The aim was to evaluate the cost of direct composite and glass ionomer class II molar restorations, and the theoretical cost per year of function, at Public Dental Services (PDS) in Sweden, years 2000 and 2005. Costs for patients, Social Insurance Offices (SI; Försäkringskassan), and total cost, were calculated based on fee schedules from all PDS in Sweden. Theoretical cost per year calculations were based on the median survival times (MST) of failed direct composite and glass ionomer class II molar restorations, derived from a set of clinical studies conducted in Nordic general practices. Due to lack of national statistics from SI, the number of direct restorations including more than one surface, made in adults, in general dentistry at PDS in the county of Halland were studied. From the year 2000 to year 2005, the total cost of composite class II molar restorations increased by 25%, whereas the total cost of glass ionomer restorations more than doubled. Theoretical calculations implied a higher cost per year of function for composite restorations in year 2000, whereas in year 2005, glass ionomer restorations had a higher cost per year of function. The cost of direct composite and glass ionomer class II molar restorations increased from year 2000 to 2005, at PDS in Sweden. In the context of planning public health care funding, theoretical models for cost prediction may prove useful.
AIM: This paper is a report of a study evaluating the effect of a repeated education programme for nursing staff in a home for older people. BACKGROUND: A strong relationship exists between oral infections and general health complications (especially aspiration pneumonia) among nursing home residents and hospitalized older people. Thus, nursing staff need to be educated in oral hygiene measures. METHODS: Forty-three nursing home resident older people (12 men, 31 women, age range 69-99 years) were included in a dental hygiene and gingivitis evaluation using gingival bleeding scores and modified plaque scores. Evaluation was conducted before and 3 weeks after a repeated dental hygiene education for nursing staff at a nursing home in Sweden in 2008. Dental hygiene education had been given 1.5 years previously. FINDINGS: Forty-one residents (12 men and 29 women) were available for evaluation after the repeated dental hygiene education (one died, one had had teeth extracted). There was a reduction in gingival bleeding scores (P
AIM: This paper is a report of a study evaluating the long-term effects on the oral hygiene status of older nursing home residents one and a half years after dental hygiene education was given to the staff. BACKGROUND: A strong relationship exists between oral infections and general health complications (especially aspiration pneumonia) among nursing home residents and hospitalized older people. It is therefore important to educate nursing home staff in oral hygiene measures and to follow up the effects of the education over time. METHODS: Dental plaque measurements were conducted at a Swedish nursing home in 2006-2008. Forty-one residents (12 men, 31 women, aged 69-99 years) fulfilled the inclusion criteria and participated in a dental hygiene evaluation 1.5 years after dental hygiene education was given to the staff at the nursing home. Plaque index scores (year 2008) were compared to those soon after the education (year 2006). FINDINGS: After the dental hygiene education in 2006, 60 nursing home residents (14 men, 46 women) were available for plaque index measurements, whereas 41 residents (12 men, 29 women) were available 1.5 years later. The median plaque index scores were 17.0 (n = 60) in 2006, and 18.0 (n = 41) in 2008 (Mann-Whitney U-test, P > 0.05). CONCLUSION: Dental hygiene education for nursing home staff is important to maintain an adequate level of oral hygiene among older nursing home residents over time. Follow-up of dental hygiene education for nursing home staff is recommended to maintain a sufficient level of oral hygiene among the residents.
The aim was to evaluate the theoretical long-term treatment costs of direct class II molar restorations (amalgam, composite, glass ionomer) using the Median Survival Times (MSTs) derived from longevity studies conducted in the Nordic countries as time for replacement. Theoretical long-term cost calculations were based on fee schedules from all Public Dental Services (PDS) in Sweden, for patients, Social Insurance Offices (SI), and total cost. Costs over 10 years were calculated and sensitivity calculations were conducted in order to demonstrate the effect of different MSTs on the long-term cost development. Glass ionomer molar class II restorations had the lowest and composite restorations had the highest initial total cost. The highest total cost over 10 years was seen for composite restorations. Amalgam restorations had the lowest long-term total cost, except when the costs were based on the shortest MSTs for each material. As there were considerable differences in the long-term costs for class II molar restorations with different materials, the importance of cost-analyses over time cannot be enough emphasised when decisions about resource allocation in the dental health insurance system are considered.
The aim was to evaluate the need of assistance with daily oral hygiene measures among nursing home resident elderly versus the actual assistance received from the staff. The need of daily oral hygiene assistance was assessed descriptively for nursing home resident elderly who participated in an annual oral health screening in three geographical regions in Sweden, in the year 2008. All individuals of age >/= 65 years were included (n = 22,453; 6,327 men; 16,126 women). The proportion of individuals in need of assistance with daily oral hygiene measures was 77.5 % (n=22,453), whereas the proportion of individuals receiving assistance with daily oral hygiene measures was 6.9 % in total (n=22,453). The proportions were largely similar in all geographical regions. There seems to be a large discrepancy between the need of assistance with daily oral hygiene measures, and the oral hygiene assistance received, among nursing home resident elderly.
We summarize an HTA report regarding patient values of drug-eluting stents and balloons for treatment of atherosclerotic disease in the lower extremities. We found 17 randomized controlled trials, 4 cohort studies and 13 case series. The total number of studied patients was substantial (about 3,000) but there was a strong heterogeneity regarding site of lesion, symptom pattern, device, drug used and outcome measures, making the analysis difficult and based on relatively small subgroups. We found low certainty of evidence (GRADE ++) for a reduced risk of restenosis in patients with critical ischemia and lesions below the knee, and also a modest beneficial effect on ischemic symptoms in a mixed patient population. However, we also identified a worrying safety signal, with increased risk for amputation in a group of patients with below-the-knee disease and critical ischemia. The results highlight the need for a structured system for validation of medical devices, a system analogous to that currently used for evaluation of new pharmacological products.
The aim of this survey was to test the impact of an oral hygiene educational model on attitudes and perceptions toward oral hygiene among nursing home staff members. A pilot questionnaire was distributed to the nursing staff before and after a course on oral hygiene at a geriatric nursing home in Stockholm in 2008. The nursing staff was of the opinion that they had sufficient time to carry out oral hygiene tasks but considered such tasks unpleasant, mainly because of unwillingness and resistance from the residents. These attitudes and perceptions among the nursing staff did not change significantly after oral hygiene education. Future oral hygiene educational models need to be developed with an aim to alter the perceptions and behavior of the nursing home staff.
The aim was to evaluate the median survival time (MST) of direct molar class II restorations (glass ionomer, composite, amalgam) in the Nordic countries and the initial cost, as well as, the theoretical cost per year of function of treatment for patients, Social Insurance Office (SI), and total cost, at Public Dental Services (PDS) in Sweden. Restoration longevity studies conducted in general practice settings in the Nordic countries were used to calculate the MSTs of class II restorations. The initial costs were based on fee schedules from all PDS in Sweden. The MSTs of class II molar restorations in Nordic general practices were shortest for glass ionomer and longest for amalgam. Glass ionomer molar class II restorations had the lowest and composite restorations had the highest initial total cost at PDS in Sweden. The highest theoretical cost per year of function was seen for composite restorations. Amalgam restorations seem to have the longest functional lifetime in Nordic general practices and the lowest theoretical cost per year of function for the patients at PDS in Sweden.