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Cetrelli L, Lundestad A, Gil EG, Fischer J, Halbig J, Frid P, Angenete O, Rosén A, Tylleskär KB, Luukko K, Nordal E, Åstrøm AN, Skeie MS, Stunes AK, Bletsa A, Sen A, Feuerherm AJ, Rygg M. Serum and salivary inflammatory biomarkers in juvenile idiopathic arthritis-an explorative cross-sectional study. Pediatr Rheumatol Online J 2024; 22:36. [PMID: 38461338 PMCID: PMC10924355 DOI: 10.1186/s12969-024-00972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/21/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Biomarkers may be useful in monitoring disease activity in juvenile idiopathic arthritis (JIA). With new treatment options and treatment goals in JIA, there is an urgent need for more sensitive and responsive biomarkers. OBJECTIVE We aimed to investigate the patterns of 92 inflammation-related biomarkers in serum and saliva in a group of Norwegian children and adolescents with JIA and controls and in active and inactive JIA. In addition, we explored whether treatment with tumor necrosis factor inhibitors (TNFi) affected the biomarker levels. METHODS This explorative, cross-sectional study comprised a subset of children and adolescents with non-systemic JIA and matched controls from the Norwegian juvenile idiopathic arthritis study (NorJIA Study). The JIA group included individuals with clinically active or inactive JIA. Serum and unstimulated saliva were analyzed using a multiplex assay of 92 inflammation-related biomarkers. Welch's t-test and Mann-Whitney U-test were used to analyze the differences in biomarker levels between JIA and controls and between active and inactive disease. RESULTS We included 42 participants with JIA and 30 controls, predominantly females, with a median age of 14 years. Of the 92 biomarkers, 87 were detected in serum, 73 in saliva, and 71 in both biofluids. A pronounced difference between serum and salivary biomarker patterns was found. Most biomarkers had higher levels in serum and lower levels in saliva in JIA versus controls, and in active versus inactive disease. In serum, TNF and S100A12 levels were notably higher in JIA and active disease. The TNF increase was less pronounced when excluding TNFi-treated individuals. In saliva, several biomarkers from the chemokine family were distinctly lower in the JIA group, and levels were even lower in active disease. CONCLUSION In this explorative study, the serum and salivary biomarker patterns differed markedly, suggesting that saliva may not be a suitable substitute for serum when assessing systemic inflammation in JIA. Increased TNF levels in serum may not be a reliable biomarker for inflammatory activity in TNFi-treated children and adolescents with JIA. The lower levels of chemokines in saliva in JIA compared to controls and in active compared to inactive disease, warrant further investigation.
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Affiliation(s)
- Lena Cetrelli
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway.
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anette Lundestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Children's Clinic, St. Olavs University Hospital, Trondheim, Norway
| | | | - Johannes Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
| | - Josefine Halbig
- Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
- Department of Clinical Dentistry, The Arctic University of Norway (UiT), Tromsø, Norway
| | - Paula Frid
- Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
- Department of Clinical Dentistry, The Arctic University of Norway (UiT), Tromsø, Norway
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway
| | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St. Olav Hospital HF, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Eastman Institute, Public Dental Health Service, Stockholm, Sweden
| | - Karin B Tylleskär
- Child and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Keijo Luukko
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
| | - Ellen Nordal
- Department of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
- Department of Pediatrics, University Hospital of Northern Norway, Tromsø, Norway
| | - Anne N Åstrøm
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
- Oral Health Centre of Expertise in Western Norway (TkV), Bergen, Norway
| | - Marit S Skeie
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
| | | | - Athanasia Bletsa
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
- Oral Health Centre of Expertise in Western Norway (TkV), Bergen, Norway
| | - Abhijit Sen
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Astrid J Feuerherm
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Children's Clinic, St. Olavs University Hospital, Trondheim, Norway
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Gil EG, Åstrøm AN, Lie SA, Rygg M, Fischer J, Rosén A, Bletsa A, Luukko K, Shi XQ, Halbig J, Frid P, Cetrelli L, Tylleskär K, Rosendahl K, Skeie MS. Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis. Acta Odontol Scand 2023; 81:50-65. [PMID: 35635806 DOI: 10.1080/00016357.2022.2078505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes. MATERIAL AND METHODS In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10-16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual. RESULTS 144 and 159 adolescents with JIA were evaluated according to OHI-S and GBI; corresponding numbers of controls were 154 and 161. Plaque and gingival bleeding were more frequent in individuals with JIA than controls. Adjusted analyses showed association between JIA status and OHI-S > 0 (OR = 2.33, 95% CI: 1.47 - 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 - 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups. CONCLUSIONS Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.
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Affiliation(s)
| | | | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Johannes Fischer
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Athanasia Bletsa
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway, Vestland, Norway
| | - Keijo Luukko
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Xie-Qi Shi
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Josefine Halbig
- Public Dental Health Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Dentistry, The Arctic University of Norway, Tromsø, Norway
| | - Paula Frid
- Public Dental Health Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Dentistry, The Arctic University of Norway, Tromsø, Norway.,Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Lena Cetrelli
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - Karin Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Clinical Dentistry, The Arctic University of Norway, Tromsø, Norway.,Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Marit Slåttelid Skeie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
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3
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Gil EG, Skeie MS, Halbig J, Jönsson B, Lie SA, Rygg M, Fischer J, Rosén A, Bletsa A, Luukko K, Shi XQ, Frid P, Cetrelli L, Tylleskär K, Rosendahl K, Åstrøm AN. Oral health-related quality of life in 4-16-year-olds with and without juvenile idiopathic arthritis. BMC Oral Health 2022; 22:387. [PMID: 36068497 PMCID: PMC9450232 DOI: 10.1186/s12903-022-02400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated oral health-related quality of life (OHRQoL) in young individuals with juvenile idiopathic arthritis (JIA). Aims were to investigate whether OHRQoL differs between children and adolescents with JIA compared to controls without JIA, while adjusting for socio-demographic-, behavioral- and oral health-related covariates. Furthermore, to explore whether socio-behavioral and oral health-related covariates of OHRQoL vary according to group affiliation and finally, specifically for individuals with JIA, to investigate whether disease-specific features associate with OHRQoL. We hypothesized that participants with JIA have poorer OHRQoL compared to participants without JIA. METHODS In this comparative cross-sectional study participants with JIA (n = 224) were matched to controls without JIA (n = 224). OHRQoL was assessed according to Early Childhood Oral Health Impact Scale (ECOHIS) (4-11-years-olds) and the child version of Oral Impacts on Daily Performances (Child-OIDP) (12-16-years-olds). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-demographic, behavioral and self-reported oral health information collected by questionnaires. Index teeth were examined for caries by calibrated dentists. Multiple variable analyses were performed using logistic regression, reporting odds ratio (OR) and 95% confidence interval (CI). Two-way interactions were tested between group affiliation and the socio-behavioral- and oral health-related variables on the respective outcome variables. RESULTS In total, 96 participants with JIA and 98 controls were evaluated according to ECOHIS, corresponding numbers for Child-OIDP was 125 and 124. Group affiliation was not associated with impaired ECOHIS or Child-OIDP in adjusted analyses (OR = 1.95, 95% CI 0.94-4.04 and OR = 0.99, 95% CI 0.46-2.17, respectively). Female adolescents with JIA were more likely than males to report oral impacts according to Child-OIDP. Continued activity or flare was found to adversely affect Child-OIDP, also self-reported outcome measures in JIA associated with Child-OIDP. CONCLUSIONS This study did not provide consistent evidence to confirm the hypothesis that children and adolescents with JIA are more likely to have impaired OHRQoL compared to their peers without JIA. However, female adolescents with JIA were more likely than males to report impacts on OHRQoL. Furthermore, within the JIA group, adolescents with continued disease activity, flare or reporting pain, physical disability, had higher risk than their counterparts of impaired OHRQoL.
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Affiliation(s)
- Elisabeth G Gil
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
| | - Marit S Skeie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Center for Oral Health Services and Research, TkMidt, Trondheim, Norway
| | - Josefine Halbig
- Public Dental Health Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Birgitta Jönsson
- Public Dental Health Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Periodontology, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Johannes Fischer
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Athanasia Bletsa
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway, Vestland, Norway
| | - Keijo Luukko
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Xie-Qi Shi
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Paula Frid
- Public Dental Health Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.,Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Lena Cetrelli
- Center for Oral Health Services and Research, TkMidt, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Karin Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.,Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Anne N Åstrøm
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Fischer J, Halbig J, Augdal T, Angenete O, Stoustrup PB, Dahl Kristensen K, Slåttelid Skeie M, Tylleskär K, Rosén A, Shi X, Rosendahl K. Observer agreement of imaging measurements used for evaluation of dentofacial deformity in juvenile idiopathic arthritis. Dentomaxillofac Radiol 2022; 51:20210478. [PMID: 35466687 PMCID: PMC10043626 DOI: 10.1259/dmfr.20210478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine the precision of imaging measures commonly used to assess mandibular morphology in children and adolescents with juvenile idiopathic arthritis (JIA). Secondly, to compare cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) in the measurement of condylar height. METHODS Those included were children diagnosed with JIA during 2015-18 who had had an MRI, a CBCT of the temporomandibular joints (TMJs) and a lateral cephalogram (ceph) of the head within one month of each other. Agreement within and between observers and methods was examined using Bland-Altman mean-difference plots and 95% limits of agreement (LOA). A 95% LOA within 15% of the sample mean was considered acceptable. Minimal detectable change (MDC) within and between observers was estimated. RESULTS 90 patients (33 males) were included, with a mean age of 12.8 years. For MRI, intra- and interobserver 95% LOA were relatively narrow for total mandibular length: 9.6% of the sample mean. For CBCT, condylar height, both intra- and interobserver 95% LOA were wide: 16.0 and 28.4% of the sample mean, respectively. For ceph, both intra- and interobserver 95% LOA were narrow for the SNA-angle and gonion angle: 5.9 and 8% of the sample mean, and 6.2 and 6.8%, respectively. CONCLUSIONS We have identified a set of precise measurements for facial morphology assessments in JIA, including one MRI-based (total mandibular length), one CBCT-based (condylar height), and three ceph-based. Condylar height was higher for MRI than for CBCT; however, the measurement was too imprecise for clinical use. MDC was also determined for a series of measurements.
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Affiliation(s)
- Johannes Fischer
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Josefine Halbig
- Public Dental Service Competence Centre of Northern-Norway (TkNN), Tromsø, Norway
| | | | | | | | | | | | - Karin Tylleskär
- The Children’s Clinic at Haukeland University Hospital, Bergen, Norway
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Cetrelli L, Bletsa A, Lundestad A, Gil EG, Fischer J, Halbig J, Frid P, Angenete O, Lillevoll I, Rosén A, Tylleskär KB, Luukko K, Nordal E, Åstrøm AN, Skeie MS, Feuerherm AJ, Sen A, Rygg M. Vitamin D, oral health, and disease characteristics in juvenile idiopathic arthritis: a multicenter cross-sectional study. BMC Oral Health 2022; 22:333. [PMID: 35941635 PMCID: PMC9361556 DOI: 10.1186/s12903-022-02349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Vitamin D deficiency has been associated with autoimmune diseases and oral health. Knowledge about the association between vitamin D status and oral conditions in JIA is limited. We aimed to investigate vitamin D status in a cohort of Norwegian children and adolescents with JIA and possible associations between serum vitamin D levels, clinical indicators of oral health, and JIA disease characteristics. Methods This multi-center, cross-sectional study, included individuals with JIA aged 4–16 years from three geographically spread regions in Norway. Demographic data, age at disease onset, disease duration, JIA category, disease status, medication, and vitamin D intake were registered. One blood sample per individual was analyzed for 25(OH) vitamin D, and the level of insufficiency was defined as < 50 nmol/L. A clinical oral examination was performed applying commonly used indices in epidemiological studies of dental caries, dental erosion, enamel defects, gingival bleeding, and oral hygiene. Serum vitamin D was used as exposure variable in multivariable regression analyses to estimate the associations between insufficient vitamin D level, JIA disease status, and oral conditions, with adjustments for age, sex, geographical region, BMI, seasonal blood sampling, and parental education. Results Among the 223 participants with JIA, 97.3% were Caucasians, 59.2% were girls, and median age was 12.6 years. Median disease duration was 4.6 years, and 44.4% had oligoarticular JIA. Mean serum vitamin D level was 61.4 nmol/L and 29.6% had insufficient levels. Vitamin D levels did not differ between sexes, but between regions, iso-BMI categories, age groups, and seasons for blood sampling. Insufficient vitamin D levels were associated with dentin caries (adjusted OR 2.89, 95% CI 1.43–5.86) and gingival bleeding (adjusted OR 2.36, 95% CI 1.10–5.01). No associations were found with active JIA disease or more severe disease characteristics. Conclusion In our study, nearly 30% had vitamin D insufficiency, with a particularly high prevalence among adolescents. Vitamin D insufficiency was associated with dentin caries and gingival bleeding, but not with JIA disease activity. These results point to the need for a multidisciplinary approach in the follow-up of children with JIA, including an increased focus on vitamin D status and oral health. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02349-1.
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Affiliation(s)
- Lena Cetrelli
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway. .,The Public Dental Health Service, Trøndelag County, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Athanasia Bletsa
- Oral Health Centre of Expertise in Western Norway (TkV), Bergen, Norway.,Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anette Lundestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
| | - Elisabet Grut Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Johannes Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Josefine Halbig
- Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Medicine, The Arctic University of Norway, Tromsø (UiT), Norway
| | - Paula Frid
- Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Dentistry, The Arctic University of Norway, Tromsø (UiT), Norway.,Division of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology, University Hospital North Norway, Tromsø, Norway
| | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St Olav Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingrid Lillevoll
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Karin B Tylleskär
- The Children's Clinic at Haukeland University Hospital, Bergen, Norway
| | - Keio Luukko
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ellen Nordal
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø (UiT), Norway.,Department of Pediatrics, University Hospital of Northern Norway, Tromsø, Norway
| | - Anne Nordrehaug Åstrøm
- Oral Health Centre of Expertise in Western Norway (TkV), Bergen, Norway.,Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marit Slåttelid Skeie
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway.,Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Abhijit Sen
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
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Gil EG, Åstrøm AN, Lie SA, Rygg M, Fischer J, Rosén A, Bletsa A, Luukko K, Shi XQ, Halbig J, Frid P, Cetrelli L, Tylleskär K, Rosendahl K, Skeie MS. Dental caries in children and adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis. BMC Oral Health 2021; 21:417. [PMID: 34433437 PMCID: PMC8390188 DOI: 10.1186/s12903-021-01758-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background Optimal utilization of dental caries data is crucial in epidemiological research of individuals with juvenile idiopathic arthritis (JIA). The aims were to: explore whether caries is more prevalent among children and adolescents with JIA compared to controls; examine presence of caries according to JIA group, socio-behavioral and intraoral characteristics, and the extent to which surface-specific caries varies between and within individuals; assess whether surface-specific caries varies according to JIA group and dentition; and investigate whether disease-specific clinical features of JIA are associated with presence of caries. Methods In this comparative cross-sectional study, calibrated dentists examined index teeth (primary 2. molars, 1. permanent molars) of 4–16-year-olds with JIA (n = 219) and matched controls (n = 224), using a detailed caries diagnosis system (including enamel caries). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-behavioral information collected by questionnaires. Multilevel mixed-effect logistic regressions reporting odds ratios (OR) with 95% confidence interval (CI) were applied (caries at surface level as outcome variable). Potential confounders were adjusted for, and the effect of dependency of surface-specific caries data was estimated by calculating intra-class correlation coefficients (ICC). Results At individual level, no significant difference in caries prevalence was found between individuals with JIA and controls, regardless of inclusion of enamel caries. Proportion of enamel lesions exceeded dentine lesions. JIA was not associated with presence of caries, but in both groups, low maternal educational level was associated with presence of caries (OR: 2.07, 95% CI: 1.24–3.46). Occlusal and mesial surfaces, compared to buccal surfaces, had generally higher OR according to presence of caries than distal and lingual surfaces (ICC = 0.56). Surface-specific caries in the permanent dentition differed significantly according to group affiliation. Some JIA disease-specific variables were suggested to associate with presence of caries. Conclusions No overall difference in caries prevalence between individuals with JIA and controls was observed, but for both groups, low maternal educational level and tooth surface associated with presence of caries. Associations between JIA disease-specific variables and presence of caries cannot be excluded. Due to predominance of enamel lesions, the potential of preventative dental strategies is considerable. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01758-y.
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Affiliation(s)
- Elisabeth G Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
| | - Anne N Åstrøm
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Pediatrics, St. Olav's Hospital, Trondheim, Norway
| | - Johannes Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Athanasia Bletsa
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway-Vestland, Bergen, Norway
| | - Keijo Luukko
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Xie-Qi Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Josefine Halbig
- Public Dental Health Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Dentistry, The Arctic University of Norway, Tromsø, Norway
| | - Paula Frid
- Public Dental Health Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Dentistry, The Arctic University of Norway, Tromsø, Norway.,Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Lena Cetrelli
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Center for Oral Health Services and Research (TKMidt), Trondheim, Norway
| | - Karin Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Clinical Dentistry, The Arctic University of Norway, Tromsø, Norway.,Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Marit S Skeie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Center for Oral Health Services and Research (TKMidt), Trondheim, Norway
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7
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Frid P, Baraniya D, Halbig J, Rypdal V, Songstad NT, Rosèn A, Berstad JR, Flatø B, Alakwaa F, Gil EG, Cetrelli L, Chen T, Al-Hebshi NN, Nordal E, Al-Haroni M. Salivary Oral Microbiome of Children With Juvenile Idiopathic Arthritis: A Norwegian Cross-Sectional Study. Front Cell Infect Microbiol 2020; 10:602239. [PMID: 33251163 PMCID: PMC7672027 DOI: 10.3389/fcimb.2020.602239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background The oral microbiota has been connected to the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. The objective of this study was to characterize the salivary oral microbiome associated with juvenile idiopathic arthritis (JIA), and correlate it with the disease activity including gingival inflammation. Methods Fifty-nine patients with JIA (mean age, 12.6 ± 2.7 years) and 34 healthy controls (HC; mean age 12.3 ± 3.0 years) were consecutively recruited in this Norwegian cross-sectional study. Information about demographics, disease activity, medication history, frequency of tooth brushing and a modified version of the gingival bleeding index (GBI) and the simplified oral hygiene index (OHI-S) was obtained. Microbiome profiling of saliva samples was performed by sequencing of the V1-V3 region of the 16S rRNA gene, coupled with a species-level taxonomy assignment algorithm; QIIME, LEfSe and R-package for Spearman correlation matrix were used for downstream analysis. Results There were no significant differences between JIA and HC in alpha- and beta-diversity. However, differential abundance analysis revealed several taxa to be associated with JIA: TM7-G1, Solobacterium and Mogibacterium at the genus level; and Leptotrichia oral taxon 417, TM7-G1 oral taxon 352 and Capnocytophaga oral taxon 864 among others, at the species level. Haemophilus species, Leptotrichia oral taxon 223, and Bacillus subtilis, were associated with healthy controls. Gemella morbillorum, Leptotrichia sp. oral taxon 498 and Alloprevotella oral taxon 914 correlated positively with the composite juvenile arthritis 10-joint disease activity score (JADAS10), while Campylobacter oral taxon 44 among others, correlated with the number of active joints. Of all microbial markers identified, only Bacillus subtilis and Campylobacter oral taxon 44 maintained false discovery rate (FDR) < 0.1. Conclusions In this exploratory study of salivary oral microbiome we found similar alpha- and beta-diversity among children with JIA and healthy. Several taxa associated with chronic inflammation were found to be associated with JIA and disease activity, which warrants further investigation.
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Affiliation(s)
- Paula Frid
- Department of ENT, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway.,Public Dental Service Competence Centre of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Divyashri Baraniya
- Oral Microbiome Laboratory, Kornberg School of Dentistry, Temple University, Philadelphia, PA, United States
| | - Josefine Halbig
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway.,Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø, Norway
| | - Veronika Rypdal
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Nils Thomas Songstad
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Annika Rosèn
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Johanna Rykke Berstad
- Department of ENT, Division of Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- Department of Rheumatology and Infectious Diseases, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Fadhl Alakwaa
- Department of Computational Medicine and Bioinformatics, University Michigan, Ann Arbor, MI, United States
| | | | - Lena Cetrelli
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway
| | - Tsute Chen
- Department of Microbiology, Forsyth Institute, Cambridge, MA, United States
| | - Nezar Noor Al-Hebshi
- Oral Microbiome Laboratory, Kornberg School of Dentistry, Temple University, Philadelphia, PA, United States
| | - Ellen Nordal
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Mohammed Al-Haroni
- Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø, Norway
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8
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Fischer J, Skeie MS, Rosendahl K, Tylleskär K, Lie S, Shi XQ, Gil EG, Cetrelli L, Halbig J, von Wangenheim Marti L, Rygg M, Frid P, Stoustrup P, Rosèn A. Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis - a Norwegian cross- sectional multicentre study. BMC Oral Health 2020; 20:282. [PMID: 33050890 PMCID: PMC7557069 DOI: 10.1186/s12903-020-01234-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD. Methods This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the TMJaw Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs. Results In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthy controls presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p < 0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p < 0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation. Conclusion Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.
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Affiliation(s)
- J Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.
| | - M S Skeie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.,Center for Oral Health Services and Research of Middle-Norway (TkMidt), Trondheim, Norway
| | - K Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway.,UiT the Arctic University of North Norway, Tromsø, Norway
| | - K Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - S Lie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway
| | - X-Q Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - E Grut Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway
| | - L Cetrelli
- Center for Oral Health Services and Research of Middle-Norway (TkMidt), Trondheim, Norway
| | - J Halbig
- Public Dental Service Competence Centre of Northern-Norway (TkNN), Tromsø, Norway
| | - L von Wangenheim Marti
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway
| | - M Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - P Frid
- Public Dental Service Competence Centre of Northern-Norway (TkNN), Tromsø, Norway.,Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - P Stoustrup
- Section of Orthodontics, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - A Rosèn
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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9
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Frid P, Augdal TA, Larheim TA, Halbig J, Rypdal V, Songstad NT, Rosén A, Tylleskär KB, Berstad JR, Flatø B, Stoustrup P, Rosendahl K, Kirkhus E, Nordal E. Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study. Pediatr Rheumatol Online J 2020; 18:75. [PMID: 32998740 PMCID: PMC7528594 DOI: 10.1186/s12969-020-00464-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting. METHODS In this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligoarthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for 2 years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation. RESULTS Among the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p = 0.045 and decreased MRI mean additive inflammatory score from 4.4 ± 1.8 standard deviations (SD) to 3.4 ± 2.0, p = 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent. CONCLUSIONS In this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No severe side effects were seen.
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Affiliation(s)
- Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway.
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway.
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Thomas A Augdal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section for Pediatric Radiology, Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Tore A Larheim
- Department of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway
| | - Josefine Halbig
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Veronika Rypdal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Nils Thomas Songstad
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Karin B Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Johanna Rykke Berstad
- Department of ENT and Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Peter Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Karen Rosendahl
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section for Pediatric Radiology, Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Ellen Nordal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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10
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Amols HI, Liska DJ, Halbig J. Erratum: The use of a dynamic rangeshifter for modifying the depth-dose distribution of negative pions [Med. Phys. 4
, 404 (1977)]. Med Phys 1978. [DOI: 10.1118/1.594504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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11
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Abstract
In order to use negative pions for the treatment of large deep-seated tumors in radiotherapy, it is necessary to produce depth-dose distributions tailored to specific shapes. We present here a method of beam shaping which utilizes a fluid-filled piston having a programmable, computer-controlled, time-dependent thickness. The fluid alters the residual range of the pions such that predetermined depth-dose distributions can be obtained. Changing from one distribution to another can be accomplished simply and rapidly without access to the treatment room. Depth-dose distributions which are flat over a range in depth up to 10 cm have been produced. Distributions tailored to produce flat "effective dose" versus depth have also been obtained.
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