BACKGROUND: Dental caries is a global public health problem with persistent inequalities. Research with a salutogenic perspective, as in, a focus on health factors, can provide important knowledge to be used in health promotion. The aim was to explore salutogenic resources among dental caries-free young adults living in vulnerable communities in South Africa.

METHODS: A total of 32 participants (28 females, 4 males, mean age 26.2 years) with no previous caries experience were purposively recruited from two under-resourced townships. The qualitative data from interviews were audio-recorded, transcribed, and analyzed via qualitative content analysis.

RESULTS: The resulting theme, A salutogenic foundation for oral health: preservation of traditions and use of personal health assets as protection against challenges, comprised two categories: (1) Individual health assets and early intergenerational learning, and (2) Ability to apply learned health strategies. Having individual health assets and tools for coping, early learning experiences by positive family influence, being exposed to healthy traditions during hardships, and the ability to apply learned health strategies were important salutogenic resources. Together, these resources formed a salutogenic foundation for oral health which enabled individuals to develop healthy routines, make healthy choices for oral health, and maintain oral health when encountering challenges and hardships.

CONCLUSIONS: Salutogenic resources for oral health empowered individuals from vulnerable communities to maintain oral health. This suggests that future health promotion interventions should be considered and directed at multiple levels, targeting individual, family, community, and structural factors to promote sustainable oral health.

AIM: Threshold concepts are concepts that, when grasped, will promote mastery of a subject by leading to proper understanding of its most central features. Some features of threshold concepts are that they are transformative, troublesome, irreversible, integrative, and bounded. The aim of this study is to report on the development and initial assessment of threshold concepts introduced in undergraduate endodontic education at Malmö University.

Methodology: By systematically reviewing published literature we evaluated how threshold concepts affect students’ experiences in dental or medical education. Through collegial discussions three central concepts were identified: “Physical and physiological barriers”, “Gradual disease development” and “Localization of inflammation/infection”. These concepts were then integrated into all theoretical learning activities in Endodontology. At the written examination, the students replied in short essays to questions about pathogenesis regarding pulpal and periapical disease. Through systematic text condensation (Malterud 2012) the answers were analyzed to discover whether their arguments indirectly or directly reflected the threshold concepts.

Results: The systematic review failed to identify studies evaluating how threshold concepts affect students’ experiences in dental education. Four papers from medical education reported that threshold concepts act as tools to overcome obstacles and foster new ways of thinking. The systematic text condensation identified four main themes: “Barrier functions and their role in the pulp defense”, “Inflammation and infection in the pulp and surrounding tissues”, “Clinical approach to endodontic diagnostics” and “Details of disease development”. These main themes were then further divided into subthemes. The results showed that the students reflected well on the central concepts of Endodontology and showed good understanding of the meaning of threshold concepts.

Conclusions (mandatory): The identified concepts were integrated into the learning activities and seem to have affected the students’ ability to grasp central concepts within Endodontology. Further studies are needed to confirm whether learning the concepts also promoted retention of knowledge over time.

For many people, a trip to the dentist can be nerve-wracking and mildly unpleasant, but for those exposed to sexual abuse it can be a deeply distressing experience that triggers overwhelming fear, anxiety, and physical symptoms. Despite oral health being essential for our overall wellbeing, many struggle to seek the dental care they need, leading to long-term health and quality of life consequences. Dr Eva Wolf from Malmö University, in Sweden, has led a team of researchers to help further understand the connections between a history of sexual abuse and fear of dental care, as well as how dentists can use a trauma-informed, patient-centred approach to better support these people

Aim: To explore the context in which general dental practitioners (GDPs) decide to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with persistent asymptomatic apical periodontitis (PAAP).

Methodology: Fifteen GDPs were strategically selected for in-depth interviews. The informants were encouraged to describe in their own words and in as much detail as possible, the three most recent patient cases of PAAP of a root canal filled tooth, in which they decided to refrain from further treatment. The interviews were recorded digitally and transcribed verbatim. The collected material was analysed according to Qualitative Content Analysis with an inductive approach.

Results: A pattern of varying degrees of uncertainty associated with the decision process was identified. The motives to refrain intervention had great diversity. The result from analysis of the qualitative data was formulated in an overall theme 'Between doubt and certainty in a complex clinical context' covering the latent content. The first main category covering the manifest content was 'The continuum of confidence' with three subcategories 'Experienced uncertainty', 'Reluctant approval' and 'At ease with refraining' illustrating the feelings and attitudes experienced by the informants. The second category was 'In support of acceptance' with three subcategories 'Patient's autonomy, risks and cost-benefits', 'Emotional aspects' and 'Relieving measures' representing the reasons for refraining from intervention.

Conclusions: The decision to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with PAAP was made with some measure of confidence, combined with compensatory strategies to support the decision, taking into account not only values beneficial to the patient and awareness of limited external resources, but also factors related to the informants' personal preferences, convenience, concerns, ambition and emotions.

The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19–23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was ‘Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health’, comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

Background/Aim: To analyse, from the perspective of adults with a history of sexual abuse, the impact of the experience on their general health and well-being.Material and Methods: The participants comprised 12 strategically selected informants (10 women), aged 19-56; all sexually abused during child- and/or adulthood. They were interviewed in-depth and encouraged to describe the impact of the sexual abuse on their daily lives. The consequences of sexual abuse on oral health have previously been reported. The interviews were recorded digitally, transcribed verbatim and analysed according to qualitative content analysis with an inductive approach.Results: The overall theme illustrating the latent content was Sexual abuse experience-limiting long-term consequences, always present in body and mind. The first category covering the manifest content was 'A lost foothold', with two subcategories: (i) emotional repercussions and (ii) physical health repercussions. The second category was 'The significance of distance to trauma', with two subcategories (i) keeping a distance and tending to escape and (ii) processing the trauma experience-a struggle towards balance.Conclusions: A history of sexual abuse cannot be understood in isolation: the long-term repercussions pervade daily life. However, after disclosure of the abuse and processing the trauma, it is possible to ameliorate some of the negative effects. In this context, the dental setting emerges as a potentially important venue for disclosure as almost every person, sooner or later, visits the dentist.

The aim was to analyze perceptions of oral health in adults who have been exposed to child sexual abuse. Eleven participants (10 women), 19 to 56 y of age, who had experienced sexual abuse as children were purposively selected and interviewed in-depth. The participants were encouraged to describe how they perceived the effect of the sexual abuse on their oral health as adults. The interviews were recorded digitally and transcribed verbatim. The collected material was analyzed according to qualitative content analysis. The theme "challenging conditions for maintaining oral health" was identified, comprising 2 categories: first, "the emotional significance," with the subcategories 1) emotional barriers and 2) powerful relief, and second, "the obstacles to oral health," with the subcategories 1) daily self-care with complications and 2) dental appointments with difficulties. The findings indicate that the experience of sexual abuse during childhood can have a negative impact on oral care in adulthood. The informants stated that oral health was of utmost importance but also associated with strong emotions. There were obstacles to maintenance of oral health that were difficult to surmount.Knowledge Transfer Statement:The study provides access to the attitudes of survivors of child sexual abuse regarding oral health and the needs and obstacles that they experience. This is important knowledge for dental professionals to optimize dental care.

AIM: Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision-making process regarding pre-medical management of root canal-filled teeth with asymptomatic apical periodontitis.

METHODOLOGY: Hospital-affiliated dentists in Sweden were contacted for a semi-structured, in-depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root canal-filled teeth with asymptomatic apical periodontitis - one case having resulted in pre-medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open-ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analyzed using Qualitative Content Analysis with an inductive approach.

RESULTS: A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes-difficult risk-benefit-estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four subcategories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference.

CONCLUSION: The current interview study found pre-medical decision-making regarding root canal-filled teeth with asymptomatic apical periodontitis to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence-based treatment guidelines, is suggested necessary.

Objectives: The aim was to define the characteristics of successful implementation of new clinical endodontic routines within a public dental health organization, following an educational program. Materials and Methods: Fifteen staff members were strategically selected for the interview. All had completed a theoretical educational intervention including a complementary endodontic treatment strategy and, for the dentists, comprising training in the nickel-titanium-rotary-technique. All experienced the successful acceptance of new clinical routines. Two thematic in-depth audiotaped interviews were conducted, wherein the informants described the implementation process in their own words. The interviews were transcribed verbatim and analyzed according to Qualitative Content Analysis. Results: A theme was identified: A multiple flexible process with governance support and gradual reinforcement of motivation, with the following main categories: Firstly, contextual facilitation, with two subcategories (i) a multifaceted organizational foundation and (ii) a tolerance of flexibility. Secondly, emotional facilitation, with two subcategories (i) an experience of simplification and (ii) an experience of improvement. Conclusion: The results improve the understanding of a multifaceted process underlying the acceptance of changes to clinical endodontic procedures by dentists in a public dental health organization. Important contributing factors identified were governance support, a committed resource person with contextual knowledge, tolerance of flexibility in implementation, and permissive informal communication channels within the local workplace. These findings might be a valuable contribution to an evidence base, facilitating the selection of the most appropriate educational strategy and structure for a specified purpose.

AIM: To describe the decision-making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth.

METHODOLOGY: GDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semi-structured in-depth interviews were conducted, focusing on the informant's personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27 - 64 (mean age 46 years), were included and analyzed according to Qualitative Content Analysis.

RESULTS: A theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven sub-categories (manifest content), were identified. The categories were clinical factors, contextual factors and patient´s views. Clinical factors underlying the GDPs´ decision included the current dental status and the estimated longevity of the intended restoration. In certain cases contextual factors were also of importance, either supporting the GDPs´ decision or modifying it. However, the patient´s views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient´s economic status and opinions.

CONCLUSIONS: With respect to coronal restoration of a root filled tooth, the GDPs' decision-making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients' views.