Background: Oral health is an integral part of the general health and quality of life. Yet oral health among older people requiring nursing care is often poor. Despite this group’s frequent contact with health care services, they tend to lose contact with dental care. In nursing care, nursing staff are tasked to assist with oral hygiene care, but this has become more demanding as many older people retain more teeth or have advanced prosthetic constructions. Previous research in the field emphasised the need of collaboration between dental- and nursing care to support the nursing staff in this task. However, there is a lack of evidence regarding the effects of these collaborations. Aim: The overall aim of the thesis is to examine two oral health programmes used within nursing care with different design regarding support from and collaboration with dental care. Methods: Quantitative research methods was used. The data in Study I comes from an oral health assessments guide (ROAG-J) performed by nursing staff in a national health register. Oral health, assessed at two occasions from older people with nursing care, were used. Study II was a controlled intervention study performed at a nursing home. The intervention involved individual coaching of nursing staff in oral hygiene care by dental hygienist for four hours per week at the ward for a period of three months. Oral assessments of older people were performed by dental hygienists and questionnaires to nursing home staff were used. Result: In Study I, 667 individuals aged 65 years or older, receiving nursing care services and assessed using ROAG-J between November 2011 and March 2014 were included. No statistically significant difference in any of the oral health variables was found between the first and subsequent assessments. At the first assessments, less than one third of participants had oral health problems. At the first assessment, status of the tongue differed in men and women (p < .01); at the subsequent assessment, gender differences were found in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006). In Study II, 33 nursing staff and 48 residents participated at the baseline measurement and 22 and 32 respectively at the 9-month follow-up. The nursing staff changed in knowledge and attitudes related to gum disease, approximal cleaning, usage of fluoride and the likelihood that older persons would express the need for oral health support. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents relatively high level of oral health was stable during the study period. Conclusions: The participants in the oral health programmes were able to maintain an acceptable level of oral health during the study periods although health was likely to decline. The nursing staff maintained a high level of knowledge and attitudes about oral health. However, there seems to be a discrepancy regarding the prevalence of oral health problems among older people. A collaboration between dental- and nursing care providers indicates a positive influence on providing oral hygiene care.

<p>Syftet med studien var att undersöka den erosiva potentialen av vanligt förekommande kolsyrade vatten med eller utan smaksättning. Studien genomfördes som en laboratoriestudie vid Institutionen för Odontologi vid Göteborgs universitet. Totalt omfattades studien av 34 buteljerade kolsyrade vatten med eller utan smak, tre kolsyrade vatten producerade i kolsyreapparat samt sex referensdrycker. Samtliga produkter testades genom registrering av initialt pH med pH-elektrod och buffring med 0,1 M NaOH till det värde då pH neutraliserats. Dryckens surhetsgrad beräknades därefter vilket anses som ett mått på dess erosiva potential. Resultatet visade att majoriteten av kolsyrade vatten hade ett initialt pH-värde >5 men variationer fanns mellan varumärken. Samtliga studerade vatten uppvisade en lägre erosiv potential jämfört med referensdrycker som färskpressad citron- och apelsinjuice, men inte jämfört med läskedrycker. Data visade att syrakoncentrationen steg när mängden kolsyra ökade. Olika smaktillsatser hade endast en mindre påverkan på den erosiva potentialen. Denna studie visade att kolsyremängden var av större betydelse än smaktillsats för syrakoncentrationen i vattnet.</p> / <p>The aim of this study was to investigate the erosive potential of the most commonly used carbonated waters with or without flavouring. The study was preformed as an <em>in vitro</em> study at the Institution of Odontology at University of Gothenburg. The study was comprised by 34 bottled carbonated waters with or without flavouring, three carbonated waters produced in a carbonator machine and six control drinks. Products were tested and pH was measured using a pH electrode and buffered gradually with 0,1 M NaOH until pH reached neutral value. Calculation of the acidity of the drinks, which is a grade on its erosive potential, was measured. The results showed that a majority of the studied carbonated waters had a pH baseline value >5, but variations existed among the different labels. All of the studied waters showed a lower erosive potential compared with the control products freshly squeezed lemon- and orangejuice, but compared to soft drinks. Data showed that the acid concentration gradually arouse when carbondioxide was added to the water. Different flavouring had only a slight influence on the erosive potential. This study showed that adding carbondioxide was of larger importance than adding flavouring for the acid concentration in the water.</p>

<p><strong>Syftet</strong> med denna studie var att undersöka upplevelser av munhälsa hos äldre personer som var medlemmar i olika pensionärsföreningar samt jämföra om det fanns skillnader mellan män och kvinnor.</p><p><strong>Material och metod:</strong><em> </em>Studien har utförts som en kvantitativ tvärsnittsundersökning och data har samlats in hos olika pensionärsföreningar i nordöstra Skåne. En enkät lämnades ut till 202 pensionärer som deltog i studien.</p><p><strong>Resultat: </strong>De flesta var nöjda med sina tänder. Kvinnor (68 %) uppgav att de tuggade all sorts mat mycket bra i jämförelse med männen (45 %) (p=0, 006P() var stor skillnad istatis är). Det största problem som förekom hos pensionärerna var muntorrhet.</p><p><strong>Konklusion: </strong>De äldre som deltog i denna studie upplevde sin munhälsa positivt. Bland de problem som förekom var muntorrhet vanligast.</p><p> </p> / <p><strong>Aim:</strong> The aims of this study were to investigate the experiences of oral health in elderly individuals who were members in various pensioners' associations, and to compare if there were differences between men and women.</p><p><strong>Materials and methods</strong><em>: </em>The study was conducted as a quantitative cross-sectional survey in various pensioners' associations in north-eastern Skåne, Sweden. A questionnaire was handed out to 202 pensions who participated in the study.</p><p><strong>Result:</strong> Most of the elderly were satisfied with their teeth. Sixty eight percent of the women indicated that they could chew at all kinds of food very well as compared to 45 % of the men (p = 0. 006). The main oral health problem was dry mouth.</p><p><strong>Conclusion: </strong>The<strong> </strong>elderly that participated in this study perceived their oral health as being good. A frequent complaint that occurred was dry mouth.</p><p> </p>

<p>Kunskaper i oral hälsa har betydelse för att sjuksköterskor på ett tidigt stadium ska kunna upptäcka olika sjukdomstillstånd i munhålan. Bristande kunskap i oral hälsa har rapporterats vara ett problem inom vården och därför behövs det ökad utbildning inom oral hälsa hos sjuksköterskor. Syftet med studien var att jämföra kunskaper inom oral hälsa mellan sjuksköterskestudenter i årskurs 1 och årskurs 3. Undersökningen skedde med användning av en strukturerad enkät som delades ut av studiens författare till sjuksköterskestudenter som gick årskurs 1 (n= 95) och årskurs 3 (n= 57) vid Högskolan Kristianstad. Studenterna ansåg sig ha bra teoretiska och praktiska kunskaper medan det i resultatet av kunskapsfrågorna framkom att det fanns brister. Resultatet visade också att statistiskt signifikanta skillnader fanns i kunskap mellan studenterna i årskurs 1 och årskurs 3 på frågor om svampinfektion, muntorrhet, protes och bedömning av munstatus. I denna studie var kunskaperna låga i flera områden inom oral hälsa hos sjuksköterskestudenterna. Ökad utbildning är önskvärt för att vårdtagare ska få de åtgärder som de är i behov av i munhålan.</p> / <p>Knowledge of oral health is important so registered nurses, at an early stage, can detect various diseases in the oral cavity. Lack of knowledge in oral health has been reported among registered nurses. The purpose of this study was to compare the knowledge in oral health between nursing students in grade 1 and grade 3. The study was based on a questionnaire with fixed response alternatives that were distributed by the author to nursing students in grade 1 and grade 3 at Kristianstad University. The students claimed to have good theoretical and practical knowledge while the survey revealed that there were gaps in knowledge. The results showed also that there was a statistically significant difference in knowledge between students in grade 1 and grade 3 concerning candidiasis, xerostomia, prosthesis and oral health assessments. In this study the knowledge is low in several areas within oral health among the nursing students. Increased education is desirable to ensure adequate oral health procedures among patients in hospital or nursing homes.</p> / nursing students, oral health, knowledge

<p><strong>Introduktion</strong>: Karies är en av de infektionssjukdomar som är mest spridda över världen. I världen sker det stora förflyttningar av människor, orsaker till förflyttningar varierar. Munhälsan påverkas ofta vid påfrestande situationer för både vuxna och barn. De vanor och den kultur som människor har med sig från sin barndom lever kvar bland annat avseende kost och munhygien. Familjer som invandrat är ofta mer socioekonomiskt utsatta än de som är födda och etablerade i det nya hemlandet, vilket är ännu en riskfaktor för karies. <strong>Syfte</strong>: Att beskriva kariesförekomsten hos barn och ungdomar med invandrarbakgrund i Norden samt hos barn och ungdomar födda i Norden. <strong>Frågeställningar</strong>: Vilken kariesprevalens föreligger bland små barn (0-5 år) med invandrarbakgrund i Norden respektive födda i Norden? Vilken kariesprevalens föreligger bland skolbarn (6-12 år) med invandrarbakgrund i Norden respektive födda i Norden? Vilken kariesprevalens föreligger bland ungdomar (13-19 år) med invandrarbakgrund i Norden respektive födda i Norden? <strong>Metod</strong>: Systematisk litteraturstudie. <strong>Resultat</strong>: Kariesprevalensen är högre bland barn och ungdomar i Norden med invandrarbakgrund jämfört med barn och ungdomar som har nordiskt ursprung. Skillnaderna följer samma mönster i alla åldrar genom barn- och ungdomsåren. <strong>Slutsats</strong>: Tandvårdspersonal bör uppmärksamma att barn och ungdomar med invandrarbakgrund i Norden kan behöva mer stöd i form av förebyggande åtgärder för att uppnå och bibehålla en god oral hälsa.</p>

<p> </p><p><strong>Introduktion:</strong> Tandlöshet är ett problem som drabbar många människor. Kraven på funktionella och snygga tänder i livets alla skeden har blivit tydligare på senare år. Dentala implantat är en möjlighet att ersätta förlorade tänder och har hjälpt många individer att få sin livskvalité tillbaka.</p><p><strong>Syfte: </strong>Att kartlägga mjukvävnads- och hårdvävnadskomplikationer som kan uppkomma efter en behandling med dentalt implantat och vilka orsaker det finns till dessa.</p><p><strong>Frågeställningar:</strong> Vad finns det för mjukvävnads- och hårdvävnadskomplikationer som kan uppkomma efter en behandling med dentalt implantat?</p><p>Vad finns det för orsaker till komplikationer efter behandling med dentalt implantat?</p><p><strong>Metod: </strong>Studien är en systematisk litteraturstudie.<strong></strong></p><p><strong>Resultat: </strong>Efter behandling med dentalt implantat kan olika mjukvävnads- och hårdvävnadskomplikationer uppstå. De två vanligaste mjukvävnadskomplikationer var peri-implantär mukosit och mukosal hyperplasi. Typiska hårdvävnadskomplikationer som upptäcktes var benförlust och apikal peri-implantit. Tidigare parodontiterfarenhet visade sig vara den viktigaste orsaken till komplikationer vid dentala implantat.</p><p><strong>Konklusion: </strong>Dental implantatbehandling är inte riskfri. Studien visade att komplikationer är vanliga efter dental implantatbehandling samt att det fanns riskfaktorer som påverkar dental implantatbehandling på ett negativt sätt.<strong></strong></p>

Kunskaper i oral hälsa har betydelse för att sjuksköterskor på ett tidigt stadium ska kunna upptäcka olika sjukdomstillstånd i munhålan. Bristande kunskap i oral hälsa har rapporterats vara ett problem inom vården och därför behövs det ökad utbildning inom oral hälsa hos sjuksköterskor. Syftet med studien var att jämföra kunskaper inom oral hälsa mellan sjuksköterskestudenter i årskurs 1 och årskurs 3. Undersökningen skedde med användning av en strukturerad enkät som delades ut av studiens författare till sjuksköterskestudenter som gick årskurs 1 (n= 95) och årskurs 3 (n= 57) vid Högskolan Kristianstad. Studenterna ansåg sig ha bra teoretiska och praktiska kunskaper medan det i resultatet av kunskapsfrågorna framkom att det fanns brister. Resultatet visade också att statistiskt signifikanta skillnader fanns i kunskap mellan studenterna i årskurs 1 och årskurs 3 på frågor om svampinfektion, muntorrhet, protes och bedömning av munstatus. I denna studie var kunskaperna låga i flera områden inom oral hälsa hos sjuksköterskestudenterna. Ökad utbildning är önskvärt för att vårdtagare ska få de åtgärder som de är i behov av i munhålan. / Knowledge of oral health is important so registered nurses, at an early stage, can detect various diseases in the oral cavity. Lack of knowledge in oral health has been reported among registered nurses. The purpose of this study was to compare the knowledge in oral health between nursing students in grade 1 and grade 3. The study was based on a questionnaire with fixed response alternatives that were distributed by the author to nursing students in grade 1 and grade 3 at Kristianstad University. The students claimed to have good theoretical and practical knowledge while the survey revealed that there were gaps in knowledge. The results showed also that there was a statistically significant difference in knowledge between students in grade 1 and grade 3 concerning candidiasis, xerostomia, prosthesis and oral health assessments. In this study the knowledge is low in several areas within oral health among the nursing students. Increased education is desirable to ensure adequate oral health procedures among patients in hospital or nursing homes. / nursing students, oral health, knowledge

Aggregatibacter (Actinobacillus) actinomycetemcomitans is a bacterium mainly associated with aggressive forms of periodontitis. Among its virulence factors, a leukotoxin is suggested to play an important role in the pathogenicity. Periodontal infections with strains producing high levels of the leukotoxin are strongly associated with severe disease. Leukotoxin selectively kills human leukocytes and can disrupt the local defense mechanisms. Previous studies examining the role of the leukotoxin in host-parasite interactions have mainly focused on polymorphonuclear leukocytes (PMNs). In the inflamed periodontium, macrophages play a significant role in the regulation of the inflammatory reactions and the tissue breakdown and remodeling. Thus, the aim of this dissertation was to investigate death mechanisms of human macrophages exposed to leukotoxin. Human lymphocytes, PMNs, and monocytes/macrophages isolated from venous blood were exposed to purified leukotoxin or live A. actinomycetemcomitans strains producing variable levels or no leukotoxin. Different target cells were characterized by their expression of cell surface molecules. Cell death and viability were studied by examining cell membrane integrity and morphological alterations. Further, processes and cellular markers involved in apoptosis and necrosis were investigated. The expression and activation of pro-inflammatory cytokines of the leukotoxin-challenged leukocytes were examined at the mRNA and protein level. The biological activity of the secreted cytokines was investigated by testing the culture supernatants in a bone resorption assay. Additionally, different intracellular signaling pathways involved in the pro-inflammatory response from the macrophages were examined. Monocytes/macrophages were the most sensitive leukocytes for A. actinomycetemcomitans leukotoxin-induced lysis. This process in monocytes/ macrophages involved caspase-1 activation, and in addition, leukotoxin triggered abundant activation and secretion of IL-1β from these cells. The secreted IL-1β was mainly the 17 kDa bioactive protein and stimulated bone resorption. This activity could be blocked by an IL-1 receptor antagonist. When live bacteria were used, the A. actinomycetemcomitans-induced IL-1β secretion from human macrophages was mainly caused by the leukotoxin. Closer examination of the macrophages exposed to leukotoxin revealed that the induced cell death proceeded through a process that differed from classical apoptosis and necrosis. Interestingly, this process resembled a newly discovered death mechanism termed pyroptosis. The extensive leukotoxin induced IL-1β secretion did not correlate to increased levels of mRNA for IL-1β. It was mainly mediated by caspase-1 activation, since blocking it by a specific inhibitor also abolished the secretion of IL-1β. A similar pattern, but at much lower level, was seen for IL-18. In conclusion, these results show that A. actinomycetemcomitans leukotoxin induces a death process in human macrophages leading to a specific and excessive pro-inflammatory response. Our results indicate that this novel virulence mechanism of leukotoxin may play an important role in the pathogenic potential of A. actinomycetemcomitans.

The prevalence of dental caries has decreased dramatically in most developed countries since the sixties and the number of remaining teeth in adults has increased during the last decades. Elderly as a group will during aging become an increasing risk group for caries. Especially older individuals with hyposalivation are at increased risk for coronal and root caries and need increased oral care. A large part of the time spent by the dental team is occupied by prevention and treatment of secondary caries, which is the main reason of replacement or repair of restorations. Traditionally, prevention of caries is directed against the different risk factors of the individual such as oral hygiene, intake of fermentable carbohydrates, cariogenic microflora and oral dryness. In some restorative materials the release of fluoride can be used to decrease the risk of secondary caries alone or in combination with other preventive methods. New alternative preventive methods are necessary to complete traditional methods in order to decrease the caries risk in elderly and/or to prevent secondary caries. Addition of methods with buffering properties have been suggested and developed to supplement the biological buffering capacity of saliva. The neutralizing effects of a hydroxyl ion-releasing resin composite and a prophylactic gel containing buffering properties on dental plaque acidogenicity was evaluated by the microtouch method. In this method, a skin reference electrode was validated in comparison with a glass capillary reference electrode and used in the subsequent studies. Change of plaque acidogenicity on proximal surfaces of aged restorations of the hydroxyl ion-releasing resin composite was compared intra-individually a conventional hybrid resin composite and a non-filled enamel proximal surface. Relative frequencies of cariogenic microorganisms in plaque on these surfaces were studied. The effect of a single application of the prophylactic gel with buffering substances was evaluated on plaque acidogenicity in healthy individuals with low and normal salivary secretion rate. It was compared intra-individually with the same gel without buffering substances. The effect of multiple applications of the prophylactic gel on plaque acidogenicity was studied in institutionalized elderly individuals with subjectively reported oral dryness and compared intra-individually with the same gel without buffering substances. Major results and conclusions from the studies are: • The use of the skin reference electrode, in combination with the microtouch electrode, showed high validity in comparison with the conventional glass capillary reference electrode • The hydroxyl ion-releasing composite resin countered plaque acidogenicity fall at two time points of the aged restorations and maintained it at levels where lesser demineralization occurs. No influence of the ion-release on the amount of cariogenic plaque microorganisms on the resin composite surface was observed • A single application of the prophylactic gel with buffering substances showed a neutralizing effect of plaque pH in healthy individuals with normal salivary secretion rate. No effect was observed in low secretion rate individuals. • Multiple applications of the prophylactic gel did not neutralize dental plaque acidogenicity in elderly individuals with subjective oral dryness

This thesis is about a behavioural medicine approach in periodontal treatment and oral hygiene self-care. The aim of this thesis was to develop, describe, and evaluate an individually tailored oral health educational program on oral hygiene behaviour and non-surgical periodontal treatment success, and to determine factors of importance for predicting oral hygiene behaviour. Two separate studies, both conducted at a specialist clinic for periodontics in a Swedish county council are described. In the first study, the program was developed and described in two experimental single-case studies with multiple baseline designs (Paper I). The second study was a randomised controlled single-blinded trial [n = 113, mean age 51.2, 53% female] in which, the effectiveness of the program was compared with standard treatment on oral hygiene habits, plaque control, and gingivitis (Paper II), periodontal status (Paper III), and attitudes, subjective norms, and self-efficacy (Paper IV). The tailored oral health educational program included a motivational interviewing method and cognitive behavioural techniques, and the individual tailoring for each participant was based on participants’ thoughts and cognitions, intermediate and long-term goals, and oral health status. Participants in the individually tailored program reported higher frequency of daily interdental cleaning and were more confident about maintaining the attained level of behaviour change, had better oral hygiene, and healthier gingival tissue, particularly interproximally. There was a great reduction in periodontal pocket depth and bleeding on probing scores (BoP) for participants in both programs with a greater reduction in BoP scores in the tailored-treatment group. A lower dental plaque score at treatment start increased the predicted probability of attaining treatment success, and self-efficacy towards interdental cleaning predicted oral hygiene behaviour. These studies demonstrate an individually tailored oral health education program is preferable to standard program as an oral hygiene behaviour change interventions in non-surgical periodontal treatment. / Behavioural medicine perspectives for change and prediction of oral hygiene behaviour