Purpose: The aim of this cross-sectional study was to explore how Swedish General Dental Practitioners (GDPs) and Specialists in Paediatric Dentistry (SPDs) use pharmacological pain management, focusing on local anesthetics (LA) when treating children. Methods: 582 GDPs in southern Sweden and 137 SPDs nationwide received a questionnaire with 4 clinical scenarios covering filling therapy and tooth extractions in children. Each scenario had questions about how often the dentist would use LA and topical anesthetics, answered on a 5-point Likert-type scale (Always, Often, Sometimes, Seldom, Never). Results: The overall response rate was 48.0% (243 GDPs and 102 SPDs). Use of LA reported as Always or Often was more common in SPDs than GDPs for filling therapy in primary molars (98.0% vs. 90.9%, p = 0.019) as well as in permanent molars (99.0% vs. 91.7%, p = 0.006). GDPs who reported Always or Often using LA for filling therapy in primary teeth were younger (42.2 years vs. 49.1 years, p = 0.004) and had fewer years of experience as a dentist (14.2 years vs. 19.9 years, p = 0.016) compared with GDPs reporting less frequent use. Conclusion: There was an underuse of LA among GDPs when treating children. The reasons for refraining from LA are not fully understood, but possible contributing factors can be identified within work environment, insufficient undergraduate training and lack of organizational support and guidelines.

Objectives: Children in out-of-home care (OHC) are at greater risk of ill health than other children in the community. The aim of this registry-based cohort study was to compare the oral health and dental care needs of children in OHC with those of other children in Sweden, by merging data from different Swedish registries. A further aim was to analyse whether children in OHC received more dental examinations after 2017, following implementation of a law requiring mandatory health evaluations prior to placement.

Methods: We identified an exposed cohort of Swedish children and young people, 0–19 years old, who had been placed in OHC 2010–2018 ( N  = 50,878), and an unexposed cohort, five times larger, matched for age, sex and county of residence ( N  = 254,380). During the study period, children in OHC received relatively fewer regular, scheduled dental examinations (4.21 vs. 4.88; p  < 0.0001). More children entering OHC in 2018 received dental examinations (81.7%) compared with 2016 (76.6%) ( p  < 0.0001), but this was still lower than the proportion of controls. Moreover, during the study period, dental caries affected more teeth in children in OHC than in the controls (dft 6-year-olds 1.56 vs. 0.74; p  < 0.0001, and DFT 12-year-olds 1.18 vs. 0.65; p  < 0.0001), and they had more extractions and more emergency dental appointments than children who had never been in OHC.

Conclusion: Not only do children in OHC have poorer oral health than other children, they also receive less support from the dental health services. It seems that society has failed in its mission to ensure that children in OHC are not disadvantaged with respect to health and access to comprehensive healthcare. Thus, there is an urgent need for reappraisal of guidelines, legislation, and organizational models for providing dental care to children and adolescents in OHC.

Antalet familjer som har barn med särskilda behov ökar både i Sverige och internationellt. Forskning visar att familjemedlemmarna ofta löper stor risk för både psykisk och fysisk ohälsa på grund av den utsatta situation som de lever i. Men vad kan professionella inom vård och omsorg göra för att hjälpa dem? Den här boken utgår från forskning och förmedlar både familjernas utsatthet och på vilket sätt de vill bli bemötta. Hur mår de anhöriga? Vilket stöd efterfrågar de? Och vilket stöd har de rätt att få, från såväl vård och omsorg som från socialtjänsten? I det avslutande kapitlet ger författarna konkreta råd och tips om kommunikation och bemötande till den yrkesverksamme som möter anhöriga till barn med särskilda behov.

Boken vänder sig till studerande vid utbildningar med fokus på barn och funktionsnedsättningar, till exempel inom socialt arbete och vård. Den kan även användas som ett diskussionsunderlag för vårdpersonal som i sitt dagliga arbete möter och arbetar med barn med särskilda behov och deras anhöriga.

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour.

Methods: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action.

Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied.

Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

OBJECTIVES: To compare self-reported pain levels across various treatment phases using passive self-ligating (Damon) and conventional (Victory) standardized fixed appliance systems.

MATERIALS AND METHODS: Adolescents (12-17 years old) with crowding and displaced teeth, planned for non-extraction treatment, were recruited from four orthodontic clinics. They were randomized into stratified blocks (1:1 ratio) using concealed allocation to receive Damon Q™ (34 boys, 28 girls) or Victory™ (39 boys, 31 girls). Pain and analgesic intake were assessed on seven different occasions with validated self-report questionnaires using a 10-grade scale.

RESULTS: Of the 132 patients included, six were lost to follow up. Clinically relevant mean pain scores (≥4) were registered in both groups after bonding upper and lower arches and after insertion of 0.019 × 0.025 stainless steel archwire. The highest mean scores were reported on day two after bonding the upper arch (Damon 5.96, Victory 7.18, P = .011). In both groups, at least 40% reported taking analgesics during various treatment phases. The Damon group reported a lower intake of analgesics on days one and two (P = .042 and .037) after treatment initiation. In the entire sample, boys reported significantly higher mean pain scores than girls on the second and third days after bonding (P = .008 and .026, respectively).

CONCLUSIONS: Lower pain levels were reported from the Damon group after bonding. In general, boys reported higher pain than girls did. Clinicians and adolescents need to be aware that clinically relevant pain levels can be expected not only after bonding but also in later phases.

INTRODUCTION: There is an underuse of pain management strategies in dental care for children, possibly owing to perceived stress and discomfort when treating children, which has also been reported by dental students. The aim of this study was to explore how undergraduate dental students experience and understand pain related to dental treatment in children.

MATERIALS AND METHODS: Interviews were held with 21 Swedish dental students, from 3 dental schools, all in their final 2 years of education. The interviews were transcribed verbatim and analysed according to Grounded Theory.

RESULTS: A core category, seeking guidance to avoid pain, was identified and related to 6 conceptual categories. The students used different strategies to manage pain prevention in child dentistry and to become skilled dentists. They described high levels of stress, as well as having high expectations on themselves when treating children. The stress led to a surface learning approach, something the students were not fully aware of.

CONCLUSION: All children should have the right to be ensured optimal pain prevention in dental care. The basis for this is laid during undergraduate education. Thus, pain management in child dentistry is an area in need of special attention in this respect. The academic staff has an important role in supporting their students in their process to gain an identity as professional dentists. To ensure that students incorporate an understanding of the importance of pain prevention when treating children there is a need to create more integration between theory and clinical training in undergraduate education.

Objective: Children frequently experience pain and/or discomfort during dental treatment. Still, pain research in dentistry has mainly been performed on adults using quantitative methods while research on the child's perspective is scarce. This study aims to explore and describe children's experiences and/or thoughts regarding pain in conjunction with tooth extraction.

Material and methods: Interviews were carried out with twelve Swedish 10-16-year-olds who had recently undergone tooth extractions due to orthodontic reasons. Interviews were transcribed verbatim and analysed according to grounded theory.

Results: A core category was identified and named 'handling the unavoidable unknown'. The informants recalled experiences of pain and discomfort during extractions. However, instead of focussing on pain, they described an urge for more information about the procedure and what to expect in terms of pain and/or discomfort, during and/or after treatment. They stated that the levels of pain/discomfort were manageable, while the lack of information negatively affected their coping abilities, causing feelings of unease.

Conclusions: To improve patients' ability to deal with pain in conjunction with dental extraction, the dental team should ensure better and individually tailored information about the treatment. Thus, the use of psychological techniques is a cornerstone in pain management and must be reflected in clinical guidelines.

Objectives This study evaluates the agreement of data on dental caries between electronic dental records and data retrieved from the national SKaPa-registry (Swedish Quality Registry for caries and periodontal disease), with special reference to e/M in deft/DMFT.

Methods In a random sample of 500 6- and 12-year-old children having received dental care in 2014 in the county region of Värmland, Sweden, the diagnostic accuracy of data in electronic dental records with corresponding data obtained from the SKaPa-registry was compared by using Cohen’s Kappa and Intraclass correlation coefficient (ICC).

Results For dft/DFT the Kappa was 0.95, and ICC 0.98 (total population). For deft/DMFT in the total population the Kappa was 0.80 and ICC 0.96. For 6-year-olds (deft) the Kappa was 0.89 and ICC 0.99 and for 12-year-olds (DMFT) the Kappa was 0.70, and ICC 0.83. The corresponding figures for Kappa and ICC when excluding individuals without caries (deft/DMFT = 0) were: Total population 0.63 and 0.94; 6-year-olds 0.79 and 0.99; 12-year-olds 0.42 and 0.68.

Conclusion Agreement between data in the dental records and SKaPa was very high for dft/DFT confirming that transfer from the dental records to the SKaPa-registry is safe and correct. As the accuracy of deft/DMFT was considerably lower than for dft/DFT we advise against using deft/DMFT data from SKaPa for research purposes at this point.