| 1. |
- Engström, Sevek, et al.
(författare)
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Can costs of screening for hypertension and diabetes in dental care and follow-up in primary health care be predicted?
- 2013
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Ingår i: Upsala Journal of Medical Sciences. - : Informa Healthcare / Upsala Medical Society. - 0300-9734 .- 2000-1967. ; 118:4, s. 256-262
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The purpose was to assess the direct costs of screening for high blood pressure and blood glucose in dental care and of follow-up in primary health care and, based on these data, arrive at a prediction function. less thanbrgreater than less thanbrgreater thanStudy population. All subjects coming for routine check-ups at three dental health clinics were invited to have blood pressure or blood glucose measurements; 1,623 agreed to participate. Subjects screening positive were referred to their primary health care centres for follow-up. less thanbrgreater than less thanbrgreater thanMethods. Information on individual screening time was registered during the screening process, and information on accountable time, costs for the screening staff, overhead costs, and analysis costs for the screening was obtained from the participating dental clinics. The corresponding items in primary care, i.e. consultation time, number of follow-up appointments, accountable time, costs for the follow-up staff, overhead costs, and analysis costs during follow-up were obtained from the primary health care centres. less thanbrgreater than less thanbrgreater thanResults. The total screening costs per screened subject ranged from (sic)7.4 to (sic)9.2 depending on subgroups, corresponding to 16.7-42.7 staff minutes. The corresponding follow-up costs were (sic)57-(sic)91. The total resource used for screening and follow-up per diagnosis was 563-3,137 staff minutes. There was a strong relationship between resource use and numbers needed to screen (NNS) to find one diagnosis (P andlt; 0.0001, degree of explanation 99%). less thanbrgreater than less thanbrgreater thanConclusions. Screening and follow-up costs were moderate and appear to be lower for combined screening of blood pressure and blood glucose than for separate screening. There was a strong relationship between resource use and NNS.
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| 2. |
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| 3. |
- Hylander, Lars D., et al.
(författare)
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High mercury emissions from dental clinics despite amalgam separators
- 2006
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 362:1-3, s. 74-84
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Tidskriftsartikel (refereegranskat)abstract
- Mercury (Hg) as amalgam has been used as a dental filling material for more than 150 years. Thereby, dentists and their patients have been directly exposed to Hg, and the public and the environment indirectly exposed via Hg emissions from incinerators and Hg in waste water from households and dental clinics. Due to the toxic properties of Hg and bioaccumulation in biota of Hg emitted via dental clinic waste water, amalgam separators were introduced in Sweden in the 1980s. Although these amalgam separators in the certification process are required to remove at least 95% of incoming Hg in a standardized laboratory test, their efficiency in practical use has not been properly investigated. Here we present actual Hg emissions via waste water from 12 dental clinics equipped with the same type of amalgam separator based on sedimentation. All waste water was collected for four consecutive working days, initially at ordinary operating conditions and a second time after a thorough revision and cleaning of the discharge system. The results indicate that mercury emissions from dental clinics can be reduced by an improved design of the discharge system, a sensible use of high pressure water cleaning, and regular maintenance, including replacement of amalgam separators and filters at certain intervals. The study also indicates that banning Hg in dentistry is the one long-term way to stop Hg emissions from dental amalgam.
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| 4. |
- Hylander, Lars D., et al.
(författare)
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Mercury recovery in situ of four different dental amalgam separators
- 2006
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 366:1, s. 320-336
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Tidskriftsartikel (refereegranskat)abstract
- Amalgam separators are used to physically remove dental amalgam from waste water in dental clinics. They are thereby supposed to reduce mercury (Hg) emissions to the municipal waste water system to acceptable levels. We here present results from a comparative study in situ of three amalgam separators available on the market, all with a claimed efficiency of 99% according to Danish and ISO protocols, and using sedimentation as the principle of separation. We also present corresponding data for an investigational prototype of an improved separator. The obtained efficiency of the three commercial separators is far below what is stated by the manufacturer and by authorities assumed to be the efficiency in clinical conditions. They reduced Hg emissions by 79 - 91%, leaving an average Hg content in outgoing waste water of 1.5 mg L(-1). However, the prototype separator participating in this study retained 99.9% of the waste water Hg emissions, leaving an average Hg content in outgoing waste water of 0.004 mg L(-1). Physical restrictions prohibit sedimentary type separators to recover the Hg fractions causing the largest damages in wastewater treatment plants. This fraction is not considered in the ISO protocol for testing amalgam separators, which therefore needs to be revised. Abolishing the use of dental amalgam and cleaning the tubing systems is the most efficient long-term solution to reduce Hg emissions from dental clinics. Until then, Hg emissions originating from placing, polishing or removing existing amalgam fillings, should be counteracted by the use of low-emission amalgam separators, already on the market or presently being developed for use alone or together with sedimentary type amalgam separators.
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| 5. |
- Astvaldsdottir, A., et al.
(författare)
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Oral health and dental care of older persons-A systematic map of systematic reviews
- 2018
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Ingår i: Gerodontology. - : Wiley. - 0734-0664 .- 1741-2358. ; 35:4, s. 290-304
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Forskningsöversikt (refereegranskat)abstract
- Objectives: To examine the current knowledge on oral health status and dental care of older persons through a systematic mapping of systematic reviews of low or moderate risk of bias. Background: Geriatric dentistry covers all aspects of oral health and oral care of older persons. Oral health is part of general health and contributes to a person's physical, psychological and social wellbeing. Methods: A literature search was performed in three different databases (PubMed, The Cochrane Library and Cinahl) within 12 domains: Dental caries, periodontitis, Orofacial pain and temporomandibular joint (TMJ) pain, mucosal lesions, oral motor function, dry mouth, halitosis, interaction between oral status and other medical conditions, ability to interrelate and communicate, quality of life, ethics and organisation of dental care for older persons. Systematic reviews were identified and scrutinised, highlighting scientific knowledge and knowledge gaps. Results: We included 32 systematic reviews of which 14 were judged to be of low/moderate risk of bias. Most of the domains lack systematic reviews with low or moderate risk of bias. In two of the domains evidence was identified; in institutionalised people aged 65 or older, effective oral hygiene can prevent pneumonia. Furthermore, there is an evidence of a relationship between malnutrition (protein energy-related malnutrition, PEM) and poor appetite and edentulousness. Conclusions: There is an urgent need for further research and evidence-based knowledge within most domains in geriatric dentistry and in other fields related to oral health and dental care for older persons striving for multi-disciplinary research programmes.
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| 6. |
- Bergström, Eva-Karin, 1974, et al.
(författare)
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Caries and costs: an evaluation of a school-based fluoride varnish programme for adolescents in a Swedish region
- 2016
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Ingår i: Community Dental Health. - 0265-539X. ; 33:2, s. 138-144
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Tidskriftsartikel (refereegranskat)abstract
- In 2003, 19 public dental clinics in Vastra Gotaland Region implemented a population-based programme with fluoride varnish applications at school every six months, for all 12 to 15 year olds. In 2008, the programme was extended to include all 112 clinics in the region. Objective: To evaluate caries increment and to perform a cost analysis of the programme. Basic research design: A retrospective design with caries data for two birth cohorts extracted from dental records. Three groups of adolescents were compared. For Group 1 (n=3,132), born in 1993, the fluoride varnish programme started in 2003 and Group 2 (n=13,490), also born in 1993, had no fluoride varnish programme at school. These groups were compared with Group 3 (n=11,321), born in 1998, when the programme was implemented for all individuals. The total cost of the four-year programme was estimated at 400SEK (approximate to 44(sic)) per adolescent. Results: Caries prevalence and caries increment in 15 year olds were significantly lower after the implementation of the programme. Group 2, without a programme, had the highest caries increment. The cost analysis showed that it was a break-even between costs and gains due to prevented fillings at the age of 15. Conclusions: This school-based fluoride varnish programme, implemented on a broad scale for all 12 to 15 year olds, contributed to a low caries increment at a low cost for the adolescents in the Vastra Gotaland Region in Sweden.
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| 7. |
- Engström, Sevek, et al.
(författare)
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Association between high blood pressure and deep periodontal pockets : a nested case-referent study
- 2007
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Ingår i: Upsala Journal of Medical Sciences, Supplement. - 0300-9726. ; 112:1, s. 95-103
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Tidskriftsartikel (refereegranskat)abstract
- A hypertension screening project was performed jointly at a dental clinic and a primary health care centre. In this report the hypothesis that there is an association between high diastolic blood pressure and deep periodontal pockets was tested. A total of 1,239 consecutive patients aged 35 - 65 years had their blood pressure measured before the dental examination or had a known hypertension. Information on medical history and tobacco use was obtained by interview and dental status was recorded. Fifty-four subjects had known hypertension and 141 had previously unknown diastolic blood pressure > 90 mmHg ( cases). For each case an age, sex and tobacco-use matched referent was chosen from those with diastolic blood pressure <= 90 mm Hg. Significantly more cases than referents had periodontal pockets >= 5 millimeters deep. In multivariate analyses the prevalence of deep periodontal pockets was associated with blood pressure status also after adjustment for the small differences between the groups in age, sex, tobacco use and number of teeth. In conclusion there was an association between diastolic blood pressure and prevalent deep periodontal pockets. Whether the relationship is a causal one remains to be explored. Screening for high blood pressure at regulary visits at the dental clinic may give the dental care a new important role in the public health field.
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| 8. |
- Engström, Sevek, 1954-
(författare)
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Dental Health Care Cooperating with Primary Health Care as a Resource in Early Case Finding of Patients with Diabetes or Hypertension
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives To investigate if there is an association between dental health status and high blood pressure, to test the effectiveness of screening for high blood pressure and high blood glucose performed by the dental health care in collaboration with primary health care and to investigate the direct costs for this type of screening organisation. Study population and methods In Paper I 54 subjects with known hypertension and 141 with a high blood pressure in the dental office were compared with matched controls. In Paper II 1,149 subjects were screened for hypertension and in Paper III 1,568 subjects were screened for diabetes in dental care. Follow up was performed in co-operating primary health care centres. In paper IV the direct costs for screening and follow-up were calculated. Results There was a significant association between deep periodontal pockets and high blood pressure, even when the influence of age, sex, smoking and number of teeth was taken into account. Among those being screened for high blood pressure and high blood glucose 20.6% and 9.9% respectively were referred to primary health care, and a hypertension or a diabetes diagnosis was found in 32.1% and 5.8% of those screening positive. For every 18th subject screened a hypertension case was found (“numbers needed to screen” (NNS)), and for every 196th a diabetes case. NNS for combined hypertension and diabetes screening was 15. The total direct costs for screening and follow up per diagnosis found were 5,298 SEK for hypertension, 19,100 SEK for diabetes, and 4,116 SEK for combined blood pressure and blood glucose screening. Conclusions There was an association between dental health and hypertension. Screening for hypertension was highly efficient, while screening for diabetes was less so, because it is a less prevalent condition. Screening for both conditions appears to be the most efficient type of screening.
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| 9. |
- Engström, Sevek, 1954-, et al.
(författare)
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Effectiveness of screening for diabetes mellitus in dental health care
- 2013
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 30:2, s. 239-245
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of the present study was to test the effectiveness of opportunistic blood glucose Methods Altogether, 1568 subjects, age 2075 years, with no previous history of diabetes, who came for Results Of the 155 (9.9%) subjects who screened positive, 139 (89.7%) came to their primary Conclusions Cooperation between dental and primary care for high blood glucose screening and
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| 10. |
- Engström, Sevek, et al.
(författare)
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Efficacy of screening for high blood pressure in dental health care
- 2011
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 11, s. 194-
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is consensus on the importance of early detection and treatment of high blood pressure. Dental care is one of few medical services to which a considerable proportion of the general population comes for regular check-ups. We tested the effects of blood pressure screening in dental care centres with subsequent workup of subjects screening positive in primary health care (PHCC). Methods: Altogether 1,149 subjects 40-65 years old or 20-39 years old with body mass index >25, and with no previously known hypertension, who came for a dental examination had their blood pressure measured with an Omron M4 (R) automatic blood pressure reading device. Subjects with systolic blood pressure readings above 160 mmHg or diastolic above 90 mmHg were referred to their PHCC for a check up. Outcome data were obtained by scrutiny of PHCC and hospital patient records for hypertension diagnoses during the three years following screening. Results: 237 (20.6%) subjects screened positive. Of these, 230 (97.1%) came to their PHCC within the 3-year follow-up period, as compared with 695 (76.2%) of those who screened negative (p < 0.0001). Of those who screened positive, 76 (32.1%) received a diagnosis of hypertension, as compared with 26 (2.9%) of those who screened negative. Sensitivity was 79.1%, specificity 84.8% and positive predictive value 30.1%. The number of subjects needed to screen to find one case of hypertension was 18. Conclusions: Co-operation between dental and primary care for blood pressure screening and work-up appears to be an effective way of detecting previously unknown hypertension.
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