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  • 1.
    Milosavljevic, Aleksandar
    Malmö University, Faculty of Odontology (OD).
    Periodontal treatment strategies in general dentistry2018Doctoral 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.

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  • 2.
    Milosavljevic, Aleksandar
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Götrick, Bengt
    Malmö högskola, Faculty of Odontology (OD).
    Hallström, Hadar
    Malmö högskola, Faculty of Odontology (OD).
    Jansson, Henrik
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Different treatment strategies are applied to patients with the same periodontal status in general dentistry2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 4, p. 290-297Article in journal (Refereed)
    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.

  • 3.
    Milosavljevic, Aleksandar
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Götrick, Bengt
    Malmö högskola, Faculty of Odontology (OD).
    Hallström, Hadar
    Malmö högskola, Faculty of Odontology (OD).
    Stavropoulos, Andreas
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Assessment of Prognosis and Periodontal Treatment Goals Among General Dental Practitioners and Dental Hygienists2016In: 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.

  • 4.
    Milosavljevic, Aleksandar
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Götrick, Bengt
    Malmö högskola, Faculty of Odontology (OD).
    Hallström, Hadar
    Malmö högskola, Faculty of Odontology (OD).
    Stavropoulos, Andreas
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Assessment of prognosis and treatment goals among general dental practitioners and dental hygienists2014Report (Other academic)
    Abstract [en]

    Introduction: Clinicians are expected to base their treatment strategies of periodontal diseases on patient history, clinical appearance, and previous experience of periodontal disease. Treatment decisions are influenced by their prognostic assessment and treatment goals. Therefore the aim was to study patterns regarding general dental practitioners (GDPs) and dental hygienists (DHs) a) assessment of prognosis, b) setting of treatment goals, and c) estimation of amount of treatment of cases with varying severity of periodontal disease. Material and Methods: Seventy-seven GDPs and 50 DHs in a Swedish county were invited to participate in a questionnaire study. The response rate was 94 %. The questionnaire included patient history, clinical charts and radiographs, of three patient cases with a varying degree of periodontal diseases. Clinicians that judged these patients as diseased assessed the prognosis, proposed treatment goals and estimated amount of treatment, i.e. number of treatment sessions. The clinicians were compared to each other regarding their prognostic assessment and estimated amount of treatment. ANOVA and Tukey´s test compared the differences in estimated amount of treatment. Results: The majority of clinicians (58-95%) assessed that a worsening of the periodontal condition (assessment of prognosis) should occur. They had different treatment goals. Regardless of the clinicians’ former prognostic assessment there were almost no differences, overall, in estimated number of treatment sessions (p>0.05). The estimated number of treatment sessions ranged from 2 to 3 sessions in all patients. Conclusions: Most clinicians assessed the prognosis as negative. All patients were estimated to require the same amount of treatment even if their periodontal condition differed significantly in severity. This could mean that patients are over- or undertreated in relation to their periodontal condition and indicates that resources are ineffectively used.

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  • 5.
    Milosavljevic, Aleksandar
    et al.
    Malmö University, Faculty of Odontology (OD).
    Stavropoulos, Andreas
    Malmö University, Faculty of Odontology (OD).
    Bertl, Kristina
    Malmö University, Faculty of Odontology (OD). Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, A-1090, Austria.
    Götrick, Bengt
    Malmö University, Faculty of Odontology (OD).
    Diagnostic Judgement and Treatment Decisions in Periodontology by Periodontists and General Dental Practitioners in Sweden: A Questionnaire-based Study2019In: Oral Health & Preventive Dentistry, ISSN 1602-1622, E-ISSN 1757-9996, Vol. 17, no 4, p. 329-337Article in journal (Refereed)
    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.

  • 6.
    Milosavljevic, Aleksandar
    et al.
    Malmö University, Faculty of Odontology (OD).
    Stavropoulos, Andreas
    Malmö University, Faculty of Odontology (OD).
    Descroix, V
    UFR Odontologie, Université Paris Diderot, Paris, France.
    Götrick, Bengt
    Malmö University, Faculty of Odontology (OD).
    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.2018In: 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.

  • 7.
    Milosavljevic, Aleksandar
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Westerberg, Jane
    Folktandvården Skåne AB, Trelleborg, Region Skåne, Sweden.
    Hellen-Halme, Kristina
    Malmö högskola, Faculty of Odontology (OD).
    Diagnostic accuracy of carious lesions in digital radiographs at a public dental clinic - can it be improved by optimizing viewing conditions and further education?2016In: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, no 2, p. 235-242Article in journal (Refereed)
    Abstract [en]

    Objective:This study investigated the diagnostic accuracy of digital dental radiography for detecting carious lesions on approximal surfaces before and after optimization of the environment, and after joint training on evaluation and review of x-rays. A further aim was to evaluate differences in diagnostic accuracy between general dental practitioners (GDPs) and dental hygienists (DHs). Materials and methods:One hundred extracted teeth (premolars and molars) underwent standardized radiography. Eleven participants (seven GDPs and four DHs) evaluated digital images for approximal carious lesions in three sessions: (1) at current conditions with no optimization or further training, (2) under optimized viewing conditions, and (3) under optimized viewing conditions after a short educational session. Receiver operating characteristic curves were used to evaluate the results. Histological evaluation was made and served as a criterion standard for differentiating sound teeth and teeth with carious lesions. Kappa statistics evaluated intra-observer agreement. Results: Diagnostic accuracy in the GDP group differed significantly for all types of carious lesions between the first and third evaluations (p=0.002), and also between the second and third (p=0.015). Diagnostic accuracy also differed significantly for carious lesions into the dentin between the first and third evaluations (p=0.010) and between the second and third (p=0.015). Conclusion: Most of the staff had optimized the environment when evaluating digital radiographs. A short educational session highlighting the difficulty of caries diagnostics in digital dental radiography can increase diagnostic accuracy. Diagnostic accuracy in the detection of approximal carious lesions on digital radiographs did not differ between GDPs and DHs.

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  • 8.
    Milosavljevic, Aleksandar
    et al.
    Malmö University, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Englander, Magnus
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Stavropoulos, Andreas
    Malmö University, Faculty of Odontology (OD).
    Götrick, Bengt
    Malmö University, Faculty of Odontology (OD).
    The lived experience of performing a periodontal treatment in the context of general dentistry2021In: BDJ Open, E-ISSN 2056-807X, Vol. 7, article id 7Article in journal (Other academic)
    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.

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  • 9.
    Stenberg, Emelie
    et al.
    Malmö University, Faculty of Odontology (OD).
    Milosavljevic, Aleksandar
    Malmö University, Faculty of Odontology (OD).
    Götrick, Bengt
    Malmö University, Faculty of Odontology (OD).
    Lundegren, Nina
    Malmö University, Faculty of Odontology (OD).
    Continuing professional development in general dentistry-experiences of an online flipped classroom2024In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579Article in journal (Refereed)
    Abstract [en]

    Introduction: Continuing professional development is a lifelong learning process. One pedagogical approach that can be used is active learning. Flipped classroom is a method that has been shown to improve deeper conceptual understanding. In an online setting, the method saves travel, time, and costs. To our knowledge, flipped classroom is rarely used in continuing professional education. This study in general dentistry explored experiences of an online flipped classroom course in continuing professional development.

    Materials and Methods: Fifteen dental hygienists, clinically active in general dental care, were interviewed. They were recruited from an online course on the latest classification system for periodontal diseases. The course had been conducted using an active learning and flipped classroom model. The interviews were semi-structured. Data were extracted using qualitative content analysis.

    Results: The experiences of the dental hygienists could be summarized in three themes: Stimulation of knowledge gain through self-paced studies, The ease of virtual networking among colleagues, and Fostering of direct practical application through collaboration.

    Conclusion: New and emerging communication technology seems to open new possibilities for continuing professional development in general dentistry. Study participants felt that, in an online environment, mixing asynchronous and synchronous communication in a flipped classroom model facilitated learning in continuing professional development. Online active learning seems to work well in continuous professional development in general dentistry. After the course, the participating dental hygienists stated that they were able to use their new knowledge clinically and felt confident doing so.

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