Kerstin Knutsson

Pathoses associated with mandibular third molars subjected to removal

OBJECTIVES To measure the prevalence of disease of mandibular third molars referred for removal and to estimate the risk for development of pathoses for two cues. STUDY DESIGN A prospective cohort study on molars subjected to removal was performed. The prevalence of different diseases and the patients age, angular position, and degree of impaction of the molars were registered. Odds ratio for molars with different positions and impaction states were estimated. RESULTS Pericoronitis was found in 64% of cases, caries in the third molar in 31%, periodontitis in association with 8%, caries in the second molar in 5%, and root resorption of the second molar with 1% of the molars with pathoses. Odds ratio was highest for distoangular molars (5.8) and for molars partially covered by soft tissue (6.7). CONCLUSIONS The odds ratio is about 22 and 34 times higher for molars partially covered by soft tissue than for molars completely covered by soft or bone tissue. For distoangular molars the odds ratio is 5 to 12 times higher than for molars in other positions.

Asymptomatic mandibular third molars: Oral Surgeons' judgment of the need for extraction☆

Ten oral surgeons were asked to judge the need for extraction of asymptomatic mandibular third molars. Thirty-six mandibular third molars with equal distribution of angular position, impaction status, and patients sex and age were selected. To estimate the consistency of judgment, the 36 cases were duplicated so that, in all, 72 cases were judged. The judgment of the oral surgeons was compared with that of 30 general dental practitioners (GDPs). The number of mandibular third molars the oral surgeons proposed to extract varied from 3 to 21 of 36 teeth. The mean number of molars proposed for extraction was 12 for the oral surgeons and 13 for the GDPs. There was no third molar that all the observers in the two groups agreed should be extracted. About three times as many observers in both groups proposed extraction of molars partially covered by soft tissue. The oral surgeons were unanimous in their judgment not to extract 11 molars, and the GDPs were also unanimous in judgment not to extract two of these. The mean intraobserver agreement within the two groups was comparable, 94% for the oral surgeons and 92% for the GDPs. We conclude that there is a great variation among oral surgeons in their judgment on the need for removal of asymptomatic mandibular third molars. A similar variation in judgment also was observed among GDPs.

Osseous changes and condyle position in TMJ tomograms: impact of RDC/TMD clinical diagnoses on agreement between expected and actual findings

OBJECTIVE The objective of this study was to evaluate the impact of clinical TMJ diagnosis, gender, and age on the agreement between expected and actual radiographic findings. STUDY DESIGN A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria (RDC/TMD). Expected radiographic findings were recorded. TMJ tomograms in closed and open mouth position were assessed for osseous changes and condyle position. Expected and actual findings were compared. Logistic regression analyses were performed with agreement on radiographic findings as the dependent variable and with clinical RDC/TMD diagnoses, gender and age as the independent variables. RESULTS The number of radiographic findings was mostly underestimated. A clinical diagnosis of osteoarthritis and age increased the chance of overestimating osseous changes. Disc displacement and age decreased the chance of agreement on certain condyle positions. CONCLUSION Tomography often revealed unexpected findings. It was not possible to select particular patient groups who would benefit more or less from a radiographic examination.

A self-directed summative examination in problem-based learning in dentistry: a new approach

This paper describes and evaluates a new method of assessment in PBL, which was developed with two cohorts of dental students. The method involves students in PBL groups designing PBL problems and assessment tasks that are in line with the objectives of the course and the principles of PBL. Construction of tasks and feedback were provided. The student groups based the summative assessment on a selection of the PBL assessments provided. The evaluation indicates that senior students are capable of designing challenging PBL assessment tasks that are in line with course objectives and PBL principles. This experience raised the pass rates of the students compared those of with earlier cohorts of students. The students rated the method favourably; they considered it enabled them to demonstrate their competences and that it was more closely in line with PBL principles than other methods of assessment that they had experienced. The method is a promising innovation, which could be used in a variety of PBL courses.

The structure of observed learning outcome (SOLO) taxonomy: a model to promote dental students’ learning

Selective memorising of isolated facts or reproducing what is thought to be required - the surface approach to learning - is not the desired outcome for a dental student or a dentist in practice. The preferred outcome is a deep approach as defined by an intention to seek understanding, develop expertise and relate information and knowledge into a coherent whole. The aim of this study was to investigate whether the structure of observed learning outcome (SOLO) taxonomy could be used as a model to assist and promote the dental students to develop a deep approach to learning assessed as learning outcomes in a summative assessment. Thirty-two students, participating in course eight in 2007 at the Faculty of Odontology at Malmö University, were introduced to the SOLO taxonomy and constituted the test group. The control group consisted of 35 students participating in course eight in 2006. The effect of the introduction was measured by evaluating responses to a question in the summative assessment by using the SOLO taxonomy. The evaluators consisted of two teachers who performed the assessment of learning outcomes independently and separately on the coded material. The SOLO taxonomy as a model for learning was found to improve the quality of learning. Compared to the control group significantly more strings and structured relations between these strings were present in the test group after the SOLO taxonomy had been introduced (P < 0.01, one tailed test for both results). The SOLO taxonomy is recommended as a model for promoting and developing a deeper approach to learning in dentistry.

Antibiotic prophylaxis in oral health care: administration strategies of general dental practitioners.

Objective. To examine the strategies that general dental practitioners (GDPs) use to administer antibiotic prophylaxis and to study the agreement between the administration strategies of GDPs and local recommendations. Methods. Postal questionnaires in combination with telephone interviews were used. Two hundred GDPs in two Swedish counties, Skåne and Örebro, were asked to participate. The response rate was 51% (n=101). The GDPs were presented with eight simulated cases of patients with different medical conditions for which antibiotic prophylaxis might be considered necessary when performing dental procedures (scaling, tooth removal, root canal treatment). The administration strategies of the GDPs were compared with local recommendations. Results. In general, the variation in the administration strategies of the GDPs was large. For two medical conditions, type 1 diabetes that was not well controlled and hip prosthesis, significantly more GDPs in Skåne than in Örebro administered antibiotic prophylaxis for tooth removal. Agreement between the administration strategies of the GDPs and local recommendations was low. Differences between the two counties were non-significant. Furthermore, within Örebro, GDPs who did not have formal access to local recommendations did not differ in their administration strategies from those who did. The choice of substance was seldom in agreement with the substance recommended, while the majority followed the recommended duration of treatment. Conclusion. Although recommendations existed, their impact appeared to be limited. This is significant, since the implementation of recommendations is crucial in making clinical practice more effective and in promoting the health of patients.

Economic aspects of mandibular third molar surgery

Abstract Objective. The aim of this study was to make estimates from a dental care and societal perspective on costs of mandibular third molar surgery. Material and methods. A total of 64 patients were recruited from three Swedish oral and maxillofacial specialist clinics. Calculations were made prospectively on utilization of labor time, specific medical services and materials, and standardized utilization of other direct costs. Indirect costs were identified from patient surveys. Results. The base case average direct cost of surgery was 217 Euro. Adding the patients average cost due to absence from work and transportation of 333 Euro increased overall costs to 550 Euro per patient. About 86% of the patients reported some absence following surgery. Conclusions. The indirect costs were on average higher than the direct costs, i.e. the patients loss of time caused higher costs than the intervention per se. Appropriate indications for mandibular third molar removal can minimize the risks of complications and individual or societal costs.

Risk Judgment by General Dental practitioners: Rational but Uninformed

Background Decisions by dentists to administer antibiotic prophylaxis to prevent infectious complications in patients involves professional risk assessment. While recommendations for rational use have been published, several studies have shown that dentists have low adherence to these recommendations. Objective To examine general dental practitioners’ (GDPs’) assessments of the risk of complications if not administering antibiotic prophylaxis in connection with dental procedures in patients with specific medical conditions. Methods Postal questionnaires in combination with telephone interviews. Risk assessments were made using visual analogue scales (VAS), where zero represented “insignificant risk” and 100 represented a “very significant risk”. Results Response rate: 51%. The mean risk assessments were higher for GDPs who administered antibiotics (mean = 54, SD = 23, range 26–72 mm on the VAS) than those who did not (mean =14, SD =12, range 7–31 mm) (P < 0.05). Generally, GDPs made higher risk assessments for patients with medical conditions that are included in recommendations than those with conditions that are not included. Overall, risk assessments were higher for tooth removal than for scaling or root canal treatment, even though the risk assessments should be considered equal for these interventions. Conclusions GDPs’ risk assessments were rational but uninformed. They administered antibiotics in a manner that was consistent with their risk assessments. Their risk assessments, however, were overestimated. Inaccurate judgments of risk should not be expected to disappear in the presence of new information. To achieve change, clinicians must be motivated to improve behaviour and an evidence-based implementation strategy is required.