Community-based preventive activities in the Public Dental Service in Norway.

OBJECTIVES: The purpose of this study was to describe community-based preventive interventions undertaken by the dental team outside the dental clinics in Norway, from the dental hygienists' and the dentists' perspective, with the main focus on target groups and existing guidelines and routines for these activities. A secondary aim was to identify the personnel responsible for developing the local guidelines and the knowledge sources for the guidelines. METHODS: With the assistance of the Chief Dental Officers in 15 Public Dental Service (PDS) regions, questionnaires were emailed to the local clinics (n = 421). In each, the most experienced dental hygienist and dentist were asked to respond; 215 dentists and 166 and dental hygienists responded (60%). RESULTS: Almost 40% of the respondents reported that their clinic had guidelines on community-based activities conducted outside the clinics. Dental hygienists and local chief dentists were responsible for planning them. The main target groups were young children and the dependent elderly; the majority of the activities were carried out at child welfare centres and for personnel at nursing homes or for home care nurses. CONCLUSION: At the regional and local level, a more strategic and coordinated approach to the provision of community-based activities is needed, including assessment of oral health needs among population groups. Continuous documentation and evaluation of results are necessary for optimal use of available resources and to facilitate an evidence-based approach.

Chair-side preventive interventions in the Public Dental Service in Norway.

Objective and setting In Norway, the Public Dental Service (PDS) caters for the young (<19 years) and smaller numbers of adults, mostly special needs patients. This study surveyed chair-side preventive measures used in the public clinics and compared them with recommendations in evidence-based guidelines in the neighbouring countries.Materials and methods After ethical approval, the regional Chief Dental Officers (CDOs) emailed questionnaires to their local clinics (N = 421) where the most experienced dentist and dental hygienist were asked to respond on behalf of the clinic. Answers were received from 256 clinics (response rate 61%). Altogether, 215 dentists and 166 dental hygienists answered.Results Of the respondents, 26% reported that their clinic had agreed guidelines on preventive treatment to be used by all staff. Oral hygiene and fluoride toothpaste recommendations were considered appropriate. Almost 60% claimed that flossing instructions were given to all children and adolescents and 40% that fluoride varnish was used on all the young. Fissure sealants were used after individual assessment (80%). A third of the respondents claimed that fluoride tablets and fluoride rinse were recommended for all or most children and fluoride rinses for adults, even in addition to regular use of fluoride toothpaste. Dental hygienists used all methods more often than dentists. On adults, preventive measures were more often used on individual assessment. Half (48%) of the respondents were interested in new evidence-based national guidelines on preventive care.Conclusions Chair-side preventive treatment measures were numerous in the well-resourced Norwegian PDS, but partly outdated.

Regression of oral lichenoid lesions after replacement of dental restorations.

The aim of the study was to determine the prognosis and to evaluate the regression of lichenoid contact reactions (LCR) and oral lichen planus (OLP) after replacement of dental restorative materials suspected as causing the lesions. Forty-four referred patients with oral lesions participated in a follow-up study that was initiated an average of 6 years after the first examination at the Department of Odontology, i.e. the baseline examination. The patients underwent odontological clinical examination and answered a questionnaire with questions regarding dental health, medical and psychological health, and treatments undertaken from baseline to follow-up. After exchange of dental materials, regression of oral lesions was significantly higher among patients with LCR than with OLP. As no cases with OLP regressed after an exchange of materials, a proper diagnosis has to be made to avoid unnecessary exchanges of intact restorations on patients with OLP.

Evaluation of a dental outreach teaching programme.

Dental health care is largely based on primary care. It is therefore logical to train students in external dental clinics in addition to university facilities. Consequently, the new dental curriculum at The University of Tromsø in Northern Norway has implemented outreach teaching and training as an extensive part of their curriculum. The overall opinion is that the external training has been very valuable both regarding volume and diversity of treatment experiences and has contributed substantially to the clinical maturity of the students. Educating the tutors is considered to be an essential part of the programme.

Changes in health over time in patients with symptoms allegedly caused by their dental restorative materials.

OBJECTIVES: In Sweden, many patients with symptoms allegedly caused by their dental materials have exchanged their restorations, but the effects of the exchange have been insufficiently investigated. Therefore, the aim of the study was to describe the change in health over time for these patients and the hypothesis was that the patients could be divided based on their symptoms and that the ability to recover differs between these groups. Furthermore, we also examined if other factors such as replacement of dental restorative materials and follow-up time had any impact on the perceived health status. METHODS: A questionnaire was sent to 614 patients who had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental restorative materials. The response rate was 55%. RESULTS: The risk of having any further complaints was higher for patients with complex symptoms (P = 0.03) and these patients had exchanged their restorations to a significantly larger extent than the others (P = 0.03). The remaining complaints was more frequent among men (P = 0.02). Exchange of dental restorative materials had no significant impact on the ability to recover completely. However, the patients who had exchanged their restorations completely perceived a significantly larger alleviation of their symptoms than the others (P < 0.01), although the frequency of most of the symptoms had increased. CONCLUSIONS: Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with localized symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. The reason for this improvement, however, is unclear. Further analyses regarding other possible explanations than the 'odontological/medical' are needed.

Clinical examination of leucite-reinforced glass-ceramic crowns (Empress) in general practice: a retrospective study.

PURPOSE: The purpose of this study was to retrospectively evaluate leucite reinforced-glass ceramic crowns (Empress) placed in patients who regularly visit general practices. MATERIALS AND METHODS: One hundred ten Empress crowns, placed in 29 patients who visited a general practice on a regular basis, were evaluated according to the California Dental Association's (CDA) quality evaluation system. In addition, the occurrence of plaque and certain gingival conditions was evaluated. All crowns were luted with resin composite cement. The mean and median years in function for the crowns were 3.6 and 3.9 years, respectively. RESULTS: Based on the CDA criteria, 92% of the 110 crowns were rated "satisfactory." Eighty-six percent were given the CDA rating "excellent" for margin integrity. Fracture was registered in 6% of the 110 crowns. Of the remaining 103 crowns, the CDA rating excellent was given to 74% for anatomic form, 86% for color, and 90% for surface. No significant differences (P > 0.05) were observed regarding fracture rates between anterior and posterior crowns. With regard to the occurrence of plaque and bleeding on probing, no significant differences (P > 0.05) were observed between the Empress crowns and the controls. CONCLUSION: Most of the fractured crowns had been placed on molars or premolars. Although the difference between anterior and posterior teeth was not statistically significant with respect to the fracture rates obtained, the number of fractured crowns placed on posterior teeth exceeded that of those placed on anterior teeth. The difference between the fracture rates may have clinical significance, and the risk of fracture has to be taken into consideration when placing crowns on teeth that are likely to be subjected to high stress levels.

Clinical evaluation of all-ceramic crowns (Dicor) in general practice.

STATEMENT OF PROBLEM: There are few studies regarding all-ceramic full crowns placed by general practitioners; however, most dental restorations are carried out by general practitioners, and their clinical performance may be of particular interest. PURPOSE: Ninety-eight all-ceramic Dicor crowns placed in 46 patients regularly visiting a general practice were evaluated with the California Dental Association's (CDA) criteria. Mean and median ages of the crowns were 6.1 and 5.8 years, respectively (range 1.4 to 10. 9 years). Crowns were luted with either a glass ionomer, zinc phosphate, or resin composite cement. RESULTS: Of the 98 crowns, 82% were rated satisfactory. For marginal integrity, 51% were rated excellent. Fracture was registered in 14 all crowns, and 1 endodontically treated tooth with a Dicor crown was extracted because of root fracture; of the remaining 83 crowns, 55% were rated excellent for color. Corresponding figures for surface and anatomic form were 46% and 23%, respectively. The most common finding was slightly rough surfaces (64%). No statistically significant difference was observed for fracture rates obtained when the crowns luted with different luting agents were compared (P >.05). There was no more plaque or bleeding on probing (P >.05) in connection with the Dicor crowns than in the control surfaces.

Odontologic survey of referred patients with symptoms allegedly caused by electricity or visual display units.

Twenty-eight consecutive patients with symptoms allegedly caused by electricity or visual display units were odontologically investigated according to a specially designed registration form including an anamnestic interview and a clinical protocol. The most common oral and general symptoms reported were burning mouth, craniomandibular dysfunction symptoms, skin complaints, and fatigue. Oral symptoms such as craniomandibular dysfunction and general symptoms such as eye complaints and dizziness scored highest on a visual analog scale regarding mean symptom intensity. The patients reported various numbers of medical diagnoses, such as allergic rhinitis or asthma and hypothyroidism. Various dental diseases were found; the most common were temporomandibular joint and masticatory muscle dysfunctions, lesions in the oral mucosa, and periodontal diseases. Urinary-Hg (U-Hg) analysis showed a mean U-Hg concentration of 8.5 nmol Hg/L urine, and none of the patients exceeded the limit of 50 nmol Hg/L urine. The U-Hg concentration was positively correlated with the number of amalgam fillings (P< 0.01) and craniomandibular disorders (P < 0.05). No or low secretion of the minor mucous glands was found in 43% of the patients. One patient showed hypersensitivity to gold and cobalt. The present study showed that various odontologic factors might be involved in some of these patients' suffering. Thus, it is important that professionals from other disciplines collaborate with dentistry if these patients are to be properly investigated.

A meta-analysis of implants in partial edentulism.

A meta-analytic technique was used to estimate the survival of implants supporting bridges or single crowns in partially edentulous patients. A survey of the literature revealed 66 studies, published between 1986 and 1996. Nine studies on single implants and 10 studies on fixed partial dentures met the inclusion criteria for the meta-analysis. Data from a total of 2686 implants, 570 single crowns (SC) and 2116 in fixed partial dentures (FPD), were analyzed. In order to calculate annual survival rates for individual studies a life-table analysis was conducted. Maximum follow-up time ranged between 1 and 8 years. After 1 year the success rate was calculated to be at least 85.7% for FPD and 97.2% for SC. When the results from the FPD studies were pooled the survival rate was 93.6% after 6-7 years. The corresponding value for SC was 97.5%.

A 9-year longitudinal study of reported oral problems and dental and periodontal status in 70- and 79-year-old city cohorts in northern Sweden.

Before 1981 no representative studies of oral health in an elderly population in northern Sweden had been presented, and longitudinal studies of oral health in the aging person were in general rare. Thus the aim of this study was to investigate longitudinal changes in oral health in a representative sample of an elderly city population in northern Sweden. Reported oral problems and treatment needs were noted, and dental and periodontal status was registered in clinical examinations. The frequency of reported annual dental visits and of being called by the dentist increased in the younger but not in the older cohort during the 9-year period. In 1990 all the 79- and 88-year-olds with annual visits reported that they were recalled by the dentist. The clinical investigation showed an increasing amount of tooth loss, root caries, and periodontal disease with increasing age. Among dentulous persons 1.7 teeth per subject were lost from 1981 to 1990 in the younger cohort, compared with 2.6 teeth per subject in the older cohort. The number of sound teeth decreased very little in the younger cohort (from 3.44 to 3.34) but more evidently in the older cohort (from 3.47 to 2.65) during the 9-year period. The frequency of surfaces with attachment level > 3 mm increased statistically significantly from 1981 to 1990 in the older cohort. Subjects with annual visits had in general fewer oral problems.

A comparison of oral health in 70-year-old city cohorts in Umeå northern Sweden in 1981 and 1990: oral problems, dental and periodontal status.

A comparison of oral health in two different samples of 70-year-old men and women living in the city of Umeå in 1981 and 1990 showed that a higher frequency of dental visits among men could be expected in the city population in 1990 (95% CI). The frequency and pattern of reported oral problems was similar in 1981 and 1990. Total edentulousness among men and women in 1981/1990 was 31.3/21.4 and 53.5/35.7% respectively. The lower frequency in 1990 was not statistically significant on the population level. The mean number of teeth was lower in dentated men (12.8 +/- 6.0 V.S. 17.4 +/- 5.4) (p < 0.05) and women (16.9 +/- 6.3 V.S. 13.9 +/- 8.4) (n.s.) in 1990 compared with in 1981 and the functional index according to Eichner showed no difference. Thus, the lower frequency of edentulousness in 1990 mainly seemed to be the result of another distribution of about the same total amount of teeth, on more people. The bleeding index showed values around 30% in both cohorts. Both men and women showed less recurrent caries in 1990 (p < or = 0.05). Men showed a higher number of missing teeth (p < or = 0.01) and of decayed root surfaces (p < or = 0.05) in 1990. The latter might be explained by a larger exposed root surface area which was indicated by a higher frequency (n.s.) of surfaces with an attachment level > 3 mm in the cohort examined in 1990. Although, the compared 70-year-old city cohorts in Umeå examined in 1981 and 199 showed a higher frequency of dental visits and of dentated subjects, no improvement in reported oral health or dental status could be found in the 70-year-old in Umeå in 1990.