The new system for classification of periodontal and peri-implant disease: A questionnaire study of implementation by Swedish dental hygienists.

OBJECTIVE: To what extent do dental hygienists (DH) employed by the Public Dental Health Service (PDHS) in Sweden use the new classification system, their knowledge of it and their attitudes towards it. METHODS: A web-based questionnaire was distributed to DHs in the PDHS in different regions of Sweden. A total of 197 registered DHs responded. The questions covered their knowledge, attitudes and possible barriers to implementation of the new classification system of periodontal and peri-implant diseases, and a question about their perceived need for a complementary digital tool to facilitate its implementation. RESULTS: Seventy per cent of the DHs stated that they used the new classification system. Twenty-nine per cent of the participants were confident in classifying periodontitis under the new system. Furthermore, 36% of the participants considered their knowledge of the new system to be good and 33% to be poor or non-existent. Several DHs stated that the new system was too time-consuming, that it caused stress, that their knowledge was inadequate and that they, therefore, considered it too difficult to use. Eighty per cent of the participants were positive to a digital tool as a complement and support to classify periodontitis and peri-implantitis. CONCLUSION: The present study showed that most of the DHs used the new classification system and one-third considered their knowledge to be good, although it was difficult and time-consuming. Furthermore, in general, the DHs were positive to a digital tool to facilitate application of the new classification system.

Immune cell composition and inflammatory profile of human peri-implantitis and periodontitis lesions.

Peri-implantitis and periodontitis are common oral inflammatory diseases, which seem to exhibit critical differences in some of their molecular features. Thus, we assessed the immune cell composition of peri-implantitis and periodontitis lesions and the corresponding inflammatory profile in soft tissues and crevicular fluid. Peri-implantitis, periodontitis and control patients were recruited (n=62), and soft tissue biopsies were collected during surgery. Crevicular fluid around implant or tooth was collected. The proportions of major immune cell populations in tissues were analyzed by flow cytometry, and the inflammatory profile in tissue and crevicular fluid by a multiplex immunoassay. No significant difference was seen between peri-implantitis and periodontitis lesions in the proportions of immune cells. Peri-implantitis tissues showed an increased frequency of B cells in comparison with control tissues, along with higher levels of IL-1ß, TNF-α, IL-4, and BAFF in tissue and crevicular fluid. Moreover, TNF-α, IL-17A and BAFF were higher in peri-implantitis tissues, but not in periodontitis, than in control tissues. The immune cell composition did not differ significantly between peri-implantitis and periodontitis, but an enhanced inflammatory profile was seen in peri-implantitis tissue. Peri-implantitis lesions were enriched in B cells, and displayed increased levels of IL-1ß, TNF-α, IL-4, and BAFF in both tissue and crevicular fluid.

Patient's experiences of dental implants, peri-implantitis and its treatment-A qualitative interview study.

OBJECTIVES: The aim of the present study was to explore peri-implantitis patients' sensations, expectations, and experiences of dental implants, the disease, as well as undergoing treatment with laser or mucosal flap surgery. METHODS: Interviews were conducted with 18 patients who had been referred for treatment of peri-implantitis at a specialist clinic. The participants underwent either laser treatment or mucosal flap surgery of affected implants. Qualitative content analysis was used for processing the transcribed interviews with coding in categories and subcategories. RESULTS: The analysis of the interviews was presented in a narrative way to display the variety of experiences in this patient group. Losing teeth was perceived as frustrating and negatively impacted their quality of life; however, receiving dental implants improved some aspects of the patients' lives. While some have symptoms, others did not seem to notice the incidence and development of peri-implantitis. Local anaesthesia was the worst part of both treatments and both modalities yielded only minor discomforts. CONCLUSION: There were a variety of positive and negative sensations and experiences perceived by patients with dental implants as a consequence of peri-implantitis, including a negative impact on quality of life. These findings emphasize the importance of thoroughly informing the potential and established dental implant patients of the risk of developing disease and its impact. The treatment of peri-implantitis created in general only slight discomfort for the patient.

Dentists´ and Dental Hygienists´ experiences of the Capitation Contract System-the dilemma of conflicting loyalties.

OBJECTIVE: The Capitation Contract system (CCS) is a payment model adopted by the Swedish Public Dental Health Service (PDHS). Patients enrolled in the CCS are usually assessed as being at lower risk of dental disease and are more regular dental attenders than those treated by Fee for Service (FFS). With increasing numbers of patients and CCS enrolments, Sweden faces a shortage of dental personnel. Our aim was to analyse dentists´ and dental hygienists´ perceptions and experiences of the capitation contact system. MATERIAL AND METHODS: Eleven dentists and dental hygienists from three Swedish regions participated in online qualitative interviews conducted according to the Grounded Theory methodology. RESULTS: When working with CCS the informants tried hard ´to find a balance between attitudes, compliance with guidelines and clinical resources´. Not all patients were offered CCS, even though they qualified: among other determinants were the informants' interpretations of guidelines and regulations, clinical resources, and patient interest. CONCLUSIONS: When dental resources are in balance, the informants appreciate the CCS and consider it to be favourable to patient health but are aware of conflicting loyalties of their dual roles of insurance sales agent and care provider. The informants´ individual mindset affects which patients are offered CCS enrolment.

Stabilized stannous fluoride dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity: A systematic review.

PURPOSE: To review the scientific evidence for the efficacy of stabilized stannous fluoride (SnF2) dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity. METHODS: Medline OVID, Embase.com, and the Cochrane Library were searched until January 2018. Two researchers independently selected studies according to inclusion and exclusion criteria, data were extracted, the risk of bias in eligible studies was assessed and a meta-analysis was performed wherever feasible. RESULTS: Three studies on dental caries, eight studies on dental erosion and 11 on dentin hypersensitivity were included. Risk of bias was judged as high for most of the caries and erosion studies and low or medium for the hypersensitivity studies. A similar or slightly higher anti-caries activity compared with non-stannous fluoride dentifrices was observed. Stannous fluoride showed a greater anti-erosive potential in seven of the eight studies. A mean difference score in favor of stannous fluoride dentifrices compared with controls was found in a meta-analysis including six 8-week hypersensitivity studies. CLINICAL SIGNIFICANCE: The use of stabilized stannous fluoride dentifrices to relieve dentin hypersensitivity and to prevent the initiation of dental erosion speaks in favor of this treatment strategy.

Stakeholder Perception of the Professional Role and Competence of Swedish Dental Hygienists: A Questionnaire and Interview Study.

OBJECTIVES: This study investigated stakeholder opinions on the competence and role of dental hygienists in Sweden. MATERIALS AND METHODS: A questionnaire was sent by e-mail to 94 stakeholders in eight Swedish counties. The survey queried the competence of recently graduated dental hygienists in skills in collaboration, communication, and problem-solving, and in clinical skills. In addition, 10 stakeholders from different Swedish dental organizations agreed to one-on-one deep interviews. Open-ended questions focused on dental hygienist competence to perform dental hygienist skills and tasks and to collaborate with other dental professionals and health-care professionals. Further topics concerning the dental hygienist included their future role and working in other European countries. The interviews were transcribed and then coded using qualitative conventional content analysis methods. RESULTS: The stakeholder consensus in both the questionnaires and the interviews was that the dental hygienist profession is essential to modern dental care. The professional knowledge possessed by dental hygienists is unique and their role has developed and broadened over the years. Furthermore, the qualitative content analysis of the deep interviews identified a core category: The dental hygienist is an important profession for good oral health. CONCLUSION: Dental hygienists, responsible for prevention and oral health promotion, are an important members of the modern dental team. The need for dental hygienists to collaborate with other dental and general health-care professionals to meet the future demands of society will increase.

Using 445 nm and 970 nm Lasers on Dental Implants-An In Vitro Study on Change in Temperature and Surface Alterations.

The aim of this study was to evaluate the safety of using a 445 nm laser on dental implants by comparing it with a laser with 970 nm wavelength. Two models, a pig mandible and glass ionomer cement, were used to evaluate the temperature increase in dental implants during laser irradiation with both wavelengths. Temperature was measured every second at four different places on the dental implants. Different power settings, effects of water cooling, distance of the laser fibre to the dental implant and continuous comparison to a pulsed laser beam were tested. Surface alterations on titanium discs after laser irradiation for 4 min at 2.0 W, were analysed in a scanning electron microscope (SEM). The maximum temperature and time to reach each of the thresholds were comparable between the 445 nm and 970 nm lasers. Neither the 445 nm nor the 970 nm wavelength showed any signs of surface alterations on the titanium discs. Using a 445 nm laser on dental implants is as safe as using a 970 nm laser, in terms of temperature increase and surface alterations. Applying a generous amount of cooling water and irradiating in short intervals is important when using lasers on dental implants.

Oral Health Knowledge, Perceptions, and Habits of Adolescents from Portugal, Romania, and Sweden: A Comparative Study.

AIMS: The study aimed to assess and compare the self-reported oral health knowledge, habits, and perceptions of adolescents in Portugal, Romania, and Sweden and the factors that may affect them. MATERIALS AND METHODS: An oral health questionnaire with 25 questions was put together in English language and translated into Portuguese, Romanian, and Swedish language to investigate and compare oral health-related knowledge, habits, and perceptions of adolescents from the different countries. A voluntary sample of 879 teenagers completed it, mean aged 14.9 (±1.83) years, from Romania (n = 455), Portugal (n = 200), and Sweden (n = 224) as part of the EuHyDens project. The survey took place between November 2015 and June 2016. RESULTS: It showed some differences between the countries studied but more similarities between Portuguese and Romanian adolescents as related to perceptions of oral health and the use of oral services. Sweden and Portugal are more similar regarding oral health habits (toothbrushing and diet) as compared to Romanian adolescents. Portuguese adolescents have a higher oral health-related knowledge. CONCLUSION: Assessment of knowledge, perceptions, and habits of a population is essential for the adequate understanding of the oral health-care needs of the society. From the data collected, several differences were found. These differences can be used for tailor interventions to minimize inequalities between countries.

The Dental Hygienists in Sweden and Portugal: A Comparative Study.

AIMS AND OBJECTIVES: The aim of the present study was to identify the dental hygienists (DHs)' working areas and compare these findings between Sweden and Portugal. MATERIALS AND METHODS: A web-based questionnaire was sent by E-mail to all 2943 members of the Swedish DH Association and 381 members of the Portuguese DH Association. The questionnaire contained questions about; number of years of work, which patient groups they worked with, if they had got sufficient knowledge from the education and what different tasks they worked with. Independent sample t-test, relative risk, and logistic regression analysis were used as statistical methods. RESULTS: The response rate for Sweden was 31% (n = 923) and the corresponding figure for Portugal was 53.5% (n = 204). The most common tasks for the DHs, in both countries, were to diagnose and treat patients with periodontitis and to diagnose and perform caries prevention. In Portugal, 86.5% worked with orthodontic patients compared to 32.3% in Sweden (P = 0.001). The logistic regression analysis showed that there was a 25% (P = 0.02) higher probability that Swedish DHs took more X-rays and 38% (P = 0.042) probability that they had more communications skills compared to the Portuguese DHs. CONCLUSION: The DH profession in Sweden and Portugal was overall quite similar. Despite a few local differences, both the academic education and scope of practice corresponded well between the countries. The few discrepancies could be explained by differences in legislations in each country.

Self-reported oral health-related habits, attitudes and knowledge in adults from Portugal, Romania and Sweden-A comparative study.

OBJECTIVE: The aim of the present study was to compare the self-reported oral health knowledge, habits and attitudes of adults in Portugal, Romania and Sweden, each benefitting from a different oral health system. METHODS: A cross-sectional study was conducted on 1081 adults in the three countries, using an adapted version of the WHO oral health questionnaire. This survey took place between November 2015 and June 2016. RESULTS: The mean age of the respondents was 46.85 with 95% CI (45.84, 47.86). Over 85% of the Portuguese and the Swedish, but only 55% of the Romanians, reported having 20 or more teeth left (P < 0.001). Most Swedes visit the dental office regularly, but only 50.5% of the Portuguese and 20.6% of the Romanians do so (P < 0.001). Interdental cleaning aids and fluoridated toothpaste were used the most in Sweden and the least in Romania. Daily consumption of sweets was lowest for Portugal and highest for Romania (P < 0.001), and daily intake of fresh fruits and vegetables was lowest for Sweden (P < 0.001). CONCLUSIONS: There is a difference between the three countries regarding oral health, diet, dental attendance and oral health-related quality of life, with Romania being in most need of improvement in these areas. The differences could be explained by the distinct healthcare systems adopted by the countries.

A pilot study on the effectiveness of a 2-year school-based oral health educational programme using experiential learning among adolescents.

OBJECTIVE: The aim of the present study was to assess the influence of a school-based experiential education programme on oral health status, knowledge and behaviour among a group of schoolchildren in Bucharest. MATERIALS AND METHODS: The study was part of an Erasmus+ project that focused on oral health promotion in schools and covered a 2-year period. Data were collected from 120 teenagers from three schools in Bucharest, Romania. At baseline, all subjects were clinically examined and received a questionnaire. They were split into two groups at baseline: a test group with 76 schoolchildren and a control group with 44 schoolchildren. The schoolchildren included in the test group received three experiential lessons. After every lesson, they filled in the same questionnaire. At the end, all subjects were clinically examined again. RESULTS: The prevalence of dental caries was increased in the control group by 8.58% (N = 3, P = 0.31) and decreased in the test group by 1.64% (N = 1, P = 0.8). Regarding incipient carious lesions, a higher decrease was observed in the test group (D1-2 S: 0.78 vs 0.63, P = 0.867). There was a statistically significant plaque index decrease in the test group (1.32 vs 1.12; P = 0.01) and an increase in the control group (1.15 vs 1.79; P = 0.0001). More children from the test group (N = 5, 7.9%, P = 0.225) adopted twice-daily tooth brushing compared to the control group (N = 1, 2.9%, P = 0.52). CONCLUSIONS: In the group studied, the oral health programme had positive effects on oral health status, oral health knowledge and behaviour among adolescents.

Influence of culture conditions on porphyrin production in Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.

BACKGROUND: Increasing antibiotic resistance among pathogens has raised the demands for new treatment methods such as antimicrobial photodynamic therapy (aPDT) and phototherapy (PT). Experiments for investigating the effects of these methods are often performed in vitro, but the procedures for cultivation of microbes vary between different studies. The aim of this study has been to elucidate how the profile of endogenously produced porphyrins differs by changing the variables of bacteria culturing conditions. METHODS: Two oral pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were selected as model organisms. The contents of porphyrins and heme in the bacteria were analysed with liquid chromatography-tandem mass spectrometry when bacteria was cultivated for different lengths of time (3-9 days), upon passaging as well as when growth medium were supplemented with or without horse blood. RESULTS: Both porphyrin and heme content in A. actinomycetemcomitans are highly affected by the age of the culture, and that the porphyrin profiles changes during cultivation. When cultivated colonies of A. actinomycetemcomitans were passaged onto a new, fresh growth medium a large change in porphyrin content occurred. Additional porphyrins were detected; uroporphyrin and 7-carboxylporphyrin, and the total porphyrin content increased up to 28 times. When P. gingivalis was grown on blood containing medium higher concentrations of protoporphyrin IX (2.5 times) and heme (5.4 times) were quantified compared to bacteria grown without blood. CONCLUSIONS: This study demonstrate that there is a need for more standardized culturing protocols when performing aPDT and PT experiments in vitro to avoid large variations in porphyrin profiles and concentrations, the aPDT/PT target compounds, depending on the culturing conditions.

Dental patients' perceptions and motivation in smoking cessation activities.

OBJECTIVE: The aim of the present study was to investigate smokers' perceptions of and motivation for smoking cessation activities in dentistry. MATERIALS AND METHODS PATIENTS: who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists. RESULTS: The sample consisted of 167 adult patients (≥ 20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR = 3.0, 95% CI = 1.03-8.55). CONCLUSIONS: This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.

Consumption of dental treatment in patients with inflammatory bowel disease, a register study.

OBJECTIVE: The aim of this study was to compare the consumption of dental treatment among patients with Crohn´s disease (CD) or ulcerative colitis (UC) compared to age and gender matched control groups. DESIGN: The study group comprised 2085 patients with CD and 3161 with UC from the Uppsala-Örebro region and from the Stockholm region. The patients in the cohort were diagnosed between 1960 and 1989. Patients up to 70 years of age were included in the study. The two patients groups were compared to age- and gender-matched, randomly selected control groups from the same geographic area comprising a corresponding number of participants. RESULTS: CD patients had significantly higher total number of procedures registered (p < 0.000). The difference was most pronounced for removable dentures (+65%), fillings in front teeth (+52%) and endodontic treatment (+46%) when Crohn's patients were compared to controls (p<0.001). The corresponding figures for UC patients were also a significantly higher total number of procedures (p < 0.005), more clinical examinations (p<0.000), fillings in canines and incisors (p < 0.001) and fillings in bicuspids and molars (p < 0.000). CONCLUSION: This study demonstrate that CD and UC individuals use more dental treatment compared to an age-gender matched control group, and more caries-related treatments. The difference was most pronounced for restorative treatment in patients with Crohn's.

Determination of porphyrins in oral bacteria by liquid chromatography electrospray ionization tandem mass spectrometry.

Biofilms in the oral cavity can be visualized by fluorescence and a common assumption is that the endogenously produced porphyrins in certain bacteria give rise to this fluorescence. Porphyrin content in oral bacteria has been sparingly investigated, and non-selective detection techniques such as utilizing the Soret fluorescence band of porphyrins are often used. In the present study, a quantitative and selective method for the determination of porphyrins in oral bacteria has been developed and validated using high performance liquid chromatography-tandem mass spectrometry. Lysis of bacteria using Tris-EDTA buffer together with ultrasonication showed high microbial killing efficiency ≥99.98%, and sample clean-up using C18-solid phase extraction resulted in low matrix effects ≤14% for all analytes. Using this method, the porphyrin content was determined in the two oral pathogens Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, as well as for baker's yeast, Saccharomyces cerevisiae. Uroporphyrin, 7-carboxylporphyrin, 6-carboxylporphyrin, coproporphyrin, and protoporphyrin IX were identified in the investigated microorganisms, and it was shown that the porphyrin profile differs between the two bacteria, as well as for S. cerevisiae. To our knowledge, this is the first time the porphyrin profile has been determined for the bacterium A. actinomycetemcomitans.

Dental caries, prevalence and risk factors in patients with Crohn's disease.

OBJECTIVE: The present study tested the hypothesis that patients with Crohn's disease (CD) have a higher prevalence and risk for caries compared to people without CD. MATERIAL AND METHODS: Patients with CD were divided into groups; 71 patients (50.7 ± 13.9 years) who had gone through resective intestinal surgery and 79 patients (42.0 ± 14.4 years) who had not. The patients were compared to 75 controls (48.6 ± 13.4 years) regarding DMF-T and DMF-S, Lactobacilli (LB), Streptococcus mutans (SM), salivary flow and dental plaque. Statistical methods including ANOVA or Chi-square test for calculation of demographic differences between groups, analysis of covariance (ANCOVA) to compare the clinical variable and Post hoc analyses were done with Fischers Least Significant Difference test or Chi-square. Non-parametric Spearman's correlation matrix coefficient was estimated between clinical variables and disease duration. RESULTS: CD patients who had been subjected to resective surgery had a higher DMF-S score (50.7 versus 36.5; p = 0.01) compared to the control group after adjusting for age, gender and smoking. These patients had higher counts of SM (1.5 versus 0.9; p = 0.04) and LB (10000.0 versus 1000.0; p = 0.01), and more dental plaque (53.7 versus 22.6; p = 0.001). CD patients reported a more frequent consumption of sweetened drinks between meals compared to controls (p = 0.001). CONCLUSIONS: The present study shows that patients with CD who had undergone resective surgery had a higher DMFs score, and higher salivary counts of Lactobacilli and Streptococcus mutans compared to the control group.

Smoking and inflammation: evidence for a synergistic role in chronic disease.

Tobacco smoking is the most important preventable risk factor for periodontitis; however, the underlying biological mechanisms responsible for the detrimental effects of smoking on periodontal health remain largely unclear. It is also well established that smoking has a negative impact on several inflammatory diseases, including rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease. The aim of this paper was to review smoking-related changes in local and systemic host responses with a focus on cellular and molecular effects that could explain a hyperinflammatory response leading to periodontal destruction. Biological mechanisms that may be common to periodontal disease and other chronic inflammatory diseases were also explored, together with gene-smoking interactions. An epidemiologic perspective on the burden of smoking on periodontal health and the potential for smoking cessation is also presented. Tobacco smoking seems to induce changes ranging from decreased leukocyte chemotaxis to decreased production of immunoglobulins. Smoking also seems to cause a stronger inflammatory reaction with an increased release of potentially tissue-destructive substances (e.g. reactive oxygen species, collagenase, serine proteases and proinflammatory cytokines). These findings support a hypothesis that periodontitis is a hyperinflammatory condition rather than a hypo-inflammatory condition.

The importance of measuring toothpaste abrasivity in both a quantitative and qualitative way.

OBJECTIVE: To evaluate the relative abrasivity of different toothpastes and polishing pastes both qualitatively and quantitatively. MATERIALS AND METHODS: Acrylic plates were exposed to brushing in a brushing machine with a toothpaste/water slurry for 1 and 6 h. Twelve different toothpastes were used and also four different polishing pastes. The results were evaluated using a profilometer after 1 and 6 h of brushing (corresponding to 2000 and 12 000 double strokes, respectively). A surface roughness value (Ra-value) and also a volume loss value were calculated from the profilometer measurements. These values were then correlated to each other. An unpaired t-test for the difference in the abrasion values between the toothpastes and the abrasion values over time was used. RESULTS: The polishing paste RDA® 170 yielded higher Ra-values than RDA 250®, both after 1 and 6 h of brushing (1.01 ± 0.22 and 8.99 ± 1.55 compared to 0.63 ± 0.26 and 7.83 ± 5.89, respectively) as well as volume loss values (3.71 ± 0.17 and 20.20 ± 2.41 compared to 2.15 ± 1.41 and 14.79 ± 11.76, respectively), thus poor correlations between the RDA and Ra and Volume loss values were shown. Among the toothpastes, Apotekets® showed the highest Ra value after 1 h of brushing and Pepsodent® whitening after 6 h of brushing. Pepsodent® whitening also showed the highest volume loss values, both after 1 and 6 h of brushing. CONCLUSION: This study emphasizes the importance of not only considering the RDA value, but also a roughness value, when describing the abrasivity of a toothpaste. Furthermore, it can be concluded that so called 'whitening' toothpastes do not necessarily have a higher abrasive effect than other toothpastes.

Patient attitudes and expectations of dental implant treatment--a questionnaire study.

The aim of the present study was to evaluate patient attitudes and expectations relative to dental implant treatment. A questionnaire was mailed to all 400 patients that had received dental implant treatment at a large multi-specialist clinic during 2008. The questionnaire included questions relative to the reasons for dental implant treatment, if the patient earlier had considered dental implants, expectations of the treatment, discomfort during and after surgery, and how the patient perceived the esthetic outcome. The response rate was 61% (114 men/130 women). The stated reason for tooth loss was in 50% of the patients periodontitis,19% caries, 8% accidents,13% other reasons, and 10% no stated reason. Almost all patients (96%) were satisfied with the esthetic appearance and also regarding the information of the treatment (94%). Regarding the time between surgery and completion of prosthetic work, 79% (n = 192) found it to be reasonable. 71% (n = 170) thought the cost was what they had expected. 47% of the patients experienced the implant surgery better than expected and 48% as expected. In conclusion, the present study revealed that almost all patients were satisfied with the function and esthetics of the dental implant reconstruction and most patients were also satisfied regarding the costs and treatment duration.

Tobacco cessation interventions by Swedish dental hygienists--a questionnaire study.

The aim of the study was to investigate tobacco cessation interventions by Swedish dental hygienists and their perception of the importance of tobacco cessation to oral health. A questionnaire was mailed to 400 randomly selected dental hygienists (DH) in Sweden. The questions covered such topics as tobacco cessation interventions, perceived barriers, and their perception of the importance of tobacco cessation in relation to caries, gingivitis, periodontitis and dental implants. The response rate was 57%. Tobacco habits were routinely recorded by 94% of the respondents. 52% of the dental hygienists reported time constraints, 50% reported insufficient competence and 43% answered that they had lack of experience to work with tobacco cessation. All respondents perceived tobacco cessation to be an important determinant of treatment outcomes in patients with dental implants and periodontitis. Bivariate analysis showed an association between training courses in tobacco cessation and tobacco cessation interventions (OR 3.25, CI 95% 1.80-5.85). A logistic multivariate regression model disclosed two other factors significantly correlated with tobacco cessation interventions: competence (OR 2.4, 95% CI 1.16-4.85), and experience (OR 2.1, 95% CI 1.06-4.28). The analyses were adjusted for age, length of undergraduate training course, and dental care organization. The dental hygienists considered tobacco cessation to be very important in patients with periodontitis and in those with dental implants. Most of the DH in this study undertook some tobacco cessation interventions, though not extensive; the main barriers reported were lack of time, competence and experience.