Self-perceived oral health and orofacial appearance in older adults - an 18-year follow-up study in Karlskrona, Sweden.

OBJECTIVES: To analyze whether self-perceived oral health and orofacial appearance change with increasing age. METHODS: This longitudinal study is based on data from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprises 160 participants 60 years of age at baseline 2001-2003. The same participants were re-examined at 66-, 72-, and 78 years of age. To analyze whether perceptions of oral health and orofacial appearance changed with increasing age, Cochran's Q test was conducted. Statistical significance was considered at p ≤ 0.05, and the calculated value Q must be equal to or greater than the critical chi-square value (Q ≥ 7.82). Significance values have been adjusted for the Bonferroni correction for multiple tests. RESULTS: Self-perceived mouth dryness, both day (Q = 7.94) and night (Q = 23.41), increased over the 18-year follow-up. When divided by gender, significant differences were only seen for mouth dryness at nighttime. A decrease in sensitive teeth was perceived with increasing age, and an increase in self-perceived satisfaction with dental appearance, and a decrease in self-perceived problems with dental gaps between the ages of 60 and 78. These changes were, however, not statistically significant. Men experienced a higher proportion of discomfort with discolored teeth at age 78 than at 60 (Q = 9.09). CONCLUSIONS: Self-perceived oral health and orofacial appearance were relatively stable, with few changes over an 18-year follow-up.

Continuing professional development in general dentistry-experiences of an online flipped classroom.

INTRODUCTION: Continuing professional development is a lifelong learning process. One pedagogical approach that can be used is active learning. Flipped classroom is a method that has been shown to improve deeper conceptual understanding. In an online setting, the method saves travel, time, and costs. To our knowledge, flipped classroom is rarely used in continuing professional education. This study in general dentistry explored experiences of an online flipped classroom course in continuing professional development. MATERIALS AND METHODS: Fifteen dental hygienists, clinically active in general dental care, were interviewed. They were recruited from an online course on the latest classification system for periodontal diseases. The course had been conducted using an active learning and flipped classroom model. The interviews were semi-structured. Data were extracted using qualitative content analysis. RESULTS: The experiences of the dental hygienists could be summarized in three themes: Stimulation of knowledge gain through self-paced studies, The ease of virtual networking among colleagues, and Fostering of direct practical application through collaboration. CONCLUSION: New and emerging communication technology seems to open new possibilities for continuing professional development in general dentistry. Study participants felt that, in an online environment, mixing asynchronous and synchronous communication in a flipped classroom model facilitated learning in continuing professional development. Online active learning seems to work well in continuous professional development in general dentistry. After the course, the participating dental hygienists stated that they were able to use their new knowledge clinically and felt confident doing so.

Experiences of the use of portfolio in dental education - A qualitative meta-ethnographic literature review.

INTRODUCTION: Portfolio with a collection of evidence has become popular in higher education, including dental education. It is valuable to study the experiences of the use and implementation processes. Meta-ethnography can be a suitable method to analyse, synthesize and construct interpretations of qualitative research. Our aim was to explore experiences from the use of a portfolio/e-portfolio in dental education, from the students' and teachers' perspectives. MATERIALS AND METHODS: A systematic search in the databases PubMed, Scopus and ERC was performed, and the established seven steps of a meta-ethnographic review were used. 278 papers were initially identified, and seven were included in the final analysis. RESULTS: Two themes (Issues to Address and Consequences) and five subthemes (Purpose, Roles, Support and Structure, Challenges and Enablers, and Gains) were constructed. DISCUSSION: Our synthesis reflects various challenges, yet the learning gains are recognized and expressed to be important once the students and teachers have overcome early thresholds. Beyond the conclusions drawn in each paper, our synthesis provides new perspectives on the complexity of an implementation process and the balance of not seeing the woods for the trees being overwhelmed by technical and other practical aspects, reducing the opportunity for learning. CONCLUSION: The portfolio implementation in undergraduate dental education should address clarification to all stakeholders of the purpose and role, presenting a purposeful portfolio structure and timely support.

Self-perceived oral health and orofacial appearance in an adult population, 60 years of age.

OBJECTIVE: The study aimed to compare self-perceived oral health and orofacial appearance in three different cohorts of 60-year-old individuals. METHOD: A cross-sectional design, based on data obtained from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprised 478 individuals, from baseline, 2001-2003 (n = 191), 2007-2009 (n = 218) and 2014-2015 (n = 69). Comparisons were made within and between the cohorts, with bivariate analysis and Fisher's exact test. Statistical significance was considered at p < 0.05. RESULTS: The result showed that a low number of the participants reported self-perceived problems with oral health. Of the problems reported, a higher proportion in cohort 2014-2015 (39.3%) experienced problems with bleeding gums. The experience of bleeding gums increased between the cohorts 2001-2003 and 2014-2015 (p = 0.040) and between 2007-2009 and 2014-2015 (p = 0.017). The prevalence of discomfort with sensitive teeth was experienced in 7%-32%. Twice as many women compared to men experienced discomfort in all cohorts (no significant differences between the cohorts). Satisfaction with dental appearance was experienced in 75%-84%. Twice as many women compared to men were dissatisfied with their dental appearance in 2001-2003 (p = 0.011) and with discoloured teeth (p = 0.020). No significant differences could be seen between the cohorts regarding discomfort with dental appearance or discoloured teeth. CONCLUSION: The 60-year-olds irrespective of birth cohort, perceived their oral health and orofacial appearance as satisfactory.

Embedding environmental sustainability within oral health professional curricula-Recommendations for teaching and assessment of learning outcomes.

The FDI World Dental Federation suggests that "dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life." This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan-European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment.

An upgrade of the Malmö model by implementing case-based teaching and learning, in an undergraduate dental education.

BACKGROUND: At our dental education, the examination failure rate amongst students has increased, resulting in subsequent involuntary dropouts. One of the main problems seems to be that the students struggle with taking the necessary responsibility for their learning, as required by the problem-based learning (PBL) methodology. AIM: To describe the background to, and the transition process from, pure PBL to case-based teaching and learning (CBT) with flipped classroom seminars at the dental programme at [anonymised for peer review]. METHODS: In this position paper, we describe our observed problems with the PBL methodology, as implemented at this faculty, and the potential benefits of a change towards CBT. The current implementation of CBT is presented, along with educational research supporting the choice of activities. RESULTS: Tentative findings are that the flipped classroom seminars and the clearer instructions appear to be successful with higher levels of activity, engagement and attendance amongst the students, and the students have evaluated the seminars as very good learning activities. CONCLUSION: Tentative findings suggest that the current implementation of CBT may be a fruitful way of teaching in dental education today. Most of the teaching staff have been reawakened to teaching, and as a result, the content of the courses are being reviewed and improved. The students appreciate that what is expected of them has been made clearer and that there is a variety of learning activities.

Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population.

OBJECTIVES: The aim was to evaluate the characteristics of the mandibular third molars, especially in relation to the inferior alveolar nerve. Further aims were to investigate incidental findings in panoramic radiographs in an adult population, and to investigate image quality related to patient positioning. MATERIALS AND METHODS: From a previous study with 451 randomly selected adult participants who lived in Sweden, 442 panoramic radiographs from four dental public health clinics were used. The third molars' characteristics and relation to inferior alveolar nerve were evaluated. Incidental findings and patient positioning were recorded. STATISTICAL ANALYSIS: Frequency analysis was used to investigate the occurrence of all findings and their possible interconnections. Whether the patients' age or gender had an impact or not was also analyzed. RESULTS: The third molars were erupted in vertical position among 73% regardless of age. When retained or semi-retained, they were most commonly in mesioangular positions. The inferior alveolar nerve was located inferior to the roots in 52%, whereas an overlapped position was most common if the third molar was retained (90%), semi-retained (83%) or the age was less than 30 years (66%). Common incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Suboptimal patient positioning was found in one-third of the radiographs. CONCLUSIONS: Panoramic radiography is a useful method to evaluate third molar prior to surgical removal and may be the only image required. Most incidental findings on panoramic radiographs does not seem to require any further odontological management.

Prosthetic dental restorations in Swedish samples: prevalence and agreement between self-report, clinical findings, and influence on quality of life.

OBJECTIVE: To determine the prevalence of dental prosthetic restorations in an adult population, to study the agreement between self-reports and clinical findings of prosthetic restorations, and to study answers from a questionnaire in relation to the prevalence of prosthetic restorations. MATERIAL AND METHODS: A questionnaire was sent to a sample of 10,000 adults. A further sample of 1000 individuals was invited to answer the questionnaire and also participate in a clinical study. The agreement between self-report and clinical findings was analyzed, as were the associations between prosthetic restorations and questionnaire responses, using the chi2 test. RESULTS: A total of 40% of the sample had fixed dental prostheses (FDP), 2.7% had removable dentures. The agreement between self-report and clinical findings was 93%. 34.7% of the individuals with no prosthetic restorations were university graduates and 4% of individuals with removable complete dentures. Oral health had the greatest impact on the quality of life of younger individuals with FDP, with an OHIP-14 (Oral Health Impact Profile) score of 7.3 for the age group 20-39 years compared to 4.9 for the age group 65-89 years. CONCLUSION: The questionnaire method can be a cost-effective way to determine the prevalence of prosthetic restorations.

Temporomandibular Disorder Pain and Related Factors in an Adult Population: A Cross-Sectional Study in Southern Sweden.

AIMS: To measure the prevalence of temporomandibular disorder (TMD) pain and examine its association with gender and other factors in an adult population in southern Sweden. METHODS: In 2006, a questionnaire was sent to randomly selected individuals (n = 10,000) aged 20 to 89 years. Two specific questions were used to screen individuals with TMD pain, and an additional 16 questions were analyzed regarding the subjects' relation to TMD pain. The chi-squared test was used to compare the distribution of categorical variables, and factors possibly related to TMD pain were analyzed by using logistic regression models with a likelihood-ratio test. RESULTS: The response rate was 63%. The prevalence of TMD pain (once a week or more) was 11.0% (95% confidence interval [CI]: 10.2% to 11.8%). Women reported experiencing TMD pain more frequently than men. Further, the prevalence of TMD pain increased significantly in adults < 50 years of age. Those with TMD pain reported headaches much more frequently than those without TMD pain, and individuals with TMD pain self-reported poorer general health than those without it. Individuals with TMD pain also had higher scores on the oral health impact profile (OHIP-14). Moreover, the TMD pain group was three times more likely to have had a dentist or hygienist comment on their tooth wear than the non-TMD pain group. CONCLUSION: The prevalence of TMD pain in the adult population in southern Sweden was 11%. Factors related to TMD pain were female gender, age < 50 years, headaches, self-reported poor general health, high scores on the OHIP-14, and tooth wear. Age was the only factor that showed a significant difference between genders for TMD pain.

Impact of periodontal disease experience on oral health-related quality of life.

BACKGROUND: Periodontal research has traditionally focused on the site level, regarding etiology, pathogenesis, and treatment outcome. Recently, some studies have indicated that the presence of periodontal disease is associated with reduced quality of life. The aim of this study is to investigate the impact of periodontal disease experience on the quality of life. METHODS: This cross-sectional study includes 443 individuals. Clinical and radiographic examinations were performed; in conjunction, the oral health-related quality of life of all participants was assessed using the Swedish short-form version of the Oral Health Impact Profile (OHIP-14). Based on marginal bone loss, measured on radiographs, three different groups were identified: participants with loss of supporting bone tissue of less than one third of the root length (BL-), loss of supporting bone tissue of one third or more of the root length in <30% of teeth (BL), or loss of supporting bone tissue of one third or more of the root length in ≥ 30% of teeth (BL+). RESULTS: The effect of periodontal disease experience on quality of life was considerable. For the BL- group, the mean OHIP-14 score was 3.91 (SD: 5.39). The corresponding mean values were 3.81 (SD: 5.29) for the BL group and 8.47 (SD: 10.38) for the BL+ group. The difference among all groups was statistically significant (P ≤ 0.001). A comparison among the mean OHIP-14 scores in the different groups (BL-, BL, and BL+) revealed significant differences in six of seven conceptual domains. CONCLUSIONS: The BL+ individuals experienced reduced quality of life, expressed as the OHIP-14 score, compared with the BL and BL- participants.

Marginal bone loss in the adult population in the county of Skåne, Sweden.

UNLABELLED: The aim of this study was to investigate the prevalence and extent of periodontal disease registered as marginal bone loss and subject characteristics in the adult population in the county of Skåne in Sweden. One thousand individuals, 20-89 years old, were randomly selected and 451 subjects agreed to participate in the study. They answered a questionnaire and in conjunction with the clinical and radiological examination the subjects answered questions about their medical history. The examiners were co-ordinated regarding the diagnostic criteria through comprehensive written instructions, practice and discussions of clinical cases. One observer estimated marginal bone loss around the teeth on digital panoramic radiographs and bitewings. The individuals were classified regarding periodontal disease experience according to the following criteria: PD- = loss of supporting bone tissue < 1/3 of the root length, PD = loss of supporting bone tissue > or = 1/3 of the root length in < 30% of the teeth and PD+ = loss of supporting bone tissue > or = 1/3 the root length in > or = 30% of the teeth. Subjects with no or minor bone loss, i.e. PD- constituted 69% of the population. Twenty percent of the study population had marginal bone loss corresponding to localised periodontal disease (PD) and 11% exhibited generalised periodontal bone loss (PD+). The periodontal treatment need, defined as probing pocket depth > or = 6 mm and bleeding on probing > or = 20%, was 53% in the PD+ group. An interesting result was that there were no differences in periodontal disease experience between the genders. CONCLUSIONS: The prevalence and extent of periodontal disease in this study correlates well with recent other studies. Eleven percent of the population has experienced generalised periodontal disease, and 53% of them have a periodontal treatment need defined as 1 or more site with PPD > or = 6 mm and BoP > or = 20%.

Salivary biomarkers for detection of systemic diseases.

BACKGROUND AND OBJECTIVE: Analysis of inflammatory biomarkers in saliva could offer an attractive opportunity for the diagnosis of different systemic conditions specifically in epidemiological surveys. The aim of this study was to investigate if certain salivary biomarkers could be used for detection of common systemic diseases. MATERIALS AND METHODS: A randomly selected sample of 1000 adults living in Skåne, a county in the southern part of Sweden, was invited to participate in a clinical study of oral health. 451 individuals were enrolled in this investigation, 51% women. All participants were asked to fill out a questionnaire, history was taken, a clinical examination was made and stimulated saliva samples were collected. Salivary concentrations of IL-1ß, -6, -8, TNF-α, lysozyme, MMP-8 and TIMP-1 were determined using ELISA, IFMA or Luminex assays. RESULTS: Salivary IL-8 concentration was found to be twice as high in subjects who had experience of tumour diseases. In addition, IL-8 levels were also elevated in patients with bowel disease. MMP-8 levels were elevated in saliva from patients after cardiac surgery or suffering from diabetes, and muscle and joint diseases. The levels of IL-1ß, IL-8 and MMP-8, as well as the MMP-8/TIMP-1 ratio were higher in subjects with muscle and joint diseases. CONCLUSION: Biomarkers in saliva have the potential to be used for screening purposes in epidemiological studies. The relatively unspecific inflammatory markers used in this study can not be used for diagnosis of specific diseases but can be seen as markers for increased systemic inflammation.

Salivary biomarkers of oral health: a cross-sectional study.

AIM: Saliva is a useful diagnostic fluid for oral-related diseases. Monitoring salivary biomarkers for oral and systemic diseases could become an important complement to clinical examinations in epidemiological surveys. Recent findings indicate that it is possible to detect biomarkers for oral diseases within saliva samples. The aim of this study was to investigate if known salivary biomarkers could be used for epidemiological studies for detection of periodontitis. MATERIALS AND METHODS: A randomly selected sample of adults (20-89 years) living in Southern Sweden were invited to participate. Four hundred and fifty-one individuals were examined clinically using standard examination procedures. Stimulated saliva samples were collected and analysed for concentrations of IL-1ß, -6, -8, lysozyme, matrix metalloproteinases (MMP)-8 and tissue inhibitor of metalloproteinase (TIMP)-1 using ELISA, immunofluorometric assay or Luminex assays. RESULTS: Patients with severe periodontitis presented with elevated salivary concentrations of IL-1ß (p < 0.001) and MMP-8 (p < 0.001). In addition, the MMP-8/TIMP-1 ratio was significantly higher in the severe periodontitis group (p < 0.001). Smokers compared with non-smokers showed slightly lower concentrations of IL-8 (p < 0.05) and MMP-8 (p = 0.052). CONCLUSION: This investigation shows that IL-1ß, MMP-8 and the ratio of MMP-8/TIMP-1 could be used as markers of periodontal disease in larger patient populations.

Oral health and self-perceived oral treatment need of adults in Sweden.

UNLABELLED: The main aim of this thesis was to study the oral health and the self-perceived oral treatment need of adults in Sweden. The first step was to analyse the self-perceived oral treatment need in a random national sample of young adults (20 to 25-year-olds). This study used one patient and one dentist questionnaire. The patient questionnaire was sent to 611 young adults and the response rate was 78%. After permission from 377 of these individuals, a questionnaire was sent to their dentists and answers were received from 85% (321 dentists). How the individuals perceived their oral treatment need was used as a dependent variable in a multivariate logistic regression model. Independent variables were self-assessed socio-economic situation, general health and dental attitudes together with information from the dentists on their patient's dental status. The results showed that having a high educational level, poorer oral health compared to one's peers, and being concerned about one's oral health significantly increased the odds for a high perceived oral treatment need. In this group of young adults, 33% perceived a high oral treatment need. In order to study if the oral treatment need was the same in all adult age groups and how the perceived oral health was in an adult Swedish population, a new questionnaire was sent to a random sample of 9 690 individuals, 20 to 89-year-olds, living in Skåne, Sweden. The response rate was 63%. The results showed that a majority of the adult population in Skåne had a positive perception of their oral health, in particular the individuals in the youngest age group. Most individuals had lost few teeth and removable dentures were uncommon. One third rated their dental treatment need as high. The highest proportion of individuals with a perceived high oral treatment need was found in the age group 70-79. In order to study the perceived oral treatment need in all adult age groups, the questionnaire was further analysed. The Andersen behavioural model was used as a theoretical framework for a multivariate logistic regression model. Questions that fit the components of individual characteristics, health behaviour and outcomes in the model were used as independent variables. The self-perceived oral treatment need was used as a dependent variable. The results showed that the Andersen behavioural model was found to be a useful tool when studying the perceived oral treatment need, and variables from all of the components in the model were significant. Important factors for the prediction of a high oral treatment need were a low educational level, previous unmet perceived oral treatment need, frequent visiting pattern, perception of worse oral health, external locus of control, and to have received information from one's dental caregiver about a need for oral treatment. The evaluated oral health was also studied using another sample of adults from the same region and of the same age. 966 individuals were invited to participate in a clinical study and 47% of the final sample was examined. Since socio-economic factors have been shown to be related to oral health, the clinical findings were studied in cross tabulations and chi-2 tests together with age, gender, ethnicity and educational level. The results showed that older age was related to a higher prevalence and an increased severity of oral diseases (except for caries) and a higher number of dental restorations. There were no significant differences between the genders. Individuals with a lower educational level had fewer teeth remaining, had more caries lesions, and had worse periodontal conditions and a higher DMFT. Individuals not born in Sweden had fewer teeth remaining, had worse periodontal conditions, more apical destructions and had received less dental fillings than those born in Sweden. CONCLUSIONS: The self-assessed and the professionally evaluated oral health of the adult population in Skåne is good both in a historical and international perspective. The evaluated oral health is comparable to other Swedish studies. There is, however, a group of individuals that has an increased risk for oral diseases. The self-perceived oral treatment need is largely affected by the patient's socio-economic background and perceptions of oral health.

Oral health in the adult population of Skåne, Sweden: a clinical study.

OBJECTIVE: The aim of this study was to describe the oral health in the adult population of Skåne by clinical factors with special reference to age, gender, ethnicity and education. MATERIALS AND METHODS: Clinical examinations were performed on 451 randomly selected individuals, 20-89 years old, living in Skåne, Sweden. The clinical examination included a radiographic examination and a questionnaire. Clinical variables were put into cross-tabulations along with age, gender, educational level and ethnicity. RESULTS: For all of the described clinical variables, except caries, the frequency increased with age. There were no differences in the clinical variables due to gender. The frequencies of missing teeth, caries, periodontal conditions and DMFT were higher among those with a lower educational level. More missing teeth, worse periodontal conditions, more apical destructions and less dental fillings were found in individuals who were not born in Sweden. CONCLUSIONS: The oral health in the adult population of Skåne was overall good, with low frequencies of oral disease and a large number of remaining teeth up to a high age. The patients' oral health status, as determined by a dentist's clinical examination, differed due to age, educational level and ethnicity, but not due to gender.

Self perceived oral health, oral treatment need and the use of oral health care of the adult population in Skåne, Sweden.

UNLABELLED: The aim was to describe how the adult population in Skåne, Sweden, perceived their oral health, dental status, oral treatment need and use of oral health care. A questionnaire was sent to a randomly selected sample of 10 000 persons in Skåne, Sweden. The individuals were between 20 and 89 years old and registered as residents of the region during 2006. After excluding those no longer living in the region, 9 690 individuals remained. The response rate to the questionnaire was 63%, of which 57% were women and 43% men.A majority was satisfied with their teeth and with their teeth's appearance, 65% and 62% respectively. Of the respondents, 35% considered their dental health to be better than others in their age group. Symptoms associated with periodontitis were experienced by 40%. 7% were missing more than ten teeth while 7% had no dental fillings. 30% rated their need of dental treatment as high and most expected their treatment need to increase in the future. Most of the respondents, 60%, received their oral care at a private practice, whereas 13% did not see a dentist regularly for check-ups. More women than men perceived a high dental treatment need, 32% compared to 28%. CONCLUSIONS: A majority of the adult population in Skåne have a positive attitude towards their oral health. Most individuals had lost few teeth and removable dentures were uncommon.A third rated their dental treatment need as high and most expected their treatment need to increase in the future..

Dental treatment need among 20 to 25-year-old Swedes: discrepancy between subjective and objective need.

Our aim was to analyze variables from a questionnaire sent to 20 to 25-year-old Swedes to determine how they perceive their oral treatment need, and to determine which variables affect this perception. The questionnaire was sent to 650 individuals randomly selected from the database of the National Social Insurance Board of Sweden. The response rate was 78%. Another questionnaire was sent to the dentists of these young adults in order to collect clinical information. The response rate was 66%. The respondent's answer to the question 'How do you rate your dental treatment need today?' was dichotomized and used as a dependent variable in a multivariate logistic regression model. Each increase in number of decayed-filled teeth led to a 13% increased treatment need, bad oral hygiene a 2.24-fold increase, and no periodontal disease an 80% reduction in treatment need. A higher education beyond comprehensive school increased the perceived treatment need 7.16 times; a poorer dental health than one's contemporaries led to a 14.47-fold increase. When dentist and patient assessments were combined, variables related to the patients' self-assessments were the only significant contributors to the statistical model. A lack of concordance between patients' and dentists' assessments of treatment need was found which highlighted the differences between patients' and dentists' views on treatment need. This study shows the importance of communication between dentist and patient.