Objectives: The aim of this study was to investigate the associations between oral health measures and oral health-related quality of life as captured by OIDP (oral impacts on daily performances). Methods: The study was performed in three dental clinics in Sweden and included 204 patients, 43.8% men and 56.2% women (aged 20-86 years), consecutively recruited in connection with their routine dental examination. The patients were interviewed using the OIDP followed by a clinical examination. Four bite-wing radiographs were taken in two of the clinics (n = 154). A self-administered questionnaire provided information about socio-economic data. Results: Subjects 60 years had significantly more missing teeth, lesser maximal jaw opening, higher number of sites with alveolar bone loss and proportionally more filled teeth than younger individuals. Impacts related to the oral health that affected their daily life were reported in 39.7%. Multivariate logistic regressions analysis showed that missing teeth (>= 10) and a limited jaw opening (<40 mm) were significantly associated with having one or more impact as measured with the OIDP [odds ratio (OR) 6.50, 95% CI 1.48-28.43 and OR 2.87, 95% CI 1.03-7.96, respectively]. Conclusions: Individuals with diminished functional oral health status (missing teeth and limited jaw opening) had significantly more often one or more oral impacts on daily life than those with fewer than 10 missing teeth and a jaw opening >= 40 mm. The OIDP instrument may be valuable for use in routine dental check-ups in patients with related problems to determine possible oral impacts on daily life.
Aims: To explore patients' experiences of very low calorie diet (VLCD) and subsequent corset treatment of obesity in a primary care setting, and to explore their perceptions of factors influencing weight control. Methods: In western Sweden, five focus group sessions were carried out. The main themes for the discussions were the informants' perceptions of the treatment they had received and their experiences of living with obesity. The analysis was based on the Grounded Theory methodology. Results: The outcomes reflect obese individuals' struggle to handle the demands of their life situation and to recognize their own resources. The core category generated was labelled "Achieving a balance in life and adjusting one's identity". Three categories related to the process of weight reduction were identified: living with obesity, reducing weight and developing self-management. The group treatment with VLCD was positively perceived by the participants, but the corset treatment was considered to be of less value. Conclusions: Maintenance after weight reduction was demanding and the findings indicate a need for extended support. For some individuals the corset treatment could be a psychological support. Follow-up after weight reduction programmes should focus on long-term self-help strategies.
The objective of this study was to investigate adolescents perceptions and desires with respect to oral health education. Aseries of focus group sessions was conducted with adolescents in schools. The groups comprised an average of 6 individuals,with a total of 34 participants. The main themes of the discussions were the informants perceptions of the oral healtheducation in different settings and under varying circumstances. The discussions were transcribed verbatim and analyzedaccording to the basic principles of Grounded Theory. One of the most important issues appeared to be the dental personnelconsidering the individual as a subject and not as an object. The adolescents in the study were uncertain about their knowledgeof oral health. Often, the participants expressed a wish to be taught more at the dental visit. Information in schools was sparse.The support of parents was acknowledged but little discussed. The methods used in advertisements to describe dentalproducts were met with skepticism. These should not be imitated in oral health education as this might undermine thecredibility of the dental services. Girls were perceived to be more interested in health than boys were. Two core categorieslabeled credibility and confidence, which interacted continually, emerged from the data in the analysis. The resultsindicate that the credibility of the intermediary of the health messages is essential, as is their ability to create confidence. Thus,oral health education among adolescents is more likely to be successful when credibility and confidence are perceived
Continuous research and development (R&D) is essential to ensure quality in dental care. A recent official report in Sweden suggests that the county councils should be obliged to arrange and support R&D activities in dental care. In this paper, a review of the R&D activities within the Public Dental Services (PDS) in the 21 Swedish counties is presented. Official PDS representatives in each county were contacted by telephone in February and March 2003 and asked questions on the following topics: the organisation of R&D activities, the fields prioritised in R&D, courses arranged in research methodology, research competence, economic matters, and personal comments.In half of the counties, R&D in the PDS was organised in collaboration with other health services. Few positions in the PDS were in R&D, and those that existed were only part-time posts. Public health matters, prevention, and clinical studies were fields that were commonly prioritised for R&D. Most of the studies published by PDS employees have been performed within specialised dental care. Competence and knowledge in how to conduct studies are essential for the quality of R&D. Courses in R&D methodology had been arranged in most counties. The number of employees who held a doctoral degree varied from zero (five counties) to over ten (four counties). Pecuniary resources available for R&D differed considerably (from around 55 EUR to a few hundreds EUR per employee in the different counties). Lower revenues from patient fees were regarded to be the major obstacle to establishing and carrying out R&D activities. How this matter was viewed and handled differed greatly between the counties. At the time of this investigation, a topic of interest in several of them was the future R&D organisation, according to the informants.It was concluded that the organisation and the preconditions for R&D in the PDS varied greatly between the Swedish counties.
ORAL HEALTH EDUCATION AMONG ADOLESCENTS Objectives: To investigate adolescents perceptions and desires with respect to oral health education. Methods:A qualitative approach was applied. A series of focus group sessions was conducted with adolescents at senior and upper secondary level schools. The groups comprised an average of 6 individuals (six groups). The main themes of the discussions were the informants perceptions of the oral health education in different settings and under varying circumstances. The discussions were transcribed verbatim and analyzed according to the constant comparative method.Results:One of the most important issues appeared to be the dental personnel considering the individual as a subject and not as an object. The adolescents in the study were uncertain about their knowledge of their oral health. Often, the participants expressed a wish to be taught more at the dental visit. Information in schools was sparse. The support of parents was acknowledged but little discussed. The methods used in advertisements to describe dental products were met with skepticism and these should not be imitated in oral health education as this might undermine the credibility of the dental services. Girls were perceived to be more interested in health than boys were. Two core categories labeled credibility and confidence, which interacted continually, emerged from the data in the analysis. Conclusion:The results indicate that the credibility of the intermediary of the health messages is essential, as is their ability to create confidence. Thus, oral health education among adolescents is more likely to be successful when credibility and confidence are perceived.
The aim of this epidemiological survey was to describe and analyze oral health habits and life-style factors in relation to the priority of regular dental care in 19-year-old individuals with specific reference to gender, residential area and socio-economic grouping. The data were generated from a randomized sample of 758 (63%) individuals in three residential areas in Western Sweden (two rural, one urban) who answered a set of questionnaires prior to a dental examination. The analysis revealed that males had significantly less favourable oral health habits than females. Forty-one % of the males and 30% of the females did not plan regular dental visits after the age of 20 when they will be charged for the care (p = 0.002). There were no statistically significant differences in oral health habits and dental care priorities with regard to residential areas and socio-economic groups. In a multivariate model, three significant factors for the probability of "not planning for future regular dental visits" were identified: toothbrushing less than twice daily (OR 1.94; 95% CI 1.28-2.94), smoking (OR 1.68; 95% CI 1.10-2.56) and male gender (OR 1.54; 95% CI 1.05-2.24). The findings emphasize the need for promotion of favourable oral health habits and smoking prevention among adolescents. There is also a need for dental personnel to recognize differences with regard to oral health-related attitudes and behaviours between males and females.
The aim of this study was to investigate the correlations between epidemiological indices (objective) and self-perceived oral health (subjective) in adolescents at the school level, and to study gender differences in epidemiological indices and in self-perceived oral health.The study comprised two sets of data from Skaraborg County, Sweden; 1. Self-reported questionnaires were answered by adolescents at all senior level schools (n=9 559, 1315 years). 2. Epidemiological indices based on clinical registrations of oral health in 13-15-year-old adolescents were collected in all 17 municipalities (n= 7 899). Simple and partial Pearson correlation coefficients were used to study correlations between subjective and objective oral health in the adolescents at the school level. Gender differences in adolescents subjective and objective oral health were estimated using a logistic regression model. The correlations between epidemiological index registrations and self-perceived oral health were weak. The strongest correlations were found between epidemiological indices and self-perceived gingival bleeding: 0.416 between the DS (decayed surfaces) index and self-perceived bleeding. Girls more seldom than boys were satisfied with the appearance of their teeth; in municipalities with clinical good oral health OR 0.76 (95% CI 0.59-0.98) and with poor clinical oral health OR 0.74 (CI 0.57-0.94). No gender differences were found in the epidemiological index registrations. The currently used epidemiological indices did not reflect adolescents own perceptions of their oral health at the school level and they could not recognize or identify gender differences. Surveillance of oral health in young people should include information on self-perceived oral health.
Objective To investigate the associations between dental attitudes and behaviours, and self-perceived oral health from a gender perspective in an adolescent population.Design A census survey. Self-reported questionnaires were answered anonymously in a standardised manner in classrooms. Studied attitudes included the importance of sound teeth and feelings towards visits to the dentist. Behaviours were represented by floss usage and sweets consumption. Setting All senior and upper secondary level schools in Skaraborg County, Sweden. Subjects 17,280 students, aged 13 18 years.Outcome measures Self-perceived oral health, represented by a single-item rating; satisfaction with the appearance of the teeth; self-assessed gum bleeding; and a perceived oral health (POH) index.Results Recognising sound teeth as important was a predominating attitude among the respondents (boys 94%, girls 97%) and was significantly associated with a good perceived oral health in all aspects. Individuals who experienced visits to dentist as unpleasant (boys 36%, girls 43%) were less likely to perceive good oral health as single-item rated (OR for boys 0.55[0.49,0.63] and for girls 0.40[0.34,0.47]). Regular use of floss did not prevent bleeding gums. Daily sweets consumption showed a significant and inverse association with self-perceived oral health as single-item rated (OR for boys 0.53[0.44,0.66], girls 0.49[0.40,0.60). Girls, more often than boys, perceived their oral health to be good, except in the perception of the appearance of their teeth. Conclusions It is concluded that the strong associations between attitudes and self-perceived oral health should be recognised in strategies for oral health promotion and that gender differences must be considered.
A cross-sectional dental questionnaire census survey was conducted in classrooms of 17,280 students aged 13-18 years in Skaraborg County, Sweden. The overall response rate, based on school attendance on the test day, was 91% with no gender differences at the senior level and 86% (boys 87%, girls 85%) at the upper secondary level. The aim was to examine gender differences in knowledge, attitude, behavior, and perceived oral health. A retest study showed good agreement. Thirty-one percent of the girls and 21% of the boys flossed regularly. Eleven percent reported daily candy consumption, with no significant gender difference. Girls, however, more often than boys considered their own consumption to be too high. This gender difference in attitude was most pronounced among older daily consumers (odds ratio (OR)= 5.8[3.7-9.2]). Oral health was regarded as important by a majority of the students (95%). Girls considered sound teeth to be more important than did boys, both among the younger (OR=1.7[1.4-2.1) and the older (OR=2.4[1.9-3.1]) adolescents. Conclusion: Most adolescents had a positive dental attitude and perceived their own oral health to be good. Poorer knowledge and behaviors concerning oral health were demonstrated. Gender differences existed in most issues. Girls scored more favorably on behavioral measures, showed more interest in oral health, and perceived their own oral health to be good to a higher degree than did boys
Introduction: Accounts on self-perceptions of oral health have hitherto been rare, although of great interest for strategies in health promotion. Purpose: The objective of this study was to increase the knowledge on adolescents perceptions of oral health and influencing factors.Methods: Semistructured interviews of 17 Swedish adolescents were performed. Criteria for strategic sampling were age (15, 18 years), gender (male, female), and dental health (healthy, unhealthy). Data were analysed according to the constant comparative method. Areas of focus were general oral health, personal oral health, life-style issues and dental care.Results: The awareness of oral health was mostly low among the informants. Two categories of oral health were identified, action and condition. Conditional aspects were most frequent in evaluations of personal oral health. Possibilities to influence oral health were considered limited. Perceptions of influences on oral health were related to personal and professional care, social support and impact, and external factors. Gender differences were indicated in health consciousness. Concern for oral health was denoted the core category of perceived influence.
Accounts of self-perceptions of oral health have hitherto been rare, although they are of great interest for strategies in health promotion. The objective of this study was to increase our knowledge of adolescents perceptions of oral health and influencing factors.Semi-structured interviews of 17 Swedish adolescents were performed. Criteria for strategic sampling were age (15, 18 years), gender (male, female), and dental health (healthy, unhealthy). Data were analyzed according to the constant comparative method. Areas of focus were general oral health, personal oral health, dental care, and life-style issues.Oral health awareness was generally low among the informants. Two categories of oral health were identified: action (the physical things we do to effect the condition of our mouths) and condition (the physical status of the mouth). Conditional aspects were most frequent in evaluations of personal oral health. The informants considered their possibilities to influence oral health limited. Perceptions of influences on oral health were related to personal and professional care, social support and impact, and external factors. Concern for oral health was derived as the core category in perceived influence on oral health. This study indicates that it is important to find factors that enhance adolescents awareness of their own resources and to seek mechanisms that govern internalization. There is a need to find strategies to convey such knowledge to the intermediaries: the dental personnel and the parents.
Objective - To investigate self-perceived oral health and its associations with family characteristics and parental employment status in an adolescent population from a gender perspective. Design - A cross-sectional study using self-reported questionnaires answered anonymously in classrooms. Setting - All senior (13-15 years) and upper secondary (16-18 years) level schools in Skaraborg County, Sweden. Subjects - 17,035 students, participation rate 88.5%.Outcome measures - A single-item rating of self-perceived oral health; satisfaction with the appearance of the teeth; self-assessed gingival bleeding; a perceived oral health index.Results - Independent of family characteristics and parental employment status, girls, more often than boys, perceived their oral health to be good and had less self-assessed gingival bleeding but were less satisfied with the appearance of their teeth. Adolescents living with a single mother (senior level OR 0.71 [CI 0.59-0.84], upper secondary level OR 0.76 [CI 0.62-0.92]) or with neither parent were less likely to perceive their oral health as good when single-item rated and reported more gingival bleeding (living with a single mother: senior level OR 1.37 [CI 1.20-1.57], upper secondary level OR 1.51 [CI 1.28-1.77]) than those who lived with both parents, while adolescents who lived with a single father did not. Associations between parental employment status and self-perceived oral health were weak and inconsistent.Conclusions - Family characteristics were important for adolescents self-perceived oral health while parental employment status was not. Children living in single-parent households should be supported and recognised in strategies for oral health promotion and prevention. Gender differences should also be taken into consideration.
Aim The aim of the present study was to explore the association between tooth loss and obesity in a defined adult Swedish population and to investigate whether psychosocial factors could explain a tentative association. Methods The study is based on a population survey 2001-2005 in two municipalities within the same mainly rural area in south-western Sweden, being part of a comprehensive epidemiological study on hypertension, type 2 diabetes, and obesity (The Skaraborg Project). A random sample of 30-74-year-olds (five year strata) was selected and 2,918 people participated (76%). Information on remaining number of teeth was collected by a self-administered questionnaire. Tooth loss was defined as <20 remaining teeth, as compared to 20. Obesity was defined as body mass index (BMI) 30 kgm-2. Associations were estimated using logistic regression and adjustments were made for demographic, clinical and life-style variables as well as co-morbidity. Results The mean BMI value was 26.9 kgm-2 in men and 26.8 kgm-2 in women. Obesity was still more frequent among women than among men (23.6% versus 17.7%, p<0.001). Including all ages, there was a statistically significant association between tooth loss and obesity among women (OR 1.98; CI 1.44-2.72), but not among men (1.40; 0.98-2.00). However, in participants below 60 years of age, this association was stronger and statistically significant in both genders, while it was lost in older participants. Conclusions In this study, tooth loss was associated with obesity in the younger adults with a stronger association in women than in men