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Divaris K, Haworth S, Shaffer J, Anttonen V, Beck J, Furuichi Y, Holtfreter B, Jönsson D, Kocher T, Levy S, Magnusson P, McNeil D, Michaëlsson K, North K, Palotie U, Papapanou P, Pussinen P, Porteous D, Reis K, Salminen A, Schaefer A, Sudo T, Sun Y, Suominen A, Tamahara T, Weinberg S, Lundberg P, Marazita M, Johansson I. Phenotype Harmonization in the GLIDE2 Oral Health Genomics Consortium. J Dent Res 2022; 101:1408-1416. [PMID: 36000800 PMCID: PMC9516613 DOI: 10.1177/00220345221109775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Genetic risk factors play important roles in the etiology of oral, dental, and craniofacial diseases. Identifying the relevant risk loci and understanding their molecular biology could highlight new prevention and management avenues. Our current understanding of oral health genomics suggests that dental caries and periodontitis are polygenic diseases, and very large sample sizes and informative phenotypic measures are required to discover signals and adequately map associations across the human genome. In this article, we introduce the second wave of the Gene-Lifestyle Interactions and Dental Endpoints consortium (GLIDE2) and discuss relevant data analytics challenges, opportunities, and applications. In this phase, the consortium comprises a diverse, multiethnic sample of over 700,000 participants from 21 studies contributing clinical data on dental caries experience and periodontitis. We outline the methodological challenges of combining data from heterogeneous populations, as well as the data reduction problem in resolving detailed clinical examination records into tractable phenotypes, and describe a strategy that addresses this. Specifically, we propose a 3-tiered phenotyping approach aimed at leveraging both the large sample size in the consortium and the detailed clinical information available in some studies, wherein binary, severity-encompassing, and "precision," data-driven clinical traits are employed. As an illustration of the use of data-driven traits across multiple cohorts, we present an application of dental caries experience data harmonization in 8 participating studies (N = 55,143) using previously developed permanent dentition tooth surface-level dental caries pattern traits. We demonstrate that these clinical patterns are transferable across multiple cohorts, have similar relative contributions within each study, and thus are prime targets for genetic interrogation in the expanded and diverse multiethnic sample of GLIDE2. We anticipate that results from GLIDE2 will decisively advance the knowledge base of mechanisms at play in oral, dental, and craniofacial health and disease and further catalyze international collaboration and data and resource sharing in genomics research.
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Affiliation(s)
- K. Divaris
- Division of Pediatric and Public
Health, Adams School of Dentistry, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
- Department of Epidemiology, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill, Chapel
Hill, NC, USA
| | - S. Haworth
- Medical Research Council Integrative
Epidemiology United, Department of Population Health Sciences, Bristol Medical
School, University of Bristol, Bristol, UK
- Bristol Dental School, University of
Bristol, Bristol, UK
| | - J.R. Shaffer
- Department of Human Genetics, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - V. Anttonen
- Research Unit of Oral Health Sciences,
Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu
University Hospital and University of Oulu, Oulu, Finland
| | - J.D. Beck
- Division of Comprehensive Oral
Health–Periodontology, Adams School of Dentistry, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Y. Furuichi
- Division of Endodontology and
Periodontology, Department of Oral Rehabilitation, Graduate School of Dentistry,
Health Sciences University of Hokkaido, Hokkaido, Japan
| | - B. Holtfreter
- Department of Restorative Dentistry,
Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University
Medicine Greifswald, Greifswald, Germany
| | - D. Jönsson
- Public Dental Service of Skåne, Lund,
Sweden
- Hypertension and Cardiovascular
Disease, Department of Clinical Sciences in Malmö, Lund University, Malmö,
Sweden
- Faculty of Odontology, Malmö
University, Malmö, Sweden
| | - T. Kocher
- Department of Restorative Dentistry,
Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University
Medicine Greifswald, Greifswald, Germany
| | - S.M. Levy
- Department of Preventive and
Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA,
USA
| | - P.K.E. Magnusson
- Department of Medical Epidemiology
and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - D.W. McNeil
- Center for Oral Health Research in
Appalachia, Appalachia, NY, USA
- Department of Psychology, West
Virginia University, Morgantown, WV, USA
- Department of Dental Public Health
& Professional Practice, West Virginia University, Morgantown, WV, USA
| | - K. Michaëlsson
- Department of Surgical Sciences, Unit
of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - K.E. North
- Department of Epidemiology, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill, Chapel
Hill, NC, USA
- Carolina Population Center,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - U. Palotie
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P.N. Papapanou
- Division of Periodontics, Section of
Oral, Diagnostic and Rehabilitation Sciences, Columbia University, College of Dental
Medicine, New York, NY, USA
| | - P.J. Pussinen
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute of Dentistry, School on
Medicine, University of Eastern Finland, Kuopio, Finland
| | - D. Porteous
- Centre for Genomic and Experimental
Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh,
UK
| | - K. Reis
- Institute of Genomics, University of
Tartu, Tartu, Estonia
| | - A. Salminen
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A.S. Schaefer
- Department of Periodontology, Oral
Medicine and Oral Surgery, Institute for Dental and Craniofacial Sciences,
Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - T. Sudo
- Institute of Education, Tokyo Medical
and Dental University, Tokyo, Japan
| | - Y.Q. Sun
- Center for Oral Health Services and
Research Mid-Norway (TkMidt), Trondheim, Norway
- Department of Clinical and Molecular
Medicine, NTNU, Norwegian University of Science and Technology, Trondheim,
Norway
| | - A.L. Suominen
- Institute of Dentistry, School on
Medicine, University of Eastern Finland, Kuopio, Finland
- Institute of Dentistry, School on
Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial
Diseases, Kuopio University Hospital, Kuopio, Finland
- Public Health Evaluation and
Projection Unit, Finnish Institute for Health and Welfare (THL), Helsinki,
Finland
| | - T. Tamahara
- Department of Community Medical
Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai,
Japan
| | - S.M. Weinberg
- Department of Human Genetics, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - P. Lundberg
- Department of Odontology, Section of
Molecular Periodontology, Umeå University, Umeå, Sweden
| | - M.L. Marazita
- Department of Human Genetics, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - I. Johansson
- Department of Odontology, Section of
Cariology, Umeå University, Umeå, Sweden
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Keränen A, Karki S, Anttonen V, Laitala ML. Validating a short form of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) in Finnish language. Eur Arch Paediatr Dent 2020; 22:561-566. [PMID: 33367989 PMCID: PMC8302523 DOI: 10.1007/s40368-020-00590-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/18/2020] [Indexed: 02/02/2023]
Abstract
Aim This study aimed to adapt the short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ), and the Family Impact Scale (FIS) in the Finnish language and to test its validity and reliability. Another aim was to compare the background factors of parents with respect to P-CPQ and FIS outcomes. Methods This study was conducted among a convenient sample of parents who visited the public dental clinic in Sievi, Finland, from May to October 2016. A total of 54 parents of 2–8-year-old children completed the short-form of the P-CPQ questionnaire and 50 parents of 2–8-year-olds completed the FIS questionnaire while visiting for their children’s routine dental check-up. Parents completed the self-administered P-CPQ and FIS questionnaires. Reliability and validity of the short-form of the P-CPQ and FIS were assessed. Differences between gender, and family size were evaluated using the Mann–Whitney U test and the differences between age groups were evaluated using the Kruskal–Wallis one-way ANOVA test. Result The Finnish versions of both the short forms of the P-CPQ and FIS had alpha values within the acceptable range. The scales also showed good construct validity. Toddlers (2–4-year olds) had the highest scores for both the P-CPQ and FIS-8 subscales. Likewise, families with 5 or more children had high FIS scores. Conclusion The short form of the P-CPQ and FIS in Finnish language are valid and reliable. The oral health of the child seems to have the greatest family impact among parents with five or more children and in families with 2–4-year olds.
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Affiliation(s)
- A Keränen
- Research Unit of Oral Health Sciences, University of Oulu, Aapistie 3, POB 5281, 90220, Oulu, Finland
| | - S Karki
- Research Unit of Oral Health Sciences, University of Oulu, Aapistie 3, POB 5281, 90220, Oulu, Finland.
| | - V Anttonen
- Research Unit of Oral Health Sciences, University of Oulu, Aapistie 3, POB 5281, 90220, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M-L Laitala
- Research Unit of Oral Health Sciences, University of Oulu, Aapistie 3, POB 5281, 90220, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Toratti A, Laitala ML, Kemppainen A, Pesonen P, Anttonen V. The effect of a brief computer-assisted intervention on oral health-related behaviours among adolescents. Eur J Paediatr Dent 2020; 21:18-22. [PMID: 32183523 DOI: 10.23804/ejpd.2020.21.01.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to see if a brief, computer-assisted intervention tool could be pleasant to use for adolescents. Another aim was to evaluate if the computer programme could affect adolescents' oral health-related behaviours. MATERIALS AND METHODS Study design: For oral health promotion on schoolchildren, a computer-assisted intervention with personal feedback was performed. The effectiveness of the programme on participants' oral health behaviours as well as the feasibility of the programme were evaluated by responses of the participants. The study was conducted on 13-15 year-old schoolchildren (n=112). The computer programme included 19 questions about oral health-related behaviours and it provided personal feedback and tips towards better oral health. Additionally, the participants gave feedback about the programme. After four weeks, the intervention was repeated, the same questions were asked again, and the effect of the intervention on oral health behaviours was evaluated. RESULTS More than half of the children considered the computer programme useful, girls (56.9%) more often than boys (44.9%) (p = 0.057). Almost everyone reported having learnt new information through the programme. Most of the new information concerned oral hygiene and the effects of different beverages on dental health (over 40% on both issues). Both genders reported having changed their oral health behaviours towards better habits. Girls generally improved their meal quality, while boys cut down on snacking and used more xylitol products. The computer-assisted intervention gave positive results and the programme seemed to be easy and pleasant to use for both adolescents and oral health professionals. STATISTICS The results concerning the computer programme were described as frequencies, distributions and graphically. Chi-square test or Fisher's exact test was used when compared distributions between different questions and gender as well as questions and groups. The participants were categorised into three groups according to their sum scores (calculated from responses to the questions on oral health-related behaviours). The differences between the sum scores at baseline and after the intervention were analysed with the paired samples t-test. CONCLUSIONS Information technology seems to have a remarkable potential in motivating patients towards better oral health behaviours.
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Affiliation(s)
- A Toratti
- Research Unit of Oral Health Sciences, Department of Cariology, Paedodontics and Endodontics, University of Oulu, Finland
| | - M-L Laitala
- Research Unit of Oral Health Sciences, Department of Cariology, Paedodontics and Endodontics, University of Oulu, Finland
| | - A Kemppainen
- Research Unit of Oral Health Sciences, Department of Cariology, Paedodontics and Endodontics, University of Oulu, Finland
| | - P Pesonen
- Research Unit of Oral Health Sciences, Department of Cariology, Paedodontics and Endodontics, University of Oulu, Finland
| | - V Anttonen
- Research Unit of Oral Health Sciences, Department of Cariology, Paedodontics and Endodontics, University of Oulu, Finland
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Kühnisch J, Anttonen V, Duggal MS, Spyridonos ML, Rajasekharan S, Sobczak M, Stratigaki E, Van Acker JWG, Aps JKM, Horner K, Tsiklakis K. Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document. Eur Arch Paediatr Dent 2019; 21:375-386. [PMID: 31768893 DOI: 10.1007/s40368-019-00493-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents. METHODS Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed. RESULTS Several clinical-based recommendations and statements were agreed upon. CONCLUSION There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).
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Affiliation(s)
- J Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Goethestraße 70, 80336, München, Germany.
| | - V Anttonen
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M S Duggal
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - S Rajasekharan
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, Ghent, Belgium
| | - M Sobczak
- Specialized Dental Practice, Warsaw, Poland
| | - E Stratigaki
- Department of Orthodontics and Paediatric Dentistry, University of Basel, Basel, Switzerland
| | - J W G Van Acker
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, Ghent, Belgium
| | - J K M Aps
- Division of Oral Diagnostic and Surgical Sciences, University of Western Australia, Perth, Australia
| | - K Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K Tsiklakis
- Department of Oral Diagnosis and Radiology National and Kapodistrian, University of Athens, Athens, Greece
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Lussi A, Buzalaf MAR, Duangthip D, Anttonen V, Ganss C, João-Souza SH, Baumann T, Carvalho TS. The use of fluoride for the prevention of dental erosion and erosive tooth wear in children and adolescents. Eur Arch Paediatr Dent 2019; 20:517-527. [PMID: 30762211 DOI: 10.1007/s40368-019-00420-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/11/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Erosive tooth wear (ETW) has gained increasing clinical relevance. It is estimated that worldwide 30-50% of deciduous and 20-45% of permanent teeth are affected. One of the most important nutritional factors causing ETW is the overconsumption of soft drinks, but also patient-related factors like reflux or eating disorders can lead to erosive lesions. Whether acids lead to erosive demineralisation depends on their degree of saturation with respect to tooth mineral at their actual pH. REVIEW Fluoride compounds like sodium or amine fluoride seem to be of limited efficacy against erosion, the main reason for this is the missing biofilm in the erosive process as well as the lower pH of the acids compared to bacterial acids. This means that to achieve some kind of preventive effect it would be necessary to use products with higher fluoride concentration, which is not an appropriate option for small children, and/or to increase the frequency of application. In addition, the fluoride compound plays a role as promising effects were found when fluoride is combined with titanium or stannous ions. TiF4 can cause acid-resistant surface coatings and when Sn2+/F- formulations are applied, Sn is not only found on the surface but is also incorporated into enamel and dentine. Both effects make the tooth surface more resistant against acid demineralisation. Different fluoride-containing vehicles have been tested to prevent erosion/ETW, such as toothpastes, rinses, gels and varnishes. Toothpastes offer some degree of protection, especially Sn2+-containing formulations, but effects of the active ingredients are sometimes counteracted by the presence of abrasives. CONCLUSION Detecting associated factors and influencing them is the main instrument in arresting erosive tooth wear. Additionally, patients at risk for dental erosion should always use an additional fluoride source preferably containing Sn2+.
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Affiliation(s)
- A Lussi
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - M A R Buzalaf
- Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - D Duangthip
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - V Anttonen
- Research Unit of Oral Health Sciences, Department of Cariology, Endodontology and Pediatric Dentistry, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - C Ganss
- Department for Conservative and Preventive Dentistry, Dental Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - S H João-Souza
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - T Baumann
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - T S Carvalho
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Rajavaara P, Laitala ML, Vähänikkilä H, Anttonen V. Survey of family-related factors of children treated under dental general anaesthesia. Eur J Paediatr Dent 2018; 19:139-144. [PMID: 29790778 DOI: 10.23804/ejpd.2018.19.02.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Treatment under general anaesthesia (DGA) is a rising trend in Finland. There is a great need to investigate the causes leading to it. Our purpose was to examine family-related factors reported by parents, such as the family size and favoring DGA in the family, and their influence on children being treated under DGA. This survey was based on a questionnaire targeted to parents of children whose dental treatment could not be performed in a conventional setting. MATERIALS AND METHODS Guardians of 87 healthy children treated under DGA at a municipal health center in the city of Oulu, Finland, between November 2014 and December 2015 answered the questionnaire on family-related background factors and on the respondent's own as well as their child's presumed dental fear. RESULTS According to most guardians (83.9% of the cases), the reason for DGA was caries. Male gender, vague family structure, large number of siblings (?4), and DGA history in the family were all important family-related background factors leading to DGA. Self-reported parental dental fear was quite common (25.3%). Children's dental fear reported by parents was associated with DGA in almost half of the cases (46.0%). CONCLUSIONS The survey highlights the role of the entire family in association with children ending up being treated under DGA. It is essential for the success of dental health care to also consider family-related factors when planning the treatment, particularly with children demanding DGA.
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Affiliation(s)
- P Rajavaara
- University of Oulu, Finland DDS (Pediatric Dentistry), PhD student, Department of Cariology, Endodontology and Pediatric Dentistry, Research Unit of Oral Health Sciences, Dental Teaching Unit and Unit of Specialized Care, Municipal Health Centre, Oral Health Care, City of Oulu, Finland
| | - M-L Laitala
- PhD, DDS, Department of Cariology, Endodontology and Pediatric Dentistry, Research Unit of Oral Health Sciences
| | - H Vähänikkilä
- PhD, Research Unit of Oral Health Sciences. University of Oulu, Finland
| | - V Anttonen
- Professor, Department of Cariology, Endodontology and Pediatric Dentistry, Research Unit of Oral Health Sciences, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Finland
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Kühnisch J, Daubländer M, Klingberg G, Dougall A, Spyridonos Loizides M, Stratigaki E, Amar JL, Anttonen V, Duggal M, Gizani S. Best clinical practice guidance for local analgesia in paediatric dentistry: an EAPD policy document. Eur Arch Paediatr Dent 2017; 18:313-321. [PMID: 29022286 DOI: 10.1007/s40368-017-0311-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The European Academy of Paediatric Dentistry (EAPD) proposes this best-practice guidance to help practitioners to decide when and how to use local analgesia to control pain in children, adolescents, and medically compromised individuals during the delivery of oral health care. METHODS A search of different databases was conducted using all terms relevant to the subject. Relevant papers were identified after a review of their titles, abstracts or full papers. Three workshops were held during the corresponding EAPD interim seminar in Torino (Italy) in 2017. Several statements were agreed upon and, furthermore, knowledge gaps were identified. RESULTS An important outcome was that when local analgesia administered appropriately-correct choice of agent(s) and dosage, proper route of administration-it is, firstly, clinically effective for pain-control in treating children and, secondly, it carries a very low risk of morbidity including adverse or side-effects. Furthermore, several gaps in knowledge were identified during the workshop which indicates future research needs. Most importantly it remains unsatisfactory that in several European countries the most frequently used injectable local analgesic agent, articaine, is not approved for usage in children below the age of 4 years. CONCLUSION When considering the dental demand to treat vulnerable (medically compromised) children and adolescents in a safe, painless, less-invasive and effective way, there seems to be an urgent need to close these gaps in knowledge.
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Affiliation(s)
- J Kühnisch
- Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany.
| | - M Daubländer
- Department of Oral Surgery, University Medical Centre Mainz, Mainz, Germany
| | - G Klingberg
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Dougall
- Department of Child and Public Dental Health, Trinity College, Dublin, Republic of Ireland.,Dublin Dental University Hospital, Dublin, Republic of Ireland
| | | | - E Stratigaki
- Department of Orthodontics and Paediatric Dentistry, University of Basel, Basel, Switzerland
| | - J L Amar
- Private Practice for Paediatric Dentistry, Geneva, Switzerland
| | - V Anttonen
- Research Unit of Oral Health Sciences, Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, Oulu, Finland.,MRC of Oulu University and University Hospital, Oulu, Finland
| | - M Duggal
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - S Gizani
- Department of Paediatric Dentistry, Dental School, National and Kapodistrian University of Athens, Athens, Greece
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Rajavaara P, Rankinen S, Laitala ML, Vähänikkilä H, Yli-Urpo H, Koskinen S, Anttonen V. The influence of general health on the need for dental general anaesthesia in children. Eur Arch Paediatr Dent 2017; 18:179-185. [PMID: 28343266 DOI: 10.1007/s40368-017-0284-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
AIM To analyse the occurrence and causes of dental general anaesthesia (DGA) in healthy and medically compromised children, and to investigate if there are differences between those groups considering factors associated with DGA and DGA procedures. METHODS The data was collected from medical records of children under 7 years of age treated under DGA in the years 2009 and 2010 at the Oulu University Hospital, Finland. The children were divided into two groups: 0-35-month-olds and ≥36-month olds. Background information (year, age, gender, dental diagnosis, health) and the procedures performed were registered. The procedures were analysed considering the child's age and tooth types. RESULTS The number of children treated under DGA increased between 2009 (58) and 2010 (82), particularly in the group of healthy children. The two main diagnoses leading to DGA were dental caries and dental fear. Dental caries as the first dental diagnosis leading to DGA was more common among the medically compromised children (61.5%) compared to the healthy children (38.6%). The procedures performed were similar among the two groups. However, they varied between the age groups and tooth types and even between upper and lower teeth. The medically compromised children had been treated more frequently under DGA in the past. CONCLUSIONS The threshold for treating medically compromised children under DGA seems to be lower than for healthy children. However, the occurrence of DGA among healthy children has increased recently. To avoid unnecessary DGA, the control of caries should be carried out according to individual needs and independent of whether the child is healthy or has a chronic disease.
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Affiliation(s)
- P Rajavaara
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland. .,Dental Teaching Unit and Unit of Specialised Care, Oral Health Care, Municipal Health Centre, Aapistie 3, P.O. Box 8, 90015, Oulu, Finland.
| | - S Rankinen
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland
| | - M-L Laitala
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland
| | - H Vähänikkilä
- Research Unit of Oral Health Sciences, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland
| | - H Yli-Urpo
- University of Helsinki, Helsinki, Finland
| | - S Koskinen
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, OYS, P.O. Box 21, 90029, Oulu, Finland
| | - V Anttonen
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, OYS, P.O. Box 21, 90029, Oulu, Finland
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9
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Laitala ML, Jaanti E, Vähänikkilä H, Määttä T, Heikka H, Hausen H, Anttonen V. Laser fluorescence in monitoring the influence of targeted tooth brushing on remineralization of initial caries lesions on newly erupted molar teeth - RCT. Int J Dent Hyg 2016; 15:e78-e84. [PMID: 26822105 DOI: 10.1111/idh.12205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to monitor mineralization changes in initial caries lesions on newly erupted second molars using laser fluorescence (LF) scanning after a 1-month targeted tooth brushing intervention. METHODS Altogether, 124 13- to 14-year-old school children were invited to participate. Of those who fulfilled the clinical criteria (at least one initial lesion with LF value >10 in second molars), 51 gave their written consent to participate. Laser fluorescence values were registered at baseline and after 1-month follow-up period. All participants were individually taught targeted tooth brushing of their second molars and randomly provided tooth paste with 0 or 1500 ppm fluoride. Brushing frequency was investigated at baseline and after the follow-up. Change in LF values was compared considering the tooth, content of fluoride in the paste and brushing frequency. RESULTS In lesions with LF values ≤30 at baseline, change in LF values demonstrated improvement. Improvement was detected especially in upper molars. In lesions with LF values >30 at baseline, improvement was least detected. Brushing frequency increased slightly during the intervention. CONCLUSIONS Laser fluorescence is a simple method and useful in monitoring remineralization of incipient lesions even in weeks. Targeted tooth brushing seems to induce remineralization even in weeks. Laser fluorescence could be a valuable motivating tool in promoting patients' self-care.
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Affiliation(s)
- M-L Laitala
- Research Unit of Oral Health Sciences, Department of Pedodontics, Cariology and Endodontology, University of Oulu, Oulu, Finland
| | - E Jaanti
- Research Unit of Oral Health Sciences, Department of Pedodontics, Cariology and Endodontology, University of Oulu, Oulu, Finland
| | - H Vähänikkilä
- Research Unit of Oral Health Sciences, Department of Pedodontics, Cariology and Endodontology, University of Oulu, Oulu, Finland
| | - T Määttä
- Research Unit of Oral Health Sciences, Department of Pedodontics, Cariology and Endodontology, University of Oulu, Oulu, Finland
| | - H Heikka
- Oulu University of Applied Sciences, Oulu, Finland
| | - H Hausen
- Research Unit of Oral Health Sciences, Department of Community Dentistry, University of Oulu, Oulu, Finland
| | - V Anttonen
- Research Unit of Oral Health Sciences, Department of Pedodontics, Cariology and Endodontology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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10
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Lehtonen V, Anttonen V, Ylikontiola LP, Koskinen S, Pesonen P, Sándor GK. Dental anomalies associated with cleft lip and palate in Northern Finland. Eur J Paediatr Dent 2015; 16:327-332. [PMID: 26637260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Despite the reported occurrence of dental anomalies of cleft lip and palate, little is known about their prevalence in children from Northern Finland with cleft lip and palate. The aim was to investigate the prevalence of dental anomalies among patients with different types of clefts in Northern Finland. MATERIALS AND METHODS Design and Statistics: patient records of 139 subjects aged three years and older (with clefts treated in Oulu University Hospital, Finland during the period 1996-2010 (total n. 183) were analysed for dental anomalies including the number of teeth, morphological and developmental anomalies and their association with the cleft type. The analyses were carried out using Chi-square test and Fisher's exact test. Differences between the groups were considered statistically significant at p values < 0.05. RESULTS More than half of the patients had clefts of the hard palate, 18% of the lip and palate, and 13% of the lip. At least one dental anomaly was detected in 47% of the study population. Almost one in three (26.6%) subjects had at least one anomaly and 17.9% had two or three anomalies. The most common type of anomaly in permanent teeth were missing teeth followed by supernumerary teeth. Supernumerary teeth were significantly more apparent when the lip was involved in the cleft compared with palatal clefts. Missing teeth were less prevalent among those 5 years or younger. The prevalence of different anomalies was significantly associated with the cleft type in both age groups. CONCLUSIONS Dental anomalies are more prevalent among cleft children than in the general population in Finland. The most prevalent anomalies associated with cleft were missing and supernumerary teeth.
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Affiliation(s)
- V Lehtonen
- University of Oulu, Institute of Dentistry, Department of Paedodontics, Cariology and Endodontology, Oulu, Finland
| | - V Anttonen
- University of Oulu, Institute of Dentistry, Department of Paedodontics, Cariology and Endodontology. Oulu University Hospital, Oulu, Finland
| | - L P Ylikontiola
- University of Oulu, Institute of Dentistry, Department of Oral and Maxillofacial Surgery. Oulu University Hospital, Oulu, Finland
| | | | - P Pesonen
- University of Oulu, Institute of Dentistry, Department of Paedodontics, Cariology and Endodontology, Oulu, Finland
| | - G K Sándor
- University of Oulu, Institute of Dentistry, Department of Oral and Maxillofacial Surgery. Oulu University Hospital, Oulu, Finland
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11
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Kämppi A, Päkkilä J, Tanner T, Patinen P, Tjäderhane L, Anttonen V. Validity of a questionnaire in estimating restorative treatment need among young adults. Community Dent Health 2014; 31:245-250. [PMID: 25665359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE There are no verified anamnestic sets of questions for assessing restorative treatment need. Finnish conscripts responded to a computer-based questionnaire on oral health during their oral health screening in 2011. This study compared the outcomes of the screening and the questionnaire concerning restorative treatment need with the aim of finding and validating a set of questions with the best association between the two methods. CLINICAL SETTING The study group comprised 8,566 conscripts. Of 50 original questions, 22 questions were chosen for closer analysis. The generalised linear mixed model was used to calculate the OR values (95% CI) for each of these questions, using restorative treatment need at individual level as the response variable. Questions with the best association (Q1-Q10) were selected for the final set; the inclusion criterion was p < 0.05. The area under curve (AUC) value was calculated for the sum function of these 10 questions. RESULTS Among the final set of 10 questions, the OR values varied between 1.12 and 4.61. The AUC value was 0.75. By increasing the number of positive responses to 8 questions, the odds for restorative treatment need were OR 69.27 and increased to infinity with 10 questions. CONCLUSIONS A selected set of questions together with clinical screening, or even alone, can be a valid instrument for screening people for restorative treatment need. The method is particularly useful in large populations. This statistical method might identify appropriate sets of questions for different contexts.
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12
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Käkilehto T, Siiskonen J, Vähänikkilä H, Salo S, Tjäderhane L, Anttonen V. Caries experience in primary teeth of four birth cohorts: a practice-based study. Eur Arch Paediatr Dent 2013; 14:59-64. [DOI: 10.1007/s40368-013-0016-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 11/06/2012] [Indexed: 11/30/2022]
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13
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Kämppi A, Tanner T, Päkkilä J, Patinen P, Järvelin MR, Tjäderhane L, Anttonen V. Geographical distribution of dental caries prevalence and associated factors in young adults in Finland. Caries Res 2013; 47:346-54. [PMID: 23548873 DOI: 10.1159/000346435] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/10/2012] [Indexed: 11/19/2022] Open
Abstract
Oral health of the young has been reported to be associated with the place of residence, due to differences in socio-economic status. The results of studies on the effect of fluoride in drinking water on caries prevalence have been contradictory. The main aim of our study was to investigate the geographical distribution of dental caries prevalence in Finland and analyse possible regional, associated factors. Oral health of 13,564 men born between 1990 and 1992 was screened using a method based on criteria of the World Health Organization for epidemiological studies by 15 calibrated dentists in 20/24 garrisons of the Finnish Defence Forces in 2011. Mean DMFT and DT values in provinces were calculated. Multilevel analysis was applied to the data using generalized linear mixed models and a logit link function. The binary outcome variable was the cariological treatment need (yes/no) and the garrison was treated as random effect. Mean DMFT and DT values varied significantly between provinces in Finland. Increased levels of fluoride in drinking water, Swedish as the main language in the municipality, and living in urban areas were protective factors against cariological treatment need. Dentist density did not affect caries prevalence. The geographical distribution of dental caries further supported estimates of the protective effects of high fluoride levels in drinking water, Swedish as the main language in the municipality, as well as living in urban areas. Effect of fluoride on caries prevalence still exists, and association with the socio-economic status was confirmed.
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Affiliation(s)
- A Kämppi
- Institute of Dentistry, FI–90014 University of Oulu, Oulu, Finland.
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14
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Anttonen V, Seppä L, Hausen H. Clinical Study on the Effect of Professional Cleaning of Occlusal Tooth Surfaces on Laser Fluorescence Measurements. Caries Res 2005; 39:280-3. [PMID: 15942187 DOI: 10.1159/000084834] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Accepted: 11/01/2004] [Indexed: 11/19/2022] Open
Abstract
Manufacturer's advice is to professionally clean teeth before using a laser fluorescence (LF) device in order to avoid false-positive diagnoses. Professional cleaning is not included in routine dental check-ups in children in Finland because it is time-consuming. The aim of our present study was to evaluate the effect of professional cleaning of teeth on LF in children. A total of 642 occlusal surfaces in permanent molars and premolars in 9- to 16-year-olds (n = 46) were first examined visually. After that the first measurements with LF were made without cleaning the teeth. At the same appointment the second measurements were carried out after professional cleaning using a soft rubber cup and either polishing paste or plain water spray. The differences in LF of uncleaned and cleaned teeth were determined separately for teeth with a visual score of 0 (sound) and > 0. In premolars cleaning had no significant effect on LF. In molars, the values increased when the teeth were cleaned, the difference of the measurements being statistically significant in molars with visual score > 0 cleaned with plain water spray. For molars that were cleaned with paste, the differences were not statistically significant. Sealants did not modify the effect of cleaning. As a conclusion cleaning with a rotating instrument and water spray before LF measurements is recommended in teeth with visible plaque. Also in clean teeth, cleaning is advisable in cases where LF readings approach threshold level for operative intervention. The finding that uncleaned teeth gave lower values than cleaned teeth is opposite to what has been suggested.
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Affiliation(s)
- V Anttonen
- Oulu Municipal Health Center, University of Oulu, Oulu, Finland.
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Abstract
OBJECTIVES The aim of this study was to evaluate the utility of the laser fluorescence device DIAGNOdent for monitoring occlusal caries longitudinally as part of a routine dental check-up in a public dental clinic. METHODS Children aged 7-8 and 13-14 years at baseline participated in the study. As part of two consecutive dental check-ups with a mean interval of 1,19, years, 423 permanent molars and 315 primary molars in 81 children were examined visually and using DIAGNOdent by one dentist. In teeth where, as judged by visual examination, caries had emerged or progressed during the follow-up, the DIAGNOdent values had increased significantly from the baseline. RESULTS In permanent teeth with a change in visual score from sound to enamel or dentin caries, the mean DIAGNOdent value increased from 24 to 37 and in primary teeth from 8 to 40. The increase in DIANGOdent values correlated positively with the increase in visual score. The mean DIAGNOdent value at baseline was significantly higher in teeth that became carious than in those that remained sound during the follow-up. For permanent teeth with a visual reversal from inactive or active enamel caries to a sound surface, the mean DIAGNOdent value decreased from 36 to 24. CONCLUSIONS These results suggest that DIAGNOdent is useful in monitoring occlusal caries in both permanent and primary molars.
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Affiliation(s)
- V Anttonen
- Oulu Municipal Health Center, University of Oulu, Oulu, Finland.
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Anttonen V, Seppä L, Hausen H. Clinical study of the use of the laser fluorescence device DIAGNOdent for detection of occlusal caries in children. Caries Res 2003; 37:17-23. [PMID: 12566634 DOI: 10.1159/000068227] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2002] [Accepted: 09/11/2002] [Indexed: 11/19/2022] Open
Abstract
Diagnosis of non-cavitated occlusal caries is generally considered problematic. The aim of this study was to evaluate the utility of the laser fluorescence device DIAGNOdent as part of routine dental check-ups in children. A total of 613 occlusal surfaces on permanent molars and 436 surfaces on primary molars in children aged 7-8 (n = 55) and 13-14 years (n = 54) were examined visually, using DIAGNOdent and for most 13- to 14-year-olds also using radiographs. The teeth were not cleaned professionally before examination. To provide a gold standard for carious teeth, the depth of the caries lesion was determined in those lesions that were judged visually to need opening by drilling (51 teeth). The higher the visual score, the higher were the mean DIAGNOdent values, but in each visual category the variation among values was large. The presence of a clear sealant did not affect DIAGNOdent measurements. The values for permanent and primary molars differed slightly. For permanent teeth, Youden's index value was highest (60%) at a cut-off value of 30, which indicates that the overall performance for DIAGNOdent in detecting dentinal caries was best at this point. Using this cut-off, sensitivity was 92% and specificity 69% with visual examination for validation, while sensitivity was 92% and specificity 82% with validation by fissure opening. Of the three methods, radiographic examination was the least accurate. In routine dental check-ups of children, DIAGNOdent appears to be useful as an adjunct to visual examination.
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Miettinen P, Anttonen V, Aukee S, Huttunen R, Lahtinen J, Poikolainen E, Pääkkönen M, Tammela T. Ranitidine versus anticholinergic/antacid for duodenal ulcer. A randomized, endoscopically controlled, single-blind multicentre trial. Scand J Gastroenterol 1985; 20:701-5. [PMID: 3898348 DOI: 10.3109/00365528509089198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One hundred and forty-nine patients with endoscopically documented duodenal or prepyloric ulcer were randomly allocated to treatment with ranitidine, 150 mg twice daily (75 patients), or glycopyrrobromide, 2 mg three times daily, and antacid suspension, 60 ml/day, with a buffering capacity of 480 mmol/day (74 patients). The patients underwent a thorough prestudy symptom analysis, and endoscopy was performed by an observer who was unaware of the treatment in use. After 4- and 8-week courses of treatment the patients were re-evaluated. Sixty-nine patients in the ranitidine group and 66 in the anticholinergic/antacid group completed the trial. Complete ulcer healing was obtained in 60 of the 69 patients (87%) in the ranitidine group and in 50 of the 66 patients (76%) in the anticholinergic/antacid group after 4 weeks of treatment and in 65 (94%) and in 61 (92%), respectively, after 8 weeks of treatment. Forty-three patients had troublesome side effects of either anticholinergic or antacid treatment, and three patients had to interrupt the treatment. There were no serious side effects of ranitidine. This study suggests that ranitidine causes faster ulcer healing than the combination of anticholinergic and antacid. The results show that ranitidine is an effective and safe drug for duodenal ulcer healing, with no troublesome side effects.
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