Quality of Life and lmplant-Based Dental Treatment

Introduction This paper seeks to answer two straightforward questions: (1) What is quality of life? And (2) How does quality of life relate to dental implant treatment? Unfortunately, neither question will be answered here, nor, probably, anywhere else. The reason is, in the first case, that there is little unanimity concerning the meaning of the concept of quality of life (QoL), and there may be even less agreement when specifying it to comprise oral health-related quality of life (OHRQoL). As for the second question, the inability to answer is caused by the scarcity of research in the field, which is understandable, considering the vagueness of the QoL concept. One reason for this deplorable situation is that when invoking the concept of QoL, one also invokes behavioral and social sciences, which are inherently different from the natural sciences in their fundamental disagreement about simple concepts, even more so An concerning complex phenomena such as QoL. Research about oral implants has been dominated by natural science—not without disagreements, to be sure—but still the research is rather unanimous about basic concepts such as tooth or mouth; social/behavioral science has not reached agreement about the meaning of society, state, personality, or similar basic concepts, not to mention the content of QoL. Still, implant researchers should be more aware than other natural scientists of the problems in new paradigms in science and in new ways of thinking, since one may well place Per Ingvar Brånemark among those pioneers opening up new ways of thought. The situation in social sciences is, however, that several paradigms may flourish simultaneously for a long time, while the change between paradigms is faster—and also cumulative—in natural séance. This has not always been the case— consider, for example, the transition between a geocentric and a heliocentric world view in astronomy, which took hundreds of years—but with the mature and well-established present-day natural sciences, new breakthroughs may take only a decade or so, eg, the discovery of DNA or, for that matter, osseointegration. However, orientation in the jungles of social concepts still requires sharp tools and great patience among those wanting precision. An overview of paradigms in social and behavioral science is outside of the scope of this aper.1 It will be enough just to sketch some of the ideas in the health research domain. Health and its counterpart, disease, are prime examples of the conceptual confusions that occur in social and behavioral science. A basic realization is, in my opinion, that neither health nor disease nor QoL are some kind of essences to be found and researched out in the world.2 be They are social concepts and are established in a very specific human relationship: the clinical encounter

What is evidence based public health - really?

Starting with a presentation of “the father of social medicine”, Alfred Grotjahn, the concept of essentialism is presented. From an overview of ideas about health and sickness, it is contended that the current concepts of health and disease still contain essentialist elements, primarily biological ones but also social and psychological. The consequence is a paradigmatic crisis of medicine and odontology - the essentialist theoretical foundation is not concordant with the practical application. A strictly rational evidence-based model is not feasible. Since it is not possible to construe health sciences with consensual theoretical definitions, they should be based on practice and practical experience. Three sets of practices can be discerned, sickness-oriented, patient-oriented and social-oriented, with the aims of curing sickness, caring for the patient, and promoting health, respectively. Sicknesses are not given entities, but changing, emerging and disappearing as conceptual objects. There are social and professional structures determining the emergence of a sickness entity. The biological essentialism which dominates limits the choices of therapies. Patient-orientation implies understanding latent needs and mechanisms for their becoming manifest. Health is a process and not a state, and the self-efficacy of patients should be the strategical target. A social, health-promoting practice should imply the realization that sickness and ill health are not due to evil Nature but socially conditioned and created. Society is neither the state nor the market, but should imply the reconstruction of the real life; the goal of salutogenic health promotion

Vad är oral hälsa? Hälso- och sjukdomsbegreppet sett ur teoretisk synvinkel

Insikten om att vårdens resurser inte kommer att räcka till för att behandla all oral sjukdom i befolkningen har betytt att begreppet oral hälsa allt mer hamnat i fokus. Rent samhällsekonomiskt är det mer fördelaktigt att förebygga än att behandla sjukdom. Det innebär också mindre lidande för patienten. Ett salutogenetiskt perspektiv (se ordförklaring) [1] minskar påfrestningarna på vården och ger ett snabbare och mer komplikationsfritt tillfrisknande [2]. Det är därför viktigt att diskutera begreppen ”oral sjukdom” och ”oral hälsa”: hur de översätts i daglig klinisk praxis, hur de beskrivs i internationella och nationella deklarationer samt i svensk lagstiftning. Författarna föreslår även tre nivåer på utfallsvariabler som bör beaktas vid forskning om oral sjukdom/ohälsa. Artikeln är ett försök att ur teoretisk synvinkel bidra till utvecklingen av hälso- och sjukdömsbegreppet

Remuneration of dental care - how to give patients and dentists what they need

There are at least three different systems in remuneration of dental care: Fee-for-service (FFS), capitation (CAP), and national health service (NHS). Empirically, FFS dominates, with elements of CAP and NHS in some countries. Advantages and disadvantages with all the systems are reviewed. In moral philosophy, there are also three different ways to distribute something good - according to Right, Desert, and Need. The matrix of these distributory principles and the remuneration systems is presented and analysed, with attention to the need concept. Right is connected to CAP, Desert to FFS, and Need to NHS. There is scarce empirical evidence relevant for this model. In the few studies done, CAP decreases restorative treatment and there is a tendency of decreased caries incidence. “Supervised neglect” cannot be established. CAP increases preventive care. Results regarding productivity are inconclusive. One study points to improved patient Oral Health-Related Quality of Life with CAP in comparison to FFS. The results on dentist´s satisfaction with work were inconclusive, as were the results regarding patient satisfaction. There are no studies evaluating need in relation to remuneration system. In conclusion, there is no empirical evidence for choice of remuneration system. whence theoretical argument is the only available. Relieving dentistry from monetary concerns in the clinical decision-making should then be desirable, pointing to some form of NHS as preferred system

Oral disease and psychosocial risk determinants in relation to self-assessments of general health in persons with chronic whiplash-related disorders

The aim of this study was to analyse how self-assessed general health was related to oral health among persons afflicted with whiplash-associated disorders (WAD), controlling for relevant background factors, confounders and other risk factors. Questionnaires included the SF-36 Health Survey, self-assessed oral health and relevant risk factors, in total 49 questions. Multivariable regression modelling was performed. Members of a nationwide Swedish association enlisting persons who have problems concerning a whiplash injury (n = 1,928) were included. A total of 979 persons participated in the study, a response rate of 50.8%. A multivariable regression model is presented, with general health as the dependent variable, and the independent variables inserted en-bloc. The model was highly significant with an explained variance of 28%. Among background factors, only older age appeared as significantly and strongly related to poorer general health. The strongest explanatory contributions came from the health related variables. Oral disease and extra-oral body pain were both strongly related to poorer general health, most obviously for the oral disease variable. Oral disease was significantly and to a clinically relevant degree associated with self-assessed general health. Several other psychosocial indicators of stress were also significantly related to the general health. These findings are consistent with the stress-behaviour-immune model for development of disease

Moral values and career : Factors shaping the image of healthy work for female dentists

Objective. Female unpromoted general practice dentists (GPDs) constitute about one-quarter of all dentists in Sweden. These female dentists suffer from many problems relating to their psychosocial working conditions. There are wide discrepancies between their perception of the ideal job situation and reality. Previously, three factors were found to constitute the ideal job situation. The aim of this study was to analyze patterns in two of these factors, i.e. the moral and the career factors, for understanding how ideal circumstances are conceived, i.e. how ‘‘good work’’ for the dentists could be obtained. Material and Methods. In the year 2000, all female unpromoted GPDs (183 persons) within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire; response rate 94%. Four multiple regression models were constructed for two factors of good work and for the differences between the ideal job situation and reality concerning these factors. Results. In all models, the explained variance was high. Those dentists who were committed to moral issues perceived large differences between the ideal and reality concerning moral values. Dentists committed to career issues experienced large differences between the ideal and reality concerning career development. Those dentists - about 60% - who would not want to be a dentist if they were to choose today, perceived large discrepancies concerning moral and career issues. Conclusions. The PDHS organization has failed to convince or engage those whom it ought to engage, that is those with the highest level of commitment. Dentists’ emphasis on moral values confirms the character of dentistry as primarily a human service work

A path analysis of contract and fee-for-service care

Objectives: In Swedish dentistry, the traditional patient financial system is fee-for-service care (FFS). Since 1999, the public dental health service (PDHS) in the county of Värmland offers an alternative system, contract care (CC). Here, the patient pays a set fee for a fixed period of time, and receives oral health care as specified by a contract, without additional costs. Previously, an association between patient financial system and oral health-related quality of life (OHRQoL) was found. The aim was to model direct and indirect effects with path analysis, to study if there were different underlying mechanisms in the patient financial systems. Material and methods: In 2003, a questionnaire was sent to randomly selected patients enrolled in CC (n=1,200) and FFS (n=1,200) in the PDHS in Värmland. The study was approved by the ethical board in the Southern region of Sweden. Response rate was 57%. Data without internal non-response (n=1,044; CC: 57%, FFS: 43%) were analysed with a multiple group path analysis. The interactions of four variables were of central interest: OHRQoL, the respondents’ perceptions of the dental caregiver’s humanistic (patient-, as opposed to disease-centred) qualities, what the respondents were prepared to pay, and what they had paid for dental care the previous year. Results: The underlying mechanisms in the systems were similar. However, there were differences regarding the central variables: the perceived humanism of the caregiver affected OHRQoL only in FFS, while what the respondents were prepared to pay for dental care was affecting the perception of humanism only in CC. Conclusions: The findings indicated that the perception of the caregiver’s humanistic qualities were important for oral health for respondents in FFS, while financial considerations were important for how the caregiver’s qualities were perceived by respondents in CC. Funding: The study was financed by the Swedish Research Council