1
|
Salazar J, Andersen C, Øzhayat EB. Effect of oral health interventions for dependent older people-A systematic review. Gerodontology 2024; 41:200-219. [PMID: 37847812 DOI: 10.1111/ger.12720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health. OBJECTIVE The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people. METHODS We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta-analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system. RESULTS We included a total of 30 randomised clinical trials assessing educational and non-educational interventions for community-dwelling older people (n = 2) and those residing in long-term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long-term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system. CONCLUSION Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long-term effect of interventions, and further research is needed, especially targeting community-dwelling older people. PROSPERO ID CRD42021231721.
Collapse
Affiliation(s)
- Josefina Salazar
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Andersen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Esben Boeskov Øzhayat
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Bryant AL, Hirschey R, Caiola CE, Chan YN, Cho Y, Plassman BL, Wu B, Anderson RA, Bailey DE. Care partners experience of an oral health intervention for individuals with mild cognitive impairment and mild dementia using behavior change technique: A qualitative study. Geriatr Nurs 2024; 56:40-45. [PMID: 38237339 PMCID: PMC10990823 DOI: 10.1016/j.gerinurse.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024]
Abstract
Oral health declines in older adults with cognitive impairment. We aimed to improve oral hygiene outcomes for individuals with mild cognitive impairment (MCI) or mild dementia (MD) by fostering behavior changes among carepartners assisting them. We used qualitative data of verbatim transcripts of coaching sessions with carepartners (n = 17 dyads:10 dyads for MCI, 7 dyads for MD). Directed and emergent coding were used to understand behavior change techniques (BCTs). BCTs were compared with carepartners of participants with MCI and MD. Most frequently used BCTs in both groups: prompts and cues, instruction on how to perform the behavior, review behavioral goal, and problem solving. Different BCTs emerged in study: social support-unspecified of the MCI group and credible source for MD group. Findings clarified active intervention components, common BCTs used by carepartners, and different BCT approaches for both participants. Findings help to elucidate the mechanisms of changes in individuals' behaviors in these interventions.
Collapse
Affiliation(s)
- Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ya-Ning Chan
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Youngmin Cho
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brenda L Plassman
- Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York City, New York, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | |
Collapse
|
3
|
Ho BV, van der Maarel-Wierink CD, de Vries R, Lobbezoo F. Oral health care services for community-dwelling older people with dementia: A scoping review. Gerodontology 2023; 40:288-298. [PMID: 36440580 DOI: 10.1111/ger.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/02/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether, and if so, which oral health care services for community-dwelling older people with dementia are available. BACKGROUND Oral health in people with dementia is poor compared with people without dementia. Although multiple oral health care interventions have previously been studied for older people living in nursing homes, little is known about interventions or services for community-dwelling older people with dementia. MATERIALS AND METHODS A literature search was performed in the databases Pubmed, Embase and CINAHL. The following search terms were used: "Dementia", "Oral health", "Dental health services" and "Older person". The term "dental health services" was intended to be an as broad as possible construct because limited search results were expected. RESULTS The search generated 1624 unique references, of which seven studies were eligible for inclusion (four cohort studies, one cross-sectional study, and two qualitative studies). The included studies described two actual oral health care services: a telephone help line on oral health and dementia, and a mobile geriatric dental programme in adult day health centres. A need was found for services and strategies specific to community-dwelling older people with dementia. One identified solution was an intervention with individually tailored daily oral hygiene self-care supported by the informal caregiver. Furthermore, increasing accessibility of oral health care professionals with treatment at other locations than their own practices, better collaboration between health care professionals and preventive oral health care are highly necessary. CONCLUSION There is limited evidence on the availability of oral health care services for community-dwelling older people with dementia, while a need was found for oral health care services that focus on good accessibility, oral hygiene self-care, preventive strategies and collaboration among health care professionals.
Collapse
Affiliation(s)
- Bach Van Ho
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claar D van der Maarel-Wierink
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Hernández-Vásquez A, Barrenechea-Pulache A, Aguirre-Ipenza R, Comandé D, Azañedo D. Interventions to Improve the Oral Hygiene of Individuals with Alzheimer's Disease: A Systematic Review. Dent J (Basel) 2022; 10:92. [PMID: 35621545 DOI: 10.3390/dj10050092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 12/10/2022] Open
Abstract
This systematic review evaluates published evidence on oral hygiene interventions conducted in Alzheimer’s disease (AD) patients. PubMed, Embase, Cochrane Library, CINAHL, Dentistry & Oral Sciences Source, and Web of Science were searched for articles published up to 19 April 2021. The main outcomes of interest were the Plaque index score (PI), oral health knowledge of participants or their caregivers, and behaviors and attitudes towards oral hygiene. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Institutes of Health. The study was conducted under PROSPERO registration code CRD42021247733. Two studies met the inclusion criteria. One was a pre-post study conducted in Brazil, and the other was a prospective cohort study carried out in China. The sample sizes of these studies were 29 and 168, respectively. Both studies were carried out in institutionalized patients and presented a significant loss to follow-up. The PI and gingival index scores both improved after the application of the respective interventions, yet the differing methodologies used precluded further comparisons. The studies were deemed to be of good and regular quality, respectively. Despite the need for more comprehensive interventions to ensure a better oral health status and a higher quality of life for AD patients, an alarming lack of studies have been conducted in this population.
Collapse
|
5
|
Czwikla J, Herzberg A, Kapp S, Kloep S, Rothgang H, Nitschke I, Haffner C, Hoffmann F. Effectiveness of a Dental Intervention to Improve Oral Health among Home Care Recipients: A Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18:9339. [PMID: 34501925 DOI: 10.3390/ijerph18179339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 01/18/2023]
Abstract
We quantified the effectiveness of an oral health intervention among home care recipients. Seven German insurance funds invited home care recipients to participate in a two-arm randomized controlled trial. At t0, the treatment group (TG) received an intervention comprising an oral health assessment, dental treatment recommendations and oral health education. The control group (CG) received usual care. At t1, blinded observers assessed objective (Oral Health Assessment Tool (OHAT)) and subjective (Oral Health Impact Profile (OHIP)) oral health and the objective periodontal situation (Periodontal Screening Index (PSI)). Of 9656 invited individuals, 527 (5.5%) participated. In the TG, 164 of 259 (63.3%) participants received the intervention and 112 (43.2%) received an outcome assessment. In the CG, 137 of 268 (51.1%) participants received an outcome assessment. The OHAT mean score (2.83 vs. 3.31, p = 0.0665) and the OHIP mean score (8.92 vs. 7.99, p = 0.1884) did not differ significantly. The prevalence of any periodontal problems (77.1% vs. 92.0%, p = 0.0027) was significantly lower in the TG than in the CG, but the prevalence of periodontitis was not (35.4% vs. 44.6%, p = 0.1764). Future studies should investigate whether other recruitment strategies and a more comprehensive intervention might be more successful in improving oral health among home care recipients.
Collapse
|
6
|
Thapa R, Chimoriya R, Arora A. The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review. BMC Geriatr 2021; 21:35. [PMID: 33422009 PMCID: PMC7797120 DOI: 10.1186/s12877-020-01989-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/25/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties. METHODS This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines. RESULTS Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria. CONCLUSIONS None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.
Collapse
Affiliation(s)
- Rojina Thapa
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Ritesh Chimoriya
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
| |
Collapse
|
7
|
Egashira R, Mizutani S, Yamaguchi M, Kato T, Umezaki Y, Oku S, Tamai K, Obata T, Naito T. Low Tongue Strength and the Number of Teeth Present Are Associated with Cognitive Decline in Older Japanese Dental Outpatients: A Cross-Sectional Study. Int J Environ Res Public Health 2020; 17:E8700. [PMID: 33238565 PMCID: PMC7700411 DOI: 10.3390/ijerph17228700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022]
Abstract
To mitigate the impact of dementia, initiating early intervention is important. This study aims to investigate the associations between deterioration in oral function and cognitive decline in older outpatients whose oral health was maintained in the dental clinic. This study included 50 outpatients aged ≥65 years. We used the Japanese version of the Montreal Cognitive Assessment (MoCA-J) to assess cognitive decline. Oral function was evaluated by tongue pressure, masticatory performance, and swallowing ability. A full-mouth periodontal examination was conducted, and the occlusal support and number of teeth were recorded. Odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline (MoCA-J score ≤ 25 points) were calculated using logistic regression models. The age, number of teeth, tongue pressure, and masticatory performance were significantly correlated with cognitive decline (p < 0.05). Logistic regression analyses revealed that cognitive decline was independently associated with age (OR: 1.25; 95% CI: 1.03-1.52; p = 0.024), number of teeth (OR = 0.83; 95% CI: 0.76-1.00; p = 0.047), and lower tongue pressure (OR: 0.87; 95% CI: 0.77-0.98; p = 0.022). Lower tongue pressure and a small number of remaining teeth may be associated with cognitive decline in Japanese outpatients.
Collapse
Affiliation(s)
- Rui Egashira
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | - Shinsuke Mizutani
- OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan;
| | - Masahiro Yamaguchi
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | - Tomotaka Kato
- Department of Oral Health Sciences, University of Washington, Seattle, WA 98195, USA;
| | - Yojiro Umezaki
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | - Saori Oku
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan;
| | - Keiko Tamai
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | | | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| |
Collapse
|
8
|
Anderson RA, Wang J, Plassman BL, Nye K, Bunn M, Poole PA, Drake C, Xu H, Ni Z, Wu B. Working together to learn new oral hygiene techniques: Pilot of a carepartner-assisted intervention for persons with cognitive impairment. Geriatr Nurs 2018; 40:269-276. [PMID: 30522909 DOI: 10.1016/j.gerinurse.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 01/23/2023]
Abstract
We pilot tested a carepartner-assisted intervention to improve oral hygiene in persons with cognitive impairment (participants) and help carepartners become leaders who can adapt approaches that foster participants' ability to develop new skills for oral hygiene care. Following the intervention, we conducted interviews with participants and carepartners to understand their challenges in working together to learn new oral hygiene skills. Participants reported challenges such as frustration using the electric toothbrush correctly, lack of desire to change, uncertainty about correctness of technique, and difficulty sustaining two minutes of toothbrushing. Carepartners reported challenges such as learning a new way of toothbrushing, learning new communication techniques, switching from instructing to working together, learning to balance leading with being too bossy, and being mindful of word choices. Findings suggested that despite challenges, participants were able to learn adaptive strategies to support new oral hygiene behaviors with support of the carepartner as the adaptive leader.
Collapse
Affiliation(s)
- Ruth A Anderson
- University of North Carolina Chapel Hill, School of Nursing, 2007 Carrington Hall CB#7460, Chapel Hill, NC 27599, USA.
| | - Jing Wang
- Duke University School of Nursing, USA
| | | | | | | | - Patricia A Poole
- University of North Carolina Chapel Hill, School of Dentistry, USA
| | - Connor Drake
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, USA
| | | | - Zhao Ni
- Duke University School of Nursing, USA
| | - Bei Wu
- New York University, Rory Meyers Collage of Nursing and NYU Aging Incubator, USA
| |
Collapse
|
9
|
Ástvaldsdóttir Á, Boström AM, Davidson T, Gabre P, Gahnberg L, Sandborgh Englund G, Skott P, Ståhlnacke K, Tranaeus S, Wilhelmsson H, Wårdh I, Östlund P, Nilsson M. Oral health and dental care of older persons-A systematic map of systematic reviews. Gerodontology 2018; 35:290-304. [PMID: 30129220 DOI: 10.1111/ger.12368] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/01/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine the current knowledge on oral health status and dental care of older persons through a systematic mapping of systematic reviews of low or moderate risk of bias. BACKGROUND Geriatric dentistry covers all aspects of oral health and oral care of older persons. Oral health is part of general health and contributes to a person's physical, psychological and social wellbeing. METHODS A literature search was performed in three different databases (PubMed, The Cochrane Library and Cinahl) within 12 domains: Dental caries, periodontitis, Orofacial pain and temporomandibular joint (TMJ) pain, mucosal lesions, oral motor function, dry mouth, halitosis, interaction between oral status and other medical conditions, ability to interrelate and communicate, quality of life, ethics and organisation of dental care for older persons. Systematic reviews were identified and scrutinised, highlighting scientific knowledge and knowledge gaps. RESULTS We included 32 systematic reviews of which 14 were judged to be of low/moderate risk of bias. Most of the domains lack systematic reviews with low or moderate risk of bias. In two of the domains evidence was identified; in institutionalised people aged 65 or older, effective oral hygiene can prevent pneumonia. Furthermore, there is an evidence of a relationship between malnutrition (protein energy-related malnutrition, PEM) and poor appetite and edentulousness. CONCLUSIONS There is an urgent need for further research and evidence-based knowledge within most domains in geriatric dentistry and in other fields related to oral health and dental care for older persons striving for multi-disciplinary research programmes.
Collapse
Affiliation(s)
| | - Anne-Marie Boström
- Division of nursing, Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden.,Department of nursing, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Thomas Davidson
- Division of health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Pia Gabre
- Department of Preventive Dentistry, Public Dental Health, Uppsala County Council, Uppsala, Sweden.,Department of Cariology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Gahnberg
- Department of Preventive Dentistry, Public Dental Service, Region Västra Götaland, Sweden.,Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Sandborgh Englund
- Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden.,Academic Center of Geriatric Dentistry, Karolinska institutet, Stockholm, Sweden
| | - Pia Skott
- Academic Center of Geriatric Dentistry, Karolinska institutet, Stockholm, Sweden
| | - Katri Ståhlnacke
- Public Dental Services, Region Örebro County, Sweden.,Faculty of Health and Medicine, Örebro University, Örebro, Sweden
| | - Sofia Tranaeus
- Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden.,Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | | | - Inger Wårdh
- Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden.,Academic Center of Geriatric Dentistry, Karolinska institutet, Stockholm, Sweden
| | - Pernilla Östlund
- Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Mikael Nilsson
- Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| |
Collapse
|