Periodontal treatment strategies in general dentistry

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Periodontal treatment strategies in general dentistry


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Publication Doctoral Thesis
Doctoral Thesis, comprehensive summary
Title Periodontal treatment strategies in general dentistry
Author Milosavljevic, Aleksandar
Date 2018
English abstract
Periodontal diseases, such as gingivitis and chronic periodontitis, are infectious diseases that are common in the adult population. In Sweden, treatment is mostly provided in general dentistry by general dental practitioners (GDPs) and dental hygienists (DHs). The care chain also comprises periodontists since they act as consultants to the GDPs and DHs. Several studies have explored how clinicians judge, diagnose, and treat patients with different diseases but no previous study has explored how patients, with commonly occurring periodontal conditions in a population, are diagnosed and treated in general dentistry. Therefore the overall aim of the thesis was to study the treatment strategies applied by general dentistry clinicians to patients with common periodontal conditions. This thesis is based on five studies, where study I-IV are based on a questionnaire and conducted using a quantitative approach while study V is based on in-depth interviews and conducted using a qualitative approach. The questionnaire in study I-IV comprised four simulated patient cases with different periodontal conditions. These four cases represent the periodontal status of the majority of middle-aged patients presented in a general dentistry practice: 1) Generalised bone loss but minimal signs of inflammation (well-maintained), 2) Generalised bone loss and signs of inflammation (periodontitis), 3) Negligible bone loss and minimal signs of inflammation (healthy), and 4) Negligible bone loss but with signs of inflammation (gingivitis). The clinicians who participated in the studies were asked to judge each patient case as healthy or diseased, propose a diagnosis, evaluate treatment needs, propose a treatment plan, and assess the prognosis. In study I, GDPs and DHs were combined in one group as general dentistry clinicians (GDCs) and compared as to their judgement, proposed diagnosis and proposed treatment. Key findings: Three of the four patient cases was each judged as healthy by some GDCs and as diseased by others. The difference in judgement did not influence the GDCs’ intention to treat or their proposed treatment measures but did influence the estimated number of treatment sessions. In study II, GDCs were compared as to their prognostic assessment, treatment goals and estimation of treatment extent in terms of more or less treatment assigned to a given patient case in comparison to the other patient cases (healthy patient case excluded). Key finding: The majority of GDCs was in general pessimistic in their prognostic assessment and anticipated that all patient cases were to experience a deterioration of their periodontal condition. The most common treatment goal, irrespective of the patient case, was to improve oral health awareness. The periodontitis patient case was estimated to need the most treatment; slightly more than the gingivitis and the well-maintained patient cases where a similar treatment extent was estimated. In Study III, dental students (DSs) from Paris (DSP) and Malmö (DSM) were compared to each other as to judgement, diagnosis, treatment plans, and prognostic assessment. This was done in order to discover if difference in educational background might influence DSs’ treatment strategies. Key finding: The majority of both groups of DSs judged all the patient cases as diseased. DSPs proposed periodontitis as a diagnosis more readily and estimated a higher risk for disease progression in patient cases with no obvious bone loss (healthy and gingivitis patient cases). DSPs also recommended more treatment measures and estimated longer treatment time for all the patient cases than DSMs. In study IV, periodontists were primarily compared amongst each other and secondly to GDPs as to their judgement, diagnosis, proposed treatment plans, and prognostic assessment. Key findings: Both periodontists and GDPs varied in their judgement and proposed diagnosis. The difference in periodontists’ judgement influenced their intention to treat and prognostic assessment. The GDPs intended to treat three out of four patient cases (except the periodontitis patient case) more often and were more pessimistic in their prognostic assessment of patient cases with negligible bone loss than the periodontists. In Study V, the phenomenon of lived experience of performing a periodontal treatment in the context of general dentistry was described by analysing interviews from three different DHs using the descriptive phenomenological psychological method. Key finding: The periodontal treatment is perceived more as a standardised workflow than as an individually tailored treatment. The patients’ oral hygiene and self-awareness are experienced as crucial parts while the mechanical infection control is perceived as successful but sometimes difficult to perform. The DHs are experiencing a need to be supportive of the patient but are sometimes doubtful of the patient’s ability to achieve and maintain a positive change in oral health behaviour.
DOI (link to publisher's fulltext.)
Publisher Malmö University, Faculty of Odontology
Series/Issue Doctoral dissertation in odontology;
ISBN 9789171049063
Language eng (iso)
Subject Periodontal Diseases
Parodontala sjukdomar
Research Subject Categories::ODONTOLOGY
Included papers
  1. I. Different treatment strategies are applied to patients with the same periodontal status in general dentistry. Milosavljevic A, Götrick B, Hallström H, Jansson H, Knutsson K. Acta Odontol Scand. 2014;72:290-7.

  2. II. Assessment of Prognosis and Periodontal Treatment Goals Among General Dental Practitioners and Dental Hygienists. Milosavljevic A, Götrick B, Hallström H, Stavropoulos A, Knutsson K. Oral Health Prev Dent. 2016;14:433- 441.

  3. III. A questionnaire-based study evaluating differences between dental students in Paris (F) and Malmö (SE) regarding diagnosis and treatment decisions of patients with different severity levels of periodontal diseases. Milosavljevic A, Stavropoulos A, Descroix V, Götrick B. Eur J Dent Educ. 2018 Jan 8. doi: 10.1111/eje.12317. [Epub ahead of print]

  4. IV. Diagnostic judgement and treatment decisions in periodontology by periodontists and general dental practitioners in Sweden – A questionnaire based study. Milosavljevic A, Stavropoulos A, Bertl K, Götrick B. Accepted for publication in Oral Health and Preventive Dentistry.

  5. V. The lived experience of performing a periodontal treatment in the context of general dentistry. Milosavljevic A, Wolf E, Englander M, Stavropoulos A, Götrick B. Submitted to International Journal of Dental Hygiene.

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