Prenatal, socio-demographic and oral hygiene-related risk factors on dental caries and periodontal conditions in adolescents : clinical and register-based studies

The overall aim of these studies was to identify risk determinants for dental caries and periodontal conditions in adolescents using clinical and register-based data.

This thesis is based on two parts. Part 1 (Papers I and II) constitutes the clinical and radiographic cross-sectional studies of 800 19-year-olds living in seven suburbs of Stockholm with different socioeconomic profiles. Part 2 (Papers III and IV), was designed as a longitudinal register-based cohort study and included all adolescents (n=18,142) at 13 years of age who resided in the county of Stockholm, Sweden, in 2000, and followed them up to 19 years of age. Finally, 15538 subjects were examined. Socio-demographic and health related information was collected from local and national data sources.

The novel findings are that the prenatal factors maternal smoking and maternal overweight during the first trimester are identified as risk factors for caries increment in their offspring between 13 and 19 years of age. In addition, our results disclosed that parental immigrant background is a risk factor of caries development during adolescence, irrespective of whether the child was born in Sweden or abroad. These children developed 53% and 109% more approximal caries lesions, respectively, compared to their counterparts with Swedish-born parents. Further, children born in eastern Europe, or western Europe exhibited an increased risk for approximal caries increment, and developed 83% and 46% more approximal caries lesions, respectively, compared to Swedish-born adolescents.

We also found that variables significantly associated with high caries experience at 19 years of age were dental fear, gingival inflammation, irregular toothbrushing at night and a mother born abroad. In addition, an increased relative risk for incipient alveolar bone loss was found in subjects with the presence of subgingival calculus as well as one or more proximal restoration(s).

The main conclusions from this thesis are that: 1) maternal overweight and smoking are identified as new risk factors for caries development in offspring; 2) children with foreign-born parents, irrespective of whether the children were born in Sweden or not and children born in eastern Europe should be regarded as risk patients for dental caries; 3) dental fear, gingival inflammation, a foreignborn mother and irregular toothbrushing at night are variables strongly associated with high caries experience in 19-year-olds; and 4) adolescents with subgingival calculus and proximal restorations are at higher relative risk of exhibiting incipient alveolar bone loss compared with those without.

List of scientific papers

I. Julihn A, Barr Agholme M, Modeer T (2008). "Risk factors and risk indicators in relation to incipient alveolar bone loss in Swedish 19-year-olds." Acta Odontol Scand 66(3): 139-47
https://pubmed.ncbi.nlm.nih.gov/18568472

II. Julihn A, Barr Agholme M, Grindefjord M, Modéer T (2006). "Risk factors and risk indicators associated with high caries experience in Swedish 19-year-olds." Acta Odontol Scand 64(5): 267-73
https://pubmed.ncbi.nlm.nih.gov/16945891

III. Julihn A, Ekbom A, Modéer T (2010). "Migration background: a risk factor of caries development during adolescence." Eur J Oral Sci (Submitted)

IV. Julihn A, Ekbom A, Modéer T (2009). "Maternal overweight and smoking: prenatal risk factors for caries development in offspring during the teenage period." Eur J Epidemiol 24(12): 753-62. Epub 2009 Oct 25
https://pubmed.ncbi.nlm.nih.gov/19856208