Search

The aim of the present study was testing the hypothesis that the adoption of nickel-titanium rotary instrumentation (NTRI) will improve the technical quality of root-fillings. The investigation was carried out within a mandatory continuing education program (CEP) for general dental practitioners (GDPs). The study was conducted amongst GDPs employed by the Public Dental Health Service in the County of Stockholm. Identical questionnaires were distributed before the CEP (Pre-Q) and 9 to 12 months after the course (Post-Q). The CEP consisted of two parts: lectures and hands-on training. From each GDP, radiographs of two cases completed before the course and two cases treated 9-12 months after the course were randomly selected. Primarily molars were selected for evaluation. The radiographs were individually evaluated by two endodontists. Teeth treated before and after training were presented in random order. Adoption rate of NTRI increased from 35% to 75%. Cases from 124 GDPs were included in the final analysis. The rate of good quality root-fillings increased from 27% to 49% (p<.001). A significantly increased radiographic quality was found between GDPs adopting NTRI and those who did not. The GDPs produced root-fillings of very poor quality before as well as after the training period. However, the rate decreased from 29% to 12% amongst adopters and from 46% to 28% amongst non-adopters. Dentists considering canal preparation and root-filling as "easy" produced more frequently good quality root-fillings than the others (p<0.05). In conclusion, the results of the present study were in favour of the idea that a shift to NTRI increases the technical quality of root-fillings produced by GDPs. However, adopters still produce root-fillings of very poor quality. This important issue needs to be addressed in future studies.

Unlabelled: Professional organisations present challenges in management compared to producing companies, as control of the work lies within the professional groups themselves. Management in the Public Dental Health Service (PDHS) has an added difficulty in the two-tiered political governance in Swedish public dentistry. The aim of this thesis was to contribute to better understanding of the organisation and management of Human Service Organisations, especially the PDHS in Sweden, thereby contributing to long-term sustainability with due regard to the professionals. The aim was also to point to some future difficulties facing the PDHS and possible solutions to these. Four papers are included in the thesis. The first paper set out to define the professions in dentistry in Sweden from theories on professions. Dentists and, to a lesser degree; dental hygienists were the identified professional groups. The second paper scrutinised the external environment for dentistry in Sweden in the form of political decisions, i.e., laws and regulations. The findings were that there can be a gap between the formal objectives and the factual behaviour from the political level, and that certain politically attractive ideas might reoccur at a later time despite good scientific arguments against them. Also indicated in this paper were ways to influence the political processes, by active participation in the early stages of decision-making The third paper dealt with the heads (CDOs) of the PDHS in the counties and is based on a questionnaire to them on management. It was found that ideas on management and organisation usually were embedded in the way the respective county council was organised. A strong belief in advantages of scale was noted, both for administration and also for dental care itself. The fourth paper compared overall job satisfaction among publicly employed dentists in Denmark and Sweden. A focus on size of clinic, on professional development and on influence at the work place was found to be important. The Danish dentists were generally more satisfied with their overall job situations than the Swedish ones. One explanation might be found in the environment for the respective service, with a much stronger element of competition in Sweden. Another aspect could be that the expectations of the Danish dentists might be more realistic when they entered the public service. In an appendix the history of the Swedish Public Dental Health Service is outlined., Conclusions: Dentists in Sweden are an established profession and dental hygienists are an emerging profession; they and society would benefit from a clearer delineation and definition of their unique competences. Political decision-making is not necessarily rational, and garbage can models or similar can give a better understanding of political processes. CDOs have a widespread belief in advantages of scale in administration as well as in care, which may pose future problems for the provision of dental care in sparsely populated areas. Overall job satisfaction, as part of Good Work, is founded in an atmosphere at the clinic that is focussed on professional values. It is noteworthy that PDHS dentists not born in Sweden had a lower job satisfaction than those born in Sweden. Perhaps a closer cooperation between the dental colleges and the PDHS might give the newly qualified dentists a more realistic view of the professional challenges in public dentistry, as well as giving the colleges access to the vast material on patients in the PDHS. The future division of tasks between the general dentists, dental hygienists and specialist care dentists has a great impact on the future need for personnel, and needs to be carefully analysed. The future diminishing numbers of dentists and the difficulty for the PDHS to retain dentists may be met by adapting the organisations to a much greater flexibility by allowing different teams to organise their own work. The possibilities to give the patients good service quality will depend on continued democratisation and less managerial control. Producer cooperatives, franchising, or similar, could be revisited and tried. However, such forms will require carefully designed contracts where the objectives and the outcomes are possible to define and to evaluate. The balance between good work for dentists, an efficient organisation and perceived good service to the public will be objects for further studies.

Work as a dentist is stressful and demanding. In the Public Dental Health Service (PDHS) the heads of clinics' have a great influence on the work environment. In turn the heads have to adapt to the overarching policies on management in each County, which create the environment for the clinics. The aims of this paper were to describe the management structure of the PDHS as described by their Chief Dental Officers (CDOs), and to test hypotheses that the management systems had "a logical administrative structure". A postal questionnaire was mailed to all 21 CDOs,who all responded. Context analysis and bivariate correlations were used. The PDHS employed on average 60% of all dentists in a county. The numbers of clinics for general dentistry in Sweden was 698, and for specialist care 144. The heads of clinics were dentists in 92%. Four hypotheses were tested. 1. separate political board did not lead to closer governance of the PDHS. 2. There was more emphasis on measurable than on qualitative objectives and followup. 3. There was only partial correlation between a larger county and a more formalized management. 4. There was no correlation between size of county and beliefs on advantages of scale. There was a widespread belief in advantages with larger clinics both from administrative, and rather surprisingly, from clinical aspects. Two of the four hypotheses could not be corroborated which indicates that the management structures were more formed by county specific principles. The four hypotheses on administrative behaviour were only partially corroborated. The implications for delivery of care to sparsely populated areas need to be monitored in view of the beliefs in larger clinics. The limits for decisions by management and for professional discretion must be monitored closely considering their effects on work environment and on the quality of care the professionals are able to deliver.

The objective was to identify dental professionals' attitudes and awareness on evidence based dentistry (EBD), and to elucidate perceived barriers and views on how to move towards EBD. A questionnaire was sent to 290 dental professionals (dental hygienists, general dentists, specialist dentists) in the county of Halland, Sweden. The questionnaire consisted of closed questions and free text sections, related to attitudes, awareness and skills on databases, EBD, and terms related to scientific publications, as well as perceived barriers towards EBD. A majority of the respondents had a welcoming attitude towards EBD. The respondents perceived their colleagues less positive towards EBD. The respondents considered EBD, at least partly, useful in daily dental practice. With the exception of general dentists in private practice, a vast majority of the dental professionals thought that EBD would improve the care of their patients. Dental professionals in the county of Halland, in Sweden, had a welcoming attitude towards EBD, and indicated an open attitude for learning more about interpretation of evidence from scientific publications. The most commonly perceived barriers towards EBD, were 'lack of time' and 'poor availability of evidence'.