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swedish dental journal vol. 39 issue 2 2015 69
swed dent j 2015; 39: 69-86 norderyd et al
Oral health of individuals
aged 3–80 years in Jönköping, Sweden
during 40 years (1973–2013)
II. Review of clinical and radiographic findings
Ola Norderyd1, 2, Göran Koch1, Apostolos Papias1, Alkisti Anastassaki Köhler1, Anna Nydell Helkimo1,
Carl-Otto Brahm1, Ulrika Lindmark3, Ninita Lindfors1, Anna Mattsson4, Bo Rolander5, Christer
Ullbro1,6, Elisabeth Wärnberg Gerdin7, Fredrik Frisk1
Abstract
The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral
health and compare the results to those of four cross-sectional studies carried out 1973–2003. In 1973, 1983, 1993, 2003,
and 2013 random samples of 1,000; 1,104; 1,078; 987; and 1,010 individuals, respectively, were studied. The individuals
were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80 years. Eighty-year-olds were not inclu-
ded in 1973. All subjects were inhabitants of the city of Jönköping, Sweden.
The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth,
caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment.
The frequency of edentulous individuals aged 40–70 years was 16, 12, 8, 1, and 0.3% in 1973, 1983, 1993, 2003, and 2013,
respectively. No complete denture wearer younger than 80-years old was found in 2013. During the 40-year period, the
mean number of teeth in the age groups 30–80 years increased. In 2013, the 60-year-olds had nearly complete denti-
tions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36
in 2013. This was higher than earlier surveys, 4 in 1993, and 18 in 2003.
The percentage of children and adults without caries and restorations increased during the 40-year period. It was
found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013.
In the age groups 10–20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013, 43%
of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5–60
years, DFS was lower in 2013 compared to the earlier examinations. There was no major change in DFS between 2003
and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40-
year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percen-
tage of crowned teeth in the age goups 40 and 50-year-olds. The percentage of endodontically treated teeth decreased
between 1973 and 2013 in all age groups.
In age groups 10–30-year-olds a major reduction from about 30% to 15% in mean plaque score was seen between
1973–2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older,
a decrease in the percentage of surfaces with plaque was observed between 2003–2013. The percentage of tooth sites
with gingivitis was for 20 years and older about 40% in 1973. In 2013, the percentage was about 15%. The frequency of
sites with gingivitis was generally lower in 2013 compared with the other years, 1973–1993.
The percentage of individuals with probing pocket depths >4mm increased with age. Between 2003–2013 a clear
reduction was seen in all age groups in frequency of individuals with probing pocket depth >4mm. Over the 40-year
period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects
with moderate alveolar bone loss were seen.
The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the
provision of dental helath care and dental delivery system in the near future.
1 The Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden
2 Malmö University, Faculty of Odontology, Malmö, Sweden
3 Jönköping University, Centre for Oral Health, Department of Biomedicine and Natural Sciences, School of Health Sciences, Jönköping, Sweden
4 Public Dental Health Service, Region Jönköping County, Jönköping, Sweden
5 Futurum, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden and Jönköping University, Department of Behavioral Science
and Social Work , School of Health Sciences, Jönköping, Sweden
6 UiT. The Arctic University of Norway, Tromsö, Norway
7 Dental Research Department, Public Dental Ser vice, Region Örebro County, Örebro, Sweden
Key words
Epidemiology, oral health, dental caries, periodontal disease, endodontics
70 swedish dental journal vol. 39 issue 2 2015
Tandhälsoförändringar hos 3–80-åringar i Jönköping
under 40 år (1973–2013)
II. Resultat från kliniska och röntgenologiska undersökningar
Ola Norderyd, Göran Koch, Apostolos Papias, Alkisti Anastassaki Köhler, Anna Nydell Helkimo,
Carl-Otto Brahm, Ulrika Lindmark, Ninita Lindfors, Anna Mattsson, Bo Rolander, Christer Ullbro,
Elisabeth Wärnberg Gerdin, Fredrik Frisk
Sammanfattning
Syftet med denna epidemiologiska studie utförd 2013 var att analysera kliniska och röntgenologiska data om oral
hälsa och jämföra resultaten med fyra tvärsnittsstudier utförda 1973 till 2003. Ettusen, 1104, 1078, 987 och 1010 slumpvis
utvalda individer undersöktes under respektive år1973, 1983, 1993, 2003 och 2013. Individerna var jämnt fördelade i ålders-
grupperna 3, 5, 10, 15, 20, 30, 40, 50, 70 och 80 år. 1973 var inga 80-åringar med. Alla studiedeltagare bodde i Jönköpings
stad.
Vid den kliniska och röntgenologiska undersökningen registrerades tandlöshet, avtagbar protetik, dentala implantat,
antal tänder, karies, fyllningar, munhygien, tandsten, parodontalt status, utförd endodontisk behandling och apikalsta-
tus.
Frekvensen av tandlösa individer 40-70 år var 16 %, 12 %, 8 %, 1 % och 0,3 % under respektive år 1973, 1983, 1993, 2003
och 2013. Det fanns inga helt tandlösa protesbärare yngre än 80 år 2013.
Under hela 40-årsperioden från 1973 ökade antalet tänder i åldersgrupperna 30-80 år. 2013 hade 60-åringar nästan
kompletta dentitioner. Implantat fanns i alla åldersgrupper från 30 år och uppåt. Trettiosex individer hade implantat
2013. Detta var signifikant fler än vid de tidigare undersökningarna med fyra 1993 och arton 2003.
Antalet karies- och fyllningsfria barn och vuxna ökade under hela 40-årsperioden. Kariesfria 3- och 5-åringar ökade
till 79 % respektive 69 % 2013. I åldersgruppen 10-20 år ökade antalet kariesfria individer mellan 2003 och 2013. Antalet
karies- och fyllningsfria 15-åringar 2013 var 43 % jämfört med 20% 2003. I alla åldersgrupper 5-60 år var DFS lägre 2013
jämfört med tidigare undersökningar, medan DFS i åldersgrupperna 70 och 80 år var oförändrad. Den mest uttalade
förändringen var minskningen i antalet fyllda ytor, FS. Bland 15-åringarna registrerades 17,8 FS 1973 jämfört med 0,9 2013.
Bland 40-åringarna var motsvarande siffror för FS 50,8 respektive 13,1.
Avseende andelen kronförsedda tänder var den mest uppenbara förändringen den procentuella minskningen i ålders-
gruppen 50 år från 24 % till 4 %. Andelen rotfyllda tänder minskade mellan 1973 och 2013 i alla åldersgrupper.
I åldersgrupperna 10-30 år sågs en stor reduktion av medelvärdet av plack 1973 – 2003. Endast en mindre förändring
sågs den senaste 10-årsperioden. För åldersgrupperna 40 år och äldre observerades en minskning av tandytor med plack
mellan 2003 och 2013.
Frekvensen av gingivit var generellt lägre 2013 jämfört med undersökningsåren 1973-1993. Ingen förändring i gingivit-
medelvärde noterades mellan 2003-2013 förutom en mindre ökning bland 20-åringarna.
Procenten individer med tandköttsfickor > 4 mm ökade med ålder. Mellan 2003 och 2013 sågs en tydlig minskning i
alla åldersgrupper med fickdjup 4 mm eller mer. Bland 50-åringar var andelen individer med tandköttsfickor > 4 mm
76 % 2003 och 38 % 2013. Över hela 40-årsperioden minskade antal individer med måttlig marginal benförlust och anta-
let individer utan marginal benförlust ökade.
En jämförelse av de fem studierna visar på en stor generell förbättring i oral hälsa över 40 år. Detta kommer innebära
betydande förändringar för tandvården.
swed dent j 2015; 39: 69-86 norderyd et al
swedish dental journal vol. 39 issue 2 2015 71
Introduction
To cope with the need for a better oral health in
Sweden, considerable resources began to be assigned
about 50 years ago. The oral health has since then
underwent a remarkable transformation, according
to earlier epidemiological studies (10, 15). Similar
changes have also been reported for other industri-
alized countries (7, 23, 27).
In 1974 a New Dental Act was introduced in Swe-
den, which made Swedish counties responsible for
providing full dental service free of charge for all
children and adolescents up to the age of 20 years.
In addition, the 1974 National Dental Health Insur-
ance Act instituted an insurance system for the adult
population. Prior to these laws were introduced, a
cross-sectional dental epidemiological survey was
initiated in 1973 in the city of Jönköping in order to
provide a representative picture of the dental health
of the city’s population (17). Repeated cross-section-
al studies were then performed in 1983, 1993, and
2003 and the results have previously been reported
(15). It was shown that the oral health status of the
general population had gradually improved during
the 30-year period of time.
Forty years after the initial survey in this series, in
2013, a further cross-sectional study was performed
aiming to investigate further changes in oral health
over the past decade. The findings from this study
on oral care habits and knowledge of oral health
have been published elsewhere (22).
The aim of the present paper was to describe the
oral health status of the examined population in 2013
with regard to the prevalence of caries, periodonti-
tis, restorations, number of teeth and edentulism.
Further objective was to compare the findings from
the present investigation to those from the previous
ones in 1973, 1983, 1993, and 2003 in terms of changes
in oral health.
Materials and Methods
All invited individuals in this study were inhabitants
in either of four parishes of Kristine, Ljungarum,
Sofia, and Järstorp, in the city of Jönköping, Swe-
den. The same parishes were used for the selection of
samples in the previous surveys in this series (1973,
1983, 1993, and 2003). In 1983, 1993, 2003, and 2013,
130 randomly selected individuals in each of the
age group of 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and
80 years, were invited to an oral examination. To se-
cure enough participants an additional sample was
invited in 2013. For the age groups 3, 5, 10, 15, 30, 40,
and 50 years, additional samples of 15, 15, 15, 55, 40,
40, and 50, respectively, were randomly invited. The
final number of the participants is presented in Ta-
ble 1 for all five surveys.
As in the earlier studies, all subjects received a writ-
ten personal invitation to take part in a dental health
examination. They were informed of the purpose of
the investigation, of the details of the examination
procedures, and about a questionnaire concerning
dental care and dental health care that they would be
asked to fill in at the clinical examination (11).
All individuals participating in the study were ex-
oral health during 40 years
Table 1. Number of subjects examined and sex distribution in each age-group 1973, 1983, 1993, 2003, and 2013.
Agegroup Number examined
1973 1983 1993 2003 2013
Female Male Female Male Female Male Female Male Female Male
3 49 51 59 42 47 53 59 37 40 61
5 47 53 42 66 58 49 45 51 46 46
10 48 52 46 65 67 47 58 58 37 58
15 55 45 55 52 51 51 51 45 49 52
20 60 40 55 45 50 50 38 46 52 23
30 49 51 46 50 63 39 50 42 49 47
40 52 48 52 47 54 39 36 47 49 46
50 60 40 60 43 45 52 50 41 59 45
60 60 40 47 51 50 42 45 45 42 40
70 52 48 51 48 36 64 47 41 53 39
80 50 30 34 37 40 21 39 38
Total 3–80 532 468 565 539 555 523 519 468 515 495
72 swedish dental journal vol. 39 issue 2 2015
amined clinically and radiographically to determine
the state of health of the teeth and jaws as well as
the presence of dental implants and removable den-
tures. The examinations in 2013 were performed by
eight dentists from the Department of Paediatric
Dentistry, Periodontology/Endodontics, Prostho-
dontics, Stomatognathic Physiology, Oral Medicine
at the Institute for Postgraduate Dental Education,
and by three general practitioners from Public Den-
tal Health Service, in Jönköping, Sweden. The ex-
aminations for the survey were performed between
autumn 2013 and autumn 2014.
The reasons why individuals selected for the study
did not participate were registered. Adult non-re-
spondents who could be reached by telephone were
asked about number of teeth, if they were edentulous
and , if they had any type of implants or prosthesis.
Details regarding the sampling procedure, number
of non-respondents and reasons for not taking part
in the study are given elsewhere (22).
Throughout the study, the ethical rules for re-
search described in the Helsinki Declaration (8) were
followed. The 2013 survey was approved in 2012 by
the Ethic Committee at the University of Linköping,
Linköping, Sweden (Dnr 2012/191-31).
Clinical examination
The clinical examinations were carried out in dental
offices with modern equipment and optimal light.
Each clinical-radiographic examination required
60–90 minutes. Before the start of the study, the
examiners were calibrated regarding the diagnostic
criteria. A standardised computerized protocol de-
signed for subsequent data processing was used.
Diagnostic criteria
Prevalence of edentulous individuals and number
of existing teeth.
The number of edentulous individuals and the
number of erupted incisors, canines, premolars, and
molars were recorded. Third molars were excluded
from the analysis. Only primary teeth were recorded
and examined for the 3–5-year-olds while only per-
manent teeth were examined in subjects 10 years or
older.
Caries.
All tooth surfaces that were possible to clinically
evaluate were examined for caries according to the
criteria stated by Koch 1967 (18). Initial caries: loss
of mineral in the enamel giving a chalky appearance
but without any clinical cavitation. Manifest caries:
new carious lesions on surfaces not previously re-
stored and of such extent that they could be verified
as cavities by probing and that, on probing in fis-
sures using light pressure, the probe became stuck.
(See also the radiographic-diagnostic criteria for
caries of approximal surfaces). Secondary caries:
carious lesions according to the criteria of manifest
caries but on restored surfaces.
Plaque.
The presence of visible plaque was recorded for all
tooth surfaces after drying with air according to the
criteria for Plaque Indices (PLI) 2 and 3 (16).
Gingival status.
The occurrence of gingival inflammation corre-
sponding to Gingival Indices (GI) 2 and 3 was re-
corded for all tooth surfaces. Gingival inflammation
was recorded if the gingivae bled on gentle probing
(21).
Probing pocket depth:
In 1973, the presence of probing pocket depths in
the permanent dentition equal to or exceeding 4
mm was recorded for all surfaces. In 1983, 1993, 2003,
and 2013 the pocket depth was recorded in mm. No
measurements were made in pockets of erupting
teeth.
Supragingival calculus.
The presence of supragingival calculus was recorded
for each tooth after drying with air.
Removable dentures.
The presence of removable partial or complete den-
tures in the upper and lower jaws were recorded.
Fissure sealings.
Fissure sealings were recorded.
Restorations.
Each tooth surface was recorded for the presence of
amalgam, glassionomer cement or composite mate-
rial, gold inlays, or metal or porcelain crowns and
bridges. If two materials had been used for restoring
the same surface, the material used most extensive-
ly was recorded. In addition, the presence of bridge
pontics were recorded.
swed dent j 2015; 39: 69-86 norderyd et al
swedish dental journal vol. 39 issue 2 2015 73
Dental implants.
The presence of implants and their location were
recorded.
Radiographic examination
The radiographic examination was carried out us-
ing both extra- and intra-oral radiographs. Due to
improved oral health and ethical considerations, the
radiographic examination was changed compared
to previous studies in this series (12).
In 2013, the radiographic examination of the
3- and 5-year-olds comprised two bite-wing radio-
graphs when there was approximal contact in the
molar regions. In the 10- and 15-year-olds four bite-
wing radiographs were taken. In the 20-, 30-, 40-, and
50-year-olds, an orthopantomogram and six bite-
wing radiographs – two each on the left and right
sides and two in the frontal region – were taken. For
the age groups 60 years and older, an orthopanto-
mogram and a full-mouth, intra-oral radiographic
examination including periapical and bite-wing
radiographs was performed in dentate individuals.
When teeth with deep carious lesions or root-filled
teeth were recognized, an additional periapical ra-
diographic examination was performed.
Edentulous individuals were radiographically ex-
amined by means of orthopantomograms.
Radiographic diagnostic criteria
Radiographically verifiable initial caries on proxi-
mal tooth surfaces:
a) the lesion was not deeper than 2/3 of the enamel
or b) the lesion was deeper than 2/3 of the enamel
but did not involve the dentine.
Radiographically verifiable manifest caries on
proximal tooth surfaces:
The lesion extended into the dentine.
Classification according to the severity of the peri-
odontal disease experience:
All dentate individuals were classified according to
clinical and radiographic findings using Hugoson &
Jordan’s criteria (1982):
Group 1. Healthy or almost healthy gingival units
and normal alveolar bone height; <_ 12 bleeding gin-
gival units in the molar–pre-molar regions.
Group 2. Gingivitis; >12 bleeding gingival units in
the molar–pre-molar regions; normal alveolar one
height.
Group 3. Alveolar bone loss around most teeth not
exceeding 1/3 of the length of the roots.
Group 4. Alveolar bone loss around most teeth rang-
ing between 1/3 and 2/3 of the length of the
roots.
Group 5 Alveolar bone loss around most teeth ex-
ceeding 2/3 of the length of the roots; presence of
angular bony defects and/or furcation defects.
Subgingival calculus:
The dentition was divided into sextants, delimited
by the canines in each jaw. Subgingival calculus visi-
ble interproximally was recorded. A sextant was reg-
istered as having calculus when calculus was visible
interproximally on at least one tooth surface.
Endodontic treatment and periapical status was re-
corded as follow:
1. Tooth not treated endodontically but with a peri-
apical or juxtaradicular destruction.
2. Endodontically treated tooth (amputated or root
canal filled).
Destruction was recorded when there was a locally
widened periodontal membrane, a loss of lamina
dura or destruction of bone adjacent to the root.
Other findings.
Findings on the radiographs which could not be cat-
egorised into any of the above mentioned diagnoses
were noted. These findings were listed separately for
dentate and edentulous individuals.
Additional variables
Occlusion, status of the oral mucosa, dental erosion,
enamel disturbances, orthodontic treatment need
(15–20-year-olds), salivary factors such as secretion
rate, buffer capacity, endodontically treated teeth
with periapical or juxtaradicular destruction, root
surface caries, stomatognathic variables, function of
complete or removable partial dentures, and preva-
lence and position of third molars were registered.
The results of these examinations will not be pre-
sented in this review but will be published later.
Data processing
The questionnaires and clinical records were de-
veloped as a web survey in the software program
EsMaker NX2 (Entergate AB, Halmstad, Sweden).
Frequencies, mean values, and distributions were
calculated. Data processing was performed with
SPSS version 22 (IBM Corporation, Armonk, New
York State, USA).
oral health during 40 years
74 swedish dental journal vol. 39 issue 2 2015
Results
Non-respondents
Depending on age group, 28–45% (mean 39%) of the
3–80-year-olds who were invited to participate in the
study declined to take part for various reasons. The
number of non-respondents was about 7% higher in
2013 compared with 2003 (22).
Prevalence of edentulous individuals and presence of
complete or partial dentures
The number of edentulous individuals and the
number of individuals with complete or partial den-
tures in one or both jaws over the 40 years from 1973
to 2013 are presented in Table 2. The frequency of
edentulous individuals aged 40–70 years was 16, 12, 8,
1, and 0.3% in 1973, 1983, 1993, 2003, and 2013, respec-
tively. No complete denture wearer younger than 80
years old was found in 2013. In total, 8 individuals
were edentulous in 2013, of whom two 70 years old
and one 80 years old, had implant supported pros-
theses (Table 3). The totally frequency of individu-
als, aged 40–70 years old, with removable dentures
of any kind was 38, 28, 19, 18, and 4% in 1973, 1983,
1993, 2003, and 2013, respectively.
Number of existing teeth (excluding edentulous
individuals)
The mean number of existing teeth is displayed
in Figures 1 and 2. In these figures, edentulous in-
dividuals are excluded. During the 40-year period,
the mean number of teeth in the age groups 30–80
years increased. In 2013, the 60-year-olds had nearly
complete dentitions. The age-groups 70 and 80 had
a mean number of teeth of 22.5 and 21.1, respectively
(Fig. 1). The frequency distributions of teeth in dif-
ferent tooth type groups are presented in Figures 2.
In 2013, most of the individuals had a complete set
of incisors and canines. In 70-year-olds, the mean
number of premolars increased from 2.4 in 1973 to
6.2 in 2013. The corresponding figures for molars
were 1.0 and 5.3 respectively. The increase in mean
number of teeth among the older age groups 60–80
years were due to an increase in premolars and mo-
lars.
Dental implants
In Table 3, the number of individuals and implants
in edentulous and dentate individuals are present-
ed. Implants were found in all age groups from 30
years of age. The total number of individuals with
implants was 36 in 2013. This was higher than earlier
surveys, 4 in 1993, and 18 in 2003.
Table 2. Number of denture wearers in the age groups 40–80 years in 1973, 1983, 1993, 2003, and 2013.
Age Complete dentures (edentulous) Complete denture (one jaw)
group
1973 1983 1993 2003 2013 1973 1983 1993 2003 2013
Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male
40 1 - - - - - - - - - - 2 2 - - - - -
50 3 2 3 1 - - - - 3 7 2 2 1 1 - - 1
60 12 8 9 5 5 4 3 1 2 6 3 5 - 6 5 1
70 21 16 19 10 10 13 - 1 8 9 10 6 11 2 7 1 3 1
Total 63 47 32 5 0 37 30 21 14 5
80 - - 30 15 10 20 1 2 4 1 - - 3 6 6 3 4 1 2 2
Removable partial dentures
1973 1983 1993 2003 2013
Female Male Female Male Female Male Female Male Female Male
40 1 - 2 1 1 - 1 - 1
50 5 5 4 1 2 2 - 2 1
60 9 8 6 7 4 7 2 2 4 2
70 10 15 11 7 4 4 7 2 2 1
Total 53 39 22 16 11
- - 7 6 8 3 6 2 1 2
swed dent j 2015; 39: 69-86 norderyd et al
swedish dental journal vol. 39 issue 2 2015 75
oral health during 40 years
Table 2. Number of denture wearers in the age groups 40–80 years in 1973, 1983, 1993, 2003, and 2013.
Age Complete dentures (edentulous) Complete denture (one jaw)
group
1973 1983 1993 2003 2013 1973 1983 1993 2003 2013
Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male
40 1 - - - - - - - - - - 2 2 - - - - -
50 3 2 3 1 - - - - 3 7 2 2 1 1 - - 1
60 12 8 9 5 5 4 3 1 2 6 3 5 - 6 5 1
70 21 16 19 10 10 13 - 1 8 9 10 6 11 2 7 1 3 1
Total 63 47 32 5 0 37 30 21 14 5
80 - - 30 15 10 20 1 2 4 1 - - 3 6 6 3 4 1 2 2 0
5
10
15
20
25
30
3 5 10 15 20 30 40 50 60 70 80
1973 19.7 19.7 18.2 27.1 27.2 25.8 23.2 21.5 18.2 13.3
1983 19.8 19.3 16.5 27.2 27.4 26.9 24.8 22.7 18.6 15.5 13.7
1993 19.9 19.7 14.1 27.1 27.3 27.3 26.6 24.7 21.7 18.1 15.7
2003 19.9 19.8 16.8 27.0 27.4 27.2 26.5 26.1 23.3 20.7 18.4
2013
18.5
17.4
16.7
27.6
27.2
27.0
27.2
26.1
25.0
22.5
21.1
Number of teeth
Age group
Fig. 1. Number of existing teeth (excluding edentulous individuals). Means in the different age
groups in 1973, 1983, 1993, 2003, and 2013.
1973
1983
1993
2003
2013
Table 3. Number of individuals with dental implants (number in brackets) in the age groups 20 to 80 years in 2003 and 2013.
Age group Edentulous Edentulous one jaw
Upper Lower
2003 2013 2003 2013 2003 2013
20
30
40
50
60 1 (11 implants) 2 (5; 6 implants) 2 (5; 6 implants)
70 2 (6; 11 implants) 1 (6 implants) 2 (5;6 implants) 1 (6 implants) 1 (5 implants)
80 1 (11 implants) 1 (6 implants)
Dentate individuals
2003 2013
20
30 1 (2 implants) 2 (1; 4 implants)
40 2 (1 implant) 1 (2 implants)
50 2 (1; 3 implants)
60 1 (3 implants) 5 (3x1; 2; 3 implants)
70 4 (1; 2; 5; 6 impl.) 10 (3x1; 5x2; 3; 6 implants)
80 3 (1; 1; 5 implants) 9 (1; 5x2; 3; 6; 7 implants
Fig. 1. Number of existing teeth (excluding edentulous individuals).
Means in the different age groups in 1973, 1983, 1993, 2003, and 2013.
76 swedish dental journal vol. 39 issue 2 2015
0
2
4
6
20 30 40 50 60 70 80
1973
4.0
4.0
3.9
3.5
2.9
1.8
1983
4.0
4.0
3.9
3.7
3.0
2.4
1.4
1993
4.0
4.0
4.0
3.9
3.6
3.6
3.3
2003
4.0
4.0
4.0
4.0
3.7
3.6
3.4
2013
4.0
4.0
4.0
3.9
3.9
3.7
3.7
Age group
Canines
0
2
4
6
8
20 30 40 50 60 70 80
1973
7.7
7.3
6.6
5.9
4.1
2.4
1983
7.5
7.5
7.0
6.2
4.5
3.2
1.6
1993
7.4
7.6
7.4
7.1
6.2
5.3
4.4
2003
7.5
7.5
7.1
7.3
6.4
5.7
4.9
2013
7.3
7.2
7.5
7.0
6.9
6.2
5.9
Age group
Premolars
0
2
4
6
8
20 30 40 50 60 70 80
1973
7.6
6.7
5.2
3.9
2.3
1.0
1983
7.9
7.5
6.3
4.7
2.8
1.8
0.7
1993
8.0
7.8
7.5
6.2
4.8
3.0
2.1
2003
7.9
7.8
7.5
7.1
5.9
4.2
3.1
2013
8.0
8.0
8.0
7.4
6.4
5.3
4.5
Age group
Molars
0
2
4
6
8
20 30 40 50 60 70 80
1973
7.9
7.8
7.6
6.8
5.4
3.3
1983
8.0
7.9
7.7
7.2
5.6
4.5
2.4
1993
8.0
8.0
8.0
7.8
7.7
7.6
7.4
2003
7.9
7.9
7.9
7.8
7.3
7.1
6.9
2013
8.0
7.9
8.0
7.8
7.7
7.2
7.0
Number of teeth
Age group
Incisors
swed dent j 2015; 39: 69-86 norderyd et al
Fig. 2. Number of incisors,
canines, premolars, molars (excluding
edentulous individuals). Means in the
different age groups in 1973, 1983,
1993, 2003, and 2013.
swedish dental journal vol. 39 issue 2 2015 7 7
oral health during 40 years
Caries and restorations
Caries (decayed) data are presented as the sum of
clinically and radiographically verifiable initial and
manifest caries. The percentage of children and
adults without caries or restorations increased dur-
ing the 40-year period (Table 4). It was found that
the percentage of caries-free 3- and 5-year-olds in-
creased to 79% and 69%, respectively, of the individ-
uals in 2013. In the age groups 10–20 years, the per-
centage of caries-free individuals increased between
2003 and 2013. In 2013, 43% of the 15-year-olds were
completely free from caries and restorations com-
pared to 20% in 2003.
In Table 5, the mean numbers of decayed and filled
teeth (dft/DFT) are given for the various age groups.
Up to the age of 60 years, the number of DFT de-
clined in 2013 compared to 2003 while only a minor
change was found for the age groups 70–80 years.
Figure 3 displays the total mean number of de-
cayed and filled tooth surfaces (dfs/DFS), decayed
tooth surfaces (ds/DS), and filled tooth surfaces (fs/
FS). In all age groups from 5–60 years, DFS were
lower in 2013 compared to the earlier examinations.
Only minor changes were seen in the age group 3
years between 1993 and 2013. There was no major
change in the number of DFS between 2003 and 2013
in the age groups 70 and 80 years. The most obvious
change was the decrease in number of FS over the
40-year period of time. Among 15-year-olds, 17.8 FS
were registered in 1973 compared to 0.9 in 2013. In
the 40-year-olds, the corresponding figures are 50.8
and 13.1, respectively.
In Table 6, the mean numbers of DFS are given for
the occlusal, proximal, buccal, and lingual surfaces.
Generally, the number of occlusal and proximal DFS
decreased in the age groups 10–60 years over time.
Concerning the occlusal surfaces, a reduction of DFS
in the age groups 10–50 years was seen in 2013 com-
pared to the earlier examinations. In the15-year-olds
the number of decayed or filled occlusal surfaces was
11.9 in 1973, compared to 0.9 in 2013. Regarding the
buccal and lingual surfaces DFS decreased in the age
groups 10–60 years.
The percentage of restorations with secondary
caries in 2013 was between 0.1 and 2.7 (Table 7).
Similar figures were recorded in 2003. In 1973, the
percentage of restorations with secondary caries was
higher compared to the other years.
Figure 4 shows the percentage of crowned teeth
for various age groups in 1973, 1983, 1993, 2003, and
2013. The most obvious changes was the decrease in
percentage of crowned teeth in the age groups 40–60
years. The percentage of crowned teeth was for the
50-year-olds, 24.5 in 1973 and 3.7 in 2013, expressed
as percentage of existing teeth.
Plaque
The frequency of tooth surfaces exhibiting plaque in
percentage of existing tooth surfaces is shown in Fig-
ure 5. In the age group 3 years no change in the total
plaque score was seen between 1973 and 2013. In age
group 5 years, there was a slight decrease in the total
plaque score during 40 years. In age-groups 10–30
years a reduction in mean plaque score was seen be-
tween 1973 and 2003. Only a minor change in plaque
score was seen the last decade in 10–30-year-olds.
For the age-groups 40 years and older, a general de-
crease in the percentage of surfaces with plaque was
observed between 2003 and 2013. In the 50-year-olds
the percentage of tooth surfaces with plaque was
44.3 in 1973 and 15.1 in 2013.
Gingivitis
The frequency of sites exhibiting gingivitis in per-
centage of existing sites is shown in Figure 6. No
change was seen in mean gingivitis score between
2003 and 2013, except for a slight increase in 20-year-
olds. The frequency of sites with gingivitis was gen-
erally lower in 2013 compared with the other years,
1973–1993. In the 50-year-olds the percentage of
tooth surfaces with gingivitis was 38.5 in 1973 and
15.3 in 2013.
Probing pocket depth
Table 8 show the percentage of individuals with
one or more deepened periodontal pockets >4mm
in 1973, 1983, 1993, 2003, and 2013. The percentage
of individuals with probing pocket depths >4mm
increased with age. Between 2003 and 2013 a clear
reduction was seen in all age groups in frequency
of individuals with probing pocket depth >4mm.
About 80% of the 50-year-old individuals showed
between 1973 and 2003 at least one pocket with prob-
ing pocket depth >4mm. The corresponding figure
for 2013 was about 40% of the individuals.
Periodontal disease experience
In Figure 7, frequency distribution of periodontal
disease experience is described. Over the 40-year pe-
riod an increase was seen in the frequency of indi-
viduals with no marginal bone loss from 8% in 1973
to 44% in 2003 and 45% in 2013. The percentage of
individuals with moderate severity of periodontal
78 swedish dental journal vol. 39 issue 2 2015
0
20
40
60
3 5 10 15 20 30 40 50 60 70 80
1973
3.9
11.2
9.3
27.7
35.1
48.4
52.6
50.5
44.5
41.0
1983
2.3
5.9
5.0
11.2
21.5
40.7
53.0
53.6
46.2
39.1
34.4
1993
1.2
3.7
2.6
11.7
15.6
23.3
41.2
55.2
53.2
52.4
45.2
2003
1.8
3.5
1.7
6.4
9.7
14.0
23.3
37.0
52.5
51.0
53.8
2013
1.3
1.9
1.1
2.9
5.9
10.9
16.4
25.0
37.0
46.4
47.8
Number of surfaces Decayed-lled
Age group
0
20
3 5 10 15 20 30 40 50 60 70 80
1973
3.7
10.3
4.2
9.9
6.5
1.7
1.9
2.4
7.8
3.2
1983
2.1
3.5
1.6
4.8
4.5
3.3
2.4
1.6
1.3
1.5
1.5
1993
1.2
2.9
2.0
9.2
6.7
3.6
1.5
0.9
0.8
0.4
0.6
2003
1.7
3.0
1.2
4.7
5.2
4.3
2.5
0.8
0.6
0.4
1.0
2013
1.2
1.6
0.9
2.0
3.7
3.7
3.3
2.1
2.0
1.3
2.9
Age group
Decayed
0
20
40
60
3 5 10 15 20 30 40 50 60 70 80
1973
0.1
0.8
5.1
17.8
28.6
46.8
50.8
48.2
41.1
37.8
1983
0.2
2.3
3.6
6.6
17.0
37.4
50.6
52.0
44.8
37.6
32.9
1993
0.0
0.8
0.6
2.6
9.0
19.7
39.7
54.3
52.4
52.0
44.6
2003
0.0
0.5
0.5
1.7
4.6
9.7
20.7
36.1
52.0
50.6
52.8
2013
0.1
0.3
0.2
0.9
2.1
7.2
13.1
22.9
35.0
45.1
44.9
Filled
Age group
swed dent j 2015; 39: 69-86 norderyd et al
Fig. 3. Number of decayed (ds/DS) and filled (fs/FS) tooth surfaces Means in the dif ferent age groups in 1973, 1983, 1993, 2003,
and 2013.
swedish dental journal vol. 39 issue 2 2015 79
oral health during 40 years
Table 5. Mean number of decayed and filled teeth (dft/DFT) in various age groups in 1973, 1983, 1993, 2003, and 2013.
Agegroup dft/DFT
1973 1983 1993 2003 2013
3 2.7 1.6 1.0 1.5 1.0
5 6.5 4.3 2.5 2.6 1.5
10 3.8 3.9 4.0 1.4 0.9
15 15.0 7.8 10.8 4.3 2.3
20 17.3 12.1 9.2 5.9 4.3
30 18.6 17.5 11.8 7.8 6.2
40 18.1 19.2 16.3 11.5 8.9
50 16.8 18.3 18.1 15.0 11.7
60 13.6 14.7 16.1 17.0 15.0
70 10.9 12.8 14.5 15.8 16.6
80 10.6 12.3 15.3 15.8
Table 4. Frequency (%) of individuals without caries and restorations in 1973, 1983, 1993, 2003, and 2013.
Agegroup Caries-free individuals (%)
1973 1983 1993 2003 2013
3 35 70 72 69 79
5 9 29 48 46 69
10 1 17 37 52 61
15 0 6 14 20 43
20 0 2 3 12 19
30 0 0 1 8 8
40 0 0 1 0 3
50 0 0 0 0 0
60 0 0 1 2 0
70 0 0 1 0 0
80 0 0 1 2 8
80 swedish dental journal vol. 39 issue 2 2015
disease experience had decreased from 47% in 1973
to 22% in 2013.
Calculus
The frequency of tooth sections with subgingival
calculus as percentage of existing dentate sextants
are presented in Table 9. Generally, a lower percent-
age of subgingival calculus was seen in the surveys
2003 and 2013 compared to the previous examina-
tions 1973–1993. In age group 20 years an increase in
frequency of subgingival calculus was seen between
2003 and 2013.
Periapical status and endodontic treatment
Table 10 shows the frequency of teeth that have not
been endodontically treated but exhibited periapical
or juxtaradicular destructions. The frequency of en-
dodontically treated teeth expressed as percentage of
existing teeth is also given. The percentage of teeth
not endodontically treated but exhibiting periapical
or juxtaradicular destructions were few and of the
same magnitude since 1983. The percentage of endo-
dontically treated teeth decreased from 1973 to 2013
in all age groups. In the age groups 70 and 80 years,
about 13–19% of all teeth had been endodontically
treated in 2013.
Discussion
This paper is part two in a series of publications de-
scribing oral health in individuals aged 3–80 years
in the city of Jönköping, Sweden during a period of
40 years. In paper one (22), there is a detailed pres-
entation of the study population, non-respondents,
findings on dental care habits, and knowledge of
oral health. In the present paper, an overview of the
clinical and radiographic findings from the same
study population is given. To avoid repetition, parts
of the discussion in the first paper can be applied to
this discussion.
In 2013, the non-response rate was 28–45% in the
various age groups. This is in line with or lower than
in other recent studies (10, 20). In this study many
of the selected individuals could not be reached by
letter or telephone. There is a trend among people
not answering telephone calls from unfamiliar num-
bers suspecting telephone sales companies. Various
reasons were given for not wanting to come to the
examination.None of them were likely to have had
any major influence on the results (22).
Table 6. Mean number of decayed and filled occlusal, proximal, buccal, and lingual tooth surfaces (DFS)
in various age groups in 1973, 1983, 1993, 2003, and 2013.
Age- dfs/DFS
group Occlusal Proximal Buccal + lingual
1973 1983 1993 2003 2013 1973 1983 1993 2003 2013 1973 1983 1993 2003 2013
3 0.8 0.7 0.5 0.7 0.5 0.8 1.3 0.3 0.1 0.2 2.3 0.3 0.5 1.0 0.6
5 3.1 2.0 1.1 1.1 0.5 4.1 3.3 1.4 1.3 1.0 4.0 0.6 1.2 1.1 0.5
10 4.6 3.3 0.6 0.5 0.3 1.4 1.1 0.6 0.6 0.4 3.3 0.6 1.3 0.6 0.4
15 11.9 5.2 2.6 1.5 0.9 9.8 5.6 6.0 3.0 1.3 6.0 0.4 3.7 1.9 0.6
20 11.5 9.4 6.0 2.8 1.7 16.3 10.4 6.0 5.0 3.4 7.3 1.7 2.9 2.0 0.6
30 10.2 12.4 9.3 5.0 4.1 28.0 22.3 10.4 6.9 5.3 10.2 6.0 3.5 2.1 1.3
40 12.5 12.3 12.5 9.4 6.4 27.5 29.4 20.3 10.3 7.3 12.6 11.3 8.4 3.5 2.5
50 9.5 10.6 13.2 11.5 9.8 26.6 29.0 27.6 18.1 10.0 14.4 14.0 14.3 7.3 4.6
60 8.8 7.1 11.4 12.8 11.7 21.4 24.1 25.8 25.4 14.8 14.3 15.0 16.0 14.3 9.8
70 9.0 5.6 10.6 10.9 12.7 19.3 19.5 24.1 24.7 17.6 12.7 14.0 17.7 15.1 15.4
80 4.3 8.9 11.1 11.8 17.4 20.4 22.9 16.4 12.7 15.0 19.7 18.2
Table 7. Frequency (%) of restored tooth sur faces
with secondary caries.
Age
group 1973 1983 1993 20 03 2013
10 13.9 2.8 7.6 0.0 0.0
15 7.5 1.8 5.7 0.0 0.0
20 8.6 1.9 0.3 0.2 0.1
30 4.8 2.5 3.2 0.3 0.2
40 6.8 2.9 2.0 0.7 0.2
50 8.6 3.5 2.8 0.8 0.7
60 8.9 2.8 2.4 0.8 1.0
70 12.6 3.7 4.3 0.8 1.2
80 8.3 5.8 2.0 2.7
swed dent j 2015; 39: 69-86 norderyd et al
swedish dental journal vol. 39 issue 2 2015 81
0
10
20
30
40
20 30 40 50 60 70 80
1973 0.5 3.4 7.5 24.5 22.4 30.5
1983 0.0 1.4 7.2 15.0 27.2 33.8 37.6
1993 0.0 1.0 3.2 14.2 19.9 38.8 34.9
2003 0.0 0.4 1.7 6.8 23.7 22.7 38.6
2013 0.0 0.4 1.1 3.7 8.3 30.0 32.8
Crowned teeth %
Age group
1973
1983
1993
2003
2013
Fig. 4. Frequency (%) of crowned teeth as a percentage of existing teeth. Means in the different age groups in
1973, 1983, 1993, 2003, and 2013.
0
20
40
60
80
100
3 5 10 15 20 30 40 50 60 70 80
1973 7.8 12.3 33.9 29.4 29.1 30.3 40.4 44.3 49.7 66.2
1983 9.8 11.9 30.6 26.0 19.9 25.3 31.8 37.5 41.1 43.1 62.1
1993 8.3 11.0 33.2 32.5 33.2 30.1 34.7 32.5 36.7 42.8 55.8
2003 7.9 8.8 14.4 12.6 15.6 19.7 22.3 18.9 23.3 25.1 30.7
2013 7.2 5.6 13.0 9.9 11.6 19.2 14.7 15.1 16.7 19.1 22.6
Plaque %
Age group
Fig. 5. Frequency (%) of total number of tooth surfaces with plaque as a percentage of total number
of existing surfaces. Means in the different age groups in 1973, 1983, 1993, 2003, and 2013.
1973
1983
1993
2003
2013
oral health during 40 years
Fig. 4. Frequency (%) of crowned teeth as a percentage of existing teeth. Means in the different age groups in 1973,
1983, 1993, 2003, and 2013.
Fig. 5. Frequency (%) of total number of tooth surf aces with plaque as a percentage of total number of existing
surfaces. Means in the dif ferent age groups in 1973, 1983, 1993, 2003, and 2013.
82 swedish dental journal vol. 39 issue 2 2015
Table 8. Frequency (%) of individuals with probing
pocket depth >4 mm in 1973, 1983, 1993, 2003, and 2013.
Agegroup Percentage of individuals with probing depth >_4 mm
1973 1983 1993 2003 2013
15 17 24 13 2
20 21 37 34 14 5
30 56 65 43 47 32
40 70 80 63 61 36
50 75 89 87 76 38
60 83 85 87 78 62
70 79 85 84 82 62
80 86 81 90 56
0
20
40
60
80
3 5 10 15 20 30 40 50 60 70 80
1973 4.8 11.5 26.3 23.2 34.5 23.9 32.7 38.5 43.5 60.2
1983 3.5 4.7 19.1 18.6 17.4 24.6 26.1 29.3 26.7 32.0 34.6
1993 6.1 9.3 18.7 20.9 32.2 31.8 28.7 31.5 30.6 26.4 36.2
2003 5.7 4.8 10.3 10.4 11.8 17.4 16.0 15.1 15.2 16.4 18.2
2013 2.4 1.8 7.1 6.9 19.4 17.3 16.1 15.3 15.1 19.3 19.5
Gingivitis %
Age group
Fig. 6. Frequency (%) of total number of sites with gingivitis as a percentage of total number of
existing sites. Means in the different age groups in 1973, 1983, 1993, 2003, and 2013.
1973
1983
1993
2003
2013
Owing to expected lower disease activity, and ow-
ing to ethical considerations, fewer intra-oral radio-
graphs were taken in 2013. This limitation in the ra-
diographic examination, however, does not preclude
the use of the diagnostic criteria that were used in
the earlier studies.
This study presents data on oral health covering
a 40-year period 1973–2013. In the early 1970s an ex-
tensive preventive activity started up in the county of
Jönköping with emphasis on diet, oral hygiene and
fluoride (13). Such programmes were initiated also
in other parts of Sweden during the same period due
to a generally poor oral health. These programmes
have during the years been modified according to
new knowledge. When analyzing changes in in oral
health during the 40-year period in the present study
it has to be understood that a large group of the indi-
viduals up to 50-year-olds have taken part in preven-
tive programmes during at least their first 20 years of
life. Dental caries, if not controlled, is a progressing
process that during life time steadily increases the
need for restorations, endodontic treatment, crown
and bridgework and finally edentulousness. If caries
is controlled during childhood and adolescences a
better oral health can be expected in the older ages
by time, much depending on that primary carious
lesions are not so commonly developing in adults as
in younger ages. This is clearly shown in the present
study.
The oral health situation of the examined popula-
tion has improved extensively if it is judged by the
prevalence of edentulousness and number of exist-
ing teeth. The prevalence of edentulous individuals
with complete dentures in the age-groups 40–70
years, decreased from approximately every sixth
individual in 1973 to none in 2013. There were still
edentulous subjects among the age-groups but these
individuals had received implant-supported pros-
theses in one or both jaws. The number of existing
teeth kept increasing in the older age-groups 60–80
years, while only minor changes were recorded
among the younger age-groups during the last dec-
swed dent j 2015; 39: 69-86 norderyd et al
Fig. 6. Frequency (%) of total number of sites with gingivitis as a percentage of total number of existing sites.
Means in the different age groups in 1973, 1983, 1993, 2003, and 2013.
swedish dental journal vol. 39 issue 2 2015 83
Fig. 7. Distribution of all individuals 20-70 years
regarding periodontal health and periodontal
disease
experience in Jönköping 1973-2013.
8
23 22
44 45
41 22
38
18 24
47
41
27 28 22
2 11 10 7 7
1 2 3 4 2
0%
20%
40%
60%
80%
100%
1973 1983 1993 2003 2013
Individuals
Year
Advanced, group 5
Severe, group 4
Moderate, group 3
Gingivitis, group 2
Healthy, group 1
ade. Up to the age of 60 years, the individuals had
almost complete dentitions. In the oldest age-group,
80 years, the mean existing number of teeth reached
one of WHO goals, stipulating that more than 50%
should be able to retain a minimum of 20 function-
al teeth (31). Consequently, the need for replacing
missing teeth with prosthetic restorations is decreas-
ing. Corresponding findings regarding prevalence of
edentulousness, removable dentures and number of
remaining teeth are in line with other studies (7, 10,
20, 23, 27).
The well-established technique of replacing miss-
ing teeth by means of osseointegrated implants has
become a common method of rehabilitation. A two
time increase in number of individuals with dental
Table 9. Frequency (%) of tooth sections with subgingival
calculus as a percentage of existing dentate sextants.
Agegroup Subgingival calculus
1973 1983 1993 2003 2013
3
5
10 0.8 0.0 0.0 0.0 0.0
15 6.8 0.5 1.3 0.0 0.0
20 15.3 2.2 5.5 1.4 8.3
30 39.4 19.4 15.5 13.6 20.6
40 52.4 27.1 24.6 17.7 16.0
50 58.8 29.3 27.8 20.1 25.6
60 61.7 30.8 22.8 20.5 21.5
70 59.0 30.0 29.1 20.9 22.6
80 32.3 40.4 17.2 14.3
Table 10. Periapical status and endodontic treatment.
Age- Percentage of teeth not endodontically Percentage of endodontically
group treated exhibiting periapical or treated teeth
juxtaradicular destructions
1973 1983 1993 2003 2013 1973 1983 1993 2003 2013
3 1.0 0 0 0 0 0 0 0 0 0
5 2.2 0 0 0 0 0 0 0 0 0
10 0.1 0 0 0 0 0 0 0.1 0.1 0
15 0.2 0.1 0 0.3 0 0 0.2 0.2 0 0
20 0.3 0.1 0 0 0 1.3 0.6 0.3 0.2 0.2
30 0.7 0.4 0 0 0.3 5.8 3.4 1.6 0.8 1.1
40 1.2 0.8 0.4 0.9 0.4 11.4 9.9 4.0 2.3 1.5
50 1.3 1.3 1.0 0.9 1.0 17.4 14.9 9.3 5.0 2.6
60 3.5 1.6 1.1 0.8 3.2 19.2 21.4 15.2 12.0 6.7
70 4.1 2.3 1.6 2.3 1.8 25.6 21.3 23.7 17.8 13.6
80 7.0 2.0 1.4 2.1 0 26.8 23.5 27.5 18.7
oral health during 40 years
Fig. 7. Distribution of all individuals 20–70 years regarding periodontal health and per iodontal disease
experience in Jönköping 1973–2013.
84 swedish dental journal vol. 39 issue 2 2015
implants were found in 2013 compared to the pre-
vious study in 2003. During the same period the
prevalence of removable dentures has decreased
among dentate individuals. In Sweden, the dental
care system includes in part economical financing
of the treatment with implant supported prosthesis,
which at least in part explains the increasing number
of subjects with dental implants.
When caries data are analyzed in the present study
it should be observed that the caries figures are the
sums of initial and manifest caries. Compared to
most other studies, where initial carious lesions are
excluded, this means that the caries situation in the
present study is no underestimation.
The oral health improvement seen over this 40-
year period is clearly reflected in the decreasing
number of carious lesions and restorations. This
dramatic reduction in caries may be exemplified by
the number of DFS in 15- and 20-year-olds who in
1973 had 28 and 35 DFS and in 2013 had 3 and 6 DFS,
respectively. The trend is very clear. The number
of DFS decreased decades after decades in all age-
groups but for the 70- and 80-year-olds. The latter
can be explained by the increasing number of ex-
isting teeth. The percentage of individuals without
carious lesions and restorations is also increasing
through the years and reached for the 15-year-olds
43% in 2013. The mean number of DF occlusal sur-
faces had also decreased. In the age group 20-year-
olds these numbers had been reduced from 12 to 2
between 1973 and 2013. This remarkable reduction
in caries and restorations in a caries prone tooth
surface should be ascribed a general fissure sealing
programme of all molars in close relation to erup-
tion (30). This fissure sealing programme was a
part of the above mentioned preventive activity. It
is reasonable to believe that a constant decrease in
carious lesions in the long run should have an effect
on the number of crowned teeth and endodontically
treated teeth. In the present study the percentage of
crowned teeth was reduced from 25% in 1973 to 4%
in 2013 in the 50-year-old group. The correspond-
ing figures for endodontically treated teeth in the
same age group was 17 and 3%, respectively. Thus
the reduced caries prevalence clearly indicates that
treatment need for more complicated procedures
will decrease.
A problem over the next decade will be the in-
creasing amount of treatment needed in the age-
groups 70-80 years due to more remaining teeth
and also a large number of restorations. However,
in all other younger age-groups, a decreasing need
for restorative treatment in the coming years can
be seen. This is also reflected in the present study
where a dramatic decrease in number of crowned
and endodontically treated teeth was observed. This
means that, although we still have a number of pa-
tients with extensive treatment needs, resources will
gradually be released.
Only a minor decrease in plaque score was seen
the last decade in 10–30-year-olds. For the age-
groups 40 years and older, a general decrease in the
percentage of surfaces with plaque was observed be-
tween 2003 and 2013. Visible plaque were recorded
without using a disclosing solution or a periodon-
tal probe. This method can underestimate the real
plaque score. However, even taking a possible under-
estimation of the mean plaque values into account,
the important finding is the positive trend of bet-
ter oral hygiene over the 40-year period, shown in
all age-groups except the youngest. A similar trend
was seen in gingivitis scores. The frequency of sites
with gingivitis was generally lower in 2003 and in
2013 compared with the other years, 1973–1993, in all
age groups.
Over the 40-year period an increase in the num-
ber of individuals with no marginal bone loss and a
decrease in the number of subjects with moderate
alveolar bone loss were seen. This is an interesting
finding due to the fact that more teeth are remaing
even in the older age groups.
This study is a descriptive presentation of epide-
miological data from a 40-year period and covering
the age-groups 3–80 years in the city of Jönköping,
Sweden. Major trends in oral health improvement
were seen between 1973 and 2013, expressed as less
edentulousness individuals, more remaining teeth,
less carious lesions, less restorations, and better
periodontal status. For better understanding of the
changes over time in-depth analysis of the data is
required and will be presented in subsequent papers.
An important question in epidemiological studies
is whether the results can be regarded as representa-
tive for a population greater then the one studied.
In the paper in this series published 2005 the pos-
sibility of generalizing data was discussed (15). The
trends in oral health development described in the
present paper are verified by several cross-sectional
epidemiological studies performed in different parts
in Sweden and at different times, which justify the
assumption that data from this study can be used to
draw general conclusions and to describe oral health
trends representative for Sweden (10, 20, 28, 29, 33).
In conclusion, this epidemiologic study which
swed dent j 2015; 39: 69-86 norderyd et al
swedish dental journal vol. 39 issue 2 2015 85
covers the last 40 years has shown a great and con-
tinuous improvement of dental health and a de-
crease of treatment need in age-groups 3–80 years.
This has implications for most parts of the dental
delivery system such as number of dental personel,
the dental insurance system, the under- and post-
graduate dental education, and for further research
activities. This is a demanding and serious challenge
for the dental profession.
Acknowledgements
Thanks to Kerstin Gröndahl, Kerstin Gustafsson,
Helén Janson, Martin Åberg, and dental assistants
in all involved departments at the Institute for Post-
graduate Dental Education. Also thanks to assisting
personnel from School of Health Sciences.
A very special thank goes to Anders Hugoson who
was the most important initiator to this series of oral
health surveys.
Financial support was provided by Public Dental
Health Service, and Futurum Academy for Health
and Care, Region Jönköping County, Sweden and
Medical Research Council of Southeast Sweden,
Linköping, Sweden.
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Corresponding author:
Dr Ola Norderyd
The Institute for Postgraduate Dental Education
P.O. Box 1030
SE-55111 Jönköping,
Sweden
E-mail: ola.norderyd@rjl.se
swed dent j 2015; 39: 69-86 norderyd et al
