The Vipeholm Studies

International College Portsmouth (ICP)

When? 1945 - 1954
Where? Vipeholm Hospital
For people who were mentally
ill in Sweden
Who? Children and adults aged 15-70
650 – 1000 participants
BACKGROUND
• Dental health in Scandinavian countries was poor
• In 1938, a Public Dental Service formed in Sweden
• Costs became very heavy
• Led to the need for research
• The Swedish government requested the Medical Board "to perform in
collaboration with the Board of the Dental School a general investigation
concerning what measures should be taken to decrease the frequency of the
most common dental diseases in Sweden.“
• Resulted a clinical study on diet and dental caries at Vipeholm
Hospital
WHAT HAPPENED?
The studies can be divided into three:

I. The clinical experimental studies of the relationship between diet

and dental caries
II. Supplementary studies
III. Special studies
 I. THE CLINICAL EXPERIMENTAL STUDIES

• At the beginning of the study, the participants’ teeth were closely examined. It was noted that
their teeth were in much better shape than the Swedish population as a whole

• During the first two years of the experiment, the children were given little starch and half the
average consumption of sugar in a typical Swedish diet. Vitamins A, C and D, along with
fluoride tablets were given, and no food was allowed between meals.

• At the end of this period, 78% of the children had no new cavities.
I. THE CLINICAL EXPERIMENTAL STUDIES

• Over the next two years the participants

were given twice the amount of sugar
typically consumed in Sweden,
administered in several ways:
 I. THE CLINICAL EXPERIMENTAL STUDIES

• One group ate sweet, sticky bread made with extra sugar with their meals
• Another group drank beverages with 1½ cups of added sugar at meals
• A third group ate chocolates, caramels or sticky toffees between meals

• The sticky candy group was further divided into children who ate 8 or 24 pieces of toffee
between meals. The toffee was developed specifically to stick better to the teeth
RESULTS
• “The [tooth decay] was high in groups which received sugar in sticky form between meals. In the
Control, Sucrose and Bread Groups the activity was still low” the study authors wrote.

• Kanger said records show researchers decided not to fix the teeth for “those who could not cooperate
with the fixing procedures (like being scared of the drill). They also chose not to fix the teeth among
many of the ‘lower’ categories of patients.”

• They did fix the teeth among many of the “higher” categories, he said. But in many cases the teeth
were pulled out instead of being fixed.
ETHICAL ISSUES

• Beneficence
• Informed consent
• Power and vulnerable population
• Autonomy
• Transparency