Effects of the Conceptual Model of Health Literacy as a Risk: A Randomised Controlled Trial in a Clinical Dental Context.

Numerous conceptual models of health literacy have been proposed in the literature, but very few have been empirically validated in clinical contexts. The aim of this study was to test the effects of the conceptual model of health literacy as a risk in a clinical dental context. A convenience sample of 133 Norwegian-speaking adults was recruited. Participants were randomly allocated to an intervention group (n = 64, 54% women, mean age = 50 years) and a control group (n = 69, 49% women, mean age = 46 years). Clinical measurements were conducted pre-intervention and six months post-intervention. In the intervention group, communication regarding patients' oral health was tailored to their health literacy levels using recommended communication techniques, whereas the control group received brief information not tailored to health literacy levels. The ANCOVA showed significant between-group effects, finding reduced post-intervention mean gingival (p < 0.000) and mean plaque (p < 0.000) indices in the intervention group when controlling for baseline index scores. The adjusted Cohen's d indicated large effect sizes between the intervention group and the control group for both the mean gingival index (-0.98) and the mean plaque index (-1.33). In conclusion, the conceptual model of health literacy as a risk had a large effect on important clinical outcomes, such as gingival status and oral hygiene. The model may be regarded as a suitable supplement to patient education in populations.

Dimensionality of stress experiences: Factorial structure of the Perceived Stress Questionnaire (PSQ) in a population-based Swedish sample.

We investigated the factorial structure of the Perceived Stress Questionnaire (PSQ-recent; Levenstein, Prantera, Varvo et al., 1993) in a large (N = 1516; 35-95 years) population-based Swedish sample (Nilsson, Adolfsson, Bäckman et al., 2004; Nilsson, Bäckman, Erngrund et al., 1997). Exploratory principal components analysis (PCA) was conducted on a first, randomly drawn subsample (n = 506). Next, the model based on the PCA was tested in a second sample (n = 505). Finally, a third sample (n = 505) was used to cross-validate the model. Five components were extracted in the PCA (eigenvalue > 1) and labeled "Demands," "Worries/Tension," "Lack of joy," "Conflict," and "Fatigue," respectively. Twenty-one out of the 30 original PSQ items were retained in a confirmatory factor analysis (CFA) model that included the five (first-order) factors and, additionally, a general (second-order) stress factor, not considered in prior models. The model showed reasonable goodness of fit [χ(2)(184) = 511.2, p < 0.001; CFI = 0.904; RMSEA = 0.059; and SRMR = 0.063]. Multigroup confirmatory factor analyses supported the validity of the established model. The results are discussed in relation to prior investigations of the factorial structure of the PSQ.

Development and validation of an instrument to assess oral health literacy in Norwegian adult dental patients.

OBJECTIVE: To develop and validate an interview instrument to assess oral health literacy in Norwegian adult dental patients. MATERIALS AND METHODS: The instrument, Adult Health Literacy Instrument for Dentistry (AHLID), was based on an OECD instrument used to assess general literacy in adults. One hundred and thirty Norwegian adults (mean age = 48 years; 57% women) participated. AHLID included a selection of oral health-related printed texts that ranged from 1-5 with respect to difficulty. A questionnaire regarding socio-demographic variables and knowledge of risk factors for oral disease was used. DMFT, stimulated salivary flow rate and streptococcus mutans and lactobacillus in saliva was also examined. RESULTS: The Cronbach's alpha values of AHLID were 0.98 for internal consistency reliability (p < 0.01) and 0.81 for test-re-test reliability (p < 0.05). AHLID score 3 was most frequent while very few fulfilled the criteria for score 1 and 5. Linear multiple regression analysis showed that lactobacillus in saliva and knowledge of risk factors for periodontitis and caries were predictor variables of AHLID score. CONCLUSIONS: AHLID appears to be reliable and valid to assess oral health literacy in Norwegian adults and suggests a method for country-specific health literacy instruments.

Relationship between natural teeth and memory in a healthy elderly population.

The relationship between mastication and cognitive function remains unclear, but both animal and experimental human studies suggest a possible causal relationship. In the present study it was hypothesized that natural teeth are of importance for hippocampus-based cognitive processes, such as episodic long-term memory. A population-based sample of 273 participants (55-80 yr of age; 145 women) was investigated in a cross-sectional study. The participants underwent health assessment, completed a battery of cognitive tests, and took part in an extensive clinical oral examination. The number of natural teeth contributed uniquely and significantly to explaining variance (3-4%) in performance on measures of episodic memory and semantic memory over and above individual differences in age, years of education, gender, occupation, living conditions, and medical history. The number of natural teeth did not have an influence on the performance of measures of working memory, visuospatial ability, or processing speed. Within the limitations of the current study, a small, but significant, relationship between episodic memory and number of natural teeth is evident.

Stressful negative life events and amalgam-related complaints.

OBJECTIVES: The role of stressful life events in the onset of self-reported amalgam-related complaints is unclear. The aim of this study was to examine the relationship between life events and amalgam-related complaints. METHOD: The participants were selected from a longitudinal population-based study. One-to-one matching of 337 participants with amalgam-related complaints to 337 participants without such complaints was performed. For 81 of the participants with amalgam-related complaints and their matched controls, data was also available approximately 5 years before the onset of complaints, making longitudinal analysis possible. All participants completed questionnaires assessing the occurrence of 55 life events. RESULTS: The results showed that many participants with amalgam-related complaints experienced negative life events before and at the onset of amalgam-related complaints. They also reported more unexpected and uncontrollable events difficult to adjust to in comparison with controls. The groups did not differ on positive or neutral life events. Somatic illness or surgical operation was the most common life event. Death of a very close family member and a major change in financial situation were also commonly reported. CONCLUSIONS: This study indicates that adverse negative life events could play a vital role in understanding and explaining amalgam-related complaints.

Oral health care and dental treatment needs in the Barents region.

OBJECTIVES: The first aim was to study how oral health care delivery was organized in member countries and to determine whether there were differences across the Barents region. The second aim was to assess the performance of the care provision systems. The Barents region is one of the largest hinterlands in northern Europe. STUDY DESIGN: Descriptions of the oral health care provision systems in Norway, Sweden, Finland and Russia were written. Performance of the care provision systems was assessed by evaluating access to and use of services in relation to oral health. METHODS: National statistics, governmental reports and scientific publications were used as data sources. Data were supplemented by sending questioning to national and local managers and experts. Inter- and intra-country comparisons included dental health status, service availability and restrictions, financial support for oral health care, availability of dental personnel and use of services. RESULTS: In the Barents region, oral health care provision systems, mainly operating via the public sector, were in place in all countries. However, in most countries, oral health was poorer, access to care more difficult and use of services lower, mainly because of a lack of dental personnel and economic constraints. Overall, there was a huge difference in the inhabitants to dentist ratios between the Nordic countries and Russia. CONCLUSIONS: Professional co-operation within dentistry should be integral to the Barents region in order to expand the number of dental personnel, improve oral health and increase access to dental care.

A patient-centred approach to teaching and learning in dental student clinical practice.

A patient-centred clinical teaching profile in the undergraduate dental curriculum at The University of Tromsø is described. This teaching profile implies that treatment planning is primarily based on the patients' perceived needs and the students are trained to retrieve information from the patients in this context. The role of the clinical instructor is primarily as a facilitator rather than an expert. The 'best interest of the patient' is not always easy to disclose and consequences related to the patients' levels of understanding, students competence, educational challenges and professional ethics are topics for discussion through the clinical education programme.

Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults.

OBJECTIVES: Several studies have been conducted on the prevalence of hyposalivation in older adults but no population-based studies in younger adults. Therefore, our aims were to determine the prevalence of very low and low unstimulated (UWSFR) and stimulated (SWSFR) whole salivary flow rates in different age groups between 20 and 69 years, and to analyse the relationship between hyposalivation, subjective oral dryness and predictors of reduced flow rate. METHODS: A randomized and stratified cross-sectional study including 1427 dental patients was conducted. UWSFR and SWSFR were measured, numbers of remaining teeth recorded and a questionnaire answered regarding subjective oral dryness, general diseases, use of drugs, body mass index (BMI) and use of tobacco. RESULTS: The prevalence of very low (<0.1 ml/min) and low (0.10-0.19 ml/min) UWSFR was similar for different age groups up to 50 years, ranging between 10.9-17.8% and 17.3-22.7%, respectively. The prevalence of very low UWSFR was significantly higher for women aged 50-69 years than for younger women. For men, prevalence of very low UWSFR was higher at 60-69 years. The prevalence of very low (<0.7 ml/min) and low (0.70 - 0.99 ml/min) SWSFR was between 0-5.5% and 0.8-8.2%, respectively, for the different age groups 20-69 years. Multiple logistic regression revealed that age above 50 years, female gender, having fewer than 20 teeth, and taking xerogenic drugs significantly increased the risk of very low UWSFR. For very low SWSFR, only having fewer than 20 teeth and taking more than two drugs were significant. In the younger individuals (<50 years) only BMI > 25 for very low UWSFR and diagnosed disease for very low SWSFR were found significant. In this younger subset, female gender combined with having fewer than 27 teeth was significant for low UWSFR. CONCLUSIONS: Hyposalivation is prevalent in younger adults, among whom it is associated with diagnosed disease and high BMI, while after age 50 years it is associated with medication. It is also associated with gender and with fewer remaining teeth.

Difference in apolipoprotein E type 4 allele (APOE epsilon 4) among dentate and edentulous subjects.

OBJECTIVES: To evaluate the frequency of apolipoprotein (APOE) alleles and determine whether APOE type 4 allele (epsilon 4) was associated with edentulousness even when certain factors were controlled. BACKGROUND: The APOE are important in lipid homeostasis, and APOE epsilon 4 has been found in many diseases and to have a negative impact on longevity. Tooth loss is more common in ill aged subjects with low income and education. MATERIALS AND METHODS: In a population-based study involving 1860 subjects between 35 and 85 years 1321 dentate (mean age = 54; 54% women, 46% men) and 539 edentulous (mean age = 72; 62% women, 38% men) subjects were studied. Logistic regression was performed with dentate/edentulous as dependent variables and years of education, socio-economic status, social network, stress level, handicap from birth, 23 various diseases and APOE epsilon 4 as covariates. Thereafter, APOE epsilon 4 frequencies were studied in 342 dentate and 336 edentulous subjects 50-85 years of age. The subjects were matched with regard to age, gender, years of education, living condition, stress level, handicap from birth and 23 various diseases. RESULTS: APOE allele frequency in the total group was epsilon 2 = 7.8%, epsilon 3 = 76.4% and epsilon 4 = 15.8%. Age, living condition, years of education and APOE epsilon 4 were significant covariates in edentulous subjects (p

Natural teeth and cognitive function in humans.

A number of neurobiological, psychological and social factors may account for cognitive impairment. In animal studies a relation between dental status and cognitive performance has been found. It is unclear whether such a relation exists for humans. In a first step we compared the performance of 1,351 participants (53% women, 47% men; age M = 54.0) with natural teeth to 487 edentulous participants (59% women, 41% men; age M = 71.3) on 12 cognitive tests. The natural teeth group had a lower mean age, fewer women, more years of education, higher mini-mental state (MMSE), and performed significantly higher on several cognitive tests. In a subsequent analysis, the cognitive performance of a subset of the participants (50-85 years) was examined. In this analysis, 211 had natural dentition and 188 were edentulous. The groups were matched for gender, age, social variables, diseases, stress and MMSE. The cognitive disadvantage of the edentulous group was still apparent. The results suggest that functional natural teeth relate to relatively preserved cognitive functioning in older age.

Buffering effect of a prophylactic gel on dental plaque in institutionalised elderly.

OBJECTIVES: The effect of multiple daily applications of a prophylactic gel, with buffering substances, on plaque acidogenicity in elderly institutionalised individuals was evaluated. BACKGROUND: Many elderly suffer from reduced salivary flow, poor oral hygiene and increased levels of cariogenic bacteria and are considered to be at an increased risk for coronal and root caries. Reinforcing the buffering capacity of dental plaque by the addition of substances such as bicarbonate and phosphates may decrease their caries activity. MATERIALS AND METHODS: Fourteen elderly, with subjective dry mouth, were treated for 16-day-periods at random with: (i) Profylin fluoride gel with buffering components; (ii) Profylin fluoride gel without buffering components and (iii) rinsing with water. Applications were made four times a day and each period was followed by a 2-week wash-out period. The plaque pH was registered after a carbohydrate challenge and the following were recorded before and after each test period: stimulated salivary secretion rate, buffer capacity, number Colony Farming Units (CFU) mutans streptococci, lactobacilli and a sample of Candida albicans on oral mucosa. RESULTS: Eleven participants (mean age 76.6 years) fulfilled the study. Changes in plaque pH measurements, when calculated as area under the curve (AUC(6.2) and AUC(5.7)) values (pH x min), before and after each of the three treatments, showed no significant differences. A tendency to a higher plaque acidogenicity and amount of cariogenic microorganisms was found after the gel treatments. C. albicans was found in low levels. CONCLUSION: Frequent applications of the gel did not result in an improved neutralising effect in the elderly. This may be caused by a combination of several factors, such as the level of oral dryness of the individuals and low solubility, release and retention of the gel substances in plaque. Instead, an increased plaque acidogenicity was noted.

Buffering effect of a prophylactic gel on dental plaque.

The aim of this study was to evaluate the effect of a new prophylactic gel on plaque pH and plaque fluoride concentration. Twelve participants with normal (n=6, >or=0.7 ml/min) and low (n=6, <0.7 ml/min) stimulated whole salivary secretion rate were included. After 3 days of plaque accumulation, at random the participants were (1) treated with Profylin fluoride gel with buffering components (active gel), (2) treated with Profylin fluoride gel without buffering components (placebo gel), (3) asked to rinse with water, and (4) given no treatment. All test series were followed by rinsing with a nutrition solution; after which registration of plaque pH was performed during 60 min. There were two drop outs with low salivary secretion rate in the water session. The overall least pronounced pH fall was found after the use of the prophylactic gel. Significant differences between the prophylactic gel and the placebo gel were found for the participants with normal secretion rate. Fluoride plaque concentrations evaluated in 12 individuals after (1) application of the active gel, (2) rinsing with 0.2% NaF, and (3) rinsing with water showed significantly higher values after rinsing with the NaF solution. It can be concluded that application of the active gel, particularly in subjects with normal salivary secretion rate, in general, buffered plaque pH to higher levels. Factors like concentration of buffering agent and solubility of the gel need to be further evaluated to improve the effect.

Psychobiological personality dimensions in two environmental-illness patient groups.

The aim of the present study was to investigate the psychobiological personality dimensions in two subgroups of patients with environmental illness (EI). Fifty-nine patients, 34 women and 25 men (aged 32-69 years), were referred for symptoms allegedly caused by abnormal sensitivity to either dental fillings (DF; n=26) or electromagnetic fields (EMF; n=33). For the evaluation of personality, the Swedish 238-item version of the Temperament and Character Inventory (TCI) was used. Compared with a control group, the EMF group scored higher on the temperament dimension Persistence. The DF group scored higher on the TCI subscales Harm Avoidance (fatigability and asthenia) and Self-Directedness (self-acceptance). Women scored higher than men did on the Novelty Seeking and Reward Dependence (RD) dimensions in the DF group and on RD in the control group, indicating an inherited gender difference. No differences were found between men and women in the EMF group. Our results indicate that the high level of persistence found in the EMF group and the high level of fatigability and asthenia in combination with high self-acceptance found in the DF group represent vulnerable personalities. No significant differences were found between the two patient groups, indicating that these groups are quite similar regarding personality. This vulnerability can be expressed as various mental and somatic symptoms, which can be interpreted as EI symptoms by the affected individual.

Temperament and character personality dimensions in patients with dental anxiety.

The aim of the present study was to investigate character and temperament dimensions of personality in six men and 31 women (aged 20-57 yr) with severe dental anxiety, and to evaluate whether these dimensions were associated with the level of dental anxiety. The Dental Anxiety Scale (DAS) and the Temperament and Character Inventory (TCI) were used. High ratings in novelty seeking and female gender predicted high DAS scores. Compared with controls, the patients scored significantly higher on the temperament dimension, novelty seeking. For character dimensions, the patients scored lower on cooperativeness and higher on self-transcendence than controls. Our results indicated that patients with dental anxiety are neurotic extravert (i.e. novelty seekers who experience brief dissociative periods and magical thinking). Furthermore, the combination of the inherited temperament dimension novelty seeking and the social learned character dimension cooperativeness and self-transcendence seem to form a vulnerable personality to develop dental anxiety.

Perceived taste disturbance in adults: prevalence and association with oral and psychological factors and medication.

Taste disturbance may cause subjective discomfort and impair appetite and food intake. The aim of this study was to estimate the prevalence of perceived taste disturbance and analyze its association to age, gender, whole salivary flow rate, subjective oral dryness, burning mouth, medication, and psychological factors. Five hundred forty-seven men and 656 women aged 20 to 69 years were randomly selected from the Public Dental Health Service register in northern Sweden. Oral complaints were registered and whole salivary flow rate measured. Medication, anxiety, depression, and stress were assessed. Thirty individuals (2.5%), five men (0.9%) and 25 women (3.8%), reported perceived taste disturbances (distorted taste or loss of taste). In men, no individual with taste disturbance was found in the youngest and oldest age groups. The prevalence in the 30-39-year age group was 1.9% and in the 40-49-year group 1.8%. In women, one individual (1%) with taste disturbance was found in the youngest age group. In the 30-39-year group, the prevalence was 3.8%, increasing to 5.1% in the oldest age group. Illness, subjective oral dryness, state anxiety, perceived stress, depression, use of antiasthmatics, and trait anxiety were associated with taste disturbance. It was concluded that perceived taste disturbance might be an interaction of various health factors such as illness and mental condition.