Better oral health related quality of life: Type of prosthesis or psychological robustness?

Self-esteem and oral health-related quality of life of women with periodontal disease - A cross-sectional study

Aim

The aim of this study is to assess the effect of periodontal disease on self-esteem and oral health-related quality of life (OHRQoL) in women.

Materials and Methods

A cross-sectional study was conducted among 522 women (mean age - 38.92 ± 14.3 years). Oral hygiene status, plaque level, gingival inflammation, probing depth, and periodontal status were assessed. The self-esteem was assessed using a Rosenberg Self-esteem Scale, and the OHRQoL was measured using a 14-item oral health impact profile (OHIP-14) questionnaire.

Results

Younger, employed women with higher income had significantly better OHRQoL and self-esteem. Women with healthy periodontium had better OHRQoL. Probing depth and community periodontal index scores were found to have a significant positive correlation with most of the sub-scale items and total OHIP-14 score in women with low self-esteem. Women with good OHRQoL and normal self-esteem were seen to be maintaining significantly better oral hygiene. No such statistically significant difference was observed in women with low self-esteem. Multiple regression analysis for the prediction of OHIP-14 score indicated that the best model included probing depth as the only statistically significant predictor (P = 0.002).

Conclusion

Periodontal disease has a significant negative impact on self-esteem and OHRQoL in women.

The Influence of Oral Health Factors on the Quality of Life in Older People: A Systematic Review

BACKGROUND AND OBJECTIVES

The number of people aged 65 years or older is growing substantially. As a result of increased health burden and tooth retention, more oral health problems are expected in this age group. A poor oral health-related quality of life (OHQoL) can compromise a person's psychological state, social relationships, personal beliefs, and physical health. The aim of this systematic review was to identify oral health factors associated with OHQoL in people aged 65 years or older and to give a comprehensive overview of the body of literature for each oral health factor separately.

RESEARCH DESIGN AND METHODS

A comprehensive search was performed in five databases. The following terms were used as index terms or free-text words: "Oral Health," "Quality of Life," "Older People." Two researchers independently assessed studies for eligibility based on predefined criteria.

RESULTS

Of 3,702 references retrieved from the databases, 68 studies were eligible and included (9 randomized clinical trials, 6 cohort studies, and 53 cross-sectional studies). All results were reported descriptively. OHQoL in people aged 65 years or older is positively associated with higher number of teeth, higher number of occluding pairs, implant-retained overdentures, and the shortened dental arch concept and negatively associated with xerostomia, orofacial pain, and poor chewing ability. In the current literature, there is no consensus on the association between edentulism, caries, and periodontal conditions and OHQoL.

DISCUSSION AND IMPLICATIONS

Having a functional dentition (either natural or prosthetic) is important for a good OHQoL, whereas painful or functional complaints are associated with impaired OHQoL.

Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses

The objective of this systematic review was to determine the effect on oral health-related outcomes from mandibular implant-retained dentures opposing maxillary complete dentures in edentulous middle-age and older adults, compared with complete removable dentures in both arches. Randomized controlled trials included participants with an average age of 65 years or older. The Cochrane Library, MEDLINE, and Web of Science were searched. A total of 228 abstracts were reviewed for inclusion criteria, with 14 trials included and analyzed for risk of bias. Eleven of these studies were assessed as being at an unclear risk of bias, and 3 were at high risk. Mandibular implant-retained overdenture therapy showed statistically significant improvements in the patients' general satisfaction (P = .003), oral health-related quality of life (P < .001), and chewing ability (P < .001), over the patients with complete dentures. There were no significant differences in the percentage of patients who were satisfied with their overdentures vs complete dentures for comfort, retention, esthetics, or chewing ability; however, only 2 studies reported these outcomes. In terms of nutritional status 1 year after treatment, vitamin B12 blood levels increased significantly in the implant-retained group (P = .003), but not the other nutritional values. Implant-retained mandibular overdentures are an option for middle-aged and elderly edentulous patients as they significantly improve some of the outcomes; however, the quality of the evidence was moderate/low, due to the small number of studies included and the risk of bias. Future research should include objective outcomes such as masticatory performance, chewing efficacy, and muscular coordination.

Sense of coherence and oral health in older adults in Southern Brazil

OBJECTIVE

The aim of this study was to evaluate the association between sense of coherence and oral health among older adults treated at family health units in southern Brazil.

MATERIAL AND METHODS

The sample was composed of 164 individuals aged 60 years old or older. Socio-demographic and oral health variables were collected using a standardised questionnaire. Sense of coherence (SOC) was measured with the questionnaire proposed by Antonovsky containing 29 closed-ended questions. Poisson regression analysis was employed to identify factors associated with SOC.

RESULTS

Among the 164 older adults, 53.9% were edentate, 54.5% did not need any type of dental prosthesis, and 82.1% had good/adequate self-assessed oral health. The multivariate analysis revealed lower SOC scores among non-white individuals [Mean Ratio (MR)=0.94; 95% CI: 0.91-0.97; P<.001], with poor/very poor self-assessed oral health (MR=0.85; 95% CI: 0.78-0.91; P<.001) and with one or more teeth present in the oral cavity (MR=0.94; 95% CI: 0.91-0.97; P<.001).

CONCLUSION

The present results show that older adults who are self-reported as non-white, with one or more teeth in the oral cavity and with poor/very poor self-assessed oral health have lower SOC scores.

Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency

The aim of this non-randomized controlled clinical trial was to evaluate the oral health-related quality of life and masticatory efficiency of patients rehabilitated with mandibular two-implant overdentures with immediate loading or conventional dentures. Fifty completely edentulous patients wearing bimaxillary conventional dentures, for at least one year, were recruited. The patients were then assigned to either two treatment groups: mandibular overdentures supported by two implants with bar-clip system and a maxillary conventional denture (n = 25), and new maxillary and mandibular conventional complete dentures (n = 25). Masticatory efficiency and oral health-related quality of life were assessed before and 3 months after denture insertion. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral health-related quality of life. Masticatory efficiency was evaluated with chewing capsules through a colorimetric method. The results revealed fewer oral health-related quality of life problems in patients wearing mandibular two-implant overdentures compared to the conventional dentures group. In addition, the implant overdenture group presented statistically significant improvement in masticatory efficiency (p = 0.001). There was no correlation between masticatory efficiency and OHIP in the implant group (p > 0.05), however a correlation was found in the conventional denture group (p < 0.05). Therefore, these short-term results suggest that mandibular overdenture retained by 2 implants with immediate loading combined with maxillary conventional dentures provide better masticatory efficiency and oral health-related quality of life than mandibular conventional dentures.

Oral health-related quality of life and satisfaction before and after treatment with complete dentures in a Dental School in Brazil

PURPOSE

The aim of this study was to evaluate the impact of treatment with new complete dentures on oral health-related quality of life and satisfaction of edentulous patients attending the Prosthodontic Department in a Dental School in Brazil.

METHODS

A total of 70 edentulous subjects (37-86 years) treated by undergradute students at the Araçatuba Dental School, University of State of São Paulo, were accessed. A specific questionnaire for edentulous patients (EDENT) based on the Oral Health Impact Profile (OHIP-EDENT) was applied to collect information on patient oral health-related quality of life. Questions related to the personal satisfaction of the edentulous patients with their complete dentures were also included. The patients were accessed before the treatment, and 3 months after receiving the new dentures.

RESULTS

After rehabilitation with new complete dentures, all domains of OHIP-EDENT showed significant improvements. There was also a significant improvement in patient satisfaction after placement of new complete dentures. Furthermore, it was possible to observe association between upper denture satisfaction and age.

CONCLUSION

Conventional complete dentures may have a positive impact on oral health-related quality of life and satisfaction of edentulous patients.

The impact of having natural teeth on the QoL of frail dentulous older people. A qualitative study

Background

In order to adapt oral care and treatment to the demands of the growing group of frail dentulous older people, it is important to understand how and to which extent having natural teeth contributes to the quality of life (QoL) of frail older people and how frailty influences their perspective.

Methods

A qualitative approach was used. Interviews with 38 Dutch frail older dentulous people were tape-recorded, transcribed, coded for content and analyzed. Additional information was collected which included age, gender, living situation, use of dental prostheses, self-reported oral health status, chronic disorders, and an index for frailty.

Results

Seven themes were identified in the relationship between natural teeth and the QoL of the participants: pride and achievement; intactness; sense of control; oral function; appearance; comfort; along with coping and adapting to disabilities. Having natural teeth generally had a positive effect on QoL. Positive effects through pride and achievement, intactness, and sense of control were most apparent for the most severely frail. They compared themselves with peers who are more often edentate, and valued the good state of their teeth against the background of their declining health, especially those with disabilities causing severe chronic pain or impaired fine-motor skills. The effect of coping with and adaptation to tooth loss was also most apparent for the most severely frail. There was a gender effect in that the men generally cared less about having natural teeth than women, regardless of their level of frailty.

Conclusions

QoL of frail older people is positively influenced by natural teeth, and this effect seems to increase with increasing frailty. Preservation of teeth contributes to a positive body image and self-worth. Oral care for frail people should aim to preserve natural teeth if possible.

Changes in mastication after an immediate loading implantation with complete fixed rehabilitation

OBJECTIVE

This study aimed to measure modifications of mastication after immediate loading full-arch prosthesis (ILFAP) rehabilitation.

MATERIALS AND METHOD

Fourteen patients were observed before and 6 months after ILFAP rehabilitation when masticating two natural, standardized foods (peanut and carrot) and three model foods with increasing hardness. The granulometry of the expectorated boluses from carrot and peanuts was characterized by median particle size (D50), determined at the natural point of swallowing. Chewing time (CT), number of chewing cycles (CC), and chewing frequency (CF) were video recorded. A self-assessment questionnaire for oral health-related quality of life [Geriatric Oral Health Assessment Index (GOHAI)] was also used.

RESULTS

After ILFAP rehabilitation, the mean D50 values for carrot and peanuts were smaller [Repeated Model Procedures (RMP), F = 41, p < 0.001]. Mean CT and CC values recorded with the three model foods decreased, while CF increased regardless of the model food hardness (RMP, F = 14, F = 10, and F = 11, respectively, p < 0.001). The GOHAI score increased from 43 ± 9 to 56 ± 3 (t test, p < 0.001).

CONCLUSION

ILFAP rehabilitation improves the ability to reduce the bolus particle size and the ability to discriminate between different food hardnesses in the 6 months post-surgery period.

CLINICAL RELEVANCE

This study encourages the clinical development of immediate loading implantation with a fixed full-arch prosthesis protocol.

Bonding of acrylic denture teeth to MMA/PMMA and light-curing denture base materials: the role of conditioning liquids

OBJECTIVES

The connection between resin denture teeth and the denture base is essential for the integrity of partial and full dentures. The aim of the present study was to analyse the bond strength of acrylic denture teeth to two light curing denture base materials compared to the gold-standard (MMA/PMMA) using different conditioning liquids.

METHODS

The ridge laps of 220 identical denture teeth were ground and pre-treated using different conditioning liquids (MMA, an experimental conditioning liquid as well as the two commercially available liquids Palabond and Versyo.bond). The denture base materials (PalaXpress, Versyo.com, Eclipse) were applied using a split mould to obtain tensile bond strength specimens of identical shape. Ten specimens per test group were either stored in water for 24h or thermocycled (5000×, 5-55°C) prior to tensile bond strength testing (cross-head speed 10mm/min). Data was subjected to parametric statistics (α=0.05).

RESULTS

The three-way ANOVA revealed a significant influence of the material, pre-treatment as well as the storage. PalaXpress showed the highest bond strength (24.3MPa) of all materials tested after TC, whereas the use of MMA led to the most constant results. Lower values were recorded for Versyo.com (17.5MPa) and Eclipse (10.4MPa) bonded with Versyo.bond.

CONCLUSIONS

The results indicate that MMA/PMMA based denture base resins provide reliable and durable bond strength to acrylic denture teeth. Using light-curing denture base materials requires the application of appropriate conditioning liquids to obtain acceptable bond strength. The use of MMA affects bond strength to light-curing denture base materials.

CLINICAL SIGNIFICANCE

The pre-treatment of denture teeth is critical regarding their bond-strength to denture base materials and in turn for the integrity of removable full and partial dentures. Light-curing denture base resins are more sensitive to the correct tooth pre-treatment compared to conventional MMA/PMMA materials, requiring specific conditioning liquids.

Implant overdentures and nutrition: a randomized controlled trial

We conducted a randomized clinical trial to determine whether providing simple mandibular implant overdentures (IODs) to elderly individuals would give them a significantly better nutritional profile than those who receive complete dentures (CDs). Two hundred fifty-five edentate patients > 65 yrs were randomly assigned to receive maxillary CDs and mandibular IODs (n = 128) or CDs (n = 127). Six-month and one-year post-treatment outcomes were blood plasma levels of homocysteine (tHcy), vitamin B12, vitamin B6, albumin, serum folate, and C-reactive protein concentrations, as well as dietary intake. The association between treatment and tHcy levels was not statistically significant. A decline of folate from baseline values in both study groups, as well as those of vitamins B6 and B12 and albumin, was observed. Significant between-group differences were detected in food preparation and in the individuals' ability to chew a variety of foods. This study suggests that implant overdentures do not have a more positive effect on the nutritional state of elderly edentate individuals at 6 and 12 mos post-treatment than new complete dentures. However, those wearing IODs are significantly more likely to take in their nutrients through fresh, whole fruits and vegetables.

The Paradox of Better Subjective Oral Health in Older Age

We analyzed data from the 2004-06 Australian National Survey of Adult Oral Health to investigate the paradoxical relationship of better subjective oral health in older adults compared with young or middle-aged adults. In interviews with 14,092 adults, prevalence of problems with eating or appearance was not significantly associated with age among dentate people with no denture(s). In contrast, among dentate denture-wearers, prevalence ranged from 18.7% in ≥ 65-year-olds to 46.7% in 25- to 34-year-olds (p < 0.01). Dentate interviewees (n = 3,724) underwent oral epidemiological examinations and completed the 14-item Oral Health Impact Profile (OHIP-14) questionnaire, evaluating adverse impacts of oral conditions. In multivariable analysis, mean OHIP-14 scores were only weakly associated with age among people who had none of 5 clinical conditions [≥ 5 missing teeth, denture(s), untreated decay, moderate/severe periodontitis, toothache]. However, for people with ≥ 2 clinical conditions, there was a three-fold, inverse association between age and mean OHIP-14 scores (p < 0.01). The findings show that experience of oral disease is more deleterious to subjective oral health when it occurs early in adulthood than when it occurs in old age, a pattern that likely reflects high expectations of young generations and, conversely, great resilience in Australia’s oldest generation.