Abstract The aim of this study was to evaluate changes and interrelationships of oral health-related knowledge, attitudes and behavior between the ages of 11 and 16 during a randomized clinical trial (RCT) for controlling caries and a program of oral health promotion (OHP). The study population consisted of all 5th and 6th graders who started the 2001−2002 school year in Pori (n=1691) and Rauma (n=807), Finland. In Pori, children were exposed for 3.4 years either to both the RCT experimental regimen and the OHP, or only to the OHP. Children in Rauma acted as reference group. Questionnaire data on children’s knowledge, attitudes and behavior were gathered before, in the middle and after the follow-up. Changes in children’s knowledge, attitudes and behavior were compared according to the interventions to which they were exposed. Individual changes in knowledge, attitudes and behavior were evaluated. The hypothesized model that knowledge affects behavior directly and via attitudes was tested using structural equation modeling (SEM). The children who were exposed to both the RCT experimental regimen and OHP tended to improve their behaviors the most, those exposed to OHP the second most, and those in the reference group least. In knowledge and attitudes, no similar differences between groups were observed. Over half of the children had stable behaviors throughout the study. Those children whose behaviors changed were more likely to improve than to worsen them. Good baseline behavior tended to help in recovering from lapses to poor behaviors and maintaining the achieved good behavior. Among the same children, all three, knowledge, attitudes and behavior, tended to improve. Knowledge influenced behavior directly and via two interrelated attitudes, and it had smaller effect on behavior than on attitudes. Concern about developing caries lesions was a background factor. The experimental regimen of the RCT and the OHP were successful, and OHP enhanced the effectiveness of the RCT. In childhood, behaviors are rather stable. If healthy behaviors are learned young, lapses into poor behaviors are likely be temporary rather than permanent. Children are ready for change at different times, so OHP’s should be continuous processes instead of short-term interventions. Changes in knowledge, attitudes and behavior are related. / Tiivistelmä Tutkimuksen tavoitteena oli selvittää suun terveyteen liittyvän tiedon, asenteiden ja tapojen muutosta ja keskinäisiä suhteita 11 ja 16 ikävuoden välillä karieksen hallintaan liittyvän satunnaistetun kliinisen kokeen ja suunterveyskampanjan aikana. Tutkimusjoukon muodostivat 5. ja 6. luokkalaiset lapset Porissa (n=1691) ja Raumalla (n=807) lukuvuonna 2001–2002. Porissa lapset osallistuivat joko 3,4-vuotiseen terveyskampanjaan tai sekä kampanjaan että kliinisen kokeen hoito-ohjelmaan. Raumalaiset lapset toimivat vertailuryhmänä. Kyselyaineisto kerättiin ennen, puolessa välissä ja jälkeen kliinisen kokeen ja terveyskampanjan. Tutkimuksessa verrattiin eri interventioiden vaikutusta lasten tiedon, asenteiden ja tapojen muutokseen. Yksilöllisiä muutoksia tiedossa, asenteissa ja tavoissa selvitettiin. Oletettua mallia, jossa tieto vaikuttaa tapoihin suoraan ja asenteiden kautta, testattiin rakenneyhtälömallituksen avulla. Sekä kliiniseen kokeeseen että kampanjaan osallistuneet lapset onnistuivat tapojen parantamisessa parhaiten, vain kampanjaan osallistuneet toiseksi parhaiten ja vertailuryhmän lapset huonoiten. Tiedossa ja asenteissa samanlaisia ryhmäeroja ei havaittu. Yli puolella lapsista oli muuttumattomat tavat koko seurannan ajan. Lapset, jotka muuttivat tapojaan, todennäköisemmin paransivat kuin huononsivat niitä. Lapset, joilla oli alussa hyvät tavat, todennäköisesti onnistuivat huonoon tapaan lipsahtamisen jälkeen parantamaan tapansa ja säilyttämään saavutetun hyvän tavan. Yleensä ottaen samat lapset paransivat sekä tietoa, asenteita että tapoja. Tieto vaikutti tapaan suoraan ja kahden toisiinsa yhteydessä olevan asenteen kautta. Tieto vaikutti enemmän asenteisiin kuin tapaan. Harmi reikiintymisestä oli taustatekijä. Kliinisen kokeen hoito-ohjelma ja terveyskampanja olivat onnistuneita, ja terveyskampanja tehosti hoito-ohjelman vaikuttavuutta. Lapsuudessa tavat ovat melko pysyviä. Jos terveelliset tavat opitaan jo nuorena, lipsahdukset huonoihin tapoihin ovat todennäköisemmin väliaikaisia kuin pysyviä. Lapset ovat valmiita muutokselle eri aikoina, joten kampanjoiden pitäisi olla jatkuvia prosesseja eikä lyhytaikaisia interventioita. Muutokset tiedossa, asenteissa ja tavoissa ovat yhteydessä toisiinsa, mikä tukee teorioita tiedon, asenteiden ja tapojen kausaalisesta ketjusta.

Hintergrund. Die zahnmedizinische Versorgung und Oralhygiene bei Menschen mit Demenz (MmD) ist auch unter Berücksichtigung der zunehmenden Anzahl der erhaltenen Zähne schwierig. Ziel der Arbeit. Es soll geklärt werden,ob das Angebot einer Beratungsstelle zum Thema Mundgesundheit und Demenz genutzt wird. Material und Methoden. Die Beratungsstelle wurde mit 3 zahnmedizinischen Spezialisten aufgebaut, und ein Jahr lang wurden die telefonischen Anfragen gesammelt sowie ausgewertet. Ergebnisse. Die zahnmedizinische Beratung wurde von 355 Anrufern (180 medizinisch-pflegerisch tätig; 175 Angehörige) im Zeitraum vom 01.06.2012 bis 31.05.2013 genutzt. Von den Anrufern wurden in den ca. 21 min dauernden Gesprächen 2535 Probleme angesprochen. Fast ein Viertel der Anrufer fragte nach einer mobilen Behandlung, und 14,4% suchten einen Zahnarzt, der auf die Behandlung der MmD spezialisiert ist. Orale Erkrankungen, die Mundhygiene und die interpersonellen Schwierigkeiten, die zwischen allen Beteiligten zur oralen Situation auftraten, wurden thematisiert. Drei Viertel des medizinisch-pflegerischen Personals fragten nach Schulungen, um die Mundgesundheit und Oralhygiene bei MmD zu verbessern. Schlussfolgerung. Die Nachfrage bei den Spezialisten zeigte, dass es großen Wissensbedarf sowohl beim Fachpersonal als auch bei den Angehörigen gibt. Die Studie belegt, dass die Probleme in der Mundhöhle von MmD breit gefächert sind. Wissen zu Mund- und Prothesenhygiene sowie den Krankheitsbildern der Mundhöhle könnte strukturiert in die Aus- und Fortbildung eingebracht werden. Neben dem Wissensdefizit wird auch deutlich,dass die zahnmedizinische Versorgungsstruktur nicht für die MmD gesichert ist. Hier sind die Politiker und die Akteure im Gesundheitswesen aufgefordert, die zahnmedizinische Versorgung in den Demenznetzwerken und -strategien zu verankern.:Bibliographische Beschreibung..................................................................4 Einführung..............................................................................................5 Krankheitsbild Demenz.............................................................................5 Einteilung der Formen der Demenz...........................................................8 Verlauf einer Erkrankung an Demenz......................................................10 Ursachen und Symptome der Demenz....................................................12 Zur Notwendigkeit der Behandlung von Menschen mit Demenz...............13 Bisheriger Kenntnisstand zur Versorgungsstruktur von Menschen mit Demenz.................................................................................................14 Zum Nutzen der vorliegenden Studie......................................................15 Publikation.............................................................................................16 Zusammenfassung.................................................................................23 Einleitung..............................................................................................23 Ziel der Studie........................................................................................24 Material und Methode.............................................................................25 Ethische Überlegungen...........................................................................25 Ergebnisse der Studie.............................................................................26 Diskussion.............................................................................................27 Literaturverzeichnis................................................................................29 Anlagen.................................................................................................34 Erklärung über die eigenständige Abfassung der Arbeit............................34 Publikation.............................................................................................36 Danksagung...........................................................................................38 / Background. The complexity of dental care and oral hygiene for people with dementia increases with increasing numbers of residual teeth. Aim. This study was carried out to determine whether the offer of a telephone helpline on oral health and dementia would be utilized. Material and methods. Over a period of 1 year contacts received by a telephone helpline manned by three oral healthcare staff were collected and analyzed. Results. From 01 June 2012 to 31 May 2013 a total of 355 callers (180 healthcare staff and 175 relatives) presented and discussed 2535 problems. The average duration of a call was 21 min. Almost one quarter of the callers were looking for mobile dental care services and 14,4% were looking for a dentist specializedin caring for patients with dementia. Oral disease, oral care and conflicts between stakeholders on aspects of oral health were discussed. Of the healthcare staff three quarters asked about training to improve the oral health of people with dementia. Conclusion. The demand on the specialists of the helpline showed a substantial knowledge deficit of healthcare staff and relatives. The study confirmed a wide range of oral health issues of people with dementia. Knowledge on oral and denture hygiene and on oral disease could be introduced into primary training and continued professional education. In addition to the lack of knowledge, deficits also exist in the oral healthcare system for people with dementia. Poliicians and healthcare stakeholders are encouraged to incorporate oral healthcare for people with dementia into strategies and dementia networks.:Bibliographische Beschreibung..................................................................4 Einführung..............................................................................................5 Krankheitsbild Demenz.............................................................................5 Einteilung der Formen der Demenz...........................................................8 Verlauf einer Erkrankung an Demenz......................................................10 Ursachen und Symptome der Demenz....................................................12 Zur Notwendigkeit der Behandlung von Menschen mit Demenz...............13 Bisheriger Kenntnisstand zur Versorgungsstruktur von Menschen mit Demenz.................................................................................................14 Zum Nutzen der vorliegenden Studie......................................................15 Publikation.............................................................................................16 Zusammenfassung.................................................................................23 Einleitung..............................................................................................23 Ziel der Studie........................................................................................24 Material und Methode.............................................................................25 Ethische Überlegungen...........................................................................25 Ergebnisse der Studie.............................................................................26 Diskussion.............................................................................................27 Literaturverzeichnis................................................................................29 Anlagen.................................................................................................34 Erklärung über die eigenständige Abfassung der Arbeit............................34 Publikation.............................................................................................36 Danksagung...........................................................................................38

Introducción: El proyecto de intervención se ejecutó en el contexto de la inmovilización social obligatoria a causa de la pandemia por COVID-19, en el periodo 2020-1 durante los meses de Mayo y Junio en un entorno familiar en el distrito de Independencia, perteneciente a la DIRIS-Lima Norte. La importancia de desarrollar este proyecto es poder lograr una mejora en el estilo de vida de los involucrados. Planificación: Al encontrar problemas en común dentro del estilo de vida del entorno familiar y para lograr mejorarlas se estableció el objetivo general “Mejorar el estilo de vida con adecuadas prácticas saludables en el entorno familiar en el distrito de Independencia durante el periodo 2020-1 (Mayo-Junio)”. Posteriormente, se plantearon los siguientes objetivos específicos: “Promover prácticas de higiene oral”, “ Promover prácticas sobre alimentación saludable” y “Promover conductas adecuadas para manejar el estrés por el trabajo/estudio”, todas en el entorno familiar en el distrito de Independencia durante el periodo 2020-1 (Mayo-Junio). Así mismo, el promotor de salud desarrollo diferentes estrategias para cada objetivo que permitieron mejorar los hábitos. Resultados: Los resultados obtenidos en este proyecto de intervención fueron favorables para los involucrados, ya que lograron cumplir con el 100% de las actividades propuestas para cada objetivo, que a su vez nos permitió alcanzar el objetivo general, debido al compromiso que tuvo cada involucrado con este proyecto, que ha permitido desarrollar mejores hábitos en su estilo de vida. / Introduction: The intervention project was carried out in the context of compulsory social immobilization due to the COVID-19 pandemic, in the period 2020-1 during the months of May and June in a family environment in the district of Independencia, belonging to the DIRIS-Lima Norte. The importance of developing this project is to be able to achieve a change and improve the lifestyle of those involved. Planning: Upon finding common problems within the lifestyle of the family environment and in order to improve them, the general objective was established “Improve the lifestyle with appropriate healthy practices in the family environment in the district of Independencia during the period 2020-1 (May-June)". Subsequently, the following specific objectives were proposed: "Promote oral hygiene practices", "Promote healthy eating practices" and "Promote appropriate to behaviors manage stress from work / study", all in the family environment in the district of Independencia during the period 2020-1 (May-June). Likewise, the health promoter developed different strategies for each objective that made it possible to improve habits. Results: The results obtained in this intervention project were favorable for those involved, since they managed to comply with 100% of the activities proposed for each objective, which in turn will achieve the general objective, due to the commitment that each involved with this project, which has allowed them to develop better habits in their lifestyle. / Trabajo de investigación

This study sought to identify the level of oral health literacy held by people who live in transitional and distressed Kentucky Appalachian areas and if this effects how often they are using oral hygiene techniques. Data were also collected to describe the attitudes Kentucky Appalachian adults hold toward oral hygiene and oral health status. Current documentation shows that poor oral health remains a public health threat in this population despite efforts such as school-based sealant programs and increased dental insurance coverage. This study followed a quantitative design and 99 participants were polled using a survey specifically developed for this study's use. Composite median scores and Spearman's correlation values established the existence of a low oral health literacy level across the participant pool, an also documented that oral hygiene techniques are not used in frequencies recommended for proper oral health. A poor self-efficacy towards the ability to utilize these techniques properly was also identified. Using the Mann-Whitney U test, responses were compared based on county designation and few significant differences were found. These findings show that oral health status and related beliefs are similar across the region and not just isolated to the economically poorest areas as the currently available literature suggests. Applying the health belief model it is predicted that Kentucky Appalachians are unlikely to adopt proper oral hygiene habits until their self-efficacy is improved. A recommendation of this study is that public health officials should promote personal control when designing public health programs geared towards improving the oral health status of this population. To do so would introduce a positive social change in that people with good oral health are less likely to experience the pain, malnutrition, and negative social stigma that is associated with poor oral health.

Bakgrund: Munhälsan hos intuberade patienter försämras successivt under vårdtiden. Risken att drabbas av VAP ökar dagligen och VAP anses vara en av de vanligaste komplikationerna till respiratorvård och patienter som drabbas kräver längre vårdtid. Munvård är en del av VAP-preventionen men det framgår inte vilka specifika munvårdsåtgärder som har effekt.    Syfte: Syftet med denna uppsats är att beskriva vilka munvårdsåtgärder som är mest effektiva avseende preventionen av VAP och därmed bör användas i intensivvårdssjuksköterskans dagliga arbete.   Metod: En systematisk litteraturöversikt med kvantitativ induktiv ansats. Sammanlagt 17 studier inkluderades i denna uppsats.    Resultat: Två huvudkategorier identifierades samt två subkategorier. Införandet av munvårdsprotokoll gav en statistiskt signifikant minskning av VAP-prevalens, klorhexidin kan vara effektivt mot VAP men det finns även andra antibakteriella lösningar som effektivt förebygger VAP.    Slutsats: För att bidra till ökad patientsäkerhet borde specialistsjuksköterskor inom intensivvård använda ett munvårdsprotokoll för att arbeta preventivt mot VAP. Utöver detta ska tandborstar regelbundet bytas ut, verksamheten borde även se över möjligheten att inkludera tandläkare. Dock är det aktuellt med ytterligare forskning om munvård för att i framtiden använda endast de munvårdsåtgärder som bevisats vara effektiva. / Background: The oral hygiene in intubated patients successively deteriorates during the period of care. The risk of contracting a VAP increases daily and VAP is considered to be one of the most common complications related to mechanical ventilation. The patients who are afflicted require a prolonged hospital stay. Oral hygiene is a part of VAP-prevention but it remains unclear as to which specific oral care measures are effective.    Aim: The aim of this study is to describe which oral care measures are the most effective in the prevention of VAP and therefore should be used by the intensive care nurse in the daily working routine.    Method: A systematic literature study with a qualitative inductive approach was used. A total of 17 studies were included in this essay.   Results: Two main categories were identified as well as two subcategories. The adoption of oral care protocols showed a statistically significant decrease of VAP, and chlorhexidine can be effective against VAP however there are also other antibacterial solutions which effectively prevent VAP.   Conclusion: In order to contribute to increased patient safety intensive care nurses should use an oral care protocol to prevent VAP. In addition to the protocol toothbrushes should be replaced regularly, and the ward should oversee the possibility of including dentists to optimize the oral care. Oral care requires additional research so that in the future it is possible to use only the oral care procedures that have been proven to be effective.

Objectives: Aim of this systematic review was to assess oral health-related quality of life (OHRQoL) of patients after stroke. Methods: The systematic literature search was performed on December 2021 based on PubMed, Medline, Web of Science, and Scopus, with the search terms: “oral health-related quality of life” AND stroke OR apoplexy OR ischemic stroke OR apoplectic insult. Articles exclusively examining patients after stroke and reporting a well-documented and valid OHRQoL measurement were included. Results: Out of 68 findings, 8 studies were included. The number of patients ranged between 31 and 549 individuals, mean age between 55.7 and 73.9 years, and 49–72% of individuals were male. Two studies included a healthy control group. Oral health parameters were rarely reported across studies. Five studies reported on the Oral Health Impact Profile (OHIP) 14 for OHRQoL, showing means between 2.87 and 33.0 in sum score. Three studies applied Geriatric Oral Assessment Index (GOHAI), with sum scores between 45.6 and 55.0. Only one study found worse OHRQoL in stroke patients compared to healthy controls. Two studies reported on an association between OHRQoL and general quality of life. Three studies found OHRQoL to be associated with different oral health parameters. Only one study found OHRQoL to be associated with stroke-related parameters. Conclusions: Patients after stroke show a reduced OHRQoL. Medical staff and caregivers should support oral hygiene and dental visits, to foster patients’ oral health and OHRQoL.

Syfte: Syftet med studien är att utföra en metodutveckling där individuella skenor framställs för att möjliggöra en standardiserad mätning av plackansamling på titanfixturers ytor samtidigt som det ska ge möjlighet för att bibehålla god munhygien.   Material och metod: Sjuttio titanfixturer ytbehandlades på tre sätt: sandblästring, etsning och implantoplastik. Studien involverade elva deltagare och det framställdes elva gipsmodeller utifrån avtryck. Tolv individuella skenor utformades med modelleringsvax med hänsyn till varje deltagares bettförhållanden. Kallpolymeriserad ortokryl användes vid framställning av skenor och cylindrar. Totalt framställdes sjuttio cylindrar, där två öppningar skapades. För vardera individuella skena innefattades sex fixturer, en från varje behandlingsmetod. Fixturerna placerades enligt en randomisera mall som innefattade sex olika variationer. Den tolfte skenan utgick inte ifrån mallen utan där placerades fyra fixturer, två av implantoplastik, en etsad och en blästrad. Skenorna lämnades ut till de frivilliga deltagarna och användes under tre dygn.   Resultat: Metodutvecklingen för att mäta plackansamling på olika ytbehandlade fixturer med hjälp av individuella skenor i förhållande till god munhygien, gick att genomföra. Resultaten visade att den råa ytan efter sandblästring hade högst plackansamling (0,604 mm), medan implantoplastik hade lägst plackansamling (0,342 mm).  Slutsats: Inom ramen för föreliggande studie kan följande slutsats dras: Genom framställning av individuella skenor är det möjligt att mäta plackansamlingen på etsade, blästrade och implantoplastik-ytbehandlade titanfixturer. Resultaten uppvisar även en tydlig indikation på att passform och komfort är en viktig faktor för deltagarnas medverkan. / Purpose: The purpose of this study is to perform a method development where individual splints are produce to enable a standardized measurements of plaque accumulation on the surfaces of titanium fixtures, while allowing to maintain good oral hygiene.    Material and method: Seventy titanium fixtures were surface-treated in three ways; sandblasting, etching, and implantoplasty. The study involved eleven participants, and eleven gypsum models were created. Twelve individual splints were designed using modeling wax, taking into consideration each participant's occlusal conditions. Cold-polymerized orthocryl was used to fabricate the splints and cylinder. A total of seventy cylinders were prepared, each with two openings. Each individual splint included six fixtures, one from each treatment method. The fixture placement followed a randomized pattern, comprising six different variations. The twelfth splint deviated from the randomized pattern and contained four fixtures: two from implantoplasty, one etched, and one sandblasted.    Results: The method development for measuring plaque accumulation on different surface-treated fixtures using individual splints in relation to good oral hygiene, was successfully conducted. The results demonstrated that the rough surface following sandblasting exhibited the highest plaque accumulation (0,604 mm), whereas implantoplasty showed the lowest plaque accumulation (0,342 mm).    Conclusion: Within the scope of this study, the following conclusion can be drawn: By individual splints, it is possible to measure plaque accumulation on etched, sandblasted, and implantoplasty-treated titanium fixtures. The results show a clear indication that fit, and comfort are important factors for participant’s compliance.

La maladie rénale peut se manifester avec différents types de pathologies buccales pouvant augmenter les risques de bactériémie. Bien que l’endocardite infectieuse soit une condition rare chez les patients atteints de maladie rénale, elle peut toutefois être retrouvée suite à des infections nosocomiales. Dans le passé, une antibiothérapie prophylactique était prescrite aux patients hémodialysés pour les protéger de l’endocardite infectieuse et de l’infection de l’accès d’hémodialyse. Aujourd’hui, cette recommandation est révolue. Afin de contrer les risques de bactériémie transitoire, une attention particulière doit être apportée aux soins d’hygiène orale à la maison. Le but de l’étude est d’évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les patients atteints de maladie rénale. Objectifs de recherche Les trois objectifs de recherche sont a) d’évaluer les connaissances des parents de patients atteints de maladies rénales sur l’endocardite infectieuse et le lien avec la santé buccodentaire; b) d’évaluer la perception des parents par rapport à la santé buccodentaire de leur enfant et leurs habitudes d’hygiène orale; et c) de comparer l’influence de deux méthodes d’hygiène orale sur l’indice de plaque chez les enfants atteints de maladies rénales. Hypothèses Les deux hypothèses de recherche sont que a) les parents d’enfants atteints de maladies rénales connaissent et adhèrent aux recommandations émises par l’American Heart Association; et que b) l’amélioration de l’indice de plaque chez les patients atteints de maladies rénales est plus grande pour le groupe recevant des instructions par le matériel audiovisuel par rapport à ceux qui les reçoivent par le néphrologue. Méthodologie Suite à l’obtention d’un certificat d’éthique à la recherche du Centre Hospitalier Universitaire Sainte-Justine, 37 des 38 sujets recrutés âgés entre 6 et 16 ans (19 filles et 18 garçons) ont participé à cette étude transversale. Suite à la signature d’un consentement éclairé, les sujets sont assignés par randomisation à l’un des deux groupes d’instructions d’hygiène orale, soit celui sans instructions spécifiques (groupe 1) ou par matériel audiovisuel (groupe 2). Un questionnaire portant sur les connaissances des parents en rapport avec la santé buccodentaire est remis aux parents. Un indice de plaque initial est noté avant l’application des instructions d’hygiène orale reçues. Un indice de plaque final mis en évidence à l’aide de pastilles révélatrices est documenté avec des photographies intra-orales et mesuré par deux observateurs, testés pour la fiabilité intra et inter-observateurs. Résultats Les analyses statistiques ne démontrent aucune différence significative entre les deux groupes d’instructions d’hygiène orale. Les variables à l’étude (âge, sexe, suivi dentaire, fréquence des soins à la maison, connaissances et motivation) ne montrent aucune influence significative sur la qualité de l’hygiène orale des sujets. Seul l’indice de plaque initial est inversement relié à la perception des parents face à la santé buccodentaire de leur enfant : plus le relevé de plaque est bas, plus la santé buccodentaire est perçue comme bonne. Conclusion Selon les résultats de notre étude, il n’existe pas de différence statistiquement significative entre les deux méthodes d’instructions d’hygiène orale. Néanmoins, les deux techniques permettent de diminuer significativement l’indice de plaque chez les enfants atteints de maladies rénales et de conscientiser cette population à l’importance du maintien d’une bonne santé buccodentaire. / Renal diseases are known to cause oral changes that can increase the risk of developping a bacteraemia. Even if infective endocarditis is a rare condition in patients with renal disease, it is associated with nosocomial infections. In the past, antimicrobial therapy was recommended for haemodialysis patients to prevent infective endocarditis and indwelling venous catheter-related infections. The administration of prophylactic antibiotics is no longer supported, given the lack of evidence concerning this approach. To prevent patients from developing a transitory bacteraemia, home oral care has to be improved. The goal of this study is to assess the efficacy of two oral health instruction methods in children with renal disease. Objectives The objectives of this study are to assess the knowledge on infective endocarditis and its link to the oral health of parents with children who present with renal disease; to evaluate the perception of parents in relation with their child’s oral health and their dental behaviour and finally to compare the impact of the oral health instruction methods on the plaque index of children with renal disease. Hypothesis The two hypotheses of this study are a) parents of children suffering from renal diseases know and respect the guidelines published by the American Heart Association and b) that the improvement of the plaque index is better in the group who receives oral health instructions from the audio-visual material compared to the one receiving instructions from the nephrologist. Methods An ethic’s certification was obtained from the Centre Hospitalier Universitaire Sainte-Justine for children. Of the 38 recruited patients, 37 patients (19 girls, 18 boys) ranging in age from 6 to 16 years participated in this transversal study. Consent was obtained prior to randomised assignment to either oral hygiene delivered by means of an audio-visual aid (groupe 1) or by a nephrologist (group 2). A questionnaire investigating parental knowledge on renal disease linked with oral health was administered. An initial plaque index was taken before applying oral health instructions. A final plaque index using disclosing tablets was measured by two observers tested for intra and inter-reliability through intra-oral pictures. Results The statistical analyses do not show any significant differences between the two oral health instruction groups. No significant relation was found between oral health status and age, gender, dental follow up, frequency of home dental hygiene and motivation. The only significant relationship found was as parents perception of their child’s oral health increases, the initial plaque index decreases. Conclusion The results indicate that even if there is no statistically significant difference between the two methods of oral health instruction, both techniques are capable of reducing the plaque index of children suffering from renal disease.

Les pratiques d'hygiène bucco-dentaire dans les établissements accueillant des personnes en situation de handicap ou dépendantes sont très nettement insuffisantes, ce qui participe à augmenter le risque des pathologies bucco-dentaires de nature infectieuse et de leurs comorbidités pour la population qu'ils accueillent. Le projet Santé Orale et Autonomie (SOA) est une mesure développée dans le cadre du plan national de Prévention bucco-dentaire 2006-2009 qui visait à rémunérer des chirurgiens-dentistes, pour qu'ils mettent en place, après une formation en ligne, une action de promotion de la santé orale dans un de ces établissements, selon un protocole commun standardisé qui comportait : 1) une conférence de sensibilisation auprès du personnel 2) l'évaluation de l'état de santé bucco-dentaire des résidents 3) des ateliers de démonstration individualisée des techniques d'hygiène impliquant le personnel et les résidents. Ce travail décrit et évalue l'impact du projet SOA. Vingt-six chirurgiens-dentistes ont participé au projet dans sa totalité. A l'issue de leur formation en ligne, une augmentation significative de leur sentiment de compétence pour 16 aptitudes spécifiques a été observée. Une amélioration du contrôle de plaque a été notée pour 33,7% des résidents (n=691). Une amélioration des habitudes d'hygiène bucco-dentaire au sein des établissements a été observée pour 11,5% des résidents (n=814). Cette étude est la première à montrer l'impact relativement faible de ce type d'action et incite leur association à d'autres dispositifs de promotion de la santé orale. / Oral hygiene practices in special care establishments are clearly unsatisfactory, increasing the risk of infectious oral disease and associated morbidity for the population attending these establishments. The 'Oral Health and Autonomy' project was part of the French Oral Health Plan for 2006-2009. Dentists taking in part in the project completed an online training course and were reimbursed for the implementation of an oral health promotion intervention in a special care establishment. The interventions followed a standardised, common protocol, which included: 1) a conference presentation for the staff, 2) individualised oral risk assessment for each resident and 3) hands-on workshops demonstrating oral hygiene techniques for the residents accompanied by their key workers. This document describes and evaluates the impact of the 'Oral Health and Autonomy' project. Twenty-six dentists completed the project. After completion of the online training course, the self-efficacy of the dentists in 16 specific skills significantly increased. A decrease in the presence of dental plaque was observed for 33.7% of the residents (n = 691). Improvement in oral hygiene behaviour within the establishment was observed for 11.5% of the residents (n=814). This study is the first to show the relatively low impact of this type of intervention and suggests that different approaches to oral health promotion should be used in conjunction to improve outcomes.

Orientador: Alessandro Lia Mondelli / Resumo: Introdução: Um dos problemas relacionados à internação em Unidades de Terapia Intensiva (UTI), diz respeito à condição bucal dos pacientes. Falta ou deficiência de higiene bucal podem levar a quadros de infecção por microrganismos patogênicos, sendo a principal delas, a pneumônica associada à ventilação mecânica (PAVM). Procedimentos Operacionais Padrão - POP de higiene bucal nem sempre são seguidos à risca, além de não contarem, na maioria das vezes, com a participação de cirurgião dentista em suas elaborações. Diante desse quadro, o objetivo desse trabalho é a criação de novo protocolo de higiene bucal para pacientes internados e intubados no Serviço de Terapia Intensiva (SETI) do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP e avaliar seu impacto na prevenção de PAVM. Materiais e métodos: Foram estudados 72 pacientes divididos em dois grupos: estudo, internados na Ala 1 do SETI, e controle, internados na ala 2 do SETI. Critérios de inclusão: pacientes em ventilação mecânica a no máximo 24 horas e que permaneceram nessa condição por período mínimo de 96 horas, idade mínima de 18 anos. Critérios de exclusão: neoplasias sob quimioterapia, imunossuprimidos, extubação (voluntária ou não) ou óbito antes do prazo mínimo de 96 horas. No grupo de estudo, foi realizada higiene bucal com clorexidina 0,12% líquida, 2 X dia, de acordo com o procedimento operacional padrão desenvolvido; no grupo controle, a higiene bucal foi realizada de acordo com o procedimento op... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: One of the problems related to hospitalization in Intensive Care Units (ICU) is the patients' oral condition. Absence or deficiency of oral hygiene may lead to infection by pathogenic microorganisms, the main one being ventilator-associated pneumonia (VAP). Oral hygiene standard operating procedures are not always followed to the letter, and in most cases, dental surgeon do not participate in its elaborations. In view of this situation, the objective of this work is the creation of a new oral hygiene standard operational procedure for hospitalized and intubated patients at the Intensive Care Unit of the Hospital das Clínicas of Botucatu Medical School - UNESP and evaluation of its impact on the prevention of VAP. Materials and methods: We studied 72 patients divided into two groups: study, hospitalized in ICU Ward 1, and control, hospitalized in Ward 2 of the ICU. Inclusion criteria: patients on mechanical ventilation for, at most, 24 hours and who remained in this condition for a minimum period of 96 hours, minimum age of 18 years. Exclusion criteria: neoplasms under chemotherapy, immunosuppressed, extubated (voluntary or not) or death before the minimum period of 96 hours. In the study group, oral hygiene was performed with chlorhexidine 0.12% liquid, 2 times a day, according to the standard operational procedure developed; in the control group, oral hygiene was performed according to the standard operational procedure existing in Hospital das Clínicas for ICU... (Complete abstract click electronic access below) / Mestre