Introdução - As transições demográfica e epidemiológica vêm gerando mudanças no perfil sanitário de vários países. Dentre os vários campos da saúde, a saúde bucal expressa pela perda dentária encontra-se em situação preocupante. Objetivo - Identificar os fatores individuais e contextuais associados à perda dentária de adultos e idosos no Brasil e as características da distribuição espacial desses fatores. Métodos - Foram utilizados dados secundários do Projeto SB Brasil 2003, em que foi realizado um levantamento epidemiológico das condições de saúde bucal da população brasileira. Neste inquérito foi utilizada a técnica de amostragem probabilística por conglomerados, realizada em três estágios, totalizando 13.431 adultos entre 35 e 44 anos e 5.349 idosos entre 65 e 74 anos. A metodologia de análise empregou um modelo multinível de abordagem e a associação foi medida pela Razão de Médias e Razão de Prevalências, brutas e ajustadas. Utilizou-se a técnica de Processo Analítico Hierárquico (Analytical Hierarchy Process - AHP) e testes de dependência espacial para conhecer a distribuição espacial dos fatores associados à perda dentária. Resultados - Entre os adultos, as variáveis contextuais associadas com maior perda dentária foram: baixo número de cirurgiões-dentistas por mil habitantes (nível regional), maior número de exodontias por habitante (nível estadual) e municípios com menor porte populacional (nível municipal). As variáveis individuais associadas à perda dentária foram: maior número de pessoas por cômodo, ter consultado o cirurgião-dentista alguma vez na vida, há três anos ou mais e por motivo de dor, não ter recebido informações sobre prevenção de doenças bucais, ser do sexo feminino e a idade maior. Entre os idosos, duas análises foram feitas. Na primeira análise, as variáveis contextuais associadas ao edentulismo funcional foram as mesmas encontradas nos adultos, exceto o porte populacional. Na segunda análise, as variáveis contextuais associadas à menor necessidade de prótese total foram: maior taxa de primeira consulta odontológica programática (nível regional), da média de anos de estudo (nível estadual) e do porte municipal. Morar na área rural, maior número de pessoas por cômodo, ter tido a última consulta odontológica em serviço público, ser do sexo masculino, nãobranco e idade mais avançada foram associados à necessidade de prótese total. A análise espacial revelou áreas de risco estatisticamente significantes para a perda dentária e para a necessidade de prótese total. Conclusões - O estudo revelou os principais aspectos contextuais e individuais associados com maior perda dentária. A combinação espacial simultânea desses atributos gerou mapas de predisposição para a perda dentária e necessidade de prótese total que podem nortear as ações de Saúde Bucal Coletiva. / Introduction - The demographic and epidemiological transitions are causing changes in the health profile worldwide. Among the various areas of health care, oral health expressed by tooth loss is in a precarious situation. Objective - The objective was thus to identify the individual and contextual factors associated with tooth-loss in adults and the elderly in Brazil and the characteristics of the spatial distribution of these factors. Methods - Secondary data from the 2003 SB Brasil Project were used. This was an epidemiological survey of the oral health of the Brazilian population. The study used the technique of probability sampling by clusters, in three stages, covering 13,431 adults aged between 35 and 44 years old and 5,349 elderly individuals aged between 65 and 74 years. A multilevel analysis was employed and the degree of association was measured using the crude and adjusted mean and prevalence ratios. The Analytical Hierachy Process (AHP) technique was used to ascertain the spatial distribution of factors associated with tooth- loss, along with tests of spatial dependence. Results - Among adults, the contextual variables associated with increased tooth-loss were: a lower number of dentists per thousand inhabitants (at regional level), an increased number of tooth extractions per capita (at state level) and a smaller population size (at municipal level). The individual variables associated with tooth-loss were: a greater number of individuals living in the same room, never having consulted a dentist, having consulted a dentist three years or more ago and because of pain, not having received information on prevention of dental diseases, being female, and increased age. A further two analyses were carried out for the elderly group. In the first analysis, the contextual variables associated with functional edentulism were found to be the same in adults, with the exception of the population size. Living in rural areas and being female were associated with functional edentulism. In the second analysis, the contextual variables associated with reduced need for total prosthesis were: greater coverage of the first dental consult program (at regional level), average number of years of schooling (at state level) and population size. Living in rural areas, a greater number of individuals per room, having had the last dental consultation in the public sector, being male, non-white and of greater age were associated with the need for total prosthesis. Spatial analysis shows critical areas of risk for tooth loss. Conclusions - The study revealed the key contextual and individual aspects associated with greater tooth-loss. The combination of simultaneous spatial attributes generated maps showing the geographical predisposition to tooth loss and the need for total prosthesis that will be able to guide the work of those working in the area of Collective Oral Health.

Introdução: A incorporação das equipes de saúde bucal (ESB) na Estratégia da Saúde da Família (ESF) buscou induzir às práticas inovadoras no cuidado, possibilitando melhor qualidade de vida aos cidadãos e com mais saúde bucal. As experiências relatadas têm demonstrado, de forma geral, um melhor acesso aos serviços, ampliação dos procedimentos coletivos, integração das equipes, principalmente em grandes centros urbanos. Poucos estudos têm demonstrado resultados efetivos na saúde bucal da população. Objetivos: Analisar o perfil epidemiológico de saúde bucal em adolescentes escolares de 12 e de 15 a 19 anos em municípios de pequeno e médio porte populacional do Rio Grande do Sul (RS) avaliando: influência da presença ou não das ESB na ESF em indicadores de saúde bucal; associação de variáveis contextuais e determinantes sociais na variação da prevalência de cárie não tratada e perda dentária entre os anos de 2003 e 2011; a distribuição temporal e espacial da cárie dentária e dos indivíduos livres de cárie por idade e macrorregião do RS. Método: Em 2011 foram selecionados 36 municípios com até 50.000 habitantes que participaram do levantamento epidemiológico em 2003, e destes, 19 municípios com ESB e 17 sem ESB na ESF. Foram realizados exames bucais em 3.531 jovens escolares de 12 e de 15 a 19 anos por quatro cirurgiões dentistas treinados segundo critérios da Organização Mundial da Saúde (OMS,1997). Dados demográficos, situação socioeconômica, escolaridades dos pais, uso e acesso aos serviços de saúde foram coletados em questionários estruturados. A saúde bucal foi avaliada por indicadores de cárie dentária como média de dentes cariados, perdidos e obturados (CPO-D), prevalência de cárie não tratada, perda dentária, indivíduos livres de cárie e taxas de variação de cárie não tratada e dentes perdidos em oito anos (2003 e 2011). Os indicadores para doença gengival foram a prevalência em pelo menos um sextante com sangramento e prevalência de cálculo dental. Prevalência da dor de dente relatada nos últimos seis meses foi outro indicador avaliado. A presença ou ausência da ESB na ESF do município foi a principal variável explicativa, além de outros fatores relativos ao município como macrorregião, porte, presença e anos de fluoretação das águas, Índice de Desenvolvimento Humano Municipal (IDHM), Coeficiente Gini, produto interno bruto (PIB) per capita, taxa de mortalidade infantil, percentual de população rural, taxas de escolaridade, analfabetismo, pobreza, taxa de habitantes por cirurgião dentista, taxa de cobertura da primeira consulta odontológica e do procedimento coletivo de escovação dentária supervisionada. As variáveis de análise relacionadas aos indivíduos foram idade, sexo, escolaridade da mãe, renda familiar, tempo, motivo e local da ultima consulta ao dentista. Inicialmente foi realizada uma análise descritiva de todos os desfechos. Após foram realizadas análises de associação, sendo dois estudos do tipo ecológico e outro com análise do efeito da ESB/ESF e de variáveis individuais em modelo multinível. Os dados foram analisados pelas médias das regressões binomiais negativas e Poisson e também por regressões linear e multivariada. As médias CPO-D e o percentual de livres de cárie foram geoprocessadas por macrorregiões do RS. Resultados: Nos modelos brutos não houve associação das ESB na ESF com os desfechos analisados. Após o ajuste, em modelo multinível, dentes perdidos foi o desfecho associado com a presença das ESB/ESF (RM=0,64 IC95%; 0,43-0,94). No estudo ecológico, a taxa de variação de cárie não tratada aos 12 anos foi significativamente associada com coeficiente Gini (β=0,39; p<0,01). A taxa de variação da perda dentária em oito anos apresentou valores significativos com o coeficiente Gini (β=0,61;p<0,001) e com a taxa de população rural municipal(β=-0,29; p<0,02), comprovando a importância das políticas públicas que buscam a redução das desigualdades sociais. Em 2003 e 2011, respectivamente, as médias de CPO-D foram 3,63 e 1,66 (12 anos) e 7,43 e 3,43 (15-19 anos). Houve aumento de adolescentes livres de cárie de 18,6% para 42,1% (12 anos) e de 7,5% para 22,2% (15-19 anos); houve redução da cárie não tratada de 50,9% para 27,2% (12 anos) e de 56,1% para 32,4% (15-19 anos), diferentemente entre municípios e macrorregiões. Conclusões: A maior parte dos municípios analisados apresentou redução significativa das médias CPO-D, da cárie não tratada e da perda dentária e aumento dos indivíduos livres de cárie nas duas idades em oito anos, mas esta melhoria se distribui desigualmente entre municípios e macrorregiões de saúde. Jovens de áreas não cobertas tiveram quase a metade da perda de dentes do que os adolescentes das áreas cobertas pelas ESB/ESF. Os indicadores de prevalência de doença como cárie não tratada, perda dentária e dor de dente expressaram as realidades contextuais da desigualdade existente nos municípios e condições da vida das familias quanto ao acesso e uso dos serviços. / Introduction: The inclusion of Oral Health Teams (OHTs) in the Family Health Strategy (FHS) led to innovative care practices, thus improving the population’s quality of life because of better oral health. Reports have shown better access to services, increased number of collective procedures, and greater team integration, especially in major urban centers. Few studies have shown effective results related to the population's oral health. Objectives: To analyze the epidemiological profile of the oral health of teenagers aged 12 and between 15 and 19 years old from small and medium-size municipalities (population size) of Rio Grande do Sul (RS), Brazil, by evaluating the following aspects: the influence of the presence or absence of OHTs in the FHS on oral health indicators, the association of contextual variables and social determinants in the variation of the prevalence of untreated caries and tooth loss between 2003 and 2011, and the temporal and spatial distribution of dental caries and caries-free individuals by age and regions of the state. Method: In 2011, we selected 36 municipalities with less than 50.000 inhabitants that had participated in the 2003 epidemiological review. Of these, 19 had OHTs in the FHS and 17 did not have OHTs in the FHS. Oral examinations were performed in 3,531 individuals aged 12 and between 15 and 19 years old. The examinations were carried out by four dentists trained according to the criteria of the World Health Organization (WHO, 1997). We used structured questionnaires to collect demographic data, socioeconomic status, parent’s educational level, and access and use of health services. Oral health was evaluated using dental caries indicators such as decayed, missing and filled teeth (DMFT), prevalence of untreated caries, caries-free individuals, and variation rates of untreated caries and tooth loss in an 8-year period (from 2003 to 2011). The periodontal disease indicators were set as at least one sextant with bleeding and prevalence of dental calculus. Another indicator was the prevalence of toothache in the past six months. The presence or absence of OHTs in the FHS was the main explanatory variable. Other factors related to the municipalities were also detected, such as macro region, population size, presence and time of water fluoridation, municipal human development index (HDI), Gini coefficient, gross domestic product (GDP) per capita, childhood mortality rate, proportion of rural population, educational levels, illiteracy, poverty, density of dentists, rate of first dental visit, and rate of supervised collective tooth brushing procedure. The analysis variables related to the individuals were age, gender, mothers' educational level, family income, and time, cause and place of last dental visit. We conducted a descriptive analysis of all possible outcomes. Then, association analyses were performed. Two ecological studies and another study analyzing the effect of OHTs/FHS and individual variables on a multilevel model were conducted. Data were analyzed using negative binomial regression, Poisson regression, and linear and multivariate regressions. Mean rates of DMFT and the percentage of caries-free individuals were geographical processed by state macro regions. Results: Gross models showed no association between the presence of OHTs in the FHS and any possible outcome. After multilevel adjustment, tooth loss was the outcome associated with OHTs in the FHS (RM = 0.64; 95%CI = 0.43-0.94). In the ecological study, the variation rate of untreated caries at 12 years old was significantly associated with the Gini coefficient (β = 0.39; p < 0.01). The variation rate of tooth loss within 8 years showed significant values with the Gini coefficient (β = 0.61; p < 0.001) and the proportion of rural population (β = -0.29; p < 0.02), thus confirming the importance of public policies that aim to reduce social inequality. In 2003 and 2011, respectively, the mean rates of DMFT were 3.63 and 1.66 (12 years old) and 7.43 and 3.43 (15-19 years old). There was an increase from 18.6% to 42.1% (12 years old) and from 7.5% to 22.2% (15-19 years old) of caries-free teenagers. There was a reduction in the number of untreated caries from 50.9% to 27.2% in 12-year-old teenagers and from 56.1% to 32.4% in 15-19-years old teenagers. These rates were different in municipalities and macro regions. Conclusions: Most municipalities had a significant reduction in the mean rates of DMFT, untreated caries, and tooth loss, as well as an increased number of caries-free individuals in both age groups in an 8-year-period. However, such improvement was unevenly distributed among the municipalities and macro regions: young people from areas not covered had nearly half of tooth loss adolescents in the areas covered by the OHT/FHS. The presence of disease prevalence indicators, such as untreated caries, tooth loss, and toothache, demonstrate social inequality in these municipalities and reveal the population’s life conditions regarding the use and access to services.

Abstract The aim of this study was to evaluate the association between dental fear and dental attendance, oral health habits and dental condition. A further aim was to study the association between subjective oral impacts and dental fear. The nationwide two-stage stratified cluster sample (n=8028) represented Finnish adults aged 30 years and older. The data were collected in interviews, with questionnaires and at clinical dental examinations. Dental fear was measured with the question: “How afraid are you of visiting a dentist?” and subjective oral impacts with the OHIP-14 questionnaire. Multiple logistic regression analyses were used to determine the association between dental fear and dental attendance, oral health habits, dental condition and subjective oral impacts, taking into consideration the possible confounding and/or modifying factors (e.g. age, gender and education). Of Finnish adults aged 30 years and older, 10% were very afraid and 30% somewhat afraid of visiting a dentist. Those with high dental fear were more likely to report subjective oral impacts than were those with lower fear. Age modified the effect of the association between dental fear and dental attendance, oral health habits and dental condition. Among all age groups, except the 30- to 34-year-olds, irregular attenders were more likely to be very afraid of visiting a dentist than regular attenders were. Dental condition was also poorer among those with high dental fear than among those with lower fear. The association between dental fear and number of decayed teeth was positive in all age groups. Among the age group 65+ years, the numbers of missing and sound teeth were positively, and among the age group 30-34 years negatively, associated with dental fear. Among the age group 65+years, those who brushed their teeth less than twice a day were more likely to have high dental fear than were those who brushed at least twice a day. Regular smokers were more likely to have high dental fear than were those who smoked occasionally or not at all. Dental fear is very common among adults in Finland. Because those with dental fear use dental services irregularly, they are likely to need emergency care. However, those for whom oral health services have been provided regularly since childhood seem to continue to use these services regularly in spite of high dental fear. Dental teams should be aware of the increased oral health risks that smoking, irregular attendance and poor tooth-cleaning habits cause among those with dental fear. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress as well as improving regular dental attendance and oral health. Birth cohort or age should be taken into account when associations between dental fear and dental attendance, oral health habits and dental condition are studied. / Tiivistelmä Tutkimuksen tarkoituksena oli selvittää hammashoitopelon ja hammashoitopalveluiden käytön, suunterveyteen liittyvien tapojen sekä hammasterveyden välisiä yhteyksiä. Tavoitteena oli myös tutkia suunterveyteen liittyvien ongelmien yhteyttä hammashoitopelkoon. Kaksivaiheinen ryvästetty otos (n=8028) edusti suomalaista 30 vuotta täyttänyttä väestöä. Tutkimuksessa käytetty tieto koottiin haastattelujen, kyselyjen ja suun kliinisen tutkimuksen avulla. Hammashoitopelkoa selvitettiin kysymyksellä ”Onko hammaslääkärissä käynti mielestänne: ei lainkaan pelottavaa, jonkin verran pelottavaa, erittäin pelottavaa?” ja suun terveyteen liittyviä ongelmia OHIP-14-kyselyllä. Logististen regressioanalyysien avulla tutkittiin hammashoitopelon ja palveluiden käytön, suunterveyteen liittyvien tapojen ja ongelmien sekä hampaiden terveyden välistä yhteyttä huomioiden mahdollisia sekoittavia ja/tai vaikutusta muovaavia tekijöitä (mm. ikä, sukupuoli, koulutus). Suomalaisista aikuisista 10 % pelkäsi hammashoitoa kovasti ja 30 % jonkin verran. Kovasti hammashoitoa pelkäävät raportoivat suunterveyteen liittyviä ongelmia useammin kuin vähän tai ei lainkaan pelkäävät. Ikä vaikutti siihen, millainen yhteys oli hammashoitopelon ja hammashoitopalvelujen käytön, suun terveyteen liittyvien tapojen ja hammasterveyden välillä. Kaikissa muissa ikäryhmissä paitsi ikäryhmässä 30–34 epäsäännöllisesti hoidossa käyvät pelkäsivät hammashoitoa todennäköisemmin kuin säännöllisesti hoidossa käyvät. Kovasti pelkäävillä oli myös huonompi hammasterveys kuin vähemmän pelkäävillä. Kaikissa ikäryhmissä kovasti hammashoitoa pelkäävillä oli useampia reikiintyneitä hampaita kuin jonkin verran tai ei lainkaan pelkäävillä. Poistettujen hampaiden lukumäärän lisääntyessä kovan hammashoitopelon todennäköisyys pieneni ikäryhmässä 30–34 ja kasvoi ikäryhmässä 65+. Näissä ikäryhmissä sama ilmiö oli havaittavissa myös terveiden hampaiden lukumäärän muuttuessa. Ikäryhmässä 65+ hampaansa harvemmin kuin kahdesti päivässä harjanneet pelkäsivät hoitoa todennäköisemmin kuin vähintään kahdesti päivässä harjanneet. Säännöllisesti tupakoivat pelkäsivät hammashoitoa todennäköisemmin kuin epäsäännöllisesti tai ei lainkaan tupakoivat. Hammashoitopelko on yleistä Suomessa. Koska pelkäävät käyvät hoidossa epäsäännöllisesti, hammaslääkärit kohtaavat pelkääviä potilaita usein akuuttivastaanotolla. Ne, jotka ovat tottuneet hammashoitopalveluiden säännölliseen käyttöön lapsuudesta alkaen, näyttävät jatkavan palveluiden säännöllistä käyttöä pelosta huolimatta. Hammashoitotiimien tulee huomioida hammashoitoa pelkäävien epäsäännöllisen hoidossa käymisen, puutteellisten kotihoitotottumusten ja tupakoinnin suunterveydelle aiheuttama kohonnut riski. Hammashoitopelon hoitamisella olisi positiivisia vaikutuksia suunterveyteen liittyvään elämänlaatuun, koska pelon hoito vähentää psykologista ja sosiaalista stressiä, lisää säännöllistä hoidossa käyntiä ja parantaa suun terveyttä. Syntymäkohortti tai ikä pitää huomioida tutkittaessa hammashoitopelon yhteyttä hammashoitopalveluiden käyttöön, suunterveyteen liittyviin tapoihin ja hammasterveyteen.

Philosophiae Doctor - PhD / Validation of the OHIP-14 for a South African adult population using CFA resulted in a 12-item scale (OHIP-12) with excellent reliability (α =0.94), but the structural pathway varied across the socio-economic groups. The prevalence of oral pain was 19.4%, and varied significantly only across area-level SEP. Cost of care over the six months was estimated at about one billion Rand. Of those residing in the lowest SEP areas, 20.8% reported that they “did nothing” to relieve their last pain episode. Oral pain resulted in an average of two days lost per person from work/school over a six months period. The prevalence of OHIP was 16.2%. Those who had never visited a dental clinic had significantly better OHRQoL and less pain experience compared to those who previously visited a dental clinic. Both individual-level and area-level SEP were associated with OHRQoL in the bi-variate analysis, but these effects did not remain significant in multivariable-adjusted analysis. In particular, the respondents‟ race completely attenuated the effect of individual-level SEP on OHRQoL, while the experience of oral pain in the past six months completely attenuated the effect of area-level SEP on OHRQoL. Both absolute and relative inequality in oral health among the South African adult population was greater in the highest SEP areas than in the areas of lowest SEP

Das Ziel dieser Arbeit war die Bestimmung der kleinsten relevanten Veränderung des wahrgenommenen Mundgesundheitszustandes, der Minimal Important Difference (MID), des Oral Health Impact Profile (OHIP). Die MID sollte für die deutsche Version des OHIP mit 49 Fragen (OHIP-G49), die deutsche Kurzversion mit 14 Fragen (OHIP-G14) sowie für die einzelnen Dimensionen der deutschen und englischen Version des OHIP bestimmt werden. Es handelt sich um eine klinische Fallserie mit 224 konsekutiv rekrutierten, prothe-tischen Patienten. Die mundgesundheitsbezogene Lebensqualität wurde mittels des OHIP- G49 an zwei Terminen vor der Behandlung (Basisuntersuchungen) sowie vier und sechs Wochen nach Behandlungsende (Nachkontrolluntersuchun-gen) bestimmt. Zu den Nachkontrolluntersuchungen schätzten die Patienten zu-sätzlich die Veränderung ihres Mundgesundheitszustandes gegenüber dem Zeit-punkt vor der Therapie anhand einer globalen Frage ein. Anhand der Ergebnisse der Basis- und Nachkontrolluntersuchungen wurde der Median der Differenzen der OHIP-Summenwerte errechnet. Dieser Wert entspricht der MID. Für die deutsche Version des OHIP mit 49 Fragen wurde ein Wert von 6,0 OHIP-Punkten ermittelt. Der Wert für den kurzen Fragebogen OHIP-G14 betrug 2,0 OHIP-Punkte. Für die Dimensionen der deutschen und englischen Sprachversion des OHIP konnten nur teilweise Ergebnisse gefunden werden. Das Studienergebnis lässt den Schluss zu, dass für beide untersuchten Versionen des OHIP ein klar definierter, minimal relevanter Unterschied (MID) der Summen-werte existiert. Die MID unterstützt die Interpretation der klinischen Bedeutung von Veränderungen des vom Patienten wahrgenommenen Mundgesundheitszustan-des. Sie stellt eine wichtige Größe zur Bewertung prothetischer Therapieeffekte dar.

Syfte: Syftet med studien är att undersöka sambandet mellan socioekonomiska faktorer, oral hälsa och oral hälsorelaterad livskvalitet. Material och metod: Det gjordes en systematisk litteratursökning som gav totalt 454 träffar varav 24 artiklar var relevanta. Artiklarna granskades efter relevans och kvalitet och inkluderades därefter i studien. Resultat: Socioekonomiska faktorerna inkomst, utbildning, yrke, social status, kön och etnicitet var associerade med oral hälsa, dock var inkomst och utbildning det som var mest korrelerat med oral hälsa. Sämre oral status kunde verifieras med klinisk undersökning som oftast undersökte antal tänder, karies och parodontit, vilket antogs kunna påverka oral hälsorelaterad livskvalitet. Detta tillsammans med patientens självskattade orala hälsa formar patientens egentliga orala hälsa ur ett biomedicinskt och biopsykosocialt perspektiv. Slutsats: Denna studie har beskrivit sambanden mellan oral hälsorelaterad livskvalitet, socioekonomiska faktorer och oralt hälsostatus. De socioekonomiska faktorer som har mest påverkan på oral hälsa är inkomst och utbildning för alla ålderskategorier. / Purpose: The purpose of this study is to examine the relationship between socio-economic factors, oral health and oral health-related quality of life. Material and methods: A systematic literature search yielded a total of 454 hits of which 24 articles were relevant. The articles were reviewed for relevance and quality before inclusion in the study. Results: Socio-economic factors such as income, education, occupation, social status, gender and ethnicity were associated with oral health status. However, income and education were strongly correlated with oral health status. Poorer oral health status such as fewer number of teeth, dental caries and periodontal disease could affect the oral health-related quality of life. This, together with the patient's self-rated oral health mold the patient's actual oral health from both a biomedical and biopsychosocial perspective. Conclusions: This study described links between oral health-related quality of life, socioeconomic factors and oral health status. The socio-economic factors that have the most impact on oral health in all age categories are income and education.

För individer med parodontal sjukdom är egenvården betydelsefull för en bättre prognos. Förebyggande åtgärder kan behöva ses i ett större sammanhang om det ska vara möjligt att främja tandhälsa eller förhindra fortsatt tandsjukdom. En insikt i patientens upplevelser och syn på sin förbättrade egenvård kan vara värdefull för att bättre förstå vad som behöver hända för att det ska ske en förflyttning mot en bättre hälsa. Syftet var att beskriva innebörden av ett upplevt förbättrat munhälso¬relaterat beteende sett utifrån ett patientperspektiv. Studiepopulation & metod: Deskriptiv fenomenologisk metod (Giorgi) valdes för insamling och analys av data. Det gjordes ett urval från patienter på en privat praktik för allmäntandvård.Resultatet visade fenomenets generella struktur med dess åtta inbördes bestånds-delar som i korthet är: a) förändring som en successiv ökning, b) förändrad syn på egenvård, c) detaljerad förståelse, automatisk rutin, och förbättring, d) uppmaningar och feedback upplevs förstärkande, e) goda tankar och tillfredställande känsla över sin egen förmåga, f) medverkan och tilltro till expert samt stimulans och upprätthållande, g) negativa erfarenheter och begränsningar, h) relatera sig själv till dåtid, nutid, framtid och andra.Diskussion: Ett salutogent patientcentrerat perspektiv framträdde. Det visade ett komplext samspel mellan förstärkande inre och yttre faktorer som slutligen resulterade i ett förbättrat munhälsorelaterat välbefinnande samt en egenvårdsrutin som upplevs som väl integrerad i vardagen. Resultatet tyder på att en förbättrad egenvård ger en ökad munhälsorealterad livskvalitet som kan behöva undersökas närmre. / For individuals with parodontal disease self-care is important for the prognosis. To be able to prevent progression of oral diseases health promotion and preventive interventions should be seen in a larger context. An insight in the patient´s experiences of her improved self-care could be valuable for a better understanding of what it´s like to move towards the direction of a better health.The aim was to describe the meaning of a perceived improved oral health related behavior from the patients´ perspective.Study population & method: Descriptive phenomenological method (Giorgi) was chosen for collection and analysis of data. A selection from patients in a private dental practice was made.The result showed the general structure and its eight constituents: a) change as a successive increase, b) a changed view on self-care, c) a detailed understanding, an automatic routine, and improvement, d) motivating challenges and feedback are perceived as strengthening, e) good thoughts and a satisfying feeling over own capacity, f) complicity and credence to an expert, and stimulation and maintenance, g) negative experiences and limitations, h) relating yourself to past time, present time, future and other people.Discussion: A salutogenic patient-centered perspective appeared. It showed a complex interaction between strengthening internal and external factors which finally resulted in improved oral health related wellbeing and a self-care routine which was experienced as well integrated in the everyday life. The result indicates that improved self-care results in increased oral health related quality of life which needs further investigation.

Bakgrund: En god munhälsa är en viktig del i vården av den äldre personen i livets slutskede. Forskning visar att munhälsan ofta blir förbisedd. En grund i att utföra munvård hos äldre personer som vårdas i livets slutskede är att utföra en munhälsobedömning. I Sverige visar mätningar i kvalitetsregister att det finns en diskrepans mellan målnivåer och utförda munhälsobedömningar. Som specialistsjuksköterska är en av kärnkompetenserna att vara väl insatt i palliativ vård och utföra strukturerade bedömningar enligt vetenskaplig praxis. Syfte: Kommunsjuksköterskans erfarenheter och upplevelser av att utföra och dokumentera munhälsobedömningar hos äldre personer i livets slutskede. Metod: Kvalitativ ansats valdes till studien. Semistrukturerade intervjuer hölls med åtta kommunsjuksköterskor som arbetar i hemsjukvård, på särskilt boende och korttidsboende. Data analyserades med induktiv latent konventionell innehållsanalys. Resultat: Efter analys av data framkom fyra huvudkategorier. Tillvägagångssätt: Munhälsobedömning är något som ingår i den palliativa vården och ska göras på alla. ROAG (Revised Oral Assessment Guide) är det validerade instrumentet som används vid en munhälsobedömning men den passar inte alltid bra vid livets slutskede. En munhälsobedömning kan leda till ett lidande för patienten samtidigt som den kan medföra minskat lidande då besvär kan hittas och lindras. Munhälsobedömningen dokumenteras inte alltid. Ansvar och samarbete: Sjuksköterskorna är medvetna om sitt ansvar att en munhälsobedömning utförs samtidigt som de beskriver att det också är ett samarbete mellan omvårdnadspersonal och sjuksköterskekollegor. Samarbetet med personal ansågs fungera bra och sjuksköterskorna förlitar sig på att de signalerar när personen i livets slutskede har besvär från munnen. Samarbetet med sjuksköterskekollegor brister vid vissa tillfällen. Munhälsobedömningens prioritet: I mötet med personer som vårdas i livets slutskede kan det bli stort fokus på de övriga symtomen och det kan vara mycket annat att tänka på vilket kan leda till utebliven munhälsobedömning. Tidsbrist är en annan faktor till att munhälsobedömningen inte utförs. Kunskap och rutiner: Resultatet visar att det är viktigt att ha en tydlig rutin för att utföra munhälsobedömning hos äldre personer som vårdas i livets slutskede. Det upplevdes att sjuksköterskorna inte alltid fått tillräcklig utbildning på utförande av munhälsobedömning och att det inte alltid fanns rutiner för hur munhälsobedömningen skulle gå till. Klinisk relevans: Det finns ett behov att synliggöra betydelsen och öka medvetenheten av att utföra munhälsobedömning genom mer utbildning till personal som arbetar med äldre personer som vårdas i livets slutskede inom kommunal hälso- och sjukvård. Det finns också ett behov av en samstämmighet kring hur munhälsobedömning bör utföras, ett förslag är att utveckla ett validerat instrument som fungerar specifikt till äldre som vårdas i livets slut. / Background: Good oral health is an important part of the care of the elderly person at the end of life. Research shows that oral health is often overlooked. A basis for performing oral care in elderly people who are cared for at the end of life is to perform an oral health assessment. In Sweden, measurements in quality registers shows that there is a discrepancy between target levels and performed oral health assessments. As a specialist nurse, one of the core competencies is to be well versed in palliative care and perform structured assessments according to scientific practice. Aim: The municipal nurse's experiences of performing and documenting oral health assessments in elderly people at the end of life. Method: A qualitative approach was chosen for the study. Semi-structured interviews were held with eight municipal nurses working in home health care, in nursing home and respite care. Data were analysed using inductive latent conventional content analysis. Results: After analysing the data, four main categories emerged. Procedure: Oral health assessment is a part of palliative care and must be done on everyone. ROAG (Revised Oral Assessment Guide) is the validated instrument used in an oral health assessment, but it does not always fit well at the end of life. An oral health assessment can lead to suffering for the patient, it can at the same time lead to reduced suffering as problems can be found and alleviated. The oral health assessment is not always documented. Responsibility and collaboration: The nurses are aware of their responsibility that an oral health assessment is carried out while describing that it is also a collaboration between nursing staff and nursing colleagues. The collaboration with staff was considered to work well and the nurses rely on them to flag when the person in the final stage of life has problems from the mouth. Cooperation with nursing colleagues breaks down on certain occasions. The priority of the oral health assessment: In the meeting with people who are cared for at the end of life, there can be a lot of focus on other symptoms and there can be a lot of other things to think about, which can lead to the absence of an oral health assessment. Lack of time is another factor why the oral health assessment is not carried out. Knowledge and routines: The result shows that it is important to have a clear routine for performing oral health assessment in elderly people who are cared for at the end of life. The registered nurses felt that they did not always receive sufficient training on performing oral health assessment and that there were not always routines for how the oral health assessment should be carried out. Clinical relevance: There is a need to make the importance visible and increase the awareness of performing oral health assessment through more education for staff working with elderly people who are cared for at the end of life in municipal health care setting. There is also a need for a better described consensus on how oral health assessment should be carried out. One suggestion is to develop a validated instrument that works specifically for elderly people who are cared for at the end of life.

Bakgrund: Sju till 20 % av den svenska befolkningen har omfattande benförlust och 40 % har kronisk parodontit. Gingivit och viss förlust av tändernas stödjevävnader ses hos nästan alla vuxna. Syfte: Syftet med journalstudien var att beskriva parodontalt status hos patienter som undersökts av tandhygieniststuderande på tandhygienistprogrammet, Högskolan Kristianstad. Metod: En empirisk studie med kvantitativ metod har använts. Data från 103 patientjournaler har sammanställts. Resultat: Resultatet baseras på patienter med en ålder mellan 21-83 år. På patientnivå var medelvärdet för antal tänder 26,2, plackindex 45,7 % och blödningsindex 23,6 %. Tandköttsfickor 5-6 mm var vanligast vid tänderna 48 (13 %) och 38 (11,4 %). Tandköttsfickor &gt;6 mm förekom vanligast vid tänderna 38 (2,3 %) och 26 (2 %). Slutsats: Medelvärdet för plackindex ligger mycket högt (45,7 %) och står inte i proportion till blödningsindex (23,6 %). Tandköttsfickor &gt;6 mm var sällsynt och var vanligast förekommande vid molarer. Tandköttsfickorna tenderade att vara djupare posteriort i munnen och hos äldre individer. / Background: Seven to 20 % of the Swedish population have extensive bone loss and 40 % have chronic periodontitis. Gingivitis and some loss of tooth supporting tissues are seen with almost all adults. Aim: The aim of the journal study was to describe periodontal status in patients who were examined by dental hygiene students at the Dental Hygienist Programme at the University of Kristianstad. Method: An empirical study was done using a quantitative method. Data from 103 patient records were compiled. Result: The result is based on patients between the ages of 21-83. At the patient level, the mean value of teeth was 26,2, plaque index 45,7 % and bleeding index 23,6 %. Periodontal pockets 5-6 mm were most common in the teeth 48 (13 %) and 38 (11,4 %). Periodontal pockets &gt;6 mm were most common in the teeth 38 (2,3 %) and 26 (2 %). Conclusion: The mean plaque index is very high (45,7 %) and is not in proportion to the bleeding index (23,6 %). Periodontal pockets &gt;6 mm were rare and most common at molars. Gingival pockets tended to be deeper posterior in the mouth and in older individuals.

På en intensivvårdsavdelning vårdas bland annat patienter som är svårt sjuka, har allvarliga skador och kan ha genomgått omfattande operationer. Patienterna är oftast helt beroende av vårdpersonalen och att de sköter deras hygien. Med tanke på att de även kan vara infektionskänsliga är det extra viktigt att dessa patienter får en så individuellt anpassad munvård som möjligt. Studier tyder på bristande kunskaper kring oral hälsa och att munvården inte prioriteras inom vården trots att allvarliga komplikationer kan uppstå. Syftet med denna studie var att belysa undersköterskors uppfattning om oral hälsa och vilka rutiner som finns för munvård på patienter vid en intensivvårdsavdelning. Åtta intervjuer ägde rum som analyserades med kvalitativ innehållsanalys. Resultatet tyder på att munvård prioriteras högt på avdelningen och att undersköterskorna har kunskaper om varför det är viktigt att patienterna har en god munhygien. Det framgick också att munvårdsrutiner finns på avdelningen och tycks utföras till stor del tillfredsställande.