Publications
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Ringstad, Ingrid Beate; Skovlund, Eva; Santervas, Leonor Roa; Kersten, Hege; Fjeld, Katrine Gahre & Hove, Lene Hystad
[Show all 9 contributors for this article]
(2026).
Association Between Anticholinergic Burden and Dry Mouth Severity in Acutely Ill Older Adults.
Drugs & Aging.
ISSN 1170-229X.
43(4),
p. 361–371.
doi:
10.1007/s40266-026-01286-w.
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Background: Dry mouth is a common and burdensome condition in older adults and its severity may increase with use of anticholinergic medications. The aims were to describe anticholinergic medication use among acutely ill older adults, examine the association between anticholinergic burden and dry mouth severity using the composite Dry Mouth Severity Points (DMSP) measure and investigate whether the association differs by sex.
Methods: Patients ≥70 years admitted to Oslo municipal inpatient acute care unit were eligible. Anticholinergic burden (ACB) was assessed using the ACB calculator and classified as 0, lower (ACB = 1-2) or high (ACB = ≥ 3). Dry mouth severity was quantified with DMSP, range 0-4, assigning one point for each indicator above cut-off: General Xerostomia Question ≥ 3, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6 and unstimulated whole saliva secretion rate ≤ 0.1 mL/min. Associations were examined with ordinal logistic regression.
Results: Of 382 examined patients, 256 (mean age 84 ± 7 years, 70% women) had complete data. Mean [standard deviation (SD)] ACB score was 2.0 (1.7); 18% had ACB = 0, 50% had ACB = 1-2 and 32% had ACB = ≥ 3. DMSP scores of 0, 1, 2 and ≥ 3 were present in 29%, 36%, 23% and 12%, respectively. Compared with patients with ACB = 0, those with ACB = 1-2 [odds ratio (OR) = 2.06, 95% confidence interval (CI) 1.07-3.97) and ACB = ≥ 3 (OR = 2.25, 95% CI 1.09-4.63) had higher odds of more severe dry mouth. Women had significantly higher ACB and DMSP scores than men.
Conclusions: Even lower anticholinergic burden was associated with greater dry mouth severity, highlighting the need for early recognition and proactive management in acutely ill older adults.
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Ringstad, Ingrid Beate; Romskaug, Rita; Santervas, Leonor Roa; Fjeld, Katrine Gahre; Hove, Lene Hystad & Skovlund, Eva
[Show all 8 contributors for this article]
(2025).
Oral Health, Xerogenic Medications, and Frailty in Acutely Ill Older Adults.
Journal of The American Geriatrics Society.
ISSN 0002-8614.
73(8),
p. 2466–2474.
doi:
10.1111/jgs.19564.
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Background
Oral health is an essential part of overall health and well-being in older adults and may be influenced by medications and frailty. This study aimed to describe the prevalence of xerostomia and hyposalivation and examine their associations with xerogenic medications and frailty in acutely ill older adults.
Methods
This cross-sectional study included patients aged ≥ 70 years admitted to the Municipal In-Patient Acute Care unit in Oslo, Norway. General xerostomia was defined as a score ≥ 3 on the General Xerostomia Question (GXQ). Specific xerostomia was measured with the Summated Xerostomia Inventory (SXI). Objective dry mouth measures included unstimulated whole saliva (UWS) secretion rate and the Clinical Oral Dryness Score (CODS), with hyposalivation defined as UWS ≤ 0.1 mL/min. Examination of dentition included numbers of missing teeth and posterior occluding pairs of teeth. Medication data included total drug burden and number of xerogenic medications. Frailty was assessed using the Clinical Frailty Scale (CFS). Associations were analyzed using logistic regression models.
Results
Among 382 patients (mean age 84 years, 72% women), general xerostomia was present in 30% and hyposalivation in 56%. Mean number (SD) of xerogenic medications was 3.7 (±2.2). The number of xerogenic medications used was significantly associated with general xerostomia in both unadjusted (OR: 1.17, 95% CI: 1.05–1.29) and adjusted models (OR: 1.13, 95% CI: 1.01–1.26). Median UWS declined numerically with increasing number of xerogenic medications. Higher CFS scores were associated with increased subjective xerostomia scores (GXQ and SXI), elevated CODS, more missing teeth, and reduced occlusion, but not with general xerostomia or hyposalivation when predefined cut-off values were applied.
Conclusion
Xerostomia and hyposalivation were common among acutely ill older adults. General xerostomia was associated with xerogenic medication use and frailty. Our findings highlight the need to incorporate oral health assessments into routine geriatric care and emphasize the importance of interdisciplinary collaborations.
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Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad
[Show all 10 contributors for this article]
(2023).
Identification and susceptibility testing of oral candidiasis in advanced cancer patients.
BMC Oral Health.
23(1).
doi:
10.1186/s12903-023-02950-y.
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Background Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity. Methods An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014–2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied. Results Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2–3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin. Conclusion C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer. Trail registration The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.
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Monsen, Ragnhild Elisabeth; Herlofson, Bente Brokstad; Gay, Caryl; Fjeld, Katrine Gahre; Hove, Lene Hystad & Malterud, Karl Egil
[Show all 11 contributors for this article]
(2021).
A mouth rinse based on a tea solution of Salvia officinalis for oral discomfort in palliative cancer care: A randomized controlled trial.
Supportive Care in Cancer.
ISSN 0941-4355.
doi:
10.1007/s00520-021-06021-2.
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Background: Few clinical studies evaluate interventions to reduce oral discomfort among patients in palliative care.
Aim: This study examines the efficacy of a Salvia officinalis (SO) based herbal mouth rinse compared to conventional normal saline (NS) in order to improve oral health.
Design: A block-randomized controlled trial. Data were collected before and after a 4-day intervention with either SO (n=44) or NS (n=44). Numerical rating scales (NRS, 0-10) and 12 items from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Oral Health 17 (EORTC QLQ-OH17) measured patient-reported oral symptoms. An oral examination was performed before and after the intervention.
Setting/participants: This study included adult patients with late-stage cancer in an inpatient hospice unit.
Results: Of the 88 patients included (mean age=63.9 years, SD=10.6), 73 (83%) completed the study. At baseline, 78% reported dry mouth on the EORTC QLQ-OH17, and 80% rated dry mouth ≥4 on the NRS. Total oral health scores based on the 12 EORTC QLQ-OH17 items improved similarly in both groups (p
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Fjeld, Katrine Gahre; Eide, Hilde; Mowe, Morten; Sandvik, Leiv & Willumsen, Tiril
(2018).
A 1-year follow-up of a randomized clinical trial with focus on manual and electric toothbrushes’ effect on dental hygiene in nursing homes.
Acta Odontologica Scandinavica.
ISSN 0001-6357.
76(4),
p. 257–261.
doi:
10.1080/00016357.2017.1416166.
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Objective: A 2-month randomized clinical trial (RCT) study comparing electric and manual toothbrushes used by residents in nursing homes showed significant reduction in plaque score for both groups. The aim of this follow up study was to study if the effect sustained in a longer perspective when toothbrushes were used according to resident’s own preference.
Materials and methods: One year after baseline of the RCT-study, 100 participants were re-examined. The simplified oral hygiene index (OHI-S) was used as outcome measure on dental plaque.
Results: The mean age was 86.6, 78.1% had three or more medical diagnoses and 52.2% had moderate to severe cognitive impairment. The mean number of natural teeth was 18.8. After 1 year, mean plaque scores was significantly reduced within the population, from 1.2 to 0.7 (p < .001). A total of 46 participants preferred to use an electric toothbrush and 54 preferred manual. No significant difference in plaque score was found between electric and manual toothbrushes.
Conclusion: After 1 year, the improvement in dental hygiene from the RCT study sustained for users of both electric and manual toothbrush. Focus upon tooth brushing seems to be efficient and both manual and electric toothbrushes should be available in nursing homes.
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Fjeld, Katrine Gahre; Eide, Hilde; Mowe, Morten; Hove, Lene Hystad & Willumsen, Tiril
(2017).
Dental hygiene registration: development, and reliability and validity testing of an assessment scale designed for nurses in institutions.
Journal of Clinical Nursing (JCN).
ISSN 0962-1067.
26(13-14),
p. 1845–1853.
doi:
10.1111/jocn.13452.
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Abstract
Aims and Objectives
To develop and test the Dental Hygiene Registration (DHR), a dental hygiene assessment scale for nurses working in institutions.
Background
Removal of dental plaque is a key factor in preventing oral health related diseases. A simple, but reliable dental hygiene assessment scale that enables nurses to monitor residents’ dental hygiene on a daily basis, will improve monitoring oral hygiene status and quality of dental health care.
Design
Descriptive study on the development and evaluation of a dental hygiene registration instrument.
Methods
The DHR was developed and tested over several stages during the period of 2011–2014. DHR consists of a five-point-plaque score scale. The score indicates whether measures are needed.
A reference group comprising both medical and dental personnel designed DHR. Dental plaque was used as a measure of dental hygiene. A pictorial series of teeth with varying amounts of plaque was used to achieve intra-examiner agreement. DHR assessments were scored fifty times to assess inter-examiner reliability between one dental hygienist and one clinical nurse. DHR was validated against the plaque index score of the Oral Hygiene Index (OHI-S). The Regional Ethics Committee approved the study (2011/915).
Results
Estimates for intra-examiner agreement on plaque score were good for the dental hygienist (kappa=0.7) and very good for the clinical nurse (kappa=0.8). Estimates for inter-examiner reliability for DHR between the dental hygienist and the clinical nurse was moderate (kappa=0.4). DHR corresponded significantly with OHI-S (Spearman's correlation coefficient=0.8, p<0.001) indicating good validity.
Conclusion
The developed DHR appears to be reliable and valid.
This article is protected by copyright. All rights reserved.
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Matri, Kristine Lindstad; Willumsen, Tiril & Fjeld, Katrine Gahre
(2015).
Nye evidensbaserte tiltak for å bedre oral helse hos eldre siste 10 år.
Den norske tannlegeforenings Tidende.
ISSN 0029-2303.
125(10),
p. 872–877.
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Fjeld, Katrine Gahre; Mowe, Morten; Eide, Hilde & Willumsen, Tiril
(2014).
Effect of electric toothbrush on residents' oral hygiene: a randomized clinical trial in nursing homes.
European Journal of Oral Sciences.
ISSN 0909-8836.
122(2),
p. 142–148.
doi:
10.1111/eos.12113.
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Maroufi, Sada; Milanovic, Blagica; Hove, Lene Hystad; Høyvik, Ann Catrin; Torgersen, Gerald R. & Fjeld, Katrine Gahre
(2025).
SimSamBot – Development of an AI-Based Training Robot Assisting Students in Communication with Dementia Patients.
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Background
The increasing prevalence of dementia presents unique challenges for dental professionals, particularly in communication and patient management. Effective communication is critical to providing compassionate, patient-centered care, yet dental students often lack the necessary training to interact confidently with dementia patients.
Aims and Objectives
This project aims to equip dental students with the skills and knowledge required to communicate effectively with dementia patients. Specific objectives include: 1 Developing a communication training module tailored to dementia care; 2 Enhancing students’ ability to recognize and adapt to the needs of patients with cognitive decline; and 3 Promoting empathy and understanding through experiential learning approaches.
Materials and Methods
A large language model (LLM) acting as communication robot is supplied with data on the patient groups it simulates. Information is collected through literature reviews and audio recordings of clinical consultations with dementia patients, with consent from the healthcare provider, patient and relatives if needed. Recordings are anonymized and transcribed immediately after consultations, with the original recordings subsequently deleted. Only anonymized data is used in the robot.
Results
While full implementation is forthcoming, anticipated outcomes include improved student confidence in communicating with dementia patients, enhanced empathy, and better preparedness for clinical practice.
Discussion and Conclusion
This initiative addresses a critical need in dental education by preparing students for the complexities of dementia care. By fostering effective communication skills, this project aligns with ADEEʼs vision of reimagining education to meet evolving societal needs. The outcomes will contribute to improved oral health care for dementia patients while advancing the pedagogical standards of dental education globally.
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Øvre, Ingrid Berget; Brelin, Jenny Alexandra; Nortvedt, Per; Fjeld, Katrine Gahre & Rønneberg, Anne
(2024).
Etiske problemstillinger i odontologistudiet - En tematisk analyse av odontologistudenters refleksjonsnotater.
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Santervas, Leonor Roa; Wyller, Torgeir Bruun; Skovlund, Eva; Jensen, Janicke Liaaen; Fjeld, Katrine Gahre & Hove, Lene Hystad
[Show all 11 contributors for this article]
(2024).
Cooperation across healthcare service levels for medication reviews in older people with polypharmacy admitted to a municipal in-patient acute care unit (The COOP II Study): study protocol for a randomized controlled trial.
Trials.
25(1).
doi:
10.1186/s13063-024-08442-w.
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Background: Polypharmacy and inappropriate drug use are associated with adverse health outcomes in older people. Collaborative interventions between geriatricians and general practitioners have demonstrated effectiveness in improving clinical outcomes for complex medication regimens in home-dwelling patients. Since 2012, Norwegian municipalities have established municipal in-patient acute care (MipAC) units, designed to contribute towards reducing the number of hospital admissions. These units predominantly serve older people who typically benefit from multidisciplinary approaches. The primary objective of this study is to evaluate the effect of cooperative medication reviews conducted by MipAC physicians, supervised by geriatricians, and in collaboration with general practitioners, on health-related quality of life and clinical outcomes in MipAC patients ≥ 70 years with polypharmacy. Additionally, the study aims to assess the carbon footprint of the intervention. Methods: This is a randomized, single-blind, controlled superiority trial with 16 weeks follow-up. Participants will be randomly assigned to either the control group, receiving usual care at the MipAC unit, or to the intervention group which in addition receive clinical medication reviews that go beyond what is considered usual care. The medication reviews will evaluate medication appropriateness using a structured but individualized framework, and the physicians will receive supervision from geriatricians. Following the clinical medication reviews, the MipAC physicians will arrange telephone meetings with the participants’ general practitioners to combine their assessments in a joint medication review. The primary outcome is health-related quality of life as measured by the 15D instrument. Secondary outcomes include physical and cognitive functioning, oral health, falls, admissions to healthcare facilities, and mortality. Discussion: This study aims to identify potential clinical benefits of collaborative, clinical medication reviews within community-level MipAC units for older patients with polypharmacy. The results may offer valuable insights into optimizing patient care in comparable municipal healthcare settings. Trial registration: The study was registered prospectively on ClinicalTrials.gov 30.08.2023 with identifier NCT06020391.
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Ringstad, Ingrid Beate; Fjeld, Katrine Gahre & Hove, Lene Hystad
(2023).
Gerodontologiske vurderinger og behandlinger anno 2023.
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Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad
[Show all 10 contributors for this article]
(2022).
Orale soppinfeksjoner - mer enn Candida albicans: mikrobiologiske analyser av prøver fra alvorlig syke pasienter med kreft.
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Bakgrunn
Pasienter med alvorlig kreftsykdom er utsatte for orale soppinfeksjoner, grunnet sykdommen, kreftbehandling og/eller svekket immunforsvar. Orale soppinfeksjon påvirker pasienters matlyst, ernæringstilstand og livskvalitet. Candida albicans er en vanlig soppart i munnhulen, men forekomst av non-albicans Candida-arter, og i kombinasjon med C. albicans, er økende. Artene har varierende toleranse for antimykotiske midler, det kan gi behandlingsutfordringer.
Hensikten med studien var å identifisere og resistensteste Candida sopparter i munnhulen til alvorlig syke pasienter med kreft.
Metode
Sopprøver tatt under studien Oral Health in Advanced Cancer i perioden 2014 – 2016, ble analysert høsten 2020. Pasientprøvene ble re-dyrket ved Institutt for oral biologi, Universitetet i Oslo. Soppartene ble identifisert biokjemisk og ved DNA sekvensering, og resistenstestet for antimykotiske legemidler: fluconazole, amphotericin B, anidulafungin og nystatin.
Resultat
Vi analyserte totalt 56 isolater fra 45 pasienter og identifiserte syv Candida arter og en Saccharomyces. Til sammen hadde 36 pasienter oppvekst av én soppart, og 9 pasienter hadde 2 til 3 ulike sopparter i munnhulen. Av C. albicans artene var 39 av 40 følsomme for fluconazole. To Candida parapsilosis og en Candida tropicalis var resistent mot anidulafungin. En C. tropicalis var resistent mot anidulafungin. En Candida glabrata var resistent mot fluconazole.
Konklusjon
Studien viste at forskjellige Candida arter forekommer både i monoinfeksjoner og blandingsinfeksjoner. C. albicans var dominerende med høy følsomhet for antimykotiske midler. Blandingsinfeksjoner kan komplisere behandlingen og forårsake gjentagende infeksjoner. Mikrobiologiske prøver og analyser med identifisering og resistenstesting, bør være en del av utredningen hos pasienter med alvorlig og tilbakevendende orale soppinfeksjoner.
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Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad
[Show all 10 contributors for this article]
(2022).
Identification and susceptibility testing of oral candidiasis in advanced cancer patients – an important diagnostic tool.
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Background: Candida albicans is the most common fungal species detected in the oral cavity. Studies of oral fungal samples have shown an increased prevalence of non-C. albicans species in mixed infection with C. albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azole. This may have implications for treatment, due to acquired antifungal resistance.
Aims: To assess the diversity and susceptibility of detected Candida species in the oral cavity in patients with advanced cancer.
Methods: Clinical fungal isolates sampled in 2014-2016 from 45 patients in a hospice unit were analyzed. A total of 56 isolates were grown on chromID Candida plates. After phenotypic identification by colour of the colonies, one single colony of each species was re-cultivated and prepared for identification on a VITEK2® system. Susceptibility testing with E-test was performed on RPMI agar, and the antifungal agents fluconazole, amphotericin B, anidulafungin and nystatin were tested.
Results: A total of 56 Candida isolates were identified. The diversity of Candida species was dominated by C. albicans at 89%, followed by C. glabrata 11%, C. parapsilosis 7%, C. tropicalis 4%, C. krusei 2%, C. guilliermondii 2% and C. dubliniesis 2%. Thirty-six patients had monoculture, and nine patients had 2-3 different species detected. Almost all C. albicans strains (97.5%) were susceptible to fluconazole. One C. parapsilosis and one C. tropicalis strain were resistant to anidulafungin. One C. glabrata was resistant to fluconazole and another was just below the threshold for resistance.
Conclusion: C. albicans was the most prevalent Candida species in our sample. Variation in susceptibility was observed in patients with both C. albicans and C. glabrata. Combinations of Candida species and the lack of identification and susceptibility testing may lead to inadequate treatment and accelerate the development of resistance.
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Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad
[Show all 10 contributors for this article]
(2022).
Oral candidiasis in advanced cancer – identification and susceptibility testing of detected Candida species.
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Introduction: Candida albicans is the most common fungal species in the oral cavity. Increased prevalence of non-C. albicans are detected, and co-infection with C. albicans may have implications for treatment, due to antifungal resistance. The aim of the study was to assess the diversity and susceptibility of oral yeasts in patients with advanced cancer.
Methods: Clinical fungal isolates were sampled in 2014-2016 from 45 patients in a hospice unit. Totally 56 isolates were grown on chromID Candida plates, prepared for biochemical identification, and controlled with DNA sequencing. E-test was performed with the antifungal agents fluconazole, amphotericin B, anidulafungin and nystatin were tested.
Results: A total of 56 isolates were identified. Candida species was dominated by C. albicans at 71%, followed by C. glabrata 9%, C. parapsilosis 5%, C. tropicalis 4%, C. krusei 2%, C. guilliermondii 2% and C. dubliniesis 2%. Nine patients had 2-3 different species. C. albicans strains were susceptible to fluconazole in 97.5%. One C. parapsilosis and one C. tropicalis strain were resistant to anidulafungin. One C. glabrata was resistant to fluconazole and another was just below the threshold for resistance. The sequencing confirmed the biochemical identification.
Conclusion: C. albicans was the most prevalent species. Variation in susceptibility was observed in patients with mixed colonies. Combinations of Candida species and the lack of identification and susceptibility testing may lead to inadequate treatment.
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Young, Alix; Jensen, Janicke Liaaen; Hove, Lene Hystad; Fjeld, Katrine Gahre & Blich, Carl Christian
(2021).
Et smil uten smerter?
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Fjeld, Katrine Gahre; Hove, Lene Hystad; Shamsolebad, Hoda & Kroglund, Sara
(2021).
Individuell munnstellboks kan hjelpe eldre med den orale hygienen.
Sykepleien.no.
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Fjeld, Katrine Gahre; Hove, Lene Hystad; Bargbidi, Mitra; Abrahamsen, Siren & Heggestad, Anne Kari Tolo
(2019).
Eldre som ikke koopererer-etiske aspekter.
Aktuell Nordisk odontologi.
ISSN 1902-3545.
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Published
June 6, 2011 2:40 PM
- Last modified
Nov. 17, 2023 3:03 PM
