Search

Objective: A trend towards the state governance of healthcare through quality indicators and national clinical guidelines has been observed, and it is argued that this trend can be a challenge to the autonomy of healthcare professionals. In Sweden, these regulatory tools have been implemented in combination with subsidies for adult dental care that are based on guideline recommendations which serve to ensure that dental care is evidence-based and cost-effective. This paper aims to analyse the implications of these changes regarding dentists' autonomy and whether the government's political intentions can be fulfilled.Material and Methods: The paper is based on documents from government authorities and professional theories.Results: The financial control over Swedish dental care has been strengthened, and it can be argued that this is a step in the right direction from a societal point of view, as public resources are limited. Dentists' professional autonomy with their patients is not affected, which is appropriate, as patients should be treated according to their individual needs and expectations.Conclusions: This article shows that the state's governance does not directly detail dentists' work, which indicates a balance between state governance and dentists' autonomy. However, further research is required to get knowledge on Swedish dentists' view of the governance. [ABSTRACT FROM AUTHOR]

Background: Academic detailing (AD) is a defined form of educational outreach that can be deployed to intrinsically motivate practitioners towards improving quality of care. This paper describes the design of the ADVOCATE Field Studies. This proof of concept study aims to evaluate the feasibility, acceptability and usefulness of AD, reinforced with feedback information to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs). Methods: Six groups of GDPs will be recruited; two groups of six to eight GDPs in each of three countries - the Netherlands, Germany and Denmark. GDPs will meet for four Academic Detailing Group (ADG) meetings for open discussions using comparative feedback data to stimulate debate about their dental practice performance and care delivery. Group meetings will be moderated using the AD methodology. Qualitative data will be collected through focus group interviews, an online discussion forum, field notes and debriefs of ADG meetings and analysed by conventional content analysis using MaxQDA software. Discussion: The results of the study will provide novel information on the feasibility, perceived acceptability and usefulness of AD and feedback data for GDPs to improve oral healthcare delivery. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the survival rate of cracked teeth after endodontic treatment. The secondary aim was to compare the survival rate of cracked teeth restored with composite filling/crown and those restored with a full crown. The study was conducted retrospectively from three general dental clinics in Stockholm, which are all part of the national dental service organisation. Two-hundred patients with teeth receiving endodontic treatment due to symptomatic cracks were included. The patient data range from year 2001 to 2016. The mean age of the patients was 48 years (range 29–69). Fifty-five per cent had cracks located above the pulpal cavity, 11% within the pulpal cavity and 3% located in the root canal. The cracks were located most commonly on the proximal surfaces. The survival rate for teeth with cracks was 68% and 54% after 5 and 10 years, respectively. The survival rate was significantly higher (97%) for cracked teeth receiving a full crown after endodontic treatment compared to teeth restored with either a composite filling or composite crown. The overall survival rate for cracked teeth was 68% after 5 years, while it was significantly higher for cracked teeth restored with a full crown. The results suggest within the limitations of this study that cracked teeth should be restored with a full crown after endodontic treatment. [ABSTRACT FROM AUTHOR]

Objective: Are patients with symptomatic unilateral maxillary sinusitis sent for a dental evaluation of odontogenic maxillary sinusitis (OMS)?Patients and Methods: The medical records of all patients diagnosed with sinusitis at a university Ear-nose and throat (ENT) clinic from 2010 to 2015 were scrutinized for symptomatic unilateral maxillary sinusitis verified on CT. Any dental evaluation was recorded, as well as symptoms of OMS, duration to dental evaluation, diagnosis of OMS and dental treatment.Results: A total of 1338 patients diagnosed with sinusitis were screened; 172 had unilateral maxillary sinusitis and 48% (82/172) OMS. 34% did not have any dental evaluation at all. Patients referred to local specialist dental care waited a median of 11 weeks for evaluation and a median of 15 weeks further for dental treatment. Symptoms more frequently reported in OMS patients were foul smell or taste (43.9% vs 11.1%, p < .0001), purulent rhinorrhea (40% vs 19.1%, p = .015) than non-OMS patients. The OMS group also reported more frequently that they were active smokers (31.7% vs 10%, p = .0005).Conclusions: OMS was found in 48% of unilateral maxillary sinusitis and one-third of the patients with unilateral maxillary sinusitis had no dental evaluation. Low awareness of OMS could delay diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: To describe a population-based organization of dentoalveolar surgical service for 0 to 18-year old subjects in a Danish municipal dental service, and analyze the type of dentoalveolar surgical interventions needed.Material and Methods: The study was conducted in the Municipality of Aarhus, Denmark during five consecutive school-years. An internal referral system was established within the municipality where patients could be referred to colleagues with a higher level of competencies and more experiences with paediatric dentoalveolar surgery. The analysis includes a total of 1812 children and a total of 2854 surgical interventions.Results: Almost 80% of the patients, representing more than 80% of the dentoalveolar surgical interventions needed, were referred internally. Denudations were the most frequent treatment type (40.3%) carried out, followed by removal of third molars (18.0%). Furthermore, 22 odontomas and 100 supernumerary teeth were removed.Conclusions: The need of dentoalveolar surgery in children and adolescents is relatively low, but includes a wide range of interventions. An organizational system, where dentists can refer to colleagues who have developed special competencies in this field, results in most of these surgical patients being referred and treated internally. [ABSTRACT FROM AUTHOR]

Objective: Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland.Materials and Methods: The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases.Results: Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications.Conclusions: Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods. [ABSTRACT FROM AUTHOR]

Background. Few data are available on dental patient safety (PS), as most PS studies have focused on other activities in health care. Objective. To detect types and causes of dental PS incidents (PSIs), including adverse events (AEs) and near misses (NMs), in Finnish dental care. Material and methods. Altogether 1041 privately or publicly employed dentists in southern Finland completed a structured questionnaire using an internet-based system (Webropol) in 2010. Results. Nearly one third of the dentists reported some PSI in the previous 12 months. Of the 872 reported events, 53% were classified as AEs, 45% as NMs and 2% remained unclassified. Nearly half of the PSIs had occurred during some form of dental treatment. One third of the AEs were related to dental equipment, devices and supplies. Most of the reported AEs resulted in little or no permanent harm to patients. However, 13% of AEs were considered as serious enough to potentially cause severe harm or did in fact cause permanent harm. Conclusions. Reported dental PSIs in Finland are in many respects similar to those reported in other countries. Compared to all annual dental visits in Finland, severe dental AEs seem to be relatively rare. Less severe AEs and NMs are not uncommon, especially in dental surgery, endodontic and restorative treatment. The results of this retrospective study, however, reveal more about incident types than their true prevalence and that further studies on dental PS are needed. [ABSTRACT FROM AUTHOR]

Objectives. To study occlusal wear of anterior teeth in orthodontic patients retained with different retainers until 5 years post-treatment, and to investigate whether type of retention influences occlusal wear. Material and methods. Orthodontic patients (n=222), aged 15 years maximally at the start of treatment, were followed until 5 years post-treatment. In the maxilla, a retainer bonded on all six teeth or a removable retainer was used; in the mandible, a lingual retainer was bonded on all anterior teeth or on canines only. Dental casts were analyzed before treatment (T0), after treatment (T1), and 5 years post-treatment (T5). Incisal and canine wear were scored by applying a grading scale. Intercanine width, overjet, and overbite were measured with an electronic caliper. Statistics used were: Paired samples t-test for differences over time; Pearson correlation coefficients for associations between wear and retention type; and backward linear regression for influence of retention type on wear. Results. There was an increase in wear during all time periods and for all teeth. From T0 to T5 an increase in maxillary intercanine width and maxillary retention had an effect on changes in canine wear. Incisal wear was associated with an increase in upper intercanine width (T1-T5). For both arches, an increase in maxillary intercanine width during treatment was associated with less progression of canine and incisal wear, but the explained variance was low, 13.4% and 19.3%, respectively. Conclusions. Retention type and, occasionally, an increase in intercanine width influence anterior teeth wear post-treatment. However, the clinical significance and impact of the examined retention methods on occlusal wear are small. [ABSTRACT FROM AUTHOR]

Objective. The purpose of the study was to present the results of an oral examination of individuals with thalidomide embryopathy in relation to dental conditions and functional aspects of the masticatory system, with a special focus on tooth wear. Material and Methods. All 108 subjects with thalidomide embryopathy living in Sweden were invited to participate in a comprehensive investigation, and approximately one-third, 31 subjects (13 F and 18 M, aged 45-49years), took part. The methods included a questionnaire and clinical and radiographic examinations. Results. Most of the subjects had regular dental care, which they in general considered sufficient. All except one always brushed their teeth themselves. One subject had limited mouth opening (25mm). There were no great deviations from normal anatomy and function of the masticatory system. Caries and periodontal conditions were also normal. Regurgitation was reported by 42% of the subjects. Tooth wear was more extensive than in comparable age groups. About a third of the subjects had Class III or edge-to-edge occlusion. Conclusions. In general, subjects with thalidomide embryopathy had no great deviations in dental conditions from people of the same age in the general population except for an increased rate of tooth wear and a higher prevalence of prenormal jaw relations. Tooth wear was related less to use of the teeth as tools and more to dental erosion associated, among other things, with a high rate of regurgitation. [ABSTRACT FROM AUTHOR]

Objective. From a dental care perspective, we analyze whether the prevention of approximal caries by fluoride varnish treatment (FVT) or by fluoride mouth rinsing (FMR) could contain costs in an extended period of follow-up after the end of school-based prevention programs.Material and methods. It is assumed in a model that, after 3 years of prevention with either FVT or FMR according to published studies, the “natural course” of approximal caries progression would follow for 5 consecutive years, as described in a Swedish longitudinal study. The outcome and costs of FVT, FMR and controls were modelled from years 4 to 8.Results. The FVT program had a better outcome in reducing approximal caries than FMR, and costs were lower. The FVT was expected to result in cost containment compared to controls 3 years after the end of the preventive FVT program. The ratio benefits to costs were 1.8: 1 for FVT and 0.9: 1 for FMR.Conclusions. Prevention of approximal caries by FVT may result in cost containment, at a benefit cost ratio of 1.8: 1, given that the program can be administered at school. [ABSTRACT FROM AUTHOR]

Objective. Amine fluoride/stannous fluoride (ASF) is proven to be effective against plaque and gingivitis. The purpose of this clinical controlled study was to investigate the influence of different application modes on the substantivity of this formulation. Material and Methods. Seventeen healthy volunteers received a professional dental prophylaxis. Undisturbed plaque growth was permitted for the next 48h. In a crossover design, participants received ASF as a single mouthrinse, toothpaste, slurries with high (HA) or low (LA) air content, or a placebo. Vitality of plaque bacteria was investigated before and at 1, 2, 3, 4, 6, and 8h after application of ASF. ANOVA was applied on a 0.05 significance level. Results. Highest reduction of plaque vitality resulted after toothpaste application, followed by mouthrinse, LA, and HA slurry. No changes occurred in the placebo group. Compared to baseline and placebo, statistically significant changes were detected up to 4h in all ASF groups. Toothpaste exerted antibacterial efficacy up to 8h. Vitality reduction was higher in the LA group than in the HA group. Conclusions. The concentration of ASF in formulations influences the time course of the antibacterial effect. Contact of ASF formulations with air might reduce their efficacy. [ABSTRACT FROM AUTHOR]

Objective. Our knowledge of how people with disabilities look upon oral health and dental care is limited. The aim of this study was thus to explore how the people with disabilities experience the encounter with dental health care. Material and Methods. With a focus on dental care and oral health, qualitative interviews with 16 informants with cognitive and/or physical disabilities were analysed in accordance with the qualitative method of grounded theory. Results. A core category identified and labeled "giving low priority to oral health care" was found to be related to four other categories: "being afraid of losing control", "having difficulties complying with instructions", "having a desire for continuity", and "wishing to be just like everyone else". The results show that oral health and dental care are important, but are not considered a priority by the people with disabilities. General health issues have much higher priority but do not include oral health, which consequently can affect oral health negatively. Conclusions. Of several factors identified that could be improved to make dental visits more pleasant for patients are enhancing a sense of control in the patient and improving continuity. [ABSTRACT FROM AUTHOR]

The push-out bond strength of cylindrical ceramic inserts (CI) to particulate filler resin composite (VC) was evaluated in this study. Various surface treatments to improve the adhesion of CI to resin composite were tested. Additionally, the effect of fiber-reinforced composite (FRC) laminate encapsulation around CI was tested. Feldspathic porcelain CI with a diameter of 3.1 mm was bonded to VC. Adhesive resin was used for bonding. In group 1, no surface treatment of CI was done. In group 2, CI was encapsulated with a thin layer of woven glass FRC. In group 3, the surface of the CI was tribochemically silica coated and silanized. In group 4, the surface of the CI was grit-blasted with 50 microm aluminum oxide and etched with hydrofluoric acid. In group 5, the grit-blasted CI was encapsulated with a layer of FRC. The specimens (n = 6/group) were either dry stored or thermocycled in water (6000 x 5-55 degrees C). The push-out test was carried out with a universal material testing machine. The highest push-out strength was achieved in group 5 (20.4 MPa) and the lowest in group 2 (11.5 MPa). ANOVA revealed that both surface treatment and storage condition had a significant effect on push-out strength (p < 0.05). We conclude that the additional glass FRC encapsulation can be used to increase the bond strength of insert to composite. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effectiveness of Carisolv with that of two other alkaline substances: NaOCl and Ca(OH)2. Sixty extracted teeth were randomly divided into three groups and split down the center of a carious lesion. In group I, one half of the cavity was excavated with NaOCl (0.5%, pH 11.7), the corresponding half with Ca(OH)2 (pH 12.4); in group II with NaOCl and Carisolv; and in group III with Ca(OH)2 and Carisolv (n = 20 in each case). Carisolv hand instruments were used. Histological specimens were subsequently produced from all cavities and analyzed with a light-microscope following Mallory-Azan staining. The thickness of the remaining caries was measured (< 1 mm or > 1 mm) and the locations were recorded. The data were statistically evaluated using the chi-square test. In group I, 50.5% of the specimens treated with NaOCI and 48.7% treated with Ca(OH)2 were evaluated to be caries-free. The results in group II were NaOCl 61.5% and Carisolv 75.4% caries-free, and in group III Ca(OH)2 61.2% and Carisolv 73.9%. No statistically significant differences were found between NaOCl and Ca(OH)2 excavation (group I: p = 0.89). Compared to NaOCl and Ca(OH)2, Carisolv produced significantly better results for chemo-mechanical caries removal (groups II + III: p < 0.05). In the NaOCl and Ca(OH)2 treated specimens, carious layers with a thickness >1 mm were found significantly more often than in the Carisolv-treated specimens (groups II + III: p < 0.05), whereas there were no differences between NaOCl and Ca(OH)2 excavation (p = 0.06). There were no statistically significant differences in the location of the remaining caries in any of the groups (p > 0.05). [ABSTRACT FROM AUTHOR]

The aim of this summary of a longitudinal investigation on temporomandibular disorders (TMD) was to present the prevalence figures of signs and symptoms of TMD and certain other examined variables, and the correlations between these variables, over a 20-year period. Originally, 402 randomly selected 7-, 11-, and 15-year-olds were examined clinically and by means of a questionnaire. The same examination procedure was repeated three times: after 4-5 years and after 10 and 20 years, respectively. Signs and symptoms of TMD were mainly mild, but common already in childhood. They increased up to young adulthood, after which they leveled out. Progression to severe pain and dysfunction was rare, and spontaneous recovery from more pronounced symptoms was also rare. Significant correlations between reported bruxism and TMD symptoms were found, and a baseline report of tooth-grinding was a predictor of TMD treatment during the 20 years covered by the investigation. Occlusal factors were only weakly associated with TMD signs and symptoms. However, a lateral forced bite between the retruded contact position (RCP) and the intercuspal contact position (ICP) and a unilateral crossbite deserve further consideration as possible local risk factors for development of TMD. In conclusion, a substantial fluctuation of TMD signs and symptoms was observed in this sample of Swedish subjects followed for 20 years from childhood to adult. The demand for TMD treatment was low at all examinations, while the estimated treatment need was larger. One-third of subjects who had some kind of orthodontic treatment did not run a higher risk of developing TMD later in life. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of storage duration on the tensile bond strength of acrylic and silicone-based denture base materials with liners either heat-cured or auto-cured.Material and Methods: The denture liners investigated were Vertex soft (acrylic-based, heat-cured), Coe soft (acrylic-based, auto-cured), Molloplast-B (silicone-based, heat-cured), and Mollosil plus (silicone-based, auto-cured). The soft liner specimens were 10 x 10 x 3 mm and were processed between two PMMA blocks. They were tested following immersion in water at 37 degrees C for 1 day, 1 week, and 1, 3, and 6 months. Tensile bond strength was measured using a universal testing machine (Testometric Micro 500) at a crosshead speed of 20 mm/min (n = 10 specimens per experimental group). Multiple ANOVA and Tukey HSD were used to analyse the data at a pre-set alpha of 0.05.Results: The results indicate that the tensile bond strength of acrylic-based soft liners is greater than that of silicone-based materials. The bond strength of all lining materials decreases with storage duration; the decrease being greatest for the acrylic-based soft liners. The decrease in bond strength of the auto-cured materials is greater than that of the heat-cured products.Clinical Significance: Comparison of the materials in this study indicates that the silicone-based, heat-cured soft liner is superior, based on the tensile bond strength property. Use of silicone-based, heat-cured soft liners may provide better clinical success over a long period. These laboratory results need to be verified by clinical testing. [ABSTRACT FROM AUTHOR]

The diagnostic value of DIAGNOdent in detecting primary occlusal caries has been investigated in many studies, although its use in in vivo detection of secondary caries remains unclear. The aim of this study was to investigate the ability of DIAGNOdent in in vivo detection of secondary caries on teeth with amalgam restorations. The material comprised 51 posterior teeth restored with amalgam material. Bitewing radiographs were taken of all teeth, in accordance with the standard clinical protocol, and analysed by five observers with respect to secondary caries. The restoration margins of each tooth were carefully scanned with DIAGNOdent and the site of the highest reading and its value were registered in a digital picture. The color (stained/unstained) of the restoration margins was also documented. The restoration material was removed and all cavities were examined carefully by two observers together, both visually and by probe. The results showed that the sensitivity and specificity of DIAGNOdent and conventional radiography in detecting secondary caries were 0.60/0.81 and 0.56/0.92, respectively. For DIAGNOdent, 100% of the teeth in the false-positive fraction had stains. Regarding receiver operating characteristic analyses, the Az values were 0.78 and 0.69 for DIAGNOdent and radiography, respectively. We conclude that DIAGNOdent may be used only as an adjunct to conventional methods in detecting secondary caries on teeth with amalgam restorations. [ABSTRACT FROM AUTHOR]

The aim of the present study was to account for treatment time and number of visits required for treatment of traumatic dental injuries in a cohort of 16-year-olds, born in 1975, and residing in the county of Västerbotten, Sweden, and to analyze the correlation between total treatment time and background factors. The study material comprised 1012 dental records from the Public Dental Health Service containing information on dental injuries to primary and/or permanent incisors or canines. The mean total treatment time per individual was 1.3 h, with a range of 0.1 to 27.5 h. For injuries to the primary dentition, the mean number of visits per individual was 2.2. One visit was sufficient in 21% of the trauma episodes. In the permanent dentition, each trauma episode required a mean of 3.4 visits, and 90% of the patients had to return for follow-up visits. The correlation between explanatory variables and total treatment time was described and analyzed by linear multiple regression analyses. Degree of severity and number of injured teeth were two parameters of major significance to treatment time. Treatment by a specialist had an impact on time in the permanent but not in the primary dentition. In the permanent dentition, the treatment time increased if the dental injury occurred before the age of 11 years. Treatment time was not dependent on where the clinic was located or on gender of the injured child. Different diagnoses could explain 33% of the variation in treatment time in the permanent dentition. [ABSTRACT FROM AUTHOR]

On the basis of the register of the Finnish Patient Insurance Association, the aim of this study was to examine malpractice claims for nerve injuries associated with third molar removals and determine whether they are concentrated among specialists, among less experienced dentists, or in certain geographic areas. During 1987-93 there were 139 claims for permanent sensory or motor disturbances related to removal of lower third molars in Finland. The lingual nerve was injured in 54% and the inferior alveolar nerve in 41% of the claims. In 91% of the cases the injury occurred in relation to surgical removal of the tooth and in 6% in relation to simple extraction. The claims were distributed among 123 dentists, of whom 78% were dental surgeons, 15% specialists in oral and maxillofacial surgery, and 7% other specialists. These figures represented 2% of the dental surgeons and 26% of the oral surgeons in Finland (P < 0.01). More than half the claims were associated with dentists with less than 10 years' experience. Claims originated more often from the eastern and northern (rural) areas of Finland than from urban areas (3.8 claims versus 2.4 claims per 100,000 inhabitants, P < 0.05). Compensation was paid to the patients in two-thirds of the cases, indicating that the dentists authorized to decide claims very often considered these injuries avoidable. Therefore, proper diagnosis, treatment planning, surgical techniques, and detailed patient information must be emphasized. In cases where risks are obvious, referral to an oral surgeon is recommended. [ABSTRACT FROM AUTHOR]