| 1. |
- Alshammari, Hatem
(författare)
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Antimicrobial potential of strontium against bacteria associated with peri-implantitis
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dental implants are nowadays a standard treatment to replace missing teeth and restore function and aesthetics. However, biological complications associated with implants, e.g., peri-implant infections, are common and jeopardize the success of treatment. The main aim of this thesis was to explore strontium (Sr) as a possible prevention strategy against peri-implant infections, since Sr has been shown to have antibacterial action and also to promote titanium (Ti) implant osseointegration. In this thesis, a systematic appraisal of the literature about the antimicrobial potential of Sr-functionalized Ti surfaces for oral applications was performed, and was followed by a series of in vitro studies assessing the antimicrobial potential of Sr against micro-organisms associated with peri-implantitis.In Study I, the systematic appraisal of the literature resulted in an initial list of 1081 potentially relevant publications, where from nine publications from in vitro studies met the inclusion criteria. Most of the included studies showed that Sr-functionalized Ti exerted a limited immediate (i.e., 24 h) antimicrobial effect, likely due to a low Sr ion release; a relevant antimicrobial effect and biofilm inhibition potential against Streptococcus aureus was observed at both early and late timepoints, with an adequate Sr ion release.Study II assessed, in vitro, five different concentrations of soluble Sr(OH)2 (100, 10, 1, 0.1, and 0.01 mM) against 6 different mono-species bacteria (Streptococcusmitis, Staphylococcus epidermidis, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Escherichia coli, and Fusobacterium nucleatum) in terms of cell growth, minimal inhibitory concentration (MIC), and biofilm viability. In the agar diffusion test, zones of inhibition were only observed for 0.01, 0.1, and 1 mM of Sr(OH)2 against P. gingivalis. Growth inhibition in planktonic cultures was achieved at 10 mM for all species tested. In the biofilm viability assay, 10 and 100 mM Sr(OH)2 showed potent bactericidal effect against S. mitis, S. epidermidis, A. actinomycetemcomitans, E. coli, and P. gingivalis. It was thus concluded that Sr(OH)2 has antimicrobial properties against bacteria associated with peri-implantitis.Study III assessed the in vitro early- and late bacteriostatic and bactericidal effect of Sr-functionalized wafers on bacteria associated with peri-implantitis (E. coli,S. aureus, Streptococcus oralis, Actinomyces naeslundii, Parvimonas micra, P.gingivalis and F. nucleatum) as mono-species after 2 and 24 hours, and as multispecies at day 1, 3, and 6. Sr-functionalized wafers, compared to Ti controls, were associated with statistically significant less viable cells in both mono- and multispecies tests. Number of colony forming units (CFUs) within the biofilm were significantly higher in Ti wafers, compared to Sr-functionalized wafers, for S. aureus at all time-points of evaluation and for E. coli at day 1. Gingipain activity was higher in Ti wafers compared to Sr-functionalized ones, and the qPCR showed that P. gingivalis comprised 15% of the total biofilm on Ti wafers at day 6, while it remained below detection levels at Sr-coated wafers.In Study IV, the impact of Ti surface roughness (turned vs moderately rough) on the antimicrobial effect of Sr on bacterial associated with peri-implantitis (S. oralis, P. micra, A. naeslundii, F. nucleatum, P. gingivalis, S. aureus, and E. coli), grown in different multispecies consortia, was assessed in vitro. Bacterial viability and biofilm formation, and well as, proteolytic activity of P. gingivalis were assessed at day 1, 3, and 6. Sr-functionalized surfaces were associated with statistically significant reduction in number of viable cells compared to nonfunctionalized surface at all times of investigation for all multispecies tested. Higher proteolytic activity of P. gingivalis was found at non-functionalized Ti disks compared to Sr-functionalized ones. Sr-functionalised surfaces were associated with notable growth inhibition of both E. coli and S. aureus, while P. gingivalis remined undetected at all time points of evaluation on all disks. The turned surface had a slightly higher release of Sr ion compared with the moderately rough surface in the first 24 hours, while both surfaces showed a sustained release for up to 15 days.Overall, the data generated with this series of projects indicate Sr surfaces exerts an antimicrobial potential on bacteria associated with peri-implantitis and it is worthwhile to further explore the potential of Sr-functionalized Ti in the prevention of peri-implant infections.
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| 4. |
- Bergström, Kamilla
(författare)
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Job satisfaction and emotional work tasks : dentists in Sweden and Denmark
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingen består av två studier som utgår från projektet ”Det goda arbetet”. Det överordnade syftet med projektet Det Goda Arbetet var att använda tandvård som ett exempel på ett arbete där relationerna med patienterna utgör arbetets kärna. Denna typ av arbete (även kallat människovårdande arbete) har speciella psykosociala arbetsmiljövillkor och känslomässiga krav som måste tas hänsyn till vid organisering av arbetet. Syftet med den första studien var att beskriva bakgrunden och utvecklingen av frågeformuläret ’Svenska och Danska tandläkares uppfattning av ’Det Goda Arbetet’ och att skapa ett mått för generell arbetstillfredsställelse, applicerat på fyra organisatoriska miljöer. Syftet med den andra studien var att introducera konceptet emotionellt arbete i tandvård genom att ge en teoretisk överblick av de emotionella aspekterna av arbetet, villkoren under vilka arbetet utförs och de potentiella effekterna på tandläkarnas välbefinnande. I kappan har kompletterande resultat från projektet Det Goda Arbetet inkluderats i syfte att ge en empirisk illustration av hur tandläkare upplever de emotionella faktorer som relaterar till patient-interaktionen och deras arbetsglädje. Data från 1226 danska och svenska verksamma tandläkare samlades in i November 2008 med en svarsprocent på 68 %. Ett additivt index skapades för att mäta generell arbetstillfredsställelse, och resultaten visade statistiska skillnader i tandläkarnas uppfattning mellan de olika organisatoriska miljöerna (Svenska offentliga/privata och Danska offentliga/privata). De danska offentliga tandläkarna hade den högsta graden av generell arbetstillfredsställelse medan de svenska offentliga hade den lägsta graden. En möjlig förklaring till detta kan vara att danska offentliga tandläkare skiljer sig från de andra tre grupperna i karakteristika vad gäller både tandläkare och patienter. Den låga graden av generell arbetstillfredsställelse hos de offentliga svenska tandläkarna kan möjligtvis vara en effekt av New Public Management-tänkande i sättet att organisera tandvård. Tilläggsresultaten visade att de svenska offentliga tandläkarna hade mycket mindre energi till sina privatliv i jämförelse med de andra tre grupperna och bara hälften av dem förväntade sig att fortsätta arbeta som nu fram till pensionen. Att arbeta med eller på människor handlar mycket om att skapa goda interaktioner och relationer mellan vårdgivaren och patienten. Goda patientrelationer kan vara ett primärt- och/eller sekundärt mål för att göra andra saker, som t.ex. den kliniska behandlingen, lättare. För många vårdgivare är relationerna med patienterna en arena där de kan leva ut sin potential som människor och kan upplevas som en bestående inre glädje av arbetet, kallat eudaimonia. I patientrelationen utför tandläkaren emotionellt arbete som ett sätt att intervenera med patienten för att vägleda denne i en bestämd riktning. Tandläkare har uttalade emotionella arbetsuppgifter i sina interaktioner med patienterna, emellertid har dessa emotionella aspekter av arbetet hitintills varit ett försummat forskningsområde inom odontologin. De emotionella arbetsuppgifterna är betingade eftersom att tandläkarens incitament inte är endimensionella och därför kräver de en hel del emotionell flexibilitet, uppmärksamhet och reflektion av tandläkaren. Påverkan från marknadskrafter och managerialism på de professionella värdena inom tandvård kan av tandläkaren uppfattas som motstridande och utmana villkoren för emotionellt arbete och tandläkarnas välbefinnande. Denna forskning syftar till att starka och uppmuntra olika nivåer av tandvård till att ytterligare undersöka, förstå och stötta dynamiken i de emotionella aspekterna av arbetet för att skapa en hållbar arbetsmiljö där värden och logik kan uppfattas som kompatibla med tandvårdens professionella värden.
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| 5. |
- Cederhag, Josefine
(författare)
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Radiographic imaging in relation to the mandibular third molar : tooth characteristics, modality choice, optimization, and absorbed dose
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Radiographic imaging of the mandibular third molar (M3) is a valuable diagnostic tool. It provides information on tooth position, root morphology, and relations to surrounding anatomical structures that facilitates diagnosis and treatment planning. Three modalities are commonly used in dentistry: intraoral and panoramic radiography, and cone beam computed tomography (CBCT). Over time, panoramic radiography became a justified choice in most cases of M3 removal. In the last decade, a three-dimensional (3D) alternative, CBCT, has seen increasing use. The advantages of 3D come at the cost of higher radiation doses and societal expense. The four studies in this thesis originated from current knowledge gaps and clinical needs.The use of panoramic radiography for evaluating the M3 and its relation to the inferior alveolar nerve (IAN) is well-established practice; however, its application has declined over time, possibly due to the rising popularity of CBCT imaging. Thus, it is of interest to investigate the suitability of panoramic imaging of the M3. Choice of imaging modality is important from dose delivery and socioeconomic standpoints. A survey of clinician experiences and preferences in imaging modalities for pre-surgical analysis was needed.In diagnostic imaging, the common goal is to reduce radiation exposure to the lowest threshold that still delivers reliable diagnostic information. Due to the growing use of CBCT, there is a need to optimize exposure settings and use reliable measurement methods in dosimetric analysis. Nevertheless, for the M3, the present literature has neither evaluated a low-dose protocol in a clinical setting nor compared the standard method of measuring absorbed dose in dental CBCT with an alternative method.This thesis is based on the following papers:Paper I, an observational study, evaluated M3 characteristics and IAN relation, incidental findings, and image quality regarding patient positioning on 442 panoramic radiographs. Key findings: A majority of M3s were erupted and vertically positioned, regardless of age. The IAN was located inferior to the roots in just over half of the cases; an overlapping position was most common if the tooth was retained or semi-retained, or patient age less than 30 years. Frequent incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Patient positioning was suboptimal in one-third of the radiographs; common errors included patient placement posterior to the image layer and an upward-tilted head. Paper II was a web-based questionnaire sent to general dentists and to residents and specialists in oral and maxillofacial surgery. The survey comprised multiple-choice questions with four M3 cases depicted in images. Key findings: A majority of respondents received a report within 2 weeks of their CBCT referral and would read it and view the images before surgery; one-third did not. Panoramic radiographs were the preferred modality in pre-surgical planning; differences between professions were significant. Panoramic radiographs and CBCT were seen as facilitating treatment planning, and CBCT as also reducing post-operative complications. CBCT tended to be preferred in more complex M3 cases. Paper III was a clinical trial investigating an alternative, low-dose CBCT protocol with lower tube current than the default protocol. After justification for CBCT, 48 patients (62 M3s) referred for a pre-surgical investigation were recruited. Two scans of each site were made using the two protocolsKey findings: No significant differences occurred in visibility of root and mandibular canal relationship and proximity, root morphology, and possible root resorption of the second molar. Visibility of the periodontal ligament was significantly better in default images. Subjective image quality in low-dose images (60% less radiation) was acceptable in most cases. Paper IV was a laboratory study comparing two dosimeters in a CBCT scan of the M3 region. Five slices of an anthropomorphic phantom were prepared with thermoluminescent dosimeters (TLD-100) at 75 sites and covered with Gafchromic film LD-V1. Key findings: Point dose measurements at all TLD sites correlated well with doses measured on film; agreement was better at lower doses. Minimum and maximum doses on film versus at TLD sites deviated greatly on all slices and for several organs. To conclude, panoramic radiography is useful in evaluating M3 and IAN relationships. Clinicians consider pre-surgical information to differ depending on imaging modality; modality preference seems to depend on case complexity. Optimized CBCT protocols can be used for the M3. Gafchromic film is a favorable alternative in dental CBCT dosimetry
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| 6. |
- Folke, Solgun
(författare)
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Xerostomia : Views among health care professionals and the main concern among afflicted adults
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)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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| 7. |
- Gillborg, Susanna
(författare)
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Orofacial pain and tooth wear in swedish adults : cross-sectional studies in southern Sweden
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim. The present licentiate thesis investigated the prevalence of TMDpainand related factors, the prevalence and severity of tooth wear, andthe etiology and factors related to tooth wear in adults in southern Sweden.Methods. The methods used included a questionnaire, history, clinical examination,intraoral photographs, and saliva sample. In Paper I, twoscreening questions for TMD pain were used to query a study samplecomprising 6123 questionnaire participants about their pain experience.In Paper II, a clinical examination and intraoral photographs helped determinethe presence and severity of tooth wear. Information from a questionnaire,patient histories, and participant saliva samples were analyzedregarding tooth wear-related factors. The study sample comprised 831 individuals.Results. Paper I found a prevalence of TMD pain once a week or moreoften in 11% of the study sample. Related factors were female gender,subjects under 50 years of age, weekly headache, self-reports of poor generalhealth, impaired oral health-related quality of life, and tooth wear.Paper II showed tooth wear in all individuals. Attrition, the most commontooth wear, was found in over 90% of the study sample. Signs of erosionwere found in almost 80% of the individuals. Men had more tooth wearthan women, but none of the factors that were investigated as related factorsdiffered between the genders. Only some of the individuals, includingthe group with severe tooth wear reported having received information about tooth wear from their clinician. Participants reported receiving informationabout tooth wear due to extensive tooth brushing more thanabout erosion.Conclusions. Paper I found a prevalence of TMD pain in 11% of the studysample. In Paper II, attrition was found in over 90% of the study sample.Almost 80% of the individuals exhibited signs of erosion. Only a few reportedhaving received information about tooth wear due to erosion fromtheir clinician.
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| 8. |
- Hawthan, Mohammed
(författare)
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On failures and complications of tooth-supported fixed prostheses
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Loss of tooth structure or loss of the tooth may affect masticatory function, phonetics, a person´s appearance, and might ultimately impair quality of life. Fixed prosthetic rehabilitation in the form of either fixed dental prosthesis (FDP)or single crown (SC) is a reliable treatment alternative to restore lost functions. Tooth-supported fixed prosthetic restorations (FDPs, SCs) are influenced by multiple combined general and local factors that may affect the risk of complication and failure. Recognizing risk factors is important in treatment planning, and will help the clinician optimize treatment outcomes. This will also be beneficial for both the patient and society from a cost-effective aspect, as a reduction in complications and failures reduces costs. Several factors have been suggested to impact the survival and failure rates of FDPs and SCs, but there is still limited evidence concerning the clinical outcomes of FDPs and SCs when subjected to a combination of multiple factors in a clinical setting. The aim of the present thesis was to evaluate whether the survival and failure rates of full-coverage tooth-supported fixed prosthetic restorations (FDPs, SC) are influenced by general and/or local factors. This thesis is based on a systematic review (Paper I) and three retrospective studies (Papers II, III, and IV). In Study I, PubMed, Web of Science and ScienceDirect databases were searched and manual searches were conducted to identify clinical human studies reporting on full-coverage tooth-supported FDPs and SCs. Cumulative survival rate (CSR) was calculated over the maximal period of follow-up reported, in a life-table survival analysis. Seventeen studies fulfilled the inclusion criteria. The highest 5-year survival rate was observed for all-ceramic and metal–ceramic SCs on vital teeth 97.8% (95%CI [97.1– 98.5%]), and all-ceramic SCs on non-vital teeth with fiber post 99.1% (95% CI [97.7– 100.4%]). Metal–ceramic SCs on vital teeth 97.5% (95% CI[96.8–98.3%]) showed a statistically significant higher estimated 5-year survival rate compared to metal–ceramic SCs with cast metal post 94.5% (95% CI [93.3–95.8%], p <0.001) and fiber post 95.1% (95% CI [93.4–96.6%], p <0.007), respectively. For FDPs, the 5-year survival rate was higher for metal–ceramic FDPs on vital abutments 96.9% (95% CI [95.5–98.4%]), compared to FDPs retained by non-vital abutment(s) with cast metal posts 94.3% (95% CI [89.3–99.3%]). The difference was not statistically significant. Tooth vitality is suggested to contribute positively to the survival of SCs. The results are, however, limited by the small number of studies and the presence of uncontrolled cofounding clinical variables. In the retrospective studies II, III, and IV, dental records archives and the digital journals of all patients at the Faculty of Odontology, Malmö University, Sweden were reviewed to identify patients rehabilitated with full-coverage toothsupported FDPs and SCs. Cox regression was used to evaluate the associations between clinical covariates and prosthesis failure. The CSR was similar for FDPs and SCs after 5 years of function. CSR was higher for SCs compared to FDPs after 10, 15, and 20 years of function. Smoking, type of prosthesis material, and bruxism significantly influenced the survival of FDPs, whereas abutment vitality, position of the non-vital abutment, or prosthesis length did not show any significant influence on the occurrence of FDP failure. The survival of SC was influenced by anterior placement, non-vital abutments, and bruxism, while the patient’s age and sex, the location of the crowns in relation to the jaws, the type of tooth, the presence of post and core, and the type of crown material, treatment providers, or smoking did not show significant effects on the survival of SC.In summary, within the limitations of the review and retrospective studies, bruxism, smoking, and type of prosthesis material are suggested to contribute toFDP failure. Anterior placement, non-vital abutments, and bruxism are factors increasing the rate of SC failure.
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| 9. |
- Isaksson, Rita
(författare)
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Oral Treatment Intention and Realistic Oral Treatment Need for Patients in Long-term Care in Sweden, 2003
- 2003
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)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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| 10. |
- Johansson, Gunvi, 1950-
(författare)
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Oral health-related quality of life and young adults
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)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.
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