Prevalence of Dental Caries in Past European Populations: A Systematic Review.

OBJECTIVE: Within the fields of anthropology and osteoarcheology, human teeth have long been studied to understand the diet, habits, and diseases of past civilizations. However, no complete review has been published to collect and analyze the extensive available data on caries prevalence in European man (Homo sapiens) over time. METHOD: In this current study, the two databases, Scopus and Art, Design, and Architecture Collection, were searched using predefined search terms. The literature was systematically reviewed and assessed by two of the authors. RESULTS: The findings include a significant nonlinear correlation with increasing caries prevalence in European populations from 9000 BC to 1850 AD, for both the number of carious teeth and the number of affected individuals. CONCLUSION: Despite the well-established collective belief that caries rates fluctuate between different locations and time and the general view that caries rates have increased from prehistoric times and onwards, this is to our knowledge the first time this relationship has been proven based on published data.

Health-related quality of life and self-related health in patients with type 2 diabetes: effects of group-based rehabilitation versus individual counselling.

BACKGROUND: Type 2 diabetes can seriously affect patients' health-related quality of life and their self-rated health. Most often, evaluation of diabetes interventions assess effects on glycemic control with little consideration of quality of life. The aim of the current study was to study the effectiveness of group-based rehabilitation versus individual counselling on health-related quality of life (HRQOL) and self-rated health in type 2 diabetes patients. METHODS: We randomised 143 type 2 diabetes patients to either a six-month multidisciplinary group-based rehabilitation programme including patient education, supervised exercise and a cooking-course or a six-month individual counselling programme. HRQOL was measured by Medical Outcomes Study Short Form 36-item Health Survey (SF-36) and self-rated health was measured by Diabetes Symptom Checklist - Revised (DCS-R). RESULTS: In both groups, the lowest estimated mean scores of the SF36 questionnaire at baseline were "vitality" and "general health". There were no significant differences in the change of any item between the two groups after the six-month intervention period. However, vitality-score increased 5.2 points (p = 0.12) within the rehabilitation group and 5.6 points (p = 0.03) points among individual counselling participants.In both groups, the highest estimated mean scores of the DSC-R questionnaire at baseline were "Fatigue" and "Hyperglycaemia". Hyperglycaemic and hypoglycaemic distress decreased significantly after individual counselling than after group-based rehabilitation (difference -0.3 points, p = 0.04). No between-group differences occurred for any other items. However, fatigue distress decreased 0.40 points within the rehabilitation group (p = 0.01) and 0.34 points within the individual counselling group (p < 0.01). In the rehabilitation group cardiovascular distress decreased 0.25 points (p = 0.01). CONCLUSIONS: A group-based rehabilitation programme did not improve health-related quality of life and self-rated health more than an individual counselling programme. In fact, the individual group experienced a significant relief in hyper- and hypoglycaemic distress compared with the rehabilitation group.However, the positive findings of several items in both groups indicate that lifestyle intervention is an important part of the management of type 2 diabetes patients.

Lifestyle intervention for type 2 diabetes patients: trial protocol of The Copenhagen Type 2 Diabetes Rehabilitation Project.

BACKGROUND: Current guidelines recommend education, physical activity and changes in diet for type 2 diabetes patients, yet the composition and organization of non-pharmacological care are still controversial. Therefore, it is very important that programmes aiming to improve non-pharmacological treatment of type 2 diabetes are developed and evaluated. The Copenhagen Type 2 Diabetes Rehabilitation Project aims to evaluate the effectiveness of a new group-based lifestyle rehabilitation programme in a Health Care Centre in primary care. METHODS/DESIGN: The group-based diabetes rehabilitation programme consists of empowerment-based education, supervised exercise and dietary intervention. The effectiveness of this multi-disciplinary intervention is compared with conventional individual counselling in a Diabetes Outpatient Clinic and evaluated in a prospective and randomized controlled trial. During the recruitment period of 18 months 180 type 2 diabetes patients will be randomized to the intervention group and the control group. Effects on glycaemic control, quality of life, self-rated diabetes symptoms, body composition, blood pressure, lipids, insulin resistance, beta-cell function and physical fitness will be examined after 6, 12 and 24 months. DISCUSSION: The Copenhagen Type 2 Diabetes Rehabilitation Project evaluates a multi-disciplinary non-pharmacological intervention programme in a primary care setting and provides important information about how to organize non-pharmacological care for type 2 diabetes patients. TRIAL REGISTRATION: (ClinicalTrials.gov) registration number: NCT00284609.

Effect of a group-based rehabilitation programme on glycaemic control and cardiovascular risk factors in type 2 diabetes patients: the Copenhagen Type 2 Diabetes Rehabilitation Project.

OBJECTIVE: To compare the effectiveness of a group-based rehabilitation programme with an individual counselling programme at improving glycaemic control and cardiovascular risk factors among patients with type 2 diabetes. METHODS: We randomised 143 adult type 2 diabetes patients to either a 6-month multidisciplinary group-based rehabilitation programme or a 6-month individual counselling programme. Outcome measures included glycated haemoglobin (HbA(1c)), blood pressure, lipid profile, weight, and waist circumference. RESULTS: Mean HbA(1c) decreased 0.3%-point (95% confidence interval [CI] = -0.5, -0.1) in the rehabilitation group and 0.6%-point (95% CI = -0.8, -0.4) among individual counselling participants (p<0.05). Within both groups, equal reductions occurred in body weight, waist circumference, systolic blood pressure and diastolic blood pressure, but no significant between-group differences between occurred for any of the cardiovascular outcomes. The group-based rehabilitation programme consumed twice as many personnel resources. CONCLUSION: The group-based rehabilitation programme resulted in changes in glycaemic control and cardiovascular risk factor reduction that were equivalent or inferior to those of an individual counselling programme. PRACTICE IMPLICATIONS: The group-based rehabilitation programme, tested in the current design, did not offer additionally improved outcomes and consumed more personnel resources than the individual counselling programme; its broad implementation is not supported by this study. Trial registration Clinicaltrials.gov NCT00284609.

Integration of healthcare rehabilitation in chronic conditions.

INTRODUCTION: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities-Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen-collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. DESCRIPTION OF CARE PRACTICE: FOUR MULTIDISCIPLINARY REHABILITATION INTERVENTION PROGRAMMES, ONE FOR EACH CHRONIC CONDITION: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. CONCLUSION AND DISCUSSION: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.

Morbidity after chin bone harvesting--a retrospective long-term follow-up study.

BACKGROUND: Resorption of the alveolar bone after tooth extraction may result in insufficient bone volume for implant placement. Augmentation of the resorbed site using autogenous bone grafts harvested from the maxillofacial region, for example, the chin, is a common method; however, it also involves donor site morbidity. Chin graft morbidity involves impaired sensibility in the frontal teeth, the gingival, and skin postoperatively. MATERIALS AND METHODS: A group of 60 patients with partial edentulism in the maxilla and insufficient bone volume for implant therapy were augmented with bone grafts from the mandibular symphysis. The grafting procedure was performed between 1991 and 2001 with a follow-up period of 1 year after surgery. Postoperative sensibility of the lip, teeth, and gingiva was registered. Forty-six patients (18 women and 28 men) also participated in a long-term follow-up study. The mean age was 49 years (range 23-81 years) and the mean follow-up time was 7.5 years (range 4-14 years). The donor site was evaluated in four parts: a standardized clinical examination, radiographic examination and measurements, a mail-in questionnaire, and a survey of the medical records regarding complications and graft size. In the donor site, both hard tissue (mandibular symphysis and teeth) and soft tissue (ie, lower lip, infralabial area, and chin) were evaluated. A questionnaire was also answered by 38 of 46 patients. RESULTS: In the long-term follow-up, impaired tactility and sensitivity of the soft tissues were registered in 7.6%. Adjacent teeth (incisors, canines, first and second premolar) (n = 418), showed increased lamina dura in seven cases (1.7%) and four teeth had apical pathology (1.0%). The donor site (n = 45) showed good remineralization in 42 patients (93.3%), and 28 patients (62.2%) had a noticeable concavity radiologically. The questionnaires from 38 patients (answer frequency 82.3%) rated high satisfaction with the grafting and implant treatment. CONCLUSIONS: This study indicates that long-term follow-up of the chin graft donor site shows some postoperative morbidity. The most frequent disturbance was impaired sensibility in the soft tissues of the chin. The lower lip and teeth showed fewer disturbances. The rate of subjective symptoms was higher than the clinical findings but did, in general, not affect the patient in daily life. At radiographic examination, bone healing after chin graft harvesting did not regenerate to the preoperative level. The donor site showed good remineralization but left a radiologic concavity in the majority of cases.

Approximal caries development in adolescents with low to moderate caries risk after different 3-year school-based supervised fluoride mouth rinsing programmes.

The aim was to evaluate a 3-year randomised controlled trial of school-based fluoride mouth rinsing (FMR) on approximal caries development in 13- to 16-year-olds with low to moderate caries risk. The adolescents used F toothpaste at home and underwent prophylactic treatment at yearly check-ups at public dental clinics. Out of 788 randomly selected 13-year-olds, 622 completed the trial, carried out in 1999-2003. Supervised by a dental nurse, the subjects rinsed with a 0.2% NaF solution at different intervals. Group 1 rinsed their teeth on the first three schooldays every semester; group 2 on the first three and the last three schooldays every semester; group 3 on three consecutive days once a month during semesters; group 4 once every fortnight during semesters, and group 5 (control) did not rinse. Radiographic recording of approximal caries was performed. FMR on the three first and the three last schooldays every semester (group 2) had a prevented fraction of 59%, with approximal enamel lesions as a diagnostic threshold. Corresponding figures for groups 1, 3 and 4 were 30, 47 and 41%, respectively. The control group differed statistically from groups 2-4 for new enamel and dentin lesions and fillings (p < 0.01). Enamel lesions constituted more than 90% of the new caries lesions. Caries progression was low for all groups and no significant differences were found between groups. The main conclusion from this randomised controlled trial is that school-based FMR, as a supplement to the daily use of F toothpaste, reduces caries incidence on approximal surfaces in adolescents with low to moderate caries risk.