Utskrift från Malmö högskola - mah.se
Licentiate Theses /OD
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Licentiate Theses /OD
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Xerostomia : Views among health care professionals and the main conc... 
Folke, Solgun : Department of Oral Public Health, Faculty of Odontology, Malmö University
Malmö University odontological dissertations (2010)LICENTIATE
THESIS
English abstract: The aims of the two studies were to survey and describe views of xerostomia among health care professionals and to explore, among afflicted adults; the main concerns associated with xerostomia and attempted remedies. Two empirical studies with qualitative design were conducted. In Paper I, 16 participants were interviewed representing health care professionals with various exposures to patients with xerostomia. The data were subjected to qualitative content analysis. In Paper II, qualitative, conversational style interviews were conducted with 15 participants with subjective complaints of dry mouth. The grounded theory method was applied for data analysis. In the findings (Paper I), the latent content was formulated into a theme: Xerostomia is a well-known problem yet, there is inadequate management of patients with xerostomia. The findings identified three major categories expressing the manifest content: awareness of xerostomia, indifferent attitude, and insufficient support. Health care professionals recognised xerostomia as a common and escalating problem, particularly among elderly. Yet, the problem received little attention. In Paper II, a model was generated to elucidate the main concerns of xerostomia among afflicted individuals and how they handle various aspects of their condition. The core category was labelled: an aggravating misery, meaning that xerostomia has a devastating and debilitating impact on multiple domains of well-being. The model involves three different categories/remedial strategies, namely professional consultation, search for affirmation, and social withdrawal. All three categories express what the participants do to resolve their problems with xerostomia. In general, the participants perceived xerostomia as a burden and as a condition they were constantly reminded of. The participants also expressed a feeling of resignation due to lack of confirmation and support. The findings underscore that xerostomia is not a trivial condition for those afflicted. Oral impairment as well as physical and psychosocial consequences of xerostomia had negative impact on the participants´ qualitative of life. Health care professionals felt that xerostomia was an underestimated problem and that clinical symptoms and subsequent treatment were often ignored. The findings revealed that xerostomia is not only a predicament of the oral cavity but affects the individual as a whole. This is of particular concern among elderly as the occurrence of xerostomia increases with advancing age due to chronic diseases and adverse medications. In summary, it is essential to adopt a holistic view, and to provide additional education and improved interdisciplinary collaboration to manage and care for individuals suffering from xerostomia. 
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Oral health-related quality of life and young adults Johansson, Gunvi : Faculty of Odontology (2009) LICENTIATE
THESIS
English abstract: The aims were to describe and analyse measures for oral health-related quality of life (OHRQOL) from a Public Health perspective and to determine young adults' views on dental care. The methods used included one literature review (Paper I) and one empirical study with qualitative design (Paper II). In Paper I, twenty-two measures for oral healthrelated quality of life (OHRQOL) were analysed from a public health perspective as to the mirroring of the health promotion principles empowerment, participation, holism and equity. In Paper II, regular dental attenders in Sweden aged 21-30 were interviewed about their views on dental care. Data from eleven interviews were analysed in accordance with the constant comparative method. The results in Paper I showed, that elements of the public health principles were found in the OHRQOL measures. There were measures developed for different ages but no measures were specifically adapted to young adults. In Paper II, two principal views in young adults’ views on dental care were discerned: patients’ attitudes to dental care costs and attitudes to given functions within dental care. Dental care costs, as well as the patients’ views on the treatment, however not expressed to the dental staff, were deemed important. Young adults were found to have specific views and demands on received dental care that was not mirrored in the instruments. An urgent task would therefore be to explore young adults’needs and expectations regarding their OHRQOL and dental care. Swedish abstract: Syftet var att ur ett folkhälsoperspektiv beskriva och analysera olika instrument för att mäta livskvalitet som är relaterad till oral hälsa (OHRQOL) och att undersöka unga vuxnas syn på tandvården. Metoderna som användes var en litteraturstudie (Arbete I) och en empirisk studie med kvalitativ design (Arbete II). Tjugotvå mätinstrument för oral hälsorelaterad livskvalitet (OHRQOL) analyserades ur ett folkhälsoperspektiv för att bedöma huruvida fyra principer förknippade med folkhälsoarbete återfanns i instrumenten. De fyra principerna var empowerment, deltagande, holism och jämlikhet. I Arbete II intervjuades unga vuxna i åldern 21- 30 år, som gjorde regelbundna tandvårdsbesök, om sin syn på tandvården. Data från 11 intervjuer analyserades i enlighet med komparativ metod. Resultatet i Arbete I visade att det fanns inslag av de fyra principerna för folkhälsoarbete i mätinstrumenten för OHRQOL. Det fanns mätinstrument för olika åldrar men inga mätinstrument var specifikt anpassade till unga vuxna. I Arbete II framkom två olika principiella synsätt i de unga vuxnas syn på tandvården: patientens syn på tandvårdskostnader och patientens förhållningssätt till beskrivna funktioner inom tandvården. Tandvårdskostnaderna såväl som synpunkter på behandlingen, som de dock inte framförde till tandvårdspersonalen, bedömdes vara viktiga. Unga vuxna tycks ha specifika synpunkter och krav på tandvården som inte speglas i de analyserade mätinstrumenten för OHRQOL. En angelägen uppgift skulle därför vara att undersöka unga vuxnas behov och förväntningar vad gäller oral hälsorelaterad livskvalitet och tandvård. -
On the management of some technical and biological complications in i... Luterbacher-Tschudin, S (2003) LICENTIATE
THESIS
English abstract: The use of osseointegrated titanium implants has become a widely accepted method to obtain retention for prosthetic reconstructions of partially dentate and edentulous patients. A range of c1inical long-term studies have been conducted to collect information on the numbers of surviving and/or successful implants for different implant systems. Overall implant success rates for several implant systems have thus repeatedly been reported to be as high as 95 % over 5 years and 90 % over 10 years ( Adell et al. 1981; Babbush et al. 1986; Albrektsson et al. 1988; Jemt et al. 1989; Adell et al. 1990; van Steenberghe et al. 1990; Henry et al. 1992; Mericske-Stern et al. 1994; Buser et al. 1997). A review of the above mentioned studies show that there are both common and system specific technical and biological complications and failures in implant prosthodontics. In the technical sector, a common observation has been that for almost all implant systems rigid connections between implants as well as between implants and teeth have turned out to be more favourable than non-rigid such connections. For the great majority of modern implant systems, rigid connections also seem to be associated with similar technical risk levels. The group of associated background factors inc1ude e.g. design features such as the extensions and dimensions of the restorations and patient specific factors such as bruxism (Aeschlimann et al. 1998; Brägger et al. 2001). Bruxing patients are at increased risk for complications in all restorative procedures. However, bruxism per se is not an absolute contraindication for dental implant therapy. Preventive measures such as the use of a habit appliance and protective nightguard should be considered. Certain specific material characteristics have also been noted. Especially over longer periods of time it has thus been reported that ceramic implants seem to be associated with high frequencies of severe mechanical complications such as fractures (Lill et al 1993). As has recently been pointed out by Brägger et al. (2001) in addition to common complications a range of system specific ones can also frequently be observed. Screw retained implant systems are thus associated with a higher frequency of loss of retention than cemented ones, although this may be balanced by possible lower frequencies for other types of technical failures. The cemented approach has the potential for being more passive than screw retention. Solid scientific and evidence-based data are missing within this field of dentistry (Nilner & Lundgren 1999). The question of whether a poorly fitting prosthesis can cause failure of osseointegrated dental implants has not been answered (Carr et al. 1996). Mollersten et al. (1997) experimentally evaluated how different joint designs influence the strength and the failure mode of dental implant systems. The strength tests focussed on the system as a whole (implant and connected abutments). Seven implant systems with different joint design were evaluated. Strength and failure mode varied significantly between the implant systems. Deep intemal joints, in contrast to shallow internal joints, favoured resistance to bending moments. A deep joint is one in which the screw takes little load and provides intimate contact with the implant walls to resist micromovement, resulting in a strong stable interface. Thus Mollersten et al. (1997) c1early demonstrated the strength advantage of an internal connection. They conc1uded that joint depth should be taken into consideration in construction of implant systems. Biological complications in the form of soft tissue reactions (periimplantitis) have been reported comparatively frequently in the field of implant prosthodontics, hut at present it is not certain if there exist any system specific risks (Wennström & Palmer 1999). -
Virtual Patient for education in academic Periodontology. Schittek Janda, Martin (2003) LICENTIATE
THESIS
English abstract: Computer assisted learning (CAL) is used in several medical and dental schools throughout the world. Lately, virtual learning environments (VLE) have been developed and especially simulators, which have become an important educational tool in the training of practical skills. A systematic literature review was conducted, in order to investigate the state of the art within CAL in dental and medical education. Furthermore, a design and usability test as well as one randomised controlled trial were undertaken, in attempt to investigate the effects of training on a virtual patient for the development of skills in history taking. Although research on CAL in the early 1990s demonstrated very positive results, recent and more carefully controlled experiments suggest a positive, but more cautious approach. It was concluded that CAL may supplement and reinforce more traditional learning and create opportunities to illustrate clinical situations in an interactive way. CAL has the potential to help students develop skills and knowledge. The utility test on the virtual patient demonstrated that such a software application, totally based on free text communication, can achieve an acceptable level of function for teaching purposes. Furthermore, the students’ abilities to perform a history taking of real patients improved significantly after one training session with the virtual patient. The students trained with the virtual patient asked a larger number and more relevant questions, showed more empathy towards the patient and performed a more complete history interview in comparison to the control students. In conclusion, the use of CAL/Virtual patients may enhance education and provide learning opportunities that cannot be taught by traditional strategies in realistic settings. At present, CAL/Virtual patients in academic learning should be used as a supplement to the traditional education. -
Oral Treatment Intention and Realistic Oral Treatment Need for Patien... Isaksson, Rita (2003) LICENTIATE
THESIS
English abstract: A new regulation within the Swedish National Dental Health Care Insurance was introduced in 1999. It stipulates increased economic support for dental care to persons, who, due to disease or handicap, are depending on the aid from nursing personnel for their daily activities. The support is intended for those receiving long term care either living in nursing homes/homes for the elderly (NH) or those enlisted in municipal care in their own dwellings, home care (HC), with extensive and permanent assistance from mobile nursing personnel. Being enrolled in such care to a great extent entitles the care receivers to get an annual, free-of-charge, oral health examination on a voluntary basis. This population group is also entitled to receive what is considered necessary dental treatment on the same economic terms as medical treatment, with a set, low fee. There were two aims of this thesis. The first aim was to evaluate the clinical oral health outcome in care receivers, by using an oral health screening protocol, after the caregivers had undergone a one-session, four-hour oral health education program. The second aim was to evaluate the realistic oral treatment need, taking into consideration the treatment intention. The first study was performed at a smaller scale; 170 subjects enrolled in municipal long term care were included, available for examination both before and 3-4 months after education to the caregivers. The second study was performed at a larger scale; a sample, of 866 persons was selected to be examined; i.e. every third person included in long term care in three municipalities. The results showed that a limited oral health education, offered to caregivers within longterm care facilities, had a positive impact on residents´ oral health status. Further, it showed that the realistic oral treatment need, guided by the examiners´estimation of the appropriate treatment intention, was quite modest in this population, as 61% not only had a need for an oral health evaluation but also a need for additional oral/dental treatment, 31% to be accomplished by prophylactics and 30% by reparative/urgent measures. Of the latter group, about half were judged as needing prophylactics beside dentist´s treatment. Only one per cent were estimated to be in urgent need. In conclusion, the first study indicates that a limited oral health education of the caregivers combined with screening and prophylactic measures, will benefit the care-receivers in long term care.The second study indicates that when considering the treatment intention, the realistic treatment need among patients in long term care is quite modest, but prophylactic measures are important. The different levels of intention do not always aim at achieving complete oral health, but rather at facilitating a realistic oral treatment and an acceptable oral comfort.
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