Pre-medical dental evaluation and treatment of oral infection – a survey study among hospital-affiliated dentists in Sweden

Figures & data

Table 1. Summary of the six patient cases included in the survey.

Case 1 – 16 teeth: Poor oral hygiene. General increased pocket depth with bleeding on probing. Marginal bone loss approximately ½ the length of the root.	Case 2 – 1 tooth: Asymptomatic root canal treated upper left second premolar with apical radiolucency. Root canal treatment >5 years ago, root canal and crown appear adequate.
Case 3 – 13 teeth: Poor oral hygiene. Numerous large caries lesions and apical infections. General pocket depth 4–6 mm, marginal bone loss approximately ^1/3 the length of the root.	Case 4 – 4 teeth: Three impacted third molars. Asymptomatic root canal treated lower left first molar with apical radiolucency of the distal root – root canal and coronal filling appear adequate.
Case 5 – 5 teeth: Good oral hygiene. Three impacted third molars. No general marginal bone loss but substantial inter-radicular bone loss lower right first and second molars.	Case 6 – 11 teeth: Numerous large caries lesions. Lower left first molar apical bone destruction. Upper right third molar and upper left second molar impacted.

Figure 1. Example of a patient case included in the survey.

Figure 2. Model for grouping of consensus on the choice of dental treatment. High consensus: ≥75% of participants agreed on choice of dental treatment. Moderate consensus: 50–74% of participants agreed on choice of dental treatment. Low consensus: <50% of participants agreed on choice of dental treatment. Treatments A–D different for each patient case.

Figure 3. Model for grouping of variability of the choice of dental treatment. High variability: ≥50% of participants altered their treatment selection in relation to underlying medical issue. Moderate variability: 25–49% of participants altered their treatment selection in relation to underlying medical issue. Low variability: <25% of participants altered their treatment selection in relation to underlying medical issue.

Figure 4. Flow-chart of study participation. w: Women; m: men.

Figure 5. Estimation of the importance of dental evaluations in relation to the various medical situations. HVS: Heart valve surgery; CT: chemotherapy; RT: radiation therapy; EC: endocarditis; IVBP: intravenous bisphosphonate treatment; SOT: solid organ transplantation.

Figure 6. Views on the level of scientific evidence for performing dental evaluations in relation to the various medical situations. HVS: Heart valve surgery; CT: chemotherapy; RT: radiation therapy; EC: endocarditis; IVBP: intravenous bisphosphonate treatment; SOT: solid organ transplantation.

Figure 7. Estimation of risk for complications if patients in cases 1–6 were to be left without dental treatment in relation to the various medical situations. HVS: Heart valve surgery; CT: chemotherapy; RT: radiation therapy; EC: endocarditis; IVBP: intravenous bisphosphonate treatment; SOT: solid organ transplantation.

Figure 8. Correlation between estimated risk for complications and rate of extractions. Y-axis: proportion of estimations in each case where extraction was selected. X-axis: estimated risk for complications. Each dot represents a case assessed by a participant having defined the risk in percentage.

Figure 9. Relation between estimated risk for complications and participant years of experience of working with hospital-affiliated dentistry. Each dot represents a case assessed by a participant having defined the risk in percentage.

Figure 10. Case 2: Proposed treatment for an asymptomatic root canal treated upper left second premolar with apical radiolucency in various medical situations. HVS: Heart valve surgery; CT: chemotherapy; RT: radiation therapy; EC: endocarditis; IVBP: intravenous bisphosphonate treatment; SOT: solid organ transplantation. Other treatment unspecified by participants.