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Biomedical subjects

B Owall

Publications and source records attributed to B Owall.

At least 19 recordsLinked to original sources

Prosthodontic claims in the Swedish Patient Insurance Scheme.

The Swedish Patient Insurance Scheme includes a guarantee insurance for prosthetic treatment. Retreatments of failures, up to 2 years after cementation of fixed prosthodontics and 1 year after delivery of removable prosthodontics, are covered by the guarantee insurance scheme. Almost all private practitioners were included in this scheme at the time of the study in 1989. During a specific period all claims were studied at the time of reporting, when annexed radiographs and so forth could be analyzed. One hundred and thirty-six claims were recorded with regard to treatment injury, reasons for remake, latency times from cementation or delivery to diagnosis, and details about the teeth or constructions involved in the claim. The dentist's opinion of the cause of the failure was also recorded. The reports covered treatment injuries, most of them root perforations during preparation for a post. The guarantee claims for single crowns concerned porcelain fractures, loss of retention, and root fractures as the most frequent failures. For fixed partial dentures the failures were recorded as loss of retention, porcelain fractures, tooth or root fractures, and metal framework fractures in that order. The dentist gave information about his/her opinion of the reason for the failure in only 38.5% of the claims. There were, however, no clear findings about the reasons for the failures.

Crowns

The Swedish patient insurance scheme and guarantee insurance for prosthodontic treatment.

During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.

Humans

Masticatory ability in experimentally induced xerostomia.

The masticatory ability of 15 nondysphagic volunteers with complete natural dentition was tested using different chewing parameters including preparation of a two-color plastic chewing gum (bolus shape, and color mixture), particle reduction of a piece of silicone, and number of strokes before swallow of almonds. The tests were performed under conditions of normal salivation and experimental oral dryness caused by intramuscular injection of methylscopolamine. The chewing gum tests as well as the silicone particle reduction tests were not influenced by lack of salivation. The number of chewing strokes prior to the initiation of swallowing of almonds was significantly increased. Oral dryness seems to cause accumulation of particles in the oral cavity from friable food and the particulate material is not transported posteriorly into a "ready-to-swallow" positioning. The absorption of saliva by dry oral content such as an almond further impaired oral manipulation of food.

Adult

Chewing and the dimension of the pharyngoesophageal segment.

Masticatory efficiency was evaluated in 21 adults for four chewing parameters: mixing of a color-patterned chewing gum mass, shaping of a chewing gum mass, particle reduction of a silicone tablet, and number of chewing strokes before the first swallow of an almond. The results of these tests were correlated with the dimension of the pharyngoesophageal (PE) segment during swallow of liquid barium and solid meat. The transverse width of the PE segment during swallow of liquid barium correlated significantly with the chewing parameters. The sagittal width of the PE segment during swallow of liquid barium correlated only weakly with the chewing parameters. The PE segment dimension during swallow of a solid meat bolus did not correlate with the chewing parameters. The results suggest that there is feedback during chewing and swallowing between the PE segment and the oral cavity.

Adult

Teeth, tooth spaces, and prosthetic appliances in elderly men in Malmö, Sweden.

A group of 483 men, all of whom were 68 or 69 yr old and had lived for a long time in the city of Malmö were examined with regard to number of teeth present, removable dentures, fixed bridges, and tooth spaces. 76.4% had one or more natural teeth remaining, 59.2% had removable dentures, and 0.2% were edentulous and without dentures. The mean number of teeth present in a fixed dentition calculated on dentate subjects was 16.21 +/- 8.02, including teeth replaced by pontics and 15.0 +/- 7.44 when natural teeth only were recorded. The number of bridges was high, 28.8% of natural dentate persons having bridgework. This cohort had fewer remaining teeth than in similar groups in other areas of Sweden, but more fixed bridges. 19.5% had open tooth spaces corresponding to one or more teeth in the visible parts of the dental arches. The availability of dentistry has been extremely good in Malmö and financial support for all types of dental care has been provided for all inhabitants since 1974. In spite of this, a low number of remaining teeth and many untreated tooth spaces in visible part of the dental arches were found, though on the other hand much fixed bridgework was found. It appears from the present study that the population tends to polarize into two groups, namely one group which takes advantage of the dental services and one which does not.

Aged

Malpractice reports in prosthodontics in Sweden.

Prosthodontics is the branch most often involved in dental malpractice cases in Sweden. The number of cases has increased with the growing production of fixed prosthodontics after the introduction of the National Dental Insurance Scheme and the increase in the number of dentists. Prosthodontic treatment accounted for one-third of the working hours of private practitioners but two-thirds of the sanctions during the period 1974-78. The patients' complaints are often justified in some parts. The most common faults are elementary and have been similar throughout the whole period 1947-1988. Bridges (2-4 units), complete dentures and single crowns are the constructions most often involved in complaints. The maxillary frontal and premolar regions are in this order the regions most often involved. There are no differences between different age groups of dentists concerning the quantity of faults, but there is probably concerning the quality of faults because older dentists get more severe sanctions than younger.

Adult

Dental malpractice in Sweden.

This study reports and analyses the handling of malpractice cases by the Swedish authorities from an odontological and legal point of view, in order to find explanatory factors and create a basis for prevention and discussion of the principles for processing such cases. Women report their dentists more often than men. The main reasons for complaint are "faulty management/performance of treatment," "unsatisfactory technical/esthetic quality," and "wrong diagnosis/indication." Many cases concern elementary and well-known clinical principles for investigation, treatment planning, and clinical management. Private practitioners from the Stockholm region are most often involved in malpractice cases, and most of the complaints concern prosthodontic treatment. Poor record keeping is not uncommon.

Adolescent

Dental claims in the Swedish Patient Insurance Scheme.

The Swedish Patient Insurance Scheme covers treatment injuries and guarantees the replacement of failed removable prostheses for 1 year and fixed prostheses for 2 years after fitting. In this paper, 573 dental cases are analysed for a 3-month period in 1986, during which crowns and bridges formed the vast majority of failed treatments that were reported.

Adult

A retrospective 5-year study of dental treatment in a group of elderly persons.

In a retrospective study, 50 patients over 70 years of age, selected from a private specialist clinic for fixed and removable prosthodontics, were studied. They all had remaining natural teeth and had undergone complete dental treatment at least 5 years before. The age-range was 70-96 and they had been treated 6-25 years before the study. The patients had on average 13.9 teeth. During the five-year observation period, 32 patients developed caries, with a mean number of 5.0 lesions (range 1-22). 79 fillings were made due to other defects than caries. 25 root canal fillings were made, due to caries lesions after loosened fillings or crowns in 5 cases and for other reasons than caries in 20 cases. 4.4% of the natural teeth had to be extracted. 19 crowns, 11 bridges and 1 splint were made. The prophylactic periodontal and cariological care delivered during the 5 years varied from 0 to 350 minutes (mean 89). The time for prophylactic treatment was not significantly correlated to the total number of natural teeth per patient but instead to the number of periodontally severely involved teeth (i.e. with 50% or less marginal bone support). The overall conclusion is that 3.5 times as much chairside treatment time was used for therapeutic measures as for prophylaxis.

Aged

Age retirement in women. III. An odontological study.

This study presents data from clinical, roentgenological and interview examinations of 116 women at the age of retirement from work. The study was part of a comprehensive investigation including general health, health behaviour and psychological status. The women were examined 5 months before and 5 months after retirement. Oral status as well as dental health behaviour was recorded. Forty per cent had been treated with removable dentures of different types; 14 women were edentulous in both jaws. The dentate women had on an average 19.8 teeth, of which 83% were either filled or decayed. Eighty-one per cent claimed that they visited a dentist regularly and about 80% actually did so during the observation period. A majority of these were included in a recall system. Almost 1/3 experienced oral dryness, occasionally or constantly. Oral dryness was combined with a somewhat higher frequency of decayed surfaces. About 22% considered themselves to have, from a dental point of view, improved their eating habits after retirement. The study shows no evidence of decline in oral health behaviour after retirement.

Aged

Prosthetic epidemiology.

The need for an epidemiological method which focuses upon the problems of missing teeth, tooth spaces and prosthetic treatment is emphasized. From the prosthetic viewpoint the distinction between missing teeth and tooth spaces must be made and examples are given to show that up to 20 per cent of missing teeth do not give rise to tooth space. The presentation of the prosthetic parameters per tooth is recommended using the six alternatives: tooth present; tooth missing (open space); tooth missing (closed space); tooth replaced by pontic in fixed bridge, by removable partial denture, or by complete denture. In the presentation of the mean number of existing teeth, fixed bridge pontics should be included as they serve as natural teeth both aesthetically and functionally. Data on removable dentures, or edentulism without denture wearing, should be presented in such a way that comparisons at jaw level as well as at person level can be made. A system for this is described. The method may be used in industrialized countries where there is much prosthetic treatment as well as in developing countries with few health services. Comparisons will still be meaningful.

Adult