First dental hygienist to become professor

I am meeting Kajsa H. Abrahamsson at “Odontologen” in Gothenburg, where she has worked for over 25 years. She has been a pioneer in many ways during her long career. In 2003, she became one of the first dental hygienists to publicly defend her doctoral thesis in Sweden, and now she was named only the fourth professor in the country with that background – the first at the University of Gothenburg.

“Many dental hygienists may not think about the opportunities that exist, and as pioneers, we have been able to pave the way. A professorship in oral health sciences strengthens the development of the field here at the University, and I think it means a lot to our students that the professors they meet are not just dentists,” says Kajsa H. Abrahamsson.

She notes that the field of oral health is academically well established at the University. Two of her dental hygienist colleagues are associate professors, and the program has several teachers with doctoral degrees.

“In total, only 44 dental hygienists in the country have a doctorate, and several of them are affiliated with the University of Gothenburg. We operate as a team of colleagues who do a lot of research together and who support and help each other.”

A long journey

Her own career has been driven by a desire to constantly evolve. She realized how much she enjoyed working in dentistry as a dental assistant at a young age. At the time, the vocational program to become a dental hygienist consisted of a one-year extension for dental assistants. Kajsa H. Abrahamsson graduated with a university diploma in dental hygiene in 1982, in one of the first student cohorts in Gothenburg.

“It was a fun and independent job, but I soon found myself at something of an impasse. I wanted to continue my studies and go further.”

She combined her job as a dental hygienist with part-time studies in psychology and earned a master’s degree. She thought of changing her profession to working in management and work organization, but chance brought her back to dentistry: 

“I completed a master’s degree project on phobic dental anxiety, which eventually resulted in my thesis on the same topic, with professor Ulf Berggren as my supervisor.”

From dental anxiety to prevention of periodontitis

After defending her thesis in 2003, she was promoted to senior lecturer, with a new line of research focusing on the prevention and treatment of periodontal diseases among both adolescents and adults. Gingivitis (inflammation of the gums) is a condition that can be reversed, but without treatment it can develop into periodontitis, a chronic condition that involves the breakdown of tooth-supporting tissues. If allowed to progress, the disease results in tooth loss. Periodontitis is common; in Sweden, about 40 percent of the adult population show signs of the disease. It is important to establish infection control to prevent the onset or progression of disease, and patients’ daily home care is critical in this regard.

“It can be difficult to motivate young people to perform the level of home care necessary to prevent a disease that may occur 30 years later. Maintaining good oral hygiene can be tedious for patients, but we know that it is absolutely essential in order to prevent periodontal disease progression. If the patient is not on board, it does not matter what we professionals do in terms of dental care.”

Despite the dental care and education that children and adolescents generally receive in Sweden, large groups of young people do not practice good oral hygiene, and they limited understanding of the causes of gum inflammation. Promoting behavioral change and inspiring patients to maintain adequate oral hygiene is an important part of the work of dental hygienists. But what is the best way to convey important information?

Intervention for improved oral hygiene among adolescents

In a study, conducted by doctoral student Sandra L. Dimenäs, adolescents were offered an oral hygiene intervention that has previously been shown to be effective in adults. The intervention, based on health psychological theory, was performed by dental hygienists trained to use person-centered communication in the dialogue with the adolescent patient.

“In addition to knowledge, individuals also need to see how a change in their behavior will benefit them, not only in the long- but also in the short-term. The intervention involves a motivational conversation between the dental hygienist and the patient, during which the individual goals for the individual’s health and health behavior are discussed. They also discuss the support patients can receive in practical terms to maintain the desired behavior.”

More than 300 young subjects received either the theory-based intervention or conventional information from their dental hygienist. Six-month results showed that the theory-based intervention was more effective. Now the research team is moving on to see how the results stand over time. The aim is to develop more effective ways to encourage young patients to adopt behaviors that benefit their oral health.

Treatment of periodontitis in adults

Another important task for dental hygienists is to treat established periodontitis, often by instrumentation of deepened periodontal pockets. The therapy typically starts with removing bacterial plaque that has formed in the pockets with hand or with ultrasonic intruments, or a combination thereof. This treatment is usually completed during several visits. The dental hygienist may also choose to condense the time of instrumentation to a single visit in order to avoid over-treatment. This approach is commonly known as full-mouth treatment.

Kajsa H. Abrahamsson describes a large field study she and her colleagues have just completed, evaluating how well these methods work in everyday clinical practice. This randomized study, which involved 700 patients and 90 dental hygienists within in the Swedish Dental Service in Region Västra Götaland, was initiated by Professor Jan L. Wennström prior to his death in 2021.

In previous randomized, controlled trials, often conducted in specialist clinics, both methods were shown to produce equivalent results in terms of clinical outcomes.

“The unique aspect to our study is that we could show that the methods are equally effective also when the treatment is carried out in everyday clinical practice,” says Kajsa H. Abrahamsson.

Although both approaches perform equally, limiting the treatment to a single visit has advantages both in terms of less chair time and less number of visits. Kajsa H. Abrahamsson points out that regardless of the method chosen for instrumentation, patient-performed home care is still crucial for a successful treatment.

“This study also shows that the patient’s sense of involvement in the treatment was critical for the outcome.”

A former doctoral student, Anna Liss, recently defended her thesis based on this field study. The research group is now conducting an 18-month follow-up. They are also proceeding with registry-based studies, including data from the comprehensive SKaPa registry (Swedish quality registry for caries and periodontal disease), to analyze how treatment continues and whether patients with periodontitis receive care on equal terms.

BY: ELIN LINDSTRÖM