Objectives: 1. To determine the proportion of people reporting time loss from work, school, or normal activities due to oral health issues. 2. To determine how much time is being lost. 3. To establish predictors of this time loss. 4. To determine the productivity losses. Methods: Data from the Canadian Health Measures Survey (2007-2009) were used. Linear and logistic regressions were employed to determine which variables were predictive of hours lost and reporting time loss. Productivity losses were determined using the lost wages approach. Results: Time loss is more likely among privately insured, high income earners. Experiencing oral pain is the best predictor of reporting time loss. Productivity losses are comparable to those of some musculoskeletal conditions. Conclusions: Participants with higher incomes report time loss more frequently while the total amount of time lost is greatest for those with the lowest incomes. Productivity losses are substantial at the societal level.

Objectives: 1. To determine the proportion of people reporting time loss from work, school, or normal activities due to oral health issues. 2. To determine how much time is being lost. 3. To establish predictors of this time loss. 4. To determine the productivity losses. Methods: Data from the Canadian Health Measures Survey (2007-2009) were used. Linear and logistic regressions were employed to determine which variables were predictive of hours lost and reporting time loss. Productivity losses were determined using the lost wages approach. Results: Time loss is more likely among privately insured, high income earners. Experiencing oral pain is the best predictor of reporting time loss. Productivity losses are comparable to those of some musculoskeletal conditions. Conclusions: Participants with higher incomes report time loss more frequently while the total amount of time lost is greatest for those with the lowest incomes. Productivity losses are substantial at the societal level.

Bakgrund: Astma är en kronisk inflammatorisk luftvägssjukdom som är vanligt förekommande i alla åldersgrupper. Över 300 miljoner människor världen över beräknas ha sjukdomen. Syfte: Syftet med litteraturstudien var att undersöka om den orala hälsan hos barn med astma skiljer sig från den orala hälsan hos barn utan astma. Metod: Metoden som användes var en allmän litteraturstudie och litteratursökningarna gjordes i den medicinska databasen PubMed. Resultatet baseras utifrån en sammanställning av 13 vetenskapliga artiklar. Artiklarna var kliniska studier och 11 av dessa hade en kontrollgrupp där barn med och utan astma jämfördes. Övriga två artiklar studerade antingen hur den orala hälsan påverkades av kombinationsbehandling med specifika läkemedel eller jämförde den orala hälsan hos barn med olika duration och medicinering mot astma. Resultat: Några av de inkluderade studierna fann att barn med astma hade en ökad kariesförekomst jämfört med barn utan astma, medan andra studier visade att det inte fanns någon skillnad mellan grupperna. Avseende plack, blödning och kariesrelaterade bakterier var resultaten också motstridiga. Barn med astma som medicinerades med β2-stimulerare kombinerat med kortikosteroider hade ett minskat salivflöde och en ökad nivå av kariesrelaterade bakterier. Slutsats: Det finns motstridigheter kring om den orala hälsan hos barn med astma skiljer sig från den orala hälsan hos barn utan astma. Kombinationsbehandling med β2-stimulerare och kortikosteroider medför ett reducerat salivflöde och en ökad nivå av kariesrelaterade bakterier hos barn med astma. / Background: Asthma is a chronic inflammatory airway disease which is common in all ages. Over 300 million people worldwide are estimated to have the disease. Aim: The aim of this study was to investigate whether the oral health differs between children with and without asthma. Method: The method used was a literature review and the literature searches were made in the medical database PubMed. The results were based on a compilation of 13 clinical scientific studies and 11 of these compared children with and without asthma. The remaining articles studied either how the oral health was affected by the combination treatment with specific drugs or compared the oral health of children with different duration and medication for asthma. Results: Some of the included studies found that children with asthma had an increased cariesprevalence compared with children without asthma, while other studies showed that there was no difference between the groups. Regarding the plaque, bleeding and caries-related bacteria, the results were also conflicting. Medication with β2-agonist combined with corticosteroids contributed to a reduced salivary flow and an increased level of caries-related bacteria among children with asthma. Conclusion: There are conflicting results regarding whether the oral health differs between children with and without asthma. Combination treatment with β2-agonists and corticosteroids contributed to a reduced salivary flow and an increased level of caries-related bacteria.

Until recently, and since the inception of the National Health Service in 1948, general dental practitioners [GDPs] have worked in a stable environment. In recent years these GDPs have experienced dramatic changes in the way that primary oral health care is delivered to the public. This research aims to understand the strategic planning processes and the issues that are involved within the management of these changes that are currently occurring in general dental practice. The research question asks "What model could General Dental Practitioners use in their strategic approach to managing the enforced changes that are occurring within primary Dental Care". This thesis adopts the approach that all GDPs work within a “Small business” environment but that they are constrained by “professional” requirements. The changes now mean that these GDPs need to become proactive in their decision-making processes. The present system of primary oral health care within the U.K. is designed for the treatment and repair of damage caused by dental disease; it has not been prevention orientated. Changes such as disease processes, the financing of the NHS, demographic changes all mean that GDPs will require, in some degree at least, to re-evaluate their personal objectives and strategies. Historically, GDPs might be considered to have been reactive in their approach to these gradual changes. The ‘item of service’ payment system used within the NHS to remunerate GDPs is unique and therefore no existing small business model satisfies the requirements of GDPs. The research involved a population of 449 West Midland GDPs. The findings of the research indicated that certain core issues were significant in how dentists decided to operate their clinical practice. Significant gaps were revealed in the current literature and the research findings were used to develop a totally new decision making model. This model attempts to embrace the current changing scenario and by using this model, GDPs can evaluate their individual position within this changing framework of general dental practice and thus be better informed in their decision making processes. The need for further research is explained and suggestions are made for other areas that might be considered of importance to dentists and the delivery of primary oral health care.

The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45-64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire. Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%). Logistic regression revealed that for the community dwelling sample, those who were dissatisfied with their teeth or dentures were 5.16 times more likely to report an impact ‘fairly/very often’, which was the strongest indicator. Among the LTC sample, those who have poor perceived mouth health were 9.87 times more likely to report an impact.

Canadian correctional institutions provide dental services to incarcerated young people, but data on the dental health of these groups do not exist. Objective: To determine the oral health status of youth in a closed-custody youth facility in the country’s largest urban centre. Methods: A cross-sectional study of male and female youth incarcerated at a Toronto-area facility was conducted from September 2010 till July 2011. Participants completed a survey on social, correctional and dental histories, and underwent oral examination. Results: The 101 adolescent participants had a mean DMFT of 4.39 with 81.2% having DMFT>0. The proportion of DT when DMFT>0 was 0.51. Race, custody history and dental pain were indicators of poor oral health. Conclusions: By quantifying the need for dental services and by identifying variables associated with greater dental disease experience, these findings may assist health care providers in youth correctional facilities with their program planning for their high-needs wards.

The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45-64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire. Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%). Logistic regression revealed that for the community dwelling sample, those who were dissatisfied with their teeth or dentures were 5.16 times more likely to report an impact ‘fairly/very often’, which was the strongest indicator. Among the LTC sample, those who have poor perceived mouth health were 9.87 times more likely to report an impact.

Canadian correctional institutions provide dental services to incarcerated young people, but data on the dental health of these groups do not exist. Objective: To determine the oral health status of youth in a closed-custody youth facility in the country’s largest urban centre. Methods: A cross-sectional study of male and female youth incarcerated at a Toronto-area facility was conducted from September 2010 till July 2011. Participants completed a survey on social, correctional and dental histories, and underwent oral examination. Results: The 101 adolescent participants had a mean DMFT of 4.39 with 81.2% having DMFT>0. The proportion of DT when DMFT>0 was 0.51. Race, custody history and dental pain were indicators of poor oral health. Conclusions: By quantifying the need for dental services and by identifying variables associated with greater dental disease experience, these findings may assist health care providers in youth correctional facilities with their program planning for their high-needs wards.

ABSTRACT Introduction Oral diseases have a severe impact on rural and remote Indigenous communities of Australia with widespread, severe dental caries leading to a significant number of Indigenous children requiring multiple dental extractions under general anaesthesia each year; a scenario rarely seen elsewhere in Australia. This burden of oral disease occurs in these communities in the context of very limited availability of dental personnel and access to oral health care. The rural and remote Indigenous communities of Australia rely on Indigenous Health Workers as key primary health care personnel. Experience in Western Australia and the Northern Territory suggests that the oral health role of these personnel can be developed to improve community oral health and reduce the burden of oral disease in Indigenous communities. The development of the Indigenous Health Worker oral health role is supported by major stakeholders including: the peak Indigenous health organisation, the National Aboriginal Community Controlled Health Organisation; the peak dental health organisation, the Australian Dental Association; and by Australia’s National Oral Health Plan. Yet limited progress has been made in the development of this role. Why? This case study seeks to answer this question through the exploration of the complex, multiple factors influencing the development of the oral health role of Indigenous Health Workers in the Cape York region and so support the development of this role among Indigenous Health Workers. Methodology This research was conducted in accordance with the National Health and Medical Research Council’s Statement and Guidelines for ethical conduct of Indigenous health research. Ongoing consultation took place with key Indigenous health organisations of the region. including Apunipima Cape York Health Council, Gurriny Yealamucka Health Service and the Queensland Aboriginal and Torres Strait Islander Health Worker Training Aboriginal Corporation, to confirm that the research focus was a priority of the communities of the region and to gain input into the design and implementation of the project. With the support of these Indigenous health organisations the study focused on the three communities in which an initial introduction to oral health promotion was provided to Indigenous Health Workers by Queensland Health through its Crocodile Smiles Project. Qualitative methodologies were used with data collection in the region undertaken through semi-structured interviews with 58 health personnel in the remote Indigenous communities of Hopevale, Napranum and Yarrabah; and in the regional centres of Cairns, Cooktown and Weipa. These interviews explored the perceptions of Indigenous Health Workers, dental personnel and their co-workers regarding the priority, characteristics and support needs of the development of the Indigenous Health Worker oral health role in the region. Results Interviews with rural and remote health personnel highlighted the severe impact of oral disease in these communities and on their health services and the high priority given to the development of the Indigenous Health Worker oral health role. These health personnel are seen as key to Indigenous health promotion in the region. Contrasting perspectives were found among rural and remote health personnel regarding the characteristics of an appropriate Indigenous Health Worker oral health role with consistent support being given to the development of the oral health promotion role and varied perspectives found concerning the development of a clinical oral health role. Rural and remote health personnel also highlighted the significant barriers to the development of the Indigenous Health Worker oral health role existing at the clinic and regional levels. Conclusion This study identifies drivers of role development as including oral health needs and oral health skills shortages in rural and remote Indigenous communities of Cape York. Facilitators to role development were found to include: the legislative and policy environment; the support of Indigenous Health Workers and their co-workers; and the policies and plans of Queensland Health and the Indigenous Community Controlled Health Organisations of the region. Significant barriers include: the existing work burden of Health Workers; the lack of clarity of Health Worker role definition; and the difficulties inherent in the development of appropriate inter-professional and cross-cultural training and management support strategies which are able to be implemented in remote settings. The research highlights the complexity of factors to be considered in achieving the system¬wide changes needed to support the development of this role and makes recommendations in the areas of policy, training, management and research to best support the development of this role. In focusing on the development of the oral health role of Indigenous Health Workers the study has examined an area of significance to the Indigenous community using culturally sensitive research methods in remote settings and has addressed a significant though little explored area of dental research – the development of the oral health role of non-dental personnel.

Licentiatavhandling Stockholm : Karolinska institutet, 2005. / Härtill 2 uppsatser.