachment level at six sites per tooth. The association between mean attachment level; mean pocket probing depth; number of teeth present and case status was analyzed by conditional logistic regression controlling for known risk factors for CHD. RESULTS: The mean attachment level was positively associated with case status (OR = 3.17; 95% CI = [1.31; 7.65]), as was the mean pocket depth (OR = 8.64; 95% CI = [1.22; 61.20]). The number of teeth present was not statistically significantly associated with case status (OR = 0.93; 95% CI = [0.83; 1.04]). CONCLUSION: The results are in accordance with those of several previous reports. If the results reflect a causal link between periodontal diseases and CHD they emphasize the need for better control of periodontal diseases. If the associations are-non-causal, they still demonstrate that CHD and periodontal diseases cluster in the same sections of the population, which is important from a public health point of view.

Adult↗
PubMed2002

Determinants of dental status and caries among adults in southern Thailand.

This study describes the tooth mortality and the prevalence and severity of dental caries among 30- to 39- and 50- to 59-year-old rural Thais from the Province of Songhkla, Thailand. Three hundred and sixty-three persons were given a clinical examination, including assessment of dental status, dental caries, and periodontal recordings. Information on religious faith, smoking, and betel use was obtained by means of an interview. The prevalence of edentulism was low (<2% among 50- to 59-year-olds). The mean number of teeth present was high, 29.4 among the 30- to 39-year-olds and 24.3 among the 50- to 59-year-olds. The prevalence of caries was high (91% among 30- to 39-year-olds and 84% among 50- to 59-year-olds). The mean DFT values were 5.7 and 5.8, respectively, and a substantial part of the DFT consisted of deep dentin lesions. The results did not corroborate the hypothesis that persons of Muslim faith have worse dental conditions than do Thai Buddhist or that dental disease levels are higher among the Thai population than among other Southeast Asian populations.

Adult↗