Most recent publications

• Håkstad, Katrine; Hovden, Ewa Alicja Szyszko; Wigen, Tove Irene; Fegran, Liv & Köpp, Unni Mette Stamnes (2026). How physical and sexual abuse impacts oral health: a cross-sectional study from a Norwegian Children’s House. BMC Oral Health. 26. doi: 10.1186/s12903-026-09143-3. Full text in Research Archive Show summary

  Although the association between neglect and an increased risk of oral disease is well established, the independent association between physical or sexual abuse and oral health has been less extensively studied. This study explored oral health condition in children suspected of being exposed to physical or sexual abuse by examining the association between abuse type and caries experience and gingival condition. It also assessed whether these associations were modified by age, sex, and ethnicity. This cross-sectional study involved 328 children, aged 1–18 years, who underwent clinical forensic dental examinations at a Norwegian Children’s House (NCH) from 2017 to 2021 (n = 328) due to suspected physical or sexual abuse. Data were collected from forensic dental and medical records at the NCH and included data from extra- and intra-oral examinations accompanied by conversations with the children. Negative binomial and logistic regression were performed for unadjusted, adjusted, and stratified analyses. Data are presented as ratios of means (RMs) and odds ratios (ORs), with 95% confidence intervals (CIs). Sexually abused children had a higher mean number of decayed teeth (DT) (RM 1.99, 95%CI 0.99–4.02) compared with physically abused children. They also more frequently received toothbrushing assistance. When stratifying by sex and ethnicity, the results revealed that sexually abused males had a higher mean number of DT compared with physically abused males (RM 4.23, 95%CI 1.37–13.12). A similar association was observed in sexually abused Ethnic Norwegian children (RM 3.53, 95%CI 1.60–7.82). Gingival condition varied by age. Sexually abused children exhibited better gingival condition before the age of four compared with their physically abused peers, but these conditions deteriorated after the age of thirteen, where the results showed an opposite association. The findings indicated that oral health condition varied according to abuse type, with poorer oral health conditions among sexually abused children than those physically abused. These results, underscore the crucial role of forensic and dental professionals in identifying oral health conditions that may signal possible abuse.

• Stangvaltaite-Mouhat, Lina; Mdala, Ibrahimu; Klepaker, Ingrid Volden; Wigen, Tove Irene; Uhlen-Strand, Marte-Mari & Skudutyte-Rysstad, Rasa (2026). Development of a nomogram for prediction of occlusal dentin caries in Norwegian children at risk: a 36-month follow-up study. BMC Oral Health. doi: 10.1186/s12903-026-09819-w. Full text in Research Archive Show summary

  Background The aim of this study was to develop and internally validate a nomogram predictive model for occlusal dentin caries development on first permanent molars (FPMs) over 36 months in children at risk in Norway. Methods For a practice-based split-mouth randomized trial (ClinicalTrials.gov ID: NCT03315312, retrospectively registered in October 2017) comparing effectiveness of caries control methods (fissure sealants versus fluoride varnish), children aged 6 to 10 years considered at high caries risk (D3MFT/d3mft > 0) were recruited by calibrated dentists and dental hygienists during routine examination in the public dental service and monitored for 36 months. Outcome was development of occlusal dentin caries lesion on FPMs. Data on biological predictors were collected at baseline by clinicians. Data on behavioral predictors were collected using a questionnaire for parents. Clinical predictors included clinic’s county, whether the participant was followed up by the same clinician and caries control method. The least absolute shrinkage and selection operator (Lasso) logistic regression model was used to select relevant predictors and develop a nomogram for predicting dentin caries development. Results Of 330 participants, 174 (51.7) were boys. The Lasso logistic regression selected four predictors, d3mft at age 5 years, occlusal surface baseline status, caries control method, and use of fluoride toothpaste, which were used to construct a nomogram. The Area Under the Receiver Operating Characteristic Curve was 0.69 (95% CI 0.62–0.77), and Concordance Index was 0.68 (95% CI 0.60–0.76) in the training set and 0.67 (95% CI 0.59–0.74) in the validation set. The calibration belt indicated good calibration of the model (p > 0.05). Conclusion In this study, based on 36-month follow-up data in children at risk, we have developed and internally validated a nomogram to predict dentin caries on occlusal surfaces of FPMs. The findings suggest that nomogram approach may be a useful visual aid in clinical practice to facilitate informed decision-making; however, external validation in a large cohort study, transportability and applicability to different settings are needed

• Saanum, Mariann; Storå, Bent Schøgren & Willumsen, Tiril (2026). Oral health status and treatment needs among adults seeking dental anxiety treatment in general practice - a cross-sectional study. Acta Odontologica Scandinavica. ISSN 0001-6357. 85, p. 520–527. doi: 10.2340/aos.v85.46516. Full text in Research Archive
• Skallevold, Hans Erling; Hol, Caroline & Wigen, Tove Irene (2026). Tilsynelatende intakt melkemolar med apikal periodontitt – dens invaginatus påvist med mikro-CT ex vivo | Den norske tannlegeforenings Tidende. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 136, p. 384–387. doi: 10.56373/69dcc7251034d. Full text in Research Archive Show summary

  Den norske tannlegeforenings Tidende – Tilsynelatende intakt melkemolar med apikal periodontitt – dens invaginatus påvist med mikro-CT ex vivo

• Håkstad, Katrine; Hovden, Ewa Alicja Szyszko; Wigen, Tove Irene; Fegran, Liv & Köpp, Unni Mette Stamnes (2026). Mapping orofacial signs of child abuse in children referred to a Norwegian Children's House. Child Abuse & Neglect. ISSN 0145-2134. 178. doi: 10.1016/j.chiabu.2026.108167. Full text in Research Archive Show summary

  Background Child physical and sexual abuse frequently involves the orofacial region, yet comprehensive forensic mapping of both traumatic and nontraumatic orofacial signs in children referred due to suspected abuse remains limited. Objective To comprehensively map extraoral and intraoral signs in children referred for forensic dental examination due to suspected physical or sexual abuse, describing injury types, anatomical distribution, and nontraumatic oral health findings across abuse types. Methods This retrospective cross-sectional study included 362 children aged 1–18 years referred to a Norwegian Children's House, an interdisciplinary forensic assessment center for children, between 2017 and 2021. Extraoral signs were identified through combined forensic dental and medical records, while intraoral signs were identified through dental examinations. Orofacial signs were classified as traumatic injuries or non-traumatic findings. Analyses were conducted at both case level (presence/absence) and the injury count level (number and anatomical distribution of injuries), stratified by suspected abuse type. Results Intraoral signs were identified in 76.1% of the children, and 45.6% had extraoral signs. Most children were aged 6–11 years (56.1%). Extraoral injuries were more common among children with suspected sexual abuse (40.7%) than among those with suspected physical abuse (34.4%), whereas intraoral injuries were similar (≈19%). Dental trauma accounted for nearly three-quarters of all intraoral injuries and was more frequent among physically abused children. Nontraumatic intraoral findings were common in both groups (∼63%), with poor oral hygiene and untreated caries occurring more often in the physical abuse group. Stress-related findings, such as tooth wear and headache, were slightly more common among children with suspected sexual abuse. Conclusions Children referred for forensic evaluation due to suspected abuse frequently presented with traumatic and nontraumatic orofacial signs. The integration of forensic dental and medical examinations strengthens the identification of head and neck injuries and highlights the pivotal role of dental professionals in multidisciplinary child protection.

• Bleka, Øyvind; Khare, Parul; Kvaal, Sigrid Ingeborg; Siddharth, M.; Rastogi, Pooja & Kopperud, Simen (2026). Comparing an Indian dataset with BioAlder using Demirjian’s staging of the third molar. International journal of legal medicine (Print). ISSN 0937-9827. 140, p. 3057–3066. doi: 10.1007/s00414-026-03828-8. Full text in Research Archive
• Kimmie-Dhansay, Faheema; Høyvik, Ann Catrin; Bhayat, Ahmed; Hussain, Faezah; Karunakaran, Arannikah & Kaya, Besime [Show all 12 contributors for this article] (2025). Dental anxiety and empathy among undergraduate oral health students in Norway, South Africa and Namibia. Acta Odontologica Scandinavica. ISSN 0001-6357. 84, p. 181–181. doi: 10.2340/aos.v84.43424. Full text in Research Archive Show summary

  Purpose/objectives: Dental anxiety is a common type of fear that can complicate dental treatment. The dental practitioner is crucial in both treating dental fear and anxiety as well as prevent it from arising. The ability to feel empathy is important in that matter. The dental practitioner’s own level of dental anxiety can possibly affect his or her ability to treat patients in an empathetic manner. The aim of this study was to assess and examine the relationship between level of empathy and dental anxiety in undergraduate oral healthcare students from Namibia, South Africa and Norway. Material and methods: A cross-sectional study was performed. Questionnaires were distributed, and responses were analyzed anonymously. Dental anxiety was assessed using Modified Dental Anxiety Scale (MDAS), and empathy level was assessed using Toronto Empathy Questionnaire (TEQ). Data were presented as means or medians and analyzed using a linear regression model in STATA with a 5% level of significance. Results: The response rate was 16.0%, and 298 completed questionnaires were received. MDAS was low in all groups (medians 7–10), however, significantly lower in Norway compared to Namibia and South Africa. The mean TEQ score was 46.8 in Namibia, 47.5 in South Africa and 50.4 in Norway, all above average empathy levels but significantly higher in Norway than in Namibia and South Africa. Conclusions: Oral healthcare students in Africa and Norway showed high empathy and low dental anxiety, which is reassuring for future oral health care professionals.

• Sørbø, Marie Flem; Sun, Yi-Qian; Kvist, Therese; Rønneberg, Anne; Myran, Lena & Havnen, Audun [Show all 10 contributors for this article] (2025). Associations between adverse childhood experiences and oral health in Norwegian adults, and the impact of social support and adulthood revictimization. The HUNT4 Survey. European Journal of Public Health. ISSN 1101-1262. doi: 10.1093/eurpub/ckaf229. Full text in Research Archive Show summary

  Abstract Adverse childhood experiences (ACEs) increase the risk of various health issues, including oral problems. ACEs also heighten the risk of revictimization, though the impact of adulthood revictimization on oral health is less understood. Conversely, positive influences, such as a trusted adult in childhood, may buffer these effects. This study examines how different dimensions of adversity relate to oral health. This cross-sectional study included 37 559 adults from the HUNT4 Survey, a general population study in Norway. We examined distinct ACE exposures: (i) specific ACEs (i.e. sexual, physical and psychological abuse, bully victimization, parental divorce, and death of a parent), (ii) cumulative ACE, (iii) combined exposure of ACE and adult support, and (iv) adversity trajectories identified by group-based trajectory modelling of ACE and adulthood sexual, physical and psychological abuse. Associations with oral health were assessed by logistic regression, estimating odds ratios with 95% confidence intervals. Most ACE types were associated with poorer adult oral health outcomes, exhibiting a dose–response gradient, where one-unit ACE increase indicated a higher likelihood of self-reported poor dental health (28%), dental fear (31%), and no dental visit in the last 2 years (10%). Combined exposure of ACE and adult support showed that those with high support had lower odds of reporting poor oral health. The revictimized trajectory exhibited the strongest association with impaired oral health outcomes. Our findings support that ACEs are linked to poor oral health later in life, especially among those revictimized as adults, whilst supportive childhood relations may buffer this effect.

• Floberg, Sandra Emilie; Shwan, Dalia Bakhtyar; Tran, Thuyen Michelle; Kvaal, Sigrid Ingeborg; Dahl, Jon Einar & Kopperud, Simen E. (2025). Scanning electron microscope analysis of elements in amalgam restorations to determine when a deceased person may have lived. A method based on data from Scandinavia. International journal of legal medicine (Print). ISSN 0937-9827. 139(6), p. 3063–3069. doi: 10.1007/s00414-025-03561-8. Full text in Research Archive Show summary

  Abstract When unidentified human remains are found, the aim must be to establish the identity of the individual. Being able to assess the time period when the deceased person has lived, might narrow down the search among missing persons. Dental amalgam alloys contain different elemental metals, and various alloy types have over time been introduced and abandoned at certain times, especially in Scandinavian countries. This study aimed to explore if a scanning electron microscope (SEM–EDS) can be used to determine the chemical composition of different dental amalgam restorations, with the focus to distinguish between copper amalgam and conventional silver amalgam. Six previously commonly used amalgams were selected, and five test samples were prepared from each of them. Each test sample was analysed with SEM–EDS at five separate sites, giving 25 readings for each amalgam brand. The SEM–EDS analyses identified noticeable differences in the composition of conventional silver amalgams compared to copper amalgams. The latter contained very low- or non-detectable amounts of silver and tin. The results showed that SEM–EDS could be a valuable accessory for identifying an unknown human remain.

• Myran, Lena; Sun, Yi-Qian; Dahllöf, Göran; Willumsen, Tiril; Rønneberg, Anne & Havnen, Audun [Show all 9 contributors for this article] (2025). Associations of adverse childhood experiences with dental fear, and the mediating role of dental fear on caries experience: the Young-HUNT4 Survey. BMC Oral Health. 25(1). doi: 10.1186/s12903-025-06486-1. Full text in Research Archive Show summary

  Abstract Background Adverse childhood experiences (ACEs) may contribute to dental fear, which can negatively affect long-term oral health. We aimed to examine associations between specific and cumulative ACEs and dental fear in adolescents, investigate possible sex differences, and explore the potential mediating role of dental fear in the relationship between ACEs and caries experience. Methods This cross-sectional study included 5882 Norwegian adolescents aged 13–17 years from the Young-HUNT4 Survey in Norway. Self-reported ACEs (i.e., physical and sexual abuse, witnessing violence, parental divorce, parental alcohol problems, and bully victimisation) and dental fear were combined with clinical measures of caries experience. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between ACEs and dental fear. Effect modification by sex was assessed using the likelihood ratio test. A counterfactual-based mediation analysis was conducted to estimate a potential mediating effect of dental fear on the relationship between ACEs and caries experience, with results presented as ratios of means (RMs) with bias-corrected 95% CIs. Results All specific ACEs were associated with higher odds of reporting dental fear, compared to those not reporting the given ACE. Adolescents reporting any ACE had a 74% higher likelihood of reporting dental fear compared to those without ACEs (OR 1.74, 95% CI 1.29–2.33). A dose-response relationship was observed, with a one-unit increase in ACE exposure associated with higher odds of reporting dental fear (OR 1.25, 95% CI 1.15–1.36). There was evidence of effect modification by sex, with the associations between any ACE and dental fear being more pronounced in females. Further, dental fear accounted for 5.9% of the total effect in the association between any ACE and caries experience. Conclusions Specific and cumulative ACEs were associated with dental fear among adolescents, with a stronger association in females. Our findings indicate a partial mediating role of dental fear in the association between ACEs and caries experience. This study highlights the value of incorporating ACEs and dental fear into patient assessment.

• Dahllöf, Göran; Sørbø, Marie Flem; Feuerherm, Astrid Jullumstrø; Myran, Lena; Havnen, Audun & Willumsen, Tiril [Show all 10 contributors for this article] (2025). Associations between childhood adversity and adult oral health-related quality of life, the HUNT4 Survey. BMC Public Health. 25(1). doi: 10.1186/s12889-025-23365-0. Full text in Research Archive
• Breivik, Anne; Kopperud, Simen E.; Mulic, Aida Gacic; Stein, Linda; Yitayew, Teferi Mekonnen & Hadler-Olsen, Elin Synnøve [Show all 7 contributors for this article] (2025). Risk Indicators Associated with Root Caries and Oral Health-Related Quality of Life among Older Adults: The Tromsø7 Study. Caries Research. ISSN 0008-6568. p. 13–13. doi: 10.1159/000547745. Full text in Research Archive Show summary

  Introduction: This study aimed to investigate risk indicators associated with root caries in older adults aged 65 years and above in Norway. A secondary aim was to explore whether root caries was associated with oral health-related quality of life (OHRQoL). Methods: This cross-sectional study included 1,075 participants aged ≥65 from the population-based Tromsø Study (Tromsø7) conducted in Northern Norway in 2015–2016. All inhabitants aged 40 years and older in Tromsø municipality (32,591) were invited, of whom 21,083 participated. The participants underwent clinical and radiographic examinations and answered extensive questionnaires. Root caries was registered on four surfaces per tooth and graded D_3-5. For analysis, prevalence of root caries was dichotomised into (1) no (if the participants had no root caries) and (2) yes (if root caries was registered on at least one surface). Characteristics of the study population were described with percentages and frequencies for the categorical variables and mean and standard deviation (SD) for continuous variables for the whole cohort and stratified on presence of root caries and OHRQoL impact. The statistical significance of differences was assessed with the Pearson χ2 test and independent sample T test. Factors associated with root caries and OHRQoL were explored using logistic regression. The significance level was set to p < 0.05 for all analysis. Results: Men had higher odds of root caries than women (OR: 1.70, 95% CI [1.08, 2.70]) and those who were smokers had a higher odds of root caries than those who had never smoked (OR: 1.83, 95% CI [1.13, 2.94]). Participants with root caries had 1.67 times higher odds of having reduced OHRQoL than those without root caries (95% CI: 1.02, 2.72). Conclusion: This study found that being male and smoking were risk indicators of root caries. Additionally, root caries had a negative impact on OHRQoL. The results could be useful for oral health professionals to guide individual and targeted root caries preventive measures in older adults.

• Aardal, Vilde Eika; Hol, Caroline; Rønneberg, Anne; Neupane, Sudan Prasad & Willumsen, Tiril (2025). Who requires dental treatment under general anesthesia due to pain and severe dental anxiety? Findings from panoramic X-ray images and anamnesis. Acta Odontologica Scandinavica. ISSN 0001-6357. 84, p. 78–85. doi: 10.2340/aos.v84.42895. Full text in Research Archive
• Pala, Kaaj; Sun, Kevin Xueying; Krogvold, Lars; Dahl-Jørgensen, Knut & Reddy, Shiva (2025). Distribution of glutathione peroxidase-1 immunoreactive cells in pancreatic islets from type 1 diabetic donors and non-diabetic donors with and without islet cell autoantibodies is variable and independent of disease. Cell and Tissue Research. ISSN 0302-766X. 400(3), p. 255–271. doi: 10.1007/s00441-025-03955-5. Full text in Research Archive
• Breivik, Anne; Kopperud, Simen E.; Khan, Qalbi; Mulic, Aida Gacic & Stein, Linda Maria (2025). Preventive measures and perceived challenges in delivering oral health care for elderly patients: a survey of dental hygienists in Norway. Acta Odontologica Scandinavica. ISSN 0001-6357. 84, p. 1–9. doi: 10.2340/aos.v84.42581. Full text in Research Archive Show summary

  Objective: This study aimed to gain knowledge of general oral health preventive measures with a specific focus on root caries preventive measures for patients ≥65 years old, performed by Norwegian dental hygienists in public and private dental health services. A secondary aim was to investigate differences and challenges in prevention practices. <p> <p>Materials and methods: An electronic survey was conducted among the sample in 2022. A total of 365 dental hygienists were included in the analyses. Chi-square tests were used to analyze differences between private and public dental hygienists regarding preventive measures and perceived challenges. <p> <p>Results: The most frequently reported general oral health preventive measures were oral hygiene instruction, professional tooth cleaning and scaling. Oral hygiene instruction and application of fluoride varnish were the most performed root caries preventive measure, and reduced manual dexterity in patients was the most perceived challenge. Public dental hygienists perceived challenges to a greater extent than private dental hygienists, particularly related to reduced mobility and ergonomic difficulties in patients. <p> <p>Conclusion: This study confirms dental hygienists’ important role in oral health promotion and showed that Norwegian dental hygienists performed a wide range of preventive measures for patients ≥65 years old. However, a number of challenges were identified in the preventive work.

• Nermo, Hege; Goll, Jeppe Bjørnskov; Isaksen, Simen; Trondsen, Sigurd Eggen; Rognmo, Kamilla & Thimm, Jens [Show all 9 contributors for this article] (2025). Associations between cumulative exposure to potentially traumatic events and self-reported oral health in the Tromsø Study: Tromsø7. BMC Oral Health. 25(1). doi: 10.1186/s12903-025-06005-2. Full text in Research Archive Show summary

  Background Potentially Traumatic Events (PTEs), such as accidents, childhood neglect or abuse, can affect mental and physical health. The study investigated the association between PTEs and self-reported oral health (SROH), focusing on cumulative exposure to multiple events, the types of events, and the timing of exposure. Methods Data were collected from the seventh survey of the Tromsø Study, which invited all residents over 40 in Tromsø, Norway. A total of 21,069 participants took part, comprising 47,5% male and 52,5% female respondents, who completed assessments of PTEs and SROH. Chi-square (Χ²) tests evaluated unadjusted associations, and a series of logistic regression models were employed to investigate the association of PTEs with poor SROH, controlling for sociodemographic variables, emotional distress, and oral health-related behaviours. Findings The likelihood of reporting poor SROH was higher among those who experienced more PTEs, and this relationship persisted after adjusting for sex, age, socioeconomic status, oral health-related behaviour, dental anxiety, emotional distress and adverse dental events. Subsequent analyses differentiated the associations by type and timing (before and after age 18) of events. Interpersonal events involve direct interactions with others (e.g., abuse, bullying), while impersonal events refer to broader circumstances (e.g., accidents, natural disasters). Adverse dental events, classified as impersonal events, demonstrated the strongest association with poor SROH. The associations between interpersonal events and poor SROH varied more depending on covariates than impersonal events. The association strengthened when adjusting for sociodemographic factors but weakened when accounting for oral health behaviours, dental anxiety, and emotional distress. Notably, impersonal events occurring before age 18 were consistently associated with poor SROH across all models. Conclusions Experiencing multiple PTEs throughout life is associated with poor SROH. Among the various PTEs, adverse dental events showed the strongest association with poor SROH, emphasising the importance of addressing dental care’s emotional and psychological aspects, particularly in paediatric settings, to support long-term oral health outcomes. Clinical trial number Not applicable.

• Tegelberg, Paula; Ólafsson, Vilhelm Grétar; Bogren, Anna; Damgaard, Christian & Wigen, Tove Irene (2025). Hvilken rolle spiller tandtråd, tandstikkere og interdentalbørster ved approksimal rengøring? Den norske tannlegeforenings Tidende. ISSN 0029-2303. 135, p. 42–45. doi: 10.56373/2025-1-9. Full text in Research Archive
• Afzal, Sadaf Haque; Skaare, Anne; Wigen, Tove Irene & Brusevold, Ingvild Johnsen (2024). Molar-Incisor Hypomineralisation: Severity, caries and hypersensitivity. Journal of Dentistry. ISSN 0300-5712. 142. doi: 10.1016/j.jdent.2024.104881. Full text in Research Archive Show summary

  Objectives To investigate distribution of affected teeth and severity of molar-incisor hypomineralisation (MIH) in 8-9-year-old children. A second aim was to study association between severity of MIH and hypersensitivity, caries, and affection of incisors and second primary molars (SPM). Methods A total of 3013 children in one age cohort participated in a cross-sectional study, of which 851 children were diagnosed with MIH. A majority of these children were re-examined and MIH diagnosis based on the European Academy of Paediatric Dentistry criteria was confirmed in 538 children. The re-examinations were undertaken at the local clinics by one calibrated dentist. Data were tested with bivariate logistic regression analysis. Results were reported using frequencies, proportions, odds ratios (OR) and confidence intervals (CI). Results Almost half of the children with MIH (46.8 %) had at least one severely affected molar. Incisors were affected in 51.9 % of children with MIH, and the prevalence was higher in children with severe affection (57.4 %, p < 0.01). Among children with MIH, second primary molars were affected in 29.6 %, hypersensitivity in at least one first permanent molar was reported by 25.8 and 30.8 % had caries extending to dentine. Children classified with severe MIH were more likely to suffer from hypersensitivity (OR 5.62, 95 % CI 3.61–8.74) and dentine caries (OR 10.32, 95 % CI 6.46–16.50) than children with mild MIH. Conclusion Prevalence of hypomineralised incisors and SPM were high in the studied children with MIH. Children with severe MIH had higher probability of incisor affection, dentin caries and hypersensitivity. Clinical significance This study highlights the importance of understanding the association between MIH, caries and hypersensitivity, especially in children with severe MIH. These children need extensive and individualized care in the dental services to prevent caries and pain.

• Angelsen, Marthe; Bjørheim, Kristina; Lundeby, Mathilde; Wigen, Tove Irene & Rønneberg, Anne (2024). Barn og deres omsorgspersoners erfaring med tannbehandling under generell anestesi. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 134(3), p. 196–202. doi: 10.56373/2024-3-3. Full text in Research Archive
• Staxrud, Frode; Mulic, Aida Gacic & Kopperud, Simen E. (2024). Dentists' Treatment Decisions Concerning Restorations in Adult Patients in North Norway: A Cross-Sectional Tromsø 7 Study. Caries Research. ISSN 0008-6568. doi: 10.1159/000541777. Full text in Research Archive Show summary

  Introduction: The aim of this cross-sectional study was to explore the degree whereby dentists differentiate between repair versus replacement for failed restorations. A random selection of adult patients from North Norway was chosen from the larger Tromsø 7 study. <p> <p>Methods: A randomized sample of 3,653 persons (11.5% of the total number of individuals invited to the Tromsø 7 study, 51.5% women, aged 40–93 years) were included. Based on FDI’s clinical criteria for the evaluation of restorations – 2010, 17 calibrated dentists evaluated patients by clinical and radiographical pictures in a specially designed software developed for this purpose. The dental practitioners’ opinions gave rise to the reported treatment decisions. Descriptive statistics and multivariable multilevel mixed-effect logistic regression models (STATA 17/SE) were performed. <p> <p>Results: The participants’ DMFT values ranged from 0 (0.9%) to 24 (8.8%) (median DMFT 21.3, mean 20.0). A total of 90.062 teeth (24.7 teeth per patient) were assessed. Re-treatment suggestions were made for 3,006 restorations, i.e., an average of 3.3% re-treatments. Of these, 25.3% (n = 814) were suggested for repair and 74.7% (n = 2,192) for replacement. Dental treatment was suggested for 1,597 patients and varying from 1 to 14 suggestions per patient. Secondary caries (37.6%) and restoration fracture (15.2%) were found to be most frequently used indications for re-treatment, surface properties the least. No significant difference was found between assessing dentists based on sex or age. Clustering by dentist level was checked using intra-class correlation coefficients, demonstrating that 16% of the variance in suggestions for restoration re-treatment was explained at the dentist level. Thus, a wide range of treatment suggestions was noted among the dentists. <p> <p>Conclusion: Need for restoration revision seems low in North Norway. There is a tendency towards larger and more indirect restorations, and the diagnosis of secondary caries is still a matter of uncertainty.

• Kildahl, Arvid Nikolai; Berggren, Tiril; Rønneberg, Anne; Molnes, Charlotte Serina Yksnøy & Nordgarden, Hilde (2024). A call for trauma-informed dental care for individuals with intellectual disabilities. Special Care in Dentistry: managing special patients, settings, and situations. ISSN 0275-1879. doi: 10.1111/scd.12959. Full text in Research Archive Show summary

  People with intellectual disabilities are at increased risk of dental anxiety and poor oral health. In addition, people with intellectual disabilities are at increased risk of potentially traumatic experiences, such as violence and sexual abuse, and appear to be more vulnerable to developing trauma-related disorders following such experiences. While psychological trauma is associated with poor oral health and dental anxiety in the general population, the potential link between dental anxiety, poor oral health and psychological trauma is yet to be explored in people with intellectual disabilities. In this conceptual paper, we provide an overview of recent findings concerning the relationships between oral health and intellectual disabilities, psychological trauma and intellectual disabilities, as well as between psychological trauma and oral health, and discuss the relevance of these findings related to dental care for people with intellectual disabilities. We conclude that psychological trauma is likely to contribute to dental anxiety and poor oral health also in people with intellectual disabilities. Implications include an urgent need for research exploring how trauma affects oral health and experiences of dental care for people with intellectual disabilities, as well as the importance of individualized and trauma-informed dental care for these individuals.

• Høyvik, Ann Catrin; Willumsen, Tiril; Lie, Birgit & Hilden, Per Kristian (2024). Torture victims’ perspective on dental treatment: “Every sign you make, every move you take” – A qualitative study. European Journal of Oral Sciences. ISSN 0909-8836. p. 1–11. doi: 10.1111/eos.13007. Full text in Research Archive Show summary

  Torture victims struggling with post-traumatic stress often experience elements in the dental treatment situation that may trigger trauma-related reactions. The aim of the study was to explore intervention strategies that will enable dental health workers to adapt dental treatment to the needs of torture survivors. Exploratory interviews were conducted with 10 torture-exposed resettled refugees with dental treatment experience in Norway. The data was analyzed using qualitative content analysis, which suggested that to minimize trauma-reactions, dental personnel should focus on creating a safe therapeutic space and strengthening the patient's sense of control. Four main categories of clinical advice were proposed: (i) Acquire knowledge about psychology, consequences of torture, cultural differences, trauma-informed care, and the patients’ individual needs; (ii) Recognize the trigger-potential of busyness or delays; (iii) Avoid surprises, such as sudden moves or actions and explore triggers individually, but make sure not to evoke images of interrogation, and; (iv) Provide overview both with respect to visibility in the clinical room, and to predictability regarding the dental treatment. Although undergoing dental treatment may be challenging for torture-exposed individuals, it is possible to reduce the predicaments considerably by making feasible adaptions to the treatment and adopting a trauma-informed approach.

• Uhlen-Strand, Marte-Mari; Stangvaltaite-Mouhat, Lina; Mdala, Ibrahimu; Klepaker, Ingrid Volden; Wang, Nina Johanne & Skudutyte-Rysstad, Rasa (2024). Fissure Sealants or Fluoride Varnish? A Randomized Pragmatic Split-Mouth Trial. Journal of Dental Research. ISSN 0022-0345. doi: 10.1177/00220345241248630. Full text in Research Archive Show summary

  This study aimed to compare the clinical effectiveness of resin-based fissure sealants (FS) and fluoride varnish (FV) in children at high caries risk. A practice-based split-mouth randomized clinical trial was conducted at 9 Public Dental Service (PDS) clinics in Norway. In total, 409 children age 6 to 10 y at high caries risk (d3mft > 0) meeting inclusion criteria were recruited by dentists and dental hygienists during routine examination. Eligibility criteria were 2 fully erupted first permanent molars (FPMs) in the same jaw, with sound occlusal surfaces or with initial caries. Participation was voluntary, caregivers and eligible children were informed about the study, and written parental consent was obtained. FS and FV were randomly applied on contralateral FPMs in the same jaw, with each participant serving as their own control. FS was applied at baseline and thereafter maintained according to clinicians’ conventional procedures, whereas FV was applied at baseline, 6 mo, and 12 mo. The study outcome was success, with no need for invasive treatment (caries control), while failure was defined as dentin carious lesion or restoration. Two-level mixed-effects logistic regression analysis was used to compare FS and FV groups. Of 409 recruited children, 369 (90%) children/tooth pairs were examined after 36 mo. Intention-to-treat analysis showed 94.1% adjusted predicted probability (aPP) of success (95% confidence interval [CI] 91.7 to 96.4) in the FS group and 89.6% aPP (95% CI 86.5 to 92.7) in the FV group. In the adjusted analysis, the FV group had a lower OR for success compared with the FS group (OR 0.54, 95% CI 0.24 to 0.87). In the population studied, the clinical effectiveness of FS was statistically significantly higher compared with FV but below the estimated minimal clinically important difference of 10%.

• Tuvrønningen, Hanne Shetelig; Rønneberg, Anne; Brusevold, Ingvild Johnsen & Wigen, Tove Irene (2024). Protetisk behandling med adhesiv teknikk – et alternativ i ung alder? Den norske tannlegeforenings Tidende. ISSN 0029-2303. 134, p. 696–700. Full text in Research Archive
• Aardal, Vilde Eika; Willumsen, Tiril & Evensen, Kjersti Berge (2024). Differences in anxiety, depression, and oral health-related quality of life among dental anxiety patients with and without reported abuse experience. European Journal of Oral Sciences. ISSN 0909-8836. doi: 10.1111/eos.12976. Full text in Research Archive Show summary

  This study aimed to explore the differences in anxiety, depression, and oral health-related quality of life between people with dental anxiety who reported abuse experience (n = 60) and people with dental anxiety who did not report abuse experience (n = 97). Both groups attended a dental service focused on the treatment of dental anxiety intended for people with a history of physiological or psychological trauma, or odontophobia. The participants responded to a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), Oral Impacts on Daily Performance (OIDP), and the Index of Dental Anxiety and Fear (IDAF-4C+). The differences between groups were tested for statistical significance using Welch's T-tests, and linear regression was used to adjust for gender. The participants with reported abuse experience expressed greater psychological symptoms of anxiety and poorer oral health-related quality of life. The participants with reported abuse experience also expressed a higher fear of losing control, as well as feeling shame and disgust. This study shows that individuals with dental anxiety and a history of abuse may face more complex challenges than those with dental anxiety and no history of abuse.

• Anjum, Faiza Sarwar; Brusevold, Ingvild Johnsen & Wigen, Tove Irene (2024). Prognosis of non-vital incisors after apexification using bioceramics: a retrospective study. European Archives of Paediatric Dentistry. ISSN 1818-6300. 25, p. 637–644. doi: 10.1007/s40368-024-00915-5. Full text in Research Archive Show summary

  Purpose To evaluate the outcome of apexification using bioceramics in immature permanent teeth, and to study the factors influencing treatment outcome and frequency of spontaneous cervical root fractures. Methods Forty-six children with 51 non-vital permanent incisors treated with a bioceramic apical plug were included. Mean age at pulp necrosis was 9.8 (SD 2.2) years and mean follow-up time was 3.3 (SD 2.4) years. Data were extracted from dental records and included stage of root development, presence of external root resorptions, clinical signs of infection, size of periapical lesion, type and placement of bioceramic plug, and spontaneous root fracture. Treatment outcome was assessed using periapical index (PAI-score) and presence of clinical symptoms. The statistical analyses were conducted using IBM SPSS Statistics for Windows, version 28 (IBM Corp., Armonk, N.Y., USA). Data were cross-tabulated and tested with chi-square statistic. Results Biodentine™ was used as apical plug in 78.4% of the teeth and MTA in 21.6%. Complete healing or signs of healing was reported in 86.3% of the teeth, whilst seven teeth (13.7%) were non-healed. All non-healed teeth had preoperative clinical signs of infection. No difference was found in stage of root development, presence of root resorption, and type and placement of bioceramic plug in healed and non-healed teeth (p > 0.05). Five teeth (9.8%) exhibited root fracture 1–6 years after treatment and all had very immature root development. Type of bioceramic or external root resorption was not associated with spontaneous root fracture. Conclusion Apexification using bioceramics showed favourable prognosis in immature permanent teeth. Very immature teeth were at risk of root fracture after apexification with bioceramics.

• Hauge, Mariann Saanum; Willumsen, Tiril & Storå, Bent Olav (2023). Changes in symptoms of anxiety, depression, and PTSD in an RCT-study of dentist-administered treatment of dental anxiety. BMC Oral Health. 23(1), p. 415–415. doi: 10.1186/s12903-023-03061-4. Full text in Research Archive Show summary

  Background Educating dentists in treatment methods for dental anxiety would increase the patients’ access to treatments that are important to their oral health. However, to avoid adverse effects on comorbid symptoms, involvement by a psychologist has been considered necessary. The objective of the present paper was to evaluate whether a dentist could implement systematized treatments for dental anxiety without an increase in comorbid symptoms of anxiety, depression or PTSD. Methods A two-arm parallel randomised controlled trial was set in a general dental practice. Eighty-two patients with self-reported dental anxiety either completed treatment with dentist-administered cognitive behavioural therapy (D-CBT, n = 36), or received dental treatment while sedated with midazolam combined with the systemized communication technique “The Four Habits Model” (Four Habits/midazolam, n = 41). Dental anxiety and comorbid symptoms were measured pre-treatment (n = 96), post-treatment (n = 77) and one-year after treatment (n = 52). Results An Intention-To-Treat analysis indicated reduced dental anxiety scores by the Modified Dental Anxiety Scale (median MDAS: 5.0 (-1,16)). The median scores on the Hospital Index of Anxiety and Depression (HADS-A/D) and the PTSD checklist for DSM-IV (PCL) were reduced as follows: HADS-A: 1 (-11, 11)/HADS-D: 0 (-7, 10)/PCL: 1 (-17,37). No between-group differences were found. Conclusions The study findings support that a general dental practitioner may treat dental anxiety with Four Habits/Midazolam or D-CBT without causing adverse effects on symptoms of anxiety, depression or PTSD. Establishing a best practice for treatment of patients with dental anxiety in general dental practice should be a shared ambition for clinicians, researchers, and educators. Trial registration The trial was approved by REC (Norwegian regional committee for medical and health research ethics) with ID number 2017/97 in March 2017, and it is registered in clinicaltrials.gov 26/09/2017 with identifier: NCT03293342.

• Hauge, Mariann Saanum; Høyvik, Ann Catrin; Strøm, Kjetil & Willumsen, Tiril (2023). Norske tannlegers kompetanse og behandling av tannbehandlingsangst. Norsk tannlegeforening Tidende. doi: 10.56373/2023-4-3. Full text in Research Archive
• Myran, Lena; Sen, Abhijit; Willumsen, Tiril; Havnen, Audun; Kvist, Therese & Rønneberg, Anne [Show all 8 contributors for this article] (2023). Associations of adverse childhood experiences with caries and toothbrushing in adolescents. The Young-HUNT4 Survey. BMC Oral Health. 23(1). doi: 10.1186/s12903-023-03492-z. Full text in Research Archive Show summary

  Background Adverse childhood experiences (ACEs) are associated with poor oral health. Using a life course theoretical framework, this study explored the associations of specific and cumulative ACEs with caries and toothbrushing frequency in a Norwegian adolescent population. Methods Participants were adolescents (n = 6351) age 13–17 years from The Young-HUNT4 Survey. Clinical data were retrieved from dental health records. Oral health outcomes were toothbrushing frequency, dentine caries experience (Decayed, Missing, and Filled Teeth – DMFT), and enamel caries. ACE exposure variables were physical abuse, sexual abuse, witness to violence, parental separation/divorce, parental alcohol problems, and bully victimization. Negative binominal regression models (incident rate ratios, IRRs; 95% confidence intervals, CIs) were used to determine the associations of the various ACEs with caries; logistic regression analyses (odds ratios, ORs; 95% CIs) were used to estimate associations with toothbrushing frequency. Potential effect modification by age was assessed using likelihood ratio test. Results Adolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs. Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing (OR 1.30, 95% CI 1.19–1.42). Similarly, increasing number of adversities were associated with both higher dentine caries experience (IRR 1.06, 95% CI 1.02–1.09) and higher enamel caries (IRR 1.07, 95% CI 1.03–1.11). This effect was modified by age (13–15 vs. 16–17 years) for dentine caries experience. Furthermore, there was evidence of effect modification by age with bully victimization for both toothbrushing frequency (Pinteraction = 0.014) and dentine caries experience (Pinteraction < 0.001). Specifically, bully victimization was associated with a higher likelihood of non-daily toothbrushing (OR 2.59, 95% CI 1.80–3.72) and higher dentine caries experience (IRR 1.30, 95% CI 1.14–1.50) among 16–17-year-olds. Conclusions Several specific ACEs were associated with non-daily toothbrushing and a higher caries experience among Norwegian adolescents in the Young-HUNT4 Survey.

• Bjørk, Mai Britt; Kopperud, Simen E. & Kvaal, Sigrid Ingeborg (2023). Aldersvurdering af tænder og kæber. Tandlægebladet. ISSN 0039-9353. 127(8), p. 672–676. Full text in Research Archive
• Sæthre-Sundli, Helene Borghild; Wang, Nina Johanne & Wigen, Tove Irene (2023). Prolonged breastfeeding and dental caries in preschool children. Acta Odontologica Scandinavica. ISSN 0001-6357. doi: 10.1080/00016357.2023.2211154. Full text in Research Archive Show summary

  Purpose To explore breastfeeding from 6 to 18 months of age and to study the association between breastfeeding and caries prevalence at 5 years of age. Methods The study included 1088 children from one Norwegian county and was based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The children had clinical dental examination at 5 years of age, and parents answered a questionnaire, which included information on breastfeeding, oral health behaviour and child characteristic. Multivariate logistic regressions were performed. The study was ethically approved. Results Of the studied children, 77% were breastfed at 6 months of age and 16% were still breastfed at 18 months of age. Few children (6%) were breastfed during night at 18 months of age, while 11% received sugary drink during night. No association was found between breastfeeding up to 18 months of age and caries prevalence at 5 years of age (p > .05). Children who at 18 months of age had their teeth brushed less than twice daily (OR 2.4, CI 1.5–3.9), consumed sugary drink once a week or more often (OR 1.7, CI 1.1–2.7) and had non-Western parents (OR 3.4, CI 1.5–8.1) were more likely to have caries experience at 5 years of age than other children. Conclusion Breastfeeding up to 18 months of age was not associated with caries development during preschool age.

• Afzal, Sadaf Haque; Wigen, Tove Irene; Skaare, Anne B & Brusevold, Ingvild Johnsen (2023). Molar–incisor hypomineralisation in Norwegian children: Prevalence and associated factors. European Journal of Oral Sciences. ISSN 0909-8836. 131(3). doi: 10.1111/eos.12930. Full text in Research Archive Show summary

  Abstract This study investigated the prevalence and associations of molar–incisor hypomineralisation (MIH) in 8–9 year‐old children in Oslo. A total of 3013 children in one age cohort participated in the study during their regular dental examination at the Public Dental Service. Hypomineralised enamel defects were recorded according to the European Academy of Paediatric Dentistry criteria for MIH. Information on health and medications used during pregnancy and in the child's first 3 years of life was obtained from a questionnaire administered to parents. The overall prevalence of MIH was 28.2%, with no gender difference. A higher prevalence of MIH was found in children who had been ill or had used medication in early life and in those whose mother had been ill during pregnancy. No association was found between MIH and prematurity or maternal use of medication during pregnancy. The multivariable analyses showed that children with MIH were more likely to have suffered from illness in early life (OR = 1.41, 95% CI: 1.17–1.70), used antibiotics during the first year of life (OR = 1.68, 95% CI: 1.19–2.35), experienced tooth pain (OR = 1.33, 95% CI: 1.03–1.72), and experienced pain while toothbrushing (OR = 2.17, 95% CI: 1.46–3.23) than children without MIH. The prevalence of MIH was high in the children participating in this study.

• Aardal, Vilde; Evensen, Kjersti Berge; Willumsen, Tiril & Bull, Vibeke Hervik (2022). The complexity of dental anxiety and its association with oral health-related quality of life: An exploratory study. European Journal of Oral Sciences. ISSN 0909-8836. doi: 10.1111/eos.12907. Full text in Research Archive Show summary

  This study aimed to explore the factors associated with oral health-related quality of life (OHRQoL) in a sample with high dental anxiety. Data were obtained from 107 patients attending a therapeutic treatment program for people who have experienced abuse and for those with dental phobia in Norway. Patients completed questionnaires, including the Index of Dental Anxiety and Fear, the Anxiety subscale of the Hospital Anxiety and Depression Scale, and the Oral Impacts on Daily Performance scale, measuring OHRQoL prior to treatment. The various measurement instruments were evaluated psychometrically, and the variables associated with OHRQoL were explored using hierarchical multiple regression. Symptoms of dental anxiety and general anxiety were high, while OHRQoL was poor. Dental anxiety, higher age, higher number of years since the last dental treatment, and higher general anxiety were discernibly associated with lower OHRQoL. The strongest association was found between general anxiety and OHRQoL. In conclusion, several factors were associated with OHRQoL in a sample with high dental anxiety, suggesting a complex picture of dental anxiety. When treating patients with high dental anxiety, dental practitioners should be aware that there may be factors complicating the therapeutic setting, such as general anxiety.

• Sæthre-Sundli, Helene Borghild; Løken, Sonja Yr; Wang, Nina Johanne & Wigen, Tove Irene (2022). Fissure sealing and caries development in Norwegian children. European Archives of Paediatric Dentistry. ISSN 1818-6300. 23, p. 905–910. doi: 10.1007/s40368-022-00729-3. Full text in Research Archive Show summary

  Purpose To explore the use of fissure sealing as a caries preventive method by describing characteristics of children who had received sealants and to study associations between sealing and caries prevalence at 12 years of age. Methods The study included 3075 children examined at 5 and 12 years of age. Data were collected by clinical examination and questionnaire to parents. The questionnaire provided information on child characteristics and oral health behaviour in children at 5 years of age. Data on sealing and caries prevalence were obtained from dental records. Bi- and multivariate logistic regressions were performed. The Regional Committee for Medical Research Ethics approved the study (2.200.54 and 2013/1881). Results Of the children, 12% had received sealants on permanent teeth before 12 years of age. Children with dentin caries at 5 years of age (OR 2.0, CI 1.5–2.7) had a higher probability of having received sealants than children without caries. Having sealants (OR 2.8, CI 2.2–3.6), enamel caries (OR 1.5, CI 1.2–1.9), dentin caries (OR 2.9, CI 2.3–3.6) and using fluoride lozenges less than daily (OR 1.5, CI 1.3–1.8) at 5 years of age were associated with having dentin caries prevalence at 12 years of age. Conclusion Few children had received fissure sealing. Although sealing was used as a caries preventive method in children who had experienced caries in primary teeth, these children continued developing caries in their permanent teeth.

• Baumgartner, Christine Sophie; Wang, Nina Johanne & Wigen, Tove Irene (2022). Self-reported satisfaction with teeth and associated factors in 12-year-olds. Community Dental Health. ISSN 0265-539X. 39(3), p. 165–168. doi: 10.1922/CDH_00287Baumgartner04. Full text in Research Archive
• Kopperud, Simen & Kvaal, Sigrid Ingeborg (2022). Hvordan utføre rettsodontologisk identifisering av personer uten tannrestaureringer? Aktuell Nordisk odontologi. ISSN 1902-3545. 47(1), p. 164–179. doi: 10.18261/issn.2058-7538-2022-01-13. Full text in Research Archive Show summary

  Den vanligste oppgaven for rettsodontologer i Norge er identifisering av døde personer. Odontologisk identifisering av en avdød person baserer seg på en objektiv sammenligning av den avdødes tannstatus med innsamlede tanndata fra en savnet person. Frem til nå har sammenlikning av tilstedeværende tannrestaureringer hos avdøde og dokumentert behandling hos den savnede i stor grad vært brukt til å fastslå odontologisk identitet. Klinisk odontologi har imidlertid gjennomgått et paradigmeskifte de senere tiårene med hensyn til behov for operativ behandling av karieslesjoner. Dette har ført til at det de siste tiårene er utført betydelig færre tannrestaureringer. En konsekvens av dette er at det i nær fremtid kan bli vanskeligere å finne sammenfallende trekk basert på restaureringer i identifiseringsarbeid. Rettsodontologer må derfor se etter andre odontologiske trekk som kan bidra til sikker identitet. Et eksempel på dette kan være dentale anomalier. Tanndannelsen og tannfrembruddet følger hos de aller fleste en viss struktur. I noen tilfeller oppstår det imidlertid uregelmessigheter, og disse særtrekkene kan brukes til å identifisere personer med få eller ingen tannrestaureringer. Dentale implantater som erstatning for tapte eller manglende tenner har i nyere tid blitt en vanlig behandlingsform, også blant pasienter uten andre tannrestaureringer. Siden flere implantater har ulik konstruksjon, er det til en viss grad mulig å gjenkjenne fabrikat på implantatet ved å studere og sammenligne røntgenbilder, og dersom opplysningene er registrert i pasientjournalen kan det bidra til odontologisk identifisering. Det er også et håp om at tannimplantater på sikt skal merkes med et ID-nummer og registreres i et nasjonalt register. Palatinale rugae er irregulære, asymmetriske bindevevsfolder i den harde gane. Det er mye som tyder på at mønsteret er unikt for hver person – nesten som et fingeravtrykk – og at det dermed kan brukes til identifisering dersom det finnes oppbevart avtrykk av ganen.

• Hauge, Mariann Saanum; Stora, Bent & Willumsen, Tiril (2022). Dental anxiety treatment by a dentist in primary care: A 1-year follow-up study. European Journal of Oral Sciences. ISSN 0909-8836. 130(4). doi: 10.1111/eos.12872. Full text in Research Archive Show summary

  In an earlier randomized controlled trial of dental anxiety treatments (n = 96) we compared the effects of dentist-administered cognitive behavioural therapy (D-CBT) and dental treatment supplemented with the Four Habits communication model plus midazolam sedation. Both treatments, applied in a general dental practice, were associated with a clinically relevant decrease in dental anxiety. In this follow-up study, 52 of the 82 treatment completers responded to an online questionnaire 1 year post-treatment. Reduction in dental anxiety persisted for both treatment groups. From baseline to 1 year post-treatment the Modified Dental Anxiety Scale was reduced by 7.8 [SD: 4.4; Cohen's d effect size: 1.2 (CI: 0.8–1.7)] and 7.8 [SD: 4.2; Cohen's d: 1.4 (0.9–1.8)] in the D-CBT and Four Habits/midazolam groups, respectively. Most patients (74% for D-CBT, 80% for Four Habits/midazolam) continued with dental treatment. Nine patients in the D-CBT and seven in the Four Habits/midazolam groups received additional CBT treatment from a psychologist/dentist team. Both methods tested should be accessible to interested dentists who receive adequate training. Effective first-line treatments for dental anxiety in general dental practice can generate more accessible care pathways for patients with dental anxiety. Evidence-based dental anxiety treatment programmes should be included in the dental curriculum and established as best practice for dentists.

• Toft, Julie; Myhre, Arne Kristian; Sun, Yi-Qian; Willumsen, Tiril & Rønneberg, Anne (2022). Oral health history in children referred to a child advocacy center in Norway. International Journal of Child Abuse & Neglect. ISSN 0145-2134. 132. doi: 10.1016/j.chiabu.2022.105789. Full text in Research Archive Show summary

  Background Some suspected child victims of physical or sexual abuse undergo dental forensic examinations at child advocacy centers (CACs) in Norway. Their oral health history has not previously been studied. Objective This study aimed to compare oral health history of CAC children to matched children. Additionally, the oral health history of children exposed to sexual abuse was compared to children exposed to physical abuse. Participants and setting The CAC cohort included 100 children, 3–16 years. The matched cohort, with no known history of abuse, included 63 children. Methods The retrospective study analyzed registered data in the children's dental records. Results CAC children were more likely than matched children to have caries experience in both primary and permanent teeth, with incidence rate ratio (IRR) 1.50 (95 % CI 1.01–2.25) and 1.92 (1.11–3.30). “Was Not Brought” to dental appointments was more than twice as likely, IRR 2.25 (1.31–3.86), in the CAC cohort. There were no significant differences in reports to the Child Protection Services or dental traumas. Suspected victims of sexual abuse had more caries, IRR 4.28 (2.36–7.77), and fillings, IRR 4.83 (2.55–9.16), in permanent teeth compared to suspected victims of physical abuse. Conclusions CAC children were more likely to have caries experience and not show up for dental appointments than the matched children. Sexual abuse suspected had four times more caries experience than physical abuse suspected. This study supports the need for addressing oral health in risk evaluations concerning child abuse, and provides valuable information to dental professionals and prosecuting authorities.

• Hauge, Mariann Saanum; Storo, Bent; Vassend, Olav Mandt; Hoffart, Asle & Willumsen, Tiril (2022). Tannlegeadministrert kognitiv atferdsterapi versus «Fire gode vaner» – bruk av midazolam: En randomisert kontrollert studie av behandling av tannbehandlingsangst i primær tannhelsetjeneste. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 132(8), p. 626–636. doi: 10.56373/2022-8-4. Full text in Research Archive
• Tanem, Kristine Eidal; Stensvold, Einar; Wilberg, Petter; Skaare, Anne B; Brandal, Petter & Herlofson, Bente Brokstad (2022). Oral and dental late effects in long-term survivors of childhood embryonal brain tumors. Supportive Care in Cancer. ISSN 0941-4355. 30, p. 10233–10241. doi: 10.1007/s00520-022-07405-8. Full text in Research Archive Show summary

  Abstract Purpose To investigate oral and dental late effects in survivors of childhood brain tumors medulloblastoma (MB) and central nervous system supratentorial primitive neuroectodermal tumor (CNS-PNET). Methods This cross-sectional study assessed oral and dental late effects in MB/CNS-PNET survivors treated before 20 years of age, and with a minimum of 2 years since treatment. Participants went through an oral and radiographic examination. We assessed oral status using the decayed-missing-filled index (DMFT), oral dryness, maximum mouth opening (MMO), fungal infection, and registration of dental developmental disturbances (DDD) in the form of hypodontia, microdontia, and enamel hypoplasia. Results The 46 participants’ mean age at enrolment was 27 ± 12.8 years and at treatment 8.5 ± 5.2 years, and the mean time since treatment was 18.9 ± 12 years. Over a third (35%) of survivors had reduced mouth opening (mean 29.3 ± 5.6 mm (range 16–35)). A significantly lower MMO was found in individuals treated ≤ 5 years compared to survivors treated &gt; 5 years ( p  = 0.021). One or more DDD were registered in 30.4% of the survivors, with a significantly higher prevalence in individuals treated ≤ 5 years ( p  &lt; 0.001). Hypodontia was the most prevalent type of DDD. There was no difference in DMFT score in relation to age at treatment. Oral dryness was not frequently reported or observed in these survivors. Conclusion Survivors of childhood MB/CNS-PNET are at risk of oral and dental late effects including reduced mouth opening and DDD. The risk is highest in survivors treated before the age of 5.

• Børsting, Torunn; Schuller, Annemarie; Dommelen, Paula van; Stafne, Signe Nilssen; Skeie, Marit Slåttelid & Skaare, Anne [Show all 13 contributors for this article] (2022). Maternal vitamin D status in pregnancy and molar incisor hypomineralisation and hypomineralised second primary molars in the offspring at 7–9 years of age: a longitudinal study. European Archives of Paediatric Dentistry. ISSN 1818-6300. 23(4), p. 557–566. doi: 10.1007/s40368-022-00712-y. Full text in Research Archive Show summary

  Purpose The study aimed to investigate associations between maternal vitamin D status during pregnancy and molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) among children. Methods The study had a longitudinal design using prospectively collected data from 176 mother and child pairs. Mothers were initially recruited in a randomised controlled trial to assess a pregnancy exercise programme. Along with the 7-year follow-up, we invited the children to a dental examination. The exposure variable was maternal serum 25-hydroxyvitamin D in gestational weeks 18–22 and 32–36, categorised as insufficient (< 50 nmol/l) and sufficient (≥ 50 nmol/l). Negative binomial hurdle models were used to analyse potential associations between the exposure variables and MIH or HSPM. The models were adjusted for potential confounders. Results Among the children (7–9 years old), 32% and 22% had at least one tooth with MIH or HSPM, respectively. A significant association was found between insufficient maternal vitamin D measured in gestational weeks 18–22 and the number of affected teeth among those with MIH at 7–9 years (adjusted RR = 1.82, 95% CI 1.13–2.93). Conclusion Considering any limitations of the present study, it has been shown that insufficient maternal serum vitamin D at mid-pregnancy was associated with a higher number of affected teeth among the offspring with MIH at 7–9 years of age. Further prospective studies are needed to investigate whether this finding is replicable and to clarify the role of maternal vitamin D status during pregnancy and MIH, as well as HSPM, in children.

• Välikangas, Tommi; Lietzén, Niina; Jaakkola, Maria K.; Krogvold, Lars; Eike, Morten Christoph & Kallionpää, Henna [Show all 14 contributors for this article] (2022). Pancreas whole tissue transcriptomics highlights the role of the exocrine pancreas in patients with recently diagnosed type 1 diabetes. Frontiers in Endocrinology. 13:881985, p. 1–12. doi: 10.3389/fendo.2022.861985. Full text in Research Archive Show summary

  Although type 1 diabetes (T1D) is primarily a disease of the pancreatic beta-cells, understanding of the disease-associated alterations in the whole pancreas could be important for the improved treatment or the prevention of the disease. We have characterized the whole-pancreas gene expression of patients with recently diagnosed T1D from the Diabetes Virus Detection (DiViD) study and non-diabetic controls. Furthermore, another parallel dataset of the whole pancreas and an additional dataset from the laser-captured pancreatic islets of the DiViD patients and non-diabetic organ donors were analyzed together with the original dataset to confirm the results and to get further insights into the potential disease-associated differences between the exocrine and the endocrine pancreas. First, higher expression of the core acinar cell genes, encoding for digestive enzymes, was detected in the whole pancreas of the DiViD patients when compared to non-diabetic controls. Second, In the pancreatic islets, upregulation of immune and inflammation related genes was observed in the DiViD patients when compared to non-diabetic controls, in line with earlier publications, while an opposite trend was observed for several immune and inflammation related genes at the whole pancreas tissue level. Third, strong downregulation of the regenerating gene family ( REG ) genes, linked to pancreatic islet growth and regeneration, was observed in the exocrine acinar cell dominated whole-pancreas data of the DiViD patients when compared with the non-diabetic controls. Fourth, analysis of unique features in the transcriptomes of each DiViD patient compared with the other DiViD patients, revealed elevated expression of central antiviral immune response genes in the whole-pancreas samples, but not in the pancreatic islets, of one DiViD patient. This difference in the extent of antiviral gene expression suggests different statuses of infection in the pancreas at the time of sampling between the DiViD patients, who were all enterovirus VP1 + in the islets by immunohistochemistry based on earlier studies. The observed features, indicating differences in the function, status and interplay between the exocrine and the endocrine pancreas of recent onset T1D patients, highlight the importance of studying both compartments for better understanding of the molecular mechanisms of T1D.

• Krogvold, Lars; Leete, Pia; Mynarek, Ida Maria; Russell, Mark A.; Gerling, Ivan C. & Lenchik, Nataliya I. [Show all 10 contributors for this article] (2022). Detection of Antiviral Tissue Responses and Increased Cell Stress in the Pancreatic Islets of Newly Diagnosed Type 1 Diabetes Patients: Results From the DiViD Study. Frontiers in Endocrinology. 13, p. 1–10. doi: 10.3389/fendo.2022.881997. Full text in Research Archive Show summary

  Aims/hypothesis: The Diabetes Virus Detection (DiViD) study has suggested the presence of low-grade enteroviral infection in pancreatic tissue collected from six of six live adult patients newly diagnosed with type 1 diabetes. The present study aimed to compare the gene and protein expression of selected virally induced pathogen recognition receptors and interferon stimulated genes in islets from these newly diagnosed type 1 diabetes (DiViD) subjects vs age-matched non-diabetic (ND) controls. Methods: RNA was extracted from laser-captured islets and Affymetrix Human Gene 2.0 ST arrays used to obtain gene expression profiles. Lists of differentially expressed genes were subjected to a data-mining pipeline searching for enrichment of canonical pathways, KEGG pathways, Gene Ontologies, transcription factor binding sites and other upstream regulators. In addition, the presence and localisation of specific viral response proteins (PKR, MxA and MDA5) were examined by combined immunofluorescent labelling in sections of pancreatic tissue. Results: The data analysis and data mining process revealed a significant enrichment of gene ontologies covering viral reproduction and infectious cycles; peptide translation, elongation and initiation, as well as oxidoreductase activity. Enrichment was identified in the KEGG pathways for oxidative phosphorylation; ribosomal and metabolic activity; antigen processing and presentation and in canonical pathways for mitochondrial dysfunction, oxidative phosphorylation and EIF2 signaling. Protein Kinase R (PKR) expression did not differ between newly diagnosed type 1 diabetes and ND islets at the level of total RNA, but a small subset of β-cells displayed markedly increased PKR protein levels. These PKR+ β-cells correspond to those previously shown to contain the viral protein, VP1. RNA encoding MDA5 was increased significantly in newly diagnosed type 1 diabetes islets, and immunostaining of MDA5 protein was seen in α- and certain β-cells in both newly diagnosed type 1 diabetes and ND islets, but the expression was increased in β-cells in type 1 diabetes. In addition, an uncharacterised subset of synaptophysin positive, but islet hormone negative, cells expressed intense MDA5 staining and these were more prevalent in DiViD cases. MxA RNA was upregulated in newly diagnosed type 1 diabetes vs ND islets and MxA protein was detected exclusively in newly diagnosed type 1 diabetes β-cells. Conclusion/interpretation: The gene expression signatures reveal that pathways associated with cellular stress and increased immunological activity are enhanced in islets from newly diagnosed type 1 diabetes patients compared to controls. The increases in viral response proteins seen in β-cells in newly diagnosed type 1 diabetes provide clear evidence for the activation of IFN signalling pathways. As such, these data strengthen the hypothesis that an enteroviral infection of islet β-cells contributes to the pathogenesis of type 1 diabetes.

• Tanem, Kristine Eidal; Wilberg, Petter; Diep, Phoi Phoi; Ruud, Ellen; Skaare, Anne B & Brinch, Lorentz [Show all 7 contributors for this article] (2022). Oral chronic GVHD after allogeneic stem cell transplantation without total body irradiation performed at a young age. Supportive Care in Cancer. ISSN 0941-4355. 30(5), p. 4121–4128. doi: 10.1007/s00520-022-06836-7. Full text in Research Archive Show summary

  Abstract Purpose Long-term survivors (LTSs) of allogeneic hematopoietic stem cell transplantation (allo-HCT) may experience oral long-term effects like chronic graft-versus-host disease (oral cGVHD). The aim of this study was to investigate oral cGVHD in patients treated at a young age (&lt; 30 years) more than 5 years after allo-HCT without total body irradiation (TBI). Methods All 94 participants went through a semi-structured interview, and an oral examination. Diagnosis of oral cGVHD was based on the “National Institutes of Health (NIH) cGVHD diagnosis and staging consensus criteria” from 2014. Results Mean age at transplantation was 17.5 years (range 0.4–29.9 years), and mean time since transplantation was 16.7 years (range 6–26 years). Oral cGVHD was diagnosed in 26 (28%) of 94 LTSs. Of which 20 (21.5%) showed lichen planus-like (LPL) changes, and additionally six (6.5%) also fulfilled the diagnostic criteria of oral cGVHD since they had one or more distinctive signs and symptoms of oral cGVHD combined with definite cGVHD in another organ. No LTSs reported oral cGVHD (NIH) grade 3. There was a significant association between cGVHD in the oral cavity and cGVHD in another organ (77% vs 29%, p  &lt; 0.001). Out of 72 LTSs, who answered the questions regarding taste disturbances, 16 (22%) reported dysgeusia. No LTSs developed secondary malignancies in the oral cavity during follow-up time. Conclusion Oral long-term effects, such as oral cGVHD, may persist for many years after allo-HCT without TBI-conditioning in patients treated at a young age.

• Tanem, Kristine Eidal; Stensvold, Einar; Wilberg, Petter; Skaare, Anne B; Singh, Preet Bano & Brandal, Petter [Show all 7 contributors for this article] (2022). Taste and smell function in long-term survivors after childhood medulloblastoma/CNS-PNET. Supportive Care in Cancer. ISSN 0941-4355. 30, p. 6155–6162. doi: 10.1007/s00520-022-07048-9. Full text in Research Archive Show summary

  Abstract Purpose To investigate taste and smell function in survivors, with a minimum of 2 years since treatment of childhood medulloblastoma (MB)/central nervous system supratentorial primitive neuroectodermal tumor (CNS-PNET). Methods This cross-sectional study included 40 survivors treated ≤ 20 years of age. Taste strips with four concentrations of sweet, sour, salt, and bitter were used to assess taste function in all participants. Score from 0 to 16; ≥ 9 normogeusia, &lt; 9 hypogeusia, and complete ageusia which equals no sensation. No sensation of a specific taste quality equals ageusia of that quality. Thirty-two participants conducted smell testing using three subtests of Sniffin’ sticks: threshold, discrimination, and identification. Together they yield a TDI-score from 1 to 48; functional anosmia ≤ 16.00, hyposmia &gt; 16.00– &lt; 30.75, normosmia ≥ 30.75– &lt; 41.50, and ≥ 41.50 hyperosmia. Results were compared with normative data. Survivors rated their taste and smell function using a numerical rating scale (NRS) score 0–10. Results Forty survivors with a mean time since treatment of 20.5 years, 13 (32.5%) were diagnosed with hypogeusia, nine (22.5%) of these being ageusic to one or more taste qualities. Seventeen (53%) of 32 participants were diagnosed with hyposmia. The mean scores of the olfactory subtests, and TDI score were significantly lower than normative data ( P  &lt; 0.0001). The mean NRS scores of smell and taste function were 7.9 ± 1.5 and 8 ± 1.3, respectively. Conclusion Our study showed impaired taste and smell function in survivors of childhood MB/CNS-PNET using objective measurements. However, subjective ratings did not reflect objective findings.

• Muhoozi, Grace Kyamazima Mehangye; Li, Kelvin; Atukunda, Prudence; Skaare, Anne B; Willumsen, Tiril & Enersen, Morten [Show all 11 contributors for this article] (2022). Child saliva microbiota and caries: a randomized controlled maternal education trial in rural Uganda. Scientific Reports. 12(1). doi: 10.1038/s41598-022-11979-y. Full text in Research Archive Show summary

  Abstract Undernutrition is a public health challenge in sub-Saharan countries, including Uganda. In a previous randomized controlled trial (RCT) with a nutrition, hygiene and stimulation education intervention among mothers of 6 months’ old children, we found less caries in the intervention group when the children were 36 months of age. We now examined the effects of (i) the intervention on the microbiota, (ii) microbiota on caries, and (iii) the intervention and microbiota on caries. The original RCT comprised 511 mother/child pairs whereas in the current study we had access to data from 344/511 (67%) children aged 36 months. The saliva microbiota was determined using 16S rRNA gene sequencing. Carious lesions (a proxy for dental health) were identified using close-up intra-oral photographs of the upper front teeth. Statistical models were used to determine host-microbiota associations. The intervention had a significant effect on the microbiota, e.g. an increase in Streptococcus abundance and decreases in Alloprevotella and Tannerella . Significant associations between the microbiota and dental caries were identified: Positive associations of Capnocytophaga and Tannerella suggest that these taxa may be deleterious to dental health while negative associations of Granulicatella , Fusobacterium , and Abiotrophia suggest taxa potentially beneficial or benign contributors to dental health. Based on taxonomic profiles, the effects of the intervention and microbiota on dental health may be independent of one another. Educational interventions with emphasis on nutrition and oral hygiene may provide a feasible strategy to decrease progression of childhood caries in low-resource settings.

• Rogers, Adam Austin; Willumsen, Tiril; Strømme, Hilde & Johnsen, Jan-Are Kolset (2022). Top-down self-regulation processes as determinants of oral hygiene self-care behaviour: A systematic scoping review. Clinical and Experimental Dental Research. 8, p. 807–826. doi: 10.1002/cre2.548. Full text in Research Archive Show summary

  Objectives: Understanding the psychological mechanisms that moderate oral hygiene self‐care behavior is anticipated to benefit efforts to change such behavior. Top‐down self‐regulatory (TSR) processes represent one group of relatively unexplored, yet potentially influential, moderating factors. This systematic scoping review aims to explore whether there is evidence that TSR processes moderate oral hygiene self‐care engagement within the current literature.<p> <p>Methods: CINAHL, The Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched up to April 2020 for articles that compared measures of TSR processes (such as self‐monitoring, inhibitory control, and task switching) to oral hygiene self‐care behavior, or tested interventions that aimed to change or support TSR processes.<p> <p>Results: The search returned 6626 articles, with 25 included in the final sample. Weak evidence supported both the role of TSR processes as moderators of interdental cleaning and the value of interventions targeting self‐monitoring of interdental cleaning behavior. Overall, methodological limitations rendered the findings somewhat inconclusive, with an absence of objective assessments of TSR capacity, and little focus on TSR processes as moderators of intervention effects.<p> <p>Conclusions: The inconclusive, but reasonably promising, findings point to the value of continuing to apply TSR processes within studies of oral hygiene behavior. Exploring why interdental cleaning appears more reliant on TSR processes than toothbrushing, employing objective neuropsychological assessment, and measuring TSR constructs within interventions targeting TSR processes, are encouraged. As a scoping review, the study hopes to generate interest and serve as a starting point for further investigation.

• Engh, Marit Stokke; Muhoozi, Grace Kyamazima Mehangye; Ngari, Moses; Skaare, Anne B; Westerberg, Ane Cecilie & Iversen, Per Ole [Show all 8 contributors for this article] (2022). Long-Term Effects of a Randomized Maternal Education Trial in Rural Uganda: Implications for Child Oral Health. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 107(4), p. 939–947. doi: 10.4269/ajtmh.22-0248. Full text in Research Archive Show summary

  The aim was to examine oral health among 5–6-year-old children whose mothers participated in a 6 months’ cluster-randomized education trial in rural Uganda starting when their children were 6–8 months old. The education focused on nutrition, oral hygiene, and child stimulation. In the current follow-up study, 357/511 (70%) children from the original trial were available for data collection (200 in the intervention and 157 in the control group). Molar caries was assessed on intraoral photographs. Children and/or caregivers answered a WHO health questionnaire for collection of oral data. Dental practices were compared between the intervention and control group using multilevel mixed effect logistic regression accounting for clustering. The children in the intervention group had less caries compared with the control group: 41% versus 60% (odds ratio [OR] 0.46; 95% confidence intervals [CI] 0.24–0.86, P = 0.02). The use of toothbrush to clean teeth was more frequent in the intervention than in the control group: 66% versus 38% (OR 3.39; 95% CI 1.54–7.45, P = 0.003), as was high teeth-cleaning frequency: 74% versus 62% (OR 1.72; 95% CI 1.09–2.69, P = 0.02). Self-reported problems such as toothache (10% versus 19%), difficulty biting (12% versus 24%) and chewing food (8.5% versus 18%) were significantly less frequent among children in the intervention compared with the control group. No significant differences were found in dietary habits. Our data shows that an educational intervention adjusted to a low-resource setting, provided in infancy, resulted in improved oral hygiene and reduced development of dental caries among children aged 5–6 years.

• Reddy, Shiva; Krogvold, Lars; Martin, Charlton; Sun, Kevin Xueying; Martin, Owen & Al-Ani, Aamenah [Show all 7 contributors for this article] (2021). Expression of immunoreactive inducible nitric oxide synthase in pancreatic islet cells from newly diagnosed and long-term type 1 diabetic donors is heterogeneous and not disease-associated. Cell and Tissue Research. ISSN 0302-766X. 384, p. 655–674. doi: 10.1007/s00441-020-03340-4. Full text in Research Archive
• Wigen, Tove Irene & Wang, Nina Johanne (2021). Characteristics of teenagers who use dental floss. Community Dental Health. ISSN 0265-539X. 38, p. 10–14. doi: 10.1922/CDH_00006Wigen05. Full text in Research Archive Show summary

  Objective: To describe the use of dental floss by teenagers and study associations between flossing and approximal caries experience, oral health behaviours, gender, parental education and national background. Methods: The study included 2156 14-year-old teenagers. Data were collected in conjunction with routine dental examinations. Teenagers answered a questionnaire about frequency of and reasons for flossing, oral health behaviours and family characteristics. Information about approximal enamel (D1-2Sa) and dentine caries experience (D3MFSa) was collected from dental records. Data were cross-tabulated and tested with Chi-Square statistics and ANOVA, and analysed using multivariable logistic regression. The data was baseline data in a longitudinal study exploring effects of dental floss. The study was performed as part of the quality assurance system required by law in the dental services and did not require ethical approval. Results: Half of the teenagers (54%) used dental floss. Among teenagers who flossed, 15% reported doing so daily. Recommendation from dental personnel was the most important reason for using dental floss. Proportionately more girls and teenagers whose parents had high educational achievement reported flossing. Teenagers who flossed more often had more favourable oral health behaviours than other teenagers but more often had approximal enamel caries (D1-2Sa) and approximal dentine caries experience (D3MFSa) than other teenagers (p<0.05). Conclusion: Use of dental floss was not a daily behaviour in most teenagers. Flossing was associated with having approximal caries lesions, indicating that teenagers having signs of approximal caries had been recommended to use dental floss. Keywords: adolescent, caries, oral health behaviour, dental floss, topical fluoride.

• Schmalfuss, Andreas Jörn; Sehic, Amer & Brusevold, Ingvild Johnsen (2021). Effects of antibiotics on the developing enamel in neonatal mice. European Archives of Paediatric Dentistry. ISSN 1818-6300. p. 1–10. doi: 10.1007/s40368-021-00677-4. Full text in Research Archive Show summary

  Purpose Identifying factors causing Molar-Incisor Hypomineralization (MIH) is an ongoing challenge. Preterm infants, routinely treated with antibiotics in cases of suspected sepsis, are more commonly afected by dental developmental defects. This study aimed to investigate the efects of gentamycin and ampicillin on the developing enamel in neonatal CD-1 mice in vivo.<p> <p>Methods Neonatal mice were randomized into a study (n=36) and a control (n=35) group. Antibiotics were injected intravenously for 4 days. All mice were sacrifced after 15–18 days. Micro-CT was used to analyse the mineral density (MD) of the enamel and the proportion of the enamel object volume (vol%) in frst molars and incisors.<p> <p>Results We demonstrated a signifcantly lower vol% enamel in the maxillary (30.9% vs. 32.7%; p=0.004) and mandibular (32.5% vs. 34.6%; p=0.015) molars in the study group than in the controls. The incisors were divided into segments upon analysis. We demonstrated both lower vol% and lower MD of the enamel in most segments in treated individuals compared to controls (p<0.05).<p> <p>Conclusion The reduced MD and vol% in the molars and incisors are likely to have been caused by the antibiotics given during tooth development. The presented analysis of teeth in neonatal mice with micro-CT could be a valid model for further research on dental developmental defects.

• Hauge, Mariann Saanum; Stora, Bent; Vassend, Olav; Hoffart, Asle & Willumsen, Tiril (2021). Dentist-administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in primary dental care. European Journal of Oral Sciences. ISSN 0909-8836. p. 1–12. doi: 10.1111/eos.12794. Full text in Research Archive Show summary

  The study aimed to test the effectiveness of cognitive behavioural therapy (CBT) administered by a general dental practitioner (GDP) in a general dental practice. In a two-arm parallel randomised controlled trial, the experimental group received a short dentist-administered CBT-intervention (D-CBT). A best-practice control group (FHM) received dental treatment during sedation with midazolam combined with an evidence-based communication model (The Four Habits Model). Ninety-six patients with self-reported dental anxiety were allocated to the treatment arms at a 1:1 ratio. Modified Dental Anxiety Scale (MDAS) scores spanned from 12 to 25, and 82 patients (85%) had a score of 19 or more, indicating severe dental anxiety. In both treatment arms, scores on MDAS and Index of Dental Anxiety and Fear (IDAF-4C) decreased significantly, but no differences were found between treatment arms. Mean reductions were: MDAS scores: −6.6 (SD = 0.5); IDAF-4C scores: −1.0 (SD = 1.1). In conclusion, local GDPs in general dental practices with proper competence have the ability for early detection of dental anxiety and, with the use of a manual-based D-CBT or FHM treatment, GDPs could offer efficient first-line treatment suitable for dental anxiety of varying severities.

• Baumgartner, Christine Sophie; Wang, Nina Johanne & Wigen, Tove Irene (2021). Oral health behaviours in 12-year-olds. Association with caries and characteristics of the children? Acta Odontologica Scandinavica. ISSN 0001-6357. 80, p. 15–20. doi: 10.1080/00016357.2021.1933173. Full text in Research Archive Show summary

  Objective To explore frequency of tooth brushing, dental flossing, fluoride supplements and sugar snacking in 12-year-olds, and to study how these oral health behaviours were associated with background characteristics and caries prevalence. Material and methods The study included 4779 children. Data were collected by clinical examination and questionnaires regarding oral health behaviours and child characteristics. Informed consent was obtained from all participants. Data were tested using Chi-square statistics and analyzed by logistic regression. The study was ethically approved. Results Of the children, 81% brushed twice daily, 36% flossed once a week or more often, 39% used fluoride supplements daily and 48% consumed sugar between meals once a week or less often. Children who brushed twice daily more often flossed regularly, used fluoride daily and consumed sugar between meals less often than other children (p < .05). Girls and children whose parents had long education more often had favourable oral health behaviours than other children; brushed more frequently, more often used floss and fluoride supplements and consumed sugary snacks less often than other children (p < .05). In total, 40% of the children were caries-free. Children who brushed less than twice daily had more often caries than other children (OR 1.50, CI 1.29–1.74) when controlling for background characteristics and other oral health behaviours. Conclusions The majority of children brushed twice daily and these children had caries less often than other children. The use of dental floss, fluoride supplements or sugar snacking in addition to brushing twice daily, did not reduce the probability of having caries.

• Oikarinen, Sami; Krogvold, Lars; Edwin, Bjørn; Buanes, Trond; Korsgren, Olle & Laiho, Jutta E. [Show all 13 contributors for this article] (2021). Characterisation of enterovirus RNA detected in the pancreas and other specimens of live patients with newly diagnosed type 1 diabetes in the DiViD study. Diabetologia. ISSN 0012-186X. 64, p. 2491–2501. doi: 10.1007/s00125-021-05525-0. Full text in Research Archive Show summary

  Abstract Aims/hypothesis The Diabetes Virus Detection (DiViD) study is the first study to laparoscopically collect pancreatic tissue and purified pancreatic islets together with duodenal mucosa, serum, peripheral blood mononuclear cells (PBMCs) and stools from six live adult patients (age 24–35 years) with newly diagnosed type 1 diabetes. The presence of enterovirus (EV) in the pancreatic islets of these patients has previously been reported. Methods In the present study we used reverse transcription quantitative real-time PCR (RT-qPCR) and sequencing to characterise EV genomes present in different tissues to understand the nature of infection in these individuals. Results All six patients were found to be EV-positive by RT-qPCR in at least one of the tested sample types. Four patients were EV-positive in purified islet culture medium, three in PBMCs, one in duodenal biopsy and two in stool, while serum was EV-negative in all individuals. Sequencing the 5′ untranslated region of these EVs suggested that all but one belonged to enterovirus B species. One patient was EV-positive in all these sample types except for serum. Sequence analysis revealed that the virus strain present in the isolated islets of this patient was different from the strain found in other sample types. None of the islet-resident viruses could be isolated using EV-permissive cell lines. Conclusions/interpretation EV RNA can be frequently detected in various tissues of patients with type 1 diabetes. At least in some patients, the EV strain in the pancreatic islets may represent a slowly replicating persisting virus. Graphical abstract

• Skaare, Anne B; Houlihan, Ciara; Nybø, Christine Jøsok & Brusevold, Ingvild Johnsen (2021). Knowledge, experience and perception regarding molar incisor hypomineralisation (MIH) among dentists and dental hygienists in Oslo, Norway. European Archives of Paediatric Dentistry. ISSN 1818-6300. 22, p. 851–860. doi: 10.1007/s40368-021-00649-8. Full text in Research Archive Show summary

  Abstract Aim The aim of this study is to gather baseline information on knowledge, perceptions, clinical experience and treatment options regarding MIH among dental care providers in Oslo, Norway, before a larger epidemiological study. Methods An electronic questionnaire was distributed to dentists ( n  = 88) and dental hygienists ( n  = 47) working in the Public Dental Service (PDS) in Oslo. The questionnaire consisted of five sections related to sociodemographic, clinical experience, perceptions, clinical management and preferences for further training. Descriptive statistics with chi-squared test was used, and level of statistical significance was set to 5%. Results Replies were obtained from 74.1% ( n  = 100) after two reminders. All respondents encountered MIH in their practice. The respondents’ perception of the prevalence of MIH in Oslo varied. The majority felt confident when diagnosing MIH (86%). The clinicians qualified in the last 10 years felt more confident than those who had qualified earlier ( p  = 0.016). Most were self-confident when treating these patients (68.3%), however, nearly all (88%) agreed that MIH was a clinical problem. The clinician’s treatment of MIH varied. Difficulties achieving adequate local anaesthetic (71.4%) and the child’s behavioural problems (84.1%) were treatment barriers for the dentists. Approximately two thirds (69%) would like further training, in particular on the aetiology (70%), diagnosis (57%) and treatment (77%) of the developmental disorder. Conclusion All clinicians were familiar with the diagnosis of MIH and experienced the condition to be a clinical problem. Continuing education on aetiology, diagnosis and treatment of MIH is requested by dental health personnel.

• Pedersen, Kristina; Haupt-Jorgensen, Martin; Krogvold, Lars; Kaur, Simranjeet; Gerling, Ivan C. & Pociot, Flemming [Show all 8 contributors for this article] (2021). Genetic predisposition in the 2′-5′A pathway in the development of type 1 diabetes: potential contribution to dysregulation of innate antiviral immunity. Diabetologia. ISSN 0012-186X. 64(8), p. 1805–1815. doi: 10.1007/s00125-021-05469-5. Full text in Research Archive
• Brusevold, Ingvild Johnsen; Kleivene, Karoline; Grimsøen, Benedikte & Skaare, Anne B (2021). Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit. European Archives of Paediatric Dentistry. ISSN 1818-6300. doi: 10.1007/s40368-021-00647-w. Full text in Research Archive Show summary

  Abstract Aim The aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment. Methods Twenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26. Results The age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1–6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled. Conclusion Extraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

• Nermo, Hege; Willumsen, Tiril; Rognmo, Kamilla; Thimm, Jens; Wang, Catharina Elisabeth Arfwedson & Johnsen, Jan-Are Kolset (2021). Dental anxiety and potentially traumatic events: a cross-sectional study based on the Tromsø Study—Tromsø 7. BMC Oral Health. 21. doi: 10.1186/s12903-021-01968-4. Full text in Research Archive Show summary

  Objective The objectives of the study were to describe the prevalence of dental anxiety and the possible associations between dental anxiety and potentially traumatic events in an adult population. Method The study is based on cross-sectional questionnaire data from the 7th wave of the Tromsø Study, a study of the adult general population in the municipality of Tromsø carried out in 2015–2016. The Modified Dental Anxiety Scale was used to measure dental anxiety across potentially traumatic events, oral health, dental attendance (avoidance) and current mental health symptoms (Hopkins Symptom Checklist). Individuals with high and low dental anxiety scores were compared to investigate differences in the distribution of potentially traumatic events, current mental health symptoms, avoidance, sex and oral health, and hierarchical multivariable regression was used to study the influence of traumatic events on dental anxiety. Results High dental anxiety was reported by 2.9% of the sample and was most prevalent among females and in the youngest age groups. Individuals with high dental anxiety reported more current mental health symptoms, and they were more likely to report poorer oral health and more irregular dental visits compared to individuals with no or lower dental anxiety scores. Concerning traumatic events, the reporting of painful or frightening dental treatment showed the biggest difference between those with high dental anxiety and low dental anxiety scores (a moderate effect). The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital and childhood neglect significantly predicted dental anxiety in the step they were entered in, but only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms. Conclusions The prevalence of high dental anxiety was lower than expected (2.9%), but dentally anxious individuals expressed a high burden of mental health symptoms, poor oral health and the avoidance of dental care. The regression analysis indicated that experiences with sexual abuse could affect dental anxiety levels in the absence of generalised symptoms of anxiety and depression.

• Høyvik, Ann Catrin; Willumsen, Tiril; Lie, Birgit & Hilden, Per Kristian (2021). The torture victim and the dentist: The social and material dynamics of trauma re-experi-encing triggered by dental visits. Journal on Rehabilitation of Torture Victims and Prevention of Torture. ISSN 1018-8185. 31(3), p. 70–83. doi: 10.7146/torture.v32i3.125290. Full text in Research Archive Show summary

  Introduction: The flow of refugees towards Europe over the past decade has placed increased demands on the health care services. A significant proportion of refugees have been subjected to torture involving their mouth or teeth, still the importance of oral health challenges is often overlooked or underestimated in the rehabilitation of torture victims. In this qualitative study, we set out to explore the processes that complicate torture victims’ ability to engage in and tolerate dental procedures.&#x0D; Methods: Ten resettled refugees with experience of torture were recruited among patients affiliated with specialized clinics for oral health rehabilitation in Norway. Data were collected through semi-structured exploratory interviews, and analyzed using a qualitative content analysis approach.&#x0D; Results and discussion: We present an exploration of what we have called the social and material anatomy of the triggering event; the process through which trauma-related reactions are produced in torture victims in the course of undergoing dental treatment. All professionals who work with torture survivors should be aware that these individuals often suffer from oral health problems that may affect both their physical and their psychological quality of life. However, although dental treatment is essential, it may still represent a major challenge. Our data suggest, we propose, that dental treatment often involves an experience being suspended, albeit temporarily, in an objectified position, acted on by subjects capable of producing deeply undesirable mental, emotional or bodily states. Three main categories emerged as the most prominent factors with such an agentic capacity: 1) pain, 2) traumatic memories and 3) the dentist. Submitting to dental treatment hence requires the patient’s willingness to give in to the actions of these factors, and avoiding treatment may therefore, in this situation, represent a means of retaining control.

• Rodriguez-Calvo, Teresa; Krogvold, Lars; Amirian, Natalie; Dahl-Jørgensen, Knut & Herrath, Matthias von (2021). One in Ten CD8+ Cells in the Pancreas of Living Individuals With Recent-Onset Type 1 Diabetes Recognizes the Preproinsulin Epitope PPI15-24. Diabetes. ISSN 0012-1797. 70(3), p. 752–758. doi: 10.2337/db20-0908. Full text in Research Archive
• Colli, Maikel L.; Ramos-Rodríguez, Mireia; Nakayasu, Ernesto S.; Alvelos, Maria I.; Lopes, Miguel & Hill, Jessica L.E. [Show all 22 contributors for this article] (2020). An integrated multi-omics approach identifies the landscape of interferon-α-mediated responses of human pancreatic beta cells. Nature Communications. 11:2584, p. 1–17. doi: 10.1038/s41467-020-16327-0. Full text in Research Archive
• Sæthre-Sundli, Helene Borghild; Wang, Nina Johanne & Wigen, Tove Irene (2020). Do enamel and dentine caries at 5 years of age predict caries development in newly erupted teeth? A prospective longitudinal study. Acta Odontologica Scandinavica. ISSN 0001-6357. 78(7), p. 509–514. doi: 10.1080/00016357.2020.1739330. Full text in Research Archive Show summary

  Objective: To explore caries development in children from 5 to 12 years of age, and to study whether enamel caries and dentine caries at 5 years of age could predict caries prevalence at 12 years of age, controlled for child characteristics. Methods: The study included 3282 children examined at 5 and 12 years of age. Data were collected by clinical examination and questionnaire. Enamel and dentine caries were registered at surface level. Data were tested by t-test and analysed by bi- and multivariate logistic regression. The study was ethically approved. Results: In 5-year-olds, 15% of the children had dentine caries experience and 21% had enamel caries. In 12-year-olds, 32% had dentine caries experience and 47% had enamel caries. Children with dentine caries experience at 5 years of age had at 12 years of age developed more surfaces with enamel caries (mean 2.8, SD 4.2) and dentine caries experience (mean 1.8, SD 2.5) than other children (p < .05). Dentine caries experience at 12 years of age was associated with having only enamel caries (OR 1.6, CI 1.2–2.0) and dentine caries experience (OR 3.2, CI 2.6–3.9) at 5 years of age. Family status and parental education were related to caries development. Conclusion: Children with caries in primary teeth continued to be caries risk children during the mixed dentition period. In addition to dentine caries experience, enamel caries in primary teeth was a predictor for caries development in young permanent teeth and may be used to improve the caries risk assessment.

• Nigi, Laura; Brusco, Noemi; Grieco, Giuseppina E.; Licata, Giada; Krogvold, Lars & Marselli, Lorella [Show all 13 contributors for this article] (2020). Pancreatic alpha-cells contribute together with beta-cells to CXCL10 expression in type 1 diabetes. Frontiers in Endocrinology. 11:630, p. 1–13. doi: 10.3389/fendo.2020.00630. Full text in Research Archive Show summary

  C-X-C Motif Chemokine Ligand 10 (CXCL10) is a pro-inflammatory chemokine specifically recognized by the ligand receptor CXCR3 which is mostly expressed in T-lymphocytes. Although CXCL10 expression and secretion have been widely associated to pancreatic islets both in non-obese diabetic (NOD) mice and in human type 1 diabetic (T1D) donors, the specific expression pattern among pancreatic endocrine cell subtypes has not been clarified yet. Therefore, the purpose of this study was to shed light on the pancreatic islet expression of CXCL10 in NOD, in C57Bl/6J and in NOD-SCID mice as well as in human T1D pancreata from new-onset T1D patients (DiViD study) compared to non-diabetic multiorgan donors from the INNODIA European Network for Pancreatic Organ Donors with Diabetes (EUnPOD). CXCL10 was expressed in pancreatic islets of normoglycaemic and new-onset diabetic NOD mice but not in C57Bl/6J and NOD-SCID mice. CXCL10 expression was increased in pancreatic islets of new-onset diabetic NOD mice compared to normoglycaemic NOD mice. In NOD mice, CXCL10 colocalized both with insulin and glucagon. Interestingly, CXCL10-glucagon colocalization rate was significantly increased in diabetic vs. normoglycaemic NOD mouse islets, indicating an increased expression of CXCL10 also in alpha-cells. CXCL10 was expressed in pancreatic islets of T1D patients but not in non-diabetic donors. The analysis of the expression pattern of CXCL10 in human T1D pancreata from DiViD study, revealed an increased colocalization rate with glucagon compared to insulin. Of note, CXCL10 was also expressed in alpha-cells residing in insulin-deficient islets (IDI), suggesting that CXCL10 expression in alpha cells is not driven by residual beta-cells and therefore may represent an independent phenomenon. In conclusion, we show that in T1D CXCL10 is expressed by alpha-cells both in NOD mice and in T1D patients, thus pointing to an additional novel role for alpha-cells in T1D pathogenesis and progression.

• Tvilde, Britt Nygard; Virtanen, Jorma; Bletsa, Athanasia; Graue, Anne Marit; Skaare, Anne & Skeie, Marit Slåttelid (2020). Dental erosive wear in primary teeth among five-year-olds–Bergen, Norway. Acta Odontologica Scandinavica. ISSN 0001-6357. p. 1–7. doi: 10.1080/00016357.2020.1791357. Full text in Research Archive Show summary

  Objective To estimate the prevalence of dental erosive wear among five-year-olds in Bergen, Norway, and to investigate associations between background factors and the condition. Methods A total of 387 children received a dental examination in five Public Dental Service clinics in Bergen, Norway. The parents responded to items about the children’s dental hygiene and drinking habits, type of beverage container, diet, and other habits, and about their own age, educational level and country of origin. We explored background variables for possible associations with the outcome status as worst affected by erosive wear (19.4%, n = 75). Chi-squared statistics and logistic regression (Odds Ratios (OR): 95% Confidence Intervals (CI), served as statistical tools). Results Approximately 80% showed erosive wear (by SEPRS and by adopted diagnostic instrument (78.5% vs 79.8%)). The condition affected maxillary anterior teeth in 13.9% (n = 54), and cuppings in molars in 79.3% (n = 307) of cases. Grinding teeth during the day and/or night (OR: 1.87, CI: 1.07–3.25) and male sex (OR: 1.76, CI: 1.05–2.96) significantly related to outcome status as worst affected by erosive wear, respectively. Conclusion Dental erosive wear was widespread. Grinding teeth and male sex associated with outcome status as worst affected by erosive wear.

• Skaare, Anne B; Szyszko, Ewa Alicja; Herlofson, Bente Brokstad & Søland, Tine Merete (2020). Orofacial granulomatosis: a questionnaire study among Norwegian dental clinicians. European Archives of Paediatric Dentistry. ISSN 1818-6300. 21(5), p. 557–564. doi: 10.1007/s40368-020-00511-3. Full text in Research Archive
• Russell, Mark A.; Redick, Sambra; Blodgett, David M.; Richardson, Sarah J.; Leete, Pia & Krogvold, Lars [Show all 20 contributors for this article] (2019). HLA class II antigen processing and presentation pathway components demonstrated by transcriptome and protein analyses of islet ?-cells from donors with type 1 diabetes. Diabetes. ISSN 0012-1797. 68(5), p. 988–1001. doi: 10.2337/db18-0686. Full text in Research Archive
• Kranstad, Vibeke; Søftestad, Siri; Fredriksen, Therese Varvin & Willumsen, Tiril (2019). Being considerate every step of the way: a qualitative study analysing trauma‐sensitive dental treatment for childhood sexual abuse survivors. European Journal of Oral Sciences. ISSN 0909-8836. 127(6), p. 539–546. doi: 10.1111/eos.12661. Full text in Research Archive Show summary

  This qualitative study aimed to obtain a deeper understanding of what makes adult dentistry possible for child sexual abuse survivors. Sixteen adult informants were recruited from four Centres against Sexual Abuse and interviewed. Qualitative analysis of the transcribed interviews was conducted consecutively until thematic saturation was reached at 16 informants. A conceptual framework was generated, and informants’ experiences of what makes dental treatment achievable were summed as the dentist working in a trauma‐sensitive way, captured by the core category: Being considerate every step of the way. The underlying categories are: (i) offering a good start; (ii) being competent; (iii) being aware of the influence of staff behaviour; (iv) building a safe relationship; (v) arranging a secure treatment situation; and (vi) exploring individual triggers. The findings revealed that dental staff should have adequate competence to build secure relationships and explore individual triggers in dental treatment situations when treating child sexual abuse survivors. Dentists should have a trauma‐sensitive approach to all patients. When treating child sexual abuse survivors, dentists should demonstrate utmost consideration every step of the way, building long‐term solid relationships, and discussing and testing coping strategies individually adapted to the specific needs of the child sexual abuse survivors, in a safe environment.

• Strøm, Kjetil; Skaare, Anne B & Willumsen, Tiril (2019). Dental anxiety in 18-year-old Norwegians in 1996 and 2016. Acta Odontologica Scandinavica. ISSN 0001-6357. 78, p. 13–19. doi: 10.1080/00016357.2019.1637933. Full text in Research Archive
• Uhlen, Marte-Mari Nordsetmoen; Valen, Håkon; Karlsen, Line Christin Schrøder; Skaare, Anne B; Bletsa, Athanasia & Ansteinsson, Vibeke [Show all 7 contributors for this article] (2019). Treatment decisions regarding caries and dental developmental defects in children - A questionnaire-based study among Norwegian dentists. BMC Oral Health. 19(1). doi: 10.1186/s12903-019-0744-2. Full text in Research Archive Show summary

  Background Current knowledge on treatment strategies and choice of restorative materials when treating deep caries or severe dental developmental defects (DDDs) in young individuals is scarce. Therefore, the aim was to investigate Norwegian dentists´ treatment decisions and reasons for treatment choice when treating deep caries in primary teeth and severe DDDs in permanent teeth in children. Methods A pre-coded questionnaire was sent electronically to all dentists employed in the Public Dental Service (PDS) in Norway (n = 1294). The clinicians were asked about their background characteristics and how often they registered DDDs. Three clinical cases were presented to the dentists and asked to prioritize treatment options and reasons for their choice. Results After three reminders, 45.8% of the dentists answered. Most clinicians were general practitioners (96.3%), females (77.9%), under 41 year-olds (59.4%), graduated in 2001 or later (61.1%), and representing all regions of Norway. The respondents registered molar incisor hypomineralisation (MIH), other DDDs and dental fluorosis (DF) frequently, 523 (91.1%), 257 (44.8%) and 158 (27.5%), respectively. In case 1a with severe dental caries in a primary molar, the preferred treatment was resin-modified glass ionomer cement (RMGIC) (58.3%), followed by glass ionomer cement (GIC) (17.9%) and zinc oxide-eugenol (ZOE) (13.2%). Extraction, compomer or stainless steel crowns (SSC) were preferred by 0.9, 0.7 and 0.4%, respectively. In case 1b, which was identical to case 1a, but treated under general anaesthesia, the preferred treatment alternatives were RMGIC (37.1%), resin composite (RC) (17.6%) and GIC (17.2%). Extraction and SSC were chosen by 15.1 and 7.2%, respectively. In case 2, showing a severely hypomineralised and symptomatic first permanent molar, the dentists preferred RC (38.4%), followed by RMGIC (26.6%) and GIC (19.0%). Extraction and SSC were chosen by 8.7 and 5.4%, respectively. The treatment choices were not significantly affected by the dentists’ background characteristics. The reasons for dentists’ treatment decisions varied for each patient case; patient cooperation, prognosis of the tooth and own experience were the dominant reasons. Conclusions A notable disparity in treatment choices was shown indicating that Norwegian dentists evaluate each case individually and base their decisions on what they consider best for the individual patient.

• Løken, Sonja Yr; Wigen, Tove Irene & Wang, Nina Johanne (2019). Recall intervals in children are individualized and extended. Acta Odontologica Scandinavica. ISSN 0001-6357. 77(6), p. 468–473. doi: 10.1080/00016357.2019.1599422. Full text in Research Archive Show summary

  Objective: The aim of this study was to follow attendance patterns longitudinally by exploring length of intervals between routine dental examinations in children at the ages of 5 and 12 years, and study associations between length of recall intervals and caries prevalence, controlled for gender, parent’s background and parent’s education. Materials and methods: The study included 2960 children in one Norwegian county monitored from 5 to 12 years of age. Data were collected at clinical examinations, from dental records and by parental questionnaires. Length of recall intervals was dichotomized into short (shorter than 18 months) and long (18 months and longer). Data were analysed and tested using Chi-square statistics, correlation coefficient and multivariate regression. The study was ethically approved. Results: Recall intervals were individualized and varied from 4 to 30 months. The most frequent used recall intervals were 12, 18, 20 and 24 months. A majority of children at both ages were given long recall intervals. Multivariate logistic regression showed that the probability of having short interval was higher in children having caries experience than in caries-free children at both 5 years (OR 12.6 CI 9.9–16.0) and 12 years (OR 2.7 CI 2.3–3.1). At 5 years of age, length of recall intervals was associated with parents’ background (OR 1.8 CI 1.4–2.4) and parents’ education (OR 1.3 CI 1.0–1.5). Conclusions: The results showed that routine intervals were individualized and extended, indicating that more resources were spent on children with the highest need of dental care, aiming at reducing health inequalities.

• Søftestad, Siri; Kranstad, Vibeke; Varvin, Therese & Willumsen, Tiril (2019). Invading Deeply into Self and Everyday Life: How Oral Health-Related Problems Affect the Lives of Child Sexual Abuse Survivors. Journal of Child Sexual Abuse. ISSN 1053-8712. doi: 10.1080/10538712.2019.1682096. Full text in Research Archive
• Rønneberg, Anne; Szyszko, Ewa Alicja; Bie, Thea Martine Granvoll; Willumsen, Tiril & Køpp, Unni Mette (2019). Klinisk rettsodontologiske undersøkelser ved Statens Barnehus - veier til tverrprofesjonell samhandling til barnets beste. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 129, p. 884–892. Full text in Research Archive
• Wigen, Tove Irene; Winsnes, Karianne Ervik; Varatharajan, Rahavy & Wang, Nina Johanne (2019). Helsesøstres erfaring med kariesforebyggende arbeid hos barn under 3 år. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 129(5), p. 432–440. Full text in Research Archive

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• Høyvik, Ann Catrin; Tønnesen, Espen Andreas & Willumsen, Tiril (2025). Oral helse hos flyktninger og asylsøkere: Status, utfordringer og tilrettelegging av tannbehandling ved psykologiske traumer. Aktuel Nordisk Odontologi. ISSN 1902-3545. doi: 10.18261/ano.50.1.3. Full text in Research Archive Show summary

  The influx of refugees to the Nordic countries entails an increasing need for oral health services to a population with more oral health challenges than the host population. Regardless of originating country, refugees present with high degree of caries, periodontitis, and tooth loss, followed by oral pain, infections and impaired oral health-related quality of life. Knowledge about prevention of oral health diseases varies, and information must therefore be culturally adjusted and translated to relevant languages. Psychologically traumatized refugees experience more oral health challenges and are more prone to dental anxiety. It is possible to help these refugees master the dental treatment situation provided the dental practitioner 1) acquires relevant trauma knowledge, 2) spends enough time /avoids signaling stress, 3) avoids surprising the patient with sudden triggers, and 4) provides overview of the consultation step by step.

• Maroufi, Sada; Milanovic, Blagica; Hove, Lene Hystad; Høyvik, Ann Catrin; Torgersen, Gerald R. & Fjeld, Katrine Gahre (2025). SimSamBot – Development of an AI-Based Training Robot Assisting Students in Communication with Dementia Patients. Full text in Research Archive Show summary

  Background The increasing prevalence of dementia presents unique challenges for dental professionals, particularly in communication and patient management. Effective communication is critical to providing compassionate, patient-centered care, yet dental students often lack the necessary training to interact confidently with dementia patients. Aims and Objectives This project aims to equip dental students with the skills and knowledge required to communicate effectively with dementia patients. Specific objectives include: 1 Developing a communication training module tailored to dementia care; 2 Enhancing students’ ability to recognize and adapt to the needs of patients with cognitive decline; and 3 Promoting empathy and understanding through experiential learning approaches. Materials and Methods A large language model (LLM) acting as communication robot is supplied with data on the patient groups it simulates. Information is collected through literature reviews and audio recordings of clinical consultations with dementia patients, with consent from the healthcare provider, patient and relatives if needed. Recordings are anonymized and transcribed immediately after consultations, with the original recordings subsequently deleted. Only anonymized data is used in the robot. Results While full implementation is forthcoming, anticipated outcomes include improved student confidence in communicating with dementia patients, enhanced empathy, and better preparedness for clinical practice. Discussion and Conclusion This initiative addresses a critical need in dental education by preparing students for the complexities of dementia care. By fostering effective communication skills, this project aligns with ADEEʼs vision of reimagining education to meet evolving societal needs. The outcomes will contribute to improved oral health care for dementia patients while advancing the pedagogical standards of dental education globally.

• Riksen, Elisabeth Aurstad & Rønneberg, Anne (2025). Smerteveilederen i ny utgave 2024. Full text in Research Archive
• Rønneberg, Anne & Strompedal, Linda Marie (2025). Med riktig behandling hjelper vi barn med tannegeskrekk Ved Tannhelsetjenestens kompetansesenter tannhelse Midt, har det over flere år blitt utviklet et systematisert program, kalt «Trygge barn i tannbehandling» - TBiT. Full text in Research Archive
• Rønneberg, Anne & Nordgarden, Hilde (2024). Snakk om etikk. Sykdom og skader i munnen: Er det mindre viktig? 134(8), p. 663–663. Full text in Research Archive
• Afzal, Sadaf Haque; Skaare, Anne B; Wigen, Tove Irene & Brusevold, Ingvild Johnsen (2024). Molar-incisor hypomineralization affects oral health-related quality of life in 8–9-year-old children. Full text in Research Archive
• Wigen, Tove Irene & Sogn, Ingunn Marie Frested (2024). Preservation of Pulp Vitality after Multiple Traumas Requiring Extensive and Long-lasting Treatment. Full text in Research Archive
• Wigen, Tove Irene & Wang, Nina Johanne (2024). Use of dental floss did not prevent interproximal caries increment in Norwegian teenagers. Full text in Research Archive
• Sapina, Sanja; Wigen, Tove Irene & Rønneberg, Anne (2024). Use of Conscious Sedation and General Anaesthesia for Dental Treatment - Dentists’ Attitudes and Practice. Full text in Research Archive
• Øvre, Ingrid Berget; Brelin, Jenny Alexandra; Nortvedt, Per; Fjeld, Katrine Gahre & Rønneberg, Anne (2024). Etiske problemstillinger i odontologistudiet - En tematisk analyse av odontologistudenters refleksjonsnotater. Full text in Research Archive
• Rønneberg, Anne; Wigen, Tove Irene; Strøm, Kjetil; Jacobsen, Arne Eldor Tvedt & Willumsen, Tiril (2023). Tannbehandling ved hjelp av lystgass-sedasjon. Aktuell Nordisk odontologi. ISSN 1902-3545. 48(1), p. 186–201. doi: 10.18261/ano.48.1.13. Full text in Research Archive Show summary

  Lystgass er svært egnet som sedasjonsmiddel ved tannbehandling til kooperative pasienter. Det kan titreres individuelt, effekten kommer raskt og kort etter avsluttet behandling er lystgassen ute av kroppen. Sedasjon med lystgass skal utføres i kombinasjon med psykologiske teknikker, med fokus på pasientmedvirkning, kontroll og god kommunikasjon samt adekvat smertekontroll. Lystgass demper uro, gir bløtvevsanalgesi og er et nyttig hjelpemiddel ved forebygging av angstinduserte opplevelser, behandling av pasienter med tannbehandlingsangst, brekninger og/eller ufrivillige muskelsammentrekninger samt for multimorbide pasienter med fare for legemiddelinterraksjoner ved bruk av benzodiazepiner. Følgelig er lystgass et utmerket verktøy i dagens odontologiske praksis med søkelys på smertefri tannbehandling samt forebygging og behandling av tannbehandlingsfrykt, -angst og -fobi.

• Afzal, Sadaf Haque; Wigen, Tove Irene; Skaare, Anne B & Brusevold, Ingvild Johnsen (2023). Molar incisor hypomineralization in Norwegian children: Distribution, severity and hypersensitivity. Full text in Research Archive
• Anjum, Faiza Sarwar; Brusevold, Ingvild Johnsen & Wigen, Tove Irene (2022). Prognosis of non-vital anterior teeth treated with apexification using bioceramic apical plug. Full text in Research Archive
• Afzal, Sadaf Haque; Wigen, Tove Irene; Skaare, Anne B & Brusevold, Ingvild Johnsen (2022). Molar Incisor Hypomineralization in Norwegian children: Prevalence and associated factors. Full text in Research Archive
• Rodd, Helen; Rønneberg, Anne; Fredriksen, Therese Varvin; Johnsen, Ingrid Berg & Marshman, Zoe (2022). Chap.9 Positive Encounters for Children to Prevent Dental Anxiety - Theory and Practice, Oral Health Psychology. Springer. ISSN 9783031042478. p. 129–146. Full text in Research Archive
• Rønneberg, Anne; Harris, Jenny; Fredriksen, Therese Varvin & Willumsen, Tiril (2022). Chap.10 Family violence and Child Maltreatment, Oral Health Psychology. Springer. ISSN 9783031042478. p. 147–164. Full text in Research Archive
• Neiden, Elen Ulseth Pedersen; Nordgarden, Hilde; Rønneberg, Anne & Bletsa, Athanasia (2022). Organtransplantert jente med Turnpenny-Fry syndrom: Utfordringer med tverrprofesjonell oppfølging. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 132(3), p. 256–261. doi: 10.56373/2022-3-6. Full text in Research Archive
• Neiden, Elen Ulseth Pedersen; Rønneberg, Anne; Bletsa, Athanasia & Nordgarden, Hilde (2022). Hvilke utfordringer møter mennesker med store og sammensatte helsebehov i tannhelsetjenesten? Samhandling og kommunikasjon i et livsløpsperspektiv. 132(3), p. 270–275. doi: 10.56373/2022-3-9. Full text in Research Archive
• Östenson, Pernilla Odile Malin; Clasen, Anne Beate Sønju & Wigen, Tove Irene (2022). Characteristics of patients in need of dental treatment under general anesthesia. Full text in Research Archive Show summary

  Dental treatment under general anesthesia (GA) is an option when conventional treatment cannot be accomplished due to un-cooperation and systemic or intellectual disabilities. Aim: The aim of this retrospective study was to describe characteristics of and dental treatment needs in patients referred for dental treatment under GA in the Public Dental Services in Oslo. Methods: All patients receiving dental treatment under GA in 2016 were included. Data was extracted from dental records and included: age, health conditions, reason for referral, recorded symptoms, dmft/DMFT and received treatment. Data was analyzed using SPSS. The study was performed as part of quality assurance system required by law in the dental services, and did not require ethical approval. Anonymized data was recorded. Results: In total 173 patients aged 2-71 years were included. Half, 95 patients (55%), were children and adolescents. The majority, 141 patients (82%), had one or more medical disorders, whereas 32 patients (18%) were medically healthy. The most common medical disorder was intellectual disability followed by epilepsy, autism spectrum disorder (ASD), genetic syndromes and cerebral palsy. Sixteen genetic syndromes were registered; Downs syndrome was most common. Barriers for conventional treatment were dental behavior management problems, anxiety, immaturity, spasm and gagging. The most frequent dental reason for referral was caries (97 patients (56%)). In 55 patients (32%), patients or caregivers reported oral symptoms. Mean dmft for preschool children (≤5 years) was 8.5 (SD 5.9), for children and adolescents 3.1 (SD 3.3) and for adults (>18 years) 12.5 (SD 11.9). Restorative treatment was performed in 141 patients (82%) and extractions in 107 (62%). Other dental treatments were endodontic, periodontal, prosthodontic, surgical, orthodontic and prophylactic treatments. Conclusion: Treatment in GA was received by a heterogenic group with varied and extensive treatment needs. The majority of patients treated under GA had intellectual disability.

• Hofmann, Bjørn Morten & Hauge, Mariann Saanum (2022). Hvordan unngå at moralske mistak følger faglige feil? Full text in Research Archive
• Brusevold, Ingvild Johnsen; Wigen, Tove Irene; Afzal, Sadaf Haque & Skaare, Anne B (2021). Hvorfor får barn emaljefeil? Aktuell Nordisk odontologi. ISSN 1902-3545. 46(1), p. 148–161. Full text in Research Archive Show summary

  Emaljefeil kan ses som lokale eller generelle misfarginger, såkaltekvalitative defekter, eller somkvantitative defekterhvor emaljener generelt tynn, manglende eller har furer, groper og ujevnstruktur. Årsaker kan være lokale påvirkninger, generellepåvirkninger eller genetiske endringer. Lokale påvirkninger somtanntraumer i melketannsettet gir ofte emaljefeil i det permanentetannsettet. Generelle påvirkninger som alvorlig sykdom undertanndannelsen, D-vitaminmangel og forgiftninger kan gi uliketyper emaljefeil. Mutasjoner i spesifikke emaljegener eller andregener som bidrar i embryogenese kan gi utviklingsforstyrrelser itannemalje. Mange emaljefeil av typen MIH kan ikke forklares ved noen av de nevnte faktorene, og det forskes på andre hittil ukjenteårsaksfaktorer.

• Skaare, Anne B; Herlofson, Bente Brokstad & Søland, Tine Merete (2020). Orofacial granulomatose og Crohns sykdom – et klinisk kasus og en litteraturgjennomgang. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 130(11), p. 914–920. Full text in Research Archive
• Høyvik, Ann Catrin; Weie, Ingrid Volden; Tveter, Karianne & Willumsen, Tiril (2019). Are dentists familiar with the rights of torture survivors? Full text in Research Archive
• Strøm, Kjetil; Willumsen, Tiril & Rønneberg, Anne (2019). Trenger tannleger utdanning i odontologisk psykologi? Aktuell Nordisk odontologi. ISSN 1902-3545. 44, p. 34–46. doi: 10.18261/ISSN.2058-7538-2019-01-04. Full text in Research Archive
• Børsting, Torunn; Schuller, Annemarie; Dommelen, Paula van; Stafne, Signe Nilssen; Skeie, Marit Slåttelid & Skaare, Anne B [Show all 13 contributors for this article] (2019). Associations between maternal vitamin D status in second and third trimester of pregnancy and offspring enamel hypomineralisation at 7-9 years: a longitudinal study. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 28. Full text in Research Archive
• Aardal, Vilde Eika & Willumsen, Tiril (2026). The Complexity of Dental Anxiety: Exploring Variables Associated with Oral Health-Related Quality of Life, Abuse, and Psychological, Somatic, and Dental Health. Universitetet i Oslo. ISSN 9788283271089. Full text in Research Archive Show summary

  Denne avhandlingen undersøker kjennetegn ved pasienter med alvorlig tannbehandlingsangst. Siden tannhelsepersonell ofte møter denne pasientgruppen, er kunnskap om deres utfordringer viktig for klinisk praksis. Avhandlingen består av tre studier som utforsker ulike aspekter ved alvorlig tannbehandlingsangst. Den første studien undersøkte oral helserelatert livskvalitet og faktorer som påvirker denne. Den andre studien sammenlignet personer med tannbehandlingsangst som rapporterte å ha vært utsatt for overgrep, med personer som ikke rapporterte overgrep. Den tredje studien beskrev pasienter som hadde behov for tannbehandling i narkose. På tvers av studiene hadde deltakerne høy grad av både tannbehandlingsangst og generell angst, samtidig som de rapporterte at deres orale helse hadde en sterk negativ påvirkning på hverdagen, altså dårlig oral helserelatert livskvalitet. Faktorer som var forbundet med dårligere oral helserelatert livskvalitet, var tannbehandlingsangst, alder, tid siden siste tannlegebesøk og grad av generelle angstsymptomer. Sammenlignet med personer uten rapportert overgrepserfaring hadde de som rapporterte overgrep mer uttalte generelle angstsymptomer, dårligere oral helserelatert livskvalitet og høyere grad av angst knyttet til tap av kontroll og følelsen av skam. Blant pasienter med alvorlig tannbehandlingsangst som trengte tannbehandling i narkose, ble det funnet svært dårlig tannstatus, høy forekomst av psykiske og somatiske helseutfordringer samt hyppig bruk av legemidler. Psykiske lidelser og somatiske helseutfordringer var vanligere blant dem som rapporterte overgrepserfaringer enn blant dem som ikke gjorde det. Dette understreker behovet for tilpassede behandlingstilbud. Tannbehandlingsangst opptrer altså ofte sammen med redusert oral helserelatert livskvalitet og betydelige psykiske og somatiske helsebelastninger, særlig hos personer som har opplevd overgrep. For noen pasienter er tilgang til tannbehandling i narkose nødvendig for å kunne behandle alvorlige tannproblemer som ellers ikke lar seg håndtere. Samlet sett viser resultatene at tannbehandlingsangst er et komplekst og sammensatt fenomen som tannhelsepersonell bør ha kjennskap til.

• Breivik, Anne; Khan, Qalbi; Stein, Linda; Mulic, Aida Gacic & Kopperud, Simen E. (2025). Prevention of root caries among elderly in Norway. Universitetet i Innlandet. ISSN 9788283805512. Full text in Research Archive Show summary

  Fremskritt innen medisin og odontologi har ført til en betydelig forbedring av den generelle og orale helsen i befolkningen, som gjør at levealderen har økt og at flere beholder sine naturlige tenner inn i alderdommen. Karies, og spesielt rotkaries, er en stor utfordring i denne aldersgruppen i tannhelsetjenesten. Det overordnede målet for avhandlingen er derfor å øke kunnskap om forebygging av rotkaries blant eldre i Norge, noe som er avgjørende for å kunne forbedre og planlegge fremtidens ressursbehov i tannhelsetjenesten. Et laboratorieeksperiment og to tverrsnittstudier ble gjennomført. Laboratorieeksperimentet fant sted på Nordisk Institutt for Odontologiske Materialer (NIOM). Formålet i denne studien var å kvantitativt evaluere Streptococcus Mutans biofilm akkumulering på human emalje og rotoverflater, samt vurdere mengden av biofilm som ble fjernet ved bruk av (1) eksperimentell tannkrem og (2) vann, i et lukket system i flow chamber. I den første tverrsnittstudien benyttet vi oss av data fra Tromsø7 undersøkelsen, hvor 1075 deltakere over 65 år ble inkludert. Studien hadde som formål å undersøke hvilke risikoindikatorer som var assosiert med rotkaries hos eldre over 65 år. Et sekundært formål var å undersøke hvorvidt rotkaries var assosiert med oral helse-relatert livskvalitet (OHRQoL). I den andre tverrsnittstudien ble det gjennomført en nettbasert spørreundersøkelse blant 365 tannpleiere i offentlig og privat sektor, hvor formålet var å øke kunnskap om hvilke forebyggende tiltak som ble utført blant eldre over 65 år, med spesielt søkelys på forebyggelse av rotkaries. Et sekundært formål var å undersøke forskjeller og utfordringer i det forebyggende arbeidet. Laboratoriestudien (Paper I) viste at mindre biofilm ble fjernet fra rotoverflatene sammenlignet med emalje. I dataen fra Tromsøundersøkelsen (Paper II) fant vi at menn og røykere hadde høyere risiko for å utvikle rotkaries. Vi fant også at rotkaries var signifikant assosiert med oral helse-relatert livskvalitet. Resultatene fra spørreundersøkelsen (Paper III) viste at tannpleierne utførte en rekke forebyggende tiltak for eldre, selv om det opplevdes som krevende. Avhandlingen understreker betydningen av forebygging av rotkaries blant eldre og indikerer et behov for mer ressurser og økt prioritering av forebyggende strategier i tannhelsetjenesten som samsvarer med tannhelsebehovene til den aldrende befolkningen i Norge. Forskningen adresserer omfattende og viktig informasjon som bør tas i betraktning av tannhelsepersonell og beslutningstakere i det forebyggende arbeidet for denne gruppen.

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