Objectives: This study investigates clear aligner treatment (CAT) of adult patients in private dental practice and aims to identify: 1) The awareness of and knowledge about CAT among citizens, 2) how citizens who have received CAT experience the treatment and 3) how general dentists and orthodontists assess CAT. Materials and methods: The study was based on an observational cross-sectional questionnaire investigation. Two separate online questionnaires were sent out to all private dental clinics in Denmark and to a group of 2000 citizens aged ≥18 years. Results: 217 citizens and 200 practitioners were included in the analysis. The citizens’ awareness of CAT was poor in general, and younger citizens were more aware of CAT. The citizens most often became aware of CAT through their own dentist or through friends and family. The citizens were in general satisfied with their treatments.The practitioners always/often informed about all parameters possible. The most frequent indication for CAT was cosmetics. The orthodontists more often included a lateral cephalogram in the diagnostics before CAT and more often made changes and more comprehensive changes to the digital treatment plan. The orthodontists were less satisfied with CAT compared to the general dentists. Conclusions: This study has provided valuable knowledge on the awareness and satisfaction of CAT among the citizens and indicated how practitioners assess CAT of adult patients in private dental practice in Denmark.

Co-creation is increasingly promoted to develop sustainable oral health programs. Little is known about how co-creation is applied in adult oral health promotion, including learnings from such programs. This review aims to map the characteristics of co-created, preventive, community-based oral health projects targeting adults and to synthesize learnings, including challenges, possibilities, and successes. A scoping review was conducted in accordance with recommended methodological steps. A bibliometric search across major databases and a grey literature search covering all WHO regions identified eligible projects. Inclusion criteria required projects to concern adult oral health, include co-creation elements, be community-based, focus on prevention, include an intervention, and be conducted within the last 10 years. Data extraction and synthesis focused on project characteristics and learnings. Included projects varied in aims, scope, and intervention types. Many sought to improve access to oral health care for vulnerable groups. Stakeholder involvement was generally narrow and dominated by dental professionals, with limited patient participation. Co-creation activities were often sporadic, typically occurring during implementation rather than across all project stages. Reported challenges included resource limitations, recruitment barriers, and difficulties sustaining collaboration. Opportunities arose from adaptive approaches, multi-sectoral collaboration, and the use of existing networks. Successes were mostly process-oriented, with some projects reporting improved oral health literacy, enhanced service access, and strengthened stakeholder relationships. In conclusion, Co-created oral health promotion projects demonstrate potential but are inconsistently implemented and reported. Future initiatives should prioritize early and sustained stakeholder engagement, structured co-creation processes, and systematic evaluation to strengthen impact and sustainability.

INTRODUCTION:Across Europe, oral health is increasingly recognized as a public health priority. Still, structural, financial, and social barriers disproportionately affect people in vulnerable circumstances. OBJECTIVE:Within the EU-funded DELIVER project, this study aimed to (1) identify which barriers to oral healthcare manifest across urban contexts, and (2) explore how community networks including citizens, healthcare professionals, social workers, policy makers, and other local stakeholders can contribute to developing local solutions related to improving quality of oral healthcare for citizens in vulnerable circumstances. METHODS:A participatory action research design, guided by the Community Health Improvement Process, was used. Participants included citizens with lived experience of poverty or social exclusion, oral healthcare professionals, social workers, and policymakers. Data collection methods included semi-structured interviews, focus groups, co-creation meetings, and creative workshops. Data were analyzed using inductive thematic analysis. RESULTS:A total of 64 participants contributed to 21 interviews, 7 focus groups, and 4 co-creation meetings. Seven key barriers were identified: high treatment costs, limited insurance coverage, low oral health literacy, emotional and psychological factors (e.g., shame and fear), competing life priorities, limited support from professional organizations, and poor communication between social and oral healthcare services. Proposed solutions included walk-in consultations in community settings, buddy systems, improved support for navigating insurance, stronger integration of dental and social care, and oral health promotion through trusted local networks. CONCLUSION:Community-network approaches can substantially reduce inequalities in access to oral healthcare. Engaging citizens as co-creators enables inclusive and needs-based solutions and improvements. This study offers a promising model for improving oral healthcare accessibility by systematically identifying barriers and addressing them through community-based collaboration.

The Arabic version of the short form of the Health Literacy in Dentistry scale (HeLD) had not yet been developed in previously published studies. This study aims to test the reliability and validity of an Arabic version of the short form of the HeLD questionnaire. The short version of HeLD was translated into Arabic and the psychometric properties were evaluated in a sample of 1,889 female students in their first year of secondary school. Test–retest reliability was assessed using the intra-class correlation coefficient (ICC), and internal consistency reliability was assessed using Cronbach’s alpha. Content validity was investigated by creating a correlation matrix between the individual items of the HeLD-14, and criterion validity was determined using Pearson’s correlation between the HeLD-14 score and an overall oral health rating. Sensitivity analysis was assessed by testing the associations of the HeLD-14 score with oral health-related behaviours and residential area. The Arabic version of HeLD-14 (A-HeLD-14) had acceptable ICC (0.54) and excellent internal consistency (Cronbach’s alpha: 0.92). The correlations between the items of the A-HeLD-14 varied from 0.3 to 0.9. The A-HeLD-14 showed a statistically significant correlation with the overall oral health rating (r = 0.37, p < 0.001). The median A-HeLD-14 score was significantly higher in participants who brushed their teeth frequently (51.31), visited the dentist regularly (52.00), consumed fresh fruit frequently (51) and consumed soda or energy drinks infrequently (51.00) than participants who brushed their teeth infrequently (41.50), visited the dentist irregularly (49.00), consumed fresh fruit infrequently (47) and consumed soda or energy drinks frequently (48.00). The A-HeLD-14 instrument demonstrates sufficient validity, reliability, and sensitivity for measuring oral health literacy among the Arabic-speaking population.

Objectives: Oral health literacy (OHL) is suggested as an important denominator of oral health. This study aimed to identify ways to improve oral health by exploring the association between oral health literacy and oral health-related behaviours among female adolescents in the Eastern Province of the Kingdom of Saudi Arabia (KSA). Methods: This cross-sectional study assessed OHL among 1,889 10th grade female students in the Eastern Province of the KSA. OHL was assessed using an Arabic version of the short version of the Health Literacy in Dentistry scale (A-HeLD-14). Self-reported socio-demographic information and oral health-related behaviours (toothbrushing, dental attendance, and sugary diet consumption) were also collected. The relationship between OHL and oral health-related behaviours was investigated using binary logistic regression, adjusted for socio-demographic information. Results: The binary logistic regression analyses showed that poor OHL was significantly associated with infrequent toothbrushing (p < 0.001) and irregular dental attendance (p = 0.005) but not with consumption of sugary diets. All A-HeLD-14 domains were significantly associated with infrequent toothbrushing, and the domains concerning access, receptivity, and financial barriers were significantly associated with irregular dental attendance. The highest odds ratios (ORs) for infrequent toothbrushing were found in the domains of receptivity (OR = 4.19) and understanding (OR = 3.85) and for irregular dental attendance in the financial barriers (OR = 1.61) and access (OR = 1.49) domains, followed by the receptivity domain (OR = 1.35). Conclusion: Poor OHL was significantly associated with infrequent toothbrushing and irregular dental attendance. Interventions focusing on OHL are warranted to improve oral health-related behaviours and thereby oral health in the population. The aspects that seem most vital to target are improved access to dental care, including the reduction of economic barriers, as well as increased awareness of oral health in the population.

AbstractBackground and AimsDelayed implementation of new knowledge into clinical practice poses patient safety risks. This study investigates agreement on use of the dental caries interventions, sealing, and stepwise excavation.MethodsA cross‐sectional questionnaire survey, based on 11 constructed cases with descriptions of patient symptoms, radiographic, and clinical findings. Interrater agreement on dental caries‐ and pulp diagnoses and interventions were measured with Cohen's and Light's κ. The data collection period was September 28 to November 5, 2021. To explore variations in use and knowledge factors, we examined Danish dentists' attitudes toward continuing education.ResultsBased on 243 responses, moderate interrater agreement for dental caries and pulp diagnoses and weak agreement on interventions were seen. The agreement with the gold standard for caries was moderate. No agreement was found for dental pulp diagnosis, and for interventions the agreement was weak. No pattern in agreement with the gold standard was seen in relation to case difficulty level. The majority reported knowing of and using stepwise excavation, in conflict with findings that less than half chose stepwise excavation in cases, where considered appropriate. One in four (25%) reported to be unfamiliar with sealing, and half (50%) use sealing regularly. Better access to continuing education and for universities to offer continuing education as alternatives to one‐sided private market were requested.ConclusionSome patients may receive too radical treatment despite available less invasive evidence‐based effective treatments. Dentists acknowledge the importance of continuing education. Easier access and perhaps more incentives for seeking out high‐quality continuing education from trustworthy sources are needed.

OBJECTIVE:To determine whether tooth loss relates to patient experiences of masticatory or aesthetic problems and is a useful measure of oral health and treatment needs and to compare experiences of tooth loss among middle-aged and older Danes. BASIC RESEARCH DESIGN:Cross sectional online- and telephone interview questionnaire study. PARTICIPANTS:1,060 Danish citizens aged 40 years or older. MAIN OUTCOME MEASURES:Experiences of difficulties eating/enjoying food or smiling/showing of teeth due to tooth related problems within the last 6 months. Data analysis used tests of proportions and ordinal logistic regression. RESULTS:Half the participants had a full or almost full dentition. Among those with tooth loss, 21-44% reported difficulties eating/enjoying food. In ordinal logistic regression, difficulties eating were associated with being younger, having fewer teeth and having visibly missing teeth. Being unwilling to smile or show one's teeth was associated with being younger, having fewer teeth, having lower socioeconomic position and having visibly missing teeth. Wearing a prosthesis did not ameliorate eating difficulties or unwillingness to smile. CONCLUSIONS:Tooth loss is a meaningful measure of oral health but cannot stand alone. Many adults with even substantial tooth loss did not experience functional or aesthetic problems. Tooth loss is associated with negative masticatory and aesthetic experiences among middle-aged than older adults. Removable prostheses were not associated with better functional or esthetic outcomes.

BACKGROUND:Since 1972 The National Child Odontology Registry has collected data on the oral health of most of all Danish children and adolescents. However, comprehensive information on the registry has not previously been available, making it difficult to approach and use the registry for research purposes.METHODS:By combining historical documentation and simple descriptive statistics we provide an overview of major events in the timeline of The National Child Odontology Registry and discuss how they impact the available data. We provide a broad overview of the dental variables in the registry, and how the registration criteria for some of the core dental variables (gingivitis, periodontitis, and dental caries) have changed over time. We then provide examples of how aggregate variables for the core dental diseases, allowing for comparison across registration criteria, can be created.RESULTS:Most of the Danish population born during or after 1965 have a least one entry in the National Child Odontology Registry, with 68% having entries spanning their entire childhood and adolescence. The prevalence of gingivitis and periodontitis seem to increase significantly in the years immediately following changes in how registration criteria for these variables, raising questions as to whether these diseases are generally underreported, or subject to overreporting in the years following the registration changes. The mandatory ages of registration instituted in 2003, do not appear to have had a strong impact on the ages at which registrations are made. For variables not directly comparable across datasets due to changes in registration criteria aggregate variables of measurements can be computed in most cases.CONCLUSIONS:The National Child Odontology Registry provides a unique opportunity to study the impact of childhood oral health on life trajectories, but using the registry is not without issues, and we strongly recommend consulting with experts in the field of odontology to ensure the best use of available data.

OBJECTIVE:To investigate the impact of the Covid-19 pandemic on the patient flow and economy as experienced by dental practices in Denmark.MATERIAL AND METHODS:A survey regarding experience of patient flow, economical turnover, financial strain and willingness to pay for large treatments during the first year of the Covid-19 pandemic (March 2020 to March 2021), along with information on the characteristics of the practice (specialist practice, ownership, practice operation and size) was distributed to all dental practices in Denmark in March 2021.RESULTS:Of the 1728 practices, 581 (33.6%) answered the survey. A decline in patient flow and a decline in economical turnover were reported by 79% and 84.4% of the practices, respectively. Financial strain was reported by 15.8% and an increased willingness to pay for large treatments was reported by 32.1%. A large decline in turnover and financial strain were associated with non-specialized practices, practices with a single owner and small practices. Logistic regressions showed that practices not receiving referrals had an odds ratio of 2.34 (CI: 1.32-4.14) for having a large decline in economic turnover compared with practices receiving referrals and that small practices had an odds ratio of 1.92 (CI: 1.16-3.19) for reporting financial strain compared with large practices.CONCLUSIONS:Reportedly, the Covid-19 pandemic resulted in a decline in both patient flow and economical turnover in Danish dental practices. Large and more specialized practices seem to have managed the economic crisis better.

DELIVER (DELiberative ImproVEment of oRal care quality) is a multinational project funded under the EU's Horizon Europe program; we aim to develop a blueprint model for improving the quality of oral health care for everyone: the DELIVER Quality Improvement Model. We are a team of partners from Denmark, England, Germany, Malta, the Netherlands, Portugal, and Sweden who will use a mixed-methods research approach to create a synergistic problem-solving ecosystem to convert deliberative dialogues into meaningful support for improving the quality of oral health care. Together with citizens/patients, providers, payers, and policymakers, new quality improvement (QI) approaches will be codeveloped and coproduced in 3 phases (over 4 y): phase 1 involves defining quality of oral health care, situational analysis of the status quo of QI, and consenting of core quality indicators for a Europe-wide monitoring framework. Phase 2 involves in-depth analysis of select QI approaches: 1) QI in dental practices based on patient-reported outcome and experience measures (PROMs/PREMs), 2) community-based QI for vulnerable groups, and 3) quality-oriented commissioning of oral health services. In addition, the regulatory determinants of oral health care QI will be scrutinized. In phase 3, the knowledge gained from phases 1 and 2 will be used to develop the DELIVER Quality Toolkit, a resource containing manuals and digital tools to support context-specific implementation of oral health care QI. DELIVER is anticipated to contribute to positive changes in oral health systems. Knowledge Transfer Statement: The EU DELIVER project aims to enhance the quality of oral health care through codevelopment and coproduction of solutions together with citizens/patients, providers, and policymakers. The unique multicountry nature of the project will facilitate fast-track prototype development and testing of innovative QI approaches in select countries. Reflective learning regarding the transferability of findings between different countries and settings offers unique opportunities to drive progress toward context-specific implementation of innovative oral health care QI approaches. The collective knowledge gained from the 7 European countries involved in DELIVER can also generate knowhow for improving the quality of oral health care in other countries around the globe.

Bakgrunnur: Lýsing og samanburður á skipulagi tannhaldsmeðferðar á Norðurlöndum getur verið stjórnmálamönnum og öðrum aðilum sem skipuleggja heilbrigðisþjónustu hvatning við áframhaldandi þróun skilvirkrar tannheilbrigðisþjónustu. Ekki liggur fyrir samræmt mat á hagkvæmni tannhaldsmeðferðar samanborið við hve vel hún mætir þörfum íbúa. Aðferð: Kerfisbundin heimildaleit var ekki gerð en þekking allra greinarhöfunda á nýjustu rannsóknum þessa efnis var nýtt til að setja fram lýsandi yfirlit um skipulag tannhaldsmeðferðar. Niðurstöður: Á öllum Norðurlöndum er bæði einkarekin og opinber tannhaldsmeðferð veitt samkvæmt þörf og niðurgreiðslur vegna kostnaðar við tannhaldsmeðferð gegnum heilbrigðistryggingar eru á bilinu 0% til 70%. Sjúklingar með sérþarfir geta fengið sérstakan styrk til viðbótarmeðferðar og aðgang að opinberum tannlæknastofum til viðbótar við einkareknar stofur. Ályktanir: Skortur á gögnum um skilvirkni tannhaldsmeðferðar í almennum tannlækningum kemur í veg fyrir samanburð milli landa. Á sumum Norðurlöndum eru vísbendingar um að þarfir fyrir tannhaldsmeðferð séu ekki uppfylltar. Samræmt eftirlit með árangri tannhaldsmeðferðar er ráðlegt til að unnt sé að meta betur skilvirkni núverandi meðferðarkerfa og áætla framtíðarþörf.

OBJECTIVES Persons with Parkinson's disease (PD) have a higher prevalence of oral diseases and orofacial dysfunction, but knowledge about the use of dental care and whether their dental care needs are met is sparse. This study aimed to investigate the dental attendance and usage of dental care services of the total PD population in Denmark and compare it with a control group. METHODS National registers were used to identify the total PD population in Denmark (n = 6874) and to obtain data on their dental care from 2015 to 2019. These data were compared with a five-fold age-, gender- and geographically matched control group without PD (n = 34 285). Register data on age, gender, civil status, educational level, income, nursing homes status and mortality were also collected and adjusted for in the analyses. The dental attendance was analysed using χ2 -test with Bonferroni correction, and the type of dental care services was analysed using negative binomial regression analysis. RESULTS A significantly higher proportion of persons with PD were irregular attenders of the dental care system (21.0%), compared with the control group (16.9%). Persons with PD had a significantly higher overall usage of dental cares services. Most prominent was the high usage of treatment services, where persons with PD had a 1.50 times higher incidence rate of tooth extractions and a 1.71 times higher incidence rate of tooth fillings in the five years compared with the control group. CONCLUSION Persons with PD are more often irregular users of dental care and receive more treatment services than the control group. This indicates a need for high-quality prophylactic initiatives to prevent high filling and tooth extraction rates. Furthermore, this knowledge can be used by clinicians and decision makers to ensure optimal dental care for persons with PD.

Abstract Objective Planning and evaluation of oral healthcare systems rely on monitoring of care patterns. Monitoring periodontal care patterns provide information on the burden and occurrence of periodontitis in the population and on the direct financial cost. The aims of the study were to describe patterns in periodontal care among dental care attenders that might incite subsequent investigation and revised treatment guidelines. Secondly, to estimate the direct societal costs of periodontal care. Material and methods A retrospective register-based study utilising data from the Danish Public Health Insurance which includes all dental care attenders in 2012–2016, three years before and one year after a national risk-based recall maintenance program was rolled out in Denmark. Results The 2.7 million yearly dental care attenders corresponded to ∼60% of the eligible population and in the range of 20–24% received periodontal care. Total expenditure for periodontal care in Denmark increased by 13% from 2012 to 2016, from €78 to €88 million. The proportion of total healthcare funding spent on periodontal care was 0.61% in 2016. Conclusions Patients with periodontitis have large out-of-pocket yearly expenses for periodontal care. Despite small changes in periodontal clinical practice that may indicate improved targeting of patients in need of periodontal care, challenges of reaching non-attenders and non-adherence to care are unsolved. More research into outcomes from periodontal therapy in daily practice, seen from both normative and patient perspectives, would help establish knowledge of the efficiency of existing periodontal care systems and help identify barriers and facilitators for attending care in Denmark.

Nýting eða aðsókn að tannlæknaþjónustu er skilgreind sem hlutfall ákveðins hóps sem fær tannlæknaþjónustu á tilteknu tímabili. Skilgreining þess hvað telst regluleg tannlæknaþjónusta tekur mið af einstaklingsbundnum þörfum. Skipulag tannlæknaþjónustu á Norðurlöndum deilir mörgum sameiginlegum þáttum þar sem hugmyndafræðin er sú að íbúar hafi rétt á jöfnu aðgengi að heilbrigðisþjónustu. Almennt er aðsókn íbúa Norðurlanda að tannlæknaþjónustu góð sem og skilningur á þörf fyrir reglulega tannlæknaþjónustu. Aðsókn sem er lægri en 100% á ársgrundvelli má að hluta til útskýra með því að munn- og tannheilsa íbúa Norðurlanda fer stöðugt batnandi og því eru sífellt fleiri einstaklingar sem ekki þurfa lengur á árlegu eftirliti að halda. Vísbendingar eru þó um að aðrir þættir komi þar einnig við sögu, svo sem tannlæknaótti, félags- og efnahagslegir þættir, erfiðleikar við aðgengi og kostnaður. Sumir þjóðfélagshópar, sérstaklega aldraðir og félagslega viðkvæmari hópar njóta ekki góðs af núverandi kerfi sem skyldi. Þessi staðreynd er bagaleg, bæði frá siðferðilegu og lagalegu sjónarmiði.

Udnyttelse af tandplejen defineres

Objectives A proof-of-concept study has shown that the Added Value for Oral Care (ADVOCATE) Field Studies approach (academic detailing with feedback data) is considered a feasible, useful, and acceptable way to motivate general dental practitioners (GDPs) to reflect on and, if required, change their oral health-care delivery. The aims of this proof-of-principle study were to test whether such results were reproducible and to reach consensus among stakeholders on recommendations for wider implementation. Methods Eleven groups of GDPs were recruited in 6 countries (Denmark, England Germany, Hungary, Ireland, and The Netherlands). Each group had 3 academic detailing meetings, being stimulated by feedback data. Focus group interviews were held to evaluate the reproducibility of the Field Studies approach. A World Cafe session explored suggestions for the wider implementation of the approach. Results Replicable results on feasibility, acceptability, and usefulness of the Field Studies approach were seen; 7 out of 9 themes identified in the proof-of-concept study were validated. Directed content analyses identified that adjustments to procedures to collect and present feedback data were desirable. Overall, the approach can stimulate GDPs to reflect on and change aspects of their oral health-care delivery. Conclusions The Field Studies approach, after some adjustments to data collection procedures, is ready for further testing in larger studies.

Background: Academic detailing (AD) is a defined form of educational outreach that can be deployed to intrinsically motivate practitioners towards improving quality of care. This paper describes the design of the ADVOCATE Field Studies. This proof of concept study aims to evaluate the feasibility, acceptability and usefulness of AD, reinforced with feedback information to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs). Methods: Six groups of GDPs will be recruited; two groups of six to eight GDPs in each of three countries - the Netherlands, Germany and Denmark. GDPs will meet for four Academic Detailing Group (ADG) meetings for open discussions using comparative feedback data to stimulate debate about their dental practice performance and care delivery. Group meetings will be moderated using the AD methodology. Qualitative data will be collected through focus group interviews, an online discussion forum, field notes and debriefs of ADG meetings and analysed by conventional content analysis using MaxQDA software. Discussion: The results of the study will provide novel information on the feasibility, perceived acceptability and usefulness of AD and feedback data for GDPs to improve oral healthcare delivery.

Equipping health systems with suitable incentives for efficient resource allocation remains a major health policy challenge. This study examines the impacts of 2015 regulatory changes in Danish dental care which aimed at effectuating a transition from six-to-twelve-monthly dental recall intervals, for every patient, towards a model where patients with higher need receive dental recalls systematically more frequently than patients with lower need. Exploiting administrative data from the years 2012-2016 from the Danish National Health Insurance database containing 72,155,539 treatment claims for 3,759,721 unique patients, we estimated a series of interrupted time-series regression models with patient-level fixed-effects. In comparison to the pre-reform period, the proportion of patients with recall intervals of up to 6 months was by 1.2%-points larger post-implementation; that of patients with 6-12-monthly recalls increased by 0.7%-points; that of patients with more than 12-monthly dental recalls decreased by 1.9%-points. The composition of care shifted more substantially: the proportion of treatment sessions including preventive care increased by 31.5%-points (95%-CI: 31.4;31.6); that of sessions including scaling increased by 24.1%-points (24.0;24.2); that of sessions including diagnostics decreased by 34.5%-points (34.4;34.6). These findings suggest that dental care providers may have responded differently to regulatory changes than intended by the health policy.