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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]

The aim of this paper was systematically to evaluate the caries-preventive effect of professional fluoride varnish treatments. A search of the literature for articles published between 1966 and August 2003 was carried out in electronic databases, reference lists of articles, and selected textbooks in accordance with the strategy of the Swedish Council on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized and controlled clinical trials comparing fluoride varnish with placebo, no active treatment or other fluoride preventive regimens of at least 2 years' study duration were included. The trials that met the inclusion criteria were assessed independently and systematically by at least two reviewers and scored from A to C according to predetermined criteria for methodology and performance. The main outcome measure was the preventive fraction expressed as a percentage. The results displayed limited evidence (evidence level 3) for the caries preventive effect of topical applications of fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0-69%) when compared with untreated controls. Inconclusive evidence (evidence level 4) was found for fluoride varnish treatment in the primary dentition and in adults. This systematic review reinforces the need for future clinical research of high quality, incorporating modern concepts of clinical performance and evaluation to assess dental caries control using professional fluoride varnish. [ABSTRACT FROM AUTHOR]

There is a knowledge gap in how dental clinicians recognise dental anxiety. The aim of this study was to identify, describe and generate concepts regarding this process. Eleven semi-structured interviews were conducted with dental clinicians from the public dental service of Östergötland, Sweden. Purposive and theoretical sampling was used. Theoretical saturation was reached after eight interviews. The interviews were audio-recorded and transcribed verbatim. Classical grounded theory was used to inductively analyse data by constant comparative analysis. The core category was identified as; 'the clinical eye', clinicians noticing behaviours possibly due to dental anxiety based on their knowledge, experiences, or intuition. The core category comprises the five categories: Sympathetic activation, Patient-reported anxiety, Controlling behaviours, Avoidance and Accomplishment. Initially there is usually uncertainty about whether a behaviour is due to dental anxiety or part of a patient's normal behaviour. To gain additional certainty, clinicians need to recognise a stressor as something in the dental setting by observing a change in behaviour, for better or for worse, in the anticipation, presence or removal of the stressor. Clinicians identify patients as dentally anxious if their behaviour changes with exposure to a stressor. [ABSTRACT FROM AUTHOR]

Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20–69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain. Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62–9.05 and OR 11.62 95% CI 5.18–27.88, respectively). These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions. [ABSTRACT FROM AUTHOR]

To examine how hospital-affiliated dentists assess risk and evaluate oral foci of infection in patients facing certain medical treatments, and whether the nature of upcoming medical treatment affects the choice of dental intervention. A survey comprising six clinical cases (50 teeth) was sent to hospital-affiliated dentists in Sweden. A treatment option for the affected tooth/teeth in each case was selected whether the patient was facing heart valve surgery, chemotherapy, radiation therapy, intravenous bisphosphonate treatment, solid organ transplantation or was diagnosed with endocarditis. Consensus in choice of dental treatment was high in 62%, moderate in 32% and low in 6% of the assessments. High variability of choice of treatment was seen for eight teeth whereas the remaining 42 teeth often received the same therapy regardless of medical issue. Chemotherapy and radiotherapy were thought to entail the highest risk for oral infectious sequelae with a risk ranging from 1% to 100%. Pre-medical dental evaluations and recommended treatments are often uniform with the exception of the management of asymptomatic root canal treated teeth with persisting apical radiolucency and heavily decayed molars. In many instances, dental diagnosis has a greater impact on choice of treatment than the underlying medical issue and associated implications thereof. [ABSTRACT FROM AUTHOR]

The aims of this systematic review were to identify the study designs and topics of Swedish orthodontic articles, to elucidate their international position, and to verify in which scientific journals the articles had been published in the past decade. A search of the Medline database for papers published between 1992 and 2002 was made using the Medical Search Heading terms 'orthodontics', 'malocclusion', 'cephalometry', and 'facial bones and growth'. Two independent reviewers selected the articles of Swedish origin and categorized each article according to research design and principal topic. Overall, 15,571 articles in orthodontic research were found, and the Swedish contribution was 1.9% with the majority of these (71.5%) being submitted by universities. Most of the Swedish articles (84.5%) had been published in 10 journals and many high-quality studies with orthodontic interest were published in non-orthodontic journals with higher impact factor scores than the orthodontic journals. Every second study was prospective, and of these, 15 (5.2% of all Swedish articles) were randomized clinical trials (RCTs). It was found that nearly every third study, prospective as well as retrospective, was uncontrolled. The main classification was treatment studies (51.9%), followed by development (18.6%) and diagnostic information (10.7%) studies. Thus, the majority of the articles evaluated therapeutic interventions; however, although the RCT is the preferred study design in evaluation studies, few used this method. In an era focused on evidence-based medicine, studies with an RCT design will be the future challenge for research in the field of orthodontics. [ABSTRACT FROM AUTHOR]

Objective: To reduce the gap between what can be achieved in endodontic treatments and the observed treatment outcome among general dental practitioners, the present study set out to assess the status of the endodontic practices as regards to knowledge and self-assessed skills among general dental practitioners in Sweden and Norway. Material and method: The questionnaire was sent to 1384 general dental practitioners. It contained questions regarding access to continuing education in endodontics, sources of knowledge for clinical management of patients, post-operative follow-ups, self-assessed success-rate, and the initial diagnosis impact on the outcome of endodontic treatments. Results: The response rate was 61.4%. Almost half estimated their endodontic success-rate to be 90%. About two-thirds of the respondents did not know, or did not believe, that the initial diagnosis could affect the outcome of their endodontic treatments. Respondents who did not believe the diagnosis could impact the outcome were more likely to estimate their success rate as the highest (p<.001). Less than half performed post-operative follow-ups a year after treatment. A third of the respondents had not attended any continuing endodontic education. Conclusion: Dentists who do not receive regular feedback on their treatments may lack insight into their own shortcomings. If this is combined with insufficient knowledge and understanding it may result in sub-par endodontic treatments being performed. It is important to have reliable ways to communicate current endodontic knowledge and to establish robust methods that may help dentists accurately assess their own performance in endodontics. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the level of knowledge and attitudes among Swedish general dentists regarding the behavior and management of patients treated with bisphosphonates and denosumabMaterials and Methods: A questionnaire was sent to 656 dentists. The web-based survey included questions on demographics, risk perception of osteonecrosis of the jaws (ONJ), the experience of managing patients treated with bisphosphonates and denosumab and requests to acquire new knowledge. Independence and associations were tested using Fisher's exact test and the chi-square test function.Results: The overall response rate was 57.6%. Most of the dentists, 69.7%, had been in the profession for more than 5 years. The criteria for ONJ were not known by 43.2% and 86.9% did not feel comfortable with their current level of knowledge when managing the patients in question. The rest of the respondents felt uncertain and more than 70% were unaware of the different stages of ONJ, when to refer a patient to a specialist and when to prescribe antibiotics.Conclusion: Dentists practicing in Sweden express a strong need for an improved level of knowledge when managing patients treated with bisphosphonates and denosumab. The results demonstrate a need for the necessary advancement of education and clinical training at dental schools in order to prepare dentists to provide safe, modern care within the healthcare sector. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective study investigated requests and indications for cone-beam computed tomography (CBCT) in children and adolescents over a 3-year period at one oral and maxillofacial radiology department. Specific aims were to determine what technical settings were used, which caregivers write the referrals, and how often and for what reasons re-exposure was necessary.Materials and methods: Patients <19 years of age who had been referred to the department and undergone a CBCT scan during 2015-2017 were included in the study.Results: CBCT were made in 617 of the 3847 eligible referrals. The most common referral was from general practice dentists (GPD) (43%). Mean age of the patients was 12.5 years (range: 6-18). Nineteen different types of requests were identified. The most common request was assessment of an ectopic canine with a question about potential resorption of adjacent teeth (38.6%). Forty (6.5%) of the CBCT needed to be re-taken due to patient motion artefacts.Conclusions: The most common request and indication for CBCT examination of children and young adults were to assess an ectopic canine and determine the presence of resorption of adjacent teeth. Referrals from GPDs were the most frequent and the largest age group was the 11- to 15-year olds. The reason for re-exposures was motion artefacts. High scanning speed to reduce motion artefacts and a half rotation (180°) to reduce the radiation dose to the patient should be preferred. The need for continuous work with quality and systematic monitoring of radiographic procedures at any radiology department should be given high priority. [ABSTRACT FROM AUTHOR]

Objective: To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program.Material and Methods: Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented.Results: Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high.Conclusions: The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended.Trial Registration: www.controlled-trials.com (ISRCTN35086887). [ABSTRACT FROM AUTHOR]

Objective: This study is a part of a project with the aim to construct and evaluate a structured treatment model (the Jönköping Dental Fear Coping Model, DFCM) for the treatment of dental patients. The aim of the present study was to evaluate the DFCM from a patient perspective.Material and Methods: The study was performed at four Public Dental Clinics, with the same 13 dentists and 14 dental hygienists participating in two treatment periods. In Period I, 1351 patients were included and in Period II, 1417. Standard care was used in Period I, and in Period II the professionals had been trained in and worked according to the DFCM. In the evaluation, the outcome measures were self-rated discomfort, pain and tension, and satisfaction with the professionals.Results: In comparison with standard care, less tension was reported among patients treated according to the DFCM, (p = .041), which was also found among female patients in a subgroup analysis (p = .028). Additional subgroup analyses revealed that patients expecting dental treatment (as opposed to examination only) reported less discomfort (p = .033), pain (p = .016) and tension (p = .012) in Period II than in Period I. Patients with low to moderate dental fear reported less pain in Period II than in Period I (p = .014).Conclusions: The DFCM has several positive effects on adult patients in routine dental care. In a Swedish context, the differences between standard care and treatment according to the model were small but, in part, statistically significant. However, it is important to evaluate the model in further studies to allow generalization to other settings. [ABSTRACT FROM AUTHOR]

Objective: To assess the occurrence of interproximal grinding as a caries therapy in primary molars, to what degree grinding replaced conventional restorative caries therapy, to what extent anaesthesia was used while grinding and to assess open comments about attitudes about grinding.Materials and Methods: A questionnaire was sent to 108 public dental service clinics with questions concerning the use of grinding as a therapy and alternative to restorative treatment, the use of anaesthesia prior to conventional caries therapy and grinding, respectively. In addition, a content analysis of open comments about grinding was performed.Results: Grinding had been performed in 96% of the clinics. Two-thirds of the dentists used grinding as an alternative to conventional restorative treatment at some point. Most dentists used anaesthesia prior to restorative therapy. Prior to grinding, the frequency of anaesthesia was lower (median 5.0) than for conventional restorative therapy (median 8.7) (p < .001). The open comment analysis revealed complex reasons for the use of grinding.Conclusions: Grinding has been widely practiced in parts of Sweden, is presently a technique employed by a multitude of dentists, and that anaesthesia is used less frequently prior to grinding, in comparison to conventional restorative therapy. Dentist considered grinding as a treatment option in specific situations. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective.Material and Methods: The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls.Results: Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear.Conclusions: The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to gain knowledge about the dentist's use and choice of digital intraoral imaging methods.Materials and Methods: A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the type of X-ray technique used, problems experienced with digital radiography, and reasons for choosing digital technology, and about indications, clinic size and type of service. Response rate was 53%.Results: Ninety-eight percent of the dentists had made the transition to digital radiography; only 2% used film technique, and solid-state detector (SSD) was the most used digital technique. More years in service decreases the likelihood of applying individual indications for performing a full mouth examination. More retakes were done with SSDs compared to storage phosphor plates. Reasons for choosing digital techniques were that work was easier and communication with the patients improved. However, dentists also experienced problems with digital techniques, such as exposure and projection errors and inadequate image quality. The Swedish Radiation Safety Authority states that all radiological examinations should be justified, something not always followed.Conclusions: This study showed that 98% of the respondents, Swedish dentists within the Swedish Dental Society, used digital techniques, and the most used was the solid-state technique. [ABSTRACT FROM AUTHOR]

Objectives: To explore the association of dental health care utilization with oral impacts on daily performances (OIDP) across time focusing ageing Norwegian and Swedish adults adjusting for predisposing, enabling, and need related-factors as defined by Andersen's model.Methods: Data were based on Norwegian and Swedish 1942 birth-cohorts conducted in 2007 (age 65) and 2012 (age 70). In Norway, the response rates ranged from 54% to 58%. Corresponding figures in Sweden were from 72% to 73%. Self-administered questionnaires assessed OIDP, dental care utilization and predisposing, enabling and need related factors. Logistic regression with robust variance estimation was used to adjust for clustering in repeated data.Results: Significant covariates of OIDP were satisfaction with dental services, dental care avoidance due to financial constraints, frightening experience with dental care during childhood and patient initiated dental visiting. Frequency and regularity of dental attendance were associated with OIDP in the Swedish cohort, only.Conclusions: In spite of country differences in the public co-financing of dental care, dental care utilization indicators were associated with OIDP across time in both cohorts. Encouraging regular and dentist initiated visiting patterns and strengthening beliefs in keeping own teeth could be useful in attempts to reduce poor oral health related quality of life in ageing people. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.Aim: Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.Design: Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.Results: An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR = 6.5, p = .002). Multiple regression analysis found the variables Beverages other than water (OR = 7.1, p < 0.001), Caries in sibling (OR = 4.8, p = .002), High level of MS (score 2-3) (OR = 3.4, p = .03) and Night meal (OR = 3.0, p = .03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.Conclusions: Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience. [ABSTRACT FROM AUTHOR]

Objectives: This study was aimed to investigate the prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population.Materials and Methods: The records of the 1066 patients seeking orthodontic treatment were screened for maxillary lateral incisor agenesis (MLIA). The following data were recorded for each subject: age; gender; unilateral or bilateral agenesis of MLI and side. The lateral cephalogram of each subject with MLIA was digitally traced. The data were compared to age-matched control orthodontic patients with skeletal Class I.Results: The prevalence of maxillary lateral incisor agenesis was 4.9% (52 patients) in which 63.5% were females. There was a significant difference between MLIA patients and controls in sagittal relationships (ANB, Wits, AB plane, angle of convexity and Co-A/Co-Gn differential analyses) p < 0.05.Conclusions: Patients with maxillary lateral incisor agenesis showed a significant tendency for skeletal Class III compared with the Class I control. This could be attributed to maxillary hypoplasia/retrognathia. [ABSTRACT FROM AUTHOR]

ObjectivesTo test the hypothesis that certain individual, environmental and lifestyle factors are positively associated with beneficial health investment behaviours and oral/periodontal health among adolescents.MethodsFive hundred and six randomly selected 19-year old subjects living in two different areas (Fyrbodal and Skaraborg) in the county council of Västra Götaland, Sweden participated in a clinical examination and answered questionnaires covering psycho-social and health behavioural issues. Two oral-health models were estimated with gingivitis score as an objective and self-perceived oral health as a subjective indicator. Three health- investment behaviour models were designed with indicators directly related to oral health and two with indicators related to general health as well. The explanatory variables included gender, upper secondary education programme, native country, living area, general self-efficacy and parents’ education level.ResultsIn the objective oral-health model, theoretical studies and living in the Skaraborg area were both positively associated with a lower gingivitis score. For the subjective oral-health indicator, none of the explanatory variables showed statistical significance. In the investment-behaviour model with ‘tooth-brushing ≥ 2 times daily’ as a health indicator, female gender and theoretical studies showed statistically significant associations. With the indicators ‘no/few missed dental appointments’, ‘no tobacco use’ and ‘weekly exercise’, theoretical studies were statistically significant and positively associated. In the investment model with ‘perceived oral health care attention’ as an indicator, a high score of general self-efficacy was significantly associated with the feeling of taking good care of the teeth.ConclusionsIndividual, environmental and lifestyle factors are associated with young individuals’ oral health investment behaviours and gingival health conditions. [ABSTRACT FROM PUBLISHER]

Objectives: The primary objective of this study was to investigate the association of systemic diseases, use of medications, allergies and tobacco habits with geographic tongue (GT) and fissured tongue (FT) lesions. The secondary objectives were to evaluate the clinical characteristics of tongue lesions and to compare the overall results for referred and non-referred patients.Methodology: Non-referred patients with GT (GTgp; n = 130) and FT (FTgp; n = 62) were examined by general practitioners (gp) and compared to a control group without oral mucosal lesions (C; n = 1029). Referred patients with GT (GTs; n = 166) and FT (FTs; n = 15) were examined by oral medicine specialists (s) and compared to GTgp and FTgp. Statistical analyses were performed using unpaired t-test or Fisher's exact test. A multiple logistic regression model was developed to control for age and gender as confounders.Results: Compared to the C group, GTgp patients used more anti-hypertensive medications and Swedish snus (p < 0.01). The GTgp group consisted of older males (p < 0.001) compared to C. Compared to the GTgp group, the GTs group was younger, more likely to have symptomatic lesions (p < 0.0001) and comprised of more females. Among the groups examined, FT patients had the highest mean age.Conclusion: This study identified an association between GT and anti-hypertensive medications, as well as the use of Swedish snus. It also found differences in the activities and symptoms of the lesions between referred patients and their counterparts who were seen in general dental practice; these parameters influenced the results when these conditions were taken into account. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to assess the impact of care experience, health factors and socioeconomic factors on satisfaction with dental care across time and to assess the stability or change in levels of self-reported satisfaction with dental care in individuals as they progress from middle age to early old age.Materials and Methods: The present work is based on five separate data collections from a cohort study with 3585 individuals responding in all years of the survey. Data collection was conducted in 1992 when the subjects were 50 years of age and again 5, 10, 15 and 20 years later. Absolute stability in satisfaction with dental care was assessed by calculating the proportion of individuals who maintained their position in the same category from one survey period to another. Changes across time were tested using Cochran's Q test. Satisfaction with dental care across the 20-year survey period was modeled using the generalized estimating equation (GEE).Results and Conclusion: The result showed that 85% of women and 83% of men remained satisfied with dental care. Binomial GEE revealed no statistical significant change in satisfaction with dental care between 1992-2012. In sum, this study has shown that this age group, born in 1942, was stably satisfied with dental care between age 50 and age 70, despite all changes during this time period. Females are more satisfied than men and the most important factors are the experience of attention during the last visit, satisfaction with dental appearance and good chewing capability. [ABSTRACT FROM AUTHOR]

Objective.To investigate the dental health of Swedish children and adolescents with reference to age, gender and residence.Material and methods.Electronic dental records from 300,988 3–19-year-olds in one Swedish region were derived in a cross-sectional study in years 2007–2009. The DMFT system was used. Age was categorized into 3–6/7–9/10–12/13–15/16–17/18–19-year-olds and residence into ‘metropolitan’, ‘urban’ and ‘rural’ areas. ANOVA, generalized linear regression models and Fisher’s exact test were used.Results.Among 7–9-year-old children, nine out of 10 were free from fillings and manifest caries, while for 18–19-year-olds; this proportion was one third. Girls (18–19-year-olds) had a significantly lower risk of caries compared to boys of the same age, RR for the DT index = 0.83 (95% CI = 0.81–0.85). This pattern was reversed in 7–12-year-old children. Children and adolescents in metropolitan and urban areas had significantly more caries than subjects in rural areas, for instance the RR for the DT index in metropolitan 7–9-year-olds was 2.26 (95% CI = 2.11–2.42) compared to their rural counterparts.Conclusions.In the permanent dentition, the overall pattern revealed that girls ≤ 12 years had a higher risk of caries, while adolescent girls had a lower risk of caries, both compared with boys of corresponding ages. Living in an urban or metropolitan area entailed a higher risk of caries than living in a rural area. A greater occurrence of dental caries in adolescents than in children was confirmed. The findings should have implications for planning and evaluation of oral health promotion and disease prevention activities. [ABSTRACT FROM PUBLISHER]

Objective: The aim of this study was to analyze dentist's clinical decision-making related to treatment need for temporomandibular disorders (TMD) in an adult population.Materials and Methods: The study population comprised 779 randomly selected 35, 50, 65 and 75 year old individuals living in the county of Västerbotten, Sweden. The participants filled out a questionnaire and were examined clinically according to a structured protocol. The four examiners (two men, two women) were experienced dentists and were calibrated before the start of the study. After examination they individually assessed the need of treatment owing to TMD.Results: In total, 15% of the study population was considered to have a treatment need owing to TMD. The highest estimate was noted for 35 and 50 years old women and the lowest for 65 and 75 years old men. Overall, 21% of the women and 8% of the men were considered to have a treatment need owing to TMD, with statistically significant differences between men and women for the 35 and 50 years old groups. Inter-individual variations in dentists' decisions were observed. In a multivariate analysis, female gender, signs and symptoms of TMD pain, signs and symptoms of TMD dysfunction and smoking were associated with estimated treatment need.Conclusions: The prevalence of estimated treatment need owing to TMD was fairly high, but the dentists' clinical decision-making process showed large inter-individual variability. The observation calls for further research on the factors affecting the decision-making process in care providers. [ABSTRACT FROM AUTHOR]

Objectives.To describe oral health-related quality-of-life (OHRQoL) and the impact of malocclusions or orthodontic treatment need in a cohort of children in Swedish dental care, using the Swedish version of the Child Perceptions Questionnaire–Impact Short Form (CPQ11–14–ISF:16).Subjects and methods.Two hundred and fifty-seven children (mean age = 11.5 years, SD = 0.8, range = 9.8–13.5 years) completed the CPQ11–14–ISF:16 in conjunction with a clinical examination. In addition to malocclusions and orthodontic treatment need (based on the Index of Orthodontic Treatment Need–Dental Health Component), possible confounders (caries, enamel defects, dental trauma, headache and socio-economic markers) were recorded. Children also rated their own dental fear on the Children’s Fear Survey Schedule–Dental Sub-scale (CFSS-DS).Results.The mean total CPQ11–14–ISF:16 score was 9.31. The logistic regression analyses revealed an impact of orthodontic treatment need on OHRQoL (CPQ), but no clear association between higher severity and higher impact on OHRQoL was seen. Dental fear and headache appeared to discriminate for poorer OHRQoL. No impact from caries, enamel defects, dental trauma, or socio-economic markers was revealed.Conclusions.This cohort of children reported good self-perceived OHRQoL. Effects on OHRQoL from malocclusions or orthodontic treatment need were limited and inconsistent. Dental fear and headache were found to be more distinct impact factors on OHRQoL than were malocclusions or orthodontic treatment need. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate if the presence of periodontitis is associated with carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population.Materials and Methods: Study individuals were randomly selected from the Swedish civil registration database representing the aging population (60-96 years) in Karlskrona, Sweden. Bleeding on probing (BOP) and the deepest probing measurement at each tooth were registered. The proportions of teeth with a probing depth ≥ 5 mm and the proportion of teeth with bleeding on probing were calculated. Analog panoramic radiographs were taken and the proportion of sites with a distance ≥ 5 mm between the alveolar bone level and the cement-enamel junction (CEJ) were assessed. A diagnosis of periodontitis was declared if a distance between the alveolar bone level and the CEJ ≥ 5 mm could be identified from the panoramic radiographs at > 10% of sites, probing depth of ≥ 5 mm at one tooth or more and with BOP at > 20% of teeth.Results: Readable radiographs were obtained from 499 individuals. Carotid calcification was identified in 39.1%. Individuals were diagnosed with periodontitis in 18.4%. Data analysis demonstrated that individuals with periodontitis had a higher prevalence of carotid calcifications (Pearson χ(2) = 4.05 p < 0.05) and with a likelihood of 1.5 (95% CI = 1.0, 2.3, p < 0.05).Conclusions: Data analysis demonstrated a significant association between periodontitis and carotid calcification. [ABSTRACT FROM AUTHOR]

Objective. Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions. Background. It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the 'global oral health question' is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is. Materials and methods. In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Örebro (T) and Östergötland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression. Results. The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR = 5.6 and 5.2), chewing capacity (OR = 6.9 and 4.2), satisfaction with dental appearance (OR = 19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR = 3.5 and 3.9). Conclusion. Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants. [ABSTRACT FROM AUTHOR]

Objective. Older adults have not been studied as much as younger ones regarding prevalence of TMD-related symptoms. The aim was to assess the prevalence of TMD-related symptoms in two population samples, 70 and 80 years old. Materials and methods. Identical questionnaires were in 2012 sent to all subjects born in 1932 and 1942 living in two Swedish counties. The response rate was 70.1%, resulting in samples of 5697 70- and 2922 80-year-old subjects. The questionnaire comprised 53 questions. Answers to questions on problems regarding TMD-related symptoms and awareness of bruxism were analysed. Results. Twelve per cent of the women and 7% of the men in the 70-year-old group reported some, rather great or severe problems regarding TMD pain. In the 80-year-olds the prevalence was 8% and 7%, respectively. Subjects who had problems with TMJ sounds reported difficulty to open the jaw wide 6-times and TMJ pain 10-13-times more frequently than subjects without such problems. Changes of taste and awareness of bruxism were the only variables significantly associated with TMD symptoms in both age groups. Number of teeth was not significantly associated with any of the TMD-related symptoms. Conclusions. Most of the elderly subjects had no severe problems with TMD-related symptoms, but 12% of the 70-year-old women reported some, rather great or severe problems. The marked gender difference at age 70 had disappeared in the 80-year-old group. The prevalence was lower among the 80- compared with the 70-year-old subjects of both sexes. The results support the comorbidity between TMD-related symptoms and general health problems. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the association between the number of teeth and cognitive functions adjusted for age and education level in a cohort of older adults living in Sweden. Materials and methods. The study employed a cross-sectional design in which 1147 individuals between 60-96 years underwent a clinical oral examination. The cognitive functions were assessed using Mini-Mental State Examination (MMSE) and Clock-test. The level of education was obtained from a questionnaire. Data were subjected to Chi-square tests and multivariate logistic regression analyses were employed, grouping the different variables into pre-determined categories. Results. The co-variables age and education were significantly associated with the number of teeth ( p < 0.05). The multivariate logistic regression analysis revealed that the association between the number of teeth and the cognitive functions persisted even after adjusting for age and level of education. Conclusions. The findings suggest that the presence of teeth may be of importance for cognitive abilities in older adults. [ABSTRACT FROM AUTHOR]

Background. In Sweden and Denmark, clinical dentistry is changing and public dentistry is in transition towards more market orientation. Dentists' overall job satisfaction is important for how public dentistry can fulfil the new expectations from patients, the public and politicians. Objectives. The aim of this study was to investigate what organizational factors were important for publicly employed salaried dentists' overall job satisfaction. Methods. A random sample of active, general dental practitioners (private and publicly employed) was selected in Denmark and in Sweden, and they received a postal questionnaire. The number of questionnaires was 1835 and the response rate was 68% ( n = 1226). This study analysed only the publicly employed dentists. The sampling frame for the Swedish dentists was 431, response rate 68.9% ( n = 297) and for the Danish ones 194, response rate 81.9% ( n = 159). Multivariate regression was used with overall job satisfaction as a dependent variable. Results. Common organizational variables were important. The used model explained between 32% (Sweden) and 39% (Denmark) of the variance in overall job satisfaction. The only significant individual factor was less job satisfaction for Swedish dentists born outside Sweden. An organizational climate characterized by a focus on professional values was associated with job satisfaction in both countries. Among the Swedish dentists, number of colleagues and degree of influence were also important and among the Danish ones sufficient time for patients. Conclusions. Organizational factors had an impact on salaried publicly employed dentists' overall job satisfaction in both countries. The findings may have implications for other Human Service Organizations with employed professionals. [ABSTRACT FROM AUTHOR]

Objectives. To validate a risk classification model according to the Public Dental Service (PDS) guidelines with the actual 3-year caries outcome in terms of predictive values. Materials and methods. All 19-year-old patients registered at eight public dental clinics in Skåne, Sweden were invited to participate ( n = 1699). The study group who completed the baseline examination consisted of 1295 subjects, representing 10% of the age group attending the public dental care in the region. A risk classification of each patient in four categories was made by the patient's regular team according to the guidelines. At the follow-up 3 years later, 75.8% were accessible. The final examinations included bitewing radiographs and the actual caries increment for 982 patients was calculated. Results. At baseline, 11.9% were assessed as being at 'high' or 'very high' risk. The dropouts had significantly more caries than the remaining patients ( p < 0.05). The general disease activity was low, but those grouped into the two highest risk groups displayed significantly more new caries than those at lower risk ( p < 0.05). With a cut-off value ΔDFS > 0 vs DFS = 0, the sensitivity was 81% and the specificity 56% for 'low' risk vs any risk. By combining the 'low' and 'some' risk categories, the PDS model generated an improved specificity (94%). Conclusions. The risk assessment scheme used by the Public Dental Service for young adults relied basically on past and current caries activity and 65-70% of the patients were correctly classified. The model was most effective to screen out patients with low caries risk. [ABSTRACT FROM AUTHOR]

Objective. The aims of this study were to identify explanatory factors of satisfaction with oral health among Norwegian and Swedish 65 year olds in terms of items from four different domains of ICF and to compare the strengths of the various ICF domains in explaining satisfaction with oral health. Further it was to assess whether the explanatory factors of ICF domains vary between Norway and Sweden. Materials and methods. In 2007, standardized questionnaires were mailed to all the residents in certain counties of Sweden and Norway who were born in 1942. Response rates were 73.1% ( n = 6078) in Sweden and 56.0% ( n = 4062) in Norway. Results. In total, 33 questions based on four different ICF domains were chosen to explain satisfaction with oral health. Logistic regression showed that four different ICF domains in terms of body function, body structure, activity/participation and environmental factors explained, respectively, 53%, 31%, 12% and 34% of the explanatory variance in the satisfaction with oral health. In the final analysis, only nine items were statistically significant ( p < 0.05). Conclusion. This study indicates that ICF as a conceptual model could cover a broad spectrum of factors embedded in OHRQoL measured by a global question in Sweden and Norway. Nine items, representing four ICF domains, were important in the final model for explaining satisfaction with oral health. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to evaluate some intra-oral caries-associated variables and tobacco use on dental caries. Materials and methods. The participants were randomly recruited from three cross-sectional studies in Jönköping, Sweden, in 1983, 1993 and 2003. Each study consisted of 130 individuals in each of the 20, 30, 40, 50, 60 and 70-year age groups. Of these, 550, 552 and 523 dentate individuals attended respective year of examination. They were all examined both clinically and radiographically. A questionnaire was completed in conjunction with the examination. In the studies, 345 were smokers, 104 snus users and 1142 non-tobacco users, in total 1591 individuals. Results. In 1983 and 1993, there were no significant differences in mean DFS between non-users and smokers, but a statistically significantly higher mean DFS in comparison with snus users. In 2003, there was no statistically significant difference in mean DFS between the groups. Multiple regressions showed that, after adjusting for age, gender and socio-demographic variables, there was a statistically significant association between DFS and smoking in 1983 (smoking excluded in favour of lactobacilli when further analysed) and DFS and plaque index (PLI) in 1993. In 2003, there was no association, apart from buffer capacity (Power rising) between DFS and the examined intra-oral caries-associated variables and tobacco use. Conclusions. The results of these epidemiological studies, performed in 1993 and 2003, indicate that daily smoking or snus use does not increase the risk of dental caries. [ABSTRACT FROM AUTHOR]

Objective. The aim of the study was to test the hypothesis that root-filled teeth are at a higher caries risk than non-root-filled teeth. Materials and methods. Two sub-samples from epidemiologically obtained data collected in 1983, 1993 and 2003 in the city of Jönköping, Sweden, were analysed. All the participants were examined clinically and radiographically and the type of filling and the presence or absence of caries were recorded. Sub-sample 1 comprised 832 individuals (9202 teeth) aged 20-70 years with at least eight premolars/molars. In sub-sample 2, 163 subjects (577 teeth) with only one or two decayed tooth surfaces and at least one tooth with full crown coverage were analysed. Results . Logistic regression analysis found that root-filled teeth were predictive of recurrent caries when controlling for the type of restoration in sub-sample 1 (OR == 1.68; 1.41-2.0; CI 95%) and sub-sample 2 (OR == 2.20; 1.07-4.52; CI 95%). Conclusion . In support of the suggested hypothesis, the data revealed a significant association between root-filled teeth and recurrent caries. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the study was to better understand the associations between work factors and professional support among dentists ( Collegial Support) as well as the sense of being part of a work community characterized by trust ( Community with Trust). Methods. A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models. Results. A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust. Conclusion. A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists. [ABSTRACT FROM AUTHOR]

Objective. We assessed the relationships between (I) ultrasonography calcaneus T-scores (PIXI) and mandibular cortex characteristics on oral panoramic radiographs in older subjects; and (II) osteoporosis and periodontitis. Material and methods. We examined 778 subjects (53% women) aged 59--96 years. Periodontitis was defined by alveolar bone loss assessed from panoramic radiographs. Results. PIXI calcaneus T-values ≤≤--2.5 (osteoporosis) were found in 16.3% of women and in 8.1% of men. PIXI calcaneus T-values <--1.6 (osteoporosis, adjusted) were found in 34.2% of women and in 21.4% of men. The age of the subjects and PIXI T-values were significantly correlated in women (Pearson's r == 0.37, P < 0.001) and men (Pearson's r == 0.19, P < 0.001). Periodontitis was found in 18.7% of subjects defined by alveolar bone level ≥≥5 mm. Subjects with osteoporosis defined by adjusted PIXI T-values had fewer remaining teeth [mean difference 4.1, 95% confidence interval (CI) --1.1 to --6.5, P < 0.001]. The crude odds ratio (OR) of an association between the panoramic assessment of mandibular cortex erosions as a sign of osteoporosis and the adjusted T-value (T-value cut-off <--1.6) was 4.8 (95% CI 3.1--7.2, P < 0.001; Pearson χχ2 == 60.1, P < 0.001). A significant OR between osteoporosis and periodontitis was only found in women for the T-value cut-off ≤≤--2.5 (crude OR 1.8, 95% CI 1.1--3.3, P < 0.03). Conclusions. An association between osteoporosis and periodontitis was only confirmed in women. The likelihood that the mandibular cortex index agrees with adjusted PIXI T-values is significant. [ABSTRACT FROM AUTHOR]

Objective. To compare the short- and long-term effectiveness of a prefabricated occlusal appliance with that of a stabilization appliance when treating headache in patients with myofascial pain. Material and methods. Sixty-six patients, 94% of whom suffered concomitantly from headache, at two centres for Stomatognathic Physiology in Sweden and Finland were included in a randomized controlled trial. History questionnaires and clinical examination according to the Research Diagnostic Criteria for Temporomandibular Disorders were used at baseline and at 10-week and 6- and 12-month follow-ups. Patients were randomly assigned to either a prefabricated (R) or a stabilization appliance (S) group. Results. There were significant decreases in the frequency and intensity of headache in both groups at all follow-ups, without statistically significant differences between groups. At baseline, 23 patients in both groups reported recurrent-continuous headache and, at 12 months, seven in the R group and four in the S group. The mean intensity (numeric rating scale) of headache prior to treatment decreased significantly at 12 months from 5.3 to 2.1 in the R group and from 6.1 to 2.9 in the S group. At the 12-month follow-up, 56% of patients in the R group reported a 30% reduction in intensity of headache and 50% a 50% reduction. In the S group, corresponding values were 39% and 36%, respectively. Non-specific physical symptoms were significantly associated with frequency of headache at baseline and at 6 months, and with depression at 6 and 12 months. Conclusion. The effectiveness of the prefabricated appliance seems to be similar to that of the stabilization appliance in the treatment of headache in patients with myofascial pain in both the short and long term. [ABSTRACT FROM AUTHOR]

Objective. To investigate sense of coherence in relation to oral health status in an adult Swedish population in order to better understand the determinants of positive oral health-promoting behavior and differences in oral health. Material and methods. A stratified random sample of 910 individuals from Jönköping, Sweden aged 20, 30, 40, 50, 60, 70 and 80 years was obtained. The investigation used the Swedish short version of the Sense of Coherence (SOC) questionnaire comprising 13 items and a self-report questionnaire to elicit demographic information. In addition, a clinical and radiographic oral examination was performed. Results. A total of 525 individuals, 261 men and 264 women, consented to participate in the study. Bivariate analysis revealed that higher mean SOC scores were statistically significantly associated with more decayed and filled surfaces (DFS) and filled surfaces (FS), fewer decayed surfaces (DS), fewer teeth with calculus and periodontal health. Multivariate analysis showed that higher SOC scores represented a predictor of fewer occurrences of a periodontal probing pocket depth of ≥4 mm and a lower risk of plaque in different regression models. Conclusions. Higher SOC scores may be a protective determinant of plaque and periodontal disease, indicating an association between SOC and oral health. [ABSTRACT FROM AUTHOR]

Objective. Human service work differs from industrial work, which should be considered when organizing work. Previous research has shown organizational differences in the perceptions of work, often with a focus on negative aspects. The aim of this study was to analyse the overall job satisfaction among private- and public-practising dentists in Sweden and Denmark. This also implied a description of the questionnaire Swedish and Danish Dentists' Perceptions of Good Work about opportunities and positive and rewarding aspects of work. Material and methods. A questionnaire covering the multidimensional concept of good work was developed. A total of 1835 dentists randomly sampled from the dental associations were sent a questionnaire in November 2008. A special non-response study was performed. Principal components analysis (PCA) was used to create a measure of overall job satisfaction, comparing four organizational subgroups. Results. The average net response rate was 68% ( n = 1226). The special non-response study of the Danish private practitioners showed more males, managers and dentists with more working hours than the respondents. PCA of three satisfaction questions showed a stable one-factor solution. There were differences in job satisfaction, with Danish public dentists ranked highest in overall job satisfaction and Swedish public dentists lowest. Conclusions. There were organizational differences in the perception of job satisfaction. Further analysis of how the human service is organized in the different groups is needed. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to examine the impact of general diseases and medication on oral health-related quality of life (OHRQoL) in a Swedish adult population using the Swedish version of Oral Impacts on Daily Performances (OIDP). Material and methods. A three-site sample of 200 adults (20-86 years; participation rate 70%) was interviewed using the OIDP, and a medical anamnesis was performed in 2006-7. A self-reported questionnaire provided complementary socio-economic data. Results. The burden of medical diagnoses and medications was greatest among the older participants in the study. The mean number of medicines in regular users was: ≥60 years, 3.6 (SD 2.6); 40-59 years, 1.9 (SD 1.5); and 20-40 years, 1.9 (SD 1.8) (p =0.013). There were no gender differences in general health or medication variables. Self-reported health, medical diagnoses and medication were significantly and consistently associated with the OIDP score: subjects with ≥1 diagnosis, OR 2.22 (95% CI 1.19-4.14) and subjects with ≥1 medicines, OR 1.85 (95% CI 1.01-3.40) versus those without diagnoses or medication. However, there was a clear gradient: OIDP scores increased with increasing numbers of diagnoses and medicines. Conclusion. The Swedish version of the OIDP was found useful for measuring impacts of general health and medication on OHRQoL. Dental care should pay special attention to patients with medical conditions or who are on medication, because these patients are more likely to experience oral impacts on daily performances. [ABSTRACT FROM AUTHOR]

Objective. The aim of this cross-sectional study was to analyze the relationship between chronic periodontitis and ischemic heart disease (IHD). Material and Methods. A cross-section of women aged 38 to 84 years were examined in 1992-93 (analysis based on n=1056). Medical and dental examinations were included in the analysis specifically with regard to IHD and periodontitis. Other well-known risk factors for IHD were used as covariates in multivariable statistical analysis. Results. Among the dentate women in this study (n=847), 74 had IHD and 773 did not. There was no statistically significant difference between numbers of pathological gingival pockets between these groups (58.1% had one or more pathological pockets in the IHD group compared to 57.6% in the non-IHD group). Bivariate analysis of dentate individuals showed significant associations between IHD and number of missing teeth, age, body mass index, waist/hip ratio, life satisfaction, hypertension, and levels of cholesterol and triglycerides. However, in the final multivariable logistic regression model, with the exception of age, only number of teeth (<17 teeth) OR = 2.13 (CI 1.20; 3.77) was found to be significantly associated with IHD. Moreover, edentulous women had an OR of 1.94 (CI 1.05; 3.60) in relation to IHD (age-adjusted model). Conclusions. In the present study, periodontitis did not seem to have a statistically significant relationship with IHD. The number of missing teeth showed a strong association with IHD, and this may act as a proxy variable tapping an array of different risk factors and behaviors. [ABSTRACT FROM AUTHOR]

Objective. Guided by the conceptual framework of Gilbert and co-workers, this study assesses satisfaction with oral health as reported by 65-year-olds in Sweden and Norway, the relationship of socio-demographic factors, clinical and subjective oral health indicators with satisfaction of oral health, and the consistency of those relationships across countries. Material and methods. In 2007, standardized questionnaires were mailed to all the residents in two counties in Sweden and three in Norway who were born in 1942. Response rates were 73.1% (n=6078) in Sweden and 56.0% (n=4062) in Norway. Results. Totals of 76.8% of the Swedish and 76.5% of the Norwegian participants reported satisfaction with oral health. Corresponding figures for toothache were 48.1% (Sweden) versus 51.5% (Norway), and for temporomandibular joint symptoms, 10.9% (Sweden) versus 15.1% (Norway). Multiple logistic regression analysis revealed that subjects who perceived they had bad health, smoked daily, had missing teeth, experienced toothache, had problems with chewing, bad breath, and oral impacts were less likely than their counterparts in the opposite groups to be satisfied with their oral health status. The corresponding odds ratios (ORs) ranged from 0.08 (problems chewing) to 0.2 (oral impact). No statistically significant two-way interactions occurred and the model explained 46% of the variance in satisfaction with oral health across the two countries (45% in Sweden and 47% in Norway). Conclusions. The oral condition of 65-year-olds in Norway and Sweden produced impacts in oral symptoms, functional limitations, and problems with daily activities that varied to some extent. Satisfaction with oral health varied by socio-demographic factors and subjective oral health indicators. A full understanding of the oral health and treatment needs of 65-year-olds cannot be captured by clinical measures alone. [ABSTRACT FROM AUTHOR]

Objectives. Oral health has a major impact on general quality of life. The aspects of oral health that are most important for each individual vary, and quality of life is a construct and not a measurable variable. The aim of this study was to describe the impact of oral health on quality of life in an adult Swedish population. Material and methods. The study comprised a stratified random sample of 519 individuals. The OHIP-14 questionnaire was used and the answers were rated on a scale of 0-4. Results. Twenty-one percent of the respondents stated that they had no oral problems related to well-being, and 79% had some form of problem related to quality of life. The mean value for the entire population was 6.4 (SD = 7.1); 5.9 (SD = 7.1) for men and 6.8 (SD = 7.2) for women. Of individuals who stated that they had oral problems, the majority were women aged 20 years. Nineteen percent of 30-year-old men and 53% of 70-year-old women stated that they had had problems that had made life less satisfactory. Individuals who frequently experienced problems related to oral health, with scores of 16-41 points, accounted for 10%. Conclusion. In this Swedish population, a number of individuals, young and old, experienced oral problems that had an impact on their well-being. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the cost of true-positive occlusal dentine caries detection in permanent molars assessed by: (I) visual-tactile examination, (II) visual-tactile examination combined with bitewing radiographs, and (III) selective radiographic examination of patients with lesions detected clinically. A second aim was to analyse the different strategies when the costs of the subsequent restorative care are considered. Methods. A model analysis was applied owing to the lack of original articles. Sensitivity and specificity were calculated from a systematic review and included in vitro and in vivo studies of medium and high quality. The direct costs for examinations and restorative care were extracted from the costs of the Public Dental Service in Sweden (2006). Results. The diagnostic costs per true-positive finding were dependent on the occurrence of occlusal caries and increased with decreasing prevalence. The strategy by which radiographs were exposed selectively on the basis of findings from visual-tactile examination resulted in higher initial costs compared with the first and second strategies. When the costs of the subsequent restorative care were added, the selective strategy was most beneficial by up to 26% savings per true-positive diagnosis. However, with this selective strategy, more cases of true-positive dentine caries were assumed would remain undetected as compared with the combined strategy with visual-tactile examination and radiographs for all. Conclusions. The cost for a true-positive caries diagnosis was inversely related to caries occurrence, and different diagnostic strategies may display contrasting outcomes when subsequent restorative care is taken into account. [ABSTRACT FROM AUTHOR]

Objective. To investigate the associations between oral sugar clearance and the prevalence of dental decay. Material and Methods. A total of 92 (44 F, 48 M) 71-year-old subjects in Goteborg, Sweden were consecutively chosen from a representative cohort study. The subjects were examined for: 1) caries-related status, 2) oral function, 3) salivary conditions, 4) cariogenic micro-organisms, and 5) oral sugar clearance. A factor analysis was used to investigate the possible existence of latent variables within these five areas. The latent variables from the factor analyses were used to study the associations between clearance and caries in multivariate regression models. Results. Only one latent variable relating to oral sugar clearance was found. In the regression model with the latent variable related to oral sugar clearance as a dependent variable and gender plus the latent variables related to oral function and salivary conditions as an independent variable, there were associations with gender and some latent variables reflecting oral function and one reflecting glucose in saliva (R2=0.20/0.17). Three latent variables relating to caries-related status were found and these were associated with the number of teeth, the percentage of filled tooth surfaces, and the percentage of decayed tooth surfaces (DS%). In the regression analysis using the latent variable associated with DS% as a dependent variable, this variable was related to the latent variables of oral sugar clearance and to some reflecting oral function, as well as glucose in saliva (R2=0.28). Conclusions: Oral sugar clearance appears to be independently associated with the prevalence of dental caries in the elderly. [ABSTRACT FROM AUTHOR]

Objective. Female unpromoted general practice dentists (GPDs) constitute about one-quarter of all dentists in Sweden. These female dentists suffer from many problems relating to their psychosocial working conditions. There are wide discrepancies between their perception of the ideal job situation and reality. Previously, three factors were found to constitute the ideal job situation. The aim of this study was to analyze patterns in two of these factors, i.e. the moral and the career factors, for understanding how ideal circumstances are conceived, i.e. how “good work” for the dentists could be obtained. Material and Methods. In the year 2000, all female unpromoted GPDs (183 persons) within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire; response rate 94%. Four multiple regression models were constructed for two factors of good work and for the differences between the ideal job situation and reality concerning these factors. Results. In all models, the explained variance was high. Those dentists who were committed to moral issues perceived large differences between the ideal and reality concerning moral values. Dentists committed to career issues experienced large differences between the ideal and reality concerning career development. Those dentists – about 60% – who would not want to be a dentist if they were to choose today, perceived large discrepancies concerning moral and career issues. Conclusions. The PDHS organization has failed to convince or engage those whom it ought to engage, that is those with the highest level of commitment. Dentists’ emphasis on moral values confirms the character of dentistry as primarily a human service work. [ABSTRACT FROM AUTHOR]

The concept of oral health-related quality of life (OHRQOL) is investigated in this study. The aim was to explore the dimensionality of variables measuring OHRQOL in an adult Swedish population and to discuss the findings in relation to existing indices. The study was based on responses to a 1998 questionnaire sent to a random sample of 1974 persons aged between 50 and 75 years. There were 22 variables based on questions concerning oral situation and the impact on 7 theoretically different dimensions of QOL. The majority were satisfied with their oral health situation. During the previous 12 months, 16% of the population had experienced problems with their mouth or teeth on at least one occasion per mouth. Principal components analysis was used to analyze the dimensionality of the variables. Three factors accounted for 59% of the variance: (1) Physical and social disability, (2) psychological discomfort and disability, and (3) functional limitation and physical pain. The perception of OHRQOL is multidimensional, but the dimensions are not equally important. The dimensions of OHRQOL found in the present study are similar to those of existing instruments. [ABSTRACT FROM AUTHOR]

The aim of the present study was to record and describe the oral condition of homeless adults in Stockholm, Sweden. There have been no clinical studies of the oral health of the homeless in Sweden since the 1970s. The study population comprised 147 homeless individuals (110 M, 37 F) in the age range 22-77 years. All underwent oral examination, including registration of periodontal status and caries data. The results show that homeless adults in Stockholm have fewer remaining teeth than the general population. Because conservative periodontal treatment is expensive and time-consuming, teeth with doubtful prognoses are usually extracted and only those with optimal periodontal health are retained. Another consequence of inadequate periodontal treatment, including insufficient oral hygiene instruction, is the high percentage of tooth surfaces with plaque accumulation. Heavy plaque accumulation will also have an effect on caries progression, expressed in this study as high DMFT values. Loss of teeth is likely to create dental and chewing problems, possibly resulting in increased dental and medical treatment needs. [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]

Earlier studies have shown that employers are keen to have employees whose attitudinal and behavioral traits are consistent with the employers' ideology. One way of ascertaining the image of ideal individuals is to analyze the required qualifications in job advertisements. The aim of this study was to explore possible changes in the employers' view of the ideal manager and dentist in the Swedish Public Dental Health Service (PDHS). The study investigated the kinds and frequencies of manifestly required qualifications concerning vacancies in the PDHS from January 1990 to December 1998. All job advertisements intended for dentists and managers on different hierarchical levels in general dentistry were included (n = 1152); 5705 qualification demands were analyzed by content analysis permitting quantitative descriptions of the textual material as well as an analysis of the underlying characteristics over time. The study indicates that, for dentists, dental professional qualifications or qualifications in accordance with the official objective of dental care were insufficient. While requests for qualifications relating to the economic organizational goals of the PDHS increased during the latter part of the period under study, requests relating to the dental profession decreased. For managers, too, the demands for dental professional qualifications had decreased at the end of the studied period compared to the demands for managerial qualifications and non-professional qualifications, which had increased. In conclusion, the job advertisement portrays the ideal dentist and manager primarily as an economic organizational asset. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop a model for how nursing personnel view oral health in general and the oral health of the care receivers in particular, applying a health promotion perspective and using grounded theory analysis. Data were collected through interviews with 17 nursing personnel, selected by strategic sampling. Analysis of the transcribed interviews showed that there were four strategies, related to staff education, hospital resources, and leadership motivation. The strategies were grounded in data and emerged from the interaction between the two main categories: 'the valuation of the importance of oral health' and 'the behavior towards oral health maintenance'. They were characterized as the routine, theoretical, practical, and flexible strategies, with the latter considered ideal. As increased knowledge is one important part in enhancing the nursing personnel's ability to perform oral hygiene procedures, there is a need for education among nursing personnel, primarily among those using a routine strategy. [ABSTRACT FROM AUTHOR]