Orthodontics and Pedodontics

Caries prevention for preschool children

One priority area is preventing caries in young children, especially those from disadvantaged socio-economic backgrounds – a group where diseases progress quickly. As part of our work in this field, we are conducting a project with health coaches in dentistry. Here, health coaches are trained to motivate and maintain contact with families where the children show early caries development. The focus is on motivating, educating and increasing a family’s own ability to prevent tooth decay.

Link between oral and overall health

Another area is the link between oral and overall health. Examples of projects include an epidemiological registry study that explores the medical, odontological and social consequences of childhood obesity, and a project that studies treatment with bisphosphonate and how this can affect tooth eruption and development amongst patients with osteogenesis imperfecta. This research is interdisciplinary in nature, involving collaboration with other units at the Department of Dental Medicine, Region Stockholm Dental Services – the Eastman Institute in particular, the paediatric clinic, clinical neuroscience and the Centre for Allogenic Stem-Cell Transplantation at the Karolinska University Hospital in Huddinge, the Department of Psychology at Stockholm University, and the Department for Medical Sciences.  

Treatment for dental phobia

Dental fear affects almost 10 % of children. Currently, cognitive behavioural therapy (CBT) is the only evidence-based treatment for phobia. However, knowledge about the treatment and access to trained professionals is low. Consequently, our research aims to enable and encourage this treatment for more people. We are currently conducting a study of internet-based CBT for treating patients with a fear of dentists. “iCBT has shown positive results for a number of psychiatric conditions, and our research group has found that it is also an effective treatment for dental phobia”, Robert Schibbey says. Often, research into paediatric diseases overlooks the perspectives of children and adolescents. There is a great need to study how various interventions affect a child’s quality of life and oral health. Using qualitative methods, mainly grounded theory and thematic analysis. Studies examine children’s experiences of taking part in CBT to treat dental fear, and living with a condition where enamel has been damaged – amelogenesis imperfecta.

The genetics behind orofacial clefts

Genetic studies of patients with orofacial clefts e.g. van der Woude Syndrome, is an ongoing collaboration between orthodontic, plastic and reconstructive surgery, and genetic departments in Stockholm and Helsinki. Patients with isolated cleft palate and syndromic features are also studied together with clinical geneticists. 

Randomized trials of primary surgery for unilateral cleft lip and palate

We have been part of the Scandcleft randomized trials of primary surgery for unilateral cleft lip (UCLP) and palate since 1997. The overall null-hypothesis is “variation in surgical technique and staging are not associated with difference in outcome”.  The aim is to study the long-term outcome of dentofacial development, nasolabial appearance, speech and language development, hearing, perioperative complication rate, symptomatic fistulas, operation time and hospitalization time. 450 children from ten North European Cleft Teams born with unilateral cleft lip and palate are recorded continuously until they reach the age of 19 years. Results have so far been published up to 8 years of age. 

Timing of surgery

TOPS (Timing of surgery of primary surgery for cleft patients) is a prospective randomized study funded by NIH.  In this study, the same technique is used for surgical palatal closure but the timing varies. All patients were originally screened by clinical geneticists, and only patients with non-syndromic cleft palate were included. The primary outcomes are speech during childhood and dental occlusion at 5 years of age. 

Swedish National Quality Registry

Swedish National Quality Registry for patients born with cleft lip and palate is a national quality registry for children born with cleft lip and palate that was founded in 1999. The registry is now a certified level 2 registry. We presently test the validity for the orthodontic variables and forms. As this register records all current patients in Sweden, updated epidemiological studies are performed together with epidemiologists on patients born and treated for cleft lip and palate with associated malformations.