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Periodontal treatment strategies in general dentistry
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0001-9449-9073
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Periodontal diseases, such as gingivitis and chronic periodontitis,are infectious diseases that are common in the adult population. InSweden, treatment is mostly provided in general dentistry by generaldental practitioners (GDPs) and dental hygienists (DHs). Thecare chain also comprises periodontists since they act as consultantsto the GDPs and DHs. Several studies have explored how cliniciansjudge, diagnose, and treat patients with different diseasesbut no previous study has explored how patients, with commonlyoccurring periodontal conditions in a population, are diagnosedand treated in general dentistry. Therefore the overall aim of thethesis was to study the treatment strategies applied by general dentistryclinicians to patients with common periodontal conditions.This thesis is based on five studies, where study I-IV are based on aquestionnaire and conducted using a quantitative approach while study V is based on in-depth interviews and conducted using aqualitative approach. The questionnaire in study I-IV comprised four simulated patientcases with different periodontal conditions. These four cases representthe periodontal status of the majority of middle-aged patientspresented in a general dentistry practice: 1) Generalised bone lossbut minimal signs of inflammation (well-maintained), 2) Generalisedbone loss and signs of inflammation (periodontitis), 3) Negligiblebone loss and minimal signs of inflammation (healthy), and4) Negligible bone loss but with signs of inflammation (gingivitis).The clinicians who participated in the studies were asked to judge each patient case as healthy or diseased, propose a diagnosis, evaluatetreatment needs, propose a treatment plan, and assess theprognosis.In study I, GDPs and DHs were combined in one group as generaldentistry clinicians (GDCs) and compared as to their judgement,proposed diagnosis and proposed treatment. Key findings: Three ofthe four patient cases was each judged as healthy by some GDCsand as diseased by others. The difference in judgement did not influencethe GDCs’ intention to treat or their proposed treatmentmeasures but did influence the estimated number of treatment sessions. In study II, GDCs were compared as to their prognostic assessment,treatment goals and estimation of treatment extent in termsof more or less treatment assigned to a given patient case in comparisonto the other patient cases (healthy patient case excluded).Key finding: The majority of GDCs was in general pessimistic intheir prognostic assessment and anticipated that all patient caseswere to experience a deterioration of their periodontal condition.The most common treatment goal, irrespective of the patient case,was to improve oral health awareness. The periodontitis patientcase was estimated to need the most treatment; slightly more thanthe gingivitis and the well-maintained patient cases where a similartreatment extent was estimated. In Study III, dental students (DSs) from Paris (DSP) and Malmö(DSM) were compared to each other as to judgement, diagnosis,treatment plans, and prognostic assessment. This was done in orderto discover if difference in educational background might influenceDSs’ treatment strategies. Key finding: The majority of bothgroups of DSs judged all the patient cases as diseased. DSPs proposedperiodontitis as a diagnosis more readily and estimated ahigher risk for disease progression in patient cases with no obviousbone loss (healthy and gingivitis patient cases). DSPs also recommendedmore treatment measures and estimated longer treatmenttime for all the patient cases than DSMs. In study IV, periodontists were primarily compared amongst eachother and secondly to GDPs as to their judgement, diagnosis, proposedtreatment plans, and prognostic assessment. Key findings:Both periodontists and GDPs varied in their judgement and proposeddiagnosis. The difference in periodontists’ judgement influencedtheir intention to treat and prognostic assessment. The GDPsintended to treat three out of four patient cases (except the periodontitispatient case) more often and were more pessimistic in theirprognostic assessment of patient cases with negligible bone lossthan the periodontists. In Study V, the phenomenon of lived experience of performing aperiodontal treatment in the context of general dentistry was describedby analysing interviews from three different DHs using thedescriptive phenomenological psychological method. Key finding:The periodontal treatment is perceived more as a standardisedworkflow than as an individually tailored treatment. The patients’oral hygiene and self-awareness are experienced as crucial partswhile the mechanical infection control is perceived as successfulbut sometimes difficult to perform. The DHs are experiencing aneed to be supportive of the patient but are sometimes doubtful ofthe patient’s ability to achieve and maintain a positive change inoral health behaviour.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology , 2018. , p. 100
Series
Doctoral Dissertation in Odontology
Keywords [en]
Periodontal Diseases, Parodontala sjukdomar, Behandling, Diagnos
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-7658DOI: 10.24834/2043/24973Local ID: 24973ISBN: 9789171049063 (print)ISBN: 9789171049070 (print)OAI: oai:DiVA.org:mau-7658DiVA, id: diva2:1404598
Note

Note: The papers are not included in the fulltext online.

Paper V in dissertation as manuscript.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-05-21Bibliographically approved
List of papers
1. Different treatment strategies are applied to patients with the same periodontal status in general dentistry
Open this publication in new window or tab >>Different treatment strategies are applied to patients with the same periodontal status in general dentistry
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2014 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 4, p. 290-297Article in journal (Refereed) Published
Abstract [en]

Abstract Objective. To analyse how general dental practitioners (GDPs) and dental hygienists judge and plan to treat patients with different periodontal conditions. Materials and methods. Seventy-seven GDPs and 50 dental hygienists in a Swedish county, Halland, participated in a questionnaire study. The response rate was 94%. The questionnaire consisted of four simulated patient cases and an attached answer sheet. The patient cases had different periodontal status, ranging from healthy to moderate bone loss with general inflammation. The clinicians judged the periodontal status as healthy or diseased. If judged as diseased the clinicians suggested a diagnosis, selected treatment options and estimated the number of treatment sessions for each patient case. The clinicians were compared to each other regarding their judgement, as healthy or diseased, diagnostics and treatment. Results. Three out of four patients were judged both as healthy and diseased by different clinicians. If judged as diseased the patients were diagnosed as having gingivitis or periodontitis. Regardless of the clinicians' former judgement and diagnostics there were no differences (p > 0.05) in the selected treatment options but there was a difference (p < 0.05) in the suggested number of treatment sessions. Conclusions. Clinicians' judgement of the same periodontal condition, as healthy or diseased, varies, which partly results in different treatment decisions considering the number of treatment sessions. The suggested number of treatment sessions varied also between clinicians even if they judged and diagnosed the condition likewise. The willingness to treat and suggested treatment options were not influenced by the variation in judgement and diagnostics.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
Keywords
clinical decision-making, gingivitis, periodontal diseases, periodontitis
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15365 (URN)10.3109/00016357.2013.824605 (DOI)000335002400006 ()24053366 (PubMedID)2-s2.0-84899007448 (Scopus ID)16462 (Local ID)16462 (Archive number)16462 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-05-21Bibliographically approved
2. Assessment of Prognosis and Periodontal Treatment Goals Among General Dental Practitioners and Dental Hygienists
Open this publication in new window or tab >>Assessment of Prognosis and Periodontal Treatment Goals Among General Dental Practitioners and Dental Hygienists
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2016 (English)In: Oral Health & Preventive Dentistry, ISSN 1602-1622, E-ISSN 1757-9996, Vol. 14, no 5, p. 433-441Article in journal (Refereed)
Abstract [en]

Purpose: To evaluate general dental practitioners' (GDPs) and dental hygienists' (DHs) assessment of prognosis, suggested treatment goals, and estimated number of treatment sessions in patients with varying severity of periodontal disease. Materials and Methods: Seventy-seven GDPs and fifty DHs in a Swedish county participated in a questionnaire study, based on three patient cases: a patient with generalised bone loss but no clinical signs of inflammation (well-maintained); a patient with clinical signs of inflammation and generalised bone loss (periodontitis); and a patient with clinical signs of inflammation but no bone loss (gingivitis). In open-ended questions, the clinicians assessed the prognosis in case of no treatment and proposed treatment goals. Furthermore, based on given fixed-alternative options, they estimated the number of treatment sessions needed for successful management of the condition. Results: Based on a response rate of 94%, the majority of clinicians expected a worsening of the periodontal condition in all three patients (well-maintained: 80%; periodontitis: 94%; gingivitis: 60%). The most common treatment goal in all 3 cases was to improve oral health awareness. The majority of clinicians estimated that the periodontitis case needed slightly more treatment sessions (mean: 3.04, 95% CI: 2.83-3.24) compared to the gingivitis (mean: 1.93, 95% CI: 1.75-2.11) or well-maintained patient case (mean: 1.84, 95% CI: 1.60-2.07). Conclusions: The majority of included clinicians did not perform an individualised risk assessment and did not individually match the number of appointments to the actual periodontal treatment needs of the patient. This may result in overtreatment in some cases and in undertreatment in others, and possibly in suboptimal use of resources.

Place, publisher, year, edition, pages
Quintessence, 2016
Keywords
treatment goals, prognosis, periodontitis, periodontal diseases, clinical decision making
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15348 (URN)10.3290/j.ohpd.a36472 (DOI)000387302900006 ()27351737 (PubMedID)2-s2.0-85012870917 (Scopus ID)23829 (Local ID)23829 (Archive number)23829 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-05-21Bibliographically approved
3. A questionnaire-based study evaluating differences between dental students in Paris (F) and Malmö (SE) regarding diagnosis and treatment decisions of patients with different severity levels of periodontal diseases.
Open this publication in new window or tab >>A questionnaire-based study evaluating differences between dental students in Paris (F) and Malmö (SE) regarding diagnosis and treatment decisions of patients with different severity levels of periodontal diseases.
2018 (English)In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 22, no 3, p. e392-e399Article in journal (Refereed)
Abstract [en]

To evaluate differences between last-year dental students in Paris (F) and Malmö (SE) Dental Schools, in regard to their judgement and decision-making within periodontology. Ninety-six last-year dental students from Paris and 45 from Malmö participated in a questionnaire study based on four patient cases: (i) Patient case with generalised alveolar bone loss but no signs of inflammation (Well-maintained), (ii) Patient case with generalised alveolar bone loss and signs of inflammation (Periodontitis), (iii) Patient case with no alveolar bone loss and no signs of inflammation (Healthy) and (iv) Patient case with no alveolar bone loss but with signs of inflammation (Gingivitis). Through multiple-choice questions, the students judged each case as healthy or diseased proposed a diagnosis and treatment measures and estimated the treatment time for each patient. Furthermore, they assessed the prognosis of each patient in case of no treatment. Based on a response rate of 83%, the majority in both groups judged all the patients as diseased. More Paris students diagnosed the healthy and the gingivitis case as having periodontitis (P < .05). Furthermore, a larger number of students from Paris recommended several treatment measures and estimated longer treatment times for all the cases (P < .05) and estimated a higher risk for disease progression for the healthy and the gingivitis case (P < .05). Significant variation between students from Paris and Malmö Dental Schools in regard to judgement and decision-making was observed; this may in turn imply that there is still need of improving consistency amongst undergraduate educations in periodontology in Europe.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
curricula, decision-making, dental education, diagnosis, gingivitis, periodontal disease, periodontitis, problem-based learning, students, undergraduate education
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15509 (URN)10.1111/eje.12317 (DOI)000436936300012 ()29316064 (PubMedID)2-s2.0-85049164882 (Scopus ID)25830 (Local ID)25830 (Archive number)25830 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-06-17Bibliographically approved
4. Diagnostic Judgement and Treatment Decisions in Periodontology by Periodontists and General Dental Practitioners in Sweden: A Questionnaire-based Study
Open this publication in new window or tab >>Diagnostic Judgement and Treatment Decisions in Periodontology by Periodontists and General Dental Practitioners in Sweden: A Questionnaire-based Study
2019 (English)In: Oral Health & Preventive Dentistry, ISSN 1602-1622, E-ISSN 1757-9996, Vol. 17, no 4, p. 329-337Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate if periodontists are coherent in their judgement and treatment decisions of patients with different periodontal conditions, and to compare them with general dental practitioners' (GDPs) findings. Materials and Methods: Eighty-six periodontists participated in a questionnaire study based on four patient cases: (a) generalised bone loss but minimal signs of inflammation (well-maintained); (b) generalised bone loss and signs of inflammation (periodontitis); (c) negligible bone loss and minimal signs of inflammation (healthy); and (d) negligible bone loss but with signs of inflammation (gingivitis). Periodontists had the option to judge each patient as healthy or diseased, propose a diagnosis, evaluate treatment needs, propose a treatment plan and assess the prognosis. Comparison between periodontists considered: (a) level of experience and (b) judgement of each patient case as healthy or diseased. Periodontists were additionally compared to a previous sample of GDPs (n = 74). Results: Periodontists' response rate was 77%. The diagnostic judgement of the four patient cases showed rather large variation both among periodontists and GDPs. Periodontists' intention to treat and prognostic assessment depended on their judgement of each patient, as healthy or diseased (p < 0.05). GDPs intended to treat three out of four patient cases (except periodontitis case) more often and were more pessimistic in their prognostic assessment of patients with negligible bone loss (p < 0.05), comparing to periodontists. Conclusions: Both periodontists and GDPs are defining periodontal health and disease differently, which affects treatment decisions and prognostic assessment. There is a need to define periodontal health and disease more precisely, in order to improve coherence in judgement.

Place, publisher, year, edition, pages
Quintessence, 2019
Keywords
clinical decision-making, gingivitis, periodontal diseases, periodontitis, specialists
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6449 (URN)10.3290/j.ohpd.a42505 (DOI)000483960300007 ()31093614 (PubMedID)2-s2.0-85071512040 (Scopus ID)30512 (Local ID)30512 (Archive number)30512 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-06-17Bibliographically approved
5. The lived experience of performing a periodontal treatment in the context of general dentistry
Open this publication in new window or tab >>The lived experience of performing a periodontal treatment in the context of general dentistry
Show others...
2021 (English)In: BDJ Open, E-ISSN 2056-807X, Vol. 7, article id 7Article in journal (Other academic) Published
Abstract [en]

Aim: To describe what characterises the lived experience of performing a periodontal treatment in the context of general dentistry.

Materials and methods: Three dental hygienists from general dentistry in Sweden, were purposively selected as participants and interviewed. The participants described a situation in which they had performed a periodontal treatment. The descriptions were analysed using the descriptive phenomenological psychological method.

Results: The general meaning structure of the lived experience of performing a periodontal treatment comprised five constituents, (a) an established treatment routine, (b) importance of oral hygiene, (c) self-awareness and motivation of the patient, (d) support and doubt, and (e) mechanical infection control. The periodontal treatment is perceived as being set prior to its commencement and as following established routines, in which the patients’ oral hygiene is experienced as a crucial part. The patients’ self-awareness and a supportive clinician are seen as important factors in motivating the patient towards positive behavioural change, although there is a presence of doubt in patients’ ability to maintain this positive change. Mechanical infection control is perceived as successful but sometimes difficult to perform.

Conclusions: Important, patient-related, factors are constituting the phenomenon of performing a periodontal treatment but an experience that the pre-existing standardised workflow influences patient management was also present.

Place, publisher, year, edition, pages
Nature Publishing Group, 2021
National Category
Dentistry
Research subject
Health and society; Health and society
Identifiers
urn:nbn:se:mau:diva-17784 (URN)10.1038/s41405-021-00059-4 (DOI)000616408800003 ()33510136 (PubMedID)2-s2.0-85100008225 (Scopus ID)
Available from: 2020-07-14 Created: 2020-07-14 Last updated: 2024-05-21Bibliographically approved

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