Oral Care Cards as a Support in Daily Oral Care of Frail Older Adults: Experiences and Perceptions of Professionals in Nursing and Dental Care-A Qualitative Study.

Frail older adults often have poor oral health. In Sweden, oral care cards are designed to be used as an interprofessional tool for documenting the oral health status of older adults with extensive care needs and to describe oral care recommendations. The aim of this study was to explore nursing and dental professionals' experiences and perceptions of oral care cards. Nursing and dental care staff were interviewed in groups or individually. The recorded data were transcribed verbatim and analyzed using qualitative content analysis. A theme emerged: Navigating an oral care responsibility that is not anchored in the nursing and dental care context. The theme was elucidated in three categories: "Accessibility and usefulness", "Coordination between nursing and dental care", and "Ethical approach". The participants perceived a lack of surrounding frameworks and collaboration concerning oral care and the use of oral care cards. An oral care card could ideally facilitate interprofessional and person-centered oral care. However, oral health does not seem to have found its place in the nursing care context. Further research is needed to investigate how oral care cards ought to be developed and designed to support oral health care work.

Long-Term Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention.

A guideline called FRAMM, which is an acronym in Swedish for the most important parts of this guideline, namely "fluoride", "advice", "arena", "motivation" and "diet", was implemented in 2008 in the Västra Götaland Region in Sweden. This guideline included fluoride varnish applications performed at school twice a year at six-monthly intervals for all 12- to 15-year-olds, together with lessons on oral health. The aim of this analysis was to estimate the long-term cost-effectiveness, using prognostic calculations, of the FRAMM Guideline for 12- to 15-year-olds, compared with routine care, until the participants were 23 years old. A cost-effectiveness analysis was performed from a health care perspective, based on four years of verified data and seven years of prognosis. Data from FRAMM were combined with cost data from price lists in Sweden. The cost-effectiveness was analyzed by relating the difference in costs to the difference in the number of approximal surfaces with fillings and/or dentin lesions (DFSa). The analysis shows that FRAMM was considered dominant compared to the controls in all alternative scenarios, hence costs were prognosed to be lowered and outcomes were prognosed to be improved. A dental health program like the FRAMM Guideline with fluoride varnish during the caries risk period from 12 to 15 years is predicted to be cost-effective in the longer perspective. To further study the actual long-term caries increment after a preventive dental health program would be of great interest to verify these results.

Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden.

Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the "low" subgroup, those with 1-3 into the "moderate" subgroup and those with ≥4 into the "high" subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12.

Dental nurses' experiences of performing a school-based fluoride varnish programme for children and adolescents in Sweden.

In many parts of Sweden today, school-based fluoride varnish programmes (FVP) are perfor- med by dental nurses. Studies have shown that the dental personnel are largely responsible for creating the atmosphere related to children's and adolescents'experiences of the program- mes. Knowledge of dental nurses'experiences of performing FVP is therefore crucial in order to develop and improve these programmes and the dental health of children and adolescents.The aim of this study was to describe dental nurses'experiences of performing FVP for children and adolescents in Sweden. Fifteen female dental nurses, strategically chosen, aged 40-63, from the Public Dental Service in the Vistra Gtaland Region, Sweden, were individually interviewed.The interviews were transcribed verbatim and analysed according to the phenomenographic ap- proach.Three themes with a total of 11 categories, all describing the dental nurses' conceptions of performing FVP, emerged in the analysis. The main conclusions were that in overall terms, performing an FVP was found to be a positive experience for the dental nurses, as it meant mee- ting children and adolescents in a context in which the children and adolescents are comforta- ble and relaxed.The opportunity to identify children and adolescents with poor dental health or poor health and to be able to offer them assistance was regarded as a major advantage. In addition,the participants described a feeling of professional development originatingfrom the challenges associated with working in an arena outside the dental clinic.

Approximal caries increment in adolescents in a low caries prevalence area in Sweden after a 3.5-year school-based fluoride varnish programme with Bifluorid 12 and Duraphat.

OBJECTIVES: To evaluate approximal caries increment among 12- to 16-year-olds in a low caries prevalence area in Sweden after a 3.5-year school-based fluoride (F) varnish programme with Bifluorid 12 and Duraphat. METHODS: The design was a RCT study with 1365 adolescents, divided into following four groups: Group 1 Bifluorid 12 two applications/year; Group 2 Duraphat two applications/year; Group 3 Bifluorid 12 four applications/year and Group 4 no F varnish at school. 1143 children (84%) completed the study. Approximal caries was registered on bitewing radiographs. RESULTS: There were no statistically significant differences in caries prevalence among the groups either at baseline or after 3.5 years . The caries increment for Group 1 was 1.34 ± 2.99 (mean ± SD), 1.24 ± 2.84 for Group 2, 1.07 ± 2.66 for Group 3 and 1.25 ± 2.75 for Group 4, with no statically significant differences either between Bifluorid 12 and Duraphat with the same frequency of F varnish applications or between the F groups and the control group. CONCLUSIONS: In an area with low caries prevalence in Sweden, the supplementary caries-preventive effect of school-based F varnish applications, to regular use of F toothpaste at home and to regular caries prevention given at the Public Dental Clinics, appears to be nonsignificant regarding approximal caries increment.

Adolescents' experiences of participating in a school-based fluoride varnish programme in Sweden.

Population-based health promotion with school-based fluoride varnish programmes is becoming more frequent, as these programmes have been implemented in many parts of Sweden during the last five years. The caries-prevention effect is well studied, but as yet there is no study aimed at adolescents'experiences of these programmes. The aim of this study was therefore to describe how a school-based fluoride varnish programme is experienced by participating adolescents. The study was performed as a qualitative study by conducting four focus-groups interviews. In all, 26 adolescents participated, all aged 15. All the participants had several years'experiences of a fluoride varnish programme at school. The participants were asked to describe their experience of participating in the programme.The analysis of the data from the interviews was carried out according to the principles of phenomenography.The three themes that emerged were"Conceptions in relation to the individual", "Conceptions in relation to the school dental nurse"and "Conceptions in relation to the group and school". The result showed that the adolescents experienced that it was positive to take part in a fluoride varnish programme at school and they regarded the school as an important health promotion arena. In spite of this, there were perceptions that were worth reflecting on for school dental nurses, such as feelings of exposure, peer pressure and a perceived lack of information. To further improve these programmes, and thereby increase population-based dental health promotion, it is important to highlight the role of dental personnel, as they are largely responsible for creating the atmosphere.