Patients' experience of partial tooth loss and expectations to treatment: a qualitative study in Danish and Swedish patients.

Knowledge of impairments, wishes and expectations is essential to make correct decisions regarding oral rehabilitation. The purpose of this study was to investigate discomforts, wishes and expectations in patients' with partial edentulism before entering oral rehabilitation. In Copenhagen, Denmark, and Malmö, Sweden, respectively, 20 patients with partial edentulism seeking rehabilitation were interviewed in a semistructured qualitative manner. The interviews were transcribed and analysed yielding overall domains. Six themes appeared as overall domains: (i) experienced impairments, (ii) experienced social awareness, (iii) expectation to treatment, (iv) expectation to durability/survival, (v) coping strategies dealing with the tooth loss including explanations of the tooth loss and (vi) modifications to experienced impairment. The impairments were mostly experienced as problems in social settings. Most participants expressed a simple wish to function normally; a fixed solution was preferred. Many Danish participants accepted a removable solution whereas only few Swedish participants did so. The domains 'coping strategies' and 'modifications' were not part of the chosen topics of interest, indicating a high wish of the participants to explain their tooth loss and how they coped with it. In conclusion, a large degree of social impairment was found in the patient group along with several coping strategies. The impairments were modified by a number of factors indicating that highly individualised care and treatment is needed. A state of normality was described as the primary treatment wish with a higher acceptance of removable solutions in Denmark than in Sweden. For final decision-making, surrounding factors seemed to influence the patients' choices.

Comparison of an individual systematic interview method and the oral health impact profile. Responsiveness and ability of describing treatment effect of oral rehabilitation.

The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) has shown potential for generating information and measuring Oral Health-Related Quality of Life (OHRQoL) in oral rehabilitation. The Oral Health Impact Profile-49 (OHIP-49) has been widely used in population studies. The purpose of this study was to compare the responsiveness and ability of the SEIQoL-DW and the OHIP-49 to qualitatively describe the change following oral rehabilitation. Twenty-two participants treated with fixed or removable prosthesis were interviewed before and after treatment using the SEIQoL-DW and the OHIP-49 questionnaire. The participants rated the subjective perception of change and answered two global oral rating questions. A clinical examination was performed to identify dental status variables. No significant difference was found between pre- and post-treatment SEIQoL-DW scores. A significant difference between pre- and post-treatment OHIP-49 scores was found. The SEIQoL-DW and OHIP-49 change scores was significantly correlated. The dental status variables such as number of teeth, number of teeth replaced, number of occluding units, type of treatment, extractions and removable dental prosthesis (RDP) before treatment did not influence the change scores. The effect size was low for the SEIQoL-DW (0.15) and moderate for the OHIP-49 (0.60). Improvement in subjective perception of change was related to both improvement and deterioration in change scores. More aspects were mentioned in the SEIQoL-DW compared to the OHIP-49. Based on the change in overall score and effect size, the SEIQoL-DW showed a weaker responsiveness than the OHIP-49. The SEIQoL-DW, however, described the change more detailed than the OHIP-49.

Patient-generated aspects in oral rehabilitation decision making I. Comparison of traditional history taking and an individual systematic interview method.

Decision making in oral rehabilitation is often based on diagnoses related to impairment of different oral functions. In making the decision when to treat, the dentist must work in cooperation with the patient. By incorporating patient-generated aspects into the decision making process, the dentist finds it easier to decide if and why treatment should be undertaken and what treatment modality to use. The purpose of this study was to describe the potential of an interview method, the 'Schedule for the Evaluation of Individual Quality of Life-Direct Weighting' (SEIQoL-DW), and compare it with a traditional history taking, in generating information to be used in decision making in oral rehabilitation. Fifty-seven participants in need of oral rehabilitation were enrolled in the study. The participants underwent a traditional history taking and were interviewed using the SEIQoL-DW method. The SEIQoL-DW generated a high number of cues for all participants. Significantly more cues and additional information were generated by the SEIQoL-DW than by the traditional history taking. The additional information concerned consultation and dentist issues, psychological aspects and treatment preferences. A high percentage of the participants were positive towards the use of the SEIQoL-DW method in their treatment planning. The SEIQoL-DW was considered to be a viable tool for decision making in oral rehabilitation.

Implants and/or teeth: consensus statements and recommendations.

In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

A method for assessment of quality of life in relation to prosthodontics. Partial edentulism and removable partial dentures.

The aim of this study was to evaluate the possible use in prosthodontics of a method for an interview technique allowing maximal individuality within the cultural boundaries. The impact of partial edentulism and removable partial denture (RPD) wearing on quality of life was chosen as the target question. The interview included patient generated selection of five quality of life cues. The current status/intensity of each cue was measured by use of a Visual Analogue Scale (VAS), the relative weight/importance between the cues by a direct-weighting (DW) instrument, and a summarized quality of life score was calculated. One hundred and one participants with partial edentulism with or without RPDs were included in the study. No correlation was found between the VAS- and DW-scores, indicating that different aspects are measured with these two instruments. Sixty to seventy per cent of the participants answered positively to questions about the test method, including self-knowledge, consciousness and identification of needs and wishes. The 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting' turned out to be a useful instrument for assessing patients' priorities, and fulfils in many ways the demands for individualized problem identification, decision-making and treatment planning. The results of the comparison of RPD wearers and non-RPD wearers showed that aesthetics is a major factor and that the overall quality of life between the experienced RPD wearers and non-RPD wearers in this study did not differ significantly.

Masticatory and nutritional aspects on fixed and removable partial dentures.

The aim of the present study was to evaluate mastication, food selection and nutritional aspects in two groups of persons restored with fixed (FPD, N=44) and removable (RPD, N=40) partial dentures respectively. The subjects were part of a cohort study of 67-68-year-old men living in Malmö, Sweden. The two groups were very similar regarding social factors and the inclusion criteria were chosen so that the groups were very equal regarding oral factors, apart from the difference in fixed and removable partial dentures. The number of natural teeth, number of replaced teeth and occlusal contacts did not differ significantly between the two groups, nor did the distribution of maxillary and mandibular dentures. A comprehensive examination of several general health factors included a home interview of dietary habits. A clinical examination included a 20-minute oral examination with registration of number of teeth, FPDs, RPDs, and occlusal contacts. It also included masticatory tests: chewing gum colour mixing, chewing gum bolus shaping, and swallowing threshold (number of strokes to the first swallow of an almond). The consumption of hard and soft foods was revealed by the dietary interview as well as the intake of energy and some nutrients. There was a significant difference between the groups regarding the capacity to mix the two-coloured chewing gum, to shape the chewing gum bolus and in the consumption of hard foods. There was no difference in the swallowing threshold and the consumption of soft foods. The intake of energy and nutrients did not differ significantly between the groups. The differences in masticatory capacity found thus seem to have little, if any, effect on the factors of importance for general health. A reasonable explanation for the differences found is that artificial teeth that are well retained, such as FPDs, make more active chewing possible than do removable, and often somewhat loose-fitting partial dentures.

Contamination level of alginate impressions arriving at a dental laboratory.

The contamination level of alginate impressions delivered to a large dental laboratory in Sweden was determined. One hundred and seven consecutive alginate impressions were included during 7 days. Samples were taken and transferred into sterile physiological saline and analysed microbiologically for colony-forming units (cfu) as well as nonhemolytic, alpha-hemolytic, and beta-hemolytic colonies. After sampling, the clinics were contacted and asked to fill in simple questionnaires about their routines of disinfecting impressions. The questionnaire study revealed that about half of the clinics had some kind of disinfection routine, while the others rinsed in running water only. Seventy-two percent of the impressions yielded growth of bacteria, with a median number of 1.3x10(2) cfu. Thirteen per cent of the samples yielded >10(3) cfu, with a maximum number of 3.4x10(4) cfu. The majority of isolates were non- and alpha-hemolytic bacteria. Growth was recorded in 61.3% of disinfected impressions, and the numbers of bacteria in disinfected and nondisinfected impressions were similar. These findings raise the question of whether impressions need to be disinfected or if proper handling and hygienic procedures are sufficient to block the possible route of infection.

In vitro study of transmission of bacteria from contaminated metal models to stone models via impressions.

The purpose of this study was to determine the risk of microbiological transmission into the dental laboratory via impressions and dental stone models. Metal master models were contaminated with Bacillus subtilis and Streptococcus sanguis. Impressions in alginate, polyvinylsiloxane, and polyether were used, and models were cast in two brands of dental stone. Samples were taken from the impression surfaces before and after casting, and sections from the stone models were taken by a technique developed for this study. After incubation, the numbers of colonies were counted and the numbers of colony-forming units per milliliter were calculated. The reductions were statistically significant but considered to be clinically insignificant. The conclusion is that even after severe contamination, the risks to dental laboratory personnel are minimal. "Normal" hygienic procedures are recommended instead of disinfection.

The effect of different polishing techniques on the surface roughness of acrylic resin materials.

This study evaluated three methods of surface polishing on acrylic denture base materials. Specimens of three commercial heat-cured acrylic resin materials were finished using burs, sandpaper discs and rubber wheels, and polished with polishing soap, paste, or by application of a UV-light-activated resin sealant. The resulting surface roughness was examined by scanning electron microscopy as well as measured by means of a stylus profile Perthometer. Surface roughness was reduced by polishing. Polishing paste and UV-light-activated resin sealant were more, and equally, effective in reducing surface roughness compared to polishing soap. Polishing paste or UV-light-activated resin sealant may be used to create a smoother surface on acrylic dentures.

First two-year complications of fixed partial dentures, eight units or more. Swedish Guarantee Insurance claims.

This study is an analysis of fixed partial dentures (FPDs), 8 units or more, that failed or suffered severe complications within the first 2 years after cementation. The material consists of claims to the Swedish Guarantee Insurance for Fixed Prosthodontics. Claim reports, radiographs, etc. were available. Over a 6-month period, 36 FPDs were sampled, 34 of which were made by general practitioners. The sampling resulted in 41 complications in 26 maxillary and 10 mandibular FPDs, 29 of which were made in metal-ceramics. The mean extension was 10.9 units, with an abutment/pontic ratio of 1.4; 40.6% of the abutments were root-canal treated and supplied with root posts. The complications were: metal framework fractures 41%, loss of retention 24%, porcelain fractures 17%, tooth/root fractures 10%, and miscellaneous 7%. The high proportion of metal framework fractures is not in accordance with other studies of FPD complications. No factor that could explain this high frequency could be identified. The fact that the selection of FPD complications applied to the first 2 years only, that the FPDs had been constructed by general practitioners, and that there were many root-canal-treated abutments and distal extension cantilever pontics, might be factors of importance.

Disinfection of dental impressions and occlusal records by ultraviolet radiation.

As chemical disinfection of dental impressions may cause adverse effects on materials and the dental personnel this study examined disinfection by ultraviolet radiation. Alginate, addition silicone rubber and red wax contaminated by Streptococcus salivarius, Fusobacterium nucleatum and five other bacteria in different suspension media were radiated for up to 18 min, and the number of colony forming units was compared to non-radiated controls. The effect of ultraviolet radiation differed among bacterial species and depended on the organic content in the suspension. Generally, the bacterial reduction after ultraviolet radiation was below 4 log steps and thus insufficient for disinfection of dental impressions.

Treatment injuries in dentistry--cases from one year in the Swedish Patient Insurance Scheme.

Eight hundred and fifty-one claims submitted to the Swedish Patient Insurance Scheme were studied and analysed. The most frequent claim referred to root fractures of roots with posts, and to root perforations also related to root posts. Other relatively frequent claims referred to pulpal complications in connection with fixed prosthodontics, root perforations related to endodontic treatment, and dysaesthesia. The mean latency time (the time from the actual treatment to the diagnosis of the injury) was for root fractures 10.6 months, and the mean latency time for root perforations that were not directly observed during preparation was 15.9 months. Pulpal complications of teeth treated with crowns or fixed partial dentures had a mean latency time of 7.6 months. Injuries with a low frequency were, for example, fracture of vital abutments for crowns or fixed partial dentures, damage to tissue by electrosurgery or to the floor of the mouth by drilling, or perforations to the antrum. Two cases of particles dropped into the patient's eye were also reported.

Precision attachment-retained removable partial dentures. Part 3. General practitioner results up to 2 years.

PURPOSE: The aim of this study was to analyze the techniques, production problems, and 2-year results of attachment-retained removable partial denture (RPD) treatment provided by general practitioners in Sweden. MATERIALS AND METHODS: At a major dental laboratory, consecutive cases involving new production of crowns, or of fixed partial dentures (FPDs) and RPDs retained with precision attachments, were studied. Parameters of the dentition, crown or FPD, type and brand of attachment, etc, as well as early satisfaction by dentist and patient, were recorded using specially designed forms at the dental laboratory and questionnaires for the dentists. After 2 years, questionnaires were again sent out to the dentists to record complications and patients' and dentists' opinions of the results. The sample gathered totaled 83 constructions. After 2 years, responses for 57 patients, all of whom had distal-extension RPDs, were received. Most drop-outs in the study were explicable. RESULTS: The most frequently cited reasons for using attachments were esthetics and need for crowning the teeth abutting the RPD. McCollum rigid slide attachment was the predominant brand used (43% of constructions). Dentists and patients were dissatisfied with 6% of the constructions. During the first 2 years, 22 of 57 constructions were complication-free. Seventeen had attachment complications and 9 had serious complications related to the abutment teeth or RPDs. A comparison between these 2 groups revealed that those with complications had every second abutment root-canal treated and a root post, while the group without complications had every fifth abutment root-canal treated. CONCLUSION: There were many technical and biotechnical complications and failures; the exact ratio, however, depended on the definition of "complications" and "failure." The 2-year results also deviated considerably from the dentists' opinions of the early results.

Removable partial denture production in Scotland.

Removable partial denture production in Scotland was studied by analyzing photographs taken of consecutive casts and dentures and reviewing prescriptions of 539 cases at a large dental laboratory. Of the casts, 70.4% were maxillary and 29.6% mandibular. The mean number of teeth present was 9.9 in the maxilla and 8.4 in the mandible. Of the partial dentures studied, 33.6% were acrylate dentures without any framework. None of these had occlusal rests, and 5.6% had clasps. Of the framework-retained maxillary dentures, the palatal strap (12.9%), horseshoe (15.8%), and anterior palatal bar (18.9%) designs were the most frequent. In the mandible, lingual bars (32.7%) and lingual plates (32.7%) predominated. Of the acrylic dentures, 89.3% were made without any instruction from the dentist. The corresponding figure for prostheses with cobalt-chromium frameworks was 15.0%.

Precision attachment-retained removable partial dentures: Part 2. Long-term study of ball attachments.

Patients provided with 24 ball attachment-retained removable partial dentures were followed up to 23.5 years. The prosthetic treatment included fixed partial dentures in 8 arches, and combinations of crowns and splint bars in 16 arches. All ball attachment matrices were supplied with vertical occlusal stops in contact with the patrices. A nonresilient hinged coupling was established between fixed partial dentures and removable partial dentures. Seventeen arches had only two or three remaining teeth. A total of 66 abutments for fixed partial dentures were included, 30 of which were root canal treated and supplied with posts. No technical failures (loss of retention/cement failure, root or tooth fracture, metal framework fracture) with the fixed partial dentures were recorded. With the removable partial dentures, additional retention with clasps was introduced in 2 of the dentures (in addition to 8 originally), 2 had to be remade after fractures, and 4 dentures were relined.

Oral bolus kneading and shaping measured with chewing gum.

A masticatory test using two-colored chewing gum is presented and analyzed. Two separate parameters of chewing were studied on the same chewing gum bolus after 10 strokes of oral preparation, color mixing, and bolus shaping. The two parameters were evaluated in indices 1-5. A test series should preferably contain three chewing gums, and color mixing can be evaluated on six sides and shape-indexed for each bolus. The medians characterize the subjects' masticatory ability. Color mixing may relate, for example, to ensalivation of the food during chewing, and bolus shape may relate to preparation into a form suitable for swallowing. The tests were used on test subjects with different dental and denture status. Significant differences in both color mixing and shape indices were found between groups with different status. The method is discussed in relation to earlier types of tests, e.g., the comminution test mostly used hitherto.

Mastication with and without removable partial dentures: an intraindividual study.

The chewing of 22 subjects, with a total of 27 removable partial dentures (RPD) that had been used for more than 6 months, was analyzed by four different methods. The study design was an intraindividual comparison of chewing, with and without the RPDs. Chewing tests were a color mixture of two-colored gums, chewing gum bolus shaping, comminution of Optosil silicone tablets, and number of chewing strokes to first swallow of an almond. The participants were also asked some standardized questions about their eating, biting, and chewing capacity. There was no significant difference in efficiency as measured by chewing gum color mixing, chewing gum shape, and pulverization of Optosil between chewing with and without the RPDs. Significantly more strokes were needed to swallow an almond without than with the RPD in place. With their RPDs in place, all subjects could chew a sandwich and an apple, and all but one could chew whole meat. The study shows that the chewing process should preferably not be analyzed by one method only.

Social network, social support and dental status in elderly Swedish men.

The objective of this study was to investigate whether there were associations between different aspects of social network and social support and dental status. The study sample (n = 621) comprised a random half of all male residents in Malmö, Sweden, born in 1914. Five hundred (80.5%) participated. Eight conceptually different aspects of social networks and social support were measured, and all men were clinically examined regarding number of teeth, prevalence of removable dentures, fixed bridges and anterior open tooth spaces. We found that some aspects of dental status were associated with social class, while others were associated with different aspects of social network and social support. Prevalence of complete dentures and fixed bridges was strongly associated with social class, a low number of functioning teeth was associated with both low social class belonging and an insufficient social network and social support, while anterior open tooth spaces were associated mostly with an insufficient social network and social support. This study shows that there are significant associations between some aspects of dental status and the social network and social support of the individual, while other aspects of dental status are associated with social class, which from a psychosocial perspective contribute to a deeper understanding of the backgrounds of dental status.

Complaint and disciplinary systems in dentistry in Sweden: a presentation and discussion of their efficacy in preventing malpractice.

The Swedish systems for complaints and supervision with many possibilities of claiming on different levels may lead to prevention of future problems in medical and dental care. The systems are corrective, preventive and compensatory, and are important in the process of quality assurance. However, some elements need improvement. The present paper gives as a background an overview of the Swedish systems and discusses a few cases. Comparisons with systems in other countries, especially the USA, are made, and new measures are discussed. There is a need for smooth, preventive measures as well as strong, punitive and corrective measures. Recidivist doctors/dentists must be stopped.

Prosthodontic claims in the Swedish Patient Insurance Scheme.

The Swedish Patient Insurance Scheme includes a guarantee insurance for prosthetic treatment. Retreatments of failures, up to 2 years after cementation of fixed prosthodontics and 1 year after delivery of removable prosthodontics, are covered by the guarantee insurance scheme. Almost all private practitioners were included in this scheme at the time of the study in 1989. During a specific period all claims were studied at the time of reporting, when annexed radiographs and so forth could be analyzed. One hundred and thirty-six claims were recorded with regard to treatment injury, reasons for remake, latency times from cementation or delivery to diagnosis, and details about the teeth or constructions involved in the claim. The dentist's opinion of the cause of the failure was also recorded. The reports covered treatment injuries, most of them root perforations during preparation for a post. The guarantee claims for single crowns concerned porcelain fractures, loss of retention, and root fractures as the most frequent failures. For fixed partial dentures the failures were recorded as loss of retention, porcelain fractures, tooth or root fractures, and metal framework fractures in that order. The dentist gave information about his/her opinion of the reason for the failure in only 38.5% of the claims. There were, however, no clear findings about the reasons for the failures.