Five-year follow-up of survival and relapse in patients who received cryotherapy during high-dose chemotherapy for stem cell transplantation shows no safety concerns

We have previously published a randomised controlled study of the efficacy of cryotherapy in preventing acute oral mucositis after high-dose chemotherapy for stem cell transplantation. The present study is a 5-year follow-up safety study of survival in these patients. In the previously published study oral cryotherapy (cooling of the oral cavity) during high-dose chemotherapy significantly reduced mucositis grade and opiate use in the treated group. All patients were followed up for at least 5 years with regard to relapse and death rates. Baseline data, transplant complications and mucositis data were compared. Significantly more patients (25/39) who received oral cryotherapy were alive after 5 years compared to 15/39 in the control group (P= 0.025). Relapse rates were similar. The only baseline difference was a lower proportion of patients in complete remission at transplantation in the control group (6 vs. 13, P= 0.047). This 5-year follow-up study gave no support for safety concerns with cryotherapy.

Does oral health matter in people's daily life? Oral health-related quality of life in adults 35-47 years of age in Norway

OBJECTIVE

The aim of this study was to assess the effect of oral health on aspects of daily life measured by the Dental Impact Profile (DIP) in 35- to 47-year-old individuals in Norway, and to study associations between reported effects and demographic variables, subjectively assessed oral health, general health, oral health behaviour and clinical oral health.

MATERIAL AND METHODS

A stratified randomized sample of 249 individuals received a questionnaire regarding demographic questions, dental visits, oral hygiene behaviour, self-rated oral health and general health and satisfaction with oral health. The DIP measured the effects of oral health on daily life. Teeth present and caries experience were registered by clinical examination. Bi- and multivariate analyses and factor analysis were used.

RESULTS

Items most frequently reported to be positively or negatively influenced by oral health were chewing and biting, eating, smiling and laughing, feeling comfortable and appearance. Only 1% reported no effects of oral health. Individuals with fewer than two decayed teeth, individuals who rated their oral health as good or practised good oral health habits reported more positive effects than others on oral quality of life (P ≤ 0.05). When the variables were included in multivariate analysis, none was statistically significant. The subscales of the DIP were somewhat different from the originally suggested subscales.

CONCLUSIONS

This study showed that most adults reported oral health to be important for masticatory functions and confirmed that oral health also had impacts on other aspects of life.

A comparison of two questionnaires measuring oral health-related quality of life before and after dental hygiene treatment in patients with periodontal disease

AIM

The aim of this study was to compare the usefulness of two different questionnaires assessing oral health-related quality of life (OHRQoL) at the basic examination and after initial dental hygiene treatment (DHtx).

METHODS

A total of 42 patients referred for periodontal treatment completed the Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI) at the basic periodontal examination. They underwent DHtx and completed the questionnaires once again after the treatment.

RESULTS

No statistically significant differences could be found between the two assessments, neither for the total scores nor for any of the separate items of the OHIP-14 or the GOHAI. However, the GOHAI questionnaire seems to result in a greater variety in the responses indicating that the floor effect is not as pronounced as for the OHIP-14. Those who had rated their oral health as good reported significantly better OHRQoL on both questionnaires. The same pattern was found for patients who reported that they were satisfied with their teeth. After DHtx and necessary extractions, there was a statistically significant correlation between the number of teeth and the total scores on both questionnaires. No other statistically significant correlations with periodontal variables could be found.

CONCLUSION

No statistically significant difference could be found after DHtx compared to before in regard to OHRQoL assessed with OHIP-14 and GOHAI. However, there was a greater variety in the responses with the GOHAI questionnaire; it may hereby be more useful for patients with periodontal disease.

The effectiveness of an individually tailored oral health educational programme on oral hygiene behaviour in patients with periodontal disease: a blinded randomized-controlled clinical trial (one-year follow-up)

AIM

To evaluate the effectiveness of an individually tailored oral health educational programme for oral hygiene self-care in patients with chronic periodontitis compared with the standard treatment.

MATERIAL AND METHOD

A randomized, evaluator-blinded, controlled trial with two different active treatments were used with 113 subjects (60 females and 53 males) randomly allocated to an experimental or a control group. The individually tailored oral health educational programme was based on cognitive behavioural principles and the individual tailoring for each participant was based on participants' thoughts, intermediate, and long-term goals, and oral health status. The effect of the programmes on gingivitis [gingival index (GI)], oral hygiene [plaque indices (PlI) and self-report], and participants' global rating of treatment was evaluated 3 and 12 months after oral health education and non-surgical treatment.

RESULTS

Between baseline and the 12-month follow-up, the experimental group improved both GI and PlI more than the control group. The mean gain-score difference was 0.27 for global GI [99.2% confidence interval (CI): 0.16-0.39, p<0.001] and 0.40 for proximal GI (99.2% CI: 0.27-0.53, p<0.001). The mean gain-score difference was 0.16 for global PlI (99.2% CI: 0.03-0.30, p=0.001), and 0.26 for proximal PlI (99.2% CI: 0.10-0.43, p<0.001). The subjects in the experimental group reported a higher frequency of daily inter-dental cleaning and were more certain that they could maintain the attained level of behaviour change.

CONCLUSION

The individually tailored oral health educational programme was efficacious in improving long-term adherence to oral hygiene in periodontal treatment. The largest difference was for interproximal surfaces.

An individually tailored treatment programme for improved oral hygiene: introduction of a new course of action in health education for patients with periodontitis

OBJECTIVES

To describe and evaluate an individually tailored treatment programme based on a behavioural medicine approach to oral hygiene self-care for patients with chronic periodontitis.

METHODS

Two experimental single-case studies with multiple-baseline design across different self-administered oral hygiene behaviours were conducted. Cognitive Behavioural techniques were used to organize the strategies for the intervention and the approach to counselling was inspired by and structured in accordance with Motivational Interviewing. The central features in the programme were the individual analysis of knowledge and oral hygiene habits, individually set goals for oral hygiene behaviour, practice of manual dexterity for oral hygiene aids, continuous self-monitoring of the behaviour and prevention of relapse.

RESULTS

Both participants reached the predecided criteria for clinical significance in reducing plaque and bleeding on probing. Reductions of periodontal probing depth were achieved as well. The positive results remained stable throughout the 2-year study period.

CONCLUSION

The successful application of this educational model suggests that it could be used as a method for tailoring interventions targeted to oral hygiene for patients with periodontal conditions. The programme will now be tested in a larger randomized controlled trial.

Comparison of oral health assessments between nursing staff and patients on medical wards

The maintenance of good oral health is essential for nutrition, recovery and well-being. This requires the involvement of the nursing staff, especially in cases where oral care and any necessary dental treatment are vital to ensure medical treatment. The aim of this study was to evaluate the validity of oral assessments performed by nursing staff using the revised oral assessment guide (ROAG), using comparisons with patients' self-assessment of oral problems. When a comparison was made of how the staff and patients assessed their oral status, a high level of agreement was found. In these assessments, with the exception of oral mucosa and teeth, the percentage agreement was >80. The kappa coefficient revealed slight to moderate agreement. When there was a disagreement, the staff assessed the oral health as being significantly poorer than the patients did. In the present study, it was shown that few oral assessments performed by the nursing staff and patient disagreed. The ROAG may therefore be useful for the nursing staff to make the patients' oral health problems visible.

Attitudes to dental hygienists: evaluation of the Dental Hygienist Beliefs Survey in a Swedish population of patients and students

The aim was to evaluate and test the psychometric properties of the Dental Hygienist Beliefs Survey (DHBS) in a Swedish sample of different patient groups and students. It was hypothesized that negative dental hygienist beliefs would discriminate between fearful and non-fearful study groups. The DHBS was distributed together with the revised Dental Beliefs Survey (DBS-R) and the Dental Anxiety Scale (DAS). The study sample included 394 subjects (130 students, 144 general dental patients, 90 periodontal patients and 30 patients on a waiting list for dental fear treatment). The results verified that the DHBS discriminates well between dentally fearful and non-fearful study groups. The DHBS had high internal consistency (Cronbach's alpha = 0.96-0.98) in all the groups. The correlation between the DHBS and the DBS-R was high (rho = 0.82, P < 0.001). Furthermore, the DHBS correlated significantly with the DAS, as well as with a low but significant correlation to age (more negative attitudes in younger age groups) and gender (more negative attitudes amongst women). Regression analysis showed that gender and the DHBS items: 23, 16 and 28, i.e. items related to feeling helpless, worries/fears not being taken seriously and fear about 'bad news' possibly preventing treatment, were the most important predictors of dental fear. The results suggest that the DHBS may be a valid and reliable scale to use in order to assess patient's specific attitudes to dental hygienists. However, the psychometric properties including test-retest analysis and the underlying factor structure of the DHBS need to be further explored.

Improved compliance and self-care in patients with periodontitis - a randomized control trial

The present study was a randomized control trial to test an intervention emanating from the Client Self-care Commitment Model (CSCCM), to encourage patients to increase their responsibility for their oral self-care.

MATERIALS AND METHODS

A total of 75 individuals were re-examined 1-2 years after their initial therapy at the Department of Periodontology, Uppsala County Council, Sweden. Patients who exhibited insufficient compliance, 37 individuals, were included in a randomized single-blind control trial to test an intervention based on the CSCCM. Patients were examined at baseline and 3 months after hygiene treatment.

RESULTS

The results demonstrated that patients in the intervention (IV) group increased their interdental cleaning and reduced their plaque index significantly compared with the control group. The former also reduced the number of periodontal pockets >4 mm significantly from baseline until after the hygiene treatment. The majority of the individuals in the IV group reported that the written commitment had influenced on their oral self-care habits in a positive direction.

CONCLUSIONS

The CSCCM enhanced the client participation in the treatment process and improved the compliance and oral self-care behaviours. In addition, the model contributed to a reduction in periodontal pockets.

Research utilization among dental hygienists in Sweden--a national survey

Over the last decade evidence-based practice has become increasingly important in health care as an approach to improve patient outcomes. It is vital that dental hygienists, like other health professionals, use research findings to inform clinical practice. The objective of the present study was to investigate the extent of research utilization among dental hygienists in Sweden and to investigate the relationship between level of education and factors related to research utilization. A random sample of 261 dental hygienists in Sweden, 113 with 1 year and 148 with 2-year education, responded to a postal questionnaire covering various aspects of research utilization, i.e. their attitudes towards research, availability and support for the implementation of research findings, use of research in daily practice, their activity in seeking new research findings and their participation in a range of research-related activities. Dental hygienists with 2-year education had a more positive attitude towards research, used research to a greater extent and were more active in seeking new research findings than dental hygienists with 1-year education. Overall, relatively few dental hygienists reported that they implemented research findings in practice; the most frequently reported activity concerned reading research articles in professional journals. The conclusions are that the length of dental hygiene education is a key factor influencing the application of research findings to practice. One-year education appears to be inadequate to achieve evidence-based practice. Moreover, not even two years of formal education guarantees necessary competence in research for evidence-based dental hygiene practice.

Accuracy of dental hygienists in diagnosing dental decay

During recent decades, the duties and care rendered by Swedish dental hygienists have continuously expanded, and since 1991 they are licensed to practice dental hygiene independently. The aim of the present study was to investigate the accuracy of dental hygienists in examining and recording dental caries in comparison with dentists performing identical examinations. The study included two parts: A) Registration of carious lesions from radiographs of 100 extracted teeth, where the correct diagnosis could be verified, and B) clinical examination and registration of carious lesions in 213 patients. No statistically significant differences could be found between the dental hygienists' and their control dentists' accuracy to diagnose and record dental decay, with the exception of the number of initial lesions (white spot lesions) registered clinically, where the dental hygienists recorded more buccal and lingual lesions. Irrespective of the group of examiners (dental hygienists or dentists), however, the inter-examiner variation was wide. The variation decreased with the size of the lesion and increased with the age of the patient. This study suggests that no patient with a restorative treatment need would have been neglected if the dental hygienists had performed the examination, and, possibly, a more accurate non-restorative treatment need would have been addressed.