Syftet med litteraturstudien var att undersöka tandtrådens effekt på plack och gingivit. Metoden som användes var en kvantitativ allmän litteraturstudie där sökningen av vetenskapliga artiklar gjordes i den medicinska databasen PubMed. Litteraturstudiens resultat sammanställdes utifrån elva vetenskapliga artiklar. Tandtrådens effekt på plack och gingivit utvärderades, i form av reduktion av: plackmängd och blödning hos såväl barn, ungdomar som vuxna individer. Tio av artiklarna visade att tandtråd hade en effekt på ovanstående parametrar medan den kvarstående artikeln inte kunde visa några sådana effekter. Slutsatsen är att användning av tandtråd i samband med tandborstning har en effekt med avseende på reduktion av plackmängd och gingivit. Ytterligare forskning krävs för en noggrann utvärdering av tandtrådens effekt.

Syfte:Syftet med studien var att undersöka munhygien- och kostvanor hos gymnasieelever i årskurs 3. Material och metod: Studien var en kvantitativ tvärsnittsstudie. Datainsamlingen genomfördes i form av enkätundersökning med 123 deltagare i åldrarna 18-22 år. Enkäten bestod av 20 frågor med fasta svarsalternativ som berörde elevernas bakgrund, munhygien- och kostvanor. Resultat: Studiens resultat visade att majoriteten av deltagarna borstade tänderna två gånger om dagen med tandborste och fluortandkräm och 28 % använde något approximalt hjälpmedel. Mer än hälften av deltagarna åt lunch och middag varje dag, däremot var det endast hälften av deltagarna som åt frukost varje dag. Deltagarna hade ett lågt intag av sötsaker. Slutsats: Studien visade att deltagarna hade relativt goda munhygienvanor, däremot var användningen av approximala hjälpmedel och fluorpreparat bristfälliga. Vidare visade resultatet att deltagarna hade bristfälliga kostvanor då endast hälften av deltagarna åt frukost varje dag.

Tandvården har goda möjligheter att få kännedom om patienters tobaksvanor eftersom flertalet människor besöker tandvården regelbundet. Det finns därför goda möjligheter att utföra tobaksavvänjning med de som röker eller snusar. Syftet med litteraturstudien var att belysa metoder som finns för tobaksavvänjning och vilka resultat dessa metoder ger. Sökningen gjordes i databasen Pubmed och begränsades till artiklar som är publicerade under de senaste tio åren och till studier som har utförts inom tandvården. Litteraturstudien inkluderade åtta studier. Resultatet visade att det finns flera olika kombinationsmetoder som används för tobaksavvänjning. I tre artiklar har 5A metoden använts i kombination med nikotinersättningsmedel. I övriga artiklar användes fem olika kombinationsmetoder med olika uppföljningstider. I en av kombinationsmetoderna beskrevs två metoder. Utöver dessa metoder fanns en metod för snusavvänjning. Resultatet visade skillnader i lyckandefrekvens med upphörande av tobaksvanor. Tolv månaders avvänjning och uppföljning i två av kombinationsmetoderna samt metoden för snusavvänjning gav högst lyckandefrekvens (36 %, 25 % och 30 %). Lägst lyckandefrekvens var 7 % efter tolv månaders uppföljning i en av 5A metoderna. Studiens slutsats är att det finns få publicerade studier om tobaksavvänjning inom tandvården som är baserade på utvärdering av tobaksavvänjningsmetoder som är utförda på patienter. Uppföljning och rådgivning samt stöttning har betydelse för resultatet.

AIMS: This study was designed to evaluate the effect of gap width and graft placement on bone healing around implants placed into simulated extraction sockets in the mandibles of four beagle dogs. MATERIALS AND METHODS: Four Ti-Unite implants (13 mm x 3.3 mm) were placed on each side of the mandible. Three implants were surrounded by a 1.35 mm circumferential and a 5 mm deep gap around the coronal portion of the implants. A fourth implant was inserted conventionally into both sides of the mandibles as a positive control. The gaps were filled with either Bio-Oss, autogenous bone or with a blood clot alone. The study design was balanced for animal, side and modality. Ground sections were prepared from biopsies taken at 3 months, and computer-aided histometric measurements of bone/implant contact and area of bone within threads were made for the coronal 5 mm. Data were analysed using analysis of variance. RESULTS: The mean bone/implant contact was 9.8 mm for the control and ranged from 9.3 to 11.3 mm for the three test modalities. The corresponding values for area within threads were 1 mm(2) and 1-1.2 mm(2). Modality had a significant effect on both bone/implant contact (F=16.9; P<0.0001) and area within threads (F=16.7; P<0.0001). CONCLUSION: The results of this study suggest that both autogenous bone graft and Bio-Oss played an important role in the amount of hard tissue fill and osseointegration occurring within marginal bone defects around implants.

Purpose: To explore and compare cancer patients' perceptions on the quality of nursing care in four European countries. Methods: Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the "Oncology Patients' Perceptions of the Quality of Nursing Care Scale" (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care. Results: Patients' age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients' perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p <0.001) as well as in the subscales responsiveness (p <0.001), individualization (p<0.001), co ordination (p<0.001) and proficiency (p<0.001). The Cronbach's alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents' demographic characteristics revealed that only the patient's country was significantly related with the patients' perceptions of quality care. Conclusion: Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

OBJECTIVE: There is a need to develop easy-to-use tools to screen periodontal condition in daily practice. This study aimed to evaluate the FDI World Dental Federation "Chairside Guide" (FDI-CG) developed by the Task Team of the FDI Global Periodontal Health Project (GPHP) as a potential tool for screening.

METHODS: Databases from 3 centres in Germany, Hong Kong, and Spain (n = 519) were used to evaluate the association of the FDI-CG and its individual items with the periodontitis case definitions proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) for population-based surveillance of periodontitis.

RESULTS: Statistically significant differences were observed among the databases for the prevalence of periodontitis and the items included in the FDI-CG. The FDI-CG score and its individual components were significantly associated with the periodontal status in the individual databases and the total sample, with bleeding on probing showing the strongest association with severe periodontitis (odds ratio [OR] = 12.9, 95% CI [5.9; 28.0], P < .001, for those presenting bleeding on probing >50%), followed by age (OR = 4.8, 95% CI [1.7; 4.2], P = .004, for those older than 65 years of age). Those subjects with a FDI-CG score >10 had an OR of 54.0 (95% CI [23.5; 124.2], P < .001) and presented with severe periodontitis. A significant correlation was found between the different FDI-CG scoring categories (mild, moderate, and severe) and the categories for mild, moderate, and severe periodontitis using the Centers for Disease Control and Prevention and the American Academy of Periodontology criteria (r = 0.57, Spearman rank correlation test, P < .001).

CONCLUSION: The FDI Chairside Guide may represent a suitable tool for screening the periodontal condition by general practitioners in daily dental practice.

Aim: The aim of this study was to evaluate the effects of non-surgical periodontal therapy on intra-oral halitosis 3months after therapy. Material and methods: Sixty-eight adults with intra-oral halitosis were included in a case series. Intra-oral halitosis was evaluated at baseline, and at 3months after treatment using the organoleptic scores (OLS), Halimeter (R), and a gas chromatograph. Results: Significant reductions for OLS (p<0.01), total sum of volatile sulphur compounds (T-VSC) (p<0.01) and methyl mercaptan (MM) (p<0.05) values were found after treatment. Hydrogen sulphide (H2S) levels were not significantly reduced. The numbers of probing pockets 4mm, 5mm and 6mm were significantly reduced as a result of therapy (p<0.001). Bleeding on probing (BOP) and plaque indices were also significantly reduced (p<0.001). For the 34 individuals with successful periodontal treatment (BOP<20% and a 50% reduction of total pocket depth) reductions in OLS (p<0.01) and T-VSC scores (p<0.01) were found. Eleven individuals were considered effectively treated for intra-oral halitosis presenting with a T-VSC value <160ppb, a H2S value <112ppb and a MM value <26ppb. Conclusion: Non-surgical periodontal therapy resulted in reduction of OLS, MM and T-VSC values 3months after therapy. Few individuals were considered as effectively treated for intra-oral halitosis.

BACKGROUND: We investigated clinical and subgingival microbiologic changes during pregnancy in 20 consecutive pregnant women > or =18 years not receiving dental care.

METHODS: Bacterial samples from weeks 12, 28, and 36 of pregnancy and at 4 to 6 weeks postpartum were processed for 37 species by checkerboard DNA-DNA hybridization. Clinical periodontal data were collected at week 12 and at 4 to 6 weeks postpartum, and bleeding on probing (BOP) was recorded at sites sampled at the four time points.

RESULTS: The mean BOP at week 12 and postpartum was 40.1% +/- 18.2% and 27.4% +/- 12.5%, respectively. The corresponding mean BOP at microbiologic test sites was 15% (week 12) and 21% (postpartum; not statistically significant). Total bacterial counts decreased between week 12 and postpartum (P <0.01). Increased bacterial counts over time were found for Neisseria mucosa (P <0.001). Lower counts (P <0.001) were found for Capnocytophaga ochracea, Capnocytophaga sputigena, Eubacterium saburreum, Fusobacterium nucleatum naviforme, Fusobacterium nucleatum polymorphum, Leptotrichia buccalis, Parvimonas micra (previously Peptostreptococcus micros or Micromonas micros), Prevotella intermedia, Prevotella melaninogenica, Staphylococcus aureus, Streptococcus anginosus, Streptococcus intermedius, Streptococcus mutans, Streptococcus oralis, Streptococcus sanguinis, Selenomonas noxia, and Veillonella parvula. No changes occurred between weeks 12 and 28 of pregnancy. Counts of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, Tannerella forsythia (previously T. forsythensis), and Treponema denticola did not change. Counts of P. gingivalis and T. forsythia at week 12 were associated with gingivitis (P <0.001).

CONCLUSIONS: Subgingival levels of bacteria associated with periodontitis did not change. P. gingivalis and T. forsythia counts were associated with BOP at week 12. A decrease was found in 17 of 37 species from week 12 to postpartum. Only counts of N. mucosa increased.

OBJECTIVE: (I) To compare the oral microflora at implant and tooth sites in subjects participating in a periodontal recall program, (II) to test whether the microflora at implant and tooth sites differ as an effect of gingival bleeding (bleeding on probing (BOP)), or pocket probing depth (PPD), and (III) to test whether smoking and gender had an impact on the microflora.

MATERIAL AND METHODS: Data were collected from 127 implants and all teeth in 56 subjects. Microbiological data were identified by the DNA-DNA checkerboard hybridization.

RESULTS: PPD> or =4 mm were found in 16.9% of tooth, and at 26.6% of implant sites (P<0.01). Tooth sites with PPD> or =4 mm had a 3.1-fold higher bacterial load than implant sites (mean difference: 66%, 95% confidence interval (CI): 40.7-91.3, P<0.001). No differences were found for the red, orange, green, and yellow complexes. A higher total bacterial load was found at implant sites with PPD> or =4 mm (mean difference 35.7 x 10(5), 95% CI: 5.2 (10(5)) to 66.1 (10(5)), P<0.02 with equal variance not assumed). At implant sites, BOP had no impact on bacterial load but influenced the load at tooth sites (P<0.01).

CONCLUSION: BOP, and smoking had no impact on bacteria at implant sites but influenced the bacterial load at tooth sites. Tooth sites harbored more bacteria than implant sites with comparable PPD. The 4 mm PPD cutoff level influenced the distribution and amounts of bacterial loads. The subject factor is explanatory to bacterial load at both tooth and implant sites.

BACKGROUND: Interleukin-1 gene polymorphism (IL-1 gene) has been associated with periodontitis. The present study examined the subgingival microbiota by IL-1 gene status in subjects undergoing supportive periodontal therapy (SPT).

METHODS: A total of 151 subjects with known IL-1 gene status (IL-1A +4845/IL-1B -3954) (IL-1 gene) were included in this study. Clinical data and subgingival plaque samples (40 taxa) were collected. These taxa were determined by the checkerboard DNA-DNA hybridization method.

RESULTS: Gender, smoking habits (n-par tests), age, and clinical periodontal conditions did not differ by IL-1 gene status. IL-1 gene-negative subjects had a higher total bacterial load (mean difference, 480.4 x 10(5); 95% confidence interval [CI], 77 to 884 x 10(5); P <0.02). The levels of Actinobacillus actinomycetemcomitans (mean difference, 30.7 x 10(5); 95% CI, 2.2 to 59.5 x 10(5); P <0.05), Eubacterium nodatum (mean difference, 4.2 x 10(5); 95% CI, 0.6 to 7.8 x 10(5); P <0.02), Porphyromonas gingivalis (mean difference, 17.9 x 10(5); 95% CI, 1.2 to 34.5 x 10(5); P <0.05), and Streptococcus anginosus (mean difference, 4.0 x 10(5); 95% CI, 0.2 to 7.2 x 10(5); P <0.05) were higher in IL-1 gene-negative subjects, an observation specifically found at sites with probing depths <5.0 mm.

CONCLUSIONS: Bleeding on probing did not differ by IL gene status, reflecting clinical SPT efficacy. IL-1 gene-negative subjects had higher levels of periodontal pathogens. This may suggest that among subjects undergoing SPT, a lower bacterial load is required in IL-1 gene-positive subjects to develop the same level of periodontitis as in IL-1 gene-negative subjects.

Background Limited evidence exists on the efficacy of regenerative treatment of peri-implantitis Materials and methods Subjects receiving antibiotics and surgical debridement were randomly assigned to placement of autogenous bone (AB) or bovine derived xenograft (BDX) with placement of a collagen membrane. The primary outcome was: evidence of radiographic bone fill and the secondary outcomes included reductions of probing depth (PD) bleeding on probing (BOP) and suppuration. Results 22 subjects were included in the AB and 23 subjects in the BDX group. Statistical analysis failed to demonstrate differences for 38/39 variables assessed at baseline. At 12 months, significant better results were obtained in the BDX group for bone levels (p < 0.001), BOP (p = 0.004), PI (p = 0.003), and suppuration (p < 0.01). When adjusting for number of implants treated per subject, a successful treatment outcome PD≤ 5.0 mm, no pus, no bone loss and BOP at 1/4 sites the likelihood of defect fill was higher in the BDX group (LR: 3.2, 95 % CI: 1.0 to 10.6, p < 0.05). Conclusions Bovine xenograft provided more radiographic bone fill than autogenous bone. The success for both surgical regenerative procedures was limited. Decreases in PD, BOP, and suppuration were observed.

OBJECTIVES: To assess if (I) the alveolar bone defect configuration at dental implants diagnosed with peri-implantitis is related to clinical parameters at the time of surgical intervention and if (II) the outcome of surgical intervention of peri-implantitis is dependent on defect configuration at the time of treatment.

MATERIALS AND METHODS: In a prospective study, 45 individuals and 74 dental implants with ≥ 2 bone wall defects were treated with either an autogenous bone transplant or an exogenous bone augmentation material. Defect fill was assessed at 1 year.

RESULTS: At baseline, no significant study group differences were identified. Most study implants (70.7%, n = 53) had been placed in the maxilla. Few implants were placed in molar regions. The mesial and distal crestal width at surgery was greater at 4-wall defects than at 2-wall defects (p = 0.001). Probing depths were also greater at 4-wall defects than at 2-wall defects (p = 0.01). Defect fill was correlated to initial defect depth (p < 0.001). Defect fill at 4-wall defects was significant (p < 0.05).

CONCLUSIONS: (I) The buccal-lingual width of the alveolar bone crest was explanatory to defect configuration, (II) 4-wall defects demonstrated more defect fill, and (III) deeper defects resulted in more defect fill.

The purpose of this study was to evaluate the effect of gap width on bone healing around implants placed into simulated extraction socket defects of varying widths in 10 mongrel dogs. All premolars were removed and the alveolar ridges were reduced to a width of 7 mm. Nine weeks later, a total of 80 implants, 10 mm long by 3.3 mm wide, were placed into osteotomy sites prepared to 3 different diameters in the coronal half, simulating extraction sockets. Three experimental sites, with gap sizes of 0.5 mm, 1.0 mm, and 1.4 mm, were created; the control sites had no gap. The depth of each defect was measured at the time of implant placement. All implants were stable at the time of placement. The dogs were euthanized 12 weeks after implant placement, and blocks containing the implants and adjacent bone were submitted for histologic evaluation. Clinically, all control and test sites healed, with complete bone fill in the defect. Percentages of bone-to-implant contact were measured histologically. As the gap widened, the amount of bone-to-implant contact decreased, and the point of the highest bone-to-implant contact shifted apically. These changes were statistically significant (P < .001). No statistically significant differences in bone-to-implant contact were found between the sites when the apical 4 mm of implants were compared. Within the limits of this study, the simulated extraction socket defects healed clinically, with complete bone fill, regardless of the initial gap size. However, the width of the gap at the time of implant placement had a significant impact on the histologic percentage and the height of bone-to-implant contact.

OBJECTIVE: The purpose of the study was to investigate whether osseointegration can occur on rough implant surfaces that previously had been coated with bacterial biofilm. MATERIALS AND METHODS: The premolars on both sides of the mandible in four beagle dogs were extracted. Following 3 months healing, three titanium implants Ti-Unite, Nobel Biocare were partially inserted in the left side of each mandible. Some threads protruded from the tissues into the oral cavity. Plaque accumulated on the exposed part of the implant. Following a 5-week healing period, the contaminated parts of each implant were treated using three different techniques: (1) swabbing with citric acid for 30 s followed by rinsing with physiological saline, (2) cleansing with a toothbrush and physiological saline for 1 min, and (3) swabbing with 10% hydrogen peroxide for 1 min followed by rinsing with physiological saline. The treated implants and one pristine implant (control) were installed to the full implant length on the contralateral sides of the mandibles. Following 11 weeks of healing, the dogs were sacrificed and biopsies were obtained. Ground sections were prepared for histomorphometric analysis. RESULTS: All treatment modalities were associated with direct bone-to-implant contact on the portion of implant surface previously exposed to the oral environment. CONCLUSIONS: The results demonstrate that rough surfaces, which were plaque contaminated and cleaned by different methods, can re-osseointegrate.

Syftet med litteraturstudien var att undersöka förekomsten av karies hos barn med autismspektrumtillstånd (AST) i jämförelse med barn utan detta tillstånd. Metoden som användes var en kvantitativ allmän litteraturstudie där sökningen av vetenskapliga artiklar gjordes i den medicinska databasen PubMed. Litteraturstudiens resultat sammanställdes utifrån nio vetenskapliga artiklar. Resultatet visade att i fyra av nio sammanställda artiklar var kariesförekomsten högre hos barn med AST jämfört med barn utan AST och i resterande fem artiklar visade resultatet lägre kariesförekomst hos barn med AST jämfört med barn utan samma tillstånd. Resultatet visade även att barn med AST hade flera riskfaktorer som kan öka risken för kariesförekomst. Slutsatsen är att litteraturstudien visade ett tvetydigt resultat avseende kariesförekomsten hos barn med AST i jämförelse med barn utan samma tillstånd. Det krävs mer forskning inom området.

OBJECTIVES: To investigate if it is possible to achieve complete decontamination of dental implant surfaces with different surface characteristics.

MATERIALS AND METHODS: Twelve implant pieces with an Osseotite^® surface and 12 implant pieces with a Ti-Unite^® surface were attached on to the complete lower dentures of six patients and were allowed to accumulate plaque for 30 days. When retrieved, the implant decontamination protocol used, involved both mechanical (PeriBrush™) and chemical (3% H₂O₂) decontamination. The number of colony forming units per millilitre was determined and the dominant micro-organisms in selected samples was identified by 16s rRNA gene amplicon sequencing. The effect of the titanium brush on the implant surface was examined by SEM.

RESULTS: Complete decontamination was achieved in five out of 24 implants (four Osseotite^® and one Ti-Unite^®). The mean CFU/ml detected after decontamination were 464.48 for Osseotite^® and 729.09 for Ti-Unite^® implants. On the surface of the implants in which complete decontamination was not achieved, all of the predominant bacteria identified were streptococci except for one which was identified as micrococcus. SEM images revealed that the surface features of the decontaminated implants were not significantly altered.

CONCLUSIONS: Mechanical decontamination using a titanium brush supplemented with chemical treatment for one minute (3% H₂O₂) can achieve complete decontamination of implant surfaces in edentulous patients.

In 2009 we described an outbreak caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in southern Sweden that occurred during 2005–2006. An important finding from the investigation was the long carriage times of the ESBL-producing E. coli in several of the patients, which in some cases exceeded 30 months. Here we report findings from the continued follow-up of bacterial carriage. In September 2010, 5 of the 42 patients still carried the bacteria after a median of 58 months (range 41–59 months), 18 had had repeatedly negative cultures after shedding bacteria for a median of 7.5 months (range 0–39 months), 16 had died while still shedding the bacteria for a median of 9 months (range 0–38 months), and 3 had been lost to follow-up.

Both schizophrenia (SCZ) and bipolar disorder (BD) are associated with disturbances in emotion processing. Previous studies suggest that patients with SCZ assess unpleasant pictures as less arousing than healthy controls (HC), while patients with BD assess neutral pictures as more arousing than HC. No previous studies have investigated whether there is a difference in emotional response across all three groups. Our aim was to explore whether there was a difference in the evaluation of valence and in arousal between SCZ, BD and HC for aversive and neutral pictures. We showed 72 pictures (neutral, non-socially aversive and socially aversive) from the International Affective Picture System (IAPS) to 347 subjects. There was a clear interaction effect between the diagnostic group and increasing picture aversiveness for both valence and arousal. There were no significant differences in valence ratings between the different groups or in arousal ratings on any type of stimuli between BD patients and HC. However, SCZ patients reported significantly lower arousal for aversive stimuli, particularly with a social content, when compared to BD patients and HC. This was more pronounced in females. The presence of lifetime psychotic symptoms did not influence emotional responses.

Smärta i livets slutskede behöver inte bara innebära det fysiska obehaget, utan kan även ha psykiska, sociala och existentiella dimensioner. Existentiell smärta har en stor plats i den palliativa vården, kropp och själ hör ihop. Tankar kring livets mening, skuld och vad som händer efter döden kan ge existentiell smärta. De existentiella behoven är enligt många studier försummade. Vårdpersonal undviker ofta dessa frågor.Syftet med studien var att beskriva existentiell smärta hos patienter med cancer i palliativt skede. Metod: En allmänlitteraturstudie genomfördes med kvalitativa artiklar. Resultatet visade att existentiell smärta förekom i stor omfattning. Informanterna upplevde ensamhet och skuldkänslor och smärtan beskrevs ofta i fysiska termer. Smärtan hade också samband med förlust av olika funktioner. Det fanns även tankar kring andlighet och rädsla för den okända framtiden.Diskussion: Det är viktigt att sjuksköterskan är uppmärksam på patientens behov av närhet eller ensamma stunder. Vårdpersonal kan även hjälpa patienten att återfinna sin autonomi genom att identifiera de funktioner som faktiskt finns kvar. Genom samtal kan patienten få stöd att orka leva de sista dagarna samt att möta den okända framtiden. Slutsatsen är att det krävs god kunskap i kommunikation och smärtbehandling för att kunna identifiera och lindra existentiell smärta.

STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.

OBJECTIVE: To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN: A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING: General population in a well-defined Swedish PHC district. SUBJECTS: A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES: Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS: Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION: Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.

OBJECTIVE: To study the relationship between reported chronic pain and the level of serum urate (SU) among women with various diagnoses of the musculoskeletal system. METHODS: Consecutive female patients (aged 20-70 years, n = 124), at rheumatology and rehabilitation practices, with chronic musculoskeletal pain of different origins were followed for 1 year after an initial survey of pain, lifestyle, quality of life, and disability. Repeated blood samples (including urate, creatinine, cholesterol, and glucose) were analysed. Multiple regression analysis was performed to explain initial variations in SU level in relation to pain and confounding factors. RESULTS: The level of SU was increased among individuals with widespread pain (>5 locations) independent of underlying diagnoses compared to those with fewer pain sites (270.5 vs. 241.2 micromol/L). Serum creatinine, body mass index (BMI), the number of pain locations, and sleep disturbances independently contributed to the SU level and explained 43% of the variation in SU. Individual variation in SU during 4 months was low. CONCLUSIONS: Epidemiological data on the relationship between the extent of body pain and SU were confirmed in a clinical setting. Besides known factors such as impaired renal function and obesity, widespread pain and sleep disturbances were related to an increase in SU. Medication and alcohol intake could not explain the findings. Longitudinal studies are necessary to elucidate whether the level of SU has any implications for the prognosis of chronic pain.

Syftet med studien var att undersöka vad klinikchefer inom Folktandvården i Region Skåne och Privattandläkarna i Skåne län ansåg om tandhygienistens kompetens. Studien var kvantitativ och bestod av en elektronisk enkät som skickades ut till samtliga klinikchefer inom Folktandvården och Privattandläkarna i Skåne län. Det skickades ut totalt 538 enkäter. Inklusionskriterierna var de klinikchefer som anställt en tandhygienist som tagit sin yrkesexamen under de senaste fyra åren. Tjugonio klinikchefer besvarade enkäten.

Resultatet av studien visade att klinikcheferna ansåg tandhygienisten kunnig inom parodontologi och kariesdiagnostik. Det var två klinikchefer som önskade att tandhygienisten skulle ha ökad kompetens inom endodonti och pedodonti.

Klinikcheferna fick svara på en fråga i enkäten om de önskade lägga till något i tandhygienistens kompetensområde och där svarade två klinikchefer att blodsocker- och blodtrycksmätning skulle ingå i tandhygienistens kompetensområde.

Slutsatsen av studien visar att merparten av klinikcheferna ansåg att tandhygienisterna hade bra kompetens inom sitt arbetsområde. På grund av låg svarsfrekvens måste reultatet tolkas med stor försiktighet.

Den orala hälsan är en viktig del av den allmänna hälsan och kan påverka välbefinnandet. Plack kan bidra till en försämrad oral hälsa och orsaka parodontala sjukdomar och karies. Tandborstar är ett viktigt verktyg för att avlägsna plack och på marknaden finns elektriska och manuella tandborstar. Syftet med litteraturstudien var att utvärdera studier som jämfört den plackavlägsnande effekten mellan elektriska och manuella tandborstar. Metoden som användes var en kvantitativ allmän litteraturstudie som baserades på randomiserade kliniska vetenskapliga studier publicerade i databasen PubMed. Litteraturstudiens resultat baserades på 13 vetenskapliga artiklar. Resultatet visade på en större plackreducering med den elektriska tandborsten jämfört med den manuella tandborsten. Slutsatsen är att en elektrisk tandborste avlägsnar mera plack jämfört med en manuell tandborste. 

The general aims of this thesis were to evaluate the usefulness of an oral assess¬ment guide and to determine the oral health status among frail patients in hospital settings. A further aim was to analyze possible factors that may be associated with oral health status, with special focus on the relationship between oral health and nutritional status among elderly rehabilitation patients. The Oral Assessment Guide (OAG) was used in patients with haematological malignancies undergoing chemotherapy. In further studies a Revised Oral Assessment Guide (ROAG) was used among geriatric rehabilitation patients. The inter-rater reliability of the OAG between registered nurses at the ward and a dental hygienist (DH) was good, as well as between a registered nurse and a DH using ROAG. Problems in the oral cavity were detected in all patients with haematological malignancies undergoing chemotherapy. Problems related to mucous membranes, teeth and/or dentures were most frequent. Oral health problems were also a frequent finding among the geriatric rehabilitation patients. The frequency of oral health problems was significantly lower at discharge compared to admission. Oral health problems were more often found among patients that stayed for longer periods at the hospital, were more dependent on help with daily activities and suffered for dysphagia, than among the healthier patients. Oral health problems were more common among the patients being at risk of undernourishment, suspected to be or severely undernourished (UN), than among the well-nourished patients. Problems in oral health status were significantly associated with the occurrence of respiratory diseases, living in special accommodation, being UN and being a woman. The highest Odds Ratio (OR) was found in problems with gums in relation to the occurrence of respiratory diseases (OR 8.9; 95 % CI 2.8-27.8). OAG as well as ROAG were found to be useful for assessing oral health status in frail patients at hospital. Oral health problems were a frequent finding among the patients. The use of an oral assessment tool on a routine basis may facilitate the detection of problems which otherwise can be hidden, and can serve as a guide for initiating individualised oral health procedures.

Den 23 april 2004 försvarade tandhygienist Pia Andersson avhandlingen ”Assessments of oral health status in frail patients in hospital” vid odontologiska fakulteten, Malmö högskola. Fakultetsopponent var professor Tony Axéll, Specialisttandvården, Halmstad. Handledare under avhandlingsarbetet har varit professor Stefan Renvert, Högskolan Kristianstad och professor Ingalill Rahm Hallberg, Vårdalinstitutet, Lund. Det övergripande syftet med avhandlingen var att utvärdera ett formulär för att bedöma munhälsan på patienter som låg inne på sjukhus och att undersöka förekomsten av problem i munnen. På äldre patienter inom rehabilitering undersöktes dessutom om det fanns samband mellan munhälsostatus och relaterade faktorer som ålder, kön, boendeform, civilstånd, sjukdomsorsak vid inskrivning till avdelningen, läkemedelsintag, funktionsstatus och nutritionsstatus med fokus på sambandet mellan munhälsostatus och nutritionsstatus.

Objective.  The aim of the present study was to evaluate the psychometric properties of the Dental Hygienist Anxiety Scale (DHAS) in a sample of adult general dental patients.  Materials and methods.  The DHAS is a questionnaire adapted to assess fear and anxiety of dental hygienist (DH) treatment. The DHAS contains four items and the sum of scores range from 4 (no anxiety) to 20 (extreme fear). A convenient sample of 80 patients in treatment at two DH programs in Sweden were consecutively included in the study. The DHAS was distributed together with questions regarding self-perceived oral health and experience of dental care at the first visit after a clinical examination performed by a DH. Re-test assessments of DHAS were conducted ∼ 2 weeks later in conjunction with the next visit to the DH before treatment (scaling session).  Results.  The results verified a significant positive correlation between the average DHAS sum of scores and global fear of DH and dentist treatment, perceived pain during the last DH treatment and female gender. The DHAS sum of scores had a high internal consistency, Cronbach's  coefficient of 0.89 and 0.87 at the first and at the second assessment, respectively. The test-re-test reliability of the DHAS sum of scores was acceptable, with an intra-class coefficient of 0.82 and Kappa coefficients between 0.49-0.78 for the four single items in the DHAS. Conclusions.  These results suggest that the DHAS has acceptable psychometric proprieties and is a valid and reliable scale to assess anxiety in DH treatment.

OBJECTIVES: The aim of this study was to investigate the associations between oral health measures and oral health-related quality of life as captured by OIDP (oral impacts on daily performances).

METHODS: The study was performed in three dental clinics in Sweden and included 204 patients, 43.8% men and 56.2% women (aged 20-86 years), consecutively recruited in connection with their routine dental examination. The patients were interviewed using the OIDP followed by a clinical examination. Four bite-wing radiographs were taken in two of the clinics (n = 154). A self-administered questionnaire provided information about socio-economic data.

RESULTS: Subjects >or=60 years had significantly more missing teeth, lesser maximal jaw opening, higher number of sites with alveolar bone loss and proportionally more filled teeth than younger individuals. Impacts related to the oral health that affected their daily life were reported in 39.7%. Multivariate logistic regressions analysis showed that missing teeth (>or=10) and a limited jaw opening (<40 mm) were significantly associated with having one or more impact as measured with the OIDP [odds ratio (OR) 6.50, 95% CI 1.48-28.43 and OR 2.87, 95% CI 1.03-7.96, respectively].

CONCLUSIONS: Individuals with diminished functional oral health status (missing teeth and limited jaw opening) had significantly more often one or more oral impacts on daily life than those with fewer than 10 missing teeth and a jaw opening >or=40 mm. The OIDP instrument may be valuable for use in routine dental check-ups in patients with related problems to determine possible oral impacts on daily life.

Forskning visar att tandvårdspersonal har bristande kunskaper i hur man hjälper patienter att sluta röka och snusa. En studie pågår därför för att öka kunskapen om metoder för tobaksavvänjning.

Objective

The aim of the present study was to investigate smokers' perceptions of and motivation for smoking cessation activities in dentistry.

Materials and methods

Patients who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists.

Results

The sample consisted of 167 adult patients (≥ 20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR = 3.0, 95% CI = 1.03-8.55).

Conclusions

This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.

Introduction: Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication.

Material and Methods: The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy.

Results: Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy.

Conclusion: The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.