Long-term effects of motivational interviewing vs. traditional counseling on dog owners' adherence to veterinary dental home care: a three-year follow-up study.

Introduction: Periodontal disease is one of the most common health issues in dogs. However, disease is largely preventable by eliminating dental plaque, best achieved by daily tooth brushing. Unfortunately, owner adherence is low to the recommendation of daily tooth brushing in dogs. Objective: This study aimed to evaluate the impact of various communication strategies, traditional advice (TA) versus motivational interviewing (MI), and compare them to a control group receiving no additional communication (CG), on dog owners' performance of dental home care and the oral health of their dogs. Methods: The study was conducted as a longitudinal clinical intervention study spanning 3 years, and involved 75 dog owners with young dogs who were randomly assigned to one of three groups: TA, MI, or CG. Intervention groups received annual telephone consultations based on their assigned methodology. A questionnaire was administered twice to all groups, and the dental health of the dogs was assessed at the study's conclusion. Result: Tooth brushing frequency demonstrated a significant increase in the MI group compared to the CG group (p < 0.01), albeit with a relatively low occurrence of daily brushing among owners. Dental health assessment revealed a significantly lower plaque index in the MI group compared to the CG group (p < 0.05), and a lower calculus index in the TA group compared to the CG group (p < 0.01). No statistically significant differences were observed between the MI and TA groups in terms of dental health. Conclusion: Regular veterinary communication appears to have a positive influence on dog owner adherence to veterinary recommendations concerning dental care in dogs. Communication with veterinarians (MI and traditional advice) improved owner knowledge, attitude, and decreased frequency of not brushing. Although dental health parameters improved, the effect size was small, suggesting the complexity of adherence. Personalized calls to dog owners offer potential for dental health improvement, warranting further comparison of MI with traditional advice.

Changing from disease-centred to person-centred - Swedish dental hygienists' views on a theory-based behavioural intervention for improved oral hygiene among adolescents.

OBJECTIVES: To explore dental hygienists' (DHs') views on (i) a person-centred, theory-based, behavioural intervention for improving oral hygiene among adolescents and (ii) professional and organizational factors to consider in the implementation of such an intervention in daily dental practice. METHODS: Semi-structured interviews were conducted with 13 DHs who had applied the person-centred, theory-based, behavioural intervention directed at adolescents with poor oral hygiene in a field study within the Public Dental Service, Region Västra Götaland, Sweden. The interviews were audio-taped, transcribed verbatim and analysed using qualitative content analysis. RESULTS: The main theme 'From individual experts to partners - DHs changing direction from a disease-centred towards a person-centred approach' illustrated a changed professional approach among DHs, from exerting their roles as experts to encouraging partnership in treatment by supporting the adolescents in taking health behavioural decisions and responsibility for their oral health. The DHs considered the changed approach as challenging, but also more enjoyable, compared to conventional information/instruction. Adequate knowledge and skills, personal interest and willingness for a change as well as support from colleagues and clinic management were identified as prerequisites for implementing the person-centred, theory-based, behavioural intervention in daily practice, while the expenditure of time needed in relation to economic demands in care were seen as barriers. CONCLUSIONS: The findings elucidate that DHs considered the application of a person-centred, theory-based, behavioural intervention to be challenging but also enjoyable. For such an intervention to be implemented in daily practice, prerequisites and barriers need to be considered on both personal/professional and organizational levels.

Adolescents' self-reported experiences following a person-centred, theory-based educational intervention versus conventional education for improved oral hygiene: Analysis of secondary outcomes of a randomized field study.

AIM: To analyse adolescents' self-reported experiences and behavioural outcomes of a person-centred, theory-based intervention in comparison with conventional information/instruction for improved oral hygiene. MATERIALS AND METHODS: Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Västra Götaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person-centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three-hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed. RESULTS: The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p < .01). CONCLUSIONS: The person-centred, theory-based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self-reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction.

Subgingival instrumentation.

The S3-level clinical guidelines for the treatment of patients with periodontitis stages I-III published by the European Federation of Periodontology in 2020, suggest a pre-established stepwise approach for oral-healthcare professionals with precise therapeutic pathways. The second step of this approach consists of the subgingival instrumentation of periodontal pockets by non-surgical means to disrupt the microbial biofilm and remove soft and mineralized deposits This step aims to resolve periodontal inflammation by closure of periodontal pockets (probing pocket depth ≤ 4 mm, absence of bleeding on probing) employing different types of instruments and treatment protocols toward this end. Novel non-surgical treatment approaches that adopt micro instruments or subgingival application of biological agents have been recently tested. Subgingival instrumentation has been shown to effectively restore the subgingival microbiota to one associated with periodontal health and to modulate the inflammatory response. The outcomes of the subgingival instrumentation have to be evaluated in order to guide the therapist in providing additional but focused treatment in the remaining pockets OR at sites with residual inflammation. Of great importance is the impact that non-surgical periodontal treatment has on the patient's well-being, based on evidence that emerges from studies evaluating patient related outcomes and quality of life.

Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study.

OBJECTIVES: Adequate oral hygiene, that is self-performed infection control, is crucial to prevent periodontal disease. Epidemiological studies reveal poor oral hygiene conditions among Swedish adolescents and indicate a need for more effective prevention programs. The aim of the current study was to analyse adolescents' experiences of a person-centred, theory-based, oral health education program for improved oral hygiene. METHODS: Data were obtained by interviewing 19 adolescents treated by dental hygienists in accord with the person-centred education program in a preceding clinical field study (ClinicalTrials.gov NCT02906098). Study participants were selected to reflect a variation of male and female adolescents, treated at clinics in areas with various socio-demographic profiles within Region Västra Götaland, Sweden. Interviews were audio-taped, transcribed verbatim and analysed with qualitative content analysis. RESULTS: A main theme was identified: 'Adolescents on a guided and challenging journey towards beneficial oral hygiene behavior'. The results elucidate the importance of a person-centred approach in therapy. The adolescents described insight on a personal level about the importance of improved oral hygiene as fundamental for behavioural change. Planning and monitoring of the behaviour, with guidance and support by the dental hygienist, was considered to facilitate change and encouraged further behavioural efforts. However, the adolescents expressed a need of reminders and support to keep up oral hygiene routines over time. CONCLUSIONS: The study brings knowledge on factors of importance in educational interventions to increase beneficial health behaviours among adolescents and emphasize areas for further improvements of such interventions.

A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice.

AIM: To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice. MATERIALS AND METHODS: Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3 months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth ≤ 4 mm) at 6 months. Multilevel models were utilized. RESULTS: Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes. CONCLUSIONS: No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking. CLINICALTRIALS: gov (NCT02168621).

A person-centred, theory-based, behavioural intervention programme for improved oral hygiene in adolescents: A randomized clinical field study.

AIM: To test the effectiveness of a person-centred and theory-based educational intervention to increase adolescents' adherence to adequate oral hygiene behaviour, that is, self-performed periodontal infection control. MATERIALS AND METHODS: Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. RESULTS: Three-hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6-month follow-up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. CONCLUSION: A person-centred and theory-based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. CLINICALTRIALS: gov (NCT02906098).

Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study.

CONTEXT: The current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis. OBJECTIVE: The specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient's adherence to self-performed infection control, i.e. adequate oral hygiene. METHODS: The study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation (scaling and root planing) integrated at required number of consecutive appointments. Clinical examinations and treatment were performed by Dental Hygienists, i.e. not blinded. Data were processed with bivariate statistics for comparison between treatment groups and with multiple regression models to identify potential predictors of subjective and clinical outcomes. The primary clinical outcome was gingival bleeding scores. RESULTS: No substantial differences were found between the two treatment approaches regarding patient-reported experiences or outcomes of therapy. Patients' experiences of definitely being involved in therapy decisions was a significant predictor for a desirable subjective and clinical outcome in terms of; (i) that oral health was considered as much improved after therapy compared to how it was before, (ii) that the treatment definitively had been worth the cost and efforts, and (iii) adherence to self-performed periodontal infection control. In addition, to be a current smoker counteracted patients' satisfaction with oral health outcome, while gingival bleeding scores at baseline predicted clinical outcome in terms of bleeding scores at 6-months. CONCLUSIONS: The results suggest that there are no differences with regard to patient-reported experiences and outcomes of therapy following a GPIC approach to periodontal infection control versus CNST. Patients' experiences of being involved in therapy decisions seem to be an important factor for satisfaction with care and for adherence to self-performed periodontal infection control. Registered at: ClinicalTrials.gov (NCT02168621).

Overcoming behavioral obstacles to prevent periodontal disease: Behavioral change techniques and self-performed periodontal infection control.

It is well established that periodontal infection control, by means of adequate oral hygiene such as daily toothbrushing and interdental cleaning, is essential for prevention of periodontal disease. Evidence suggests that oral health behavioral intervention is more effective if based on a theoretic framework that includes behavioral change techniques based on goals and planning and on feedback and monitoring. This review focuses on factors that influence behavioral changes in oral hygiene measures (both obstacles and facilitators) and a person-centered approach to treatment planning and communication with patients. A person-centered model of oral hygiene is presented that can be integrated into periodontal treatment using different behavioral techniques.

Complexity of best-evidenced practice in periodontal therapy: Views of Swedish Dental Hygienists.

OBJECTIVES: Dental hygienists (DHs) have an important role in the treatment of patients with periodontitis. The objective of the current qualitative interview study was to gain understanding about personal and organizational factors that influence best-evidenced DH practice in the treatment of periodontitis. METHODS: Data were obtained by interviewing Swedish DHs, who had been engaged in a preceding clinical field study on evidence-based periodontal therapy. Qualitative content analysis was used for analysis. Data sampling was terminated after 18 interviews, when deemed that sufficient amount of information had been gained. RESULTS: In the analysis of the interview data, a main theme was identified as "I know what to do, but I do as I usually do; DHs' ambivalence between theory and practice in the treatment of patients with periodontitis." The results elucidated that the DHs were well aware of "what to do" in order to offer their patients adequate periodontal care, but this knowledge was not congruent with how they usually worked. Established routines and culture at the clinic, DHs' predetermined beliefs about lack of motivation and ability to cooperate among patients, lack of time and reflection, economic demands in care and lack of interest and support by co-working dentists were barriers to best-evidenced DH practice in periodontal care. CONCLUSIONS: The results elucidate the complexity of best-evidenced DH practice in the treatment of periodontal patients and indicate needs for quality improvement of the periodontal care provided in general dental practice, by actions taken on both individual/professional and organizational levels.

Altered expectations on dental implant therapy; views of patients referred for treatment of peri-implantitis.

AIM: The aim was to explore patients' reactions on being diagnosed with peri-implantitis, their opinions on dental implant therapy and expectations on treatment of the disease. MATERIAL AND METHODS: The study subjects were patients referred to a specialist clinic for treatment of peri-implantitis. The method of grounded theory was used in collecting and analyzing data. Audiotaped, thematized open-ended interviews were conducted. The interviews were transcribed verbatim and consecutively analyzed in hierarchical coding processes that continued until saturation was met (n = 15). RESULTS: In the analysis, a conceptual model was generated that illuminated a process among patients. From having very high initial expectations on dental implant therapy as a permanent solution of oral/dental problems, patients realized that dental implants, such as teeth, require continuous care and that there is no guarantee for that dental implants provides a treatment alternative free from future problems. The core concept of the model "altered expectations on dental implant therapy" was composed of three main categories: "initial expectations on dental implant therapy and living with dental implants", "being referred to periodontist and become diagnosed with peri-implantitis" and "investing again in an expensive therapy with no guarantee for the future". CONCLUSION: Patients may have unrealistically high expectations on dental implant therapy. The results illuminate the importance of patient-centered communication in dentistry and that treatment decisions should be based not only on professional expertise but also on expectations, abilities, wishes and life circumstances of the individual patient.

Health investment behaviours and oral/gingival health condition, a cross-sectional study among Swedish 19-year olds.

OBJECTIVES: To test the hypothesis that certain individual, environmental and lifestyle factors are positively associated with beneficial health investment behaviours and oral/periodontal health among adolescents. METHODS: Five hundred and six randomly selected 19-year old subjects living in two different areas (Fyrbodal and Skaraborg) in the county council of Västra Götaland, Sweden participated in a clinical examination and answered questionnaires covering psycho-social and health behavioural issues. Two oral-health models were estimated with gingivitis score as an objective and self-perceived oral health as a subjective indicator. Three health- investment behaviour models were designed with indicators directly related to oral health and two with indicators related to general health as well. The explanatory variables included gender, upper secondary education programme, native country, living area, general self-efficacy and parents' education level. RESULTS: In the objective oral-health model, theoretical studies and living in the Skaraborg area were both positively associated with a lower gingivitis score. For the subjective oral-health indicator, none of the explanatory variables showed statistical significance. In the investment-behaviour model with 'tooth-brushing ≥ 2 times daily' as a health indicator, female gender and theoretical studies showed statistically significant associations. With the indicators 'no/few missed dental appointments', 'no tobacco use' and 'weekly exercise', theoretical studies were statistically significant and positively associated. In the investment model with 'perceived oral health care attention' as an indicator, a high score of general self-efficacy was significantly associated with the feeling of taking good care of the teeth. CONCLUSIONS: Individual, environmental and lifestyle factors are associated with young individuals' oral health investment behaviours and gingival health conditions.

Oral health locus of control in a Swedish adolescent population.

OBJECTIVE: The aim was to test and evaluate the psychometric properties of the Oral Health Locus of Control (OHLoC) instrument and its relation to dental anxiety, self-efficacy and self-perceived oral health among Swedish adolescents. MATERIALS AND METHODS: A random sample of 758 (63% of 1208 invited) 19-year-old individuals in three residential areas in western Sweden (two rural, one urban) answered a set of questionnaires prior to a dental examination. RESULTS: The face and content validity of the OHLoC was deemed good in pilot interviews with individuals of the target age. Explorative factor analysis verified the dimensions of the OHLoC sub-scales (internal, external, chance locus of control) with loadings from 0.503 - 0.812, explaining 54.6% of the variance. Construct validity was confirmed in relation to two other psychometric scales, on dental anxiety (DAS) and on general self-efficacy (GSE), with correlations in the expected directions. In multivariate logistic regression analyses, the internal sub-scale displayed the most consistent statistically significant associations with self-perceived oral health, also when accounting for gender, demography and health behavior. There were no significant differences between genders on the OHLoC, but females scored statistically significantly higher on the DAS (p = 0.005) and lower on the GSE (p = 0.021) than males. CONCLUSIONS: The Swedish version of the OHLoC appears to have acceptable psychometric properties for use in an adolescent population.

Psychometric properties of the Dental Hygienist Anxiety Scale in a group of general dental patients.

OBJECTIVE: The aim of the present study was to evaluate the psychometric properties of the Dental Hygienist Anxiety Scale (DHAS) in a sample of adult general dental patients. MATERIALS AND METHODS: The DHAS is a questionnaire adapted to assess fear and anxiety of dental hygienist (DH) treatment. The DHAS contains four items and the sum of scores range from 4 (no anxiety) to 20 (extreme fear). A convenient sample of 80 patients in treatment at two DH programs in Sweden were consecutively included in the study. The DHAS was distributed together with questions regarding self-perceived oral health and experience of dental care at the first visit after a clinical examination performed by a DH. Re-test assessments of DHAS were conducted ≈ 2 weeks later in conjunction with the next visit to the DH before treatment (scaling session). RESULTS: The results verified a significant positive correlation between the average DHAS sum of scores and global fear of DH and dentist treatment, perceived pain during the last DH treatment and female gender. The DHAS sum of scores had a high internal consistency, Cronbach's coefficient of 0.89 and 0.87 at the first and at the second assessment, respectively. The test-re-test reliability of the DHAS sum of scores was acceptable, with an intra-class coefficient of 0.82 and Kappa coefficients between 0.49-0.78 for the four single items in the DHAS. CONCLUSIONS: These results suggest that the DHAS has acceptable psychometric proprieties and is a valid and reliable scale to assess anxiety in DH treatment.

A single session of motivational interviewing as an additive means to improve adherence in periodontal infection control: a randomized controlled trial.

AIM: To evaluate the effect of a single session of motivational interviewing (MI) on self-performed periodontal infection control. MATERIAL AND METHODS: A randomized, examiner masked, controlled clinical trial of 6-month duration was performed involving 44 patients with chronic periodontitis, referred for periodontal treatment. At baseline, all subjects were examined concerning marginal gingival bleeding (MBI) and plaque (PI). Test subjects received a single MI-session before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non-surgical periodontal therapy. Efficacy variables for evaluation of self-performed periodontal infection control were MBI (primary variable) and PI. RESULTS: The MI intervention resulted in a negligible decrease (3-4%) in MBI and PI that was not significantly different from the changes observed in the control group without any intervention. Neither was any additive effect of the initial MI-session found on the standard of oral hygiene subsequent to conventional treatment. A desirable MBI score of ≤20% at the end of treatment was associated with being a female patient, whereas high plaque scores at baseline counteracted a corresponding desirable final PI of ≤20%. CONCLUSION: A single freestanding MI session as a prelude to conventional periodontal treatment had no significant effect on the individuals' standard of self-performed periodontal infection control in a short-term perspective.

Oral health-related perceptions, attitudes, and behavior in relation to oral hygiene conditions in an adolescent population.

The aim was to analyze oral health-related perceptions, attitudes, and behavior in relation to oral hygiene conditions among 19-yr-old Swedish subjects. A random sample of 506 individuals was clinically examined regarding oral hygiene conditions and provided questionnaire-based information on oral health-related perceptions, attitudes, and behaviors. Higher scores of plaque and gingivitis were significantly related to the following perceptions: (i) a less favorable oral health situation, (ii) a lower satisfaction with the esthetic appearance of the teeth, (iii) more frequent gingival bleeding during toothbrushing, (iv) less favorable self-care of the teeth, (v) a lower possibility to impact on own oral health, (vi) a lower importance of cleaning the teeth, and (vii) a lower importance of good oral health conditions. More favorable oral hygiene conditions and more positive perceptions, attitudes, and behaviors towards oral health were found among female subjects than among male subjects. In conclusion, adolescents with high scores of plaque and gingivitis had less positive perceptions, attitudes, and behaviors towards oral health than those with more favorable oral hygiene conditions.

Socio-economic and lifestyle factors in relation to priority of dental care in a Swedish adolescent population.

The aim of this epidemiological survey was to describe and analyze oral health habits and life-style factors in relation to the priority of regular dental care in 19-year-old individuals with specific reference to gender, residential area and socio-economic grouping. The data were generated from a randomized sample of 758 (63%) individuals in three residential areas in Western Sweden (two rural, one urban) who answered a set of questionnaires prior to a dental examination. The analysis revealed that males had significantly less favourable oral health habits than females. Forty-one % of the males and 30% of the females did not plan regular dental visits after the age of 20 when they will be charged for the care (p = 0.002). There were no statistically significant differences in oral health habits and dental care priorities with regard to residential areas and socio-economic groups. In a multivariate model, three significant factors for the probability of "not planning for future regular dental visits" were identified: toothbrushing less than twice daily (OR 1.94; 95% CI 1.28-2.94), smoking (OR 1.68; 95% CI 1.10-2.56) and male gender (OR 1.54; 95% CI 1.05-2.24). The findings emphasize the need for promotion of favourable oral health habits and smoking prevention among adolescents. There is also a need for dental personnel to recognize differences with regard to oral health-related attitudes and behaviours between males and females.

Periodontal health status in Swedish adolescents: an epidemiological, cross-sectional study.

The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in two rural county areas, i.e. Fyrbodal and Skaraborg, Västra Götaland, Sweden, with special reference to gender and socioeconomic grouping. A randomized sample of 506 individuals (Fyrbodal 250 and Skaraborg 256 individuals, respectively) was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets and gingival recession. Bitewing radiographs were used for assessment of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. A majority of the subjects (76%) claimed to brush their teeth at least twice a day, while interdental hygiene means were used daily by 4%. The subjects showed a mean plaque score of 47% and a gingivitis score of 56%. Forty-six % of the adolescents had a plaque score of > or = 50%, whereas the corresponding figure for gingivitis was 62%. The subjects had on average 5.5 teeth with facial gingival recession. The mean prevalence of sites with probing depth (PPD) of > or = 4 mm was 8, out of which 99% were located at proximal sites. A radiographic bone level of > 2 mm was observed at on average 0.4 teeth per subject. Logistic regression analyses revealed that gender (males) and county area (Fyrbodal) were significant factors for a high plaque and gingivitis score. There was no significant difference in periodontal conditions in relation to socio-economic grouping. In conclusion, the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents, but no differences between socioeconomic groups.

Patients' attitudes towards oral health and experiences of periodontal treatment: a qualitative interview study.

PURPOSE: The aim of the present qualitative study was to analyse patients' attitudes towards oral health and experiences of periodontal treatment. MATERIALS AND METHODS: Patients who were referred to a specialist clinic in periodontics were subjected to open-ended interviews before (Abrahamsson et al, 2008), as well as after, the phase of cause-related periodontal therapy. An interview guide was used with themes of interest. The time interval between the interviews was about 6 months. Because the study focused on psychosocial interactions, the qualitative method used for the analysis was Grounded Theory (Glaser and Strauss, 1967). Data collection and analysis were simultaneous processes that focus on psychosocial processes, existing problems and how these problems were dealt with. The interviews were tape-recorded and transcribed verbatim, and consequently analysed in a hierarchical coding process until saturation was met (n = 16). RESULTS: In the analysis, a core category was identified: 'Understanding the seriousness of the disease condition'. This core concept was related to four additional categories and dimensions: 'The need to be treated respectfully', 'To gain insight', 'Frustration about the financial cost for treatment' and 'Feelings of control over the situation'. Taken together, the core category and its related subcategories described a psychosocial process that was related to periodontal treatment. CONCLUSIONS: The results elucidated the patients' vulnerability and the importance of patient communication in the treatment for chronic periodontitis in order for the patient to feel in control of the situation.

Dental beliefs: factor structure of the revised dental beliefs survey in a group of regular dental patients.

The aim of this study was to investigate the factor structure of the revised dental beliefs survey (DBS-R) in a group of regular dental patients. The study group consisted of 278 patients (mean age 54 yr), 61% of whom were women. The DBS-R item mean value was 1.6. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were performed. The initial PCA among the 28 DBS-R items showed four factors with eigenvalues of > 1 explaining 67% of the total variance. Five different CFA models were tested. The final model revealed a four-factor solution with one second-order factor (i.e. a hierarchical CFA). Thus, the latent second-order variable, 'dental beliefs', explains the variance from all DBS-R items through the four first-order factors labeled 'ethics', 'belittlement', 'communication and empathy', and 'control and anxiety'. The results suggest a somewhat different factor structure of DBS-R than previously reported for dental-fear patients. Hence, the underlying factor structure of the DBS-R may differ between different patient groups. The results point towards the use of the original 28-item DBS-R and interpreting the scale as measuring an overall construct of 'dental beliefs' and thus patients' attitudes and feelings related to dentists and dentistry.