<p>Oral complications and symptoms are common among patients with cancer. The aim of this thesis is to study several aspects of oral status, oral health and its relation to quality of life, and oral care among patients treated with radiotherapy or chemotherapy. Descriptive, comparative and correlational designs were used. </p><p>A series of consecutive patients admitted to a university hospital or a regional hospital to receive radiotherapy for head and neck cancer or chemotherapy for haematological malignancies, were studied prospectively with regard to oral symptoms and their relation to health-related quality of life using interviews and questionnaires, examination of the oral cavity and saliva tests. All nurses and enrolled nurses who worked with these patients or with patients with lung cancer were interviewed about their education and knowledge in oral care and performed oral care. The medical and nursing records on patients with these cancer diseases at the two hospitals were reviewed. </p><p>The results indicate that patients receiving radiotherapy experienced increasing oral symptoms, which remained to a large extent one month after treatment. Patients receiving chemotherapy did not experience oral symptoms to the same extent. The oral symptoms were significantly related to patients' health-related quality of life, particularly among those receiving radiotherapy. Data also indicate that there is a lack of adequate education and continuing education in oral care among nursing staff. All patients were not examined orally before or during treatment, nor did they receive sufficient information or instruction related to oral hygiene. Patient compliance with oral hygiene procedures was acceptable, although some patients reported difficulties. Oral status and oral care were insufficiently documented, particularly in nursing records. The attitudes to oral examination and discussion on oral hygiene differed between nursing staff and patients. Nursing staff objected to examining the oral cavity referring to patient integrity. This was not considered as a hindrance among patients. In conclusion, oral health is related to health-related quality of life, which motivates a multi-disciplinary approach to oral care. </p>

Oral complications and symptoms are common among patients with cancer. The aim of this thesis is to study several aspects of oral status, oral health and its relation to quality of life, and oral care among patients treated with radiotherapy or chemotherapy. Descriptive, comparative and correlational designs were used. A series of consecutive patients admitted to a university hospital or a regional hospital to receive radiotherapy for head and neck cancer or chemotherapy for haematological malignancies, were studied prospectively with regard to oral symptoms and their relation to health-related quality of life using interviews and questionnaires, examination of the oral cavity and saliva tests. All nurses and enrolled nurses who worked with these patients or with patients with lung cancer were interviewed about their education and knowledge in oral care and performed oral care. The medical and nursing records on patients with these cancer diseases at the two hospitals were reviewed. The results indicate that patients receiving radiotherapy experienced increasing oral symptoms, which remained to a large extent one month after treatment. Patients receiving chemotherapy did not experience oral symptoms to the same extent. The oral symptoms were significantly related to patients' health-related quality of life, particularly among those receiving radiotherapy. Data also indicate that there is a lack of adequate education and continuing education in oral care among nursing staff. All patients were not examined orally before or during treatment, nor did they receive sufficient information or instruction related to oral hygiene. Patient compliance with oral hygiene procedures was acceptable, although some patients reported difficulties. Oral status and oral care were insufficiently documented, particularly in nursing records. The attitudes to oral examination and discussion on oral hygiene differed between nursing staff and patients. Nursing staff objected to examining the oral cavity referring to patient integrity. This was not considered as a hindrance among patients. In conclusion, oral health is related to health-related quality of life, which motivates a multi-disciplinary approach to oral care.

Tidigare forskning inom intensivvårdsområdet har visat att ej adekvat utförd munvård kan leda till allvarliga livshotande sjukdomar. Det är av därför av vikt att munvård utförs enligt gällande rekommendationer och följer evidensbaserad forskning. Syftet var att identifiera intensivvårdssjuksköterskans beskrivning av tillvägagångssätt, delaktighet och dokumentation vid utförande av munvård hos patienter inneliggande på IVA. En kvantitativ ansats valdes med målsättning att göra en undersökning med hjälp av enkätfrågor. Inklusionskriterier var specialistutbildade sjuksköterskor inom intensivvård som tjänstgjorde på tre intensivvårdsavdelningar i västra Sverige under aktuell studieperiod. Sammanlagt distribuerades 182 enkäter och 103 svar erhölls vilket gav en svarsfrekvens på 60 %. Resultatet visade att munvård var en prioriterad omvårdnadsåtgärd på avdelningarna och tillvägagångssättet följde till stor del fastställda riktlinjer. Det framkom att i begreppet munvård ingick huvudsakligen inspektion av munhålan, mekanisk rengöring, fuktning av slemhinna och läppar, inspektion av tänder och tandkött samt sugning av munhåla och svalg. De verktyg som huvudsakligen användes var tandborste, muntork eller liknande samt antibakteriellt medel. Ett signifikant samband förekom vad gäller sjuksköterskans delaktighet vid utförande av munvård hos intuberade patienter jämfört med övriga patienter (p=0,02). Detta ansågs vara en mer komplex omvårdnadsåtgärd vilken krävde samarbete med övriga medarbetare. Munvård delegerades ofta till undersköterskor men det är dock sjuksköterskans uppgift att leda och ansvara för omvårdnaden.  Dokumentation vad gäller munvård utfördes i de flesta fall på en observationskurva. Ett mindre antal sjuksköterskor angav att dokumentation även utfördes i datajournal. Ett flertal sjuksköterskor angav att dokumentation dessutom utfördes på interna checklistor. Det framkom att flera sjuksköterskor dokumenterade i datajournal enbart vid avvikelser eller om komplikationer tillstött. / Previous studies in the intensive care areas have shown that inadequate oral care may predispose patients to life-threatening diseases and conditions. The role of oral hygiene in maintaining the health of patients in the ICU is indisputable and therefore the importance of oral care evidence-based clinical recommendations. The purpose of this study was to identify the intensive care nurses description of the conducting, participation and documentation of oral care performed by nurses on patients in ICUs. A quantitative study with a describing design has been used which is based on the statistical analysis of data collected by structured questionnaires. The inclusion criteria were nurses working in three ICUs located in West Sweden during the study period. One hundred eighty-two questionnaires were distributed and replies were received from 103 nurses which gave a response rate of 60%. The result showed that the oral care conducted followed the evidence-based clinical recommendations and was given a high priority. The majority of the nurses performed an oral assessment before beginning oral care which included inspection of the oral cavity and inspection of teeth and gum. Oropharyngeal suction and moisturizing of lips and the mucosal membrane was also included. The most common used equipment was toothbrushes and foam swabs. Chlorhexidine was the most common solution used. A significant correlation was observed regarding nurse participation when conducting oral care for an intubated patient compared to other patients (p=0,02). Intubated patients were considered having more complex oral care needs which were associated with the demand of more than one person providing oral care. In practice, nurses frequently delegate the conducting of oral hygiene to nursing assistants, but the law clearly describes the role of the nurse as responsible and the leader of care practices. Oral care was in most cases documented on the unit’s flow sheet. A fewer number of nurses commented on that oral care was documented in the electronical clinical journal. A considerable   number of nurses also indicated that oral care in addition was documented on the unit’s internal checklists. It appeared that several nurses used the electronical clinical journal in cases only when abnormalities or complications had occurred.

Utförandet av munvård hos äldre är en omvårdnadsåtgärd som har betydelse för människan och dess helhet, trots vetskap om detta har munvård kommit att vara den del inom vården som ofta bortprioriteras. Därför är det av stor vikt att uppmärksamma vårdpersonalens upplevelser av att utföra munvård för att förstå varför munvård negligeras. Syftet med litteraturstudien var att beskriva vårdpersonalens upplevelser av att utföra munvård hos äldre. En litteraturstudie genomfördes där resultatet grundas på 11 vetenskapliga artiklar som svarar mot syftet. Resultatet beskrivs i fem olika teman: Upplevelser av rädsla och känslor av obehag, komplex omvårdnadsåtgärd som väcker etiska dilemman, upplevelser av rutiner och ansvarsområden, en lågt prioriterad omvårdnadsåtgärd och vårdpersonalens behov av kunskap. Resultatet visar vårdpersonalens upplevelser av att utföra munvård i sammanhang som färgas av vårdmiljö, kompetens och attityder. Resultatet belyser bland annat vårdpersonalens egen tandvårdsrädsla som påverkar munvården de erbjuder. Utförandet av munvård ansågs som en komplex uppgift, så vida att omvårdnadsåtgärder som involverade inkontinensskydd föredrogs. Om vårdpersonal erhåller mer tid och kunskap kring utförandet av munvård kan upplevelsen av omvårdnadsåtgärden förändras. Därför bör ytterligare forskning kring upplevelser och utbildning appliceras inom vårdområdet. / The execution of oral care amongst seniors is a care action which carries great importance for the person and its being. Despite aforementioned knowledge, oral care is often neglected within the health sector. Therefore it is of utmost importance to highlight the experiences of health care professionals conducting oral care, in order to further discern the nature of its neglect. The literature review attempts to explain the prevailing experiences of health care professionals in regards to oral care. The literature review was conducted on the basis of 11 articles of scientific nature interpreting the formulated question. The outcome formed five categories: the experience of fear or discomfort, complex care that provokes ethical dilemmas, responsibilities and routines, an overlooked care act, knowledge requirements. The result illustrates health care personnel and their experience of oral care in the context of care environment, competence and attitudes. Furthermore, it exposes dental phobia as a factor affecting the available and recommended care. The execution of oral care proves to be a complex task, to the extent that aid for incontinence was preferred. If health care personnel had further training of oral care execution the experience of providing this type of care could change. There is a discrepancy between theory and practice when it comes to providing oral care. Consequently, additional research of experiences and education ought to be conducted within this field of health care.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Good oral health has a major influence on the general quality of life and well-being. Several chronic and systemic diseases have been attributed to poor oral health. With the increasing incidence of oral diseases, the global need for alterative prevention and treatment methods and safe, effective, and economical products has expanded. There are many studies showed that Streptococcus mutans has been implicated as major etiological agent of dental caries. South African has very rich natural flora especially Cape region. Several South African medicinal plants have been used since immemorial time for treatment of different human pathologies including dental problems. The antibacterial activities of plants extracts have been recognized and documented scientifically during the last few decades. In this project we aimed at the screening of 31 South African plants randomly collected from Cape region for their antibacterial activity against Streptococcus mutans initially at two concentrations (500 and 100 µg/ml).MIC’s and MBC’s were determined for the active plant extracts, as well as the qualitative studies of the effect of the active extracts on the biofilm formation. The best or the most active safe plant (Psoralea fruticans) was submitted to chromatographic separation to isolate the bioactive compounds which could be responsible for such activity. Identification of the pure active compounds was carried out using different spectroscopic techniques. Finally the biological evaluation of the isolated pure compounds was measured against S. mutans and also the cytotoxicity studies in-vitro against normal cells lines was carried out.

Bakgrund: På intensivvårdsavdelningar finns olika rutiner kring huruvida endotrakealtubens position hos intuberade skall skiftas eller bibehållas i samma mungipa, då sidbyten kan leda till allvarliga komplikationer. Rutinen vid CIVA har varit att byta endotrakealtubens position på alla intuberade patienter en gång per dygn. Varken rutinen med skifte samt bibehållen position har utvärderats. Syftet med studien är att undersöka oralt intuberade patienters munhälsa vid bibehållen position av endotrakealtub under vårdtiden. Metod: Studien är en kvantitativ deskriptiv tvärsnittsstudie. Ett protokoll utformades för att undersöka hur stor andel av patienterna som får tryckskador i munnen med bibehållen tublägesposition. Resultat: Av totalt 85 oralt intuberade patienter utvecklade 10 rodnad och 7 sår medan 68 hade helt intakt slemhinna. Flest nyupptäckta sår uppkom efter 3-4 dagars intubering medan rodnader var jämnt fördelat. Slutsats: Endast ett fåtal patienter utvecklade tryckskador. Rutinen att bibehålla endotrakealtuben i samma position lämpar sig på patientkategorin på CIVA eftersom medelvårdtiden för intuberade är 3,2 dagar och flertalet extuberas under de 3 första dagarna. Klinisk betydelse: Studien ligger till grund för CIVA:s ändrade rutin att bibehålla endotrakealtubspositionen i samma mungipa och skulle på sikt kunna bidra till att minska samhällskostnaderna genom att reducera förekomsten av VAP och därmed patientvårdtiden / Background: Intensive care units have different routines whether the endotracheal tube position should be shifted or maintained in the same corner of the mouth. Repositioning of the tube can lead to serious complications. The routine at CIVA has been to change the endotracheal tube position in all intubated patients once per day. None of the routines have been evaluated. The objective of this study is to examine the oral health of intubated patients with maintained tube position. Method: The study is a quantitative descriptive cross-sectional study. A protocol was designed to examine the proportion of patients receiving pressure sores in the mouth. Results: Of a total of 85 orally intubated patients, 10 developed redness and 7 wounds while 68 had intact mucosa. The majority of the newly discovered sores occurred after 3-4 days of intubation. Conclusion: Only a few patients developed pressure sores. The routine to maintain the endotracheal tube in the same position is suitable for the patient category at CIVA since the average length of stay for intubated is 3.2 days and the majority were extubated during the first 3 days . Clinical significance: This study is the basis for CIVA's changed routine to maintain the endotracheal tube position in the same corner of the mouth and could eventually help to reduce the costs for society by reducing the incidence of VAP and thus patient care period.

Bakgrund: Fysiska och kognitiva handikapp kan leda till minskad förmåga att klara sin munvård och risken att drabbas av ohälsa i munnen ökar. Omsorgspersonal har bristande kunskaper inom munhälsa och munvården prioriteras lägre än andra omvårdnadsåtgärder. Sjuksköterskan är ytterst ansvarig för omvårdnaden men det saknas studier om hur sjuksköterskor arbetar med munhälsa inom kommunal hälso- och sjukvård. Syftet med studien var att undersöka sjuksköterskors erfarenhet av att arbeta med munhälsa och munvård i kommunal hälso- och sjukvård. Metoden som användes var en kvalitativ innehållsanalys med induktiv ansats med en fokusgruppsintervju samt sju enskilda intervjuer. Resultat: Tre kategorier identifierades: Munhälsa är att främja hälsa, Arbetar med munhälsa vid egenvårdsbrist och Aktörer i omvårdnadssystemet. Slutsats: De intervjuade sjuksköterskorna ansåg att munhälsa är något självklart och att det är viktigt att värna om patientens egenvård och integritet. I arbetet med kvalitetsregister ökade sjuksköterskornas delaktighet i munhälsoarbetet men de arbetade främst med munhälsa först när ett problem uppstått. Stort fokus lades på munhälsa och munvård hos palliativa patienter medan arbetet med munhälsa kunde bli lidande hos patienter som till viss del sköter sig själva. För att förbättra munhälsan, hos patienter i den kommunala hemsjukvården, finns ett behov av ökad kunskap hos både omsorgspersonal och sjuksköterskor, bättre rutiner och ökat samarbete med tandvården. / Background: Physical and cognitive disabilities may affect patients’ ability to cope with oral health and increase the risk of suffering from illness in the mouth. Studies show that staff in municipality provided care have poor knowledge in oral health and that oral health is less prioritized than other nursing interventions. Registered Nurses (RN) have the ultimate responsibility for providing care but there are few studies that describe how nurses experience working with oral health. Aim: To examine the experience of RN’s with regards to oral health and oral care in municipal health care. Method: A qualitative content analysis with an inductive approach including one focus group discussion, with five RN’s participating, and seven patientual interviews. Results: Three categories were identified: Oral health promotes general health, Works with oral health when self-care deficit and Agents in the nursing system. Conclusion: The RN’s believed that oral health is self-evident and that it is important to safeguard the patient's self-care and integrity. When working in quality registers, the RN participation in oral health work increase, but they primarily work with oral health when a problem arises. Great focus was placed on oral health and oral care in palliative patients, but the work with oral health could be suffering in patients who to some extent manage themselves. To improve oral health, the study showed that there is a need for more education for health care workers providing municipality care and RN’s, there is also a need for better routines and better collaboration with the dental care.

Philosophiae Doctor - PhD / Introduction: Untreated caries of the permanent dentition is the most prevalent condition worldwide. Ongoing globalisation and the heightened exposure to a refined, westernised diet against a backdrop of deficient health services and inadequate implementation of preventive public health measures, means that dental caries remains pervasive, especially in emerging economies. In South Africa, an estimated 90% of caries remains untreated, disproportionately affecting the poor and detrimentally impacting on the economy. The use of an effective fluoridated toothpaste is regarded as the best clinical practice available today in caries management. Aim: The aim of the present study was to evaluate the availability, pricing and affordability of fluoridated toothpastes marketed to South African households and to identify mechanisms to improve financial access among low-income households. Methods: A cross-sectional survey of fluoridated toothpastes, retail price and unit weight/volume was undertaken. Following calculation of a median reference price for each paste, affordability relative to household income brackets was assessed using a modification of the WHO/HAI’s essential medicines pricing protocol. Affordability was expressed in terms of the number of days of disposable household income required to purchase the annual, household therapeutic dosage of a fluoridated toothpaste. Results: Despite the wide availability (n=142) of fluoridated toothpastes, of those assessed for affordability (n=130), none and 49% were affordable to households located in the first and second lowest income brackets, collectively termed low-income earners. Accessibility (±96%) increased sharply for low emerging middle income households and upwards. In general, as household income declined, the proportion of daily, disposable income required to purchase the annual, household therapeutic dosage increased. Households located in the lowest income bracket spent 104.3% of daily income on the annual dosage of the lowest priced toothpaste in contrast to 0.23% spent by the wealthiest households. Horizontal disparity in terms of affordability between household income brackets differed significantly (p<0.00001). Conclusion: Stark inequity in affordability of fluoridated toothpastes exists between low income and affluent households with dire implications in terms of oral health and economic hardship suffered by the poor. To redress this social injustice, a number of price regulatory policies and funding mechanisms are suggested to stimulate dialogue and urge all relevant entities (clinical, legal, industrial, and governmental) to take action urgently.

Bakgrund: En god munhälsa är av stor vikt för att uppehålla en adekvat näringstillförsel samt förebyggandet av eventuella sjukdomar till följd av förändringar i munnen. Patienten kan eventuellt drabbas av smärta, parodontit, påverkan av smak och aptit samt sjukdomar som exempelvis lunginflammation om munhälsan bortses av vårdpersonal. Syfte: Syftet är att beskriva vårdpersonals attityd till och kunskap om munhälsa vid den kirurgiska akutvårdsavdelningen (KAVA) i Skaraborgs sjukhus Skövde. Metod - En enkätstudie med mixad metod. Resultat: I resultatet framkom tidsbrist, ansvarsfördelning, möjligheten att med klinisk blick bedöma en patients munhälsa samt aspekten om resursfördelning. Konklusion - Studien visar att kunskap om tidsbrist, ansvarsfördelning och material kan generera en bättre munvård för KAVAS patienter. / Background: A good health of the mouth is essential for nutrition status and the prevention of possible diseases due to changes in the mouth. The patient can suffer pain, periodontitis, change of taste and appetite, and pneumonia if the health care workers neglect mouth care. Aim: This study investigates the attitudes and knowledge of the health care workers at the emergency surgical ward (KAVA) at Skaraborg hospital. Method: a mixed-method survey study. Result: In the result, the findings of lack of time, division of responsibilities, the nurse's clinical eye to assess a patient's mouth status, and the allocation of resources. Conclusion: The study shows that knowledge about lack of time, division of responsibilities, and the knowledge about materials can generate better mouth care for the patients of KAVA.

Among elderly persons living in nursing homes in Sweden, 42 percent have poor oral health. Poor oral health is a suffering for the elderly person and can affect the person's ability to speak, chew and smile but can also lead to poor self-esteem and depression and in worst case critical illness. Therefore, oral health is an area of nursing that must be updated and prioritized. Nurses hold a key position to be able to promote good oral health for older people and could identify oral health problems at an early stage. Therefore, nursing staff need to get knowledge about oral health related to general health. The purpose of the literature review is to shed light on how care staff can improve the oral health of people in nursing homes. The method chosen was a literature review, based on four qualitative, four quantitative and two mixed method studies. Two main categories and six subcategories were created. The two main categories were barriers to good oral health and factors for good oral health and the subcategories describe lack of knowledge among care staff, priorities and attitudes, dislike to oral care as well as interprofessional collaboration, progressive strategies and organizational support. Oral health is neglected due to barriers such as lack of time, high workload, and priorities in nursing homes. For oral health to be improved among people in nursing homes, increased knowledge and cooperation between care staff and dental staff is required.