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- Dahlström, Lisbeth, 1962, et al.
(författare)
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Introducing nickel-titanium rotary instrumentation in a public dental service: The long-term effect on root filling quality
- 2011
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Ingår i: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. - : Elsevier BV. - 1079-2104. ; 112:6, s. 814-819
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to study the long-term effect on root filling quality after the introduction of nickel titanium rotary instrumentation (NTRI) within a public dental health organization. STUDY DESIGN: After an education package, including hands-on training and/or lectures, the root filling quality was evaluated at the organizational level. All general dental practitioners (GDPs) employed at primary evaluation (n = 120) and after 4 years (n = 174) were included. RESULTS: The improved root filling quality had been maintained 4 years later. The frequency of excellent root fillings was slightly higher at the long-term follow-up (52%) compared with the short-term follow-up (45%; P = .038). A nonsignificant decrease in very poor-quality root fillings was registered. CONCLUSIONS: A technology shift among GDPs to NTRI will increase the rate of good-quality root fillings. However, the shift per se will not eliminate the problem of substandard clinical performance.
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| 2. |
- Dahlström, Lisbeth, 1962, et al.
(författare)
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“It′s good enough”: Swedish general dental practitioners on reasons for accepting sub-standard root filling quality
- 2018
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 51:S3
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Tidskriftsartikel (refereegranskat)abstract
- Aim The concept of “good enough” is central and necessary in the assessment of root filling quality. The aim was to explore the concept by analysing reasons and arguments for the acceptance or rejection of substandard root filling quality as reported by GDPs in Sweden. Methodology The study was designed as a qualitative and exploratory study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Thirty-three general dental practitioners (GDPs) employed in the Public Dental Health Service in Gothenburg, Sweden, participated (4-6 GDPs/interview). In all nine predetermined questions were followed. Before each focus group, the participants received radiographs of 37 root fillings and were asked to assess the root filling quality. The three cases representing the most divergent assessments served as a basis for the discussion. The cases were presented without clinical information, the dentists would relate to the cases as being just root filled by themselves. Results The radiographs did not provide a sufficient basis for decisions on whether or not to accept the root filling. The present study emphasised that dentists did not primarily look for these arguments in the technical details of the root filling per se but instead they considered selected features of the contextual situation. The GDPs constantly introduced relevant “ad hoc considerations” in order to account for the decisions they made. These contextual considerations were related to aspects of pulpal and periapical disease, risks (e.g. technical complications) or to consumed resources (personal and/or economic). Conclusions It was obvious that the concept of “good enough” does not exist as a general formula ready to be applied in particular situations. Instead, it is necessarily and irremediably tied to contextual properties that emerge from case to case.
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| 3. |
- Dahlström, Lisbeth, 1962
(författare)
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On root-filling quality in general dental practice
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden, 250,000 root fillings are performed every year. The outcome of root canal treatment (RCT) is strongly correlated to the technical quality of the root filling. Epidemiological studies show high frequencies of suboptimal technical quality. Within the Swedish population, there are about 2,500,000 root-filled teeth with persistent periapical infections. There is therefore a discrepancy between the results that can be achieved and what is actually achieved in general dentistry. RCT is technically complicated, but new technology for instrumentation appears to have facilitated the procedure, as well as the technical results. Study I is a long-term follow-up of an implementation programme in the Gothenburg Public Dental Health Service (DHS), where all the dentists were educated in the new technology. The initial improvement in root-filling quality as seen in the radiographs remained. However, poor quality root fillings were still performed. In Study II, a different educational approach was investigated among all the dentists in the Södra Älvsborg DHS. The aims were to activate local networks at the clinics and enable the hands-on training to be performed by an educated dentist from each clinic. The results corresponded to the results in the Gothenburg study. Most dentists adopted the new technique and the frequency of good quality root fillings improved, albeit without any concomitant decrease in poor quality cases. It seems obvious that dentists fairly frequently accept inadequate technical results. With a view to understanding the reasons and decision-making related to suboptimal treatment, Studies III and IV used focus-group discussions with dentists within the Gothenburg DHS. Before the interviews, the dentists assessed the root-filling quality in a number of cases. The three cases causing the most divergent opinions were chosen for further discussions in the focus groups. Seven interviews were video taped, transcribed and analysed using qualitative content analysis. In Study III, the attitude to RCT was highlighted. The treatment was often associated with negative feelings, such as stress and frustration. The treatments were perceived as complex and technically difficult, often performed with a feeling of loss of control. Most dentists stated that they were not able to complete a case within the allotted time. Often “good enough” was seen as a realistic goal instead of optimal quality. The idea of “good enough” was further explored in Study IV. The analysis showed that the radiographic image was not a sufficient basis for whether or not to accept a poor root filling. Instead, it was always the specific situation in which the root filling was made that was decisive. These situations were related to pulpal or periapical health, risk assessments or personal or economic resources.
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| 4. |
- Dahlström, Lisbeth, 1962
(författare)
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Retrograd instrumentering
- 2010
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Ingår i: Tandläkartidningen. - 0039-6982. ; 102:15, s. 82-85
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Dahlström, Lisbeth, 1962
(författare)
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Temporära förband
- 2011
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Ingår i: Internetodontologi.
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Annan publikation (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Dahlström, Lisbeth, 1962, et al.
(författare)
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The impact of a continuing education programme on the adoption of nickel-titanium rotary instrumentation and root-filling quality amongst a group of Swedish general dental practitioners
- 2015
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Ingår i: European journal of dental education : official journal of the Association for Dental Education in Europe. - : Wiley. - 1396-5883 .- 1600-0579. ; 19:1, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim of the study was to test the hypothesis that a further education programme relating to nickel-titanium rotary instrumentation (NTRI), with the concurrent activation of social/professional networks amongst all general dental practitioners (GDPs) in a public dental service in Sweden, would increase the adoption rate and improve root-filling quality. MATERIAL AND METHOD: To activate the networks, the GDPs at the 25 clinics elected training coaches from amongst themselves. The coaches were educated by a specialist and were then free to organise and conduct the training of the local GDPs. However, collective hands-on training and discussions were mandatory. Lectures were held by an endodontist. The rate of adoption and root-filling quality was evaluated just before and 6 months after the education. Statistical tests were performed with chi-square using a 95% confidence interval. RESULTS: Nickel-titanium rotary instrumentation was adopted by 88%. Excellent root fillings (score 1) increased from 45% to 59% (P = 0.003). The rate of poor-quality root fillings (score 4 and score 5) was not affected. The quality ratio (score 1/score 5) increased from 5.36 (118/22) to 9.5 (133/14). Eleven dentists (17%) at nine different clinics produced 49% of the poor-quality root fillings (score 4 and score 5). Seventy-three per cent of these dentists stated that they had adopted NTRI. CONCLUSIONS: The introduction of NTRI will increase the adoption rate and the frequency of good-quality root fillings. However, it will not overcome the problems associated with dentists producing a low-quality level, even if a local professional network is activated.
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| 7. |
- Dahlström, Lisbeth, 1962, et al.
(författare)
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"Working in the dark”: Swedish general dental practitioners on the complexity of root-canal treatment
- 2017
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 50:7
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore elements of reasoning and understanding that might obstruct the performance of good-quality root canal treatment (RCT) and make general dental practitioners (GDPs) produce and accept root fillings of inferior quality. Methodology: The study was designed as a qualitative and explorative study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Nine predetermined questions were followed. Thirty-three GDPs (4–6 dentists/interview), employed in the Public Dental Health Service in Gothenburg, Sweden, participated. Results: Feelings such as anxiety, frustration, stress or exhaustion were associated with RCT. In general, RCT was regarded as complex, mysterious and embedded in uncertainty. A feeling of loss of control was frequently described in relation to all procedural steps from negotiating the canal to prognostic deliberations. Reasons could include challenging canals, complicated instruments and the fact that treatment had to be performed in a concealed space without visible insight. Several dentists questioned the requirements for correctly performing RCT, and some indicated that striving towards optimal technical root filling quality should not be expected in each case in general practice. Most of the GDPs were unable to complete a case within the remuneration system, and they therefore either spent more time than the set fee allowed for or accepted a suboptimal root filling when the time limit was reached. Conclusions: High levels of stress and frustration in relation to RCT were reported by the GDPs. RCT was regarded as complex and was often performed with an overall sense of lack of control.
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