Advances in the pathogenesis of periodontitis. Group B consensus report of the fifth European Workshop in Periodontology.
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Animals↗
Biomedical subjects
R Attström
Publications and source records attributed to R Attström.
A comparative evaluation of computer literacy amongst dental educators and students.
A task-oriented questionnaire was designed, aiming to quickly assess competence with the use of computers. The questionnaire consisted of distinct computer-related skills, representing various competences in educational computer use. A total score from 0 to 49 was calculated upon completion of the questionnaire, based on the sum of all the positively identified competences. The questionnaire was distributed to an international group of leading dental educators during the DentEd Global Congress in Prague in 2001 and to a cohort of first year dental students (2001) in the Dental Faculty, University of Malmo, Sweden. Certain attitudes towards the role of information and communication technology (ICT) in dental education were also measured through Visual Analogue Scales in the educator's group. A total of 149 questionnaires were collected from the educators' group and 58 from the dental students. There was no significant difference in the average computer competence score between the two groups. The educators' group average score was 20.7 (SD 9.9) and students' average was 18.1 (SD 8.5). A significant positive correlation (r = 0.395277, P < 0.0001) was found between the competence measured by the questionnaire and the year of graduation in the educators' group. The attitudes towards the role of ICT in dental education amongst the educators were very positive, regardless of their competence with computers, year of graduation or academic position. The results from this study indicate that there is wide diversity in computer competence amongst both students and academic staff. In addition, students' actual competence in the use of computers might not be as high as is often perceived through self-assessment and ordinal scales.
Adult↗
Computer-mediated instructional video: a randomised controlled trial comparing a sequential and a segmented instructional video in surgical hand wash.
BACKGROUND: Video-based instructions for clinical procedures have been used frequently during the preceding decades. AIM: To investigate in a randomised controlled trial the learning effectiveness of fragmented videos vs. the complete sequential video and to analyse the attitudes of the user towards video as a learning aid. MATERIALS AND METHODS: An instructional video on surgical hand wash was produced. The video was available in two different forms in two separate web pages: one as a sequential video and one fragmented into eight short clips. Twenty-eight dental students in the second semester were randomised into an experimental (n = 15) and a control group (n = 13). The experimental group used the fragmented form of the video and the control group watched the complete one. The use of the videos was logged and the students were video taped whilst undertaking a test hand wash. The videos were analysed systematically and blindly by two independent clinicians. The students also performed a written test concerning learning outcome from the videos as well as they answered an attitude questionnaire. RESULTS: The students in the experimental group watched the video significantly longer than the control group. There were no significant differences between the groups with regard to the ratings and scores when performing the hand wash. The experimental group had significantly better results in the written test compared with those of the control group. There was no significant difference between the groups with regard to attitudes towards the use of video for learning, as measured by the Visual Analogue Scales. Most students in both groups expressed satisfaction with the use of video for learning. CONCLUSION: The students demonstrated positive attitudes and acceptable learning outcome from viewing CAL videos as a part of their pre-clinical training. Videos that are part of computer-based learning settings would ideally be presented to the students both as a segmented and as a whole video to give the students the option to choose the form of video which suits the individual student's learning style.
Attitude of Health Personnel↗
The effectiveness of video support in the teaching of manual skills related to initial periodontal therapy tested on phantoms.
INTRODUCTION: The teaching of manual skills and competencies is among the most time-consuming aspects of oral health-care education, especially when large groups of students are involved. Video has been repeatedly used as an educational tool with varying results. PURPOSE: The present study aimed to investigate the effectiveness of a computer-based video support system during practical training of manual skills and competencies related to periodontal treatment. MATERIALS AND METHODS: Eighty-four students were randomized into 9 groups: 5 experimental and 4 control groups. The control groups received instruction in the use of scaling and root planing instruments during a 7-hour seminar, and 2 hours of manual practice. The experimental groups received the same instruction, but in addition had access to a computer-based video support system, the Visual Training System (VTS), during practical training. During the 2-hour long practice session, all students practiced 21 different procedures, which were video recorded. The videos were later evaluated by an independent observer. RESULTS: On the whole, the students in the experimental group performed significantly better than their colleagues in the control group. Specifically, the groups that utilized the VTS video support performed significantly better in 9 of the 21 procedures tested. CONCLUSION: These results suggest that this computer-based video support can be an effective aid in the teaching of manual skills related to oral health care.
Adult↗
Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skills.
Simulations are important educational tools in the development of health care competence. This study describes a virtual learning environment (VLE) for diagnosis and treatment planning in oral health care. The VLE is a web-based, database application where the learner uses free text communication on the screen to interact with patient data. The VLE contains forms for history taking, clinical images, clinical data and X-rays. After reviewing the patient information, the student proposes therapy and makes prognostic evaluations of the case in free text. A usability test of the application was performed with seven dental students. The usability test showed that the software responded with correct answers to the majority of the free text questions. The application is generic in its basic functions and can be adapted to other dental or medical subject areas. A randomised controlled trial was carried out with 39 students who attended instruction in history taking with problem-based learning cases, lectures and seminars. In addition, 16 of the 39 students were randomly chosen to practise history taking using the virtual patient prior to their first patient encounter. The performance of each student was recorded on video during the patient sessions. The type and order of the questions asked by the student and the degree of empathy displayed towards the patient were analysed systematically on the videos. The data indicate that students who also undertook history taking with a virtual patient asked more relevant questions, spent more time on patient issues, and performed a more complete history interview compared with students who had only undergone standard teaching. The students who had worked with the virtual patient also seemed to have more empathy for the patients than the students who had not. The practising of history taking with a virtual patient appears to improve the capability of dental students to take a relevant oral health history.
Clinical Competence↗
Computer literacy and attitudes among students in 16 European dental schools: current aspects, regional differences and future trends.
A questionnaire survey was carried out to investigate the competence and attitude of dental students towards computers. The current study presents the findings deriving from 590 questionnaires collected from 16 European dental schools from 9 countries between October 1998 and October 1999. The results suggest that 60% of students use computers for their education, while 72% have access to the Internet. The overall figures, however, disguise major differences between the various universities. Students in Northern and Western Europe seem to rely mostly on university facilities to access the Internet. The same however, is not true for students in Greece and Spain, who appear to depend on home computers. Less than half the students have been exposed to some form of computer literacy education in their universities, with the great majority acquiring their competence in other ways. The Information and Communication Technology (ICT) skills of the average dental student, within this limited sample of dental schools, do not facilitate full use of new media available. In addition, if the observed regional differences are valid, there may be an educational and political problem that could intensify inequalities among professionals in the future. To minimize this potential problem, closer cooperation between academic institutions, with sharing of resources and expertise, is recommended.
Adult↗
Evaluation following functional loading of titanium fixtures placed in ridges augmented by deproteinized bone mineral. A human case study.
The aim of this investigation was to clinically evaluate the periimplant tissues of titanium fixtures, placed in regions augmented using deproteinized bone mineral, after initial functional loading. The original material included 18 individuals (mean age 71+/-9 years) treated using a graft material, Bio-Oss (6 Patients), or Bio-Oss+autogenous bone mixture (12 patients) for alveolar ridge augmentation. 6 titanium fixtures were placed at the time of ridge augmentation. 46 fixtures were placed at a second surgical stage, median 9.5 months after augmentation. Augmentation included crest width (26 fixtures), crest height and width (12 fixtures) and sinus floor lift (14 fixtures) procedures. In addition, 16 fixtures were placed in regions of adequate bone volume. Reconstructions were placed and patients were recalled on a yearly basis. After 4-6.5 years of functional loading, the reconstructions were removed and assessments of fixture stability and periimplant mucosal conditions were made. At this time, 3 patients (13 fixtures) were lost to follow-up (1 deceased, 1 declined to participate, and 1 too ill to attend). In the remaining 15 patients, 7 fixtures were lost due to osseo-disintegration, 2 in one patient in the mandible, and 5 in a second patient in the maxilla. Both individuals were smokers. The remaining 32 fixtures were clinically stable. Periimplant mucosa was healthy with a mean modified sulcular bleeding index of 0.1+/-0.2 and a mean probing depth of 1.5+/-1.1 mm. Radiographic evaluation showed alveolar bone levels at or above the level of the first fixture thread. There were no perifixtural radiolucencies. The survival rate, which coincided with success rate, for fixtures placed in conjunction with ridge augmentation using deproteinized bone mineral was 100% for non-smokers and 43% for smokers after 4-6.5 years of functional loading. No fixture loss occurred in non-augmented areas.
Aged↗
Cytokine gene expression in chronic periodontitis.
BACKGROUND: Cytokines play an important rôle in controlling inflammatory processes and tissue homeostasis. Periodontitis, as any other chronic inflammatory disease, results from a disarrangement of host factors, mainly cytokines and the initiating agent. Modulation of the cytokines is not only controlled by the host but also by infecting bacteria and their products. AIM: In the present study, we examined the cytokine mRNA expression profiles in six patients, each presenting sites affected with (1) severe progressive periodontitis, (2) chronic, but stable periodontal lesions, and (3) with healthy sites. Analysis using a quantitative RT-PCR included IFN-gamma, IL-1beta, IL-2, IL-4, IL-5, IL-6, and TNF-alpha. MATERIAL AND METHODS: 6 patients with chronic periodontitis were following treatment observed for a period of six years for local sites staying healthy, local sites with periodontal pathology but without signs of progression of attachment loss and sites with verified progression were biopsied. The biopsies were lyzed and analyzed for levels of cytokine mRNAs. RESULTS: Results revealed considerable variation not only between patients, but also between individual sites. Each patient's site has thus to be looked at as an independent entity. CONCLUSIONS: The local action of cytokines, which is heavily dependent on recruitment, interaction and activation of immunocompetent cells can explain the site-specific nature of cytokine expression. Cytokine data from individual sites together with the local clinical status and data from the literature demonstrate the complexity of periodontal disease pathogenesis. To gain insight to specific mechanisms further studies are needed.
Aged↗
Distance learning in academic health education.
Distance learning is an apparent alternative to traditional methods in education of health care professionals. Non-interactive distance learning, interactive courses and virtual learning environments exist as three different generations in distance learning, each with unique methodologies, strengths and potential. Different methodologies have been recommended for distance learning, varying from a didactic approach to a problem-based learning procedure. Accreditation, teamwork and personal contact between the tutors and the students during a course provided by distance learning are recommended as motivating factors in order to enhance the effectiveness of the learning. Numerous assessment methods for distance learning courses have been proposed. However, few studies report adequate tests for the effectiveness of the distance-learning environment. Available information indicates that distance learning may significantly decrease the cost of academic health education at all levels. Furthermore, such courses can provide education to students and professionals not accessible by traditional methods. Distance learning applications still lack the support of a solid theoretical framework and are only evaluated to a limited extent. Cases reported so far tend to present enthusiastic results, while more carefully-controlled studies suggest a cautious attitude towards distance learning. There is a vital need for research evidence to identify the factors of importance and variables involved in distance learning. The effectiveness of distance learning courses, especially in relation to traditional teaching methods, must therefore be further investigated.
Accreditation↗
Computer assisted learning. A review.
Since 1980 the amount of medical information has doubled approximately every second year. This implies that oral health students as well as professionals need to manage the flow of information rationally, in order to learn how to undertake evidence-based decision-making for diagnosis and treatment in a given patient situation. Current research indicates that computer connected databases and computer assisted learning (CAL) may enhance learning and provide the clinician with information for decision-making when treating patients. Multimedia for CAL, which combines audio and visual data in an interactive form, has proved to be an effective tool in education. CAL may supplement and reinforce more traditional learning and create opportunities to illustrate clinical situations in an interactive way. CAL has the potential to help students develop skills and knowledge. Students, staff and professionals consider CAL stimulating and motivating. Students easily adapt to CAL although their current computer literacy is still low. New authoring tools make it easier for faculties to develop their own CAL software. In the future we will see more sophisticated software with virtual patients who can communicate and interact with the student in a very realistic way. The software will even "step out" from the screen and help the student with clinical procedures. However, at present CAL should not replace traditional education, but rather be used more as a supplement and for self-directed studies.
Attitude↗
A virtual classroom for undergraduate periodontology: a pilot study.
The Integrated Distributed Learning Environments or virtual classrooms constitute a new promising structure in education of health care personnel. A virtual classroom was developed aiming to teach periodontology to an international group of 28 dental students using a problem-based learning (PBL) approach. The course was web-based and included synchronous and asynchronous communication, on-line libraries and multimedia material. Students were organised in 4 independent groups and each group was appointed a tutor. The results of the study indicate that one of the most positive effects students experienced was competence in using the computer. They also rated highly the use of multimedia for learning of clinical procedures. It was found that web boards and email were too slow to allow group work in the virtual classroom. Real time communication programs were found to be superior for problem discussion and hypothesis formulation. However, email and the web board played a significant role during certain steps of the PBL method. The students expressed a positive attitude for the combined use of network-based learning and problem-based education. Our present experience suggests that distance learning should be organised with a mixture of different media, allowing communication of knowledge and skills between the resources and the students, as well as cooperation between the students. Computer literacy among teachers and students is limited and should be enhanced. Finally, personal contact between the resource persons and the students before the distant learning course commences helps the learning process.
Attitude↗
Effects of mouthrinses with linseed extract Salinum without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome. A double-blind crossover investigation.
OBJECTIVES: To study the effect of mouthrinses with salivary replacement substances on oral conditions in patients with primary Sjögren's syndrome. DESIGN: Cross-over, double-blind study. SETTING: Facilities at the Centre for Oral Health Sciences, Malmö University and at Malmö University Hospital, Malmö, Sweden. SUBJECTS: Twenty-two patients with Sjogren's syndrome. INTERVENTION: Linseed extract Salinum alone (Sal) or with addition of chlorhexidine (Sal/Chx) was used for mouthrinsing during 3-week periods of rinsings separated by a 3-week "wash-out" period. MEASUREMENTS: Recordings of percentages of sites with dental plaque and bleeding on probing, mirror friction test and microbiological analyses. Questionnaire on oral symptoms due to reduced salivation. RESULTS: Dental plaque and bleeding on probing were reduced after Sal and after Sal/Chx. Friction was reduced after both treatments. No significant differences for counts of studied microbial groups were seen after Sal but the total anaerobically cultured microorganisms and of mutans streptococci fell after Sal/Chx (p<0.05 and p<0.001). Symptoms of oral dryness improved following Sal and Sal/Chx (p<0.05 and p<0.001 respectively). Speaking problems and burning mouth symptoms improved after use of Sal (p<0.05). CONCLUSIONS: Positive effects on symptoms in patients with Sjögren's syndrome were seen after use of Salinum without or with chlorhexidine.
Adult↗
Salivary immunoglobulin A levels in rapid and slow plaque formers: a pilot study.
The aim of this study was to investigate the salivary immunoglobulin A concentration in rapid and slow plaque formers. After 3 days of oral hygiene abstinence, 49 healthy volunteers were screened using the plaque index (PI) to assess their plaque formation rates. Five subjects with the highest, and five with the lowest mean PI were selected as rapid and slow plaque formers, respectively. Unstimulated whole saliva was collected from each of these ten subjects and the levels of salivary IgA assessed using a conventional ELISA technique. Reference curves for salivary IgA were established by testing serial dilutions of human IgA with known concentrations. When the differences between the two groups were compared, almost a twofold increase in the mean salivary IgA concentration in the slow (16 microg/ml +/- 4) compared with the rapid (9 microg/ml +/- 3) plaque formers was recorded (p < 0.05). These findings, reported for the first time, imply that salivary IgA may play a crucial role in regulating the pioneer plaque development on enamel surfaces.
Adult↗
[Marginal fit of dental restorations and the periodontium in Swiss army recruits].
The present study analyzed the relationship between periodontal health adjacent to filled and unfilled tooth sites in young men (recruits). The status of oral health of 419 Swiss army recruits, aged 19 to 20 years was assessed by determining Plaque Index (PI), Retention Index (RI) and Gingival Index (GI) as well as Pocket Probing Depth (PPD) and Probing Attachment Loss (PAL). In addition, the level of alveolar bone was measured using digitized bite-wing radiographs with an enlargement of 4.5x. Filling margins were assessed and the distance between the alveolar bone crest and the cemento-enamel junction (CEJ) measured to the nearest one tenth of a millimeter. These data were compared with the clinical parameters. A total of 8'050 sites were examined. 765 or 9.5 of the sites in the posterior area were filled. 119 of them showed filling overhangs larger than 0.2 mm. Thus, 1.5 % of the examined sites had a significant overhanging margin. All clinical parameters had greater values at filled than at unfilled sites. The differences were statistically not significant. Even the sites with margins overhanging more than 0.8 mm (n=14) did not show significantly different parameters compared to unfilled sites. The comparison with a similar study involving recruits 11 years earlier assessed that the recruits of 1996 had less and smaller filling overhangs. This, in turn, means that, in Switzerland restorative dentistry in young males has been markedly improved during the 1980's and 1990's.
Adult↗
An in vivo replica study of microbial colonization in "rapid" and "slow" dental plaque formers.
The aim of the present study was to investigate the morphological features of supragingival plaque development in "rapid" and "slow" plaque formers using the replica technique. Forty-nine healthy volunteers were screened for their plaque formation rate after 3 days of oral hygiene abstinence using the plaque index (PI). Five subjects with the highest mean PI and six with the lowest mean PI were selected as "rapid" and "slow" plaque formers, respectively. After a series of thorough prophylaxis and oral hygiene instruction, all subjects went through a 14-day period of no oral hygiene to allow undisturbed plaque formation. Light body silicone elastomeric impressions were taken for the upper right central incisor of each subject on day-0, 1, 3, 7, and 14. Positive replicas were then poured from the impressions using epoxy resin and observed under a scanning electron microscope. A more complex supragingival plaque structure was seen in the day-1 and day-3 replicas of the "rapid" group compared to the "slow" group. From day-7 to day-14, during the maturation period of supragingival plaque, no discernible differences were noted between the two groups. Quantitatively, the percentage of plaque coverage on the tooth surfaces was higher in the "rapid" group than in the "slow" group in day-1 and day-3 replicas. These observations indicate that the morphological and topographical features of supragingival plaque in "slow" and "rapid" plaque formers differ, especially in the early developmental phase.
Bacteria↗
Local CD-ROM in interaction with HTML documents over the Internet.
The internet and computer assisted learning have enhanced the possibilities of providing quality distance learning in dentistry. The use of multimedia material is an essential part of such distance learning courses. However the Internet technology available has limitations regarding transmission of large multimedia files. Therefore especially when addressing undergraduate students or geographically isolated professionals, large download times make distance learning unattractive. This problem was technically solved in a distance learning course for undergraduate students from all over Europe. The present communication describes a method to bypass the problem of transmitting large multimedia files by the use of a specially designed CD-ROM. This CD-ROM was run locally on the students' PC interacting with HTML documents sent over the Internet.
CD-ROM↗
A multilevel analysis of factors affecting pocket probing depth in patients responding differently to periodontal treatment.
3 distinct levels are involved in the periodontal inflammatory process: site, tooth, and individual. By focusing attention on the levels in the population, multilevel or hierarchical modelling (MLM) enables the researcher to understand where and how the effects at the levels involved are occurring. The aim of this paper is therefore to analyse the progression of periodontal disease using analytical models that consider the level hierarchy. 22 patients with periodontitis, in previous reports described as either non-responsive or responsive to periodontal treatment, were investigated. In the multilevel modelling method (MLM), the site pocket probing depth (PPD) is summarised in 3 parameters: the overall mean, the between-individual variance, and the within-individual, between-site variance. The model can readily be extended to include independent variables for sites, teeth and individuals. If these variables are important determinants of PPD, their inclusion in the model will lead to a reduction in residual variances between sites, teeth and individuals. The PPDs were used for construction of a PPD change variable (cPPD). This variable, together with the final registrations of PPD (fPPD) alone, were used as dependent variables in the MLM. Independent predictor variables, 12 on site-level, 3 on tooth-level, and 19 on individual-level, were constructed. The total number of sites assessed was 2236 distributed on 559 teeth in 22 subjects. Initially, a fixed, fully unconditional model (models A and E) was assessed, where no predictor variables were specified at any level. Different random-intercept models (B-D, F-H) were then calculated where the independent variables were inserted in blocks relating to each level. The variance components at all 3 levels were significantly larger than zero. This indicates that MLM is recommended for analysing the present data. The inserted predictors showed 100% sensitivity relating to the subject-level variance. Subsequent testing of the patient with disease or at high risk of disease would have to focus on diagnostic tests aimed at the individual teeth and sites. These tests would need to have a balance of sensitivity and specificity. Thus, by using multilevel modelling, the theoretical understanding of important factors in the pathogenesis of periodontitis is stimulated.
Adult↗
The microbiota of periodontal pockets with different depths in therapy-resistant periodontitis.
This study presents the composition of the cultivable microbiota colonising periodontal pockets of different depths among 2 patient-groups classified as non-responsive (NR-group; 11 participants) or responsive (R-group; 10 participants) to periodontal treatment. Microbiological samples from three types of pocket (< 4 mm deep A-samples; 4-5 mm B-samples; > 5 mm C-samples) were analysed by cultural methods for putative periodontitis pathogens, microbial groups constituting > or = 5% of the total cultivable flora and opportunistic pathogens. Actinomyces naeslundii, A. israelii, Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia, Peptostreptococcus micros, anaerobic streptococci and facultative anaerobic streptococci were most prevalent. Actinobacillus actinomycetemcomitans, Staphylococcus aureus, enteric rods and yeasts were less prevalent. The periodontitis pathogens Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia and Peptostreptococcus micros constituted together (on average) < or = 23% of the viable counts in the A- and B-samples of both patient groups and in the C-samples of the R-group. In the C-samples of the NR-group their mean counts were 45%. Correlations were found between smoking habits and the five pathogens in the C-samples and in pooled pocket depth samples. The results show that groups of periodontopathogens should be considered a causal factor in therapy-resistant periodontitis. Further, smoking and deep pockets can enhance a shift in the balance of the subgingival microflora predisposing a site to disease and a susceptible host may be the pre-requisite to therapy-resistant periodontitis.
Actinomyces↗