The aim of this study was to analyse how self-assessed general health was related to oral health among persons afflicted with whiplash-associated disorders (WAD), controlling for relevant background factors, confounders and other risk factors. Questionnaires included the SF-36 Health Survey, self-assessed oral health and relevant risk factors, in total 49 questions. Multivariable regression modelling was performed. Members of a nationwide Swedish association enlisting persons who have problems concerning a whiplash injury (n = 1,928) were included. A total of 979 persons participated in the study, a response rate of 50.8%. A multivariable regression model is presented, with general health as the dependent variable, and the independent variables inserted en-bloc. The model was highly significant with an explained variance of 28%. Among background factors, only older age appeared as significantly and strongly related to poorer general health. The strongest explanatory contributions came from the health related variables. Oral disease and extra-oral body pain were both strongly related to poorer general health, most obviously for the oral disease variable. Oral disease was significantly and to a clinically relevant degree associated with self-assessed general health. Several other psychosocial indicators of stress were also significantly related to the general health. These findings are consistent with the stress-behaviour-immune model for development of disease.

Insikten om att vårdens resurser inte kommer att räcka till för att behandla all oral sjukdom i befolkningen har betytt att begreppet oral hälsa allt mer hamnat i fokus. Rent samhällsekonomiskt är det mer fördelaktigt att förebygga än att behandla sjukdom. Det innebär också mindre lidande för patienten. Ett salutogenetiskt perspektiv (se ordförklaring) [1] minskar påfrestningarna på vården och ger ett snabbare och mer komplikationsfritt tillfrisknande [2]. Det är därför viktigt att diskutera begreppen ”oral sjukdom” och ”oral hälsa”: hur de översätts i daglig klinisk praxis, hur de beskrivs i internationella och nationella deklarationer samt i svensk lagstiftning. Författarna föreslår även tre nivåer på utfallsvariabler som bör beaktas vid forskning om oral sjukdom/ohälsa. Artikeln är ett försök att ur teoretisk synvinkel bidra till utvecklingen av hälso- och sjukdömsbegreppet.

Objective. The aim of this paper was to study the association between dental satisfaction and oral health-related quality-of-life (OHRQoL) when controlling for individual, clinical and psychological factors. Materials. Secondary analysis was conducted using data from a large study carried out in the Swedish region of Varmland in 2004. The questionnaire included demographic variables, clinical assessment and the following instruments: the Dental Visit Satisfaction Scale (DVSS), the short version of Oral Health Impact Profile (OHIP-14) and a modified version of the revised helping alliance questionnaire. Internal consistency analysis was undertaken on the instruments to assess reliability; bivariate comparisons were assessed to compare DVSS scores with individual factors (age, gender and education). In addition, a three step hierarchical multiple regression analysis was performed with DVSS as a dependent variable. Results. Data were completed for 485 randomly selected patients. The mean age of participants was 43.5 years, 54.6% were women, and 41.2% had high education. The median DVSS score was 48 (range 10-50) and the median OHIP was 3.0 (range 0-56). All the instruments showed good reliability. Bivariate analysis showed that females were more satisfied than males (p <= 0.01) and patients of 50 years or older were more satisfied than the younger ones (p <= 0.05). Finally, the following variables explained 31% of the variance of being very satisfied with dental visit: a good OHRQoL and patients' positive perceptions of the relationship with their care provider. Conclusion. This study showed positive associations between dental satisfaction and OHRQoL when controlling for related factors. The result suggests that care providers should take into account the various dimensions of OHRQoL rather than use only clinical measurements when they evaluate patient satisfaction.

Objective. To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa. Materials and methods. Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review. Results. An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined. Conclusions. Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

Aim To examine the prevalence of infant dental enucleation (IDE) of primary canines, an East African traditional remedial procedure, in a multiethnic population of children in Sweden. Design A cross-sectional study was conducted of dental records of 1133 patients (mean age 4.6years, SD +/- 1.4) attending one public dental service clinic in Sweden. The clinic was located in an area with a large multiethnic community. All were born within the years 2002-2006 and had received a check-up in one of the years 2007-2009. A registry was made of missing primary canines where no reason could be found. In documented cases, information about ethnic origin was extracted. Statistical grouping was made according to known East African ethnicities. Results At least 36 ethnicities were recorded. Twenty-four (2.1%) patients were missing one or more canines according to the criteria for IDE. Significant difference was seen when comparison was made between patients of known East African ethnicities, of whom 20.8% (21/101) manifested findings consistent with the criteria, and the rest of the population (3/1032; P<0.001). Conclusions Prevalence of cases suggestive of IDE among patients of East African origin points to a need for increased awareness within dental and healthcare communities.

Objectives: Good work in dentistry concerns the manual skills as well as the patient relation. The ability to provide quality care in dentistry is not only dependent on individual resources but also on work organization, which can affect the job satisfaction. This study aims to describe dentists in different organizational settings in Sweden and Denmark and the relation to their overall job satisfaction. Materials and methods: In 2008, a questionnaire was sent to a random proportionally stratified sample of practicing dentists in Sweden (n=898) and Denmark (n=937). The study was approved by the Swedish regional ethical board. Principal Component Analysis (PCA) was used on three items aiming to measure overall job satisfaction; (1) work fulfillment, (2) satisfaction with the work as a whole, and (3) the perception of having a good working life. Kruskal-Wallis tests were used to compare the overall job satisfaction between Swedish and Danish private and public practitioners. Results: The response rate was 68%, whereas 51% were Swedes and 49% Danes, 62% were women and 32% men. Further, 61% were private and 39% were public practitioners. PCA on the three items showed a one factor solution with 78% variance explained. The PCA was stable when splitting the sample as to gender and organizational affiliation. An index for overall job satisfaction was established, having a Cronbach’s alpha 0.86. The overall job satisfaction means (range 3-15) for the four subgroups were; Swedish public (11.0) and private (11.8) practitioners and Danish public (11.9) and private (11.8) practitioners. Statistically significant differences were found between the groups (P< 0.001). Conclusions: The average response rate was reasonably satisfactory. The PCA showed an index of overall job satisfaction as a measure of eudaimonic work life elements as well as more practical contentment with work. The initial results showed that Danish and Swedish dentists have a high overall job satisfaction. The Swedish public practitioners had the lowest overall job satisfaction compared to the other groups. The results are to be further analyzed as to more specific organizational differences. Funding: The Swedish Council for Working Life and Social Research, Malmö University, The Danish Dental Association.

Introduction The emotional aspects of work for dentists are little researched. Emotion work is a part of the intervention toolkit of the dentist for example emotional contagion or persuasion of the patient or a way to make other thing easier. As a condition of human service work, the emotional aspects can be a source to burnout because of frequent contradictory emotional demands from the organization, patient, and the dentist self. However, the emotional aspects of work can also be a source to positive inner experiences. Eudaimonic and hedonic rewards can arise from the interaction with patients, and thereby potentially enhance satisfaction and fulfillment of work. Material and methods A questionnaire was developed covering the multidimensional concept of good work, including perceptions of emotion work. A total of 1835 dentists randomly sampled from the dental associations were sent a questionnaire in November 2008. Because emotion work in dentistry has little previous research, a theoretical overview and conceptualization for dentistry were created. Principal components analysis (PCA) was used to reduce measures of emotion work. Covariance between the indices and variables were grouped as setting, work and person. Results The average net response rate was 68% (n = 1226). Three dimensions were theoretically relevant in the dental context: Emotion work, emotional labor and emotional work can all influence the dentist in different ways. PCA of the questions showed unidimensional solutions and six indices were created: Patient relations values, emotional support, emotional display, emotional dissonance, emotional hedonic rewards and emotional eudaimonic rewards stable over gender and nationality. Conclusion Emotion work is a considerable part of being a professional dentist. It is requirement of work as well as constituting the balance between being dentist and person. Potentially, emotion work can influence the dentists’ perceptions of work in a positive way. The emotional aspects of work should be investigated more closely as a central component of work environment and job satisfaction.

Objectives: Dentistry is an example of human service work, involving cognitively, emotionally and technically demanding tasks. These tasks are potentially implicative of negative as well as positive personal effects. The aim was to study work enjoyment, satisfaction with work, and good working life, comparing Danish and Swedish general dental practitioners. Materials and methods: In 2008, a questionnaire was sent to a randomly selected sample of practicing dentists in Sweden (n=900) and Denmark (n=937). The study was approved by the Swedish regional ethical board. Distribution analysis and Mann-Whitney U test were used for comparison between the groups Swedes/Danes, private-/public practitioners, and dentists with/without management responsibility. Results: Response rate was 68%, whereas 51% were Swedes and 49% Danes. Sixty percent had management responsibility and 40% had not. Further, 58% were private and 37% were public practitioners. Frequency analysis showed that almost three fourths of the dentists experienced a high or a very high degree of (1) work enjoyment (73%), (2) of satisfaction with their work as a whole (72%) and (3) of a good working life (74%). The items (1) and (2) showed differences between all three groups: Danes, private practitioners and dentists with management responsibility scored higher than their counterparts (p≤0.05). Item (3) showed similar results (p≤0.05), except for the comparison Danes/Swedes, which was non-significant. Conclusions: The initial results corroborate that Danish and Swedish dentists have positive perceptions of their work. The differences between the three groups are to be further studied to track potential correlations promoting positive perceptions of work. Funding: The Swedish Council for Working Life and Social Research, Malmö University, The Danish Dental Association.

Objective. Human service work differs from industrial work, which should be considered when organizing work. Previous research has shown organizational differences in the perceptions of work, often with a focus on negative aspects. The aim of this study was to analyse the overall job satisfaction among private- and public-practising dentists in Sweden and Denmark. This also implied a description of the questionnaire Swedish and Danish Dentists' Perceptions of Good Work about opportunities and positive and rewarding aspects of work. Material and methods. A questionnaire covering the multidimensional concept of good work was developed. A total of 1835 dentists randomly sampled from the dental associations were sent a questionnaire in November 2008. A special non-response study was performed. Principal components analysis (PCA) was used to create a measure of overall job satisfaction, comparing four organizational subgroups. Results. The average net response rate was 68% (n = 1226). The special non-response study of the Danish private practitioners showed more males, managers and dentists with more working hours than the respondents. PCA of three satisfaction questions showed a stable one-factor solution. There were differences in job satisfaction, with Danish public dentists ranked highest in overall job satisfaction and Swedish public dentists lowest. Conclusions. There were organizational differences in the perception of job satisfaction. Further analysis of how the human service is organized in the different groups is needed.

The psychosocial work environment in dentistry is well documented as demanding, but less is known of what makes dentists stay engaged. Aim.The aim was to explore the rewarding aspects of the work as general dental practitioner..Methods. A qualitative approach was used to ensure a deeper understanding of the subject as perceived by dentists working in the field. Among Danish and Swedish general dental practitioners, six informants were in 2007-08 selected step by step to obtain maximal variation of respondents as to country of origin, gender, age and clinical work experience. Semi-structured, in-depth interviews based on Kvale’s principles were performed in the mother tongue of the informants. The interviews were audio-recorded and later transcribed verbatim in the original language by the interviewers. Statements covering rewarding aspects of dentistry were used for systematic text condensation according to the principles of Giorgi’s phenomenological analysis, modified by Malterud following 4 steps: (1) reading all the material to obtain an overall impression, and bracketing preconceptions; (2) identifying units of meaning representing different rewarding aspects of good work, and coding for these aspects; (3) condensing and abstracting the meaning within each of the coded groups; and (4) summarizing the contents of each code group to generalize descriptions and concepts reflecting aspects of good work. The study was approved by The Regional Ethical Review Board in Lund, Sweden Results. The first overall impression of data was that the rewarding aspects of the work as a dentist emerged directly from the clinical encounter; from the relation with the patient and the opportunity for performing a high quality odontological handicraft. Next, the dentists described some basic conditions as their relations to workmates, peers and managers as well as how organisational values and conditions influenced the opportunities for achieving the perceived rewarding aspects from the clinical encounter.Conclusion. The results comprising the moral aspects as essential in the work as a dentist confirm Hasenfelds’ theory of Human Service Organizations. This implicates a need for developing work environmental models with internal as well as external rewards when dealing with human service organizations. Acknowledgements. The authors wish to acknowledge the Swedish Council for working life and social research for financial support.

Objective: This study explores dentists' perceptions of Good Work in the meaning of positive and rewarding aspects in their work in contrast to a traditional problem-centred focus on work life. Methods: Nine informants were selected among Danish and Swedish general dental practitioners to obtain variation as to country of origin, gender, age and clinical work experience. Semi-structured, in-depth interviews were audio-recorded and transcribed verbatim in the original language. Statements concerning positive aspects of work were used for systematic text condensation according to the principles of Giorgi's phenomenological analysis, as modified by Malterud, generalizing descriptions reflecting aspects of Good Work. Selection of participants continued until saturation of the emerging categories was achieved. Results: The core of Good Work emanates from the clinical encounter: from the relation with the patient and from the opportunity to carry out high quality odontological handicraft. Social relations at the workplace, as well as organizational values and conditions were perceived as influencing the opportunities to achieve the rewarding aspects from the clinical encounter. Conclusions: The results implicate a need for developing a work-environmental model with intrinsic as well as extrinsic rewards when dealing with human service organizations. At policy level it is necessary to address the professional culture.

Perceived social support is a central concept in classical stress models and is known to be important to health. Aim The aim of this study was to investigate to what extent Danish general dental practitioners support each other, in relation to background factors. Methods The study was a cross-sectional survey with a postal questionnaire sent to 300 dentists who were randomly selected members of the Danish Dental Association. Response rate was 80% after one reminder. Factor analyses of items describing collaboration among colleagues were performed. The extracted support factors were used as outcome variables in multiple regression analyses with background factors like age, gender, and work characteristics as independent variables. Results Two factors were extracted describing perceived support and were interpreted as emotional and practical support. The regression analyses with support as dependent variables gave the following main results (Model 1: R2=0.34; F=13.53 8/184; p≤0.000; Model 2: R2=0.24; F=8.50 8/184; p≤0.000): • Dentists from solo practices perceived significantly less emotional and practical support than dentists working in bigger units (p=0.002; p= 0.001); • The more time dentists spent with colleagues outside the clinical sphere, the more emotional support was perceived (p≤0.000). A parallel relation, but weaker was found for practical support (p=0.041); • Male dentists reported significantly less emotional support than their female colleagues (p=0.004). A similar gender difference was not found for practical support (p=0.843). • Being single in private life was associated with less perception of practical support compared to married dentists (p=0.044). Conclusion The study underlines the importance of structural and cultural conditions in work environment for the perception of social support from colleagues. Acknowledgements The study was financially supported by Telia and PFA.

Social support is an important phenomenon in the psychosocial work environment. The aim of this study was to assess the extent to which Danish general dental practitioners perceived support from colleagues and to relate perceived support to demographic and work related background factors. A questionnaire was sent to a random sample of 300 Danish dentists. The response rate was 80% after one reminder. Factor analyses and multiple regression analyses were carried out. The results showed that clinic size was the overall most important variable explaining perceived support among dentists. Gender differences were found in perceived emotional and practical support, and women perceived more emotional support (e.g. discussing problematic patients with peers) than their male colleagues. A similar gender difference was not found for the perception of practical support, such as helping each other in the event of falling behind schedule. Dentists from small and large practices did not differ in the extent of peer contact outside the clinical environment. This study emphasized the importance of the organizational setting for a professional and personal supportive psychosocial working environment in dentistry.

Background and aim: Relationships among people at work have previously been found to contribute to the perception of having a good work. The aim of the present paper was to develop scales measuring aspects of social support, trust, and community among dentists, and to evaluate psychometric properties of the scales. Material and methods: In 2008, a questionnaire was sent to 1835 general dental practitioners randomly selected from the dental associations in Sweden and Denmark. The response rate was 68% after two reminders. Principal Component Analysis was applied to 14 items and scales were established based on the resulting factors. Internal consistency was evaluated by Cronbach’s alpha. Differential Item Functioning (DIF) with respect to gender, nationality and employment sector was analysed using ordinal logistic regression methods. Construct validity was assessed in relation to selfrated health and a range of work satisfaction outcomes. Results: The percentage of missing values on the items was low (range 0.7%–3.8%). Two scales (range 0–100) were established to measure ‘Community with Trust’ (nine items, mean = 79.2 [SD = 13.4], Cronbach’s alpha = 0.89) and ‘Collegial Support’ (five items, mean = 70.4 [SD = 20.8], Cronbach’s alpha = 0.89). DIF of only minor importance was found which supported cultural equivalence. The two scales were weakly positively correlated with each other. ‘Community with Trust’ was in general more strongly correlated with work satisfaction variables than ‘Collegial Support’ was. Conclusions: Stability and internal consistency of the scales were considered as satisfactory. Content validity and construct validity were considered as good. Further validation in other populations is recommended.

The psychosocial work environment in dentistry is well documented as demanding, while less is known of what constitutes work fulfilment for dentists. Aim. The aim was to explore the rewarding aspects of the work as general dental practitioner. Methods. A qualitative approach was used to ensure a deeper understanding of the subject as perceived by dentists working in the field. Among Danish and Swedish general dental practitioners, eight informants were in 2007-08 selected step by step to obtain maximal variation of participants as to country of origin, gender, age and clinical work experience. Semi-structured, in-depth interviews based on Kvale’s principles were performed in the mother tongue of the informants. The interviews were audio-recorded and later transcribed verbatim in the original language by the interviewers. Statements covering rewarding aspects of dentistry were used for systematic text condensation according to the principles of Giorgi’s phenomenological analysis, following 4 steps as modified by Malterud: (1) reading all the material to obtain an overall impression, and bracketing preconceptions; (2) identifying units of meaning representing different rewarding aspects of good work, and coding for these aspects; (3) condensing and abstracting the meaning within each of the coded groups; and (4) summarizing the contents of each code group to generalize descriptions and concepts reflecting aspects of good work. The study was approved by The Regional Ethical Review Board in Lund, Sweden. Results. The first overall impression of data was that the rewarding aspects of the work as a dentist emerged directly from the clinical encounter: From the opportunity for performing a high quality odontological handicraft and from the relation with patients. It was formulated as an emotion of internal self satisfaction. Next, the dentists described some basic conditions as their relations to workmates, peers and managers as well as how organisational values and conditions influenced the opportunities for achieving the perceived rewarding aspects from the clinical encounter. Conclusion. The results comprising the moral aspects as essential in the work as a dentist support Hasenfelds’ theory of Human Service Organizations. This implicates a need for developing work environmental models with internal as well as external rewards when dealing with human service organizations. Acknowledgements. The authors wish to acknowledge the Swedish Council for working life and social research for financial support.

Background and aim: At workplace it is relevant to study trust in the relations among colleagues (horizontal trust) and trust between management and employees (vertical trust). In the Copenhagen Psychosocial Questionnaire (COPSOQ) a measure of these two concepts has been developed, but the validity of the measures in a specific context as dentistry is unknown. The aim of the present study was to apply the measurements of trust from COPSOQ to a population of general dental practitioners from Denmark and Sweden, comparing factor solutions and scoring norms to the original results. Besides dentistry is an example of a human service organization, which implicates that also the patients take a central role in the daily work. Materials and methods: In 2008, a questionnaire was sent to 1835 general dental practitioners, randomly selected among members of the dental associations in Sweden and Denmark. The response rate was 68% after two reminders. Distribution analyses of two items concerning the importance of colleagues and relationship with patients were performed. Principal Components Analysis was applied to seven items concerning trust, taken directly from the second version of COPSOQ. The analyses were performed for the total sample as well as for subgroups according to gender, country, and employment sector. Results: Relationships to colleagues as well as patients were considered as very important for the perception of work fullfillment. The analyses resulted in two stable factors, interpreted as “trust” and “hindered information flow”. Conclusions: The suggested two factors from COPSOQ: vertical and horizontal trust, could not be reproduced in the present study. Consequently, the constructs cannot be regarded as valid for small enterprises as dentistry in Sweden and Denmark. Besides, it is suggested to include measurement of trust in the relationship with patients, when dealing with psychosocial work environment in human service organizations. The authors wish to acknowledge the Swedish Council for Working Life and Social Research, Malmö University and The Danish Dental Association for financial support.

Background and aim: In the Copenhagen Psychosocial Questionnaire (COPSOQ)measures of community at workplace, horizontal and vertical trust have been developed, but the validity of the measures in a specific context as dentistry is unknown. The aim was to apply the measurements from COPSOQ to a population of general dental practitioners from Denmark and Sweden, comparing factor solutions and scoring norms to the original results. Materials and methods: In 2008, a questionnaire was sent to 1835 general dental practitioners, randomly selected among members of the dental associations in Sweden and Denmark. The response rate was 68% after two reminders. Distribution analyses of two items concerning the importance of colleagues and relationship with patients were performed. Principal Components Analysis with Varimax rotation (PCA) was applied to seven COPSOQ items on trust and two on community together with three new developed questions. The analyses were performed for the total sample and for subgroups according to gender, country, employment sector and managerial responsibility. Results: The PCA resulted in two stable factors, interpreted as “trust” and “hindered information flow". Conclusions: The suggested concepts from COPSOQ: vertical and horizontal trust and community could not be reproduced in the present study. Consequently, the constructs cannot be regarded as valid for small enterprises as dentistry in Sweden and Denmark. The authors wish to acknowledge the Swedish Council for Working Life and Social Research, Malmö University and The Danish Dental Association for financial support.

Objectives: Karasek and Theorell define job control as the worker's control over work tasks and performance during the working day. This study aims to analyze differences in job control as decision authority over aspects of the work, among general dental practitioners from Denmark and Sweden. Materials and methods: In 2008, a questionnaire was sent to 1835 general dental practitioners, randomly selected from the dental associations in Sweden and Denmark (17% of the eligible population). The response rate was 68% after two reminders. Principal Components Analysis was applied to eight items about influence. Based on the resulting two factors, additive indices were established to measure decision authority: “influence on scheduling appointments” (2 items) and “general influence” (6 items). ANOVA with Tukey's HSD test was used for comparison between groups based on nationality and sector for dentists with/without managerial responsibility. For analyses without equal variances, Kruskal-Wallis test was applied. Results: Influence on scheduling appointments: In both Denmark and Sweden, dentists from the public sector reported lower influence on scheduling appointments than private practitioners (p≤0.01). Comparing dentists from the same sector showed no significant differences between the countries, neither after controlling for managerial responsibility. Dentists with managerial responsibility had higher influence than employed dentists (p≤0.001). Influence in general: For dentists without leadership tasks, similar patterns were seen. In contrast, Swedish dentists with managerial responsibility reported higher general influence than their Danish colleagues (p≤0.01). Independently of gender and nationality, private managers had higher general influence than their public counterpart (p≤0.01). Dentists with managerial responsibility had higher influence than employed dentists (p≤0.001). Conclusion and perspective: Differences in decision authority were found between general dental practitioners working in the public and the private sector in both countries. The results may reflect different management cultures as well as different structural organization of the work. In light of changes in demands made on health care professionals it is important to secure decision authority in order to keep work balance as well as quality in care. The authors wish to acknowledge the Swedish Council for Working Life and Social Research, Malmö University and The Danish Dental Association for financial support.

Objectives. The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust). Methods. A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models. Results. A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust. Conclusion. A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.

Background Earlier research emphasizes the importance of positive work relations for dentists’ perception of opportunities for quality in handicraft and patient relations. A scale for positive work relations, Community with Trust, has been developed and its psychometrical properties evaluated. Objectives. The aim of the study was a) to compare mean scores on Community with Trust across subgroups based on organizational affiliation; b) to analyse associations between work factors (size of practice, common breaks, formalized managerial education of the daily leader, influence on work, profession-oriented and productivity-oriented practice climate) and Community with Trust; and c) to assess the correlation between the scales for Community with Trust and Overall Job Satisfaction. Methods. A questionnaire was sent to 1835 general dental practitioners, randomly selected from dental associations in Sweden and Denmark. The response rate was 68%. Kruskal Wallis test and Pearson’s correlation were applied and a hierarchical linear multiple regression model with the outcome variable Community with Trust was built. Results. Significant differences in mean score of Community with Trust were found for dentists working in different organizational forms. The final regression analysis explained 49 % of the variation and showed that factors such as common breaks, influence on work, and a practice climate with values corresponding with those of the profession contributed to explanation of the differences in average among dentists with different organizational affiliation. Community with Trust and Overall Job Satisfaction were moderately to strongly correlated (0.52). Conclusion. The study pointed to the relevance of addressing the professional ethos when organizing and managing dentistry for a sustainable work environment supporting quality in handicraft and in relations with patients.

Objectives: Karasek and Theorell define job control as the worker's control over work tasks and performance during the working day. This study aims to analyze differences in job control as decision authority over aspects of the work, among general dental practitioners from Denmark and Sweden. Materials and methods: In 2008, a questionnaire was sent to 1835 general dental practitioners, randomly selected from the dental associations in Sweden and Denmark (17% of the eligible population). The response rate was 68% after two reminders. Principal Components Analysis was applied to eight items about influence. Based on the resulting two factors, additive indices were established to measure decision authority: “influence on scheduling appointments” (2 items) and “general influence” (6 items). ANOVA with Tukey's HSD test was used for comparison between groups based on nationality and sector for dentists with/without managerial responsibility. For analyses without equal variances, Kruskal-Wallis test was applied. Results: Influence on scheduling appointments: In both Denmark and Sweden, dentists from the public sector reported lower influence on scheduling appointments than private practitioners (p≤0.01). Comparing dentists from the same sector showed no significant differences between the countries, neither after controlling for managerial responsibility. Dentists with managerial responsibility had higher influence than employed dentists (p≤0.001). Influence in general: For dentists without leadership tasks, similar patterns were seen. In contrast, Swedish dentists with managerial responsibility reported higher general influence than their Danish colleagues (p≤0.01). Independently of gender and nationality, private managers had higher general influence than their public counterpart (p≤0.01). Dentists with managerial responsibility had higher influence than employed dentists (p≤0.001). Conclusions: Differences in decision authority were found between general dental practitioners working in the public and the private sector in both countries. The results may reflect different management cultures as well as different structural organization of the work. The authors wish to acknowledge the Swedish Council for Working Life and Social Research, Malmö University and The Danish Dental Association for financial support.

The concept of oral health-related quality of life (OHRQOL) is investigated in this study. The aim was to explore the dimensionality of variables measuring OHRQOL in an adult Swedish population and to discuss the findings in relation to existing indices. The study was based on responses to a 1998 questionnaire sent to a random sample of 1974 persons aged between 50 and 75 years. There were 22 variables based on questions concerning oral situation and the impact on 7 theoretically different dimensions of QOL. The majority were satisfied with their oral health situation. During the previous 12 months, 16% of the population had experienced problems with their mouth or teeth on at least one occasion per mouth. Principal components analysis was used to analyze the dimensionality of the variables. Three factors accounted for 59% of the variance: (1) Physical and social disability, (2) psychological discomfort and disability, and (3) functional limitation and physical pain. The perception of OHRQOL is multidimensional, but the dimensions are not equally important. The dimensions of OHRQOL found in the present study are similar to those of existing instruments.

PURPOSE: The purpose of the study was to investigate whether oral health-related quality of life (OHRQOL) in an adult Swedish population could be explained by social attributes; individual attributes; dental status, with a special focus on the role of prosthodontics; and dental care attitudes. MATERIALS AND METHODS: The study was based on responses to a questionnaire sent in 1998 to a random sample of 1,974 persons aged 50 to 75 years (66% response rate). Three factors representing various aspects of OHRQOL were set as dependent variables in multiple-regression models: oral health impact on everyday activities, oral health impact on the psychologic dimension, and oral health impact on oral function. Independent variables in the models were social attributes, individual attributes, number of teeth, denture (ie, type of denture, if present), and dental care attitudes. RESULTS: General health in relation to age peers had the strongest association with all 3 dependent variables, followed by number of teeth and need care--cost barrier. When number of teeth was excluded, removable denture was found to covary with the dependent variables in each of the 3 regression models. CONCLUSION: The number of remaining teeth is more important than the type of denture in explaining OHRQOL. It is less important that a denture is fixed for those with few remaining teeth, in contrast to all others. Explanations are also found in general health and various aspects of dental care costs.

This study investigates dental care utilization in an adult population in Southern Sweden in relation to dental and social conditions, attitudes to costs, and perceived need to obtain dental services. The study was based on responses to a questionnaire sent in 1998 to a random sample, 1974 persons, aged 56-75 years. The response rate was 66%. A significantly higher probability of dental care utilization less than once a year was found for men, for those with few remaining teeth, and for those with removable dentures. A higher probability of dental care utilization less than once a year was found for those who stated perceived need to obtain dental care with no possibility because of the cost and for those who stated that the cost had influenced their attendance for dental care. The results showed that there were differences for sex and dental conditions in dental care utilization and that dental care utilization was related to attitudes towards costs of dental care.

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.

The aim of the present study was to evaluate the prevalence of malocclusion traits and sucking habits among 3-year-old children. A sample of 457 3-year-old children (234 girls and 223 boys) was obtained from three Public Dental Health clinics in Orebro County Council, Sweden. Data from clinical examination and a questionnaire were used to determine malocclusion traits, sucking habits, snoring and breathing pattern including nocturnal breathing disturbances. The results showed that 70% had one or more malocclusion traits at 3 years of age. The most common malocclusion traits were anterior open bite (50%), Class II occlusion (26%), increased overjet (23%) and posterior crossbite (19%). The prevalence of sucking habit was 66% and dummy sucking was dominating and in connection with more malocclusion traits than finger/thumb sucking. A significant association was found between the sucking habits and the most prevalent malocclusions, anterior open bite, Class II occlusion, increased overjet and posterior crossbite. In conclusion, the prevalence of malocclusion traits in 3-year-old children was high. Sucking habits was highly prevalent and dummy sucking resulted in more malocclusion traits than finger/thumb sucking did.

The aim of this longitudinal study was to compare the prevalence of malocclusion at ages 3 and 7 years in a sample of children, exploring the hypothesis that prevalence of malocclusion is higher at 3 than at 7 years of age and may be influenced by sucking habits. The study sample comprised 386 children (199 girls and 187 boys), aged 3 years at study start, sourced from three Public Dental Service clinics in Sweden. Malocclusion was diagnosed by clinical examination, using a specific protocol. Data on allergy, traumatic injuries, sucking habits, and breathing pattern including nocturnal breathing disturbances were obtained by means of a questionnaire answered by child and parent in conjunction with the initial and final clinical examination. The overall prevalence of malocclusion decreased significantly, from 70 to 58% (P < 0.0001): predominantly anterior open bite, excessive overjet, and Class III malocclusion. Although high rates of spontaneous correction were also noted for deep bite, Class II malocclusion and posterior and anterior crossbites, new cases developed at almost the same rate; thus, the prevalence was unchanged at the end of the observation period. Anterior open bite and posterior crossbite were the only conditions showing significant associations with sucking habits. The results confirm the hypothesis of higher prevalence of malocclusion at 3 years of age and clearly support the strategy of deferring orthodontic correction of malocclusion until the mixed dentition stage.

What is Academic Quality? On the Decline of Academic Autonomy In light of the transformations that universities currently undergo, with Bologna as a keyword, the following questions are put: What ideals lie behind the assessment of academic “excellence” and “quality”? Who are the agents having the ability to define what is good science and education today? These questions are approached through Pierre Bourdieu’s concept of field. Looking at the development during the last decade, traditional academic values, such as the ideals of universal knowledge as (personal and collective) enrichment and of intellectual independence “of all political authority and economic power”, as stated in the Magna Charta Universitatum, seem to have been pushed into the shadow of employability, knowledge control, competitiveness, and economic benefit. In connection with the formation of concepts such as “the knowledge society” and “knowledge based economies” the university has received a somewhat different and more central role in society. The university has come to take the role more of a knowledge producing enterprise clearly directed towards the surrounding society. There are higher demands on academic knowledge to contribute to economic, regional or national development and competitiveness. When the university is regarded as a knowledge company whose task is to account for the requests of the students, the labour market, and the business world it undertakes to follow trends and short term social trends rather than to critically examine them, which has been a traditional task for the university. If the academic work is guided by the market economy principle, that clients decide what quality is, instead of experts on the academic field (i.e. the scientists,) it is obviously not scientific ideals that constitute the criteria for what is good science and education.

Xerostomia, the subjective sensation of dry mouth, is associated with qualitative and quantitative changes of saliva. Poor health, certain medications and radiation therapy constitute major risk factors. To gain further understanding of this condition the present study explored the main concerns of xerostomia expressed by afflicted adults. Qualitative interviews were conducted with 15 participants and analyzed according to the grounded theory method. An aggravating misery was identified as the core category, meaning that the main concern of xerostomia is its devastating and debilitating impact on multiple domains of well-being. Professional consultation, search for affirmation and social withdrawal were strategies of management. The findings reveal that xerostomia is not a trivial condition for those suffering. Oral impairment as well as physical and psychosocial consequences of xerostomia has a negative impact on quality of life. There is an obvious need to enhance professional competence to improve the compassion for and the support of individuals afflicted by xerostomia.

Earlier studies hav  e shown that employers ar e keen to hav e employees whose attitudinal and behavioraltrait  s are consistent with the employers’ ideology. One wa y of ascertaining th e imag   e of idea  l individuals isto analyze th e required qualifications in job advertisements. The ai m of  thi  s study wa s to explore possiblechanges in the employers’ vie w of the idea  l manager and dentist in the Swedish Public Dental HealthService (PDHS). The stud y investigated th e kind s an d frequencies of  manifestly required qualificationsconcerning vacancies in the PDHS fro m January 1990 to December 1998. All job advertisements intendedfo r dentists an d managers on different hierarchical level   s in general dentistry wer e included (n= 1152);570  5 qualification demands were analyzed by  content analysis permitting quantitative descriptions of  thetextual material as  wel  l as  an analysis of th e underlying characteristics over time. The stud  y indicates that  ,fo r dentists, dental professional qualifications or  qualifications in accordance with the official objective ofdental car  e wer  e insufficient. Whil   e requests for qualifications relating to th e economic organizationalgoal   s of  the PDHS increased during the latte r par t of  the period under study, requests relating to thedental profession decreased. For managers, too  , th e demands for dental professional qualifications haddecreased at  the end of  the studied period compared to th e demands fo r managerial qualifications an dnon-professional qualifications, whic h ha d increased. In conclusion, th e job advertisement portrays theidea  l dentist and manager primarily as an economic organizational asset.

Th e manifestly required qualifications in job advertisements in theJournal of the Swedish Dental Associationwere analyzed as indicators of th e organizational ideology in the Swedish Public Dental Health Servicefro m the employers’ viewpoint. Al l job advertisements that concerned dentists an d managers on differenthierarchical level   s in general dentistry from January 199  0 to December 199  8 were included (n= 1152).Th e number of vacancies was 1856 . Th e textual material wa s analyzed by content analysis, permittingquantitative descriptions of the tex t and analysis of th e laten t characteristics. Words an d phrases wereclassified into categories on different level   s of abstraction developed fro m the theoretical background an dthe purpose of the study. Altogether 5705 required qualifications wer  e categorized. Th e inter-coderreliability of  the first-level categorization resulted in 81% correspondence of the classification, an dl= 0.90 . Qualifications wer  e mor   e frequently required wit h higher hierarchical jo b positions, an dpersonality characteristics were mor   e frequent tha  n technical competence an d knowledge. Qualificationsinterpreted as related to economic goal   s occurred mor   e frequently than thos  e related to odontologicalgoals. The qualification demands reflected the language of human resource management (HR M),emphasizing the ‘soft  ’ people-centered approach an d was interpreted as an ‘ideal   ’ model of HRM. Dentistswere regarded as a profitable organizational asse  t rather tha  n participants in relations wit h patients. Inconclusion, the results indicate an  organizational ideology primarily of economic character.

Background: Altered palatal morphology has been observed among some preterm children, with possible consequences on chewing, speaking and esthetics, but determinants remain unknown. Aim: To explore the role of neonatal characteristics and neuromotor dysfunction in alteration of palatal morphology at 5 years of age in very preterm children. Study design: Prospective population-based cohort study. Subjects: 1711 children born between 22 and 32 weeks of gestation in 1997 or born between 22 and 26 weeks of gestation in 1998 were included in the study. They all had a medical examination at 5 years of age. Outcome measures: Alteration of palatal morphology. Results: The prevalence of altered palatal morphology was 3.7% in the overall sample, 5.1% among boys and 2.2% among girls (adj OR: 2.52; 95%CI: 1.44–4.42). The risk for altered palatal morphology was higher for lower gestational age (adj OR: 0.85; 95%CI: 0.74–0.97 per week), small-for-gestational age children (adj OR: 2.11; 95%CI: 1.20–3.72) or children intubated for more than 28 days (adj OR: 3.16; 95%CI: 1.11–8.98). Altered palatal morphology was more common in case of cerebral palsy or moderate neuromotor dysfunction assessed at 5 years. Results were basically the same when neuromotor dysfunction was taken into account, except for intubation. Conclusion: Male sex, low gestational age, small-for-gestational age and long intubation have been identified as probable neonatal risk factors for alteration of palatal morphology at 5 years of age in very preterm children. Further studies are needed to confirm these results.

Goda patientrelationer och möjlighet att utföra kvalitetsarbete i en bra arbetsmiljö. Det är viktigast för att tandläkare ska känna arbetsglädje, visar en studie på avdelningen för samhällsodontologi vid odontologiska fakulteten i Malmö.

This study describes how female unpromoted general practice dentists (GPDs) in a region in Sweden perceived “healthy work”, i.e. their image of the dimensions that the dentistry profession should contain if it is to be really healthy work. The study also investigates whether there is a gulf between ideal and reality for this group. All unpromoted GPDs within the Public Dental Health Service’s general practice in a region in Sweden received a questionnaire, and 94% responded. The data were collected during July and August 2000 and the question about healthy work was taken from work environment studies. A principal components analysis was performed. Three factors explaining more than half the variance (53%), forming three well defined vector clusters: 1) a factor for moral values and possibilities for skill discretion, i.e. properties specific for human services, 2) a factor for career development and 3) a factor for work environment. We found that factor 1 alone explained a greater proportion of the variance (28%) for the respondents. The main results were that the female unpromoted GPDs emphasized free and intellectually stimulating work and that the gulf between the ideal and the reality was wide, especially concerning the dentist’s influence on important decisions. A salutogenetic approach built on good communication and democracy at work, and based on freedom and the employees’ influence, could bring ideal and reality closer.

Objective. Female unpromoted general practice dentists (GPDs) constitute about one-quarter of all dentists in Sweden. These female dentists suffer from many problems relating to their psychosocial working conditions. There are wide discrepancies between their perception of the ideal job situation and reality. Previously, three factors were found to constitute the ideal job situation. The aim of this study was to analyze patterns in two of these factors, i.e. the moral and the career factors, for understanding how ideal circumstances are conceived, i.e. how ‘‘good work’’ for the dentists could be obtained. Material and Methods. In the year 2000, all female unpromoted GPDs (183 persons) within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire; response rate 94%. Four multiple regression models were constructed for two factors of good work and for the differences between the ideal job situation and reality concerning these factors. Results. In all models, the explained variance was high. Those dentists who were committed to moral issues perceived large differences between the ideal and reality concerning moral values. Dentists committed to career issues experienced large differences between the ideal and reality concerning career development. Those dentists - about 60% - who would not want to be a dentist if they were to choose today, perceived large discrepancies concerning moral and career issues. Conclusions. The PDHS organization has failed to convince or engage those whom it ought to engage, that is those with the highest level of commitment. Dentists’ emphasis on moral values confirms the character of dentistry as primarily a human service work.

Unpromoted female general practice dentists have a working situation with hard work conditions. The aim of the present study was to describe the perceived health for unpromoted female general practice dentists in comparison with others laving a somewhat similar working situation. Questionnaires were sent to all unpromoted female general practice dentists (n=183) within the Public Dental Health Service in a region in Sweden. The response rate was 94%. Comparisons have been done with personnel in the Social Insurance Organization in Sweden and Children Clinics in the Public Health Care in a region in Sweden. The dentists in this study suffered from many physical and mental troubles and also linked them to the working situation. They reported high prevalences of tiredness (70%) and back, neck and shoulder pain (76%) and related these symptoms to the job situation in 83% and 95%, respectively. The study showed statistically significant differences (p < 0.0001) in the comparison between all the samples that were investigated. In conclusion, the results show problems concerning self-perceived health for the unpromoted female dentists. We have shown that they are feeling unhealthy, worse than other high-risk-groups in a human service working situation, and they suffer from a multitude of problems also connected to their working environment.

Studies have shown that female unpromoted general practice (GP) dentists have a taxing work situation with many problems related to their psychosocial work environment. This study aims to describe 1) the participation for this group in organized network activity (support groups) in a region in Sweden, 2) the sense of support with comparison to another organization and to a nationwide sample of GP dentists, and 3) the covariation of network participation with support. All unpromoted female dentists within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire, and 94% re-sponded. Those participating in network activity ≥ 4 times a year constituted 12% of the respondents. The co-operation between colleagues was lower than in the nationwide sample. The experienced support from the organization PDHS was weak. It was not possible to explain why the female unpromoted GP dentists participated ≥ 4 times a year, but the female dentists who felt lonely in their work were to a higher degree participants in a network. Almost nine out of ten reported being strengthened by the network both as a person and in the professional role. The female dentist was three times more likely to participate in a network if she had a male head of the clinic. In conclusion, the main results are the paucity of intercolleague contact and the lack of association between support and network participation. The many affirmative comments indicated though, that network participation might be a good coping strategy for unpromoted female GP dentists.

A supplementary regulation in the Swedish National Dental Health Care Insurance stipulates an increased economic support to those, who are dependent permanently due to disease or handicap. Once enlisted to care, they are entitled to an annual dental examination and individual prophylactic advice free of charge, and to necessary dental treatment, offered within the ordinary medical care, regulated and funded by the county council. A population of persons, > or = 65 years of age and enrolled in municipal long-term care (LTC) in a county in the south of Sweden, was followed regarding changes in oral status and treatment needs for two years. The number of persons examined the year 2002 was 2416 and the corresponding figure for 2004 was 2846. Totally 1170, i.e. 48.4%, of those examined 2002 were deceased two years after the initial examination. Only 914, assessed in 2002, were available for assessment with full data at follow up 2004 and the results are based upon assessments in this group. Analyzing the assessed variables (dental status, oral hygiene status, oral mucosal inflammation, oral mucosal friction) revealed a change during these two years. Significant impairments were recognised, regarding mucosal inflammation and mucosal friction. Regarding treatment needs assessed by a dentist and a dental hygienist, there was a maintained and even increased need for extensive treatment, both by the dentist and, to a greater extent, by the dental hygienist. In sum, prevention efforts both from the dental profession and from other care providers are important to achieve and maintain acceptable oral status.

The aim of the study was to evaluate the realistic oral treatment need in a population in southern Sweden enrolled in long-term care (LTC), in nursing homes (NH), or home care (HC), taking into consideration treatment intention. Every third individual enrolled in LTC was selected after proportionally stratifying a total of 866 subjects according to gender. Of these, 732 (85%) were available for a simple clinical oral health evaluation in their own homes. Dental status, oral mucosal status, oral hygiene status, oral mucosal inflammation, and oral mucosal friction were assessed by observational examinations; suspected malignancies were also noted. Oral treatment need was expressed in accordance with the Treatment Need Index (TNI) as no, minor, major, or urgent, while treatment intention was expressed in accordance with the Treatment Intention Index (TII) as the aim to relieve, delay, maintain, or improve. The rationale for using the TII is to offer subjects in this generally frail population oral treatment at an appropriate level, taking their medical condition into consideration. It was found that 61% of the sample had a need not just for an oral health evaluation but also for additional dental treatment, 31% to be accomplished by prophylactic and 30% by reparative or emergency measures; only l % were estimated to be in urgent need. Furthermore, one manifest and one suspected oral malignancy were found. The results indicate that realistic oral treatment need, guided by the examiner’s estimation of the appropriate treatment intention, is modest in this population, but that regular oral screening is mandatory.

The aim of this study was to analyse whether the interleukin-1 (IL-1) and IL-6 gene polymorphisms were associated with the susceptibility of chronic periodontitis. Genomic DNA was obtained from 20 patients with chronic periodontitis and 31 periodontally healthy subjects. All subjects were of North European heritage. The test subjects were kept in a maintenance program after periodontal treatment but yet showing signs of recurrent disease. Genotyping of the IL-1alpha [+4845C>T], IL-1beta [-3954C>T] and IL-6 [-174G>C] polymorphisms was carried out using an allelic discrimination Assay-by-Design method on ABI PRISM 7900 Sequence Detection System. All genotypes were analyzed using the GeneMapper 2.0 software. A similar distribution of Single Nucleotide Polymorphism (SNP) was seen in both groups. Analysis by logistic regression including gender, IL-1alpha [+4845C>T], IL-1beta [-3954C>T], IL-6 [-174G>C] genotypes, the composite IL-1 genotype, the combination of the composite IL-1 genotype and the IL-6 -174G>C genotype and adjusting for smoking did not result in any statistically significant difference. SNPs in IL-1alpha [+4845C>T], IL-1beta [-3954C>T] and IL-6 [-174G>C] do not seem to increase the susceptibility to chronic periodontitis in this group of subjects.

OBJECTIVE: To assess possible changes in the prevalence of four temporomandibular disorder (TMD) symptoms reported by subjects at age 50 and again 10 years later. MATERIAL AND METHODS: Identical questionnaires were sent out in 1992 and in 2002 to all subjects born in 1942 and living in two Swedish counties. Of those who answered the four questions on TMD symptoms in 1992, 74% responded in 2002 (n=4639). The response alternatives were dichotomized into two groups: 1) No problems and 2) some, rather severe and severe problems. RESULTS: The mean prevalence of TMD-related symptoms reflected small and mainly non-significant changes, whereas the prevalence of reported bruxism was significantly greater at age 60 than at age 50. Among those with no TMD symptoms at age 50, 5-7% of the men and 8-9% of the women reported symptoms at age 60. Of those reporting one or more TMD symptoms at age 50, 47-65% of the men and 40-48% of the women had no symptoms 10 years later. There was a significant and markedly increased risk of reporting TMD symptoms and bruxism (OR>10) at age 60 among those who had symptoms at age 50. CONCLUSIONS: The mean prevalence of reported TMD symptoms was relatively consistent from age 50 to age 60. The group reporting symptoms at the first examination were highly likely still to have the symptoms 10 years later. However, approximately half of the subjects with TMD symptoms at age 50 reported no symptoms at age 60.

Aims: To investigate, by means of a mail questionnaire, the prevalence of symptoms related to temporomandibular disorders (TMD) in 50-year-old subjects living in the counties of Örebro and Östergötland, Sweden. Methods: The total population comprised 8,888 individuals, and the overall response rate was 71%. A clinical evaluation of the masticatory system was performed in subgroups to validate the responses to the questionnaire. There was satisfactory correspondence between self-reports and welldefined clinical conditions. Results: Women reported, more often than men, pain from the temporomandibular joints (TMJs), TMJ sounds, bruxism, sensitive teeth, and burning mouth symptoms. The prevalences of difficulties in jaw opening, loss of anterior teeth due to trauma, and masticatory problems were greater in men than in women. No gender difference was found in the number of remaining teeth. Logistic regression analysis with pain from the TMJ as the dependent variable identified bruxism, impaired chewing efficiency, and gender (women) as the most significant risk factors. With reduced chewing ability as the dependent variable, several missing teeth constituted the highest risk, followed by pain from the TMJ, bruxism, gender (men), and loss of anterior teeth due to trauma. Conclusion: There were significant gender differences in reported TMD-related symptoms in 50-year-old Swedes. Bruxism was a significant risk factor for pain from the TMJ. Reduced number of teeth and pain from the TMJ were significant risk factors for impaired chewing ability.

The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio-economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50- and 60-year-old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50- and 60- year-old subjects in two Swedish counties, Örebro and Östergötland (n =17 138; n 50 = 8878; n 60 = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72.8% (n = 12 468). The reported responses to questions regarding ‘pain in the TMJ region’ and ‘difficulty to open the mouth wide’ were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and bluecollar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and wlth teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio-economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.

The aim of this epidemiological study was to examine associations between temporomandibular (TMD)-related problems and variables from three domains: (1) socio-economic attributes, (2) general health and health-related lifestyle, and (3) dental attitudes and behaviors. The overall response rate to a questionnaire mailed to the total population of 50-year-old subjects in two Swedish counties (8,888 individuals) was 71 %. Among the 53 questions in the questionnaire, those related to social, general health, and health-related factors were used as independent variables in logistic regression models. Three TMD-related symptoms and reported bruxism were used as dependent variables. Impaired general health was the strongest risk factor for reported TMD symptoms. Along with female gender and dissatisfaction with dental care, impaired general health was significantly associated with all three TMD symptoms. A few more factors were associated with pain from the TMJ only. In comparison, reported bruxism showed more significant associations with the independent variables. In addition to the variables associated with TMD symptoms, being single, college/university education, and daily tobacco use were also significantly correlated with bruxism. Besides female gender, impaired general health, dissatisfaction with dental care, and a few social and health-related factors demonstrated significant associations with TMD symptoms and reported bruxism.

The paper aims to analyse measures of oral health-related quality of life (OHQOL) from a Public Health perspective. Twenty-two measures were analysed conceptually as to their mirroring of the Public Health principles: empowerment, participation, holism and equity. Elements of empowerment were found in connection with application of the measures. Participation was found in using lay opinions during development in 12 measures. All measures analysed had elements of a holistic approach so far that they were not wholly biological. Two measures captured positive health effects. Measures were available for all ages, various languages and populations, an element of equity. No measure was wholly compatible with Public Health. They were based on a utilitarian theory not in full accordance with modern health promotion. There is a need to develop measures that more obviously capture the positive aspects of health and health as a process, as well as the personal perspective of oral health

OBJECTIVE: The aim of this study was to explore the views of young adults on the relevance of three measures of oral health-related quality of life (OHRQoL). METHODS: Sixteen young adults aged 21-29 years were interviewed. The selection was strategic with reference to age (21-25 years.; 26-30 years), sex and education (university degree; upper secondary school). The interview guide covered areas on the content and construction of the measures: The Oral Health Impact Profile (OHIP), the Oral Impacts on Daily Performances (OIDP) and the Oral Health-Related Quality of Life UK (OHRQoL-UK). The data were analysed using qualitative content analysis. RESULTS: A theme expressing the latent content was formulated during the data analysis: 'young adults' own experiences were reflected in their views on the OHRQoL measures'; that is, the experiences of young adults of own oral problems and aspects that were found to be especially important for their age group influenced their view on the measures. The self-reported ability to understand and answer the questions varied and the perceived advantages and disadvantages were almost equally distributed among the three measures. CONCLUSIONS: The OHIP, OIDP and OHRQoL-UK were evaluated as being equal by the young adults in this study, with regard both to their pros and cons. The clarity of the measures was regarded as the most important factor, while the length and assessment period were less significant.

Objectives: In Swedish dentistry, the traditional patient financial system is fee-for-service care (FFS). Since 1999, the public dental health service (PDHS) in the county of Värmland offers an alternative system, contract care (CC). Here, the patient pays a set fee for a fixed period of time, and receives oral health care as specified by a contract, without additional costs. Previously, an association between patient financial system and oral health-related quality of life (OHRQoL) was found. The aim was to model direct and indirect effects with path analysis, to study if there were different underlying mechanisms in the patient financial systems. Material and methods: In 2003, a questionnaire was sent to randomly selected patients enrolled in CC (n=1,200) and FFS (n=1,200) in the PDHS in Värmland. The study was approved by the ethical board in the Southern region of Sweden. Response rate was 57%. Data without internal non-response (n=1,044; CC: 57%, FFS: 43%) were analysed with a multiple group path analysis. The interactions of four variables were of central interest: OHRQoL, the respondents’ perceptions of the dental caregiver’s humanistic (patient-, as opposed to disease-centred) qualities, what the respondents were prepared to pay, and what they had paid for dental care the previous year. Results: The underlying mechanisms in the systems were similar. However, there were differences regarding the central variables: the perceived humanism of the caregiver affected OHRQoL only in FFS, while what the respondents were prepared to pay for dental care was affecting the perception of humanism only in CC. Conclusions: The findings indicated that the perception of the caregiver’s humanistic qualities were important for oral health for respondents in FFS, while financial considerations were important for how the caregiver’s qualities were perceived by respondents in CC. Funding: The study was financed by the Swedish Research Council.

Objective This review covers the impact of financial systems on dental care. Background Remuneration in fee-for-service (FFS) is done per service provided and in capitation (CAP) per patient enrolled. It may be expected that dentists’ incentive in CAP is to keep the number of services provided at a minimum, while in FFS it is to keep the number of services at a maximum. This should lead to a different impact on care, with the dentists in CAP focusing more on prevention and dentists in FFS more on restorative treatment. Six questions were put: Does CAP increase or decrease caries incidence? Does CAP increase or decrease restorative treatments? Does CAP increase preventive care? Does CAP increase or decrease productivity? Does CAP increase or decrease the dentist’s satisfaction with his/her work? Does CAP increase or decrease the patients’ satisfaction with the oral care provided? Methods Literature was obtained through searches in databases. A format was developed to define the literature of interest. Results CAP decreases restorative treatment and there is a tendency of decreased caries incidence. “Supervised neglect” cannot be established. CAP increases preventive care. A conclusion regarding productivity was not possible. The results on dentist’s satisfaction with work were inconclusive, as were the results regarding patient satisfaction. Conclusions CAP has a different impact on provided care than FFS. More research is needed in this area and focus on efficiency is of importance. This review was funded by the Swedish Research Council.