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Browsing Licentiate Theses /OD by Title
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Browsing Licentiate Theses /OD by Title
Now showing items 1-9 of 9
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Developing a Problem Based Learning model for Internet-based teaching... 
Mattheos, N : Centre for Oral Health Sciences, Department of Periodontology, University of Malmö
Lic. (sammanfattning) Malmö : Högsk., 2001 (2001)LICENTIATE
THESIS
English abstract: Problem Based Learning (PBL) has been fully or partly adopted by several medical and dental schools throughout the world, but only few attempts have been made to adjust this method to Distance Learning (DL) environments. It appears that the interaction demands of PBL could not be easily facilitated by the technologies used for DL in the past. The recent introduction of Virtual Learning Environments or Virtual Classrooms, is suggested by many as the development that could allow Distance Learning to utilise highly structured collaborative learning methods such as PBL. A literature review and two pilot studies were undertaken, in an attempt to investigate the possibility of adjusting an existing in-classroom PBL model to Internet-based environments for distance learning. There is a strong need of a conceptual theoretical framework and research results to support the function and effectiveness of distance learning in health education. Drop-out rates are still high in all kinds of distance education. Accreditation, team-work and personal contact, appear to be factors of importance for increasing motivation and minimising drop-out rates in distance learning. During the pilot studies it was evident that both postgraduate and undergraduate students were very positive towards the PBL method, as they experienced it while working over the network. However, it is very difficult to introduce inexperienced students to PBL through distance. Students? competence with computers seems to be an important factor for the success of a virtual classroom and their computer literacy has to be objectively assessed prior to any course. Significant differences were identified between in-classroom and over the Internet communication. These differences, although measured in the quantity of interaction, appear to influence the quality and depth of discussion as well. Tutor involvement was higher in the Internet discussions than the in-classroom ones. It was concluded that an entirely Internet-based PBL course is possible, if properly organised. However, such a model might constitute a compromise over the quality standards of in-classroom PBL, at least with the currently available Internet technology. A hybrid approach, which will combine personal contact with network-based interaction, might be the safest and most beneficial option right now. 
MattheosLic.pdf
(2.212Mb)
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Distal movement of maxillary molars. Studies of efficiency and timing...
Karlsson, Ingela : Malmö University (2008) LICENTIATE
THESIS
English abstract: Maxillary molar distalization is a frequently used treatment method in cases with crowding associated with dental Class II molar relationship or Class I skeletal relationship. Despite the fact that several studies have been published concerning the treatment outcome of different appliances for distal movement of maxillary molars, it is still difficult to interpret the results and evidence presented in these studies because a variety of study designs, sample sizes and research approaches exists. In view of this, well-designed randomized clinical trials comparing patient compliant and non patient compliant extra- and intraoral appliance as methods of distalizing maxillary first molars is desirable as well as a systematic review of the present knowledge. Furthermore, there is a need for further evaluations and knowledge about the most appropriate time to move maxillary molars distally, i.e. evaluation of movement efficiency including anchorage loss before and after eruption of second maxillary molars. The overall aim of this thesis was to evaluate the outcome measures by distalizing maxillary molars with either the conventional extraoral traction (EOA) or a intraoral fixed appliance (IOA) and also to evaluate the optimal timing of distalizing treatment – either before or after the eruption of the second maxillary molars. This thesis was based on two studies and a systematic review included in the frame story: Paper I was a randomized controlled trial involving 40 patients in orthodontic treatment. The study evaluated and compared the treatment effects of an EOA and an IOA for distal molar movement of maxillary first molars. Paper II was a retrospective study involving 40 patients evaluating the maxillary molar distalization and anchorage loss in two groups, one before (MD 1 group) and one after eruption of second maxillary molars (MD 2 group). The systematic literature search was made in 4 different databases to determine what appliances for distal molar movement of maxillary molars have been evaluated in an evidence based manner and with focus on the most efficient method and outcome of molar movement and anchorage loss. Also, the evidence-based standard of Paper I and II was evaluated. These conclusions were drawn: • The IOA was more effective than the EOA to create distal movement of maxillary first molars, and thus, for the clinician the IOA is the most favourable method. • Moderate and acceptable anchorage loss was produced with the IOA implying increased overjet whereas the EOA created decreased overjet. • The two appliances did not have any considerable corrective effect on Class II skeletal relationships and these appliances shall therefore only be used in cases of moderate dental sagittal discrepancies and arch-length deficiencies. • The most opportune time to move maxillary first molars distally is before eruption of the second molars, since molar movement is then most effective and the anchorage loss lesser. • There is limited level of evidence that intraoral appliance is more efficient than extraoral to create distal movement of maxillary molars and that anchorage loss was produced with the intraoral appliance. • It is still difficult to draw any conclusions as to which of the intraoral appliances that were the most effective, and therefore, more RCTs are desireable. Swedish abstract: Den vanligaste bettavvikelsen som behandlas bland barn och ungdomar är trångställning. När funktionellt och estetiskt störande trångställning i överkäken ska behandlas kan man vanligtvis ta bort tänder eller flytta de första stora kindtänderna (sexårständerna) bakåt för att sedan göra tandraden jämn. Det finns flera vetenskapliga studier som beskriver behandlingseffekterna av olika tandställningar för att flytta de stora kindtänderna bakåt. Det är oklart vilken typ av tandställning som är effektivast och i allmänhet saknas ett evidensbaserat perspektiv. Det är också oklart vid vilken tidpunkt som det är mest effektivt att flytta sexårständerna bakåt, dvs. före eller efter det att de andra stora kindtänderna kommit på plats i tandbågen. Licentiatavhandlingen är baserad på följande studier: Med randomiserad kontrollerad studiedesign var syftet i Studie I att utvärdera behandlingseffekterna av två olika tandställningar för att flytta överkäkens sexårständer bakåt i tandbågen. Fyrtio patienter randomiserades, 20 till en avtagbar tandställning (extraoralt drag) och 20 patienter till en fast tandställning. Studie II hade syftet att analysera när behandlingen var effektivast, dvs. att tandreglera sexårstanden bakåt innan eller efter att den bakomvarande stora kindtanden kommit på plats i tandbågen. I ramberättelsen utfördes dessutom en systematisk litteraturöversikt med syfte att på ett evidensbaserat sätt utvärdera olika metoders effektivitet i att tandreglera de stora kindtänderna bakåt i tandbågen och att göra en kvalitetsbedömning av de utvalda studierna. Översikten omfattade tidsperioden från januari 1966 t o m april 2008 vilket innebar att bedömningen även inkluderade studierna I och II. Konklusioner: • Fast tandställning var effektivare än avtagbar för att flytta de första stora kindtänderna bakåt i tandbågen. • Sidoeffekter i form av 1-2 mm ökat överbett (förankringsförlust) uppstod vid behandling med fast tandställning medan avtagbar tandställning bidrog till minskat överbett. • Det var mest effektivt att tandreglera sexårstanden bakåt innan den bakomvarande stora kindtanden kommit på plats i tandbågen. • I litteraturen fanns det begränsat bevisvärde för att fast tandställning är mer effektiv än avtagbar för bakåtförflyttning av första stora kindtanden i överkäken och att sidoeffekter (1-2 mm ökat överbett) blir följden av den fastsittande apparaturen. • Det är fortfarande svårt att via litteraturen dra några slutsatser om vilken typ av fast tandställning som är mest effektiv och därför behövs det ännu mer forskning om detta.
Distal Movement MUEP.pdf
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Knowledge of periodontal disease before and after a mass media campai... Mårtensson, Carina : Faculty of Odontology, Malmö University (2006) LICENTIATE
THESIS
English abstract: The aims were to evaluate if a mass media campaign regarding periodontal disease could increases the knowledge of diagnosis, symptom and treatment options of periodontal disease, and to analyse factors associated with knowledge before and after the campaign according to social attributes, care system attributes and perceived oral health aspects. The Swedish Association of Periodontology initiated the mass media campaign. It was conducted through brochures, newspapers, radio and television. The studies were based on a questionnaire in a panel design. From the national population register 900 individuals 50-75 years of age were randomly sampled. The response rate of the questionnaire was 70% before the campaign, 65% after and 64% answered both questionnaires. Data were analysed as to correct answers before and after the campaign and to change in knowledge. Knowledge improved about periodontitis regarding symptoms, diagnoses and treatment options of periodontal disease. Individuals with "secondary education" had more knowledge of periodontal disease both before and after the campaign, compared to individuals with "primary education". High utilization of dentistry was also associated with knowledge before and after the campaign. To conclude mass media campaigns may increase knowledge of periodontal disease. Swedish abstract: Syftet var att utvärdera om en massmedia kampanj ökar kunskapen om diagnos, symptom och behandling av parodontit och att analysera kunskap i förhållande till sociala faktorer, användande av tandvård och uppfattning om oral hälsa. Kampanjen utarbetades av Svenska Parodontologiföreningen och genomfördes via tidningsartiklar, radio, TV program och broschyrer som kunde rekvireras av tandvårdskliniker. För att genomföra studien användes postenkäter i en före och efter design, som skickades ut till 900 ur befolkningsregistret slumpvis utvalda 50-75 åringar. Svarsandelen var 70 % före kampanjen och 65 % efter kampanjen. Totalt svarade 64 % på båda enkäterna. Data analyserades i förhållande till rätt svar före och efter kampanjen samt beträffande förändring av kunskap. Kunskapen om parodontit ökade efter kampanjen med fler rätta svar angående symptom, diagnos och behandling av parodontit. Analysen av förändringarna i kunskap visade att fler individer med högre utbildningsnivå kunde mer om parodontit före och efter kampanjen än de med lägre utbildningsnivå. Kunskap före och efter kampanjen associerades också med högt utnyttjande av tandvård. Slutsatsen av studien är att en massmedia kampanj kan öka kunskapen om parodontit -
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). -
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. -
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. -
The Rosengård Study
Wennhall, Inger (2008) LICENTIATE
THESIS
English abstract: Despite a remarkable reduction in prevalence of dental caries in the developed countries, childhood tooth decay is still a public health problem, and it is well known that children from disadvantaged communities and from minority ethnic groups continue to experience a high level of disease. Even in Sweden there are groups of children in need of early intervention to prevent oral diseases, and especially socially deprived city communities require special attention. Here, preventive strategies adapted to children and families with a multicultural background are needed. The aim of this study was to evaluate a comprehensive oral health programme, based on a High-risk group strategy, and directed towards young children living in a low socio-economic, multicultural area in the city of Malmö, Sweden. The specific aims were to investigate the effect on the prevalence of dental caries after one and three years of intervention, and the impact of parent education and training on various factors related to caries development. 804 2-year-old children were enrolled in the programme and constituted the Intervention group. These children were recalled every 3rd month between ages 2 and 3 years and semi-annually between ages 3 and 5 years for individualized oral health information. Except for the yearly dental examinations the information took place at an outreach facility located in the local shopping area, not in direct connection with the local Public Dental Service clinic. The parent information focused on tooth-brushing and dietary habits, and fluoride tablets were provided free of charge. Clinical examinations were carried out at baseline (2 years of age) and at age 3 and 5 years. On the same occasions the guardians were interviewed with the aid of a structured questionnaire. The results after one year of intervention (3 years of age) were compared with a non-intervention Reference group from the same district consisting of 217 children of the same age. A final comparison between the groups was made at the age of 5, after three years of intervention. The programme significantly reduced the caries increment during the 3 year period of study. The main impact of the programme was noted during the first year of study, the number of caries-free children at the age of 3 (initial and cavitated lesions included) being 37% in the Intervention group as compared with 15% in the Reference group (p<0.001). At the age of 5, the corresponding figures were CV 14% and 6% (p<0.001). At this age, 45% of the children in the Intervention group had cavitated or filled lesions compared with 67% in the Reference group (p<0.001). The self-reported compliance with taking fluoride tables was high in the Intervention group and the difference between the groups was considerable. No difference in the reported use of fluoride toothpaste was found, the use being close to 100% in both groups. A significant positive effect on the dietary habits, recorded as frequent small-eating and sweet drinks at night, was seen after one year of intervention, but no significant difference between the two groups was found after 3 years. The programme had a positive effect on the parents’ brushing habits, but no effect on the oral hygiene level. In conclusion, the study showed that the oral health programme, using conventional caries-preventive measures, significantly improved the oral health situation in this multicultural, low socioeconomic city area of Malmö. The main caries preventive impact was noted during the first year of study, which was haracterized by a more intense preventive intervention. A high compliance with the programme might be explained by the use of an outreach facility for oral health information, located in the centre of the local community.
Wennhall MUEP.pdf
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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. -
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.
Solgun Folke muep.pdf
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