Pia Gabre

Incidence of, and reasons for, tooth mortality among mentally retarded adults during a 10-year period.

The aim of the study was to investigate the reasons for, and incidence of, tooth mortality over a 10-year period in mentally retarded adults receiving regular dental care. The number of teeth present in 115 individuals (mean age in 1984 was 41.0, range 19-83 years) was registered in 1984 and 1994. The reasons for tooth mortality, medication utilization, frequency of dental care visits and cooperation during dental treatment were registered and related to tooth loss. The average incidence of tooth mortality was 3.72 teeth during the 10-year period. The mean number of dental care visits per year was 6.6. Most of the 428 teeth (58%) were lost due to periodontal disease. The preventive dental care given was not sufficient to arrest oral diseases. The data indicate, however, that achievement of cooperation in dental care situations not only makes dental treatment possible, but also leads to a decreased incidence of tooth mortality.

Strategies for caries risk assessment in children and adolescents at public dental clinics in a Swedish county.

BACKGROUND Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood. AIM The aim of this study was to identify the factors forming the basis for dentists caries risk assessment in dental care for children and adolescents. DESIGN From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3-19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records. RESULTS The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered. CONCLUSIONS Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.

Oral Sugar Clearance in Individuals with Oral Motor Dysfunctions

Feeding problems due to impaired oral motor functions resulting in prolonged meals are common among persons with brain damage. The aim of the present investigation was to study the oral sugar clearance in 16 individuals with oral motor dysfunction (OMD) and 16 individuals with normal oral functions (control group). Repeated saliva samples were collected on filter paper discs at two locations before and during 30 min after intake of a glucose tablet. The individuals with OMD had significantly higher initial glucose concentrations in saliva and longer glucose elimination time compared to the control group. For some of the subjects with OMD, sugar clearance was extremely slow. The sugar clearance time was positively related to the severity of drooling problems, but not to the degree of dysphagia. The results from this study indicate that individuals with OMD have an increased risk of dental caries.

Fluoride Retention of a Mucosa Adhesive Paste Compared with Other Home-Care Fluoride Products

Home-care use of fluoride (F) requires a motivated individual and several F products rely on a person’s ability to follow instructions and to cooperate with the treatment. The aim of this crossover study was to investigate concentrations, distribution in the oral cavity and duration of the elevated F concentrations after using four F products: (1) a mucosa adhesive paste with 0.1% F, (2) a mouth rinsing solution with 0.2% NaF, (3) toothpaste containing 0.5% F and (4) a tablet with 0.75 mg F. Fourteen subjects used the four products in randomized order either during the daytime or just before going to bed. The F concentration was measured both in saliva and at interproximal sites. After 6 h of sleep, the F concentration after using the mucosa adhesive paste and the mouth rinse solution was high in saliva. In the interproximal area, the adhesive paste showed the highest values. During daytime use, all the products increased the F concentration, but only the mucosa adhesive paste and the rinsing solution elevated F in saliva for up to 2 h. In the interproximal area, the paste increased the F concentration most. In conclusion, this study showed that the mucosa adhesive paste and the mouth rinse solution led to higher F concentrations and for a longer time than tablets and toothpaste. For patients who are unable to comply with traditional F treatment, an F-containing adhesive paste therefore has the potential to be a useful vehicle. For individuals who are able to cooperate, a mouth rinse with an F solution is a simple, efficient and well-known method for preventing dental caries.

Oral status, oral hygiene, and patient satisfaction in the elderly with dental implants dependent on substantial needs of care for daily living

Using osseointegrated implants to replace teeth is a routine procedure today. This study investigated oral status, oral hygiene habits, and patient satisfaction in elderly with dental implants who were dependent on substantial support for daily living. Twenty-six persons over the age of 65 who were dependent on supportive care were examined. Data collected included the number of teeth and implants, plaque scores, bleeding on probing, and oral hygiene habits. Self-perceived knowledge about managing their implants and satisfaction with the implants was recorded. Subjects had a total of 148 natural teeth and 144 implants. Only a few signs of oral disease were found and the tissues around implants were healthier than around natural teeth. No correlations between oral hygiene habits and plaque scores or bleeding were found. A majority of the subjects were satisfied with their implants. Dental implants have satisfactory function even in individuals who are elderly and have substantial needs for supportive care.

Oral health-related quality-of-life in homebound elderly dependent on moderate and substantial supportive care for daily living

Abstract Objectives. To describe the oral health-related quality-of-life in homebound elderly dependent on moderate and substantial supportive care for daily living. Materials and methods. A total of 302 selected persons in three counties in Sweden over 65 years of age and in need of daily support from society participated in the study. Half of the participants had moderate needs of support, defined as supportive care of 15–50 h per month and half had substantial needs of supportive care, i.e. 3-times a day with a night overview. An oral examination was performed and structured questions were asked about general health and living conditions, medication, oral care routines and quality-of-life, using the instrument GOHAI (Geriatric Oral Health Assessment Instrument). Results. Cardiovascular disease was common and an average of seven prescription drugs was used. More than half of the participants had dentures. The strongest correlation with GOHAI was the total number of teeth. There was a significant difference between individuals with moderate and substantial needs according to GOHAI, irrespective of gender. More elderly people with substantial needs of support had low GOHAI values. Decayed teeth, DT/T, root remnants and dry mouth were negatively correlated to GOHAI among individuals with substantial needs. Conclusions. This study found that elderly homebound individuals with substantial needs of supportive care had a lower quality-of-life than elderly homebound individuals with moderate needs of supportive care, although both medical and odontological variables were similar in the groups.

Simplified methods of topical fluoride administration: effects in individuals with hyposalivation

The aim was to compare fluoride (F) levels in individuals with normal salivary secretion and hyposalivation in connection with their use of F solutions and toothpaste. Seven individuals with normal salivation and nine with hyposalivation rinsed with 0.2% NaF solution for 1 minute. In addition, individuals with hyposalivation performed the following: (i) 0.2% NaF rinsing for 20 seconds, (ii) rubbing oral mucosa with a swab soaked with 0.2% NaF solution, and (iii) brushing with 5,000 ppm F (1.1% NaF) toothpaste. Subjects characterized by hyposalivation reached approximately five times higher peak values of F concentrations in saliva after 1 minute rinsing with the F solution and higher area under the curve (AUC) values. The simplified methods exhibited the same AUC values as did 1 minute of rinsing. Brushing with 5,000 ppm F toothpaste resulted in higher AUC values than did the simplified methods. The F concentrations reached higher levels in individuals with hyposalivation compared to those with normal salivation. The simplified methods tested showed similar effects as conventional methods.

Factors of importance to maintaining regular dental care after a behavioural intervention for adults with dental fear: a qualitative study

Abstract Objective. Dental phobia is prevalent in the general population and can be successfully treated through cognitive behavioural therapy, which results in patients being able to cope with dental treatments. The aim of this study was to increase the understanding of factors of importance for maintaining regular dental care after completion of a cognitive behavioural therapy programme. Material and methods. A qualitative study design was used. Fourteen individuals who had successfully completed the programme and had thereafter been referred to a general dental practitioner were interviewed. An interview guide with open-ended questions was used. The interviews were tape-recorded and transcribed verbatim. The texts were analysed using descriptive and qualitative content analysis (Grounded Theory). Results. The manifest analysis identified four content areas: experience of dental care, content of the behavioural therapy programme, perception of therapy and impact on quality of life. The latent analysis identified influence on quality of life, security, activity and barriers to dental care as categories. Although all informants had successfully completed the dental fear treatment programme, only a few stated that they had an uncomplicated relation to dental care afterwards. Barriers to dental care were lack of money and fear. A sense of security was conclusive to coping with dental care, and a respectful approach on the part of the dental care personnel was essential to development of this sense. Conclusions. Confidence in ones own ability to cope with dental care and the right to guide the treatment were important. Thus the theme in the present study was self-efficacy and respectful dental care personnel.

Oral health status in older immigrants in a medium-sized Swedish city.

AIM The aim of the study was to investigate oral health and oral care habits among older immigrants to Sweden from countries outside the Nordic region. METHOD Participants ≥60 years of age from senior social centers for immigrants were invited to attend oral examinations. Data was collected on the number of teeth, dentures, caries, periodontal status, saliva secretion, and plaque scores. Participants also described their general health and oral care habits. RESULTS Fourteen men and 28 women, median age 71.5 years, participated. Seventeen percent were edentulous, women often than men. Three out of four had caries and 63% had gingival bleeding. Two-thirds brushed their teeth twice per day and 60% had visited dental services in the last 2 years. CONCLUSION The group had a high prevalence of oral diseases and discomfort. They used dental services and brushed their teeth less frequently than Swedish populations of the same age.

Dental attendance patterns among older people: a retrospective review of records in public and private dental care in Sweden

OBJECTIVES Nowadays, older people retain their natural teeth more frequently and so are at increased risk of oral disease. At the same time, discontinued contacts with dental services prevent access to preventive care and increase the risk of undetected disease. This study aims to evaluate how often older people discontinue regular dental visits and to establish the reasons. METHODS This study is a retrospective review of records of patients aged ≥75 years from seven Swedish clinics, three in the public dental service (PuDS) and four in the private (PrDS). All patients were examined in 2010, and their dental attendance records from 2010 to 2014 studied. Data included gender, dental insurance system, last performed planned examination, emergency visits, registrations in the recall system, cause of discontinued care and number of teeth and implants. RESULTS In total, 993 records were studied, 303 in PuDS and 690 in PrDS. In both groups, 10% of patients had no complete dental examinations between 2010 and 2014 after baseline examination in 2010. One-quarter were not registered in the recall system after their last examinations, and this was more common in PrDS than PuDS. In many cases, no reason for discontinued regular visits were described in the records. The mean number of natural teeth was 19.0 in both groups, but there were more implants in the PrDS group. CONCLUSIONS A large proportion of the participants risked losing regular contact with dental services. Dental services appeared to lack strategies for maintaining regular dental care for elderly patients.