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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]

Objective: By 2023, fewer dentists are expected in Sweden, at the same time as the demand for dental care is expected to increase. Older people, in particular, are expected to require more dental health than previous generations. To meet this demand, the public sector dentistry in Sweden is moving towards changes in division of labour among dental professionals, including dentists, dental hygienists and dental nurses. However, the impact of this reallocation on the physical and psychosocial wellbeing of employees is unknown. The aim of this study was to compare workplaces with an equal or larger proportion of dental hygienists than dentists (HDH) with workplaces with a larger proportion of dentists than dental hygienists (HD) on the physical and psychosocial work load, musculoskeletal and psychosomatic disorders and sickness presence.Material: A total of 298 persons employed in the Public Dental Service in a Swedish County Council participated in this study.Conclusion: The medium large clinics HDH reported 85% of employee's with considerably more high psychosocial demands compared to employees in medium HD (53%) and large HD (57%). Employees in medium large clinics HDH also reported sleep problems due to work (25%) compared with employees in medium large clinics HD (6%), large clinics HD (11%) and small clinics HDH (3%). Clinic size does not seem to influence the outcome of the HD and HD clinics to any great extent. Of all employees, about 94-100% reported high precision demands and 78-91% poor work postures. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs).Material and Methods: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n = 128) and 2014 (n = 113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001.Results: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines.Conclusions: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD. [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]

Three UEDMA/TEGDMA (50:50 by weight) based dental composites were made, each with filler loadings of 53 vol.%. The three composites contained silane-treated filler particles with average particle diameters of 1.5, 3.0, or 10.0 microm. Twelve specimens per composite were mounted on wear wheels and run through 200,000 cycles in an ACTA wear machine. Six of these specimens per material were worn in slurries consisting of 30 g ground Millet seed shells and 120 g ground rice mixed with 275 mL water. The remaining six specimens were worn in similar 25% ethanol-water slurries. The composite wear profiles were recorded with a profilometer and used to calculate the wear. Hardness values of the composites were also measured both before and after storage for 2 weeks in either water or in a 25% ethanol water solution. The wear and hardness values from the measurements were analyzed using ANOVA. The wear analysis showed that the finer composites (1.5 microm filler diameter) wore the least and the coarsest composites (10 microm filler diameter) the most. The wear was significantly higher in the ethanol water slurry than in the water slurry. The hardness value of the coarsest composite decreased more than the finest composite during storage in water or 25% ethanol water. The hardness decrease was most pronounced in the alcohol solution. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify differences and similarities between the Nordic countries in dentists' use of dental amalgam as a restorative material, and also their knowledge and attitudes about amalgam from health, environmental, ethical, economic and social points of view. Procedures for handling amalgam waste were also studied. A random sample of 250 dentists was drawn from the national registers of authorized dentists in each country in late autumn 1997. At the beginning of 1998, a questionnaire was sent to all the dentists in the study group. The response rate was 77.6% in Denmark, 73.2% in Finland, 78.8% in Norway, and 84.0% in Sweden. In Finland and Sweden the use of dental amalgam had almost ceased, particularly for younger patients, while in Norway and especially in Denmark it was still widely used. Dentists' knowledge of the environmental effects of amalgam was confused, but most dentists had installed amalgam separators in their dental units by 1998. The majority of dentists in each country wanted to keep dental amalgam as a restorative material even in the future, and they did not want to ban the import of mercury to their home countries. Most dentists considered amalgam to be a health risk for at least some patients, and a great majority (from 76% in Sweden to 94% in Norway) considered composite as a possible odontological risk to patients. Since a majority of the dentists considered both amalgam and composites possibly harmful to patients, efforts to develop better alternatives to amalgam should continue. [ABSTRACT FROM AUTHOR]

In this article we report on how 64 dentists working in a big city in southern Sweden view their profession. The dentists ranged in age from 30 to 70 years (as it was indicated in intervals of 10 years). Their professional experience ranged from 2 to 44 years (mean, 23 years). We collected their views on the ideal skills of a good dentist by means of a questionnaire. From this material we identified three categories: 1) interpersonal skills; 2) clinical skills; and 3) others, such as self-confidence, stress tolerance, and managerial and administrative skills. Next, they rated the relative importance of a number of listed attributes in dentistry in this order: contact with patients, communication skills, empathy, manual skills, and theory. Finally, they described a number of aspects of their profession. We conclude that the importance of interpersonal skills, as well as stress tolerance and administrative skills, is emphasized by experienced practitioners but that these skills are not focused on in the dental curriculum. [ABSTRACT FROM AUTHOR]