Svante Twetman

IT University of Copenhagen, København, Capital Region, Denmark

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Publications (208)253.17 Total impact

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    ABSTRACT: Abstract Aim. To investigate selected lifestyle factors in relation to active caries and restored root surface lesions in adults. Materials and methods. Based on clinical examinations and questionnaires, data on root caries, socioeconomic status, body mass index, dietary habits, alcohol consumption, tobacco use and oral hygiene routines were collected from 4369 adults aged 21-89 who took part in a survey covering 13 municipalities across Denmark. Uni- and multivariate logistic regression analyses were applied to analyse the relationship between the independent lifestyle variables and active caries and restored root surface lesions, respectively. Results. The prevalence of active root caries was 4%, while 26% displayed restored root surfaces. The sugar intake was not related to root caries. A multivariate logistic regression analysis revealed that, in subjects aged 45 or over, smoking and wearing dentures were significantly associated with presence of active root caries (p < 0.01). The intake of 15 drinks or more per week was associated with higher odds of root surface restorations compared with no alcohol intake (OR = 1.7; p < 0.001). Conclusions. Lifestyle factors such as tobacco use and alcohol consumption, as well as wearing dentures, were significantly associated with the occurrence of untreated caries and restored root surface lesions, especially in persons over 45. Thus, such lifestyle factors should be taken into consideration, identifying persons with a need of preventive dental services. In addition, oral health education should focus on the possible risks of smoking and a high alcohol intake.
    Acta odontologica Scandinavica. 12/2014;
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    ABSTRACT: The aim of the present study was to investigate the reproducibility of bacterial enumeration from subsequent subgingival samples collected from patients with peri-implant mucositis.
    Clinical Oral Investigations 09/2014; · 2.20 Impact Factor
  • Lisa Twetman, Svante Twetman
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    ABSTRACT: To compare the prevalence and levels of salivary Mutans Streptococci (MS) assessed with two commercial chair-side methods based on culture growth or monoclonal antibodies, respectively.
    Oral health and dental management. 09/2014; 13(3):580-3.
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    ABSTRACT: To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1,000ppm fluoride toothpaste.
    Journal of dentistry. 08/2014;
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    ABSTRACT: Objective: To investigate the effect of tablets containing probiotic lactobacilli on early caries lesions in adolescents with aid of quantitative light-induced fluorescence (QLF). Method: Thirty-six healthy adolescents of both sexes (12-17 years of age) were enrolled and randomly allocated to a placebo-controlled trial with two parallel groups. The test group received two tablets daily containing two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) for a period of three months, while the control group got identical placebo tablets without live bacteria. The primary outcome was QLF-readings (mineral content, DF and lesion area, mm2) at baseline and after 3 months, conducted at two buccal sites of each individual, pre-selected with clearly visible clinical signs of enamel demineralisation (white spots). The study was approved by the Danish Ethical Committee (H-4-2012-096) and registered at ClinicalTrials.gov (H-4-2012-096). Result: There were no statistically significant differences in fluorescence values between the groups, neither at baseline, nor at the follow-up. There was however a significant decrease in fluorescence over time in the test group but not in the placebo group (p<0.05). No alterations of the lesion area (ΔA) were found in any group. The inter-examiner ICC-value for QLF-readings was excellent. No side- or adverse effects were reported during the intervention period. Conclusion: This pilot study revealed a weak tendency that probiotic supplements may beneficially affect early non-cavitated caries lesions in high caries risk adolescents but the findings must be confirmed in a larger setting.
    IADR General Session and Exhibition 2014; 06/2014
  • S. TWETMAN
    IADR General Session and Exhibition 2014; 06/2014
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    ABSTRACT: The objective of the study was to investigate the effect of tablets containing probiotic lactobacilli on early caries lesions in adolescents with quantitative light-induced fluorescence (QLF). 36 healthy adolescents of both sexes (12-17 years of age) were enrolled and randomly allocated to a placebo-controlled trial with two parallel groups. The test group received two tablets daily containing two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) for a period of three months, while the control group got identical placebo tablets without live bacteria. The primary outcome was QLF-readings (change in fluorescence, ?F and lesion area, mm2) at baseline and after 3 months, conducted at two buccal sites of each individual, pre-selected with clearly visible clinical signs of enamel demineralisation (white spots). Significantly more premolars were allocated to the placebo group, while the test group had more incisors (P<0.05). There were no statistically significant differences in fluorescence values between the groups, neither at baseline, nor at the follow-up. There was however a significant decrease in fluorescence over time in the test group, but not in the placebo group (P<0.05). No alterations of the lesion area (?A) were found in any group. The inter-examiner intra-class correlation coefficient-value for QLF-readings was excellent. No side- or adverse effects were reported during the intervention period. This pilot study found a significant decrease over time in the test group. However, no statistically significant differences in fluorescence values between the groups were found. Hence, the null hypothesis could not be rejected.
    Beneficial Microbes 06/2014; · 1.47 Impact Factor
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    ABSTRACT: The aim of this study was to learn whether presence of caries in an adult population was associated with a salivary bacterial profile different from that of individuals without untreated caries. Stimulated saliva samples from 621 participants of the Danish Health Examination Survey were analyzed using the Human Oral Microbe Identification Microarray technology. Samples from 174 individuals with dental caries and 447 from a control cohort were compared using frequency and levels of identified bacterial taxa/clusters as endpoints. Differences at taxon/cluster level were analyzed using Mann-Whitney's test with Benjamini-Hochberg correction for multiple comparisons. Principal component analysis was used to visualize bacterial community profiles. A reduced bacterial diversity was observed in samples from subjects with dental caries. Five bacterial taxa (Veillonella parvula, Veillonella atypica, Megasphaera micronuciformis, Fusobacterium periodontium and Achromobacter xylosoxidans) and one bacterial cluster (Leptotrichia sp. clones C3MKM102 and GT018_ot417/462) were less frequently found in the caries group (adjusted p value <0.01) while two bacterial taxa (Solobacterium moorei and Streptococcus salivarius) and three bacterial clusters (Streptococcus parasanguinis I and II and sp. clone BE024_ot057/411/721, Streptococcus parasanguinis I and II and sinensis_ot411/721/767, Streptococcus salivarius and sp. clone FO042_ot067/755) were present at significantly higher levels (adjusted p value <0.01). The principal component analysis displayed a marked difference in the bacterial community profiles between groups. Presence of manifest caries was associated with a reduced diversity and an altered salivary bacterial community profile. Our data support recent theories that ecological stress-induced changes of commensal microbial communities are involved in the shift from oral health to tooth decay. © 2014 S. Karger AG, Basel.
    Caries Research 03/2014; 48(5):368-375. · 2.51 Impact Factor
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    ABSTRACT: Abstract Objective: To compare the Cariogram caries risk profiles with and without salivary buffer capacity and mutans streptococci (MS) counts in adolescents with fixed orthodontic appliances. Materials and Methods: The sample consisted of 90 healthy Greek adolescents who were undergoing orthodontic treatment. The Cariogram risk model was applied through a questionnaire and clinical and salivary examinations. The actual chance of avoiding new caries was calculated, and participants were categorized into three groups (0-40% = high caries risk, 41-60% = medium caries risk, and 61-100% = low caries risk) using a nine-item Cariogram or by excluding either salivary buffer capacity or MS or both. Cohen's Kappa statistical analysis was used for comparing the Cariogram outcome with and without salivary variables. The distribution of variables was compared by nonparametric marginal homogeneity tests. Results: Using the Cariogram with nine variables, 62% of the patients were assigned to the high caries risk category, 13% to the medium risk category, and 24% to the low risk category. Omission of salivary buffer capacity did not alter the risk categories significantly, while more subjects were assigned to the medium risk category when MS counts were excluded. The difference between the nine-item Cariogram and the MS-reduced version, however, was not statistically significant (P = .07). Conclusions: The Cariogram model may be used both with and without salivary tests for risk grouping in orthodontic practice.
    The Angle Orthodontist 02/2014; · 1.18 Impact Factor
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    ABSTRACT: To evaluate the performance of an impedance spectroscopy technology for detecting non-cavitated occlusal caries lesions in permanent teeth in vitro. The method was compared with a commonly used laser fluorescence device and validated against histology. A non-cavitated sample of 100 extracted posterior teeth was randomly selected and assessed for caries on enamel and dentin level with aid of CarioScan PRO (ACIS) and DIAGNOdent pen (LF pen) by three examiners. After the measurements, the extension of the lesion was histologically determined as gold standard. Sensitivity, specificity, accuracy and receiver-operating curves were calculated. Intra- and inter-examiner reproducibility was expressed by intra class correlation coefficients. The histological caries prevalence was 99% and 41% exhibited dentin caries. The ACIS technique displayed high specificities but almost negligible sensitivities at readings >50. A similar pattern was noted for the LF pen at readings >30. The intra- and inter-examiner reproducibility varied between 0.47 and 0.98 and the values were generally lower for the ACIS technique than for the LF pen. The inter-examiner agreement reached excellent levels with both methods. In vitro,the ACIS technique showed a low ability to disclose occlusal caries lesions in the enamel and/or dentin of non-cavitated permanent molars. However, further in vivo studies of permanent occlusal surfaces are needed to mirror the clinical situation.
    The Open Dentistry Journal 01/2014; 8:28-32.
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    ABSTRACT: The bacterial profile of saliva is composed of bacteria from different oral surfaces. The objective of this study was to determine whether different diet intake, lifestyle, or socioeconomic status is associated with characteristic bacterial saliva profiles. Stimulated saliva samples from 292 participants with low levels of dental caries and periodontitis, enrolled in the Danish Health Examination Survey (DANHES), were analyzed for the presence of approximately 300 bacterial species by means of the Human Oral Microbe Identification Microarray (HOMIM). Using presence and levels (mean HOMIM-value) of bacterial probes as endpoints, the influence of diet intake, lifestyle, and socioeconomic status on the bacterial saliva profile was analyzed by Mann-Whitney tests with Benjamini-Hochberg's correction for multiple comparisons and principal component analysis. Targets for 131 different probes were identified in 292 samples, with Streptococcus and Veillonella being the most predominant genera identified. Two bacterial taxa (Streptococcus sobrinus and Eubacterium [11][G-3] brachy) were more associated with smokers than non-smokers (adjusted p-value<0.01). Stratification of the group based on extreme ends of the parameters age, gender, alcohol consumption, body mass index (BMI), and diet intake had no statistical influence on the composition of the bacterial profile of saliva. Conversely, differences in socioeconomic status were reflected by the bacterial profiles of saliva. The bacterial profile of saliva seems independent of diet intake, but influenced by smoking and maybe socioeconomic status.
    Journal of Oral Microbiology 01/2014; 6.
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    ABSTRACT: Abstract Objective. It was hypothesized that, by comparing matched subjects with major differences in these dental diseases, but yet normal saliva flow rates, it would be possible to obtain data on the effect of saliva composition on dental disease isolated from the effect of the flow rate. Thus, the aim of the study was to compare the major physicochemical characteristics of stimulated whole saliva in three groups of 85 subjects, each with normal saliva flow rates and at least 24 remaining teeth. Materials and methods. A group with very little dental disease (healthy), a group with dental erosion (erosion) and a group with very high caries experience (caries) were chosen. Furthermore, the aim was to determine whether differences among groups could also be found on an individual level. Results. Although it was not possible to retrieve three groups whose members were completely identical, the present study points in the direction that, on a group level, subjects with very little dental disease seemed to have a more favorable physicochemical saliva composition with respect to higher calcium, phosphate, bicarbonate, pH, degree of saturation with respect to hydroxyapatite and a lower critical pH (p < 0.05 or less). However, on an individual level the explanatory power for the saliva composition was only 10% for caries experience and only 11% for dental erosion (p < 0.001). Conclusion. The compositional analyses performed in this study on stimulated whole saliva, including major physicochemical characteristics of saliva, will most likely have little predictive value for future dental caries and erosion in single individuals.
    Acta odontologica Scandinavica 12/2013; · 1.41 Impact Factor
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    ABSTRACT: Periodontitis is a multifactorial disease in which subgingival bacteria play an important role in the pathogenesis of the disease. The objective of this study was to determine if periodontitis is associated with a characteristic salivary bacterial profile. This was accomplished by comparing the bacterial profile of saliva from subjects with chronic periodontitis with that of saliva from a control cohort. Stimulated saliva samples from 139 chronic periodontitis patients and 447 samples from a control cohort were analysed using the Human Oral Microbe Identification Microarray (HOMIM). Frequency and levels (mean HOMIM-value) of around 300 bacterial taxa/clusters in samples were used as parameters for investigation. Differences at taxon/cluster values between groups were analysed using Mann-Whitney U-test with Benjamini-Hochberg correction for multiple comparisons. Principal component analysis was used to visualize bacterial community profiles obtained by the HOMIM. Eight bacterial taxa, including putative periodontal pathogens as Parvimonas micra and Filifactor alocis, and four bacterial clusters were identified statistically more frequently and at higher levels in samples from periodontitis patients than in samples from the control cohort. These differences were independent of the individuals' smoking status. Periodontitis is associated with a characteristic bacterial profile of saliva different from that of a control cohort.
    Journal Of Clinical Periodontology 11/2013; · 3.69 Impact Factor
  • S. TWETMAN
    10th World Congress on Preventive Dentistry 2013; 10/2013
  • S. TWETMAN
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    ABSTRACT: The first three years of life is a true risk age for ECC due the eruption of 20 new teeth and the child’s total dependence of parental care. Thus, the primary health care system has an essential role in supporting parents to early establish healthy dietary and dental behaviors. The preventive efforts can be organized as a mix of community, individual and vulnerable group strategies and the presentation will provide a current example from Scandinavia. At a first step, a regional geo-mapping of pre-school caries risk, based on current epidemiology, family income, level of education and immigrant status, is performed. Children from areas with a lower caries risk than the average are checked for an individual risk assessment at the age of 1 year. Teeth are examined dry and clean and any sign of early enamel demineralization renders secondary preventive action. Children from areas with a higher caries risk than the average are all offered a collective community oral health program from the age of one year emphasizing self-applied and professional fluorides. For vulnerable groups, such as immigrants and refugees, a tailored outreach approach from ambassadors with cultural and linguistic skills is employed. The current ECC prevalence at 3 years of age varies from 2% in the low-risk areas to 11.5% among the vulnerable groups which partly may be due to a lower the compliance with the primary care programs in the low SES-groups. Thus, the future challenge is to improve the communication on the value of a healthy primary dentition and further support parents to take an active role in oral care.
    10th World Congress on Preventive Dentistry 2013; 10/2013
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    ABSTRACT: This cross-sectional study aimed to investigate the prevalence and experience of dental caries among children from public middle schools in Bucharest in relation to socioeconomic status and access to school-based dental care. Clinical data were collected from 1,595 schoolchildren aged 10-17 years, randomly allocated by clusters into a stratified sample population. The dental caries were scored according to the World Health Organization (WHO) clinical criteria and expressed based on tooth and surface levels [Decayed-Missing-Filled Teeth/Surfaces indices (DMFT/DMFS)]. A questionnaire was administered to the children to determine the education level of their parents and their living standard. The caries prevalence was 75 percent, and 64 percent had untreated caries. The mean DMFT value for the entire sample was 2.8, and its highest component was decayed teeth (mean DT 2). Parental education level had the strongest influence on the caries scores; 70 percent of children whose parents had not completed a university degree had untreated caries (%DT) compared to only 49 percent of children whose parents had a higher level of education (P < 0.05). Children with access to school-based dental care had significantly better dental health (P < 0.05). Compared to previous national surveys, the caries rates among schoolchildren in Bucharest are slowly declining. However, there was still a high proportion of untreated caries with a clear socioeconomic gradient, and a change in the school-based oral preventive strategy is needed to meet the needs of the children.
    Journal of Public Health Dentistry 10/2013; · 1.21 Impact Factor
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    ABSTRACT: Abstract Objective. To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach. Results. Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited. Conclusions. Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.
    Acta odontologica Scandinavica 09/2013; · 1.41 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the relationship between salivary buffer capacity and menarche, and to explore any association with levels of the sex hormone progesterone in stimulated whole saliva in adolescent girls. The material comprised 162 girls, 12 years of age at baseline in the 6th grade, who were followed for 3 years. Every 4th month, a stimulated whole saliva sample was collected, secretion rate and buffer capacity were determined, and information was gathered on menarche, ongoing menses, and caries increment. Once yearly, the salivary concentration of progesterone was determined with an enzyme immunoassay kit. The results showed a significantly impaired salivary buffer capacity over the years (P
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    ABSTRACT: Smoking and the use of smokeless tobacco have a detrimental impact on general and oral health. The relationship to dental caries is however still unclear. As caries is a multi-factorial disease with clear life-style, socio-economic and socio-demographic gradients, the tobacco use may be a co-variable in this complex rather than a direct etiological factor. Our aim was to analyze the impact of tobacco use on caries incidence among adolescents, with consideration to socio-economic variables by residency, using epidemiological data from a longitudinal study in the region of Halland, Sweden. The study population consisted of 10,068 adolescents between 16--19 years of age from whom yearly data on caries and tobacco use (cigarette smoking and use of smokeless tobacco) were obtained during the period 2006--2012. Reported DMFS increment between 16 and 19 years of age ([increment]DMFS) for an individual was considered as the primary caries outcome. The outcome data were compared for self-reported never vs. ever users of tobacco, with consideration to neighborhood-level socio-economy (4 strata), baseline (i.e., 16 years of age) DMFS and sex. The region consists of 65 parishes with various socio-economic conditions and each study individual was geo-coded with respect to his/her residence parish. Neighborhood (parish-level) socio-economy was assessed by proportion of residing families with low household purchasing power. [increment]DMFS differed evidently between ever and never users of tobacco (mean values: 1.8 vs. 1.2; proportion with [increment]DMFS > 0: 54.2% vs. 40.5%; p < 0.0001). Significant differences were observed in each neighborhood-level socio-economic stratum. Even after controlling for baseline DMFS and sex, [increment]DMFS differed highly significantly between the ever and never users of tobacco (overall p < 0.0001). Tobacco use was clearly associated with increased caries increment during adolescence. Hence, this factor is relevant to consider in the clinical caries risk assessment of the individual patient as well as for community health plans dealing with oral health.
    BMC Oral Health 07/2013; 13(1):31. · 1.34 Impact Factor
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    ABSTRACT: Abstract Objectives. To validate a risk classification model according to the Public Dental Service (PDS) guidelines with the actual 3-year caries outcome in terms of predictive values. Materials and methods. All 19-year-old patients registered at eight public dental clinics in Skåne, Sweden were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects, representing 10% of the age group attending the public dental care in the region. A risk classification of each patient in four categories was made by the patient's regular team according to the guidelines. At the follow-up 3 years later, 75.8% were accessible. The final examinations included bitewing radiographs and the actual caries increment for 982 patients was calculated. Results. At baseline, 11.9% were assessed as being at 'high' or 'very high' risk. The dropouts had significantly more caries than the remaining patients (p < 0.05). The general disease activity was low, but those grouped into the two highest risk groups displayed significantly more new caries than those at lower risk (p < 0.05). With a cut-off value ΔDFS > 0 vs DFS = 0, the sensitivity was 81% and the specificity 56% for 'low' risk vs any risk. By combining the 'low' and 'some' risk categories, the PDS model generated an improved specificity (94%). Conclusions. The risk assessment scheme used by the Public Dental Service for young adults relied basically on past and current caries activity and 65-70% of the patients were correctly classified. The model was most effective to screen out patients with low caries risk.
    Acta odontologica Scandinavica 07/2013; · 1.41 Impact Factor

Publication Stats

2k Citations
253.17 Total Impact Points

Institutions

  • 2008–2014
    • IT University of Copenhagen
      København, Capital Region, Denmark
  • 2007–2014
    • University of Copenhagen
      • • Department of Odontology
      • • School of Dentistry
      København, Capital Region, Denmark
    • Jönköping University
      Jönköping, Jönköping, Sweden
  • 2005–2013
    • Region Skåne
      Malmö, Skåne, Sweden
  • 2001–2013
    • Umeå University
      • Department of Odontology
      Umeå, Vaesterbotten, Sweden
  • 1999–2013
    • Malmö University
      • • Department of Cariology
      • • Faculty of Odontology (OD)
      Malmö, Skåne, Sweden
  • 1989–2011
    • Länssjukhuset Ryhov
      Jönköping, Jönköping, Sweden
  • 2006–2008
    • Yeditepe University
      • Faculty of Dentistry
      İstanbul, Istanbul, Turkey
  • 1982–2006
    • Karolinska Institutet
      • • Department of Dental Medicine
      • • Department of Medicine, Huddinge
      Solna, Stockholm, Sweden
  • 2004
    • University of Milan
      • Department of Health Science - DISS
      Milano, Lombardy, Italy
    • Statens folkhälsoinstitut
      Östersund, Jämtland, Sweden
    • King Faisal Specialist Hospital and Research Centre
      • Department of Dentistry
      Jeddah, Mintaqat Makkah, Saudi Arabia
  • 2003
    • University of Southern California
      Los Angeles, California, United States
  • 1998–1999
    • Lund University
      Lund, Skåne, Sweden
  • 1994
    • University of Gothenburg
      • Department of Pedodontics
      Göteborg, Vaestra Goetaland, Sweden