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Tan, E., Lexomboon, D., Sandborgh-Englund, G., Haasum, Y. & Johnell, K. (2018). Medications That Cause Dry Mouth As an Adverse Effect in Older People: A Systematic Review and Metaanalysis. Journal of The American Geriatrics Society, 66(1), 76-84
Open this publication in new window or tab >>Medications That Cause Dry Mouth As an Adverse Effect in Older People: A Systematic Review and Metaanalysis
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2018 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 66, no 1, p. 76-84Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To assess and quantify the risk of drug-induced dry mouth as a side effect in older people. DESIGN: Systematic review and meta analysis. SETTING: A search of the literature was undertaken using Medline, Embase, Cochrane, Web of Science, and PubMed from 1990 to 2016. PARTICIPANTS: Older people (aged ≥60) who participated in intervention or observational studies investigating drug use as an exposure and xerostomia or salivary gland hypofunction as adverse drug outcomes. MEASUREMENTS: Two pairs of authors screened titles and abstracts of studies for relevance. Two authors independently extracted data, including study characteristics, definitions of exposure and outcome, and methodological quality. For the metaanalyses, random-effects models were used for pooling the data and I2 statistics for exploring heterogeneity. RESULTS: Of 1,544 potentially relevant studies, 52 were deemed eligible for inclusion in the final review and 26 in meta analyses. The majority of studies were of moderate methodological quality. In the intervention studies, urological medications (odds ratio (OR) = 5.91, 95% confidence interval (CI) = 4.04–8.63; I2 = 62%), antidepressants (OR = 4.74, 95% CI = 2.69–8.32, I2 = 21%), and psycholeptics (OR = 2.59, 95% CI = 1.79–3.95, I2 = 0%) were significantly associated with dry mouth. In the observational studies, numbers of medications and several medication classes were significantly associated with xerostomia and salivary gland hypofunction.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
xerostomia; dry mouth; medication; systematic review; metaanalysis
National Category
Medical and Health Sciences Geriatrics
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-65019 (URN)10.1111/jgs.15151 (DOI)
Available from: 2017-10-30 Created: 2017-10-30 Last updated: 2018-06-12
Lexomboon, D., Tan, E. C., Höijer, J., Garcia-Ptacek, S., Eriksdotter, M., Religa, D., . . . Sandborgh-Englund, G. (2018). The Effect of Xerostomic Medication on Oral Health in Persons With Dementia. Journal of the American Medical Directors Association, 19(12), 1080-1085
Open this publication in new window or tab >>The Effect of Xerostomic Medication on Oral Health in Persons With Dementia
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2018 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 12, p. 1080-1085Article in journal (Refereed) Published
Abstract [en]

Objectives: Medication-induced hyposalivation can increase the risk for oral complications, including dental caries and tooth loss. This problem is particularly important in people with dementia because of their declining ability to maintain oral care. The objective of this study was to describe the association between the number of xerostomic medications used and tooth loss and restorative and dental preventive treatment in a population of persons with dementia. Design: A longitudinal population-based register study with a 3-year follow-up was conducted. Data were extracted from the Swedish Dementia Registry (SveDem), the Swedish Prescribed Drug Register (SPDR), the Swedish National Patient Register (SNPR), and the Dental Health Register (DHR). Setting and participants: Participants were persons with dementia who were registered in the SveDem at the time of their dementia diagnosis. Measures: The exposure was continuous use of xerostomic medications over the 3 years prior to dementia diagnosis (baseline). The outcomes were the incidence of tooth extractions, tooth restorations, and dental preventive procedures. Poisson regression models were used to estimate incidence rate ratios (IRRs) for the association between the exposure and outcomes, adjusting for relevant confounders. Results: A total of 34,037 persons were included in the analysis. A dose-response relationship between the exposure and tooth extractions was observed. Compared with nonusers of xerostomic medication, the rate of tooth extractions increased with increasing number of xerostomic medications used (IRR = 1.03, 1.11, and 1.40 for persons using an average >0-1, >1-3, and >3 xerostomic medications, respectively). However, the risk for having new dental restorations and receiving preventive procedures did not differ between groups. Conclusion: Continuous use of xerostomic medications can increase the risk for tooth extraction in people with dementia. This study highlights the importance of careful consideration when prescribing xerostomic medications to people with dementia, and the need for regular and ongoing dental care.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
aged, Dementia, dental care, longitudinal studies, medication, national register, polypharmacy, tooth loss, xerostomia
National Category
Health Sciences
Research subject
Dental Hygiene
Identifiers
urn:nbn:se:kau:diva-69029 (URN)10.1016/j.jamda.2018.05.014 (DOI)000450912100009 ()2-s2.0-85049308751 (Scopus ID)
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-12-06Bibliographically approved
Lexomboon, D., Karlsson, P., Adolfsson, J., Ekbom, A., Naimi-Akbar, A., Bahmanyar, S., . . . Sandborgh-Englund, G. (2017). Consumption and direct costs of dental care for patients with head and neck cancer: A 16-year cohort study. PLoS ONE, 12(8), Article ID e0182877.
Open this publication in new window or tab >>Consumption and direct costs of dental care for patients with head and neck cancer: A 16-year cohort study
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0182877Article in journal (Refereed) Published
Abstract [en]

Patients with head and neck (H&N) cancer are commonly treated with surgery and/or radiotherapy, which can increase the risk of oral infection, dental caries, and periodontal disease. The present study investigated dental care consumption and costs in patient with H&N cancer before and after the cancer diagnosis. Data from Swedish regional and national registers were used to follow up dental care utilization and dental procedure costs. The analysis included 2,754 patients who had been diagnosed with H&N cancer (exposed cohort) in Stockholm County, Sweden, during 2000–2012 and 13,036 matched persons without cancer (unexposed cohort). The exposed cohort was sub-grouped into irradiated and non-irradiated patients for analysis. The exposed cohort underwent a moderately higher number of dental procedures per year than the unexposed cohort in both the year of the cancer diagnosis and the year after cancer diagnosis; in addition, these numbers were higher in the irradiated than in the non-irradiated subgroup of the exposed cohort. Dental care consumption and costs in the exposed cohort declined over time but remained at a slightly higher level than in the unexposed cohort over the long term (more than two years). Examinations and preventive procedures accounted for most of the higher consumption in the short term (2 years) and at the longer term follow-up. Swedish national insurance subsidized costs for dental treatment, which were highest in the irradiated subgroup and lowest in the unexposed cohort. Direct costs to the patient, however, were similar among the groups. Swedish national health insurance protects patients with H&N cancer from high dental expenditures. Further studies on the cost-effectiveness of preventive dental care for patients are needed.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2017
Keywords
Cancer detection and diagnosis, Dental and oral procedures, Cancer treatment, Surgical oncology, Surgical and invasive medical procedures, Radiation therapy, Swedes, Long-term care
National Category
Cancer and Oncology
Research subject
Biomedical Sciences
Identifiers
urn:nbn:se:kau:diva-62865 (URN)10.1371/journal.pone.0182877 (DOI)000408355800038 ()
Funder
Stockholm County Council, OF18101423
Available from: 2017-08-31 Created: 2017-08-31 Last updated: 2019-04-04Bibliographically approved
Lexomboon, D., Carlson, C., Andersson, R., von Bultzingslowen, I. & Mensah, T. (2016). Incidence and causes of dental trauma in children living in the county of Varmland, Sweden. Dental Traumatology, 32(1), 58-64
Open this publication in new window or tab >>Incidence and causes of dental trauma in children living in the county of Varmland, Sweden
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2016 (English)In: Dental Traumatology, ISSN 1600-4469, E-ISSN 1600-9657, Vol. 32, no 1, p. 58-64Article in journal (Refereed) Published
Abstract [en]

AimThe aims of this study were to determine the incidence of injuries to permanent incisors in 2011-2013 in children aged 8-10years living in the county of Varmland, Sweden, and to compare it with the incidence rates in 1989/1990 in the county of Vastmanland, as well as to determine the cause of dental trauma in relation to time and place. MethodThe study analysed the patient records from dental visits (2011-2013) of trauma to the permanent incisors in children aged 8-10years. The incidence rates were the incidence per 1000 children at risk. Standardized incidence rates were calculated for the comparison between different years. Information about month, location where the trauma occurred as well as cause of trauma was recorded. ResultsA total of 2.2% of 21721 children aged 8-10years had experienced at least one trauma. The incidence rate in Varmland increased from 18.9 in 2011 to 21.3 in 2012 to 28.5 in 2013. The standardized incidence rate in Varmland in 2011 and 2012 was not significantly different than in Vastmanland in 1989/1990 (P>0.05), but the standardized rates in 2013 were significantly higher than in 1989/90 (P<0.001). Dental trauma occurred most often outdoors, followed by sports arenas/sports fields, and more often at school than at home. Falling and slipping was the most common cause of trauma, followed by accidents during leisure activities, playing and sports. ConclusionThe incidence rate for dental trauma has not decreased in the past 20years, and there is an indication that parents and teachers should be more aware of the risks of dental trauma at leisure times and at school as well as during sports and exercise.

Keywords
dental trauma, trauma incidence, facial trauma, playground safety, school safety, sports accident
National Category
Health Sciences
Research subject
Dental Hygiene; Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-41124 (URN)10.1111/edt.12218 (DOI)000369186300011 ()26351260 (PubMedID)
Available from: 2016-03-23 Created: 2016-03-23 Last updated: 2019-07-12Bibliographically approved
Lexomboon, D., Wårdh, I., Parker, M. G. & Thorslund, M. (2015). Determinants of tooth loss and chewing ability in mid- and late life in three Swedish birth cohorts. Ageing & Society, 35(5), 1304-1317
Open this publication in new window or tab >>Determinants of tooth loss and chewing ability in mid- and late life in three Swedish birth cohorts
2015 (English)In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 35, no 5, p. 1304-1317Article in journal (Refereed) Published
Abstract [en]

The aim of the research presented is to determine the influence of socio-economic factors in childhood and mid-life on multiple tooth loss and chewing problems in mid- and late life in three Swedish birth cohorts (1903–1910, 1911–1920 and 1921–1925). Longitudinal national Swedish surveys were used for the analysis. Participants were interviewed in mid-life in 1968 and later in life (77–99 years of age) in 2002. Childhood socio-economic positions (SEP) did not result in different odds of multiple tooth loss and chewing problems in mid- and late life, but persons with higher mid-life SEP had lower odds. Persons born into the 1921–1925 birth cohort had significantly lower odds of multiple tooth loss in late life than the 1903–1910 birth cohort. Women had higher odds of losing multiple teeth than men in late life but not mid-life. Neither gender nor childhood and mid-life SEP predicted chewing problems late in life, but older people with multiple tooth loss had higher odds of chewing difficulty than those with mainly natural teeth. Childhood conditions may contribute to multiple tooth loss in mid-life, which subsequently contributes to multiple tooth loss in late life. Tooth loss in late life is strongly associated with difficulty chewing hard food. Prevalence of multiple tooth loss is higher in women than in men in late life but not in mid-life.

Keywords
Tooth loss, chewing difficulty, tooth loss, birth cohorts, socio-economic position
National Category
Health Sciences
Research subject
Dental Hygiene
Identifiers
urn:nbn:se:kau:diva-33490 (URN)10.1017/S0144686X14000282 (DOI)000357882700008 ()
Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2018-06-20Bibliographically approved
Lexomboon, D. (2014). The oral health of the elderly; yesterday, today and tomorrow. In: Age Well: Challenges for Individuals and Society. Paper presented at 22nd Nordic Congress of Gerontology Gothenburg 25-28 May, 2014.
Open this publication in new window or tab >>The oral health of the elderly; yesterday, today and tomorrow
2014 (English)In: Age Well: Challenges for Individuals and Society, 2014Conference paper, Oral presentation only (Other academic)
Abstract [en]

Oral health of elderly person has many close links to general health and wellbeing. Periodontal disease is associated with various diseases such as diabetes, cardiovascular diseases, and stroke. Common oral health conditions among the elderly population, such as xerostomia/hyposalivation, difficulty in swallowing, yeast infection, poor taste sensation, and poor chewing ability, can lead to poor quality of life. Epidemiological data show higher proportion of Swedish elderly persons maintains their natural teeth in their old age. The Swedish population surveys report the proportion of persons aged 65-76 years being edentulous has decreased from higher than 80% in 1968 to lower than 30% in 2002. The 34-year longitudinal data analysis shows that persons who were born in more recent birth cohort had lower risk of tooth loss and chewing difficulty at old age.The analysis also shows that childhood social position, an indicator for risk and protective factors, increases risk for multiple tooth loss at midlife and also are associated with social position at midlife. Social position at midlife contributes to multiple tooth loss at old age, which subsequently increases risk for difficulty chewing hard food. Additional data analysis also shows that chewing difficulty increases risk for cognitive impairment.The longitudinal data analysis also shows that prevalence of multiple tooth loss is higher in women than in men at old age but not in midlife, while there is no gender different in chewing difficulty neither at midlife nor at old age.While elderly persons tend to maintain their teeth at old age, it becomes great important that they also maintain good oral hygiene since poor oral hygiene can increase risk for periodontal diseases and aspiration pneumonia. Special attention should also be given to prevent tooth loss in women in mid-to-late life.

National Category
Health Sciences
Research subject
Dental Hygiene
Identifiers
urn:nbn:se:kau:diva-33496 (URN)
Conference
22nd Nordic Congress of Gerontology Gothenburg 25-28 May, 2014
Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2018-06-20Bibliographically approved
Lexomboon, D., Trulsson, M., Wårdh, I. & Parker, M. G. (2013). CHEWING ABILITY AND DEMENTIA RESPONSE: Response letter to Savikko et al.. Journal of The American Geriatrics Society, 61(5), 851-852
Open this publication in new window or tab >>CHEWING ABILITY AND DEMENTIA RESPONSE: Response letter to Savikko et al.
2013 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 61, no 5, p. 851-852Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
Keywords
Cognition Disorders/complications* Cognition Disorders/physiopathology* Female Humans, Male, Mastication physiology, Tooth Loss complications, Tooth Loss physiopathology
National Category
Dentistry
Research subject
Dental Hygiene
Identifiers
urn:nbn:se:kau:diva-38451 (URN)10.1111/jgs.12240 (DOI)000319002100045 ()23672569 (PubMedID)
Available from: 2015-12-11 Created: 2015-11-19 Last updated: 2018-06-20Bibliographically approved
Lexomboon, D. & Tau-ngam, P. (2013). The community-based oral health promotion in a rural area, Thailand. In: Effective Integration of Oral Health into Health Systems: . Paper presented at 10th IADR World Congress on Preventive Dentistry (WCPD), Budapest, 9–12 October 2013.
Open this publication in new window or tab >>The community-based oral health promotion in a rural area, Thailand
2013 (English)In: Effective Integration of Oral Health into Health Systems, 2013Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Introduction: The dental caries in preschool children living in underserved remote rural areas in Thailand is a dental public health problem. The limited access to dental care contributes to the significance of an effective oral health promotion program that based on resources available in these areas. Objectives: To reduce dental caries rate and risk behaviours in pre-school children as well as to increase oral care knowledge and attitude of child-caretakers living in underserved rural areas. Method: A pilot community-based oral health promotion program was launched in Srimongkol Sub-district, Kanchanaburi Province. The program included tooth brushing after lunch, limited cariogenic snacking during school time, oral health educational games, fluoride varnish application every six months by dental nurses in school setting, and mass media oral health campaign in the village. Results: A three-year evaluation compared caries experiences of 40 children at year-three in a childcare center at the evaluation year (Program group, PG) with 18 children at year-three at the beginning of the program (Control group, CG). The PG children were slightly older than the CG children (73.6±7.6 vs. 69.4±4.1 months; p<.05). The dmft of the PG children was 8.8±4.3, significantly lower than 12.1±4.4 of the CG children (p<.01). However, the new caries rate was 3.0±2.6 teeth in three years. Of the PG children, the percentages of parents who had increased knowledge on child oral care were 64.3 – 90.9%, the percentage who thought that primary teeth were important increased 55.6%, and the percentage who believed that he/she could prevent caries in his/her child increased 20.0%. Conclusion: Children who joined the program had significantly lower caries experience compared to the control group and the parents had better knowledge and attitude about child oral care at evaluation year. A controlled field study with larger number of children and a cost-effectiveness study are indicated.

National Category
Health Sciences
Research subject
Dental Hygiene
Identifiers
urn:nbn:se:kau:diva-33492 (URN)
Conference
10th IADR World Congress on Preventive Dentistry (WCPD), Budapest, 9–12 October 2013
Note

Abstract ID#: 182778

Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2019-08-28Bibliographically approved
Lexomboon, D., Trulsson, M., Wårdh, I. & Parker, M. G. (2012). Chewing ability and tooth loss: association with cognitive impairment in an elderly population study. Journal of The American Geriatrics Society, 60(10), 1951-1956
Open this publication in new window or tab >>Chewing ability and tooth loss: association with cognitive impairment in an elderly population study
2012 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 60, no 10, p. 1951-1956Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To determine whether there is an association between tooth loss, chewing ability, and cognitive function in a general elderly population.

DESIGN: Data from the Panel Study of Living Conditions of the Oldest Old in 2002 were analyzed. Stepwise logistic regression analyses were used to examine the relationship between cognitive function and tooth loss and chewing ability.

PARTICIPANTS: Five hundred fifty-seven persons who were nationally representative of the Swedish population aged 77 and older.

MEASUREMENTS: Cognitive function was measured using the abridged version of the Mini-Mental State Examination. Information on dental status and chewing difficulty was obtained according to self-assessment.

RESULTS: Persons with multiple tooth loss and persons with difficulty chewing hard food had significantly higher odds of cognitive impairment. When adjusted for sex, age, and education, the odds of cognitive impairment were not significantly different between persons with natural teeth and with multiple tooth loss, but the odds of impairment remained significantly higher for persons with chewing difficulty even when adjusted for sex, age, education, depression, and mental illness.

CONCLUSION: Sex, age, education, and certain illnesses do not explain the association between cognition and chewing ability. Whether elderly persons chew with natural teeth or prostheses may not contribute significantly to cognitive impairment as long as they have no chewing difficulty. The results add to the evidence of the association between chewing ability and cognitive impairment in elderly persons.

Keywords
chewing ability, multiple tooth loss, cognitive impairment, elderly population
National Category
Gerontology, specialising in Medical and Health Sciences
Research subject
Dental Hygiene
Identifiers
urn:nbn:se:kau:diva-16198 (URN)10.1111/j.1532-5415.2012.04154.x (DOI)000309740400022 ()
Available from: 2012-12-18 Created: 2012-12-18 Last updated: 2018-06-20Bibliographically approved
Vichayanrat, T., Steckler, A., Tanasugarn, C. & Lexomboon, D. (2012). The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool children. Southeast Asian Journal of Tropical Medicine and Public Health, 43(2), 526-539
Open this publication in new window or tab >>The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool children
2012 (English)In: Southeast Asian Journal of Tropical Medicine and Public Health, ISSN 0125-1562, Vol. 43, no 2, p. 526-539Article in journal (Refereed) Published
Abstract [en]

This study reports the effects of a pilot multi-level oral health interventionon caregivers’ oral health practices and their determinants. Quasi-experimental,pretest-posttest evaluations using a comparison group design were employedto evaluate the effectiveness of a proposed intervention for promoting caregiveroral health behavior. The intervention consisted of three components: home visitsby lay health workers (LHWs), enhancing oral health education and services athealth centers, and community mobilization. These components were designedto target factors at intrapersonal, interpersonal, organizational and communitylevels based on a Social Ecological Model (SEM). Four oral health behaviors associatedwith early childhood caries (infant bottle feeding, tooth brushing, snackconsumption and fluoride use), and multi-level determinants were assessed duringpre- and post-tests. The one-year intervention demonstrated a positive effect ontooth brushing, using toothpaste, and fluoride supplements, but did not have asignificant effect on bottle feeding and snack consumption among children. Theintervention also had no effect on dental caries; in fact caries increased in bothcontrol and experimental groups. The caregiver knowledge, attitudes, outcomeexpectations, and self-efficacy towards these behaviors were significantly increasedin the experimental group after intervention. Caregivers in the experimentalgroup received greater social support by LHWs and health center staff than thosein the control group (p<0.001). The program had an impact on integrating oralhealth services at health centers and community participation in children’s oralhealth. These findings confirm multi-level factors influence reported oral healthbehavior, but not outcomes in terms of caries. Process evaluation is needed todetermine actual implementation levels, barriers and suggests for modificationof the program in the future to improve outcomes in terms of caries.

Keywords
social ecoloical model, oral health promotion, early childhood caries, caregivers, preschool children
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Dental Hygiene
Identifiers
urn:nbn:se:kau:diva-14287 (URN)
Available from: 2012-07-10 Created: 2012-07-10 Last updated: 2018-06-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9309-543x

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