Det har skett ett ökat inflöde av flyktingar och invandrare till Sverige under de senaste tre decennierna. Det övergripande syftet med denna avhandling var i första hand att öka kunskapen om bettavvikelser och ortodontiskt behandlingsbehov, både självupplevt och normativt, hos barn och ungdomar med varierande geografisk bakgrund. Syftet var också att bedöma om eventuella skillnader i uppfattning om det egna utseendet och psykosocialt välbefinnande var kopplat till geografiskt ursprung.
Delarbete I och II handlar om självupplevt och normativt ortodontiskt behandlingsbehov. Cirka 500 12-13-åriga ungdomar, indelade i olika grupper: A-Sverige, B-Östra/Sydöstra Europa, C-Asien och D-övriga länder, besvarade ett frågeformulär och genomgick en klinisk undersökning av författaren. I delarbete III analyseras sambandet mellan de två variablerna i delarbete I och II. Delarbete IV är en uppföljande studie, vid 18-19 års ålder, av sambandet mellan geografiskt ursprung, förekomst av bettavvikelser, självupplevt behandlingsbehov, symptom i käksystemet och psykologiskt välbefinnande. I delarbete V gjordes en kvalitativ studie av unga vuxna, för att identifiera hur de hanterade förekomsten av kvarstående estetiska bettavvikelser.
De huvudsakliga resultaten är att vid 12-13 års ålder har ungdomar med utländsk bakgrund ett lägre självupplevt ortodontiskt behandlingsbehov än ungdomar med svensk bakgrund. Flickor med svensk bakgrund har det högsta självupplevda behandlingsbehovet, medan flickor med utländsk bakgrund är mest bekymrade för behandlingsrelaterad smärta. För några få variabler, registrerade vid 12-13 års ålder, uppvisar den svenska gruppen den största platsbristen och oregelbundenheten i både över- och underkäkens frontparti och större horisontellt överbett jämfört med grupperna Östra/Sydöstra Europa och Asien. Den kliniska betydelsen av detta är obetydlig. Ortodontiskt behandlingsbehov enligt ”Index of Orthodontic Treatment Need” ”Dental Health Component” (IOTN-DHC) grad 4 och 5, varierar mellan 30 och 40 procent, utan några skillnader mellan grupperna. Det finns ett starkt samband mellan
individer med ett självupplevt ortodontiskt behandlingsbehov och IOTN-DHC grad 4 och 5, frontal invertering och att man undviker att le på grund av tändernas utseende.
Vid 18-19 års ålder, är förekomsten av bettavvikelser lika i alla grupper. Ungdomar, 18-19 år med asiatiskt ursprung, har ett högre självupplevt ortodontiskt behandlingsbehov jämfört med sina svenska jämnåriga, och en högre frekvens av huvudvärk jämfört med ungdomar med Öst/Sydösteuropeiskt ursprung. Ett lågt psykologiskt välbefinnande noteras hos nästan en fjärdedel av ungdomarna, vanligare bland flickor än pojkar. Något samband mellan självupplevt ortodontiskt behandlingsbehov och psykologiskt välbefinnande finns ej.
“Att vara under trycket från sociala normer” är den teori som genererades i delarbete V, och den kan användas för att öka vår förståelse för unga vuxna som har anpassat sig att leva med en estetisk bettavvikelse och också identifiera de som inte anpassat sig, och som troligen skulle tjäna på att få behandling. Dold tandvårdsrädsla är ett betydande hinder för att acceptera ortodontisk behandling i tidiga ungdomsår.
Sammanfattningsvis konstateras att trots demografiska förändringar orsakade av invandring, kan inga stora förändringar i förekomst av bettavvikelser eller normativt ortodontiskt behandlingsbehov noteras.
Acknowledgements
The completion of this thesis would not have been achieved without the support of many people, to whom I wish to express my gratitude, specially to all the subjects who participated in the studies.
I also wish to acknowledge the following people for their invaluable contributions :
My research supervisor, Associate Professor Krister Bjerklin, for sharing with me his great knowledge of the field of orthodontics, for his steadfast belief in this project and for guiding me through the many small steps in the research process.
My co-supervisor, Associate Professor Rune Lindsten, for excellent advice in all methodological discussions, never-ending patience and personal support.
My co-author, Professor Lillemor Hallberg, for introducing me to the field of qualitative research and guiding me through the qualitative study.
My co-author, Professor emeritus Arne Halling, who encouraged me to begin this journey, for his expert knowledge, good spirits and support.
Professor Tomas Magnusson, for excellent advice and training in the field of Stomatognathic Physiology.
Dr Thomas Björnestedt, Motala, for allowing me the use of his clinic for most of the examinations and for many years of support and friendship.
Marie Kindgren, orthodontic assistant, Motala, for excellent assistance and administrative help throughout the study.
Annette Thimén, orthodontic assistant, Jönköping, for help with the clinical examinations and excellent support when I away from the Institute.
Annica Stavander, dental assistant, Department of Orthodontics, Jönköping, for excellent co-ordination of patient administration throughout the studies.
My colleagues and the staff at the Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, for never-failing support and friendship throughout this project.
My colleagues and the staff at the Orthodontic Clinic, Motala, for all help and support at the start of this project.
Joan Bevenius-Carrick PhD, for professional language revision, advice on research writing and friendship.
Elisabeth Wilhelm, statistician, Linköping, Birgit Ljungquist PhD, Jönköping, and Mats P Nilsson, epidemiologist, Jönköping, for invaluable statistical help and advice.
Thanks to librarians Åsa Zetterling and Gudrun Ahrén, for assistance with the references.
Kent, my life companion, for love and never- ending patience.
Hanna and Lovisa, my lovely daughters, for their frank criticism and for keeping me in touch with reality.
The research was supported by grants from the Medical Research Council of Southeast Sweden, Public Dental Health Service of
Östergötland County, Futurum – the Academy for Healthcare, County Council, Jönköping and The Sigrid de Verdier Memorial Fund.
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