Patient-reported outcomes following dental implant rehabilitation according to reason for missing teeth: A survey from a Norwegian population 8 years following treatment.

AIM: The aim of this study was to assess patient-reported outcomes (PROs) 8 years after dental implant rehabilitation in a sample with tooth loss due to periodontitis (TLP) and a sample with missing teeth for other reasons (MTOR). MATERIALS AND METHODS: The Norwegian National Insurance Scheme registry of subsidized dental implant therapy was searched, and patients (n = 3083) rehabilitated with dental implants in 2014 were mailed a questionnaire. PROs were described by relative frequencies, and the TLP and MTOR subsamples were compared using chi-square test. Multiple linear regression analyses were used to investigate variables potentially predicting PROs. RESULTS: Of the respondents (n = 1299), more than 90% were partly or fully satisfied with the treatment outcome. Complications were reported by 44.2%. Patients who lost teeth due to periodontitis (n = 784) reported greater oral function improvement and better pre-treatment information, and were more likely to experience complications when compared with patients who lost teeth for other reasons (n = 515). Age, level of education, self-funded cost, pre-treatment information, history of complications and the reason for missing teeth were found to predict PROs. CONCLUSIONS: In a Norwegian population rehabilitated with dental implants in 2014, satisfaction with the treatment outcome and the aesthetic outcome was high, irrespective of the reason for missing teeth. Self-report of complications and lack of pre-treatment information were the strongest predictors of inferior patient satisfaction and also predicted inferior oral function.

A Cross-Sectional Study of Peri-Implant Diseases in a Random Norwegian Population: Prevalence, Risk Indicators, and Clinical Validation of Patient-Reported Outcomes.

OBJECTIVES: The primary aim of this study was to investigate the prevalence of peri-implant diseases in a randomly selected Norwegian population. The secondary aims were to explore risk indicators for peri-implant diseases and to validate self-reported outcome measures from a survey with clinical parameters. MATERIAL AND METHODS: Patients (n = 3083) rehabilitated with dental implants in 2014 were mailed a questionnaire and invited to a clinical examination. A randomly selected subset of responders underwent a clinical examination (n = 242). Full mouth clinical and radiographic examinations were conducted. Multiple logistic regression was used to assess patient-related risk indicators for peri-implantitis. Self-reported data were compared with data from the clinical examination using Spearman correlation and binary logistic regression. RESULTS: The prevalence of peri-implantitis was 17.0% at patient level and 8.6% at implant level, according to the 2018 classification. Risk indicators for peri-implantitis included smoking and periodontitis in the adjusted model. The correlation was strong (r = 0.91, p < 0.001) between number of self-reported implants and clinical counts, whereas self-reported peri-implant inflammation was associated with peri-implantitis (OR 6.4 [95% CI 3.0, 13.7]). CONCLUSIONS: Smoking and periodontitis were identified as key risk indicators for peri-implantitis. Questionnaire data rendered clinically valid estimates of implant number, and self-reported peri-implant inflammation was associated with clinical peri-implantitis.

Prisoners' perceived oral and general health and their experience with accessing, understanding and assessing health information: A qualitative study.

Prisoners' oral health and general health are closely connected and generally poorer than that of the wider population. Moreover, knowledge of prisoners' health literacy is scarce. This study aimed to explore prisoners' perceived oral and general health and how they accessed, understood and assessed health information to gain insight into their health literacy. Twelve prisoners in a high-security prison and a halfway house participated in individual semi-structured interviews. Data was analysed through thematic analysis, which identified five themes: inconsistent self-reporting of general and oral health; autonomous health behaviour through utilizing personal resources; preference for personalized adapted health information; psychological and physical proximity; and barriers. The prisoners perceived their oral and general health as good despite several health problems. They expressed scepticism towards health information from public authorities and made their own health-related choices based on previous experiences, their own 'common sense' and the experiences of people they trusted. Health information was considered useful when adjusted to their needs. Obtaining health-related information through physical encounters was considered more accessible than through online platforms. Adapting the communication to prisoners' expressed needs and their health literacy can enhance the accessibility to improve their oral and general health. In-person encounters would be preferable.

Seeing the person before the teeth: A realist evaluation of a dental anxiety service in Norway.

Patients with a trauma history, whether sexual abuse or torture, or dental phobia, tend to avoid dental services due to severe dental anxiety. Subsequently, they experience poor oral health, lower quality of life, and poorer general health. In Norway, a specific service (torture, abuse, and dental anxiety [TADA]) targets these patients' dental anxiety through cognitive behavioural therapy (CBT) prior to dental restoration. By exploring patients' experiences with TADA services using a realist evaluation approach, this paper aims to increase our understanding of how this type of service addresses patients' dental anxiety in terms of its mechanisms and contextual factors. Interviews with TADA patients (n = 15) were analysed through a template analysis driven by context-mechanism-outcome heuristics. The analysis revealed that patients value a dental practitioner who provides a calm and holistic approach, positive judgements and predictability elements that lean towards a person-centred care approach. Provided this, patients felt understood and cared for, their shame was reduced, self-esteem emerged, and control was gained, which led to alleviation of dental anxiety. Therefore, our findings suggest that combining CBT with a person-centred care approach helps alleviate patients' dental anxiety. This provides insights into how dental services could be executed for these patients.

Exploring the contexts, mechanisms and outcomes of a torture, abuse and dental anxiety service in Norway: a realist evaluation.

BACKGROUND: Torture, abuse and dental anxiety (TADA) are often precursors to developing a pathological relationship with dental care due to elevated anxiety. Consequently, patients who suffer from one or more of these tend to avoid dental services. This could leave them with severe tooth decay, which could affect their general and psychosocial health. Norwegian dental services have implemented the TADA service to specifically alleviate dental anxiety and restore oral health for the TADA patient group. However, the service has not been evaluated, and there is a need to understand how and why this service works, for whom, under what circumstances. Therefore, this study aimed to develop theories on how the service's structure alleviates dental anxiety and restores these patients' oral health. Although developed in a Norwegian context, these theories may be applicable to other national and international contexts. METHODS: This realist evaluation comprised multiple sequential methods of service and policy documents (n = 13), followed by interviews with service developers (n = 12). RESULTS: The analysis suggests that, by subsidising the TADA service, the Norwegian state has removed financial barriers for patients. This has improved their access to the service and, hence, their service uptake. National guidelines on service delivery are perceived as open to interpretation, and can hereby meet the needs of a heterogeneous patient group. The services have become tailored according to the available regional resources and heterogeneous needs of the patient population. A perceived lack of explicit national leadership and cooperative practices has resulted in regional service teams becoming self-reliant and insular. While this has led to cohesion within each regional service, it is not conducive to interservice collaborations. Lastly, the complexity of migration processes and poor dissemination practices is presumed to be the cause of the lack of recruitment of torture survivors to the service. CONCLUSIONS: Policy documents and service developers described the TADA service as a hybrid bottom-up/top-down service that allows teams to practise discretion and tailor their approach to meet individual needs. Being free of charge has improved access to the service by vulnerable groups, but the service still struggles to reach torture survivors.

Knowledge about caries and erosive tooth wear is confused among Norwegian high school students.

OBJECTIVES: This study investigated differences in high school students' subjective and objective knowledge- and concerns about preventing caries and/or erosive tooth wear and the associations between these variables. MATERIALS AND METHODS: A survey was conducted among students at 16 high schools in Norway. The survey included a range of fact-based questions to measure objective knowledge about caries and erosive tooth wear, as well as questions about students' perceptions of his/her own knowledge (subjective knowledge) and concerns about preventing the two conditions. RESULTS: There were small differences in subjective knowledge about caries and erosive tooth wear among the 784 students who completed the survey (p < .01). However, students scored significantly higher on objective knowledge about caries (mean 2.99) than about erosive tooth wear (mean 1.45), p < .01, and seemed to confuse the two conditions. By contrast, students scored significantly worse on questions about beverages' potential to cause caries (mean 5.18) than to cause erosive tooth wear (mean 6.30), p < .001. Finally, objective knowledge about caries was positively associated with subjective knowledge about caries, but corresponding associations could not be found for erosive tooth wear. CONCLUSIONS: Knowledge about caries and erosive tooth wear seemed to be confused among Norwegian high school students.

Consumption of acidic drinks, knowledge and concern about dental erosive wear in Norwegian high school students.

OBJECTIVES: The objectives of the present study were to assess the consumption of acidic beverages, knowledge and concern about preventing dental erosive wear, and to examine potential associations between these variables, in a sample of high school students. MATERIALS AND METHODS: A survey measuring acidic beverage consumption, knowledge and concern about erosive tooth wear was conducted at 13 high schools in Rogaland county, Norway. RESULTS: Of the 850 students who completed the questionnaire, 26% reported that they drink acidic beverages every day. There were significant gender differences for the consumption of acidic drinks. The survey also demonstrated that a high proportion of students lacks basic knowledge of what erosive tooth wear is, and that this lack of knowledge is associated with a more frequent intake of acidic beverages. However, students who responded that they are concerned about preventing dental erosive wear reported that they drink soft drinks and energy drinks less frequently than students who are not concerned about this. CONCLUSIONS: Results from this study support assumptions about a lack of knowledge about dental erosive wear in youth, and that this lack of knowledge is associated with a more frequent intake of acidic drinks.

Oral health in prison: an integrative review.

PURPOSE: Prisoners' oral health is an often overseen, yet important aspect of the general health of prisoners. To develop effective measures to improve the situation, it is important to get an overview of existing research. The purpose of this study is to examine and analyse existing research on oral health of prisoners and provide a thorough understanding of prisoners' oral health and related factors. DESIGN/METHODOLOGY/APPROACH: Due to relatively few scientific papers on prisoners' oral health, an integrative review was chosen. Integrative reviews allow for the inclusion of diverse methodologies. A literature search was conducted, followed by an assessment of the quality of the studies by using the Mixed Methods Appraisal Tool. Thematic analysis was used to analyse the studies. FINDINGS: The few studies addressing European prisoners' oral health in the last 21 years differ in design and methodology. The results from this review indicate that prisoners' oral health is a complex phenomenon and should be understood from both individual and organisational perspectives. More research is needed to bridge the gap in the literature on prisoners' oral health. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first literature review on European prisoners' oral health.

Assessment of the SmartJournal Intervention for Improved Oral Care in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Poor oral health is common in nursing home residents, and health care professionals report numerous barriers when it comes to the provision of oral care for care-dependent older adults, such as a lack of oral health knowledge and skills, care-resistant behaviors in residents, lack of adequate oral care routines, insufficient systems for documentation of issues related to oral health, a high workload, and unclear responsibilities. An intervention, SmartJournal, has been developed to assist health personnel in preserving older patients' oral health. SmartJournal is a digital tool with three components: (1) documentation of oral hygiene routines; (2) monthly oral health assessment; and (3) education on geriatric oral care. An updated framework for research on complex interventions has been used to guide the various phases in the development of this intervention. This study focuses on the evaluation phase. OBJECTIVE: We aim to assess (1) the effectiveness of SmartJournal use in enhancing nursing home caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) whether SmartJournal use results in improved oral health for nursing home residents. METHODS: We will use a cluster randomized controlled trial to assess impacts of SmartJournal use as specified under study objectives. Nursing homes located in Rogaland, Norway, will be recruited and randomly assigned to an intervention and a control group. The intervention group will be provided with tablets containing SmartJournal and support from research staff, while the control group will continue with existing oral care routines. Both groups will receive oral hygiene packages. The intervention will last for 12 weeks. Measurements will be performed in both groups at baseline, 3 months, and 9 months and include (1) a survey assessing caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) assessment of oral health status in residents using mucosal-plaque score as a primary outcome measure. Analyses will include descriptive statistics and statistical techniques to look for changes and differences in the study variables within and between the intervention and control groups throughout the study period. Associations between study variables will also be investigated. RESULTS: Recruitment of nursing homes for the intervention and control groups was completed in February 2023. Recruitment of individual participants (ie, nursing home residents and caregivers) is ongoing, and baseline measurements are being performed consecutively. Results are expected to be ready for analyses in fall 2024. CONCLUSIONS: We aim to assess the effects of SmartJournal use on oral care and oral health in nursing homes. Results from this work may inform further development and implementation of SmartJournal and similar digital tools aiming to enhance health care services offered to care-dependent people. Finally, SmartJournal may have potential as a learning tool in educational programs for nurses and other health care professionals. TRIAL REGISTRATION: ClinicalTrials.gov NCT05724043; https://clinicaltrials.gov/study/NCT05724043. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46926.

Sorafenib-induced mitochondrial complex I inactivation and cell death in human neuroblastoma cells.

Sorafenib is a multikinase inhibitor that is approved for use against renal cell and hepatocellular carcinoma. We found that sorafenib potently induced cell death in human neuroblastoma cells. To understand the molecular basis of sorafenib-mediated cell death in human SH-SY5Y cells, we performed a temporal quantitative proteome analysis. The results showed significant quantitative changes of 193 unique proteins. Bioinformatics-assisted pathway analysis of the regulated proteins revealed that mitochondrial proteins, especially components of the electron transport chain and the mitochondrial ribosomes, were significantly affected upon exposure to sorafenib. The observed down-regulation of the respiratory chain complex I (NADH dehydrogenase) was accompanied with loss of mitochondrial transmembrane potential (Δψm) and complete impairment of complex I enzyme activity. The destabilization of complex I subunits was consistent, rapid, and independent of caspase activation as well as Bcl-2 overexpression. This study provides an overview of the molecular machinery driving sorafenib-mediated cell death in neuroblastoma cells and suggests that sorafenib could be a potential therapeutic drug for the treatment of neuroblastoma.

Proteome analysis of tunicamycin-induced ER stress.

Endoplasmic reticulum (ER) stress occurs upon increased levels of unfolded proteins and results in activation of cellular responses such as the unfolded protein response (UPR) and ER-associated protein degradation (ERAD). To examine ER stress, we performed a quantitative proteome analysis of human neuroblastoma cells using stable isotope labeling with amino acids in cell culture (SILAC) in combination with SDS-PAGE and LC-MS/MS. Proteins associated with the ER were overrepresented in the dataset of altered proteins. In particular, ER chaperones responsible for protein folding were significantly upregulated in response to ER stress. The important ER stress regulator 78 kDa glucose-regulated protein (GRP-78 or BiP) was highly upregulated together with several proteins that have been found to form a multiprotein complex with BiP including cyclophilin B, DnaJ homolog subfamily B member 11, endoplasmin, hypoxia upregulated protein 1, protein disulfide isomerase and protein disulfide isomerase A4 upon tunicamycin-induced ER stress. Furthermore, seven aminoacyl-tRNA synthetases and five proteins belonging to the Sec61 complex were increased in response to tunicamycin-induced ER stress.

Biomarkers common for inflammatory periodontal disease and depression: A systematic review.

Background: Dysregulated immune response arising in the periphery can induce depressive symptoms through neuroimmune interactions. Inflammatory oral pathology can be a potent inducer of chronic neuroimmune response relevant to depression. We aimed to synthesize available evidence for the association between inflammatory periodontal diseases (IPD) and major depression (MD) in relation to a broad range of biomarkers. Methods: Medline, Embase, PsycInfo, Cochrane Library, Web of Science and Scopus databases were searched from inception until January 27, 2022. Search terms included subject headings and synonyms for inflammatory periodontal disease and depression. Studies that reported data on both depression and inflammatory periodontal disease as categories along with measurement of a biomarker were considered. Two reviewers independently selected the articles for inclusion, extracted data and assessed the quality of each study. The protocol for this study was registered with PROSPERO, CRD42021215524. Results: Twenty-eight studies were included in the final review-eleven cross-sectional studies, seven case-control studies, and six prospective cohort studies conducted in humans; the remaining four were experimental animal studies. Eighteen studies including all animal studies reported a positive association between depression and periodontal disease; one study reported a negative association and another nine studies found no such associations. Twenty studies reported mixed associations between IPD and biomarkers (i.e, salivary, serum, urine or gingival crevicular fluid cortisol, C reactive protein, cytokines, etc.). Biomarkers related to depression were gingival crevicular fluid cortisol, interleukin 6 (IL-6), Il-1ß, immunoglobulin G against Bacterioides forsythus; root canal lipopolysaccharides; blood IL-6, IL-1ß, cortisol, advanced oxidation protein products, nitric oxide metabolites, lipid hydroperoxides and trapping antioxidant parameter; whereas five studies found no associations between depression and a biomarker. Although animal studies showed interaction of immune, inflammatory and neurotrophic biomarkers in the relationship between depression and periodontal disease, human studies showed mixed findings. In most studies, there were risks of bias due to the sample selection and assessment protocol. Study heterogeneity and limited number of comparable studies reporting on shared biomarkers precluded a meta-analysis. Conclusion: Immune-inflammatory contribution to depression was evident in the context of inflammatory periodontal diseases, but whether biomarkers mediate the associations between IPD and MD needs to be tested through methodologically rigorous studies aiming specifically at this hypothesis.

A health promotion intervention to improve oral health of prisoners: results from a pilot study.

PURPOSE: Prisoners have poorer oral health than the general population. Good oral health is essential for both social and physical well-being. For prisoners, poor oral health is also related to drug use after release, whereas good oral health is related to successful reintegration into society. The purpose of this study was twofold: to examine the effect of an intervention based on motivational interviewing (MI) on prisoners' oral health-related behavior and to assess if the intervention is a good fit for this population. DESIGN/METHODOLOGY/APPROACH: In total, 16 prisoners in a Norwegian prison were offered a brief MI-based intervention focusing on changing their oral health-related behavior. An oral examination was also performed and the prisoners received a small package containing oral hygiene aids. Two weeks later, a second oral examination and a semi-structured interview were conducted to explore the effect of the intervention and examine the prisoners' responses to the intervention. Qualitative data analyzes were guided by thematic analysis. FINDINGS: The findings indicate that the intervention had positive effects on both the prisoners' motivation to use oral health-related behavior and their performance of oral health-related behavior. The findings also indicate that the intervention was well adapted to the target population. ORIGINALITY/VALUE: This is one of the first studies that explore the effect of an intervention in improving prisoners' oral health and bridges a knowledge gap in the literature. The findings may increase the understanding of how dental services should be organized and offered to provide dental health care to this vulnerable group.