Changes in dental status and dental care utilization in the Swedish population over three decades: age,period, or cohort effects?

Abstract – Objectives: In cross‐sectional data, cohort effects give a false impression of changes in edentulousness over age and time. This study, therefore, corroborated cross‐sectional data with corresponding longitudinal analyses. Complete or partial edentulousness and yearly dental care utilization were studied from 1968 to 2002. Methods: A nationally representative Swedish panel study allowed repeated cross‐sectional comparisons of ages 18–75 (5 waves n ≈ 5000), and ages 77+ at later waves (2 waves n ≈ 500). Cross‐sectional 10‐year age group differences in 5 waves, time‐lag differences between waves for age groups, and within‐cohort differences between waves for 10‐year birth cohorts were examined. Results: Regular over time analysis revealed large decreases in edentulousness between waves. While cross‐sectional differences indicated an exponential curve‐linear age‐dependency, longitudinal differences revealed little decline, contradicting cross‐sectional results. Following the cohorts showed little change within cohorts but large differences between cohorts. Care utilization increased between 1968 and 2002 in older age groups but decreased somewhat in younger ones. In 1968, utilization was highly age‐related with lower utilization rates among older age groups. By 2000/2002, this had almost reversed. However, all cohorts had aged with little change in their rates of care utilization, while at the same time great between‐cohort differences were demonstrated. Conclusions: For both edentulousness and dental care utilization, almost all variation originated before 1968. These cohort effects are probably the consequences of changes in dentistry going back several decades and they demonstrate the early socialization of health behavior.     

How do social-psychological concerns impede the delivery of care to people with HIV? Issues for dental education

Oral health is an essential aspect of the overall medical care for patients with HIV. However, fear of status disclosure is a significant barrier to access to care. Preparing future oral health care providers to maintain all aspects of confidentiality and to understand the role stigma plays in the lives of HIV-positive individuals are critical issues that must be addressed by dental education. To provide important perspectives regarding HIV-related stigma and confidentiality, data from the HAART (Highly Active Antiretroviral Therapy) Project is presented. This study is a five-year National Institute of Allergy and Infectious Disease (NIAID)-funded longitudinal qualitative study of sero-positive African Americans' adherence to antiretroviral therapy (N=137). The current literature regarding HIV patient confidentiality and student attitudes regarding HIV/AIDS is also reviewed. Findings suggest that dental student attitudes may be improved by providing more comprehensive experiences and information and that procedures in place in dental clinics should be continuously monitored to ensure that patient confidentiality is maintained. Strategies for addressing these important issues in dental education are presented. Ensuring that dental school graduates are well prepared to maintain confidentiality with sensitivity to the role stigma plays in HIV disease has the potential to enhance access to health care.     

Why be down in the mouth? Three decades of research in oral microbiology

This paper describes some of the work done in the author's laboratory over the past 35 years. The research covers the following areas: the physiology of oral streptococci and their interactions; the physiology of some Gram-negative anaerobes and their interactions in relation to periodontal diseases; preventing the major dental diseases; and the future of oral microbiology.     

What is the role of specialties in dentistry?

Dental specialties have an important, positive role in improving education and practice, stimulating research and defining quality expectations in their areas of expertise. However, it is well-known that general dental practitioners accomplish a significant portion of the dental therapy that commonly is classified as being within the scope of the respective recognized specialty areas. In this column, I have made suggestions about methods for improving the interaction between specialists and generalists and a call for better acceptance by each group of the capabilities of the other.     

Defensive behavior in medical care. A lesson for the dentist?

Defensive behaviour in medical care is defined as a clear deviation from the physicians (dentists) usual behaviour and from what he/she considers to be good practice in order to prevent problems in the contact with patients and their families. General practitioners behave defensively in substantial proportion of their referrals to a specialist (15%) and of their ordering diagnostic tests (25%). In both instances varying (clinical and non-clinical) reasons can prompt the physician to refer or to test. Defensive considerations can play an equally varying role within all these reasons, which shed more light on the nature of the daily work in primary care. It is concluded that no reason exists to presume that Dutch dentists are more free either from non-clinical considerations and from defensive behaviour when they treat their patients than general practitioners.     

Clinical leadership and prevention in practice: is a needs led preventive approach to the delivery of care to improve quality,outcomes and value in primary dental care practice a realistic concept?

Background

There is a need to improve access to, and the quality of, service delivery in NHS primary dental care. Building public health thinking and leadership capacity in clinicians from primary care teams was seen as an underpinning component to achieving this goal. Clinical teams contributed to service redesign concepts and were contractually supported to embrace a preventive approach.

Methods

Improvement in quality and preventive focus of dental practice care delivery was explored through determining the impact of several projects, to share how evidence, skill mix and clinical leadership could be utilised in design, implementation and measurement of care outcomes in general dental practice in order to champion and advocate change, during a period of substantial change within the NHS system.The projects were:1. A needs-led, evidence informed preventive care pathway approach to primary dental care delivery with a focus on quality and outcomes.2. Building clinical leadership to influence and advocate for improved quality of care; and spread of learning through local professional networks. This comprised two separate projects: improved access for very young children called “Baby Teeth DO Matter” and the production of a clinically led, evidence-based guidance for periodontyal treatment in primary care called “Healthy Gums DO Matter”.

Results

What worked and what hindered progress, is described. The projects developed understanding of how working with ‘local majorities’ of clinicians influenced, adoption and spread of learning, and the impact in prompting wider policy and contract reform in England.

Conclusions

The projects identified issues that required change to meet population need. Clinicians were allowed to innovate in an evironment working together with commissioners, patients and public health colleagues. Communication and the development of clinical leadership led to the development of an infrastructure to define care pathways and decision points in the patient's journey.

     

What is the dentist's role in the recognition of child abuse?

For a Dutch dentist, the chance to recognise a physical abused child with injuries in the head-neck region, is less than once every 18 months. But child abuse is difficult to recognize. In spite of all this, it's still important for dentists to know how to recognise child abuse, since the effects on a child can be harmful. Child abuse finds its expression in, for example bruises, burns, laceration of the labial frenulum or avulsed teeth. There are also often behavioural problems. Clothes can mask lesions. The fact that child abuse can't be reported anonymously is a misconception. Professionals can report a case of child abuse anonymously to the "Advies en Meldpunten Kindermishandeling", although a not anonymous report is favoured.     

Palpation of the lateral pterygoid region in TMD--where is the evidence?

OBJECTIVE: Palpation of the lower head of the lateral pterygoid muscle is included in many study protocols and examination schemes of the masticatory system. The aim of this investigation was to search the medical/dental literature to find evidence for the validity and reliability of this diagnostic procedure. METHODS: A systematic search was carried out using different electronic databases (Medline Ovid, PubMed, Cochrane Library, Embase, Current Contents Connect, Science Citation Index, Web of Science, Japana Centra Revuo Medicina), supplemented by handsearch in selected journals and by examination of the bibliographies of the identified articles. RESULTS: Validity: As far as the palpability of the inferior head of the lateral pterygoid muscle is concerned, five publications representing four studies could be identified. According to these investigations, the lateral pterygoid muscle is practically inaccessible for intraoral palpation due to topographical and anatomical reasons. Other anatomical structures, such as the superficial head of the medial pterygoid muscle, may be palpated instead in this region. Reliability: Determination of the palpability of the lateral pterygoid muscle is characterized by poor interexaminer agreement. Studies investigating the presence of pain in response to palpation of the lateral pterygoid area revealed a moderate intra- and interindividual reliability. Because of the tenderness of the lateral pterygoid region even among healthy subjects, positive findings may lead to wrong conclusions with regard to the need of treatment. CONCLUSIONS: Considering the lack of validity and reliability associated with the palpation of the lateral pterygoid area, this diagnostic procedure should be discarded.     

What is the role of dentists in smoking cessation?

The associations between tobacco use and diseases affecting the oral cavity, such as periodontal disease and cancer, are now well recognised. This has lead to proposals from some members of the profession and the BDA that members of the dental team should provide smoking cessation services. Many dentists have positive attitudes towards the idea of dentists encouraging patients to stop smoking. However the belief that members of the dental team should engage in delivering smoking cessation interventions is not held by all parties. More dentists believe that they should offer smoking cessation support than actually do provide it and reasons for not providing it include time and reimbursement issues, need for further training and poor co-ordination of dental and smoking cessation services.