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Assessment of Prognosis and Periodontal Treatment Goals Among General Dental Practitioners and Dental Hygienists
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0001-9449-9073
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0002-6337-4988
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0001-8161-3754
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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. Vol. 14, no 5, p. 433-441
Keywords [en]
treatment goals, prognosis, periodontitis, periodontal diseases, clinical decision making
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-15348DOI: 10.3290/j.ohpd.a36472ISI: 000387302900006PubMedID: 27351737Scopus ID: 2-s2.0-85012870917Local ID: 23829OAI: oai:DiVA.org:mau-15348DiVA, id: diva2:1418869
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-05-21Bibliographically approved
In thesis
1. Periodontal treatment strategies in general dentistry
Open this publication in new window or tab >>Periodontal treatment strategies in general dentistry
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
Periodontal Diseases, Parodontala sjukdomar, Behandling, Diagnos
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7658 (URN)10.24834/2043/24973 (DOI)24973 (Local ID)9789171049063 (ISBN)9789171049070 (ISBN)24973 (Archive number)24973 (OAI)
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

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Milosavljevic, AleksandarGötrick, BengtHallström, HadarStavropoulos, AndreasKnutsson, Kerstin

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