Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly

Effectiveness of Surgical Periodontal Therapy in Oral Health-Related Quality of Life

Background and objective The objective of this study is to evaluate and compare the surrogate and true end points following surgical periodontal therapy using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Materials and methods The study included a total of 30 participants, comprising 15 males and 15 females aged between 25 and 50 years. All individuals who had undergone periodontal flap surgery for generalized chronic periodontitis at the Department of Periodontology, Saveetha Dental College and Hospitals were included in the study. The OHIP-14 questionnaire was used to assess the patient-centered outcomes (true end points) pre- and post-flap surgery at baseline and six months. Surrogate end points such as the clinical attachment level (CAL), probing pocket depth (PPD), and gingival index (GI) were recorded at baseline and six months pre- and post-flap surgery. Results Clinical parameters such as the GI (p=0.03*), CAL (p=0.03), and PPD (p=0.02*) showed a statistically significant improvement after surgery. Patient-centered outcomes showed statistically significant differences in terms of taste perception, reduction in pain sensation, improvement in self-consciousness and reduction in anxiety levels, diminution of the feeling of embarrassment and enhancement in the ability to relax due to problems associated with gums, and improvement in the workplace (p<0.05) post-operatively. Conclusion Surgical periodontal therapy plays a pivotal role in improving oral health-related quality of life (OHRQoL) among patients with chronic periodontal disease. Utilizing OHIP-14 as an assessment tool enables a comprehensive evaluation of treatment outcomes, encompassing various dimensions of oral health impact. Patient-centered outcomes such as psychological discomfort and functional limitations can be achieved only by an interdisciplinary approach.

Evaluating conceptual model measurement and psychometric properties of Oral health-related quality of life instruments available for older adults: a systematic review

BACKGROUND

Older adults present a variety of oral diseases and conditions, in addition to co-morbidities and limited access to dental care, which significantly impact their oral health-related quality of life (OHRQoL). There are many instruments published to measure OHRQoL. However, it is challenging for clinicians and researchers to choose the best instrument for a given purpose.

PURPOSE

To identify OHRQoL instruments available for older adults and summarize the evidence on the conceptual and measurement model, psychometric properties, interpretability, and administration issues of OHRQoL instruments available for older adults through a systematic review.

METHODS

A systematic search was conducted in MEDLINE, EMBASE, LILACS, and CENTRAL up to February 2023. Articles reporting information on the concept model measurement, psychometric properties, and administration issues of an instrument measuring OHRQoL in older adults were included. Two researchers independently evaluated each instrument using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. The overall score and seven attribute-specific scores were calculated (range 0-100): Conceptual and measurement model, Reliability, Validity, Responsiveness, Interpretability, Burden, and Alternative forms.

RESULTS

We identified 14 instruments evaluated in 97 articles. The overall score varied between 73.7 and 8.9, with only six questionnaires over the threshold score 50.0. EORTC QLQ OH-15 (cancer-specific questionnaire) achieved the highest score (73.7), followed by OHIP (generic OHRQoL questionnaire) (66.9), GOHAI (generic OHRQoL questionnaire) (65.5), and OHIDL (generic OHRQoL questionnaire) (65.2). Overall, the Conceptual and measurement model and Validity showed the best performance, while Responsiveness and Interpretability showed the worst. Insufficient information was presented for an overall evaluation of DSQ and OHAI.

CONCLUSION

The evidence supports using EORTC QLQ-OH15 as a specific instrument to assess OHRQoL in cancer patients and the OHIP-49, GOHAI, or OHIDL as generic instruments to assess OHRQoL either for cross-sectional or longitudinal studies in older adults.

Development and Validation of Oral Health-Related Quality of Life Scale for Patients Undergoing Endodontic Treatment (OHQE) for Irreversible Pulpitis

An oral health-related quality of life measure specific to patients undergoing endodontic treatment has not been developed. This study aimed to validate the oral health-related quality of life scale for patients undergoing endodontic treatment (OHQE) for irreversible pulpitis, comprised of 42 questions. Sixty-two patients with irreversible pulpitis, comprising 23 (37.1%) males and 39 (62.9%) females, were enrolled between August 2022 and February 2023. Data were collected at three time points: pretreatment, post-treatment, and at the second week post-treatment. Factor analysis revealed physical, psychological, and expectations as subscales of OHQE. Cronbach's alpha coefficients ranged from 0.87 to 0.95 for each subscale. Each subscale of the General Oral Health Assessment Index (GOHAI) was moderately correlated with the OHQE subscales. Good-poor analysis revealed a significant difference between the high-scoring and low-scoring groups for each OHQE subscale. The intraclass correlation coefficients of the OHQE subscales ranged from 0.89 to 0.95. Multivariate linear regression analysis revealed a significant correlation between the pretreatment and post-treatment psychological factors (p < 0.05). Thus, OHQE will help researchers and policymakers understand the impact of oral health on the quality of life of patients with irreversible pulpitis undergoing endodontic treatment. OHQE could contribute to the appropriate planning, treatment decisions, and management of dental treatment.

Evaluating the influence of static management on individuals' oral health

PURPOSE

This study aimed to evaluate the effect of static management on individuals' oral health-related quality of life (OHRQoL) according to the dynamic zero-COVID policy in China.

METHODS

The digital questionnaire conducted with three sub-questionnaires was sent to 700 patients who accepted treatment at the Department of Stomatology, 363 Hospital. Data on demographic characteristics, the Oral Health Impact Profile-14 and willingness to invest in oral health were collected from the 658 completed questionnaires. According to the state of individuals' lives, participants were divided into two groups: a static management group (Group 1) and a nonstatic management group (Group 2). The scores of the Oral Health Impact Profile-14 and willingness to invest in oral health were compared between these two groups using IBM SPSS Statistics.

RESULTS

The results showed that individuals undergoing static management reported better OHRQoL. Meanwhile, they also presented lower willingness to invest money and dental visits in oral health. Furthermore, according to the results of the logistic regression analysis, aging acts as a negative correlation factor for the OHRQoL of people undergoing static management, while the willingness to invest money and dental visits in oral health is defined as a positive predictor for OHRQoL.

CONCLUSION

Static management effects the OHRQoL of individuals. Aging and WTIOH in money and dental visits are related the individuals' OHRQoL during static management.

Comparison of oral health-related quality of life and its association with the periodontal status among the adults: A questionnaire-based study

Background

Oral health-related quality of life (OHRQoL) is used for evaluating needs of people, their health problems, their level of satisfaction, and various effects of any intervention which have been provided for recording of various nonclinical aspects of oral health.

Aim

The objective of the study was to compare OHRQoL and its association with periodontal health among adult population.

Materials and Methods

This prospective and cross-sectional study was conducted on 300 respondents who were diagnosed with periodontitis. 14-item containing Oral Health Impact Profile 14 (OHIP-14) questionnaire was used for study analysis. A single observer made clinical examinations. Mann-Whitney "U" and Kruskal-Wallis statistical tests were used for comparing the OHIP-14 scores. Statistically significance was set at P < 0.05.

Results

Majority of study participants were of female gender (62.0%). A significant association was observed between loss of attachment and OHIP14 scores (P = 0.003).

Conclusion

Poor periodontal health may affect the OHRQoL.

Effects of Integrative Cognitive Function Improvement Program on Cognitive Function, Oral Health, and Mental Health in Older People: A Randomized Clinical Trial

We aimed to investigate the effects of an integrative cognitive function improvement program that combined existing cognitive, emotional, and physical therapies on cognitive function, oral health, and mental health in elder participants. Participants were classified into one of the following groups: cognitively normal (CN; n = 18), mild cognitive impairment (MCI; n = 17), and control (n = 17). An integrative cognitive function improvement program was administered to the CN and MCI groups for six weeks. To measure cognitive function, electroencephalogram (EEG) and cerebral blood flow (CBF) were evaluated, and to measure oral health, the O'Leary index, Löe & Silness index, tongue coating, unstimulated saliva flow rate, and oral muscle strength were measured. To measure mental health status, mental health, happiness and social support were measured. The CN and MCI groups showed a significant change in EEG-based indices for awareness level and physical stress. Regarding oral health, the O'Leary and the Löe & Silness index score decreased significantly in the CN and MCI groups. Saliva flow rate increased significantly in the CN and MCI groups. In regards to mental health, the happiness score increased post-intervention in the CN and MCI groups. In conclusion, the integrative cognitive function improvement program was effective in improving cognitive function, oral health, and mental health of elder people.

Developing and pilot testing an oral health screening tool for diabetes care providers

Background

People with poorly managed diabetes are at greater risk of periodontal disease. Periodontal disease that is not effectively managed can affect glycaemic levels. Diabetes care providers, including general practitioners and diabetes educators, are encouraged to promote oral health of their clients. However, valid and reliable oral health screening tools that assess the risk of poor oral health, that are easy to administer among non-dental professionals, currently do not exist. Existing screening tools are difficult to incorporate into routine diabetes consultations due to their length. Thus, this study aimed to develop and pilot a short oral health screening tool that would identify risk of existing oral diseases and encourage appropriate referrals to the dental service.

Methods

A three-item screening tool was developed after a comprehensive review of the literature and consensus from an expert panel. The tool was then piloted as part of a larger cross-sectional survey of 260 adults with diabetes who were accessing public diabetes clinics at two locations in Sydney, Australia. As part of the survey, participants completed the three-item screening tool and a 14-item validated tool, the Oral Health Impact Profile (OHIP-14), which has been used previously in the preliminary validation of screening tools. Sensitivity and specificity analyses were then undertaken comparing the results of the two tools.

Results

A statistically significant correlation was found between the shorter screening tool and the OHIP-14 (rho = 0.453, p < 0.001), indicating adequate validity. The three-item tool had high sensitivity (90.5%, 95% CI 84.9%, 94.7%), with a specificity of 46.3% (95% CI 37.7%, 55.2%). The negative predictive value was 81.4% (95% CI 71.3, 89.3). No single item performed as well regarding sensitivity and negative predictive value when compared to the three items collectively.

Conclusions

The three-item screening tool developed was found to be valid and sensitive in identifying risk of poor oral health, requiring oral health referrals, among people with diabetes in this pilot. This is a simple, accessible tool that diabetes care providers could incorporate into their routine consultations. Further validation against comprehensive dental assessments is needed to reassess the tool’s specificity and sensitivity in diverse settings.

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.

Oral Health-Related Quality of Life and Missing Teeth in an Adult Population: A Cross-Sectional Study from Poland

The aim of the study was to determine oral health–related quality of life (OHRQoL) using the measures Geriatric/General Oral Health Assessment (GOHAI) and Oral Health Impact Profile (OHIP-14) in relation to missing teeth in the Polish population aged 20–79. This was a cross-sectional study carried out among 1112 randomly selected participants. The mean age was 48.72 and mean number of teeth was 20.12. Altogether, in the GOHAI, the percentage that gave a positive response to each question ranged from 3.3% to 48.0%; in the OHIP-14, these answers ranged from 2.4% to 25.1%. The GOHAI measure was statistically significant, with more grouping variables than the OHIP-14 measure. Both measures showed significant associations with gender, age, dry mouth, education, professional status, number of teeth, and upper and lower total dentures. We detected a significant relationship between oral health–related quality of life and the factors influencing the presence or absence of dentition. Missing teeth were statistically associated with GOHAI, OHIP-14, advanced age, self-reported dry mouth, lower education, higher Body Mass Index (BMI), lower professional status, diabetes, myocardial infraction, and total dentures in upper or/and lower jaws. However, edentulous individuals had two times higher risk of having an OHIP-14 score above the median. This suggests that oral health practitioners should work to prevent oral diseases that lead to tooth loss in their patients, starting from an early age.

Impact of COVID-19 Pandemic on Quality of Life of Type II Diabetes Patients With Periodontitis

Background: Confinement due to the COVID-19 pandemic has made dental treatments impossible in Chile and many other countries, including diabetic patients with periodontitis. The aim of the present study was to evaluate the impact of periodontal therapy in terms of oral health-related quality of life (OHRQoL) during the COVID-19 pandemic in a cohort of diabetic patients with periodontitis. Material and Methods: Thirty-eight diabetic patients with stage III-IV periodontitis, enrolled for periodontal therapy, were screened. Periodontal clinical parameters including clinical attachment loss (CAL), probing pocket depth (PPD) and bleeding on probing (BOP) as well as glycated hemoglobin (HbA1c) were evaluated at baseline and 3 months follow-up prior the pandemic. The OHRQoL changes by means of Oral Health Impact Profile (OHIP-14) and a self-reported oral health questionnaire were assessed at baseline (prior pandemic) and during the pandemic via telemonitoring. Results: Thirty-one patients received non-surgical periodontal therapy prior to the pandemic. Out of the 31 patients, four died due to COVID-19 resulting in 27 patients available for telemonitoring at the time of the pandemic. Periodontal therapy significantly improved CAL, PPD and BOP (p < 0.05) but not HbA1c (p > 0.05) between baseline and 3 months follow-up pior to the pandemic. Total OHIP-14 scores significantly improved between baseline and the middle of pandemic (intragroup comparison p = 0.00411). In particular, OHIP-14 scores related to the "Physical pain" (intragroup comparison p = 0.04) and "Psychological disability" (intragroup comparison p = 0.00) significantly improved between baseline and the middle of pandemic. Conclusions: In diabetic type II patients with periodontitis periodontal therapy tends to improve the oral health-related quality of life despite the COVID-19 pandemic.

Associations Between Oral Health Status, Perceived Stress, and Neuropsychiatric Symptoms Among Community Individuals With Alzheimer's Disease: A Mediation Analysis

Community individuals with Alzheimer's disease (AD) experience oral disease alongside neuropsychiatric symptoms (NPS) with disease progression. Despite growing evidence for the link between oral health and cognitive status, few studies have investigated the associations between oral health and NPS, especially based on individuals' experience of AD. The primary aim of this study was to examine (a) the difference in oral health-related stressors among individuals with AD, mild cognitive impairment (MCI), and subjective cognitive decline (SCD); and (b) the associations of these stressors with NPS under the framework of the stress process model (SPM). A cross-sectional study was conducted among individuals diagnosed with AD (n = 35), MCI (n = 36) or SCD (n = 35), matched for age, sex education, and body mass index (BMI). Multiple regression and mediation model analyses were performed to explore predictors and their relationships with NPS based on the SPM. Data collection comprised four sections: (a) individual context; (b) oral health-related stressors, including dental caries, periodontal status, oral hygiene, the geriatric oral health assessment index (GOHAI), oral salivary microbiota, pro-inflammatory cytokines, and oral health behavior; (c) subjective stressors (i.e., perceived stress [PS]); and (d) NPS. Decayed, missing, and filled teeth (DMFT), missing teeth (MT), loss of attachment (LoA), plaque index (PLI), PS, oral health behavior, GOHAI, pro-inflammatory cytokines, and salivary bacterial composition were significantly different among the three groups; these parameters were poorer in the AD group than SCD and/or MCI group. LoA, PLI, PS, and pain or discomfort in the GOHAI were directly associated with NPS. PLI, LoA, and psychosocial function in the GOHAI indirectly affected NPS, and this relationship was mediated by PS. Individuals with AD reported greater oral health-related stressors. This study identifies direct and indirect associations linking oral health-related stressors and PS with NPS in individuals with AD. Our findings suggest that targeted dental care and oral-related stressor control may be valuable for managing NPS.

Comparison of general satisfaction, oral health-related quality of life, and patient's self-assessment between mandibular single-implant overdentures and experimental removable complete dentures: A randomized crossover clinical trial

Objective Patient satisfaction with single-implant overdentures (1-IODs) is unclear. This randomized crossover trial aimed to compare the general satisfaction, oral health-related quality of life, and patients' self-assessment between mandibular 1-IODs and experimental removable complete dentures (eRCDs). Methods New mandibular RCDs were fabricated for 22 patients with edentulous mandibles. After adapting to the RCDs, one implant was inserted in the mandibular midline. The participants were then randomly classified into groups 1 and 2. Group 1 received IODs for the first 2 months, while group 2 used eRCDs with a non-loaded implant in the midline. After 2 months, the treatment was switched. Four validated, patient-reported dental outcome measures were assessed: general satisfaction, Japanese version of the Oral Health Impact Profile for edentulous subjects (OHIP EDENT-J), General Oral Health Assessment Index (GOHAI), and Patient's Denture Assessment (PDA). The assessments were performed at the end of the IOD- and eRCD- use periods. Results General satisfaction was significantly higher during the IOD period (p = 0.002). Significant differences were observed in all domains of the OHIP, except orofacial pain (p = 0.084). Further, the total score (p<0.001) and the scores of the physical (p<0.001) and psychosocial functioning (p = 0.001) domains of the GOHAI differed significantly. The total PDA score (p = 0.001) and the scores of the function (p = 0.004), lower denture (p = 0.002), esthetics and speech (p = 0.026), and importance (p = 0.009) domains were significantly higher during the IOD period than during the eRCD period. Conclusion General satisfaction, oral health-related quality of life, and patient self-assessment scores were significantly higher for 1-IODs than for eRCDs. Clinical significance Within the limitations of this study, we found that mandibular single-implant overdentures may be an efficient alternative to mandibular experimental removable complete dentures due to higher general satisfaction, oral health-related quality of life, and patient self-assessment scores of dentures.

The severity of facial burns, dental caries, periodontal disease, and oral hygiene impact oral health-related quality of life of burns victims in Pakistan: a cross-sectional study

Background

A burn to the face and neck area leaves a visible scar that impacts the victims physically and psychologically. This report was aimed to examine the factors associated with oral health-related quality of life (OHRQoL) in patients with a facial burn injury.

Methods

Patients with facial burn who attended the Burn Care Centre in Islamabad, Pakistan were systematically and randomly invited to participate in this cross-sectional study. They underwent extra- and intra-oral examinations and, completed self-administered instruments in the Urdu language. The severity of disfigurement, dental caries experience (DMFT), periodontal disease (CPI) and oral hygiene (OHI-S) statuses were assessed. The validated instruments collected information relating to sociodemographic background, oral health behaviours, OHRQoL and satisfaction with appearance (SWAP). Information relating to the time of the incident, cause and severity (type, TBSA) of the burn were obtained from medical records. The OHRQoL prevalence of impact and severity measures were derived and analysed using simple and multiple, logistic and linear regression.

Results

A total of 271 patients had participated in the study. The OHIP-14 prevalence of impact was 94% with mean severity score = 37 unit (sd = 8.5). The most impacted domains were physical pain (87%), psychological disability (87%), social disability (85%) and physical discomfort (83%). The main determinants of oral health-related quality of life were poor clinical oral conditions - particularly caries, and severity deformity. Other risk factors included poor oral health behaviours, psychological distress and longer time elapsed since the incident, and sex (p < 0.05).

Conclusion

Dental caries, the severity of the facial deformity, oral health behaviour and time are associated with oral health-related quality of life of patients with facial burns. Oral health behaviour improvement can lower the risk of developing dental problems and oral health-related quality of life impact.

Effect of Oral Health Education Using a Mobile App (OHEMA) on the Oral Health and Swallowing-Related Quality of Life in Community-Based Integrated Care of the Elderly: A Randomized Clinical Trial

This study investigated the effect of oral health education using a mobile app (OHEMA) on the oral health and swallowing-related quality of life (SWAL-QoL) of the elderly population in a community-based integrated care project (CICP). Forty elderly individuals in the CICP were randomized into intervention and control groups. OHEMA provided information on customized oral health care management, oral exercises, and intraoral and extraoral massage methods for 50 min/session, once a week, for 6 weeks. Pre- and post-intervention surveys assessed the unstimulated salivary flow rate, subjective oral dryness, tongue pressure, and SWAL-QoL, which were analyzed using ANCOVA and repeated measures ANOVA. In the intervention group, tongue pressure increased significantly from pre- (17.75) to post-intervention (27.24) (p < 0.001), and subjective oral dryness decreased from pre- (30.75) to post-intervention (18.50). The unstimulated salivary flow rate had a higher mean score in the intervention group (7.19) than in the control group (5.04) (p < 0.001). The SWAL-QoL significantly improved from pre- (152.10) to post-intervention (171.50) in the intervention group (p < 0.001) but did not change significantly in the control group (p > 0.05). OHEMA appears to be a useful tool for oral health education for the elderly as it improved the SWAL-QoL, with increased tongue pressure and reduced oral dryness.

Analysis of the Hardness of Soft Relining Materials for Removable Dentures

The main functional feature of elastomeric soft linings materials is the ability to discharge loads in the tissues of the mucosa. As a result, there are fewer injuries to the mucosa and chewing ability increases. In addition, these prostheses are more comfortable in the patient’s opinion. To obtain the equal distribution of forces on the muco-bone basis and to reduce the traumatizing effect of the denture plate for patients using full dentures, soft lining materials can be used. Aim of the study: the aim of the work was a comparative laboratory study of ten materials used for soft lining of acrylic complete dentures. Methodology: Materials based on acrylates (Vertex Soft, Villacryl Soft, Flexacryl Soft) and on silicones (Sofreliner Tough Medium, Sofreliner Tough Medium, Ufi Gel SC, GC Reline Soft, Elite Soft Relining, Molloplast) were compared. Laboratory tests include tests of changes in Shore’a A hardness of soft lining material. The tests were conducted taking into account 90 day term aging in the distilled water environment based on the methodology presented in the European Standard ISO 10139-2. Results: For most silicone materials, only small changes in hardness were found in the range of 0.7 (Ufi Gel SC) to 3.3 (Sofreliner Tough Medium) on the Shore A scale. The exception was GC Reline Soft, for which a marked increase in hardness was noted. All materials based on acrylates were characterized by successive increase in hardness over time. However, in the case of the Vertex Soft material, the increase in hardness was relatively small (5.5 ShA).

Assessment of Age-Related Changes on Masticatory Function in a Population with Normal Dentition

This study aimed to investigate the influence of changes in age-related physiological muscular and dental factors on masticatory function. This study was conducted in 211 healthy participants divided into four different age groups: 20–45 years (Gr1); 45–60 years (Gr2); 61–70 years (Gr3); and ≥71 years (Gr4). For objective evaluation of masticatory function, the masticatory performance, bite force, posterior bite area (PBA), functional tooth units (FTUs), the number of remaining teeth, tongue pressure, masseter muscle thickness (MMT), and handgrip strength were examined. Food intake ability (FIA) and the Oral Health Impact Profile-14 score were assessed subjectively using questionnaires. A significant decrease in the number of remaining teeth, FTUs, handgrip strength, and FIA was found in Gr4, and a significant decrease in the tongue pressure, PBA, and bite force was found in those aged ≥61 years. In groups 1 and 3, an association of the PBA with masticatory performance was observed. However, there was no significant decreasing trend in the MMT with respect to masticatory performance with aging. With sufficient FTUs and posterior tooth support, although age-dependent decreases in the bite force, tongue pressure and handgrip strength were observed, masticatory performance was maintained. Establishing the PBA by improving occlusion through dental treatment is thought to be important for masticatory function.

Oral Health-Related Quality of Life among Croatian University Students

Oral health-related quality of life (OHRQoL) is utilized in health services research to examine trends in oral health and population-based needs assessment. To determine the impact of oral diseases on everyday life, measures of oral quality of life are needed. In addition to common disease-based measures, they assess the need for oral care to evaluate oral health care programs and treatment management. The aim of this study was to evaluate the OHRQoL among Croatian university students. A cross-sectional study was conducted among 895 students (mean age 22 ± 4 years; 54.75% were females). The data collection was carried out through a self-administered short-form oral health impact profile (OHIP-14) questionnaire which comprises 14 items that describe 7 subscales. Each subscale is named according to its constitutive items: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and social handicap. The quality of data was descriptively analysed and internal consistency reliability was assessed by Chronbach’s alpha coefficient. Pearson’s correlation was performed on the OHIP-14 total score and 7 subscale scores. The level of significance was set to p < 0.05. The prevalence of reported impact on OHRQoL was 31.84% and the mean OHIP-14 score was 11.66 ± 8.72. Chronbach’s alpha for the OHIP-14 total score was 0.91 (range for subscales: 0.70–0.87). Total OHIP-14 score was correlated with each of the seven subscales (correlation range: 0.56–0.84). The psychological discomfort and physical pain subscales recorded the highest impact with 56.09% and 24.47%, respectively, while the least impact was recorded in the physical disability subscale with 13.35%. The mean OHIP-14 score of the students in this study reflects that the oral health status of most of the students did not significantly affect their OHRQoL. However, the psychological discomfort and physical pain subscales were the most severely affected aspects of their OHRQoL. The OHIP-14 had reasonable reliability in relation to subjective global oral health indicators among students and thus appears to be a useful OHRQoL measure in this context.

Factors associated with oral health-related quality of life during pregnancy: a prospective observational study

PURPOSE

To evaluate the evolution of perceived quality of life in relation to oral health during pregnancy and to determine the risk factors involved in this process.

METHODS

A follow-up study was carried out with pregnant Spanish women. Two oral examinations and an oral health-related quality of life (OHRQoL) assessment, using the OHIP-14 questionnaire, were performed in the first and third trimester of pregnancy. Data on sociodemographic characteristics, medical history, O'Sullivan Test measures, oral hygiene habits, history of caries, and periodontal status of participants were collected through structured medical-dental questionnaires.

RESULTS

A complete dataset comprising 246 pregnant women was available for analysis. Overall scores for negative impacts on the OHIP questionnaire were significantly higher during late pregnancy (74%). This indicated a deterioration in oral health-related quality of life amongst participants. Items describing "painful aching", "self-consciousness", "unsatisfactory diet", and "interrupted meals" showed the greatest increase between the first and third trimester of gestation. Multivariate analysis showed that pre-gestational/gestational diabetes mellitus and poor oral hygiene habits during the first trimester of gestation were directly associated with worse oral health-related quality of life during the third trimester of gestation (hyperglycemia: OR 2.86; 95% CI 1.019-8.050: p = 0.043 / oral hygiene: OR 1.33; 95% CI 0.970-1.836; p = 0.076).

CONCLUSIONS

In the present research, hyperglycemia during pregnancy and poor oral hygiene habits during the first trimester of gestation led to a higher risk of poor oral quality of life during late pregnancy.

The use of Oral Health Impact on Daily Living (OHIDL) transition scale in measuring the change in oral health-related quality of life among older adults

Background

This longitudinal study aimed to evaluate the longitudinal validity and reliability of the Oral Health Impact on Daily Living (OHIDL) transition scale and measure the perceived change in oral health-related quality of life (OHRQoL) after dental treatments among older adults.

Methods

OHIDL was administered to older adults who sought dental treatments. Participants were asked to assess changes in impact for each OHIDL item retrospectively compared with that before the treatment. The responsiveness, minimal clinically important difference (MCID), internal consistency and test–retest reliability of the OHIDL transition scale were evaluated. Multiple linear regression was employed to predict the change in oral health impacts after dental treatment. Beta coefficients (β) and 95% confidence intervals (CI) were reported.

Results

One hundred and seventy-six participants were followed-up with upon completing their dental treatments. The follow-up rate was 70.4% (176/250). The OHIDL transition score strongly correlated with the global rating of change (r_s = 0.76, P < 0.01). MCID was determined by participants who reported “a little improved” in the perceived oral health impacts, and their mean transition score was 3.3. Cronbach’s alpha of the transition scale was 0.87, and many items had a test–retest correlation of at least 0.60. Patients who perceived more oral health impacts at baseline as measured by the total intensity score (β = 0.32, 95% CI: 0.20, 0.44, P < 0.001) and those who had received endodontic treatment (β = 8.04, 95% CI: 4.36, 11.71, P < 0.001) would have more improvement in perceived oral health impacts.

Conclusions

The OHIDL transition scale has good psychometric properties and is sensitive to change over time. After receiving dental treatment, most of the study’s older adults perceived a lower intensity of OHIDL.

Clinical relevance

The OHIDL transition scale is a valid and reliable instrument to measure the change in OHRQoL after dental treatments.

Oral Health and Related Quality of Life in Older People: A Systematic Review and Meta-Analysis

Background

Of the most important implications and complaints in the elderly group of the population, is oral and dental health problems. This study aimed to assess oral health- related quality of life in older people.

Methods

To data collection, databases were searched including PubMed, EMBASE, Scopus, SID, MagIran, Cochrane Central Register of Controlled Trials and scholar google The keywords were "older adults", "Geriatric" Elderly", "Older", "Aged", "Ageing", "Oral health", "Oral hygiene" and "Quality of life", "QOL. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Studies from 1st Jan 2000 to 30^th Jan 2017 were included. Studies were subjected to meta-analysis to calculate indexes, using CMA:2 (Comprehensive Meta-Analysis) software.

Results

Totally, 3707 articles were searched that 48 of them were subjected to the oral and dental health-related quality of life in 59 groups of the elderly population with the mean age of 73.57+6.62 in the 26 countries. The obtained percentage values of dental and oral health were 80.2% (0-60), 14.8% (0-12), 16.4% (0-70), 22% (0-14 or 0-59) and 19.2% (0-196) for GOHAI with the additive method, GOHAI with Simple Count Method, OHIP-14 with the additive method, OHIP-14 with Simple Count method and OHIP-49 with additive method indexes, respectively.

Conclusion

The elderly group of the population had no proper oral health-related quality of life. Regarding the importance and necessity of oral and dental health and its effect on general health care in the target group, it is recommended to improve dental hygiene in the mentioned group of population.

Association between denture use, chewing ability, and all-cause mortality in middle-aged and older adults who exercised regularly in Korea

Herein, using data from the Korean Longitudinal Study of Aging (2006–2018), we evaluated denture use and chewing ability to determine the status of oral health in middle-aged adults who exercised regularly; further, we investigated the relationship of oral health with all-cause mortality. From the basic survey conducted in 2006, we interviewed 10,254 participants who were followed up until death. The participants were grouped based on regular exercise into REG (n = 3921) and non-REG (n = 6290) groups. The mortality rate was higher in the non-REG group than in the REG group (35.8% versus 26.9%; p < 0.001). The mortality rate was higher in denture users (versus non-denture users), non-drinkers (versus alcohol drinkers), and those on medical aid (versus national health insurance). The mortality rate was higher in participants with poor masticatory ability, lower education level, and poor subjective health perception (p < 0.001). Denture use and masticatory discomfort were not significant risk factors for mortality in the non-REG group (p > 0.05). In conclusion, masticatory discomfort was a risk factor for increased mortality in middle-aged Korean adults who exercised regularly, at least once a week. Thus, assessment of masticatory ability could be a useful indicator of life expectancy in middle-aged adults.

Associations of Oral Health-Related Quality of Life with age, oral status, and oral function among psychiatric inpatients in Japan: a cross-sectional study

BACKGROUND

As the general population of Japan ages, the population of hospitalized psychiatric patients is also ageing. The purpose of this study was to investigate the associations of oral health-related quality of life (OHRQoL) with age and oral health, including oral and swallowing function, among psychiatric inpatients.

METHODS

The subjects included 165 psychiatric inpatients in psychiatric hospitals in Japan. The General Oral Health Assessment Index (GOHAI) and the Eating Assessment Tool (EAT-10) were included in the questionnaire survey for the measurement of OHRQoL and the screening of dysphagia. A score ≥ 3 on the EAT-10 was defined as suspected dysphagia. Oral examinations and oral diadochokinesis (ODK) measurements for the tongue-lip motor function evaluation were conducted. The inpatients with acute psychiatric symptoms, moderate and severe dementia, and cognitive impairment that affected their ability to communicate and relate their feelings were excluded. A chi-squared test, the Mann-Whitney U test, and linear regression analysis were used for the analysis. The data were analysed at the 5% significance level.

RESULTS

A total of 100 (64.5%) psychiatric inpatients (mean age, 67.3 [SD, 14.5] years, 49% males, and 51% females) participated in this study. The means ± SDs for the decayed missing filled teeth (DMFT) index and GOHAI score were 20.6 ± 6 and 49.7 ± 7.9, respectively. The GOHAI score in the older age group (≥ 65 years) was significantly lower than that in the younger age group (< 65 years). The mean ODK scores were less than 3 times/s for all syllables. The percentage of the participants with suspected dysphagia was 45.0%. Tooth loss and suspected dysphagia were significantly associated with low GOHAI scores. The EAT-10 score was significantly correlated with the GOHAI score only after adjusting for age and sex (β = - 0.725, 95% CI - 0.97, - 0.64).

CONCLUSIONS

In hospitalized psychiatric patients, impaired oral health in the older subjects was more pronounced compared with that among general adults. Tooth loss and swallowing function were associated with OHRQoL. Therefore, oral care for the recovery of occlusal and swallowing functions may be needed to improve OHRQoL among psychiatric patients.

The Effects of Dental Status and Chewing Efficiency on the Oral-Health-Related Quality of Life of Nursing-Home Residents

Objective

The aim of this study was to evaluate the effects of dental status and chewing efficiency on the oral-health-related quality of life (OHRQoL) of nursing-home residents.

Materials and Methods

The study was conducted in nine nursing homes. All eligible participants were included, and general and medical data, information about nutritional status and their dental and prosthetic status were collected. Chewing efficiency was assessed by means of a two-colour mixing-ability test. The simple count version of the Geriatric Oral Health Assessment Index (SC-GOHAI) was used to evaluate participants’ OHRQoL, and the Mini-Mental State Examination to classify the presence of cognitive impairment. Univariate and multivariate regression models were used to analyse data.

Results

The mean age of the participants was 82.1 (± 9.8) years and most participants suffered from at least very mild cognitive impairment. OHRQoL for all participants (n = 143) and denture wearers only (n = 105) was substantially associated with the type of prosthesis, the presence of natural teeth, the number of functional occluding pairs and dental and denture-related (if applicable) treatment needs. Furthermore, in both model’s univariate analysis showed that chewing efficiency also affected OHRQoL. In contrast, multivariate analysis of all participants revealed that only a higher number of functional occluding pairs (C: 0.250; p < 0.001), fewer dental treatment needs (C: −1.733; p = 0.019) and a better nutritional status (C: −1.298; p = 0.048) were relevant for better OHRQoL. For denture wearers, a higher number of functional occluding pairs (C: 0.192; p = 0.011), a better denture condition (C: −2.194; p= 0.003) and a higher body mass index (BMI) (C: 0.145; p = 0.006) were the main variables associated with better OHRQoL among participants.

Conclusion

Good oral health and oral function, including chewing efficiency, are associated with a high OHRQoL of nursing-home residents. However, few dental treatment needs, well-fitting dentures without treatment needs and a high number of functional occluding pairs seem to be the principal variables for an acceptable OHRQoL of nursing-home residents.

Oral health improvement for nursing home residents through delegated remotivation and reinstruction (MundZaRR Study): study protocol of a cluster-randomised controlled trial

INTRODUCTION

Oral health and oral health-related quality of life (OHrQL) of residents in German long-term residential care (LRC) are poor. We will develop an evidence-based catalogue of interventions ('Oral Health Toolbox') and provide care-accompanying reinstruction and remotivation of nursing staff by dental assistants (DA). We hypothesise that such intervention will significantly improve OHrQL, daily oral hygiene/care behaviour and is cost-effective.

METHODS AND ANALYSIS

A scoping review will be used to identify possible intervention components. Mixed methods will be used to identify barriers and enablers of oral hygiene and care in German LRC. The result will be the 'Oral Health Toolbox', a two-phased instrument supporting both initial intervention allocation to improve oral health/hygiene and reinstruction/remotivation. A two-arm clustered, randomised controlled trial (ratio of 1:1 via block randomisation) will be performed in LRC in Rhineland-Palatinate, Germany. Each nursing home represents a cluster. Based on a feasibility study, considering clustering and possible attrition, we aim at recruiting 618 residents in 18 clusters. In the intervention group, dentists will assign one or more intervention component from the box (phase 1). During follow-up, nursing staff will be reinstructed and remotivated by DA, who use the box to decide how to maintain the intervention (phase 2). In the control group residents will receive care as usual. The primary outcome, OHrQL, will be measured using the General Oral Health Assessment Index. Secondary outcomes include pain condition, general health-related quality of life, caries increment, oral/prosthetic hygiene and gingival status, incidence of dental emergencies and hospitalisations, and cost-utility/effectiveness. The endpoints will be measured at baseline and after 12 months. For our primary outcome, a mixed-linear model will be used within an intention-to-treat analysis. A process evaluation using mixed methods will be conducted alongside the trial.

ETHICS AND DISSEMINATION

Ethical approval by the University of Kiel was granted (D480/18).

TRIAL REGISTRATION NUMBER

NCT04140929.

Evaluation of changes in oral health-related quality of life over time in patients with Sjögren's syndrome

OBJECTIVES

To assess oral health-related quality of life (OHRQoL) and changes in OHRQoL in 3 years of patients with Sjögren's symdrome (SS).

METHODS

Thirty-five SS patients and 23 non-SS individuals were enrolled. OHRQoL were quantitatively evaluated using the shortened Oral Health Impact Profile (OHIP-14). After 3 years, 22 patients and 14 controls tool the OHIP-14 survey again.

RESULTS

The SS group had a significantly higher OHIP-14 score, which indicated a lower OHRQoL, than the non-SS group. Among individual questions in the OHIP-14, scores for 'trouble pronouncing words', 'uncomfortable to eat foods', 'self-conscious', and 'diet unsatisfactory' were markedly higher in the SS group than in the non-SS group. The OHIP-14 score significantly increased in 3 years in the SS group. Furthermore, there was an inverse correlation between the change rate of salivary flow rate and change of OHIP-14 scores in 3 years in patients with SS whose OHIP-14 score increased. Scores for 'irritable with other people', 'difficulty doing usual jobs', 'felt life less satisfying', and 'unable to function' significantly increased in 3 years.

CONCLUSION

In SS, OHRQoL decreased in 3 years, which was associated with a decrease in saliva secretion. Moreover, troubles related to psychosocial aspects in SS patients were found to intensify over time.

The Association of Oral Function with Oral Health-Related Quality of Life in University Students: A Cross-Sectional Pilot Study

The aim of this cross-sectional study was to investigate the association between oral function and oral health-related quality of life (OHRQoL) in healthy university students. Oral functions and OHRQoL (General Oral Health Assessment Index; GOHAI) were investigated in 58 healthy university students. Oral functions, such as tongue pressure, tongue-lip motor function, occlusal force, and masticatory function, were examined. The participants were divided into two groups based on low and high GOHAI scores. Information about oral health, dental caries treatment history, insomnia, and personality and lifestyle was obtained using a self-reported questionnaire. Oral mucosal wetness scores and tongue-lip motor functions (oral diadochokinesis /ka/) were significantly decreased in the low GOHAI score group compared to the high GOHAI score group (p = 0.001 and p = 0.017, respectively). In the logistic regression model, the GOHAI score was independently associated with the oral mucosal wetness score (odds ratio (OR) = 0.622; 95% confidence interval (CI), 0.411–0.941; p = 0.025) and oral diadochokinesis /ka/ (OR = 0.376; 95% CI, 0.170–0.832; p = 0.016). Our study demonstrated the presence of low oral function in university students and suggested its association to low OHRQoL in this population.

Oral health-related quality of life and associated factors among older people in short-term care

Objectives

It is well known that oral health status is associated with oral health‐related quality of life (OHRQoL) in the general population. The aim of this study was to describe and analyse OHRQoL among older people in short‐term care and its associated factors.

Materials and Methods

This cross‐sectional study included 391 older people in 36 short‐term care units. Data were collected via clinical oral assessments, questions about self‐perceived oral and general health, Katz Index of Activities of Daily Living (Katz‐ADL) and the Revised Oral Assessment Guide (ROAG). OHRQoL was measured using the Oral Health Impact Profile (OHIP‐14). Multivariate logistic regression models were applied in the analysis.

Results

Poor OHRQoL was reported by 34% of the older people. Associated factors were swallowing problems according to ROAG; quite poor/poor self‐perceived physical, psychological and oral health; and being a woman.

Conclusions

There is an association between OHRQoL and older people's self‐perceived health according to the OHIP‐14. This indicates the importance of early detection of oral health problems in frail older people and to assess both oral health and swallowing problems among older people in short‐term care.

Interkingdom interactions on the denture surface: Implications for oral hygiene

Background

Evidence to support the role of Candida species in oral disease is limited. Often considered a commensal, this opportunistic yeast has been shown to play a role in denture related disease, though whether it is an active participant or innocent bystander remains to be determined. This study sought to understand the role of Candida species alongside the bacterial microbiome in a denture patient cohort, exploring how the microbiology of the denture was affected by oral hygiene practices.

Materials and methods

In vitro denture cleansing studies were performed on a complex 9-species interkingdom denture biofilm model, with quantitative assessment of retained bacterial and fungal viable bioburdens. Patient hygiene measures were also collected from 131 patients, including OHIP, frequency of denture cleansing, oral hygiene measure and patient demographics. The bacterial microbiome was analysed from each patient, alongside quantitative PCR assessment of ITS (fungal) and 16S (bacterial) bioburden from denture, mucosa and intact dentition.

Results

It was shown that following in vitro denture cleansing C. albicans were unresponsive to treatment, whereas bacterial biofilms could repopulate 100-fold, but were susceptible to subsequent treatment. Within the patient cohort, oral hygiene did not impact candidal or bacterial composition, nor diversity. The levels of Candida did not significantly influence the bacterial microbiome, though an observed gradient was suggestive of a microbial composition change in response to Candida load, indicating interkingdom interaction rather than an oral hygiene effect. Indeed, correlation analysis was able to show significant correlations between Candida species and key genera (Lactobacillus, Scardovia, Fusobacterium).

Conclusions

Overall, this study has shown that the denture microbiome/mycobiome is relatively resilient to oral hygiene challenges, but that Candida species have potential interactions with key oral genera. These interactions may have a bearing on shaping community structure and a shift from health to disease when the opportunity arises.

Oral Health-Related Quality of Life Among Publicly Insured Mental Health Service Outpatients With Serious Mental Illness

OBJECTIVE

The study investigated factors associated with unmet need for dental care and oral health-related quality of life (OHQoL) among individuals with serious mental illness receiving outpatient care in a public mental health program serving a largely low-income population, mostly from racial-ethnic minority groups.

METHODS

Cross-sectional interview data were collected from a convenience sample (N=150) of outpatients. Adjusted risk ratios (ARRs) and adjusted risk differences (ARDs) were estimated by logistic regression models to examine the independent contribution of sociodemographic and clinical factors to low OHQoL and past-year unmet dental need, defined as inability to obtain all needed dental care.

RESULTS

More than half of participants reported low OHQoL (54%) and a past-year dental visit (61%). Over one-third (39%) had past-year unmet dental need. Financial barriers (ARR=3.16) and nonfinancial barriers (ARR=2.18) were associated with greater risk for past-year unmet dental need after control for age, gender, high dental anxiety, and limited English proficiency. ARDs for financial and nonfinancial barriers indicated absolute differences of 40 and 27 percentage points, respectively. Unmet dental need (ARR=1.31), xerostomia severity (ARR=1.20), and a schizophrenia spectrum diagnosis (ARR=1.33) were associated with low OHQoL, after control for age and current smoking, with ARDs ranging from 11 to 15 percentage points.

CONCLUSIONS

Improving oral health promotion, oral health service access, and the integration of the mental and oral health systems may help reduce the high prevalence of low OHQoL in this population, given that low OHQoL is partly driven by unmet dental need.

Oral Health–Related Quality of Life After Gastric Bypass Surgery

Objective

The aim was to examine how individuals treated for obesity with gastric bypass (GBP) surgery perceived their oral health and oral health–related quality of life (OHRQoL).

Method

All individuals in one Swedish region who had undergone GBP surgery (n = 1182) were sent a postal questionnaire 2 years after surgery. The questionnaire comprised items on sociodemographics, oral symptoms and the Oral Health Impact Profile-49 to assess the OHRQoL.

Results

The mean age was 47.6 years with 75% females, response rate 55.3%. The self-perceived oral health was rated low by 45% of the respondents. Gender differences were seen, for instance, regarding hypersensitive teeth (men 18.8%, women 30.8%, p = 0.003). Nine out of ten reported at least one oral impact experienced sometimes, fairly or very often, according to the Oral Health Impact Profile-49 (OHIP-49). The mean additive OHIP-49 score was 30.3 (SD 36.1). The associations between self-reported oral health and OHRQoL were consistent throughout. Tooth hypersensitivity generated an OR of 2.28 (95% CI 2.28–8.46) of having ≥ 2 impacts on OHRQoL.

Conclusion

A large proportion of individuals having undergone GBP surgery reported problems with their oral health and impacts on their OHRQoL, indicating a need for medical and dental staff—surgeons and general practitioners as well as other health professionals—to offer oral health promotion and prevention measures.

Assessment of the Effect of Oral Health on Quality of Life and Oral-Health Indicators among ESRD Patients in Southwest Florida: A Pilot Study

Purpose

To determine and compare OHRQoL (oral-health-related quality of life) using the Geriatric Oral Health Assessment Index (GOHAI-12) and Oral Health Impact Profile (OHIP-14) among patients receiving hemodialysis (HD).

Methods

Face-to-face interviews and intraoral examinations were conducted among 70 patients. Mann-Whitney U test and Kruskal-Wallis test were used to compare each item score with demographics and dental and overall health status.

Results

The mean number of years on dialysis was 4.7 ± 7.5 yrs; the mean number of teeth present was 19.7 ± 11.04; median values of OHRQoL using GOHAI-12 and OHIP-14 were 52 and 64. Within GOHAI-12, limiting food (p 0.043), uncomfortable eating in front of people (p 0.045), limiting contact with people (p 0.046), and eating without discomfort (p 0.011) were significantly associated with females. Being worried (p 0.040) and self-conscious (p 0.048) were significant for age groups ≤65 years. Prevented from speaking was associated with >20 teeth (p 0.016). Being worried about oral health was associated with number of years on dialysis (p 0.042). Within OHIP-14, speech was associated with number of teeth present (p 0.024). Total inability to function was significantly associated with race (p 0.018), number of teeth (p 0.028), and edentulousness (p 0.031).

Conclusions

GOHAI-12 was more effective than OHIP-14 in assessing OHRQoL. However, most subjective experiences did not correlate with clinical findings. Systemic health issue like end-stage renal disease affecting QoL might have taken precedence over dental problems. Clinical assessments should be inherent in oral-health evaluation and there should be cooperation between nephrologists and dentists in promoting oral health and treating systemic conditions among HD patients.

An Oral Health-Related Quality of Life Comparison Between Adults With Unilateral Cleft Lip and Palate and Class III Malocclusion

OBJECTIVE

To compare oral health-related quality of life (OHRQoL) before treatment of adults with unilateral cleft lip and palate (UCLP) and surgical Class III malocclusion, and to consider if clefts needing different orthodontic treatment protocols could influence people's self-perception.

DESIGN

Cross sectional.

SETTING

Cleft Lip and Palate Center and Clinic of Orthognathic Surgery from a School of Dentistry.

PARTICIPANTS

A sample of adults with repaired nonsyndromic UCLP (n = 52) which was age- and sex-matched with a noncleft Class III malocclusion sample seeking orthognathic surgery (n = 51). In turn, the cleft group was subdivided according to treatment planning into nonsurgical orthodontic and surgical orthodontic approaches.

MAIN OUTCOME MEASURE

The whole sample was assessed using the short-form oral health impact profile (OHIP-14), with higher scores indicating a poorer OHRQoL. Statistical comparisons were performed with Mann-Whitney U and Kruskal-Wallis tests, and effect size. Bonferroni adjustment was used for post hoc tests (P < .017).

RESULTS

The OHIP-14 scores of the UCLP and Class III groups were significantly different (P = .001, η² = 0.108), and higher in Class III. The largest commitment was in the physical disability, physical pain, and psychological disability domains. In addition, no differences were found when the UCLP treatment planning was considered.

CONCLUSION

Surgical Class III malocclusion have a poorer OHRQoL when compared to patients with UCLP, irrespective of whether they are treated surgically or orthodontically. Therefore, the greater commitment of OHRQoL appears to be influenced by the etiology of Class III, and not by treatment plan.

Effectiveness of the implementation project 'Don't forget the mouth!' of community dwelling older people with dementia: a prospective longitudinal single-blind multicentre study protocol (DFTM!)

BACKGROUND

The oral health of community dwelling frail older people is poor, and depends on the oral health care provisions available within their own community. The implementation project 'Don't forget the mouth!' (i.e., the intervention) was created with the aim of maintaining and improving the oral health and the general health of community dwelling frail older people, with education and interdisciplinary collaborations of health care professionals and informal caregivers. Critical scientific assessment of the intervention will be described in this study protocol, focused on community dwelling older people with dementia.

METHODS

This protocol describes a prospective longitudinal single-blind multicentre study, which will take place in 14 towns, each with an intervention and a control group receiving oral health care as usual. Assessment will take place four times during 12 months (i.e., at baseline, after 3, 6, and 12 months). Participants are 65 years and older, community dwelling, and suspected of dementia by their home care worker. The home care organizations will inform, and approach their clients about the study, before the researcher will reach out. The effectiveness of the intervention will be determined with the primary outcome variable 'oral hygiene', assessed through the presence of dental plaque (DP) or dental prosthetic plaque (DPP). The secondary outcome variables are: 'oral health', 'oral health related quality of life', 'oral health care behaviour', 'general health and care dependency', and 'compliance of the health care professionals'.

DISCUSSION

This protocol aims to assess the effectiveness of the implementation project 'Don't forget the mouth!' focused on community dwelling older people with dementia. The strengths of the current study are the national roll-out of the intervention, interdisciplinary collaborations and education, and the scientific evaluation over the course of 12 months. The threats and weaknesses are in the recruitment procedure, and the adherence and compliance of the health care professionals to the project.

TRIAL REGISTRATION

The Netherlands Trail Register NTR6159 .

Subjective Evaluation of Denture Adhesives: A Multicenter Randomized Controlled Trial

INTRODUCTION

Many reports show that denture adhesives improve the retention and stability of dentures. However, few randomized controlled trials have examined the effects of denture adhesives.

OBJECTIVE

This 10-center randomized controlled trial with parallel groups involving 200 edentulous patients wearing complete dentures aimed to evaluate the effects of short-term use of cream and powder denture adhesives.

METHODS

Patients were allocated into 2 cream- and powder-type adhesive groups and 1 control group. Intervention groups were treated with the 2 adhesives (1 each), and the control group received saline solution. Adhesive or control was applied to the denture-mucosal surface for 4 d, and data at baseline and after day 4 of intervention (i.e., 8 meals) were obtained. Patient satisfaction was evaluated with a 100-mm visual analog scale. Oral health-related quality of life was measured with the Japanese version of the Oral Health Impact Profile for Edentulous Patients. Perceived chewing ability was evaluated by a questionnaire regarding ease of chewing and swallowing food. Between-group comparisons were performed with Kruskal-Wallis tests with the Mann-Whitney U test adjusted by Bonferroni correction. Within-group comparisons of pre- and postintervention measurements were performed with the Wilcoxon signed-rank test. Intention-to-treat analysis was also performed.

RESULTS

Between-group comparisons showed no significant differences for general satisfaction or Oral Health Impact Profile for Edentulous Patients. However, significant differences in satisfaction with various denture functions with cream- and powder-type adhesives were seen in pre- and postintervention comparisons (P < 0.05). Significant differences were also observed for perceived chewing ability of hard foods (P < 0.05).

CONCLUSION

These results suggest that although denture adhesives do not invariably improve denture function, they do affect subjective evaluations and possibly chewing of hard foods. Therefore, the effects of denture adhesive use are insufficient to resolve any fundamental dissatisfaction with dentures ( ClinicalTrials.gov NCT01712802 ).

KNOWLEDGE TRANSFER STATEMENT

The results of this study suggest that denture adhesives should be applied under certain conditions; however, an appropriate diagnosis is important before application. These practice-based data provide information to establish evidence-based guidelines for applying denture adhesives.

Oral health status and oral health related quality of life in adolescent workers

Background and aim

Oral health status and oral health related quality of life (OHRQoL) of working adolescents has been very little reported in literature. Therefore, this study aimed to determine oral health status and OHRQoL in a group of adolescent workers.

Methods

This cross-sectional study was conducted in an apprentice training center in western Turkey between December 2016 and January 2017. The study group population was 585, and the sample size was 514 students between 14 and 18 years old. The Decayed, Missing, and Filled Teeth (DMFT) Index, the Turkish version of the Oral Health Impact Profile-14 (OHIP-14), and a form requesting the socio-demographic information of the students were used as data collection tools. Permissions were obtained from the relevant school, parents, students, and ethical committee. The data were analyzed using descriptive statistics, the Student's t-test, and the Pearson correlation coefficient.

Results

The results showed significant relationships between the tooth brushing frequency, dental visit frequency, dental trauma history, smoking, and the OHIP-14 subdomains (p < 0.05).

Conclusion

Poor oral health and a lack of good oral health attitudes may have negative impact on the oral health related quality of life (OHRQoL) of working adolescents. Dental health education programs in collaboration with schools and dental health services may be beneficial for promoting oral health and improving the OHRQoL of working adolescents.

Effects of dropping out of dental treatment on the oral health-related quality of life among middle-aged subjects using web research

Objective

The oral health-related quality of life has recently been reported to be a rather important aspect of general health. Dropping out of dental treatment has long been a problem plaguing oral health. However, the relationship between dropout for dental treatment and the oral health-related quality of life is unclear. The purpose of this study was to investigate the oral health-related quality of life in patients who dropped out of dental treatment.

Materials and methods

We conducted a questionnaire-based investigation using web research. The participants were allocated to two groups (dropout group and maintenance group). The dropout group included participants who had stopped visiting their dental office in the past and had not revisited in the last decade. The maintenance group included patients who visited their dental office continually for a regular checkup. We analyzed the General Oral Health Assessment Index (GOHAI) as an indicator of the oral health-related quality of life and assessed the background characteristics of the subjects.

Results

We analyzed 225 people in the dropout group and 236 people in the maintenance group. The score of GOHAI was significantly different between the 2 groups (dropout group:47.07, maintenance:48.97, p = 0.035), and the more frequent dropouts brought the less GOHAI score (p = 0.012). Furthermore, the results of a logistic regression analysis showed that dropping out of dental treatment was significantly associated with the GOHAI score (p = 0.002).

Conclusion

A relationship was demonstrated between the oral health-related quality of life and dental treatment dropout. Furthermore, dental treatment dropout seemed to have negative effects on the oral health-related quality of life.

Validation and comparison of the Arabic versions of GOHAI and OHIP-14 in patients with and without denture experience

BACKGROUND

The assessment of oral heath related quality of life (OHRQoL) for complete denture wearers according to a participant's subjective perception may provide an indication of the adaptive capacity of the individual. The aim of this study was to compare and assess the validation of two quality of life measures, the Oral Health Impact Profile-14 (OHIP-14) and Geriatric Oral Health Assessment Index (GOHAI), in patients with and without previous denture experience.

METHODS

A total of 69 elders (36 male and 34 female; mean age, 63 years) from Dental Clinics of the University of Khartoum and the National University in Sudan, with and without previous denture experience, were included in the study. OHRQoL was assessed using two Arabic-translated questionnaires (OHIP-14 and GOHAI) before and after complete denture therapy. Global self-ratings of oral and general health were obtained, and denture satisfaction was assessed using the Denture Satisfaction questionnaire.

RESULTS

Both tools had significant correlations with self-rating oral health in patients without denture experience (P < 0.05). However, no significant correlations were found in patients with denture experience. There were significant differences between pre-and post-treatment total scores with both the GOHAI and OHIP-14 (P < 0.001). Responsiveness to treatment using GOHAI and OHIP-14 revealed overall mean effect size higher in patients without (1.49) and (0.83) than those with previous denture experience (0.89) and (0.60), respectively. However, neither tool could detect significant differences between patients with and without denture experience (P > 0.05).

CONCLUSION

Greater improvements of OHRQoL after complete denture therapy were observed in participants without than those with previous denture experience. The Arabic-translated versions of GOHAI and OHIP-14 can be regarded as effective measures for assessing treatment outcomes of complete denture therapy.

Health State Utilities in Edentulous Patients: A Time Trade-off Approach

BACKGROUND

Health is generally regarded as a very high good, and oral health may substantially affect the quality of life of patients. Oral health-related quality of life has usually been investigated by means of disease-specific descriptive instruments, such as the Oral Health Impact Profile and the General Oral Health Assessment Index. These instruments, however, do not enable a comparison of oral health-related quality of life with other medical diseases. Economic methods, such as the time trade-off technique, enable a comparison of the impact of oral health with other medical diseases and thus provide a means to build a bridge in quality-of-life assessments between medicine and dentistry.

METHODS

We included in our study a total of 58 patients who received a complete denture in our clinic in the last 10 y (between January 2001 and May 2012) and who were ≥65 y old. Patient preferences for the edentulous and poorest imaginable oral health state were assessed via the time trade-off method.

RESULTS

Edentulous patients rated their current oral health state as 0.73 (SD, 0.25) and the poorest oral health state as 0.43 (SD, 0.33) on a scale between 0 (death) and 1 (best possible health state). These results are comparable to patient preferences for other serious diseases, such as breast cancer (0.75), asymptomatic HIV infection (0.69), depression (0.44), and osteoarthritis of the hip (0.44).

CONCLUSION

In conclusion, our results suggest that oral health may substantially affect quality of life no less than other medical diseases.

KNOWLEDGE TRANSFER STATEMENT

Health is generally considered the highest good of humankind. In the present article, we show that oral health substantially affects quality of life. In particular, we show that loss of teeth (i.e., being edentulous) reduces quality of life no less than other systemic diseases. Treatment modalities for the edentulous patient may therefore substantially improve the patient's well-being and should be a research priority.

Novel PAradigm to improve Inflammatory burden in end stage Renal disease (rePAIR): study protocol for a randomized controlled trial

Background

Given the importance of inflammation as a predictor of poor outcomes in End Stage Renal Disease (ESRD), reductions in inflammatory biomarkers have been proposed as a critical target in this population. This study targets chronic periodontitis, an oral inflammatory disease of microbial etiology causing persistent inflammation in ESRD. Unlike the previously reported episodic periodontal interventions, we propose to control periodontal inflammation with a continuous maintenance and oral health behavior modifications. We hypothesize that this strategy will improve systemic inflammation and oxidative stress, oral health and quality of life within the 6-month observation period.

Methods

The rePAIR (novel PAradigm to improve Inflammatory burden in ESRD) study is a pilot and feasibility, parallel-arm, and randomized controlled clinical trial that will recruit 72 ESRD subjects with periodontitis in a model of computerized block randomization. This trial aims to compare the effect of standard-of-care vs. repeated non-surgical periodontal therapy on systemic and oral inflammatory burden. This trial will recruit ESRD adult patients with periodontitis older than 21 years old with a minimum of 12 teeth and no history of periodontal treatment within a year. The trial will examine serum C-reactive protein (CRP) (primary outcome) as a biomarker of inflammation as well as interleukin-6 (IL-6), F2 isofurans and F2 isoprostanes (secondary outcomes) and compare their difference between groups from baseline to 6 months. The trial will also compare the difference between groups in patient-centered and clinical oral outcomes from baseline to 6 months.

Discussion

The trial follows a rigorous and transparent study design capturing elements such as pre-specified eligibility criteria, pre-specified primary and secondary outcomes, detailed intervention description to allow replication, intervention random allocation and concealment, blinding in outcome assessment, appropriate sample size calculations, explanation of interim analysis, as per CONSORT Guidelines. Further, gender diversity is secured not only at recruitment but also throughout the trial and during the analysis. Therefore, treatment response outcomes will be examined per gender category. In order to manage anticipated problems, the protocol has included alternative approaches.

Trial registration

ClinicalTrials.gov, NCT03241511. Registered on 7 August 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2760-y) contains supplementary material, which is available to authorized users.

An integrated oral health program for rural residential aged care facilities: a mixed methods comparative study

BACKGROUND

People in residential aged care facilities (RACF) are at very high risk of developing complex oral diseases and dental problems. A multidisciplinary approach incorporating oral health professionals and RACF staff is important for improving and sustaining oral health in RACFs. However, difficulties exist with access to oral health services for RACFs, particularly those in regional and rural areas. This study investigated the impact and experience of an integrated oral health program utilising tele-dentistry and Oral Health Therapists (OHT) in RACFs in a rural setting within Australia.

METHODS

A mixed method comparison study was undertaken. Two hundred fifty-two clinical audits were completed across nine facilities with and without access to the integrated oral health program. Twenty-seven oral health quality of life surveys were completed with eligible residents. One focus group discussions (FGD) and eight interviews were completed with RACF staff. Thematic analysis was conducted on the transcribed FGDs and IDIs. Quantitative data were analysed using descriptive statistics.

RESULTS

Audits showed an improved compliance to Australian Aged Care Quality Accreditation Standards for oral health in the facilities with access to the integrated program compared to those without the program. Thematic analysis revealed that facilities with the integrated program reported improvements in importance placed on OH, better access to OH services and training, and decreased disruption of residents, particularly those with high care needs.

CONCLUSIONS

The integrated oral health program incorporating OHTs and tele-dentistry shows potential to improve the oral health outcomes of residents of RACFs. Improvements for managing oral health of residents with high care needs were observed. RACFs without easy access to an oral health service will also likely benefit from the increased support and training opportunities that the program enables.

Anterior tooth wear and quality of life in a nursing home population

AIMS

The aim of the study was to assess the extent to which a relationship may exist between the wear of the anterior teeth and quality of life in a population of nursing home residents.

METHODS AND RESULTS

A population (n = 100) of nursing home residents (mean age 75.7 years) was recruited all members of which had at least 4 upper and 4 lower anterior teeth and were assessed as cognitively intact by nursing personnel who were familiar with their behavior. The investigator evaluated the level of tooth wear of each subject according to the Tooth Wear Index of Donachie and Walls (Adapted) and then verbally administered the Geriatric Oral Health Assessment Index (GOHAI) of Atchison and Dolan. Analyses did not reveal significant differences in tooth wear between males and females nor between age and GOHAI score; however, tooth wear was positively related to age and inversely related to quality of life.

CONCLUSIONS

Results suggest that tooth wear is negatively related to quality of life.

Oral health-related quality of life in patients undergoing chronic hemodialysis

AIMS

The aims of the study were to determine oral health-related quality of life (OHRQoL) in chronic hemodialysis (HD) patients and to estimate which scale describing OHRQoL, Oral Health Impact Profile (OHIP-14) or Geriatric/General Oral Health Assessment Index (GOHAI), was more useful in this particular group.

METHODS

This was a cross-sectional study conducted by means of a census survey. The Polish versions of OHIP-14 and GOHAI were used to assess OHRQoL. The oral examination included decayed, missing and filled teeth (DMF-T) Index; Oral Hygiene Index simplified; Plaque Index and Gingival Index. In the statistical analysis, the Kruskal-Wallis test, Mann-Whitney U test, Pearson's χ² test and Spearman's rank correlation coefficients were used as appropriate.

RESULTS

The final sample consisted of 72 patients (mean age 63.2±15.2 years). The mean duration of HD treatment was 43.8 months. The mean number of teeth was 10.9. The majority of participants (81.9%) were dentate; only 22.2% of the respondents had >20 teeth. Among the dentate subjects, 44.1% wore removable dental prostheses (60.7% women). The most prevalent items for GOHAI (mean 14.71; SD 7.21) were uncomfortable to swallow, discomfort when eating and unhappy with appearance. The most prevalent items for OHIP-14 (mean 8.87; SD 10.95) were uncomfortable to eat foods, and diet has been unsatisfactory. The internal reliability (Cronbach's alpha) was 0.637 for GOHAI and 0.918 for OHIP-14. Chewing problems were significantly related to GOHAI (p=0.001) and OHIP-14 (p<0.001) scales. Higher OHIP-14 scores were significantly associated with dental treatment needs (p=0.029) and poor self-rated oral status (p=0.001).

CONCLUSION

The HD patients had an unsatisfactory oral status, but using only OHRQoL scale was insufficient to capture all their oral health problems. The scales did not fully reflect poor oral health in HD patients. The oral problems were not a major concern for this group of patients, which could indicate the adaptation to impaired oral health or a change in health priorities. Regular dental examinations together with the assessment of OHRQoL in HD patients are required for a comprehensive patients' state. In our study, more variables were significantly related to the OHIP-14 scale than to the GOHAI scale. Thus, the OHIP-14 scale may be more useful in assessing OHRQoL in HD patients.

Oral Health Indicators for Risk of Malnutrition in Elders

OBJECTIVES

Using both clinical parameters and subjective measures of oral health, this study aimed to identify useful oral health indicators for the risk of malnutrition in elders.

DESIGN

Cross-sectional study.

SETTING

Five community centers run by non-government organizations (NGOs).

PARTICIPANTS

195 community dwelling elders (65 or above).

MEASUREMENTS

An interviewer-administered questionnaire was completed to collect information on elders' socio-demographic background and oral health perception and practice. Their number of teeth, number of occluding tooth pairs, dental caries, and periodontal condition were examined. General Oral Health Assessment Index (GOHAI), an instrument for assessing oral health related quality of life (OHQoL), was used as a subjective measure of oral health. The elders' nutritional status was evaluated by using the Mini-Nutritional Assessment (MNA).

RESULTS

The mean (SD) DFT was 3.3 (3.1). Over 60% of elders had periodontal pockets; 33% had fewer than 20 teeth and 6% were edentulous. The mean (SD) of occluding tooth pairs was 7.1 (4.8). The mean (SD) total GOHAI score was 56.4 (8.0); 60% reported negative impact of oral health on their quality of life. The mean (SD) MNA score was 25.0 (2.9); 30% had malnutrition or were at risk. After controlling for socio-demographic factors, none of the clinical indicators (dental caries, periodontal status, number of teeth, and number of occluding tooth pairs) were associated with risk of malnutrition (all p>0.05). Poorer OHQoL indicated a higher chance for malnutrition in both adjusted models (OR of 0.914; 95% CI of 0.850-0.982; p=0.014 and OR of 0.915; 95% CI of 0.852-0.984; p=0.017). Tooth loss and untreated decayed teeth (DT) were significant/marginally significant determinants of poor OHQoL.

CONCLUSION

Elders' tooth loss and unmet treatment need for dental caries were associated with compromised quality of life, which indicated increased likelihood for malnutrition.

Magnifying the Senescence: Impact of Oral Health on Quality of Life and Daily Performance in Geriatrics: A Cross-Sectional Study

OBJECTIVE

The objective of the study is to study the behavior of the GOHAI as well as the OIDPs as potent measures in oral health related to quality of life in senior citizens.

MATERIALS AND METHODS

An outreach program-based cross-sectional study conducted in Modinagar, Uttar Pradesh, India. A total of 340 study participants aged >60 years were selected from outreach program which were held between January 2017 and April 2017 based on inclusion and exclusion criterion. The dental health status and its influence on the self-perceived value of life was assessed using GOHAI and OIDP index among the participants. The data were estimated using Statistical Package for the Social Sciences version 21.0 (SPSS Inc., Chicago, IL, USA). Chi-square analysis and Pearson correlation were used to test the significance of the independent variables and the distinct the overall oral impact scores in groups with different dental status.

RESULTS

OIDP shows that most of the patients are suffering from eating food (57.74) and speaking clearly (45.96). GOHAI shows that most of the geriatric population with a lowest mean score of 2.12 and 2.13 were difficulty in chewing food and sorrowful with the condition of mouth and teeth. Similarly, a lower number of population of 3.68 had difficulty in swallowing food.

CONCLUSION

The prevalence of OIDPs in this geriatric population was high. Oral impact mainly effect their quality or value of life leading to difficulty in eating and verbal communication.

A pilot study on the feasibility of training nurses to formulate multicomponent oral health interventions in a residential aged care facility

OBJECTIVES

This 10 weeks feasibility study investigated whether residential care nurses with 12 hours advanced oral health training in assessments and saliva testing could formulate, implement and monitor individualised oral care plans of early dementia residents.

METHOD

Four trained lead advocate nurses using SXI-D, OHIP14, oral health assessment tool (OHAT) assessments and a modified saliva test formulated nurse scheduled comprehensive oral care plans (NSCOCPs) by selecting and scheduling preventive products and procedures multiple times throughout the day to alkalise the mouth of 8 residents as an adjunct to assisted brushing and high-fluoride toothpaste.

RESULTS

Nurse assessments, saliva tests and care plans were validated against oral health therapist (OHT) findings. Care plan agreement between Nurse and OHT intervention selection and scheduling was high (75%-88%). Untrained nurse compliance was very high, 86%-99% for the 4930 scheduled interventions. Untrained nurses delivered multiple scheduled interventions by following NSCOCPs despite initially not understanding the reason for each of 9 interventions categories. NSCOCPs could track and monitor whether a recommended intervention had been completed by general nursing staff over 3 nursing shifts.

CONCLUSION

The role of nurses may have to be expanded beyond traditional roles to meet the growth and changes in oral health needs in residential facilities. Intensive training of a few lead advocate nurses to assess risk and formulate individualised NSCOCPs provides a method to transfer knowledge to untrained staff and deliver multicomponent preventive interventions soon after entry into residential care where timely visits by dental professionals to examine residents and prescribe preventive interventions are infrequent or unlikely.