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| 2. |
- Brahm, Carl-Otto, 1974, et al.
(author)
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Dentists' skills with fearful patients: education and treatment.
- 2013
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In: European journal of oral sciences. - : Wiley. - 1600-0722 .- 0909-8836. ; 121:3 Pt 2, s. 283-291
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Journal article (peer-reviewed)abstract
- The aims were to explore dentists' skills in dental fear, current strategies when treating fearful adult patients, and the possible need for additional education among dentists working in Sweden. A sample of 1,293 members of the Association of Public Health Dentists in Sweden were asked to respond to a Web survey concerning dental fear. The response rate was 69% (n = 889); 91% trained in Sweden and 9% trained in another country. The most frequently used pharmacological anxiety-reducing techniques were medication with a midazolame mixture (72%) and benzodiazepine tablets (77%), and the most commonly used psychological techniques were relaxation (68%), distraction (66%), and Tell-Show-Do (86%). A larger proportion of dentists trained in Sweden, compared with dentists who were trained in other countries, reported that they had received undergraduate training in dental fear. Dentists trained in Sweden more often reported competence in pharmacological and psychological anxiety-reducing techniques, compared with dentists who were trained in other countries. Higher levels of self-rated efficacy in treating fearful patients accompanied additional education in dental fear after graduation. In conclusion, Swedish dentists use a variety of techniques to meet the needs of fearful dental patients. Competence in anxiety-reducing techniques is associated with self-efficacy and the site of education.
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| 3. |
- Brahm, Carl-Otto, 1974, et al.
(author)
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Dentists' views on fearful patients. Problems and promises.
- 2012
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In: Swedish Dental Journal. - 0347-9994. ; 36:2, s. 79-89
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Journal article (peer-reviewed)abstract
- Abstract A large number of patients treated in the general dental health service in Western countries report dental fear to some degree. Dentists' views of treating these fearful patients are not well described in the literature.Therefore, the aims of the study were to explore dentists' attitudes towards, experience of, and feelings about treating fearful patients. The sample consisted of 1293 members of the Association of Public Health Dentists in Sweden who were asked to respond to a web survey concerning dental fear. The response rate was 69% (n = 889).The majority of the responding dentists stated that dental fear is a problem in routine dental care,treating patients with dental fear is a positive challenge and they felt they were making a contribution.They also reported that treating patients with dental fear is associated with hard work, poor revenues, and little appreciation by employers. Female dentists reported a greater proportion of patients with dental fear and greater self-efficacy regarding the treatment of these patients, compared with their male colleagues. Dentists trained in other EU countries reported stress more often and less perceived contribution when treating fearful patients, compared with colleagues trained in Sweden. CONCLUSION: Dentists' views of treating fearful patients are mainly positive; however, it is problematic that dentists feel stress and that dentists who treat many fearful patients feel their employers do not appreciate their efforts.
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| 4. |
- Brahm, Carl-Otto, et al.
(author)
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Development and evaluation of the Jönköping Dental Fear Coping Model : a health professional perspective
- 2018
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In: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 76:5, s. 320-330
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Journal article (peer-reviewed)abstract
- Objective: The purpose of this study was to design a structured treatment model focusing on all levels of adult’s dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective.Material and methods: The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls.Results: Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear.Conclusions: The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.
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| 5. |
- Brahm, Carl-Otto, et al.
(author)
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Evaluation of the Jönköping dental fear coping model : a patient perspective
- 2019
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In: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:3, s. 238-247
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Journal article (peer-reviewed)abstract
- Objective: This study is a part of a project with the aim to construct and evaluate a structured treatment model (the Jönköping Dental Fear Coping Model, DFCM) for the treatment of dental patients. The aim of the present study was to evaluate the DFCM from a patient perspective.Material and methods: The study was performed at four Public Dental Clinics, with the same 13 dentists and 14 dental hygienists participating in two treatment periods. In Period I, 1351 patients were included and in Period II, 1417. Standard care was used in Period I, and in Period II the professionals had been trained in and worked according to the DFCM. In the evaluation, the outcome measures were self-rated discomfort, pain and tension, and satisfaction with the professionals.Results: In comparison with standard care, less tension was reported among patients treated according to the DFCM, (p =.041), which was also found among female patients in a subgroup analysis (p =.028). Additional subgroup analyses revealed that patients expecting dental treatment (as opposed to examination only) reported less discomfort (p =.033), pain (p =.016) and tension (p =.012) in Period II than in Period I. Patients with low to moderate dental fear reported less pain in Period II than in Period I (p =.014).Conclusions: The DFCM has several positive effects on adult patients in routine dental care. In a Swedish context, the differences between standard care and treatment according to the model were small but, in part, statistically significant. However, it is important to evaluate the model in further studies to allow generalization to other settings.
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| 6. |
- Brahm, Carl-Otto, et al.
(author)
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Patients with head and neck cancer treated with radiotherapy : Their experiences after 6 months of prophylactic tooth extractions and temporary removable dentures
- 2021
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In: Clinical and Experimental Dental Research. - : John Wiley & Sons. - 2057-4347. ; 7:5, s. 894-902
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Journal article (peer-reviewed)abstract
- Objectives: The impact of dental occlusion on the experiences of head and neck cancer patients and their oral, social and psychological functioning has been sparsely investigated. There is a lack of knowledge regarding the experience of tooth loss and dentures among patients treated for head and neck cancer. The aim of this study was to describe the experiences of head and neck cancer patients of prophylactic tooth extractions and temporary removable dentures, 6 months after radiotherapy treatment. Material and methods: An individual interview with 25 patients 6 months after radiotherapy was subjected to a qualitative content analysis. Results: Two categories, Impaired oral function and Belief in the future, and seven subcategories described the patients' experiences of temporary removable dentures during the first 6 months after prophylactic tooth extractions. The temporary removable dentures affected the patients' ability to chew, swallow and speak, caused pain, and were experienced as an enemy. Despite that, the patients were hopeful and had a wish for recovery, which gave them the energy to live. Conclusion: Prophylactic tooth extractions and temporary removable dentures 6 months after radiotherapy treatment affect head and neck cancer patients' recovery and everyday life. However, they have the will to take on these challenges, pertaining not only to themselves, but also to relatives and health professionals. At the individual level, the patient needs individualized professional support to get through the arduous procedure, from the acute situation until the end of the rehabilitation phase.
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| 7. |
- Brahm, Carl-Otto, et al.
(author)
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Prosthodontic treatment of patients with disabilities at dental specialist clinics in the County of Västra Götaland.
- 2009
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In: Swedish dental journal. - 0347-9994. ; 33:1, s. 11-8
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Journal article (peer-reviewed)abstract
- In 1998 the Swedish Parliament decided about increased financing of dental support and service given to persons with disabilities who were dependent on nursing personnel or others in their activities of daily life including oral hygiene procedures. One part of the legislation called "Necessary dental care, group 3" (NDC3) includes persons with intellectual disabilities and disabilities due to brain damage, autism and autism-like disorders, and persons with lasting mental and physical disabilities not related to normal ageing. The objectives where to investigate persons affected by this legislation; how many and what patients covered by NDC3 in Västra Götaland County received prosthodontic therapy from 2001 through 2004, at hospital dental clinics or dental specialist clinics. Patients treated with prosthodontic restorations covered financially by the county council under the terms of NDC3 were identified through the county council's registers. The application forms for NDC3 were retrieved and information about patient characteristics and type of treatments were compiled. It was shown that 57 patients covered by NDC3 in Västra Götaland County received prosthodontic therapy at dental specialist clinics and 50 were treated at the hospital dental clinics for extensive prosthodontic treatment needs. The mean age for the patients rehabilitated with removable dentures was higher (56.2 years) compared with patients treated with single tooth implants (39.7 years). About 30 patients, representing 1 to 2% of the NDC3 population in Västra Götaland County were rehabilitated with more advanced prosthodontic restorations in hospital dental clinics or dental specialist clinics each year. In conclusion and with respect to the probably large need for prosthodontic therapy among persons with disabilities, the use of NDC3 has not been properly utilized.
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| 8. |
- Brahm, Carl-Otto, 1974
(author)
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The fearful patient in routine dental care
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Background: Managing dental fear is a daily challenge in dental care. The overall aims of this thesis were to study the attitudes of dental health professionals to fearful dental patients, and their skills and strategies when treating these patients. A second overarching aim was to develop and evaluate a structured model for information and communication about dental fear in the treatment situation, the Jönköping Dental Fear Coping Model (DFCM), to the benefit of both the dental health professionals and their adult patients. The evaluation of the DFCM primarily focuses on outcomes pertaining to dental health professionals, but also on patient outcomes. Most dental fear treatment has focused on extreme dental fear; however, the DFCM is designed to work with the different levels of dental fear encountered in ordinary dental clinical work. Material and Methods: The focus of the thesis is on dental health professionals treating adult patients, with or without dental fear. In a web survey, the experience and preparedness of dentists in Sweden to treat fearful patients were investigated. The DFCM was then developed with the aim to reduce stress among dental health professionals when treating fearful patients, and to reduce dental fear among patients. An intervention study was performed to evaluate the DFCM, both from a staff and a patient perspective. Results: In the web survey, 20% of the dentists reported that they experienced stress when treating fearful patients. Despite reporting relatively good skills and expressing mainly positive attitudes towards treating adult fearful patients, a need for training in dental fear was expressed by the dentists. Data from the intervention study did not support the main hypothesis that the DFCM strengthened the professionals’ self-efficacy at treating fearful patients; however, it does indicate that using the DFCM facilitates the dental professionals’ identification of dental fear and their communication with patients. Furthermore, it seems to reduce tension among fearful patients. Conclusion: The Jönköping DFCM can be used to improve the rapport with patients during the dental examination, and a Dental Fear Summary provides important information to support the dental treatment. The Jönköping DFCM needs to be evaluated in other studies and in other contexts, such as in private dental care/management.
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| 9. |
- Norderyd, Ola, et al.
(author)
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Oral health of individuals aged 3-80 years in Jonkoping, Sweden, during 40 years (1973-2013)
- 2015
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In: Swedish Dental Journal. - : Swedish Dental Journal. - 0347-9994. ; 39:2, s. 57-68
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Journal article (peer-reviewed)abstract
- The aim of the this study was to present data on oral care habits and knowledge of oral health in 2013, and to compare these data with results from a series of four previous cross-sectional epidemiological studies. All these studies were carried out in the city ofionkoping, Sweden, in 1973,1983,1993, 2003, and 2o13.The 1973 study constituted a random sample of L000 individuals evenly distributed in the age groups 3, 5,10,15, 20, 30,40, 50, 6o, and 7o yea rs.The same age groups with addition of a group of 8o-year-olds were included in the 1983,1993, 2003, and 2013 studies, which comprised 1,104;1,078; 987; and 1,010 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used. The questionnaire contained the same questions in all the five studies, although some had to be slightly modernised during the 40-year period. During the period 1973-2013, a continous increase of individuals in the age group 20-6o years were treated by the Public Dental Service amounting to about 5o%. Almost 7o% of the 70- and 80-year-olds were treated by private practitioners. In 2013,10-20% of the individuals in the age groups 30-40 years did not regularly visit neither Public Dental Service nor a private practitioner.The corresponding figures for the individuals 50-80 years old were 4-7%. Similar number of avoidance was reported in the previous studies. In the survey 2013, about 20-30% of the individuals in the age groups 20-50 felt frightened, sick, or ill at ease at the prospect of an appointment with the dentist.These findings were in agreement with the results from the surveys 1973-2003. Among the younger age groups, 10-15 years, a reduction in self-reported "ill at ease" was found in the surveys 2003 and 2013 compared to the previous surveys in this series. In 2013, the knowledge of the etiology of caries was known by about 6o% of the individuals which was similar to that reported 1973 zoo3.Twenty per cent of the individuals stated that they did not know which etiological factors that causes caries.This percentage was equivalent during the period 1973-2013. About 85% of the individuals in all age groups brushed their teeth with fluoride tooth paste at least two times a day.These frequencies have gradually increased during the 40-year period. Around 40% in the age groups 50-8o years used toothpicks regularly in 2013.This is a about 1/3-1/2 less compared to 2003. In the age groups 20-40 years 3-14% used toothpicks for proximal cleaning in 2013. In 2013, about 35% of the individuals never consumed soft drinks, in comparison with 20% in 2003. In the age groups 3-20 years about 20% were consuming soft drinks every day or several times a week, which is a reduction by half compared to 2013
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| 10. |
- Norderyd, Ola, et al.
(author)
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Oral health of individuals aged 3-80 years in Jonkoping, Sweden during 40 years (1973-2013)
- 2015
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In: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 39:2, s. 69-86
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Journal article (peer-reviewed)abstract
- The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried out 1973-2003. In 1973,1983,1993,2003, and 2013 random samples of 1,000;1,104;1,078; 987; and 1,010 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3,5,10,15, 20,30,40,50, 60,70, and 8o years. Eighty-year-olds were not included in 1973. All subjects were inhabitants of the city of Jonkoping, Sweden.The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment.The frequency of edentulous individuals aged 40-70 years was 16,12, 8,1, and 0.3% in 1973,1983,1993, 2003, and 2013, respectively. No complete denture wearer younger than 80-years old was found in 2013. During the 40-year period, the mean number of teeth in the age groups 30-80 years increased. In 2013, the 60-year-olds had nearly complete dentitions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36 in 2013.This was higher than earlier surveys,4 in 1993, and 18 in 2003.The percentage of children and adults without caries and restorations increased during the 40-year period. It was found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013. In the age groups 10-20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013,43% of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5-60 years, DFS was lower in 2013 compared to the earlier examinations. There was no major change in DFS between 2003 and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40 year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percentage of crowned teeth in the age goups 4o and 50-year-olds. The percentage of endodontically treated teeth decreased between 1973 and 2013 in all age groups.In age groups-Jo-30-year-olds a major reduction from about 3o% to 15% in mean plaque score was seen between 1973-2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older, a decrease in the percentage of surfaces with plaque was observed between 2003-2o13.The percentage of tooth sites with gingivitis was for zo years and older about 4o% in 1973. In 2013, the percentage was about15%. The frequency of sites with gingivitis was generally lower in 2013 compared with the other years:1973-1993.The percentage of individuals with probing pocket depths >4mm increased with age. Between 2003-2013 a clear reduction was seen in all age groups in frequency of individuals with probing pocket depth >4mm. Over the 40-year period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects with moderate alveolar bone loss were seen.The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the provision of dental helath care and dental delivery system in the near future.
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