Public Dental Health Service Research Articles

'Feeling more like a mechanic' - A qualitative study on experiences of caries prevention to patients with recurrent cavities among experienced dentists.

To explore experiences of caries prevention in adult patients with recurrent cavities among experienced dentists. Method: Five focus group discussions consisting of seven men and nine women, 38-61 years of age, and with working experience as dentists between 5 and 35 years, were conducted. The participants represented Public Dental Health Service clinics and private practitioners. Qualitative content analysis was used to analyze data. Results: The participants emphasized the importance of effective communication and patient engagement in caries prevention. They described their experiences as an endless trail, making fillings. They expressed their inability to take necessary responsibility and being stuck in the dental care system due to various circumstances. The understanding of caries was contradictory, and an inadequate mandate to control time to fulfill their preventive work was evident. They felt responsible to do the best for their patients, but how to share responsibility with colleagues and patients and having enough time for this seemed difficult and unclear. These problems did not motivate to further education in cariology. The findings underscore the urgent need for improvement in preventive caries treatment and the necessity of allocating sufficient time for dentists to engage in this crucial aspect of their work.

The new system for classification of periodontal and peri-implant disease: A questionnaire study of implementation by Swedish dental hygienists.

To what extent do dental hygienists (DH) employed by the Public Dental Health Service (PDHS) in Sweden use the new classification system, their knowledge of it and their attitudes towards it. A web-based questionnaire was distributed to DHs in the PDHS in different regions of Sweden. A total of 197 registered DHs responded. The questions covered their knowledge, attitudes and possible barriers to implementation of the new classification system of periodontal and peri-implant diseases, and a question about their perceived need for a complementary digital tool to facilitate its implementation. Seventy per cent of the DHs stated that they used the new classification system. Twenty-nine per cent of the participants were confident in classifying periodontitis under the new system. Furthermore, 36% of the participants considered their knowledge of the new system to be good and 33% to be poor or non-existent. Several DHs stated that the new system was too time-consuming, that it caused stress, that their knowledge was inadequate and that they, therefore, considered it too difficult to use. Eighty per cent of the participants were positive to a digital tool as a complement and support to classify periodontitis and peri-implantitis. The present study showed that most of the DHs used the new classification system and one-third considered their knowledge to be good, although it was difficult and time-consuming. Furthermore, in general, the DHs were positive to a digital tool to facilitate application of the new classification system.

Characteristics and impact of pain from root-filled teeth. A practice-based cross-sectional study comparing painful teeth with and without signs of inflammatory dental disease

To compare pain characteristics, impact of pain and characteristics of patients with painful root-filled teeth with and without signs of inflammatory dental disease. This cross-sectional study was performed in the Public Dental Health services, Region Örebro County, Sweden. Adult patients with ≥1 root-filled tooth identified at their regular check-up were included and assigned to one of two groups; those with ≥1 sign of inflammatory dental disease (DD+) and those without any such sign (DD−). Patients/teeth were compared regarding pain characteristics (intensity, frequency, duration, quality and provoking factors), impact of pain (medication intake, impact on life) and patient characteristics as background factors (general health, other bodily and orofacial pain). Statistics included descriptive data (frequency tables) and group comparisons (Chi-square, Fisher’s Exact and Mann-Whitney U-tests). The DD+ group included 27 participants (30 teeth) and the DD− group 22 participants (23 teeth). On average, pain intensity was mild, the frequency most often recurrent, and the impact was low. Average pain duration since onset exceeded 2 years in both groups. The only observed between-group differences were average pain intensity; 3.1 (0–10 Numerical Rating Scale (NRS)) in DD− group compared to 1.6 for DD+ (p = 0.030), and tenderness to apical palpation; only reported in the DD+ group. The similarities in clinical presentation between the two groups underscore the difficulties in correctly distinguishing between pain of odontogenic and non-odontogenic origin in root-filled teeth with a standard clinical investigation. Additional diagnostic methods need to be investigated for their ability to differentiate between tooth pain or discomfort of different origins.

Oral health-related quality of life, impaired physical health and orofacial pain in children and adolescents with juvenile idiopathic arthritis – a prospective multicenter cohort study

BackgroundKnowledge on oral health-related quality of life (OHRQoL) in children and adolescents with juvenile idiopathic arthritis (JIA) is limited, and longitudinal studies are lacking. We aimed to describe OHRQoL in children and adolescents with JIA compared to controls, and to explore the validity and internal consistency of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Child Oral Impact on Daily Performance (Child-OIDP). Furthermore, we wanted to investigate associations between OHRQoL and orofacial pain, physical health, disease activity, and temporomandibular joint (TMJ) involvement in JIA.MethodsThe Norwegian prospective, multicenter cohort study recruited participants with JIA between 4 and 16 years of age and corresponding controls from three pediatric university hospital departments and public dental health services. In the present study, we analyzed OHRQoL in all children < 12 years with the ECOHIS and adolescents ≥ 12 years with the Child-OIDP at the first visit and the two-year follow-up. Associations between OHRQoL and JIA characteristics, collected in clinical exam and questionnaires, were analyzed in logistic regressions.ResultsThe same OHRQoL questionnaire was completed both at first visit and two-year follow-up in 101 children < 12 years (47 JIA, 54 controls) and 213 adolescents ≥ 12 years (111 JIA, 102 controls). The frequency of OHRQoL impacts in children was similar at the first visit and the two-year follow-up (ECOHIS > 0: JIA group 81% and 85%, p = 0.791; control group 65% and 69%, p = 0.815), while adolescents with JIA reported fewer impacts at the two-year follow-up (Child OIDP > 0: JIA group 27% and 15%, p = 0.004; control group 21% and 14%, p = 0.230). The internal consistency of the OHRQoL instruments was overall acceptable and the criterion validity indicated that the instruments were valid at both visits. Orofacial pain was more frequent in children and adolescents with JIA than in controls. We found associations between OHRQoL impacts and orofacial pain, impaired physical health, disease activity, and TMJ involvement.ConclusionsChildren and adolescents with orofacial pain or impaired physical health were more likely to report impacts on daily life activities than those without. Pediatric rheumatologists and dentists should be aware of impaired OHRQoL in individuals with JIA with active disease or temporomandibular joint involvement.Trial registrationRegistered on clinicaltrials.gov (NCT03904459, 05/04/2019).

Patients’ experiences of temporomandibular disorders and related treatment

BackgroundTemporomandibular disorders (TMD) are common and therefore managed by dentists on a daily basis. However, patients with TMD consistently go undetected and therefore untreated in dentistry. The reasons for these shortcomings have not been fully explored, specifically with regard to patients’ perspectives. Therefore, this study aimed to explore patients’ experiences of TMD and related treatment, with special focus on the experiences of having TMD, factors related to seeking care, and perspectives on received treatment.MethodsPurposive sampling was used to recruit adult patients at the Public Dental Health services (PDHS) in the Region of Västerbotten, Sweden, during 2019. Individual semi-structured interviews were conducted and analysed using Qualitative Content Analysis. Sixteen patients were interviewed (ten women and six men, 20–65 years). The interviews probed the patients’ perspectives of having TMD, seeking care, and receiving treatment. All participants were also examined according to the Diagnostic Criteria for TMD (DC/TMD) and qualified for at least one DC/TMD diagnosis.ResultsThe data analysis led to the main theme Seeking care when the situation becomes untenable, but dental care fails to meet all needs. The patients expressed worry and social discomfort because of the symptoms but still strived to have an as normal daily life as possible. However, severe symptoms and associated consequences compelled them to seek professional help. Experiences of distrust together with challenges to access the PDHS were identified and related to the patients’ unfulfilled expectations.ConclusionsPatients’ reported experiences indicate that receiving timely and appropriate care is more of an unfulfilled expectation than the current state of management of patients with TMD in dentistry.

Orthodontic management of traumatic dental injuries in Norway and orthodontists' perceptions of referral routines: A quality assurance survey.

Orthodontic treatment of patients with traumatic dental injuries is challenging, with limited evidence of routines and outcomes. The aims of this study were: (i) to describe how orthodontists perceive the information on traumatic dental injuries received by referral from the Public Dental Health Service before orthodontic treatment and (ii) to assess orthodontists' knowledge and working routines in managing traumatic dental injuries. Data were obtained through a survey of all practicing orthodontists registered as members of the Norwegian Association of Orthodontists (n = 203). Eighty-three orthodontists were enrolled, most of whom had received their dental degree (73.0%) and specialist orthodontic training (88.5%) in Norway. They reported examining patients with a history of traumatic dental injury at weekly (34.2%) or monthly (38.0%) basis. In 85.5% of cases, they obtained a history of traumatic dental injury from patients. Half of the respondents (51.3%) favoured two-phase early orthodontic treatment for patients with an overjet ≥6 mm. The observation time and treatment strategy showed considerable discrepancies across traumatic dental injury diagnoses. Most (59.1%) orthodontists considered the information on previous traumatic dental injuries provided by the Public Dental Health Services referral 'inadequate', more commonly in cases of mild (83.5%) than severe (57.5%) traumatic dental injuries. Orthodontic management of patients with traumatic dental injuries was characterised by lack of uniformity in both recommended observation time before orthodontic treatment and management strategy. The referral routines by the Public Dental Health Services for patients with traumatic dental injuries were perceived as 'inadequate' in terms of frequency and quality. The results indicate the requirement of standardisation of routines related to orthodontic management of traumatic dental injuries and referral routines by the Public Dental Health Services.

The Longitudinal Relationship between Jaw Catching/Locking and Pain

Orofacial pain and joint-related dysfunction can negatively affect daily jaw function. A common cause for limitations in jaw movements is joint-related dysfunction such as various forms of catching and locking. However, knowledge is limited regarding the development and natural course of joint-related jaw dysfunction and its relationship to the onset and course of orofacial pain. Therefore, the aim was to evaluate the incidence, prevalence, and gender differences in jaw catching/locking over time and in relation to orofacial pain in the general population. Data from 3 validated screening questions on orofacial pain and jaw catching/locking were collected from all routine dental checkups in the Public Dental Health Services in Västerbotten, Sweden, from 2010 to 2017. Logistic generalized estimating equation was used to account for repeated observations and Poisson regression for incidence analysis. In total, 180,308 individuals (aged 5–104 y) were screened in 525,707 dental checkups. In 2010, based on 37,647 individuals, the prevalence of self-reported catching/locking was higher in women than in men (3.2% vs. 1.5%; odds ratio, 2.11; 95% confidence interval [CI], 1.83–2.43), and this relationship and magnitude remained similar throughout the study period. The annual incidence rate was 1.1% in women and 0.5% in men. Women were at a higher risk than men for reporting both first onset (incidence rate ratio [IRR], 2.29; 95% CI, 2.11–2.49) and persistent (IRR, 2.31; 95% CI, 2.04–2.63) catching/locking. For the onset subcohort (n = 135,801), an independent onset of orofacial pain or jaw catching/locking exclusively was reported by 84.1%, whereas a concurrent onset was reported by 13.4%. Our findings of higher incidence, prevalence, and persistence in women than in men indicate that the gender differences seen for orofacial pain are evident also for jaw catching/locking. The findings also suggest independent onset of self-reported catching/locking and orofacial pain, which reinforces the pathophysiological differences between these conditions.

Adaptations in dental public health services during the COVID-19 pandemic in municipalities of Southern Brazil: a grounded theory and collaborative research.

The aim of this study was to analyze oral health actions in four municipalities in Brazil during the COVID-19 pandemic according to a theoretical framework model on oral healthcare management. It was a qualitative study carried out in two stages. A theoretical-empirical model on the significance of oral healthcare management was developed, following the Grounded Theory method. Fourteen dentists and five healthcare managers participated, through open interview. Subsequently, collaborative research was performed, and the model was applied to analyze the documents produced to address the pandemic by each of four municipalities in Santa Catarina State. The model provided a framework for analyzing actions for coping with the pandemic regarding oral health services. Actions were identified in all dimensions of the model: reduction in supply of dental care due to restricted access to elective services; search for biosafety care standards; dissemination of standardized science-based guidelines; attempt to maintain comprehensive dental assistance through re-adaptation of specialized services and collective actions; and relocation of oral health professionals to assist in other sectors. The oral health care management framework can serve as a reference for redesigning oral health actions and services in other municipalities during the COVID-19 pandemic, in a broader perspective.

Cention N Compared to Other Contemporary Tooth-Colored Restorative Materials in Terms of Fluoride Ion Releasing Efficacy: Validation of a Novel Caries-Prevention-Initiative by the Ministry of Health, Malaysia

Background: The Dental Public Health Services of the Ministry of Health, Malaysia have introduced Cention N as a primary restorative material in the health care centers all over the country. Thus, in this scenario, a comprehensive evaluation of Cention N as compared to other restorative materials, in terms of fluoride release, assumes to be of utmost relevance. Fluoride release plays a pivotal role in the prevention of secondary dental caries, and dental restorations facilitate direct fluoride delivery to the susceptible tooth surface. Aim: To evaluate and compare the fluoride releasing property of Cention N with other restorative materials, EQUIA Forte, Beautifil II and Estelite Quick. Methods and Material: A total of 20 disk-shaped brass-mold samples (6±0.1mm in diameter and 2±0.1mm thickness) for the dental restorative materials were prepared, with five samples for each of Cention N, EQUIA Forte, Beautifil II and Estelite Quick. Following the immersion of samples in deionizing water, the released fluoride ions were measured over 28 days using ion chromatography. Data were obtained at day 1, 7 and 28 post-immersion. Statistical analysis: Data obtained from this investigation was analyzed using the MedCalc statistical software (v. 19.05). Kolmogorov-Smirnove test followed by Repeated Measures ANOVA and ‘Comparison of multiple method’ was applied to statistically compare the fluoride release efficacy of Cention N individually with each of the other three materials. Any difference found was considered significant at P&lt;0.05. Results: Cention N showed significantly higher fluoride release than Beautifil II and Estelite Quick when observed on Day 1, 7 and 28. ‘Comparison of multiple method’ confirmed the results obtained via ANOVA and showed Cention N is a significantly better (P&lt;0.05) material in terms of fluoride release as compared to Beautifil II and Estelite Quick on Day 1, 7 and 28. Conclusions: Cention N displays consistent fluoride release while weighing against other contemporary and more expensive restorative materials.

Dentists´ and Dental Hygienists´ experiences of the Capitation Contract System—the dilemma of conflicting loyalties

ObjectiveThe Capitation Contract system (CCS) is a payment model adopted by the Swedish Public Dental Health Service (PDHS). Patients enrolled in the CCS are usually assessed as being at lower risk of dental disease and are more regular dental attenders than those treated by Fee for Service (FFS). With increasing numbers of patients and CCS enrolments, Sweden faces a shortage of dental personnel. Our aim was to analyse dentists´ and dental hygienists´ perceptions and experiences of the capitation contact system.Material and methodsEleven dentists and dental hygienists from three Swedish regions participated in online qualitative interviews conducted according to the Grounded Theory methodology.ResultsWhen working with CCS the informants tried hard ´to find a balance between attitudes, compliance with guidelines and clinical resources´. Not all patients were offered CCS, even though they qualified: among other determinants were the informants’ interpretations of guidelines and regulations, clinical resources, and patient interest.ConclusionsWhen dental resources are in balance, the informants appreciate the CCS and consider it to be favourable to patient health but are aware of conflicting loyalties of their dual roles of insurance sales agent and care provider. The informants´ individual mindset affects which patients are offered CCS enrolment.

Factors associated with initiation and use of snus among adolescents.

We investigated factors associated with the initiation and continuation of snus use in adolescents in Norway. The associations with adolescents' own educational plans, the parents' educational level(s) and tobacco habits were estimated. In this cross-sectional questionnaire-based study, 1465 patients aged 18-20 years participated. The questionnaire was administered at regular dental examinations in the public dental health service. To assess the association between individual factors and the initiation of tobacco habits, a generalised structural equation model with random effects at the clinic level was used. Binary responses were modelled using multilevel binary logistic regression, while the number of snus boxes used per month was modelled using a multilevel Poisson regression model. Of current (daily and occasional) tobacco users, 85% were snus users, including dual users of both snus and cigarettes. The median age of snus initiation was 16 years. Both parental snus use and smoking were associated with an increased risk of snus initiation, snus use and a higher amount of use. An increased risk of using snus was associated with male gender and with no educational plans or planning for further vocational education. The amount of snus used was higher among current snus users with a prior smoking history and among those planning for further vocational education. These findings may aid in developing and targeting tobacco prevention strategies aimed at young people. Tobacco prevention measures should start at the elementary school level. The strong association with parental tobacco habits underlines the importance of parents' influence on their children's tobacco use.

Evaluation of a caries prevention programme for preschool children in Switzerland: is the target group being reached?

BackgroundWith the goal of reducing the prevalence of early childhood caries, the city of Zurich, Switzerland, started a specific prevention programme in 2010. All 2-year-olds are invited to a free dental check-up at a local public dental health service before the first legally mandated yearly dental check-up for school children between 4 and 5 years of age (at kindergarten). However, for the success of this prevention programme, it is of particular importance that children at high risk of caries are reached. The objective of our study was to assess the effectiveness of the prevention programme in (1) reaching the children who needed it the most and (2) improving subsequent oral health.MethodsThis retrospective cohort study included all children born between July 1, 2013 and July 15, 2014 who had lived in Zurich between the ages of 23 and 36 months. Socio-economic data were extracted from official school records, and dental health data from public dental clinic records. Binomial and quasi-binomial generalised linear models were used to identify the socio-economic factors associated with toddler check-up attendance and to assess the associations between attendance and caries experience (dmft ge 1) as well as degree of treatment (proportion m+f out of dmft) at the kindergarten check-up, adjusting for socio-economic factors.ResultsFrom a total of 4376 children, 2360 (54%) attended the toddler check-up (mean age 2.4 years) and 3452 (79%) had a dental examination at kindergarten (mean age 5.3 years). Non-Swiss origin of the primary caretaker, presence of older siblings, low amount of savings and allocation to certain public dental clinics were associated with a lower odds of attendance. Factors associated with a higher odds of caries experience were similar to those associated with a lower odds of attendance at the toddler check-up, but additionally included low income. Attendance at the toddler check-up was non-significantly associated with a lower odds of caries experience at kindergarten (adjusted OR 0.84, 95% CI from 0.70 to 1.01), but was significantly associated with a higher degree of treatment at this stage (adjusted OR 2.41, 95% CI from 1.79 to 3.24).ConclusionsOur study suggests that children with a high caries risk are less likely to attend the toddler check-up. Greater effort should be put into reaching these children.

Patient satisfaction with root canal treatment and outcomes in the Swedish public dental health service. A prospective cohort study.

To document satisfaction with root canal treatment procedures and outcomes among patients treated at Swedish public dental clinics. The original material comprised 243 patients who began root canal treatment (RCT) at 20 public dental clinics in the county of Västra Götaland, Sweden. One to three years later, 236 (97.1%) were posted a questionnaire of eight items, rating patient perceptions of RCT-completion, present pain intensity and satisfaction with the RCT. To evaluate the reliability of the original responses, the first 50 respondents were mailed a follow-up questionnaire. Both descriptive and analytical statistics were used to compare respondents and non-respondents and tooth groups. One hundred and fifty-nine patients (67.4%) responded: 86 (54.1%) women and 73 (45.9%) men. The mean age 52.5 years, was higher than for non-respondents (P<0.001). A completed root filling was registered for the majority of the teeth (n = 112, 70.9%), but significantly fewer molars had been completed (n = 46, 59.7%, P = 0.02). Fifty percent (n = 59) of the patients reported current pain, mostly mild in intensity (n = 45, 38.1%). One hundred and twenty-three patients (80.9%) recalled experiencing pain during RCT. The highest satisfaction was registered for the item 'chewing ability' (mean = 1.6, SD = 1.9). The majority of patients (n = 114, 75.0%) stated that in retrospect they would still have chosen RCT. However, these patients belonged to the group which either registered the tooth as still present, or had not experienced much discomfort during or after RCT. Forty-four patients (88.0%) responded to the second questionnaire. The reliability of the responses was good. In summary, one to 3 years after beginning RCT at a public dental clinic, patient satisfaction was high, even though every fourth molar had been extracted or treatment had not been completed and half the patients reported persistent pain. The reliability of the patients' responses was considered to be good. The results indicate a need for further clinical observational studies of RCTs undertaken in general dental practice, with special reference to patient-centred outcomes.

Parents' experiences of participating in health-promoting activities at a family centre for preschool children in Sweden.

To explore and describe the parents' experiences of participating in health-promoting activities at the family centre. A qualitative design based on interviews, analysed using a phenomenograpic approach. Six focus groups with two to six participants in each group. Three themes, all describing parents' experiences of visiting the family centre, emerged in the analysis. The themes were as follows; "Social fellowship", "A secure place" and "A learning environment". Each theme contained three categories, which represent the parents' different conceptions. The present study showed that the parents who visit the family centre found that the collaboration is perceived as positive and has many benefits. The participants found that the family centre is an institution that increases social interaction. Furthermore, meeting dental professionals in an arena outside the clinic creates confidence and makes people feel secure. Parents also learn both from the staff and from each other. According to these findings, the family centre is a suitable arena to work on health-promotion activities.

장애인의 구강건강증진을 위한 공공구강보건의료서비스의 최근 동향과

연구목적 구강건강관리에 취약한 장애인의 구강건강증진을 위해서는 반드시 국가 및 지방자치단체의 지원이 뒷받침되어야 한다. 이 연구에서는 공공구강보건의료사업를 진행하는데 근거가 되어 줄 법령들을 확인하고 최근 시행 중인 복지사업과 정부 계획을 조사하여 장애인의 구강건강 증진을 위한 방안을 찾고자 한다. 연구방법 이 연구는 장애인 구강건강과 관련된 법령을 살펴보고 장애인을 위한 구강보건사업 및 최근 발표된 국가정책 등을 확인하여 문헌고찰방법으로 연구되었다. 결과 구강보건법과 2017년 신설된 장애인건강권법 등의 법적인 근거를 바탕으로 중앙, 권역, 지역의 장애인구강센터가 설치·운영 중이고, 특수학교 구강보건사업, CBR과 연계된 방문구강건강관리사업, 구강보건 이동진료차량 지원사업이 진행 중이다. 정부는 양질의 공공구강보건의료서비스의 공급을 확대하기 위한 장기적인 목표를 제시하였다. 결론 사업의 지속성과 혜택을 받는 수혜자을 증가시키기 위해서는 치과위생사의 업무와 역할이 중요하며 이와 관련된 제도까지 개선된다면 장애인의 구강건강증진, 구강질환 예방, 의료접근성 향상, 형평성 재고와 같은 결과를 얻을 수 있을 것이다.

Follow-up of patients subjected to direct and indirect pulp capping of young permanent teeth. A retrospective study.

ObjectiveA retrospective study of the success rate of direct pulp capping (DPC) and indirect pulp capping (IPC) was carried out in children between 6–14 years‐old, considering separately primary caries or caries affecting teeth with molar incisor hypomineralization (MIH).Material and methodsData were collected in a dental public health service. Following the inclusion criteria, 232 treatments were analyzed. Success was defined by the presence of a functional tooth without clinical signs or symptoms of pulpal or periapical disease. The success rate was correlated to patient gender, the affected tooth and the indication of therapy using the chi‐squared and Fisher exact test. The success time related to treatment type was evaluated through the Mann–Whitney test.ResultsThe IPC and DPC success rate was 99.4%, and 84.6%, respectively (p = .01). Success was significantly lower when caries affected teeth with MIH than when caries affected teeth without MIH (p = .01). The mean survival for DPC and IPC was 14.07 ± 1.30 and 15.98 ± 0.80 months, respectively (p = .07).ConclusionsWhen caries were located in teeth that were not affected by MIH, IPC was significantly more successful than DPC, but did not differ significantly when caries were placed in teeth with MIH.Key points Minimally invasive therapy is a successful approach for decayed young permanent teeth.The success of IPC was greater than the success of DPC wen caries was placed in teeth not affected by MIH.In teeth not affected by MIH the success of DPC or IPC did not differ significantly.

Biofilms in Dental Unit Water Lines.

Biofilm formation has become a significant problem in dental unit water lines (DUWLs). The formation of biofilms and microbial growth in DUWLs leads to an unacceptably high number of microorganisms in the water used for spraying, cooling, and ultrasonication procedures. These procedures form aerosols which can be inhaled by the patients, and consequently dentistry constitutes an area of specific concern for patient safety. In particular, older and immunocompromised patients are at risk of serious respiratory tract infections if the water contains pathogens such as Legionella pneumophila and Pseudomonas spp. In the EU it is recommended that the water in DUWLs should not exceed 200 colony-forming units (CFU) of heterotrophic bacteria (bacteria living on organic material) per milliliter of water to be acceptable in dental work. A number of efficient products are available on the market that can be applied onto dental units. New dental units are nowadays equipped with "inbuilt" systems. Such measures have resulted in an acceptable standard of water in 95% of the 1,200 dental units in the Public Dental Health Service of the Västra Götalands region of Sweden that were followed yearly for 4 years. For the majority of the remaining DUWLs with an unacceptable standard this is due to neglect or inappropriate routines for water-cleaning procedures. It is the ability to follow instructions rather than the cleaning procedure itself that is decisive if clinics and dental units are to have an appropriate standard of water in their systems.

Satisfação dos usuários com a atenção à saúde bucal em Pauini, Amazonas, Brasil

OBJETIVO: Este estudo objetivou compreender a satisfação dos usuários com as Equipe de Saúde Bucal das Unidades Básicas de Saúde do município de Pauini, Amazonas. MATERIAL E MÉTODO: Este estudo transversal foi conduzido entre dezembro de 2019 e fevereiro de 2020 nas três unidades básicas de saúde da área urbana do município e teve como participantes os usuários dos serviços de saúde odontológicos. Foram utilizados dois questionários: o primeiro para avaliar o acesso aos serviços de saúde e outro sobre a satisfação dos usuários com a atenção à saúde bucal. Os resultados foram analisados de modo descritivo por meio de frequências absolutas e relativas. RESULTADOS: Participaram do estudo 265 indivíduos, e ao serem questionados como foi feito agendamento, 61,51% responderam que se deu por meio de visita à unidade de saúde, e com relação ao principal motivo para a última consulta, 47,17% dos usuários responderam que os principais motivos foram dor de dente e extração. Os percentuais mais elevados de satisfação foram encontrados no domínio estrutura física e o domínio com menores percentuais foram informação e apoio. CONCLUSÃO: os resultados evidenciaram necessidade de aperfeiçoar a forma de acesso aos serviços de saúde público odontológicos e uma percepção positiva pelos usuários dos serviços de saúde bucal de Pauiní, AM, entretanto, os melhores resultados foram observados em relação à infraestrutura das unidades de saúde, e foi verificada necessidade de melhorar o processo de trabalho no que tange às informações e apoio aos usuários dos serviços de saúde bucal.

Traumatic dental injuries and pulp sequelae in an adolescent population.

Traumatic dental injuries (TDI) occur frequently and may result in pulp sequelae. This includes pulp necrosis with infection, pulp canal obliteration and root resorption. The aim of this study was to assess the prevalence and risk factors of pulp sequelae after TDI among Norwegian adolescents. A retrospective longitudinal study, including historical clinical data, was conducted with 16-year-old pupils in western Norway. All first-grade pupils, born in 1997 (n=5184), attending public high schools, were invited to participate and to respond to an electronically administered closed-ended questionnaire (response rate 39.6%, n=2055). Consent was given to access the dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs were interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible). Outcome variables of TDI were registered and analysed using logistic regression, Kaplan-Meier survival estimates and log-rank test. The prevalence of TDI in the sample population was 16.4% (338 pupils), with a total of 637 teeth involved. The number of included teeth for analysis was 571 (90.5%). The prevalence of pulp necrosis with infection was 7.5%. Moderate and severe TDI was associated with a higher frequency of pulp necrosis with infection. Pulp canal obliteration and root resorption were found in 2.8% and 2.3% of teeth with TDI, respectively. Dental hard tissue injuries were more prone to the development of pulp necrosis than luxation injuries and combination injuries. The relationship between root development stage and development of pulp necrosis with infection was not statistically significant. Occurrence of different pulp sequelae among teeth affected with TDI was low. Moderate and severe TDI were more at risk of developing pulpal complications and hard tissue injuries were at higher risk of developing pulp necrosis with infection.

Experience of collaboration at a family centre for preschool children in Sweden.

To describe the personnel's experience of collaboration. Qualitative interviews with transcripts analysed using the phenomenographic approach. Seven staff with experience of collaboration. All were female, aged 34-62 and were dental nurses, child health-care nurses, preschool teacher or family centre co-ordinators. Three themes describing personnel's experience of collaboration at the family centre emerged: Collaboration produces an holistic approach, Co-location creates added value and Working methods result in development. Each theme was represented by three to four categories that represent different conceptions of collaboration at a family centre. The staff had found that the way of working was positive, mainly because it gave an increased overall view and that the co-location created added value. It also created development through mutual learning and new methods. However, it took time to establish collaboration and required permissive leadership.