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  • 1. De Visschere, Luc
    et al.
    de Baat, Cees
    De Meyer, Lize
    van der Putten, Gert-Jan
    Peeters, Bart
    Söderfeldt, Björn
    Malmö högskola, Faculty of Odontology (OD).
    Vanobbergen, Jacques
    The integration of oral health care into day-to-day care in nursing homes: a qualitative study2015In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 32, no 2, p. 115-122Article in journal (Refereed)
    Abstract [en]

    ObjectiveThis qualitative study explored barriers and enabling factors to the implementation of an oral hygiene protocol in nursing homes. BackgroundOral health care in nursing homes in Flanders (Belgium) is inadequate. Materials and methodsQualitative data were obtained from nurses employed in 13 nursing homes involved in two randomised controlled trials in Flanders-Belgium. Data were collected by focus group and face-to-face interviews during April 2005 and December 2009. All transcripts were analysed with support of NVivo 8 (Version 2008). Transcripts were intuitively analysed in a two-step method. ResultsMost revealed barriers were consistent with previous findings in the literature. Newly reported barriers were respect for residents' self-determination, experience based oral health care by nurses, residents' oral health status and nurses' inability to notice residents' oral health status. Demand-driven oral health care was found to be a strong enabling factor. ConclusionThe integration of oral health care into day-to-day care seems to be a major problem due to a multitude of barriers. In future implementation innovations in oral health care an a priori assessment of influencing factors is recommended.

  • 2.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Region Örebro County, Örebro, Sweden; Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ordell, Sven
    Malmö högskola, Faculty of Odontology (OD). Dental Commissioning Unit, Östergötland County Council, Linköping University, Sweden.
    Self-perceived taste disturbance: a 20-year prospective study of a Swedish 1942 birth cohort2017In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 34, no 2, p. 180-186Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to assess the impact of dental care factors, general health factors and socio-economic factors on perceived taste disturbance (PTD) over time and to assess the stability of or change in PTD in a panel of individuals as they progressed from middle age (50 years) to early old age (70 years). Materials and methods: Data collection was conducted from a cohort study beginning in 1992, when the participants were 50 years old, and again 5, 10, 15 and 20 years later. Stability and change in PTD were described using cross-tabulation. Perceived taste disturbance over the 20-year survey period was modelled using the generalised estimating equation (GEE). Results: The prevalence of PTD during a 5-year period found in this study ranged from 2.4 to 2.9%, the latter in individuals between 60 and 70 years of age. Women generally had PTD more often than men. The longitudinal analysis showed that problems with bad breath (OR = 3.6), blisters (OR = 3.4), burning mouth (OR = 3.4) and self-perceived health (OR = 2.7) were the most important factors explaining PTD. Conclusions: This study showed that PTD does not increase between 50 and 70 years of age in ordinary community-living individuals. There were no long-term impacts on PTD over time from socio-economic factors, and over time, there were a limited number of factors contributing to the effect. Bad breath, blisters, burning mouth and self-perceived health are important factors for the dentist to discuss with the patient in the case of PTD.

  • 3.
    Ericson, Dan
    et al.
    Malmö University, Faculty of Odontology (OD).
    Carlsson, Peter
    Malmö University, Faculty of Odontology (OD).
    Gabre, Pia
    Institute of Odontology The Sahlgrenska Academy of Gothenburg Gothenburg Sweden.
    Wårdh, Inger
    Department of dental medicine and Academic centre for geriatric dentistry, Karolinska institutet, Stockholm and Department of health sciences University of Karlstad Karlstad Sweden.
    Zimmerman, Mikael
    Ad Modum AB Hässleholm Sweden.
    Sjögren, Petteri
    Oral Care AB Stockholm Sweden.
    Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults: A randomised clinical trial2023In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 40, no 3, p. 390-397Article in journal (Refereed)
    Abstract [en]

    Objective: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents.

    Method: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute.

    Results: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level.

    Conclusion: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.

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  • 4.
    Ericson, Dan
    et al.
    Malmö University, Faculty of Odontology (OD).
    Carlsson, Peter
    Malmö University, Faculty of Odontology (OD).
    Gabre, Pia
    Institute of Odontology, The Sahlgrenska Academy of Gothenburg, Göteborg, Sweden.
    Wårdh, Inger
    Department of Dental Medicine and Academic Centre for Geriatric Dentistry, Karolinska Institutet, Stockholm and Department of Health Sciences, University of Karlstad, Karlstad, Sweden.
    Zimmerman, Mikael
    Ad Modum AB, Hässleholm, Sweden.
    Sjögren, Petteri
    Oral Care AB, Stockholm, Sweden.
    Response to professor Milgrom.2023In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 40, no 3, p. 407-407Article in journal (Other academic)
  • 5. Eskafi, Mahmoud
    et al.
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Cline, Charles
    Israelsson, Bo
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Use of a Mandibular Advancement Device in Patients with Con-gestive Heart Failure and Sleep Apnoea2004In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 21, no 2, p. 100-107Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. Subjects: Twentyfive patients aged 66 ± 8 years (mean ± SD) met the inclusion criteria and were included in the study. Design: In a prospective, clinical trial, the apnoea-hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4-6 weeks, 6 months and 1 year after intervention. Results: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 ± 12.1 to 11.8 ± 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by ten patients. Dental complications were observed in two patients. Sixtyfour per cent of the patients were still using the MAD at the 1-year follow-up. Conclusion: both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.

  • 6.
    Gullberg, Joanna
    et al.
    Malmö University, Faculty of Odontology (OD).
    Lindh, Christina
    Malmö University, Faculty of Odontology (OD).
    Axtelius, Björn
    Malmö University, Faculty of Odontology (OD).
    Horner, Keith
    Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK.
    Devlin, Hugh
    Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK.
    Povlsen, Lene
    Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
    Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists2020In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 37, no 2, p. 208-216Article in journal (Refereed)
    Abstract [en]

    Objective To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. Background Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. Materials and methods A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. Results From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. Conclusion Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.

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  • 7. Isaksson, Rita
    et al.
    Becktor, Jonas P
    Malmö högskola, Faculty of Odontology (OD).
    Brown, Andrew
    Laurizohn, Christer
    Isaksson, Sten
    Oral health and oral implant status in edentulous patients with implant-supported dental prostheses who are receiving long-term nursing care2009In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 26, no 4, p. 245-249Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate oral health and oral implant status in a group of edentulous patients receiving long-term residential or nursing care (LTC), all of whom had implant-supported fixed or removable dental prostheses. MATERIAL AND METHODS: A dental examination was performed on a total of 3310 patients receiving LTC and from this population 35 edentulous patients in whom dental implants had been placed formed the cohort for this study. All examinations were performed by a specialist in hospital dentistry and took place in the patients' own home environment. Oral health was assessed by means of a protocol which evaluated oral hygiene status, possible oral mucosal inflammation and oral mucosal friction levels. Any problems with the implant-supported prosthesis, implant mobility or other complications were also assessed. In addition, patients were asked about any oral symptoms and their usual oral hygiene procedures. RESULTS: About half of the subjects (17/35) were registered as having no/mild inflammation with 18 of 35 having moderate/severe inflammation. Twelve of the 35 patients had good/acceptable oral hygiene and 23 of 35 had poor/bad oral hygiene. Twenty-one of the 35 patients depended on help from the nursing personnel for their daily oral hygiene procedures. Obvious problems with food impaction were noted in 11 patients. A total of 229 implants had been placed in 43 jaws supporting 40 full arch-fixed prostheses and three implant-borne overdentures. There was no evidence of mobility or fractures of either the implants or the prostheses. Fifteen implants showed some exposed screw threads. Pus was exuding from one implant site and general peri-implant gingival hyperplasia was noted in two patients. Twenty-four patients were completely satisfied with the function and appearance of their implant-supported prostheses. Two patients were totally dissatisfied. CONCLUSION: This study indicates that oral implant therapy can be considered as a treatment of choice in elderly patients, even if oral hygiene is sub-optimal.

  • 8.
    Liedberg, Birgitta
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Stoltze, Kaj
    Norlén, Per
    Öwall, Bengt
    'Inadequate' dietary habits and mastication in elderly men2007In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 24, no 1, p. 41-46Article in journal (Refereed)
    Abstract [en]

    Objective: the aim of this study was to re-evaluate data about oral status, mastication and nutrition in elderly men in Malmö, Sweden, recorded in 1985-1987, to assess associations between inadequate dietary habits, oral conditions and masticatory function. Material and methods: Four hundred and eighty-one med, aged 67-68, participated in a comprehensive health examination, including tooth and denture status and masticatory tests. A separate study of dietary habits and nutritional status was made. Ninety-five men had inadequate dietary habits. The databases of dental/denture status, mastication, nutritional status and social network factors were re-evaluated for assessment of associations. Results: No significant differences between those with adequate or inadequate nutrition were found with regard to the number of teeth, occlusal contracts or removable dentures. Also self-assessed chewing did not show any differences. Conclusion: Inadequate dietary habits were independent of teeth and denture status. Some correlations to social network conditions could be identified. Overweight, obesity, low physical activity and high alcohol intake were more common among those with inadequate nutritional intake.

  • 9.
    Liedberg, Birgitta
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Stoltze, Kaj
    Öwall, Bengt
    The Masticatory Handicap of Wearing Removable Dentures in Elderly Men2005In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 22, no 1, p. 10-16Article in journal (Other academic)
    Abstract [en]

    Objective: This study aimed at describing the masticatory handicap of wearing removable dentures measured by some masticatory tests and the intake of hard and soft foods. Materials and methods: The subjects were participants in a comprehensive health examination of 67- 68-year-old men living in Malmö, Sweden. Four hundred eighty-three men took part in a clinical oral examination which recorded the number of teeth and removable dentures. One hundred and one had complete dentures in both jaws and 131 had removable partial dentures in different combinations. Masticatory tests used almonds to record the number of strokes to the first swallow, and two-coloured chewing gums for recording bolus kneading and shaping. A nutritionist paid a home visit to assess dietary habits including the consumption of hard and soft foods. The data could be split into groups of different tooth and denture situations which were large enough to enable statistical analysis to be carried out. The results of a regression analysis of the group with different numbers of natural teeth (NT) and no removable dentures could be used as a reference for correlation with the masticatory capacity of removable denture wearers. Results: Number of strokes to the first swallow revealed no masticatory limitations of wearing removable dentures, while chewing gum colour-mixing and shaping revealed more differentiated impairments equivalent to the function of five to 16 teeth in a remaining natural dentition. Hard food intake for the removable denture groups was comparable to 17-19 NT. Soft food intake was not influenced by denture wearing. In a ranking of oral conditions, those with more than 24 NT had the highest test values for all tests, and those with complete sets of dentures the lowest except for the number of strokes to the first swallow of an almond. Conclusion: Removable denture wearing can be regarded as a handicap when measured with objective masticatory tests using chewing gum and the intake of hard foods. The number of chewing strokes to the first swallow of an almond and the intake of soft foods is not affected by the wearing of removable dentures.

  • 10.
    Norderyd, Ola
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Moesgaard Henriksen, Birgitte
    Jansson, Henrik
    Malmö högskola, Faculty of Odontology (OD).
    Periodontal disease in Norwegian old-age pensioners2012In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 29, no 1, p. 4-8Article in journal (Refereed)
    Abstract [en]

    PURPOSE:  To identify factors of importance for periodontal health and disease on an old-age Norwegian population. MATERIALS AND METHODS: From a random sample of 1152 urban and rural elderly Norwegians, aged 67 years or older, 582 individuals were agreed to participate in the study. After exclusion of edentulous individuals, 394 individuals were remained. A standardised clinical examination was performed by the same examiner. In conjunction with the clinical examination, a questionnaire was filled out regarding demographic and social status, educational level, tobacco habits and general condition. RESULTS: In the examined population, 33% of the subjects had periodontal disease. Out of those, 12% had severe periodontitis, that is, ≥3 periodontal pockets ≥6 mm. All variables were tested separately in a logistic regression model with periodontal pockets 6 mm and above, as the outcome variable. After univariate testing the following variables were included in a multivariate logistic regression model: daily smoking, higher plaque score, rural living and lower education. Only daily smoking remained significantly correlated to periodontal disease in the multivariate model. CONCLUSIONS:  This study has shown a prevalence of periodontal disease in 33% of the study population. Out of those approximately 12% had more severe periodontitis. Daily tobacco use was the only factor significantly correlated to presence of periodontal disease.

  • 11.
    Unell, Lennart
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Johansson, Anders Arne
    Ekbäck, Gunnar
    Ordell, Sven
    Malmö högskola, Faculty of Odontology (OD).
    Carlsson, Gunnar E
    Prevalence of troublesome symptoms related to temporomandibular disorders and awareness of bruxism in 65- and 75-year-old subjects2012In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 29, no 2, p. e772-e779Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the prevalence of 3 troublesome temporomandibular disorder (TMD) symptoms and awareness of bruxism in 2 cohorts of subjects aged 65 and 75 years. Background: Epidemiological studies have demonstrated a high, though varying, prevalence of TMD symptoms. The results concerning elderly people are inconclusive. Material and methods: Identical questionnaires were in 2007 sent to all subjects born in 1942 and 1932 living in two Swedish counties. The response rate was 73.1% for the 65- and 71.9 % for the 75-year-old subjects, totally 9093 subjects. This study focused on 3 questions on the severity of TMD symptoms and 1 question on awareness of bruxism. Results: The great majority reported no or only few TMD problems. Less than 3 % (måste kontrolleras!) considered their TMD symptoms to be rather great or severe. The mean prevalence of TMD-related symptoms and bruxism was greater in women than in men in both age groups. The 75-year-old women reported a marked lower prevalence of TMD symptoms and bruxism than the 65-year-old women, whereas the age differences were small among the men. Self-reported bruxism was associated with higher prevalence of TMD symptoms. Conclusions: The great majority of the 65- and 75 year-old subjects did not report any troublesome TMD related symptoms.

  • 12.
    Ástvaldsdóttir, Álfheiður
    et al.
    Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden.
    Boström, Anne-Marie
    Division of nursing, Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Huddinge, Sweden; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Department of nursing, Western Norway University of Applied Sciences, Haugesund, Norway.
    Davidson, Thomas
    Malmö University, Faculty of Odontology (OD). Division of health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Gabre, Pia
    Department of Preventive Dentistry, Public Dental Health, Uppsala County Council, Uppsala, Sweden; Department of Cariology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gahnberg, Lars
    Department of Preventive Dentistry, Public Dental Service, Region Västra Götaland, Sweden; Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sandborgh Englund, Gunilla
    Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden; Academic Center of Geriatric Dentistry, Karolinska institutet, Stockholm, Sweden.
    Skott, Pia
    Academic Center of Geriatric Dentistry, Karolinska institutet, Stockholm, Sweden.
    Ståhlnacke, Katri
    Public Dental Services, Region Örebro County, Sweden; Faculty of Health and Medicine, Örebro University, Örebro, Sweden.
    Tranæus, Sofia
    Malmö University, Faculty of Odontology (OD). Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Wilhelmsson, Hanna
    Malmö University, Malmö University Library.
    Wårdh, Inger
    Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden; Academic Center of Geriatric Dentistry, Karolinska institutet, Stockholm, Sweden.
    Östlund, Pernilla
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Mikael
    Malmö University, Faculty of Odontology (OD).
    Oral health and dental care of older persons: a systematic map of systematic reviews2018In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, no 4, p. 290-304Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: To examine the current knowledge on oral health status and dental care of older persons through a systematic mapping of systematic reviews of low or moderate risk of bias. BACKGROUND: Geriatric dentistry covers all aspects of oral health and oral care of older persons. Oral health is part of general health and contributes to a person's physical, psychological and social wellbeing. METHODS: A literature search was performed in three different databases (PubMed, The Cochrane Library and Cinahl) within 12 domains: Dental caries, periodontitis, Orofacial pain and temporomandibular joint (TMJ) pain, mucosal lesions, oral motor function, dry mouth, halitosis, interaction between oral status and other medical conditions, ability to interrelate and communicate, quality of life, ethics and organisation of dental care for older persons. Systematic reviews were identified and scrutinised, highlighting scientific knowledge and knowledge gaps. RESULTS: We included 32 systematic reviews of which 14 were judged to be of low/moderate risk of bias. Most of the domains lack systematic reviews with low or moderate risk of bias. In two of the domains evidence was identified; in institutionalised people aged 65 or older, effective oral hygiene can prevent pneumonia. Furthermore, there is an evidence of a relationship between malnutrition (protein energy-related malnutrition, PEM) and poor appetite and edentulousness. CONCLUSIONS: There is an urgent need for further research and evidence-based knowledge within most domains in geriatric dentistry and in other fields related to oral health and dental care for older persons striving for multi-disciplinary research programmes.

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