Adult Swedish Population Research Articles

Risk of severe periodontal disease in a Swedish adult population. A cross-sectional study.

In this study, potential risk factors for severe periodontal disease were identified in a cross-sectional sample from the county of Jonkoping, Sweden. 547 adults 20-70 years of age were categorised clinically and radiographically by level of periodontal disease experience. These levels were used to divide the sample into groups--individuals without any reduction in periodontal bone level (60%) and those with severe periodontal bone loss (13%)--which were then used in univariate and multivariate logistic regression analyses as dependent variable. Demographic, socio-economic, general health, smoking habits, clinical, and dental care variables were used in the different regression analyses. In the univariate model, age (20-70 years) was found to be correlated with more severe periodontal disease experience (odds ratio: 1.13; 95% CI: 1.10-1.17). The association with periodontal disease was more pronounced for the older age groups (50, 60, and 70 years). A negative financial situation was also related to severe periodontal bone loss when regressed univariately (odds ratio 2.20 [95%: 1.04-4.68]). Moderate-heavy smoking (> or =10 cigarettes/day) appeared to be associated with severe periodontal destruction with an odds ratio of 9.78 (95% CI: 3.62-36.42). Of the clinical variables in the univariate model, higher mean levels of supragingival dental plaque and the presence of subgingival calculus were related to more severe periodontal disease with odds ratios of 1.02 (95%: 1.01-1.03) and 2.96 (95%: 1.50-5.88), respectively. When the same variables were regressed multivariately, age (continuous) (odds ratio 1.17 [95% CI: 1.12-1.22]), moderate-heavy smoking (odds ratio 11.84 [95% CI: 4.19-33.50]), and higher mean levels of plaque (odds ratio 1.02 [95% CI: 1.00-1.03]) remained significant. Light smoking (1-9 cigarettes/day) was not significantly associated with severe periodontal disease in the 2 regression models. The present study demonstrated that smoking, greater age, and higher mean levels of plaque are potential risk factors for severe periodontal disease in this specific population.

Immunity in the Swedish population: diphtheria, tetanus and poliomyelitis.

Large-scale vaccination programmes have been carried out for a long time in Sweden, as in many other countries. However, often little is known of the effects of these vaccinations. During 1990 and 1991 a survey of immunity based on a random adult population sample was carried out. The main purpose was to estimate the level of immunity to diphtheria, tetanus and polio of the adult population in Sweden. In total 4800 people were randomly selected according to a stratified, two-stage, sampling plan. Based on standard sampling theory, methods for calculations of estimates and confidence intervals of the proportion of the population that is immune are given. The response patterns and its possible effects on the estimates are discussed. In total, 70.6% of the 4800 selected gave a blood sample. The response rate differs for men and women and for different age groups. Among the oldest, the response rate was close to 80%, but it was only about 60% among the youngest. With the survey design used, it was possible to obtain a sufficient degree of response. Our experience is that the response rate depends to a large extent on the efforts made to explain and motivate participation.

Immunity to tetanus, diphtheria and poliomyelitis in the adult population of Sweden in 1991.

During 1990 and 1991 a survey of immunity was carried out in Sweden. The main purpose was to estimate the level of immunity to diphtheria, tetanus and polio in the adult population. In total, 4800 people, randomly selected according to a stratified, two-stage, sampling plan, were contacted and asked to contribute a blood sample. Of those selected, 70.6% gave a blood sample. Estimates and confidence intervals of the proportion of the population with antibodies exceeding some titre was calculated. The population was divided according to sex, year of birth (five age groups) and residence (four regions). In age groups that were born after the introduction of childhood vaccination, > or =90% and 75-90% of people have demonstrable antibodies at a protective level against tetanus and diphtheria respectively. Those born earlier, especially women, are poorly protected with less than 50% having protective antibody levels for both tetanus and diphtheria. Differences between men and women were particularly seen in the age groups born between 1930 and 1950. Less than 5% of the Swedish population lacked the protective level antibodies against polio types 1, 2 and 3 respectively. Vaccination against tetanus, which can be combined with vaccination against diphtheria, can be recommended especially to women born before 1950 and with no documented previous vaccination. The same recommendation can be given for men born before the 1930s. As regards poliomyelitis, general booster vaccination of the adult population does not appear to be necessary at present.

Prevalence of antibodies to hepatitis E virus among hemodialysis patients in Sweden.

In order to study the prevalence of antibody to hepatitis E virus (HEV) among hemodialysis patients and to evaluate whether chronic hemodialysis is associated with an increased risk of exposure to HEV in developed countries, the IgG anti-HEV was determined in serum samples obtained from 182 patients on chronic hemodialysis and 349 statistically selected, healthy Swedish control subjects. Serum specimens from 11 of the 182 (6.0%) hemodialysis patients and from 18 of the 349 (5.2%) control subjects were repeatedly positive for HEV antibodies (the difference was not significant: P = .67). Analysis of serial serum samples obtained at the initiation of hemodialysis and consecutively during follow-up periods of several years demonstrated no IgG anti-HEV seroconversion during chronic hemodialysis. The seroprevalence of anti-HEV antibody in the adult Swedish population was associated significantly with age. In persons younger than 40 years, the percentage of seropositive individuals was 2.5%, whereas the seroprevalence rate of anti-HEV was 7.4% in subjects older than 40 years (P < .05). This study indicates that nosocomial transmission of HEV to patients on maintenance hemodialysis was non-existent in three dialysis centers in Sweden (a developed country) and that chronic hemodialysis is not associated with an increased risk of exposure to HEV infection in this region.

The prevalence of hepatitis B in Sweden; a statistical serosurvey of 3381 Swedish inhabitants.

The prevalence of hepatitis B virus markers in the adult Swedish population was investigated according to age, sex, origin and demographic stratum. Sera were collected from 3382 persons in 1990-1. The sera were selected on a statistical basis considered to be representative of the Swedish population from adults aged > or = 18 years. Two of the sera (0.06%) were found to be hepatitis B surface antigen positive. The two hepatitis B carriers were of non-Scandinavian origin as were (8.9%) of those tested. A total of 90 persons had a marker of previous, hepatitis B virus infection, i.e. antibodies against hepatitis B core antigen. Of these, 66 (2.0%) were of Scandinavian origin and 24 (18.1%) from highly endemic areas. The overall hepatitis B virus marker prevalence was 2.7%. The highest age-specific prevalence of hepatitis B markers in those of Scandinavian origin was in those born in 1939 and earlier. In this age-group, women had a significantly higher prevalence (3.6%) than males (1.9%). The lowest prevalence was found in those born in 1970 and later. No significant, age-related differences between younger or older persons, or between men and women, could be found in persons of non-Scandinavian origin. The results showed significant differences in exposure to hepatitis B virus among the indigenous population, compared with those of non-Scandinavian extraction. The results do not support the proposal to include hepatitis B vaccination in the Swedish immunization schedule.

Prevalence of perceived symptoms of dry mouth in an adult Swedish population--relation to age, sex and pharmacotherapy.

The aim of the study was to evaluate the prevalence of subjective perception of dry mouth in an adult population and to determine the prevalence of pharmacotherapy in this population. An additional aim was to assess a possible co-morbidity between symptoms of dry mouth and continuing pharmacotherapy. Four-thousand-two-hundred persons were selected at random from the national census register of the adult population of the southern part of the province of Halland, Sweden. The sample was stratified according to age and sex, and 300 men and an equal number of women aged 20, 30, 40, 50, 60, 70 and 80, were included. A newly developed questionnaire was mailed to each individual. In addition to questions about subjective perception of dry mouth, the subjects were asked to report on present diseases and continuing pharmacotherapy. Three-thousand-three-hundred and thirteen (80.5%) evaluable questionnaires were returned. The estimated prevalence of xerostomia in the population was 21.3% and 27.3% for men and women, respectively. This difference between the sexes was statistically significant. In non-medicated subjects, women tended to report a higher prevalence of xerostomia compared with men, 18.8% vs. 14.6%, and also among medicated subjects the estimated prevalence of dry mouth was higher for women than for men, 32.5% vs. 28.4%. There was a strong association between xerostomia and increasing age and also between xerostomia and continuing pharmacotherapy. The average prevalence of dry mouth among medicated and non-medicated subjects was 32.1% and 16.9%, respectively, the difference being statistically significant. There was also a strong association between xerostomia and the number of medications. In a logistic regression, the probability of reporting mouth dryness was significantly greater in older subjects and in women, and the probability increased with the number of medications taken. In conclusion, this epidemiological survey of an adult population has demonstrated that women, independent of age, do report a higher prevalence of xerostomia than men and that the symptom of dry mouth is strongly associated with age and pharmacotherapy. It is, however, not possible to discriminate between disease and pharmacotherapy as causal factors.

Hepatitis A immunity in the Swedish population. A study of the prevalence of markers in the Swedish population.

After a 20-year interval, the prevalence of seroimmunity to Hepatitis A (HA) was again investigated in a statistical sample of the adult Swedish population. Sera from 3382 of the 4800 originally selected persons were tested. The prevalence of antibodies to HA had not changed since the 1960s when only the Scandinavian population was considered. In the oldest population born at the beginning of this century, the presence of antibodies amounted to 69%. It gradually declined to 6% in those born in the 1940s. In the population born after 1950, the percentage of seropositive individuals was only 2%. A slightly higher prevalence was seen in the big cities, compared with the rural areas (13% vs 9%). Persons of non-Scandinavian origin showed a different pattern. Those from other European countries showed a prevalence of about 70% in all the age-groups investigated. Among the young adults of Arabic or Asiatic origin, the figure was > 90%. The conclusion is that the native Swedish population has a low natural exposure to HA, which has not changed during the last 20 years. Prophylaxis before going to countries where the disease is endemic is strongly recommended.

Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions.

To investigate the possible influence of attendance at cultural events, reading books or periodicals, making music or singing in a choir as determinants for survival. A simple random sample was drawn of 15,198 individuals aged 16-74 years. Of these, 85% (12,982) were interviewed by trained non-medical interviewers between 1982 and 1983 about cultural activities. They were followed up with respect to survival until 31 December 1991. Swedish interview survey of living conditions comprising a random sample of the adult Swedish population. 12,675 people interviewed between 1982 and 1983. Survival of subjects after controlling for eight confounding variables: age, sex, education level, income, long term disease, social network, smoking, and physical exercise. 6,301 men and 6,374 women were followed up; 533 men and 314 women died during this period. The control variables influenced survival in the expected directions except for social network for men; a significant negative effective was found when the analysis was made separately for men and women. We found an influence on mortality when the eight control variables were controlled for in people who rarely attended events compared with those attending most often, the relative risk being 1.57 (95% confidence interval 1.18 to 2.09). Attendance at cultural events may have a positive influence on survival. Long term follow up of large samples with confounders that are well controlled for and with the cultural stimulation more highly specified should be used to try to falsify the hypothesis before experiments start.

Prevalence of some oral complaints and their relation to oral health variables in an adult Swedish population.

The aim of the study was to determine, in a randomly selected 20- to 70-year-old Swedish population, the prevalence of oral burning sensations and taste disturbances and their possible correlation to salivary factors, the presence of mandibular dysfunction, the prevalence of teeth, restorative procedures, caries and periodontal disease, and smoking habits. Of a total of 533 dentate individuals, 112 reported a total of 139 symptoms. Eleven of the 40 edentulous individuals reported a total of 14 symptoms. Burning sensations were reported by 18 (3.4%) of the dentate and 1 (2.5%) of the edentulous individuals. The symptoms of pricking and burning were significantly correlated to mandibular dysfunction and negatively correlated to the number of teeth. The symptom of bad taste was correlated to the number of amalgam-filled surfaces and to cigarette smoking. No other statistically significant correlation could be found.

Prognosis of and factors associated with dental status in the adult Swedish population, 1975-1989.

The aim was to describe changes in dental status in the Swedish population during the period 1975-89 and to make a prognosis based on these data for the year 2000. This study is based on investigations of the living conditions in 1975, 1977, 1980/81 and 1988/89 performed by The National Central Bureau of Statistics. The samples varied for each year from 11,500 to 15,000 participants and a response rate from 80 to 86%. The odontological questions of the interview were focused on dental status, utilization of dental services and chewing ability. The prevalence of edentulism in age group 16-74 yr decreased from 15% in 1975 to 6% in 1988/89. In 1988/89 19% of the 65-74-yr-old inhabitants of the big cities were edentulous and 45% in rural populations, indicating a 15-20-yr delay of the development in rural areas. The prognosis for the year 2000 indicates a further decrease of edentulism to 3-4% in age groups 45-64 yr and in age 75-84 yr more than 60% will be dentate. As a consequence of the reduction in edentulism and changes in populations the number of dentate inhabitants in age group 25-74 yr increased by about 800,000 from 1975 to 1989 and a further increase of 400,000 will occur up to the year 2000. The consequences of these changes for the dental care services are discussed.

Effects of smoking and physical activity on body weight: developments in Sweden between 1980 and 1989

To study the effects of changes in smoking and exercise habits on body weighty in Sweden. Analysis of factors affecting relative body weight by construction of regression equations using two models: one adjusted for age, education, socioeconomic group, geographical region and nationality, the other further adjusted for cigarette smoking and leisure-time physical activity. Cross-sectional interview data derived from the Undersökning om LevnadsFŏrhållanden' (Living Conditions) survey 1980-81 and 1989-89. Nationally representative samples of Swedish men and women aged 16-84. Changes in body-mass index (BMI) in Sweden during the 1980s. Using the first model, an increase in the BMI of 0.23 kg/m2 in men and 0.17 kg/m2 in women, from 1980 to 1989, was found. When controlling for smoking and physical activity, these values were 0.20 and 0.18 kg/m2, respectively. (P at least < 0.003). These findings indicate that the reported decrease in smoking and changes in physical activity during the 1980s only marginally explain the BMI increase in the adult Swedish population. The health programmes launched during the 1980s seem to have little beneficial effects on body-weight development, in particular in younger generations of both sexes.

Periodontal status in an urban adult population in Sweden

The purpose was to describe the current periodontal status in a Swedish urban population aged 31-40 yr. 1681 individuals, 840 men and 841 women, participated in the study. 68.5% of the subjects had low amount of plaque, 82.8% low level of calculus and 28.9% healthy gingiva or mild gingivitis. 82.8% of the subjects had no pockets with probing depth (PD) > or = 5 mm. 4.9% of the subjects had one tooth with PD > or = 5 mm, 6.7% 2-5 teeth, 2.4% 6-9 teeth and 3.2% > or = 10 teeth with pockets. 55.8% of the subjects had no missing teeth, third molars excluded. 16.5% had one tooth missing, 23.8% 2-5 teeth, 2.7% 6-9 teeth and 1.2% > or = 10 teeth. 8.6% of the subjects had at least one front tooth missing, 28.7% one premolar and 24.1% one molar missing. Men had significantly higher scores than women for plaque (DI-S), calculus (CI-S), gingivitis (GI-M), and number and percent of remaining teeth with PD > or = 5 mm. Smokers had significantly higher scores than non-smokers for DI-S, CI-S, GI-M, number and percent of remaining teeth with PD > or = 5 mm, and number of missing teeth. The individuals who visited the dentist every year had better oral hygiene and gingival status than those who attended for > 3 yr. The multiple regression analysis showed that calculus (P = 0.0001) smoking (P = 0.001), and dental visits (P = 0.0284) were significantly correlated to the number of teeth with PD > or = 5 mm.

The epidemiology of abdominal symptoms: prevalence and demographic characteristics in a Swedish adult population. A report from the Abdominal Symptom Study.

The prevalence of abdominal symptoms was studied by means of a postal questionnaire sent to a representative sample (n = 1290) of the adult population of a Swedish municipality. The subjects were asked about the occurrence of 35 abdominal symptoms during the preceding 3 months. The participation rate was 89.6%, and 54.3% of the responders reported at least one discomforting abdominal symptom. The overall prevalence rate was significantly higher in women than in men, and the highest rate (75%) was found among young women. The average number of symptoms per individual was also significantly higher in women. The overall prevalence rate in women decreased significantly with age, irrespective of menopause. The prevalence of most individual symptoms decreased with age and/or was higher in women. However, the prevalence of symptoms indicative of gastro-oesophageal reflux disease did not vary with age or sex. The prevalence of symptoms usually regarded as ominous did not increase with age; in some instances it even decreased. With the exception of reflux symptoms and night pain, the apparent disappearance with increasing age implies that most of the complaints are of functional origin.

Endodontic status of mandibular premolars and molars in Swedish adults. A repeated cross‐sectional study in 1974 and in 1985

Abstract The purpose of the study was to find out whether the prevalence of endodontically treated teeth and teeth with apical periodontitis, as observed in the mandibular premolar and molar region., was lower in 1985 compared with 1974 in the adult Swedish population. Another purpose was to determine whether the technical quality of the root fillings had improved between 1974 and 1985. The material examined consisted of periapical radiographs of the mandibular premolar and molar region in 861 of 1;502 people sampled in 1974 and in 586 of 726 people sampled in 1985 both representing an adult Swedish population. The observations in this study of the prevalence of endodontically treated teeth and teeth with apical periodontitis in 1985 and in 1974 indicated a markedly improved endodontic health in the adult Swedish population in the age‐groups under 40 years in 1985 compared with 1974. These findings were in line with observations on the number of intact and restored teeth in the same cross‐sectional samples. Another finding was an improved technical quality of the root fillings in 1985 compared with in 1974. Favourable periapical conditions were observed in teeth with adequately obturated root canals in 1985 as well as in 1974.

Need and demand for orthodontic treatment in an adult Swedish population.

The prevalence of malocclusion, the need for and the demand for orthodontic treatment was studied in a randomly selected adult Swedish population > or = 20 years of age. Nine-hundred-and-twenty subjects were examined of whom 669 had their own teeth in occlusion. From those a group of 157 subjects was selected on the basis of objective need and/or subjective demand for orthodontic treatment. The various regimens of treatment required in this group were investigated. The prevalence of malocclusion ranged from 17 to 53 per cent in the various age groups. The spectrum of malocclusion was similar to that previously reported in Swedish children. The awareness of their malocclusion was higher among younger than older subjects and among those who had severe malocclusion. Objective treatment need, evaluated by two experienced orthodontists, was estimated at 11 per cent of the total population, whilst orthodontic treatment was requested by approximately 5 per cent of the population studied.

Differential diagnosis and treatment of psychogenic voice disorder.

Forty consecutive patients with psychogenic voice disorder were studied prospectively to shed light on some problems of differential diagnosis met by the otolaryngologist. The females (n = 35) were on average younger than males (n = 5) (mean age 34.5 vs 51.8 years, respectively). Although an upper respiratory tract infection preceding the voice disorder was reported by no more than 25% of the patients, as many as 40% had been treated with antibiotics on one or more occasions. Other treatment and voice rest had been prescribed to a further 20% of the patients. The frequency rate of reported asthma/allergy-like symptoms (37.5) exceeded the incidence of asthma/allergy in the normal Swedish adult population. Minor laryngeal abnormalities found in 10 patients could be rejected as causative since they were inconsistent with the voice disturbance. In most of the patients (n = 27), vocal function returned to normal or improved after voice therapy combined with counselling. Vocal abnormalities remained unchanged in three patients. The patients who required multiple therapy sessions (n = 10) were older (mean age 48.8 years) and seemed to have more profound personal problems than the average. The findings suggest that psychogenic voice disorder may often be misdiagnosed as acute laryngitis or asthma/allergy. Restricted use of antibiotics and other drugs is to be recommended in the treatment of benign voice disorders.

Follow‐up study of endodontic status in an adult Swedish population

The purpose of this study was to examine changes in the endodontic status of selected teeth in a population over time, in order to get a long-term perspective of endodontically treated teeth. A random sample of the adult Swedish population was selected in 1974 and offered a clinical and radiographic examination. Eleven years later 351 of the selected persons attended a follow-up examination (1985). In radiographs, covering the mandibular premolar and molar regions, the status of 1974 was directly compared, tooth by tooth, with the status of 1985. The results showed that a number of endodontically treated teeth with an apical periodontitis healed during the observation period. During the same period, approximately the same number of endodontically treated teeth presented with a new apical periodontitis. This finding suggested that cross-sectional studies could provide reliable information on the long-term success rate of endodontic treatment at the population level. The periapical lesions that persisted or developed during the observation period were strongly related to incomplete root canal obturation, which is in agreement with observations in follow-up studies from teaching and specialist clinics.

Cohort comparisons of dental status in the adult Swedish population between 1975 and 1981

The aim was to describe and analyze changes in dental status in Sweden over a 6-yr period, and to establish a baseline for a subsequent investigation. Representative samples of the Swedish population in 1975, 1977, and 1981 were investigated by means of interviews. The participation rate varied between 81 and 86% and the number of participants between 11,582 and 14,964. Dental status, based on a question about natural teeth and/or removable denture(s), was analyzed in relation to demographic, socio-economic, social support and life style factors. The prevalence of edentulism in the age group 16-74 years decreased during the observation period from 12.7% to 9.9% in men and from 15.5% to 11.2 in women. Besides age, urbanization, occupation and tobacco smoking had the highest explanatory value for edentulism. The findings are discussed with respect to the increasing life expectancy and possible changes in the need and demand for dental care.

Marginal alveolar bone height in an adult Swedish population

The purpose of the present cross-sectional epidemiologic study was to assess the interproximal alveolar bone level within the dentition of 732 randomly selected adult individuals, stratified according to gender and age. Full mouth series of periapical radiographs were used for the assessments of the relation alveolar bone height/root length (B/R). A computer/digitizer recording method was utilized for the assessments. The results were presented as (i) mean values per age group and gender, (ii) mean frequency of subjects with sites exceeding certain thresholds of bone loss and (iii) cumulative frequencies of subjects with various number and percentual proportion of sites in relation to different B/R-ratio intervals. The results showed a reduction in mean alveolar bone/root ratio with age. The women had a significantly more favourable mean B/R-ratio than men in the ages above 40 years; the women had, however, more missing sites above age 60 years. By older age, there was observed an increased variation between individual mean B/R-ratios. Only a few subjects had a mean B/R-ratio less than or equal to 50%. A subfraction of the subjects in the different age groups had greater than 20% of their sites below a B/R-ratio of 60%. This fraction increased with age.

Mutans Streptococci, Oral Hygiene, and Caries in an Adult Swedish Population

The objective of the present study was to describe the distribution of salivary mutans streptococci in a randomly selected adult population and to relate the distribution to the prevalence of caries. The aim was also to study the association between caries and different levels of oral hygiene (OH). The results were based on the assessment of caries, dental plaque, and concentration of salivary mutans streptococci in 914 subjects who represented 95% of an age- and gender-stratified population sample of 967 individuals, randomly selected from the total adult population living in Alvsborg County, Sweden. The results showed that the distribution of mutans streptococci among dentate adults not wearing any kind of removable denture(s) was similar to that previously reported from studies on Swedish schoolchildren, while a comparably higher proportion of subjects with high levels of mutans streptococci was found among the dentate individuals wearing some kind of removable denture(s). Even higher proportions were found among edentulous individuals with complete denture(s). There was a correlation between mutans streptococci concentration in saliva and caries. The subjects with lower concentrations showed a significantly lower mean number of decayed surfaces, compared with the individuals with higher concentrations of mutans streptococci in their saliva. The median OH standard was lower in the older age groups, and there was a higher ratio of decayed surfaces per remaining tooth in those age groups, in comparison with the younger groups. However, for individuals without mutans streptococci, no relation between OH standard and caries could be found and, regardless of OH standard, higher numbers of decayed surfaces were found with an increasing concentration of mutans streptococci in saliva.