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| 2. |
- Bazsefidpay, Nikoo, 1984-, et al.
(författare)
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Antibiotic prescription in bone augmentation and dental implant procedures : a multi-center study
- 2023
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Ingår i: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Adherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections.METHODS: Medical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010-2011 and 200 in 2014-2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012.RESULTS: There was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010-2011 to 18.5% (n = 37/200) in 2014-2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P < 0.001). The administration of a 3-7-days antibiotic prescription increased significantly from 25.5% in 2010-2011 to 35% in 2014-2015. The postoperative infection rates (4.5% and 6.5%) were without difference between the studied periods. Smoking and omitted antibiotic prophylaxis significantly increased the risk of postoperative infection. Logistic regression analyses showed that patient male gender and suffering from a disease were predictive factors for the clinician to adhere to the guidelines.CONCLUSIONS: After introduction of national recommendations for antibiotic prophylaxis before bone augmentation procedures, the patient group receiving a single preoperative dose decreased while the group not given antibiotic prophylaxis increased. There was no difference in occurrence of postoperative infections between the two time periods. The results indicate a need for educational efforts and strategies for implementation of antibiotic prudence and awareness among surgeons performing bone augmentation procedures.
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| 3. |
- Friman, Göran, et al.
(författare)
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Identifying patients in dental settings at risk of cardiovascular disease and diabetes
- 2013
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Ingår i: Cardiovascular system. - : Herbert open access journals. - 2052-4358. ; 1:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of our study was to identify patients in a dental setting at risk of already having or developing high blood pressure or high plasma glucose, investigate possible associations between these conditions and periodontal status and explore the correlation between screening results and follow-up assessments concerning the need for medical treatment and/or lifestyle changes performed by medical staff.Methods: A total of 170 dental patients were consecutively included at their regular yearly check-up visit. Data on age, weight, height, amount and use of tobacco and medication for cardiovascular disease and diabetes mellitus were collected, as well as data about systolic and diastolic blood pressure, in addition to pulse and plasma glucose. Clinical and radiographic examinations revealed data about periodontal status by probing periodontal pockets and measuring marginal alveolar bone loss by means of x-rays. Patients who exceeded normal diastolic blood pressure and plasma glucose values were referred for diagnosis and care.Results: Thirty-nine patients exhibiting high values were provided referrals and 24 or 14.1% of the 170 participants required additional care. The correlation between oral and medical health care concerning blood pressure recorded was 64.5% (p<0.001), while the correlation was 40.0% (p<0.001) concerning plasma glucose. Among middle aged men and elderly subjects, the data revealed/showed a significant correlation between marginal alveolar bone loss and high systolic blood pressure (p=0.001).Conclusions: The correlation between oral health care and medical health care registrations based on blood pressure and plasma glucose indicates that it may be appropriate for dental professionals to perform opportunistic medical screening and refer risk patients to the medical care system before complications occur. In order to identify medical risk patients in dental settings on the basis of high blood pressure, a suggestion may be to examine middle-aged men and elderly patients of both sexes who exhibit radiographic markers for marginal alveolar bone loss.
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| 4. |
- Friman, Göran, DDS PhD, 1956-, et al.
(författare)
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Medical screening in dental settings : A qualitative study of the views of authorities and organizations Health Services Research
- 2015
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Ingår i: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The practice of identifying individuals with undiagnosed diabetes mellitus type II or undiagnosed hypertension by medical screening in dental settings has been received positively by both patients and dentistry professionals. This identification has also shown to be cost-effective by achieving savings and health benefits, but no investigation has been made of the attitudes of authorities and organizations. The aim of this study was to describe the views of authorities and organizations. Results: Thirteen authorities and organizations were interviewed of the sample of 20 requested. Seven approached authorities and organizations did not believe it was relevant to participate in the study. The manifest analysis resulted in four categories: medical screening ought to be established in the society; dentistry must have relevant competence to perform medical screening; medical screening requires cooperation between dentistry and health care; and dentistry is not the only context where medical screening could be performed. The latent analysis resulted in an emerging theme: positive to, but uncertain about, the concept of medical screening in dental settings. The spokespersons for the approached authorities and organizations had a positive view of medical screening but the respondents experienced a lack of facts concerning the scientific communities’ position, guidelines and procedures in the topic. Conclusions and implications: Approached authorities and organizations generally had a positive view of medical screening in dental settings but were uncertain about the concept. Further scientific knowledge and guidelines concerning the topic are needed before it can be commonly introduced and additional research on implementation strategies and long-term follow-up of medical screening are needed.
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| 5. |
- Friman, Göran, DDS PhD, 1956-, et al.
(författare)
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Seven-Year Follow-Up of Screening for Hypertension and Diabetes at a Dental Clinic
- 2019
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Ingår i: Journal of Dentistry and Oral Sciences. - : Maples. - 2582-3736. ; :2, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the distribution of risk, diagnosis and pharmacological treatments for diabetes and hypertension after seven years among patients provided with opportunistic medical screening in a dental setting.Material and Methods: The initial screening’s 170 participants were asked to take part in a seven-year follow-up study. Data were collected through self-reported information in a written health declaration. Outcome measures:• Number of study participants who had passed away• Prescription of antidiabetics or antihypertensives• Changes in weight and height to calculate body mass index (BMI)Results: The follow-up study consisted of 151 participants. Twenty had passed away. The risk needs for medicating with antihypertensive drugs after seven years for those not receiving pharmacological treatment at the initial screening was 3.7 times greater (p=0.025 CI 1.2-11.3) for participants with a diastolic blood pressure (BP) ≥ 90 mm Hg (85 for diabetics) than for the others. The risk was 3.9 times greater (p=0.020 CI 1.2-12.6) for those with a systolic BP of 140-159 mm Hg and 54.2 times greater (p<0.0001 CI 9.8-300.3) for those with a systolic BP ≥ 160 mm Hg than for those with a systolic BP 140 mm Hg. There were no changes in BMI.Conclusion: At least one in ten cases of incorrect medication or undiagnosed hypertension may be identifiable through opportunistic medical screening.
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| 6. |
- Hultin, Lisa, et al.
(författare)
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Information and Communication Technology Can Increase Patient Participation in Pressure Injury Prevention A Qualitative Study in Older Orthopedic Patients
- 2019
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Ingår i: Journal of Wound, Ostomy and Continence Nursing (WOCN). - : LIPPINCOTT WILLIAMS & WILKINS. - 1071-5754 .- 1528-3976. ; 46:5, s. 383-389
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to assess the participatory capabilities of hospitalized older adults in response to the Continuous Bedside Pressure Mapping system placed on the beds to prevent pressure injuries. DESIGN: Descriptive study. SUBJECTS AND SETTING: A convenience sample of 31 orthopedic patients were recruited from an orthopedic rehabilitation unit at a university hospital in Uppsala, Sweden, that served patients aged 65 years and older. METHODS: Semistructured interviews were conducted between November 2016 and February 2017, audio-recorded, and transcribed verbatim. Data were analyzed using qualitative content analysis. RESULT: The overall theme from 21 interviews was "A new way of understanding helped patients to recognize vulnerable pressure points and to take action in their own care" from which 2 categories, "awareness" and "action," emerged. The study showed that verbally adapted information combined with using information and communication technology increased most participants' knowledge and as they became aware of increased pressure, they started to take preventative action by changing position. CONCLUSIONS: It is possible for older participants in a rehabilitation unit who had recent orthopedic surgery to understand and use new information and communication technology and should be invited to participate in pressure injury prevention.
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| 7. |
- Hultin, Lisa, et al.
(författare)
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PURPOSE T in Swedish hospital wards and nursing homes : A psychometric evaluation of a new pressure ulcer riskassessment instrument
- 2020
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 29:21/22, s. 4066-4075
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the psychometric characteristics of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T); reliability (inter-rater and test–retest) and validity (convergent validity) in a Swedish context.Background: Pressure ulcers are considered as an adverse event and are a problem in healthcare worldwide. The first step in pressure ulcer prevention is to identify pa-tients that are at risk. PURPOSE T is a new pressure ulcer risk assessment instrument that was developed in the UK using “golden standard” instrument method.Design: Observational, descriptive and comparative.Methods: A total of 235 patients and 28 registered nurses were recruited (May 2018–November 2018) from six hospital wards at a university hospital and two community nursing homes in Sweden. Blinded (ward/nursing home nurses and expert nurses) PURPOSE T assessments and follow-up retests were undertaken. Cross-tabulation and kappa statistics were used to examine the reliability, and phi correlation was used to test the convergent validity. The study followed the STROBE guideline.Results: The clinical evaluation showed “very good” (kappa) inter-rater and test–re-test reliability for PURPOSE T assessment decision overall. The agreement of “at risk”/“not at risk” for both inter-rater and test–retest was also high, at least 95.5%. The convergent validity between PURPOSE T and other traditional assessment in-struments was moderate.Conclusion: The evaluation of PURPOSE T demonstrated good psychometric char-acteristics. Further research is needed to evaluate PURPOSE T’s usability among reg-istered nurses.Relevance to clinical practice: There is a lack of evidence-based validated pressure ulcer risk assessment instruments for use in health care. According to our findings, the Swedish version of PURPOSE T could be used in hospitals and nursing homes to identify patients in risk or with pressure ulcers.
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| 8. |
- Hultin, Margareta, et al.
(författare)
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Dental implant procedures contribution to the total antibiotic use in Swedish dentistry. A register-based study
- 2023
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 81:2
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study the influence of demographic and organizational factors to antibiotic utilization in dental implant surgery in Sweden. Material and methods Descriptive statistics regarding antibiotic prescription between 2009 and 2019 was retrieved from two national registers, the Swedish Prescribed Drug Register and the Dental Health register, both administered by the National Board of Health and Welfare. Results During the years 2009-2019 a significant decrease of the proportion of prescriptions of systemic antibiotics in conjunction with implant surgical procedures occurred in all patient groups where the most common procedure was the insertion of a single implant. The proportion of dental visits when implant surgical treatment was performed which resulted in a prescription of antibiotics decreased significantly from 1/3 to approximately 1/5. However, comparing Public and Private dental care providers, the reduction was significantly greater in Public dental care. Patients with low level of education in urban regions, treated in Private dental clinics were more likely to receive antibiotics in conjunction to implant surgery compared to other groups. Phenoxymethylpenicillin is the most widely used substance in conjunction with implant surgery. Conclusion There is still room for improvement in reduction of antibiotic prescriptions in conjunction to implant surgical procedures in Sweden.
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| 9. |
- Hultin, Margareta
(författare)
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Factors affecting peri-implant tissue reactions
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Screw- shaped titanium implants are today routinely used m the substitution of lost teeth. In this thesis some of the biological factors related to the long-term survival and maintenance of dental implants were studied. The first arm of these studies was to evaluate the neutrophil activation around teeth and dental implants (Papers I & II). Secondly we wanted to evaluate the clinical radiographic and microbiological status of implants after long-term. function m partly edentulous patients (Paper III). The long-term treatment outcome of implant treatment m fully edentulous was also compared to that m partially edentulous patients (Papers III & IV). The third and final purpose of these studies was to investigate the influence of smoking, a history of periodontitis and a specific host-response pattern on the occurrence of late fixture loss and marginal bone loss around dental implants (Papers IV & V). Papers I and II showed that the inflammation around implants m partly edentulous patients induced a stronger neutrophil reaction than did the inflammation around implants m edentulous patients albeit similar clinical appearance and absence of significant differences m the microbiota. Paper III, showed that marginal bone loss around implants after ten years of function in partly edentulous patients was limited and comparable to that m edentulous jaws. There was no major difference in the microbiota colonising teeth and implants. In Paper IV, 143 consecutively treated patients were evaluated retrospectively after five years of function of implants. Only 2% of the fixtures were lost during function. No correlation was found between bone loss around implants and teeth. A history of periodontitis did not influence mar~ bone loss around implants Smoking was not found to correlate with marginal bone loss at neither implants nor teeth. In Paper V a site-specific inflammatory reaction around implants with peri- implantitis rather than a patient-associated host-response was found in patients with failing implants Patients with peri-implantitis harboured high levels of periodontal pathogens, Actinobacillus actinomycetemcomitans Porphyromonas gingivalis Prevotella intermedia, Bacteroides forsythus and Treponema denticola. In conclusion Although the inflammation around implants m partly edentulous patients induces a stronger neutrophil reaction, than M m the edentulous ones, the marginal bone loss after long-term function in the former is limited and similar to that in edentulous jaws. In patients treated for periodontal disease stable periodontal and peri-implant conditions can be maintained during long term function The periodontally-associated microbiota constitute a risk for future development of peri-implantitis In patients with a history of periodontitis Le. individuals who previously have shown a tissue destructive inflammatory response, this risk is more pronounced.
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| 10. |
- Klinge, Anna, et al.
(författare)
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Prophylactic antibiotics for staged bone augmentation in implant dentistry
- 2020
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 78:1, s. 64-73
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Forskningsöversikt (refereegranskat)abstract
- Background: The objective of the study was to assess the effect of prophylactic antibiotics on the outcome of bone augmentation and subsequent dental implant placement by combining the recommended quality assessment methods for systematic reviews and primary studies.Materials and methods: This is a complex systematic review in which systematic reviews as well as primary studies are scrutinised. A search of Medline (OVID), The Cochrane Library (Wiley) and EMBASE, PubMed and Health technology assessment (HTA) organisations as-well as a complementary hand-search was carried out. Selected primary studies were assessed using GRADE. Each study was reviewed by three authors independently.Results: Abstract screening yielded six potential systematic reviews allocated for full-text inspection. A total of ten primary studies were read in full-text. No relevant systematic reviews regarding the topic of this article were found. The quality assessment resulted in two primary studies with a moderate risk of bias. Of the two studies with a moderate risk of bias, one compared a single dose of clindamycin 600 mg preoperatively with the same preoperative dose followed by four doses of 300 mg every 6 h. The second study compared a single dose prophylaxis of two different types of antibiotic compounds.Conclusion: In conclusion, the scientific evidence regarding the use of antibiotic prophylaxis for reducing the risk of infection in conjunction with bone augmentation procedures during dental implant placement is very limited. The infection rate as compared to nonusage of prophylactic antibiotics, selection of the most suitable compound, and the optimal duration of prophylactic treatment is still unknown.
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