On oral disease, illness and impairment among 50-year-olds in two Swedish counties

There were three general aims of the thesis. To investigate: 1) the fulfillment of the judiciary Swedish goal of good dental care on equal conditions in an adult population born 1942 in two Swedish counties in 1992. Both selfrated oral health and clinical observations indicated good oral health in the study population. Full social equality of dental care was not attained, but the social gradient was modest. 2) To find models for risk prediction on population level for oral health, expressed as number of remaining teeth, as caries and as periodontitis. Relatively efficient such models were constructed, with the lowest efficiency for periodontitis indicators. Oral health and disease were found to be qualitatively different. Still, use of tobacco was a consistent risk factor for both poor health and presence of disease. 3) To investigate if questionnaires can be used to monitor oral health, disease and illness. It was found that this is the case on population level, but also that questionnaire surveys cannot wholly replace clinical studies, especially regarding periodontal disease. For number of remaining teeth and frequency of removable dentures, the questionnaire methodology is appropriate for monitoring in this type of population, which has been utilized by setting the present study as a baseline for ongoing longitudinal studies relying on survey methodology

Eating disorders and biochemical composition of saliva: a retrospective matched case-control study

This study aimed to compare the biochemical composition of saliva from patients with eating disorders (EDs) with saliva from control subjects with no ED. All patients who initiated outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of the 65 patients who started treatment during the period, 54 (50 female patients/four male patients; mean age: 21.5 yr) agreed to participate. The controls were 54 sex- and age-matched patients from a dental health clinic. All participants completed a questionnaire and underwent dental clinical examinations, including laboratory analyses of saliva. The proportion of subjects with unstimulated salivary hyposalivation was lower in the ED group and not correlated with intake of xerogenic drugs. Significant differences in the biochemical composition of saliva were found almost exclusively in the unstimulated state, with albumin, inorganic phosphate, aspartate aminotransferase (ASAT), chloride, magnesium, and total protein all being significantly higher in the ED group. Conditional logistic regression showed that higher ASAT and total protein concentrations were relatively good predictors of ED, with sensitivity and specificity of 65% and 67%, respectively. In conclusion, elevated salivary concentrations of ASAT and total protein may serve as indicators of ED as well as of disease severity. Future studies are needed to corroborate these initial findings

An analysis of present dental professions in Sweden

Dentistry in Sweden is predicted to have a shortage of dentists in the future and the division of labour within dentistry will be a more debated question. In order to forecast the effects of such a shortage the professional status of the involved groups must be made clearer. The objective of this paper is to analyse the emergence and present professional status of clinical dental professions in Sweden. The study was conducted on the basis of theories on professions, and their roles in organizations was analysed.The results were applied on the historical emergence, establishment and consolidation of clinical dental professions in Sweden. The results show that a large sector of salaried dentists has not diminished the professional status of the Swedish dentists. Professional ambitions such as many clinical subspecialties and a strong element of research have not been restrained by the public health ambitions in the Public Dental Health Service (PDHS). Presently, other dental professions are dental hygienists, dental technicians and dental nurses. Of these the only other licensed group, the dental hygienists, are an emerging profession.They have an uphill struggle to obtain a full professional status, mainly because their knowledge domains are neither specific nor exclusive to their group. Development of a common core curriculum on a clearly academic level would enhance their professional status. Dental technicians and nurses are lacking fundamental traits as professions. There appears to be little need for additional groups of clinical professions besides dentists and dental hygienists in Swedish dentistry. In conclusion,this analysis provided better understanding of the present status of the Swedish dental professions, to prepare for future restructuring of the dental care system. Further work will be needed to understand the impact of professional traits on the management of groups of professionals

Self-perceived oral health among 19-year-olds in two Swedish counties

The primary purpose of the present study, which focused on a census of 19-yearolds (2006) attending dental clinics in two Swedish counties, was to describe the frequency distribution of clinically- and self-perceived oral health indicators in terms of DSa (Decayed Surfaces approximal), four global dimensions of oral health and one ‘all-embracing’ oral health measure, according to county of residence and gender. A second purpose was to examine to what extent the clinical indicator of oral health and the global dimensions of self-perceived oral health contribute to the explainable variance of the global single-item indicator. Finally, the study examined whether or not the association of clinically- and self-perceived oral health indicators with the single global oral health indicator varied as a function of gender and place of residence. The study base was 46.5% (n=3658) of all children attending for dental checks (n=7866). The questionnaire included thirteen questions, divided into four global dimensions. These were Knowledge, Quality of life, Social and Function. There was also one ‘all-embracing’ oral health question, one question about gender and finally information about clinically-registered disease. The findings of this study were that females reported more serious problems than males in the Social and Quality of life dimensions and there were differences between counties in knowledge about oral diseases. The group with poor self-reported oral health in the ‘all-embracing’ oral health question had significantly more problems with all global dimensions, especially Quality of life and Social dimensions. Statistically-significant two-way interactions occurred between county and Knowledge and between county and Quality of life. This study supports the idea of one or several questions concerning self-perceived oral health to be used as a complement to the traditional epidemiological clinical registration of oral diseases

Patient satisfaction with dental care in one Swedish age cohort. Part II - What affects satisfaction

The aim of this study was to investigate satisfaction with dental care in relation to dental care factors, recent dental care experiences, past dental care experiences, general health factors, oral health factors and socio-economic factors and all over time. All persons born in 1942 in two counties in Sweden, Örebro and Östergötland, were surveyed by post in 1992 at the age of 50, and resurveyed at the age 55. There were 5363 persons responding at both times, constituting the study group. A conceptual theoretical model was constructed to be used as a framework in the analysis. Multiple regression analysis and contingency tables were used. Factors related to satisfaction with dental care were: care organisation, cost for care, visit to dental specialist, time spent in waiting room, regular attendance, reception at dental clinic, feelings of anxiety, taking part of school dentistry, smoking, oral health factors, dental appearance and being dissatisfied 5 years previously. Change between the two study years was affected by perceived oral health, experiences from the most recent dental visit and care organisation. Oral health related factors and dental care factors like cost for care and care organisation were related to satisfaction with dental care. Likewise were experiences from the most recent dental visit and to some extent past care experiences like school dentistry. Almost no correlation was seen between socio-economic factors and satisfaction

Patient satisfaction with dental care in one Swedish age cohort. Part 1 - descriptions and dimensions

The aim of this study were to investigate the dimensionality of satisfaction with dental care, to control the reproducibility of the analysis over time, to investigate changes between the two studied years and to relate satisfaction with elapsed time since the most recent visit to dental care. All persons born in 1942 in two counties in Sweden, Orebro and Ostergötland, were surveyed by post in 1992 at the age of 50 and resurveyed at the age of 55. There were 5363 persons responding at both times, constituting the study group. In this study, opinions are analysed about general satisfaction with dental care and about the most recent dental visit. Factor analysis, one-way ANOVA and contingency tables were used. Overall satisfaction was high both as to general satisfaction and as to the most recent dental care visit. Those with their most recent dental visit more than a year ago felt more pain, anxiety and unpleasantness and were also more generally dissatisfied. Of those having experiences of pain, anxiety and unpleasantness at most recent visit, there was an overrepresentation of non regular attenders. Factor analysis showed that the questions used revealed a stable pattern. In conclusion, the overall satisfaction with dental care was high. Differences between the two studied years were small. Persons not visiting dental care within the last year were more dissatisfied both generally and with the most recent visit. A greater number of regular attenders had no feelings of anxiety, pain or unpleasantness at all

Perceived oral health : changes over 5 years in one Swedish age-cohort

Objectives: The purpose of this study was to investigate if a change in the social gradients in perceived oral health occurred over a 5-year period, 1992-97, using a cohort population from two Swedish counties. Methods: In 1992, a cross-sectional mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Örebro and Östergotland, and altogether there were 8888 persons. In 1997, the same population was sent a new questionnaire. The cohort, comprising the same respondents from 1992 and 1997, was of 5363 persons. An index of perceived oral health was constructed out of three questionnaire variables: satisfaction with teeth, chewing ability and the number of remaining teeth. This index value was set as a dependent variable in a regression model. Reports of toothache were investigated in a separate logistic regression model. Results: There were obvious social gradients in the perceived oral health index both in 1992 and in 1997. Marital status, foreign birth, education and occupation were all substantially related to the perceived oral health. The change in perceived oral health was analyzed. Almost half of the cohort (47.4%) showed no change at all. Those with increased and those with decreased health were rather evenly distributed on both sides, with 22.0% with better health in 1997 and 30.6% with worse health. Gender and education were related to toothache experience. Conclusion: Changes have been moderate in the perceived oral health in this cohort, despite the rather drastic changes in the remuneration of dental care during this study time. On the other hand, this also means that the social differences remain, despite the official goals of increased equity

Diet and behavioral habits related to oral health in eating disorder patients: a matched case-control study

Background Patients suffering from eating disorders (ED) have a substantially increased risk for developing poor oral health. In this regard, dietary habits in combination with obsessive behavior as well as the expression and intensity of the disease are of utmost importance. This study aimed to investigate diet and behavioral habits in patients with ED compared to healthy controls. Methods All patients who initiated treatment in an ED clinic during 1 year were invited to participate in the study. Sixty-five patients were admitted out of which 54 agreed to participate: 50 women and 4 men, mean age 21.5 years, range 10–50 years. From a public dental health clinic, 54 sex-and age-matched controls where selected. In all participants a comprehensive questionnaire was completed. ED patients were analyzed with respect to their self-perceived disease state: when they felt “relatively good” (ED-good) and “bad” (ED-bad) as well as if they reported vomiting or not. Results The ED-good patients reported significantly higher intake of caffeine-containing and cola light soft drinks and both study groups reported a lower intake of regularly sweetened carbonated drinks compared to controls. ED-bad reported significantly lower intake of number of meal and sweet intake while both study groups brushed their teeth more frequently than controls. As regards awareness of detrimental dietary intake and the possible risk for oral health complications did not differ between patients and controls except that the ED groups were more aware that vomiting and brushing thereafter could damage their teeth. ED patients went less often to the dentist for regular checkups than controls. Vomiting ED patients differed in several of the parameters related to dietary and other behaviors compared to no vomiting subjects. According to regression analyses and compared to healthy controls, predictive variables for ED-good were: higher intake of caffeine containing drinks (OR 1.34, CI 1.10–1.64) and lower intake of regular soft drinks (OR 0.57, CI 0.35–0.94). For ED-bad, lower frequency intake of lunch meals (OR 0.59, CI 0.39–0.88) and sweet biscuits were predictive (OR 0.15, CI 0.05–0.48). Conclusions ED patients present a number of dietary and other types of behavior that are potentially harmful for oral health. It is important to retrieve reports on the ED behaviors in both relatively good and bad disease state in order for the medical team to prescribe adequate advice and treatment

Self-perceived oral health among 65 and 75 year olds in two Swedish counties

The aim of this study was to investigate self-perceived oral health in two elderly populations, age's 65 and 75 years, and its relation to background factors, socioeconomic, individual, and dental health service system factors. Another purpose was to investigate if there were any differences in these respects, between the two age groups, born in 1932 or 1942. In two counties in Sweden, Orebro and Ostergötland, all persons born in 1942 have been surveyed by mail every fifth year since 1992. In the year 2007 all persons born in 1932 were also surveyed using the same questionnaire. Those born in 1932 consisted of 3735 persons and those born in 1942 6078 persons. From an outline of a general model of inequalities in oral health data were analyzed with descriptive statistics and contingency tables with chi2 analysis. Multivariable analysis was performed by using multiple regression analysis. Factors related to self-perceived oral health were age group, social network, ethnicity, education, general health,tobacco habits, oral hygiene routines, dental visit habits and cost for care. The self-perceived oral health was overall rather high, especially in view of the studied ages, although it was worse for those of age 75. Socio-economic factors, dental health service system as well as individual lifestyle factors affected self-perceived oral health. To have a satisfying dental appearance, in the aspect of howyou are judged by other people, was important for these age groups. This presents a challenge for dental health planners especially since the proportion of older age groups are growing