Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden – a randomized trial

<p>Abstract</p> <p>Background</p> <p>Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.</p> <p>Methods</p> <p>300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (≥ 183 days) at the 12-month follow-up.</p> <p>Results</p> <p>Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.</p> <p>Conclusion</p> <p>Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.</p> <p>Trial Registration</p> <p>Trial registration number: NCT00670514</p

Eating disorders - knowledge, attitudes, management and clinical experience of Norwegian dentists

Background The purpose of this study was to investigate knowledge, attitudes and clinical experience with regard to patients with eating disorders (ED) among Norwegian dentists. Methods In 2010, a questionnaire was sent to all dentists in Norway (N = 4282) comprising 33 questions related to demographics of the participating dentists, their knowledge of ED (general and oral health aspects), clinical experience, attitudes and perceived management preferences. Results The participation rate was 40 % (47 % women and 53 % men). Their knowledge about ED was often retrieved from common media sources and the greater part of the participants reported they had seen very few patients with ED during their professional career. Female dentists reported superior knowledge about ED compared to males, but the former experienced greater difficulties to inform about the condition. Referrals of the patient to other health facilities were significantly more common among female compared to male dentists. The majority of dentists (76 %) reported a need of more education related to ED management. Conclusions The Norwegian dentists in this study reported limited clinical experience and insufficient knowledge regarding ED. There is therefore a need to increase both undergraduate and continuing education in this field, which can improve preventive and management measures that a dentist can provide for ED patients.publishedVersio

Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery

Introduction This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics. Material and methods In a randomized, controlled, single-blinded procedure, 87 men and women aged 18–44 years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery. Results Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M + S group (193 min) and the C group (110 min) (p = 0.001) as well as the M + T group (157 min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation. Discussion and conclusion The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies

Bettfysiologi i Sverige : vilkor och ramar

Svensk bettfysiologi är framgångsrik sett med internationella glasögon. Denna framgång har uppnåtts genom den omfattande forskning som bedrivits. Ämnets status höjdes genom att bli godkänd specialitet i 1993

Oral apparatur värdefull vid sömnapnébehandling

Studien omfattar en prospektiv konsekutiv serie av 60 vuxna patienter som behandlats för obstruktiv sömnapné (osa) hos allmäntandläkare med intraoral mandibelframdragande apparatur (oral apparatur, oa). Syftet var att kvalitetsutvärdera behandlingseffekter och eventuella biverkningar av oa-behandling. Patienterna besvarade enkäter före behandlingsstart och efter en respektive sex månaders behandling. 55 av de ursprungliga 60 patienterna svarade på samtliga enkäter, varav 41 var män och 19 var kvinnor med en medelålder på 54 år. Efter sex månaders behandling rapporterade 47 procent att deras allmänna välbefinnande var mycket bättre, 65 procent att deras sömnkvalitet blivit mycket bättre och hos 74 procent hade snarkningsbesvären minskat mycket. Andelen personer som uppgav att de aldrig hade huvudvärk var före behandling 23 procent som ökade till 75 procent efter behandling. Hos två av tre patienter förelåg ingen trötthets-/stelhetskänsla i käksystemet och detta förändrades inte under behandlingstiden. De som intermittent upplevde trötthets-/stelhetskänsla vid käkfunktion ökade från 18 procent till 27 procent efter behandlingen. Rörelsesmärtan vid käkfunktion ökade något efter oa-användning, men denna biverkning var låg (5 procent). Majoriteten av patienterna (67 procent) upplevde inga bettförändringar i samband med behandling, dock uppgav 4 procent att de fått en stor bettförändring i och med användandet av oa. Sammanfattningsvis kan sägas att oral apparatur är en värdefull behandlingsmetod vid lätt till måttligt osa med få biverkningar av oftast mindre omfattning avseende käkfunktionen eller andra komplikationer

Obstructive sleep apnoea : patients' experiences of oral appliance treatment

Over the past few decades, there has been a pronounced increase in the number of patients being treated by general dental practitioners for obstructive sleep apnoea (OSA). The purpose of this study was to survey the care and patient experiences and the self-reported effectiveness of OSA treatment with an oral appliance (OA) incorporating mandibular advancement. The design was a retrospective, cross-sectional study, with follow-up between 6 months to 1 year after commencement of treatment. A survey form was posted to 1150 subjects, identified in the regional register over a 1-year period as having been treated with an OA for OSA. The questionnaire comprised 70 questions and assertions in various domains, such as general health/lifestyle, changes in symptoms/quality of life and sleep-related experiences, daytime sleepiness, changes in life situation, evaluation of treatment and the value of treatment. The overall response rate was 64% (n = 738). Treatment with OA gave relief of symptoms in 83% of the respondents. Quality of life, somatic and cognitive symptoms improved significantly in patients who used the appliance frequently (P 85%). OA treatment of OSA by general dental practitioners is a safe procedure. Most of the survey respondents experienced relief of symptoms. Those who used their appliance frequently reported improvement in quality of life, somatic and cognitive symptoms. Excessive daytime sleepiness was reduced in the majority of the patients under treatment

General practice dentists' knowledge of temporomandibular disorders in children and adolescents

Aim: The aim of the study was to map general practice dentists' (GPDs) knowledge of temporomandibular disorders (TMD) in children and adolescents. Materials and methods: A questionnaire was mailed to 286 Swedish dentists in the Public Dental Service and 17 TMD specialists with documented research experience. The questionnaire contained 37 statements on aetiology, diagnostics, classification, chronic pain and pain behaviour, treatment, and prognosis. Each statement was judged on a 0-10 point scale with the endpoint definitions agree or disagree. Results: The overall response rate to the questionnaire was 87%. In 28 of all 37 statements, the TMD specialists endorsed a consensus, i.e. >75% of the specialists had the same opinion about the statement. TMD specialists differed most in opinion in the domain diagnostics and classification. In 65% of the statements, differences in knowledge between GPDs and TMD specialists were non-significant. The greatest number of significant between-group differences was found in the domain treatment and prognosis. Most of these statements were related to morphological factors. Conclusion: There is a high degree of consensus in TMD knowledge amongst the TMD specialists and a high degree of agreement in knowledge between GPDs and TMD specialists. In some areas, however, TMD specialists still need to reach a consensus which is founded on evidence-based TMD knowledge in children and adolescents and that can be used in undergraduate teaching. It is therefore important to develop and strengthen the undergraduate dental teaching in TMD and orofacial pain