Background: A home visiting programme was offered to first-time parents in the south of Sweden to reduce health inequalities among young children and support parents. The programme involved a collaboration between child healthcare nurses and midwives, social work-ers, and dental hygienists/dental nurses. It is unusual for dental professionals to participate in such programmes. Objective: To describe the experiences of collaboration between child healthcare nurses and dental professionals and their views on the programme from a dental perspective. Basic Research Design: Qualitative semi-structured interview study with content analysis. Participants: Four child healthcare nurses, three dental hygienists, and two dental nurses. Results: Analysis identified five themes: contribution of knowledge, reinforced oral health advice, family-based oral health advice, financial considerations, and future role of the dental care. Conclusions: Participants stressed the importance of dental professionals' knowledge, the need for child healthcare nurses and dental professional to conduct home visits together to deliver family-based and reinforced dental advice. They suggested a follow-up visit and the participation of the public dental service before a private dental care provider since most children will visit a public dentist later. The programme was perceived as worth the costs, but for the best utility, the resources should primarily be for non-native parents. Further research should focus on the effect of the home visiting programme on the children's oral health.

Objective

To explore dental professionals’ perceptions of their role in the practice of oral health promotion.

Material and method

In-depth interviews were conducted with three dentists, one specialist dentist and seven dental hygienists. All were employed in the public dental service in Kalmar County, Sweden and had at least two years’ work experience. The interview questions addressed the experience and views of dental professionals with reference to their role in the practice of health promotion. The interview data were subjected to qualitative content analysis.

Results

Analysis revealed two themes which capture the essence of the dental professionals’ perception of their role in the practice of oral health promotion. One theme, having person-focused approach, comprised four categories: ‘considering the patient’s life situation’, ‘establishing a trusting relationship with patients’, ’strengthening patients’ commitment to oral health’ and ‘health education’. The other theme, perceiving social responsibility for oral health, comprised three categories: ‘dissemination of oral health knowledge’, ‘interprofessional collaboration’ and ‘equality in oral health care’.

Conclusion

Dental professionals perceived promotion of oral health to be an important aspect of their professional role. They aspired to patient participation in the decisionmaking process and educational activities, as well as practising and evaluating skills development. Although the dental professionals perceived that they undertook health promotion activities, they did not clearly distinguish between oral health promotion and disease prevention. There was intra- and interprofessional agreement among the dentists and dental hygienists with respect to expected outcomes for health promotion activities.

OBJECTIVE: This study aimed to explore oral health-related salutogenic factors in orally healthy older Swedish people, applying the three components of Antonovsky's Sense of Coherence (SOC) concept: comprehensibility, manageability and meaningfulness.

MATERIAL AND METHOD: Interviews were conducted with 12 orally healthy patients, aged 75 years and older, enrolled at public dental clinics. The interviews were subjected to qualitative content analysis, applying the SOC concept as the theoretical framework.

RESULTS: Three themes were formulated under the predefined SOC components, describing the central meaning of the informants' perception of factors favourable to their good oral health. The theme 'comprehension of cause and effect' consisted of three categories, for example importance of oral hygiene, and reflected the component comprehensibility. The theme 'living in confidence and trust in supporting society' consisted of five categories, for example self-esteem, and reflected the component manageability. The theme 'good oral health as a basis for satisfaction and social confidence' consisted of two categories, for example social norms, and reflected the component meaningfulness.

CONCLUSION: This study discloses how orally healthy elderly Swedish people perceive the lifelong impact of salutogenic factors in response to lifelong stressors on their oral health and highlights the important roles of their internal resources, dental professionals, family and society in supporting and reinforcing lifelong oral health.

Family home visiting programs delivering early childhood services are supported by politicians and policy makers in many countries. This study focuses on a home visiting program for first-time parents in a county in Sweden. The program comprises six home visits conducted by interprofessional teams, including child healthcare nurses, midwives, social workers and dental hygienists, with the aim to increase accessibility to child healthcare and to promote more equal health in young children. Child healthcare, maternal care, social services and dental care organisations participated voluntarily in the program. This study explores how middle managers of the participating organisations view the program. Data were collected from semi-structured interviews with ten middle managers. The interviews were analysed using qualitative content analysis as a method. The results show that the middle managers saw the home visiting program as beneficial for society, parents and children, and the participating organisations and professionals. In other words, they expressed both altruistic goals and a self-interest in participating. The study is of importance as middle managers‟ decision to participate in a home visiting program might be grounded on their perceptions of the program. 

This article concerns how dentists in a Swedish dental care organisation conceptualized work division when teamwork was requested by the senior manager and their boundary work in relation to dental auxiliaries. Data were drawn from semi-structured interviews with the dentists. The dentists’ made claims to tasks based on legislation and their wanting to focus on tasks that required their expertise. Dental auxiliaries may be reluctant to take on new tasks and become more involved in patient care, which indicates that they have some influence in the work division. Nevertheless, the dentists retained control as their invitation for dental auxiliaries in patient care was based on certain conditions. The dentists’ claim to certain tasks may have strengthened their identity as experts and reinforced boundaries between themselves and dental auxiliaries.

The aim of this article is to outline a theoretical framework for how the concept of trust can be used as analytical tool for a study of the aim, design, output and societal legitimacy of a Swedish welfare programme conducted to reduce disparities in health and social inequities and to give newborn a positive start in life. This programme, labelled Grow Safely, implies that home visits will be conducted at six occasions at first-time parents by different professionals: child health care nurses, midwifes, dental hygienists and counsellors from the social services. Prior to when the intervention is carried out, the involved professionals in the programme will be participating in training in order to increase the possibility that the home visits will be carried out in similar ways and be followed the same manual throughout the programme.

The welfare programme will be based on relationships on different levels: between professionals and parents, between different professionals, between professionals and managers, and between organisations. Trust is believed to be of significance for the development of relationships as well as for the social legitimacy of the implantation of welfare programmes. Therefore, our ambition is to embrace a broad perspective on trust, combining insights from a variety of research traditions and analyses on macro, meso and micro levels in the outline a model for how the concept of trust can be used as an analytical tool for studying welfare programmes like Grow Safely. We argue for that the model can capture the significance of trust at different levels: individual, professional, organisational and societal levels as well as interplays between these levels, and consequently be useful in to analyse implementations of welfare programmes.

To cope with dentist shortage, Swedish government reports have recommend teamwork, which allows dental auxiliaries to undertake some of the dentists’ tasks. Dentists are key actors for teamwork development due to their role as team leaders and their autonomy in patient care. This study aimed to examine how dentists perceived their autonomy to realise their desired teamwork in a dental organisation and how their autonomy affected the development of teamwork. The results showed that dentists had authority to decide work division but had reduced ability to realise their wishes. Their autonomy was reduced by resistance from or shortage of dental auxiliaries and by limited support from clinic managers. Dentists’ reduced autonomy led to reduced commitment to develop teamwork.

Det åtgärdsbaserade ersättningssystemet bör finnas kvar i vuxentandvården, menar Cecilia Franzén och Thomas Davidson. Dagens tandvårdsstöd bör emellertid utvecklas, delvis genom förenklingar av hur ATB och STB används, men även genom ökad satsning på forskning för att kunna förbättra rekommendationerna i de nationella riktlinjerna, anser de.

Objective: A trend towards the state governance of healthcare through quality indicators and national clinical guidelines has been observed, and it is argued that this trend can be a challenge to the autonomy of healthcare professionals. In Sweden, these regulatory tools have been implemented in combination with subsidies for adult dental care that are based on guideline recommendations which serve to ensure that dental care is evidence-based and cost-effective. This paper aims to analyse the implications of these changes regarding dentists’ autonomy and whether the government’s political intentions can be fulfilled. Material and methods: The paper is based on documents from government authorities and professional theories. Results: The financial control over Swedish dental care has been strengthened, and it can be argued that this is a step in the right direction from a societal point of view, as public resources are limited. Dentists’ professional autonomy with their patients is not affected, which is appropriate, as patients should be treated according to their individual needs and expectations. Conclusions: This article shows that the state’s governance does not directly detail dentists’ work, which indicates a balance between state governance and dentists’ autonomy. However, further research is required to get knowledge on Swedish dentists’ view of the governance.

One aim of higher education is to develop professional identities in students to equip them for future working life. Health professional students will work under financial pressures in a market-based environment, which can lead to conflicts with professional ethical values. This study explores how Swedish dental students perceive economic aspects of dentistry. The article is based on a study of undergraduate research projects. In the analysis of the projects, two themes were identified: (1) cost-effective organizing of dentistry and (2) costs and benefits of interventions. The students displayed socially responsible values by emphasizing the need for dentists to utilize resources effectively, which implies that professional education can support the development of the perception that economic values can be compatible with professional ethical values.

To be safe and effective, dentistry should be knowledge based, which implies that dentists should apply the best possible scientific theories and principles in the care of patients. In order to do this dentists should understand the importance of research and be able to critically appraise scientific findings, solve problems and make decisions on when and how findings are usable. Research interest and problem solving, and the development of skills necessary to make critical reflections must begin at undergraduate dental education. Undergraduate degree projects, that are student research projects, are currently integrated into the curriculum of the Swedish dental education programmes. These projects include undertaking a research study and writing a short thesis. The rationale behind this integration is that the degree project should allow for the development of research skills among the dental students and enable them to demonstrate an ability to reflect on the relevance of scientific knowledge for dental practice. The opportunity for students to undertake a research project should also be seen in the background of the Humboldtian ideal of higher education that emphasizes that research and education should be intertwined. However, it may not be obvious that the degree project can contribute to knowledge-based dentistry. A study of Swedish dental students’ short thesis’ showed shortcomings in their reflections on the implications of their project results in general dental practice. Dental students’ shortcomings were not unique, as studies of students on other health professional educations have also showed similar findings. Nevertheless, in dental education more emphasis should be put on learning to critical appraise scientific findings in relation to patient care as this is an important skill in dental practice.

Abstract Objectives: The undergraduate degree project is a requisite part of higher education in Sweden, designed to prepare students for professional work and postgraduate studies. This article examines the extent to which the degree project in Swedish dental education helps students achieve these purposes. The focus was on the students’ choice of topics and research methods as well as their ability to reflect on the implications of their results for dental practice. Methods: Degree projects from three of the four Swedish dental schools were analysed using content analysis. Results: The students’ topics concerned clinical dentistry, biomedicine, educational issues and public oral health. Quantitative research methods were used more often than qualitative ones. Some of the degree projects were based on literature reviews. Students demonstrated shortcomings in their reflections on the implications of their results for dental practice. The level of reflection was particularly low in one of the schools; this may be because the students in this school were not expected to reflect on the results. Conclusions: The degree project gives the students an opportunity to develop their knowledge on a topic relevant to dentistry, to be trained in conducting research and to reflect on scientific knowledge in relation to dentistry. However, this study shows the need of assessment criteria that urge the students to reflect on the link between science and clinical work and motivate them to learn to reflect so they become critical thinkers. It is also suggested that dental students should learn more about qualitative research methods.

Introduction: Undergraduate degree projects have currently been introduced into courses in the four Swedish dental schools. The rationale for research projects is that they enable students to develop research expertise skills and to show their ability to apply and develop knowledge relevant to professional practice. This paper reports a qualitative analysis of the curriculum documents and handbooks including the criteria used to assess the students’ research reports. The aim was to investigate commonalities and differences in the design of degree projects between the four Swedish dental schools and to explore any inconsistencies within the documents. Methods: The documentary analysis was based on the constant comparison method. Results: Four overarching themes emerged from the analysis: (1) developing scientific expertise, (2) developing professional expertise, (3) following rules and (4) fostering creativity. Conclusions: The documents from the four dental schools revealed similar views on the purposes of the projects and provided similar assessment criteria. The students were requested to formulate an odontological problem, apply a relevant scientific method, analyse texts and empirical data, express critical reflections and write a short thesis. The students were free to choose topics. There were differences between the dental schools on the emphasis placed on practical uses of the projects and theoretical background of the projects. Two of the schools insisted on rigid rules of completing and writing the project yet paradoxically emphasised creativity. There were wide variations in the required length of the project report. The report may prove useful to dental schools in other countries who are about to design undergraduate research projects.

Objective The Swedish policy objectives in dental care provision – to meet public demands for dental care and to increase the cost-effectiveness of the service – require dentists to work in teams with dental hygienists and dental nurses. This study focused on the role of dentists in the distribution of work tasks within teams in one Swedish Public Dental Service organisation. Dental clinics were viewed as micro-political arenas in which dentists attempt to demarcate professional boundaries in response to teamwork. Methods Semi-structured interviews, observations and documents were used. The interviewed individuals were seven dentists employed at two clinics, the managers of each clinic and the general manager. The dentists were interviewed to investigate how they defend or blur professional boundaries. They were also observed at work. The clinic managers and the general manager were interviewed to identify their expectations of dentists concerning work division. The documents comprised organisational plans and annual reports. Results Dentists demarcated professional boundaries by utilising various power resources: treatment responsibility, specialist knowledge, discretion, and avoidance of work considered to be low status work. The dentists also contributed to blurred boundaries between themselves and the other dental professionals by discussing patient treatment, giving and receiving advice, and assisting the others in skill development. Conclusion Although dentists' boundary work could obstruct implementation of policy objectives, dentists' behaviour contributed to effective collaboration within the teams.

Den här avhandlingen handlar om hur tandläkare som arbetar i folktandvården konstruerar sin yrkesidentitet i yrkeslivet. En bakgrund till avhandlingen är att folktandvården både har människors goda munhälsa som mål och att verksamheten ska vara kostnadseffektiv. För att beskriva vad detta kan betyda för tandläkares yrkesidentitet har tandläkare i en folktandvård intervjuats och observerats. Studien bygger även på intervjuer med tandvårdschefen och klinikchefer och dokument. Tandläkarna förväntas arbeta för att människor ska ha en god munhälsa, men de förväntas även uppnå så höga intäkter som möjligt och överlåta arbetsuppgifter till tandsköterskor så att verksamheten kan vara kostnadseffektiv. Tandvårdschefen och klinikcheferna mäter och följer upp såväl patienternas munhälsa som klinikernas ekonomiska resultat och de enskilda tandläkarnas intäkter. Det är en mångsidig bild av vad det innebär att vara en tandläkare i folktandvården som träder fram. Tandläkarna framställer sig som resultatinriktade tandläkare, som anser att det är viktigt att uppnå höga intäkter dels för deras egen skull, dels för klinikens skull. De beskriver sig vidare som arbetskamrater som hjälper varandra i arbetet med patienter så att dessa kan få god vård. Tandläkarna framställer sig också som samhällstjänare som har som sin främsta uppgift att arbeta för att människor ska ha en god munhälsa och att patienter ska vara väl omhändertagna i en behandlingssituation. En del av tandläkarna understryker skillnader mellan dem och tandsköterskorna och slår vakt om arbetsuppgifter som de anser att de är mest lämpliga att utföra. Dessa tandläkare framställer sig som grindvakter. Även om intäkterna är viktiga för tandläkarna har den ekonomiska styrningen begränsad påverkan på deras yrkesidentitet. Att tandläkare är yrkesutövare som utför ett arbete som är viktigt för andra människor är en central del av deras självbild, det vill säga att de är samhällstjänare.

Whether employees are loyal or not to the organization they work for, might have consequences for the organizational activity. In this article, dentists’ loyalty to the public dental service is discussed. Dentists’ loyalty might have consequences for both the degree to which the organizational objectives are fulfilled, as well as whether they stay in the organization or not. Therefore, one interesting question is to what extent managers can strengthen dentists’ loyalty. This subject is discussed in the light of dentists being professional workers, and in relation to organizational and societal circumstances that are considered to have an impact on people’s loyalty to an organization.

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.