Measuring oral health: does your treatment really make a difference

Cross-cultural adaptation of oral health-related quality of life measures used to assess the impacts of malocclusion and dentofacial deformities in Saudi Arabia: A literature review

Since the World Health Organization broadened its definition of health, beyond biological boundaries, to include physical, emotional, and social wellbeing. Oral health-related quality of life (OHRQoL) became common outcome measure in clinical trials and epidemiological studies in Dentistry and Medicine. It is not surprising, therefore, to see quality of life as one of the programs of the Saudi 2030 vision. That said, it can be difficult to interpret the findings of OHRQoL research if the measures used were not appropriately adapted and validated in the population being studied. In this review article, the concept of cross-cultural adaptation of OHRQoL and its use in the Saudi context, as applied to orthodontic research, was discussed. An electronic search in PubMed and MEDLINE databases was conducted. A second search was conducted to locate methodological papers discussing cross-cultural adaptation and translations. Appraisal of relevant research was conducted to provide a better understanding of the process of adapting OHRQoL measures to assess the impact of malocclusion and dentofacial abnormalities on quality of life. This review pointed out important methodological concerns that warrant considerations during the translation and adaptation of OHRQoL measures.

Oral Health-Related Quality of Life and Severity of Periodontal Disease

Background:

Oral diseases are among the most common diseases which could not dissociate from general conditions with regards to impacts on quality of life (QoL). The present study is aimed to assess the impact of the severity of periodontal disease on oral health QoL using oral health-related quality of life (OHQoL)-UK questionnaire.

Materials and Methods:

The OHQoL-UK questionnaire consists of 16 variables within four domains made up of symptoms, psychological, social dimensions, and physical dimensions. Summing up the responses produce overall OHQoL-UK scores ranging from 16 to 80. Internal consistency was assessed using Cronbach's reliability coefficient. Each patient underwent a periodontal examination including periodontal attachment levels with Williams' periodontal probe as part of his or her routine assessment by one clinician collaborating on the study.

Results:

Within 200 patients participating in this study, 51% were < diploma, 32% were < bachelor's degree, and 17% were bachelor's degree and higher. Patients with higher educational level have a higher mean QoL score (P = 0.0001) which was statistically significant in regard to all aspects.

Conclusion:

The mean QoL score was significantly lower in patients with severe periodontitis when compared to patients with mild periodontitis, patients with better academic qualification have higher mean QoL score. According to the effect of severity of periodontal condition and educational level on QoL, required intervention should be done for treatment to improve QoL as a result.

Effect of peri-implant disease on oral health-related quality of life in geriatric patients

OBJECTIVE

This study aimed to evaluate the effect of peri-implant disease on the quality of life in geriatric patients using implant-supported overdentures.

BACKGROUND

Peri-implant disease and bone loss are two main complications of dental implant treatment that can impact the quality of life in the geriatric population.

MATERIALS AND METHODS

This cross-sectional study included 109 geriatric individuals treated in the prosthodontics and periodontology departments. On clinical examination, periodontal pocket depth, gingival index (GI) and plaque index (PIn) were measured to determine peri-implant status. Marginal bone loss was measured by radiological examination, using ImageJ software. Moreover, the Oral Healthy Impact Profile-14 (OHIP-14) questionnaire was used to evaluate participants' perceived oral health-related quality of life.

RESULTS

Peri-implantitis (PI) and peri-implant mucositis (PM) prevalence were 30% and 24%, respectively. Only 44% of patients had healthy implants. Although total OHIP-14 scores were higher in the PI group than in the healthy and PM groups, this difference was not statistically significant (P = .148). Total OHIP-14 score was significantly correlated with PIn and GI.

CONCLUSIONS

Within the limitations of this study, it can be said that on quality of life in patients using implant-supported overdenture related to clinical parameters such as PIn and GI. Results also indicated that geriatric patients should take action to improve their oral health. Further longitudinal studies are needed to support our results and should include control groups that use conventional removable dentures.

HIV-1 impact on oral health-related quality of life: a cross-sectional study

This cross-sectional study compared the Oral-Health-Related Quality of Life (OHRQoL) in HIV negative patients (Group 1, n=129, mean age: 39.9 ± 15.6, 75 females) and HIV+ patients (Group 2, n=670, mean age: 43.2 ± 9.8, 246 females) from the same socio-economic environment using the OHIP-49 questionnaire. OHIP total score were determined by simple summing. A multiple linear regression model was carried out to predict OHIP scores in which HIV+ patients experienced a significantly (p<0.001) worst OHRQoL for total and every dimension. A general linear model was used for estimating the means in the two groups adjusted for covariates included in the previous model. Adjusted means for subscale and total OHIP scores were significantly higher for Group 2 (61.6 ± 6.26 vs. 119.8 ± 3.31) with a large effect size (0.94). HIV+ infection, decayed teeth, prosthodontic and surgical needs, care index, drug use, employment and age presented an independent effect on questionnaire scores. This study shows that HIV+ infection has an independent and negative impact on the OHRQoL while care index presents a positive impact. Additional factors like high decayed teeth, prosthodontic treatment needs and drug use are independently associated with total OHIP scores, presenting a negative effect on OHRQoL.

Effect of Dental Treatment on the Quality of Life of Children with Traumatic Dental Injuries in Ibadan, Nigeria

Background

Anterior dental trauma is known to be common in our environment as well as the complications that come with it. These injuries have been seen to impact the quality of life (QoL) of children significantly due to the fact that they compromise their dental health. This leads to aesthetic, psychological, social, and therapeutic problems impacting both the children and their parents. Treatment of these injuries has also been severely neglected possibly due to lack of awareness of where or how to access treatment as well as fear of dental treatment. However, treatment may on the other hand bring about a substantial improvement on the QoL of children in terms of their daily living.

Aim

To assess the effect of dental treatment on the QoL of 12- to 15-year-old Nigerian school children previously identified as having had traumatized anterior teeth.

Design

This is a follow-up study where secondary data were extracted from a cross-sectional study involving 1575 children attending public and private secondary schools in Ibadan, Nigeria. One hundred and ninety-six adolescents with evidence of dental trauma, previously identified as having their QoL negatively affected as a result of dental trauma, were called to take part in the follow-up study. The Child Perception Questionnaire (CPQ11-14) was used in assessing the QoL of participants with dental trauma before and after treatment. Data were analysed using the IBM® SPSS® Statistics version 20.0, and the effect of dental treatment on the QoL of the participants was assessed using the McNemar's test. Statistical significance was set at P < 0.05.

Results

Fifty-one (26.0%) out of the 196 invited children participated; there were 31 males and 20 females. The mean age was 13.4 years (standard deviation 1.1 years). Eighty traumatized anterior teeth were involved, with the maxillary centrals being the commonest (68, 85%). Twenty-three (45.1%) participants had more than one traumatized tooth. The commonest dental trauma was enamel fracture, which involved the dentine (39, 48.8%). The main treatments given were composite build-up (36, 45%) and root canal treatment (42, 52.5%). With the CPQ11-14, in the oral symptoms domain, the number adversely affected before treatment fell from 30 (58.8%) to 3 (5.9%) (P < 0.001); in the emotional well-being domain, the number dropped from 35 (68.6%) to 10 (19.6%) (P < 0.001); and in the social well-being domain, the number fell from 34 (66.7%) to 22 (43.1%) (P = 0.004). However, in the functional limitation domain, the number adversely affected increased from 24 (47.1%) before to 46 (90.2%) after treatment (P < 0.001).

Conclusion

Treatment resulted in a significant improvement in the QoL of participants, especially regarding their oral symptoms, and emotional and social well-being. However, there was worsening in the functional limitation domain. There is the need to introduce oral health into the school curriculum in order to encourage early reporting and prompt treatment of traumatic dental injuries.

The facilitators and barriers to nurses' participation in continuing education programs: a mixed method explanatory sequential study

Background:

Since several factors affect nurses’ participation in Continuing Education, and that nurses’ Continuing Education affects patients’ and community health status, it is essential to know facilitators and barriers of participation in Continuing Education programs and plan accordingly. This mixed approach study aimed to investigate the facilitators and barriers of nurses’ participation, to explore nurses’ perception of the most common facilitators and barriers.

Methods:

An explanatory sequential mixed methods design with follow up explanations variant were used, and it involved collecting quantitative data (361 nurses) first and then explaining the quantitative results with in-depth interviews during a qualitative study.

Results:

The results showed that the mean score of facilitators to nurses’ participation in Continuing Education was significantly higher than the mean score of barriers (61.99±10.85 versus 51.17±12.83; p<0.001, t=12.23). The highest mean score of facilitators of nurses’ participation in Continuing Education was related to “Update my knowledge”. By reviewing the handwritings in qualitative phase, two main levels of updating information and professional skills were extracted as the most common facilitators and lack of support as the most common barrier to nurses’ participation in continuing education program.

Conclusion:

According to important role Continuing Education on professional skills, nurse managers should facilitate the nurse’ participation in the Continues Education.

Promoting menstrual health among persian adolescent girls from low socioeconomic backgrounds: a quasi-experimental study

Background

Research in the past decade has revealed average to poor menstrual health among many Iranian girls. The present study investigated the effectiveness of a health promotion project on improving menstrual health in adolescent girls in Iran.

Methods

A quasi-experimental study was conducted to evaluate the effectiveness of the health intervention program. A total of 698 students (study participants and controls) in several schools in Mazandaran province, Iran were included. The project comprised 10 two-hour educational sessions. Educational topics included the significance of adolescence, physical and emotional changes during adolescence, pubertal and menstruation health and premenstrual syndrome. A self-administered questionnaire measuring demographic characteristics, behaviors during menstruation, menstrual patterns, sources of information about menstruation and personal health data was administered. The questionnaire was administered to all participating students after the experimental group received the training.

Results

Among the most significant results was the impact of educational sessions on bathing and genital hygiene. A total of 61.6% in the experimental group compared with 49.3% in the control group engaged in usual bathing during menstruation (p = 0.002). Individual health status was significantly statistically correlated with menstrual health. Attitude towards menstruation was also significantly related to menstrual health.

Conclusions

The present study confirms that educational interventions, such as the health promotion project in this study, can be quite effective in promoting menstrual health.

Comparative assessment of validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross-sectional survey among adolescents in Davanagere city, Karnataka, India

AIM

To evaluate reliability and validity of an abbreviated version of the Oral Impact on Daily Performance (OIDP) questionnaire and to analyse the interrelationship between OIDP scores, socio-demographic characteristics and oral health status among high school children in Davanagere city, Karnataka, India.

MATERIALS AND METHODS

This cross-sectional survey was conducted with 900 school children aged between 12 and 15. The subjects were randomly selected from six high schools. Selected subjects completed a survey instrument predesigned to measure subjective oral health indicators including the eight-item OIDP frequency scores. The study participants were clinically examined for dental caries, and they completed a self-administered questionnaire about demographic information and oral behaviours.

RESULTS

44% of the students reported at least one oral impact in the previous 6 months. The reliability of the instrument was measured in terms of Cronbach's alpha for the OIDP frequency. It was found to be 0.81. Eating was the most common performance affected (33%) followed by cleaning teeth (22%) and speaking (20%). The severity of impacts was low for relaxing and carrying out works.

CONCLUSION

The OIDP frequency score has acceptable psychometric properties in the context of an oral health survey among high school children of Davanagere city, Karnataka, India.

Homeless who Accessed a Healthy Living Centre in Swansea, South Wales: An Assessment of the Impact of Oral Ill-Health

Aim

To quantify the way that oral diseases affect the lives of homeless and vulnerable people in Swansea, using the short-form Oral Health Impact Profile (OHIP-14).

Method

A convenience sample of people using the services of a healthy living centre for the homeless was surveyed using a questionnaire and the short-form OHIP-14.

Results

One hundred subjects were recruited to the study. The mean score for the OHIP-14 was 21.8 (SD 17.0). The most commonly reported impacts experienced were problems with toothache, discomfort, ability to relax, and feeling ashamed regarding the appearance of teeth. Of the different categories of homeless people, rough sleepers experienced higher levels of impact ( P=0.004). Those having more than 20 teeth were more likely to experience lower levels of impact ( P=0.001).

Conclusion

The survey highlighted an increased prevalence of oral health impacts in this special needs group. In addition to physical factors, psychosocial factors must be considered, particularly with regard to appearance and psychological disability and discomfort, in the development of services.

Psychometric properties of the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) - short forms

BACKGROUND

The need to evaluate the impact of oral health has led to the development of instruments for measuring oral health-related quality of life (OHQoL). One such instrument is the Child Perceptions Questionnaire (CPQ(11-14)), developed specifically for 11-to-14-year-old children. As this questionnaire was considered long (37 items), shorter forms were developed with 8 (Impact Short Form: 8--ISF:8) and 16 items (Impact Short Form: 16--ISF:16) to facilitate use in the clinical setting and population-based health surveys. The aim of the present study was to translate and cross-culturally adapt these CPQ(11-14) short forms for Brazilian Portuguese and evaluate the measurement properties of these versions for use on Brazilian children.

METHODS

Following translation and cross-cultural adaptation, the ISF:8 and ISF:16 were tested on 136 children from 11 to 14 years of age in the city of Belo Horizonte, Brazil. The instrument was administered by a trained researcher who also performed clinical examinations. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability, test-retest reliability) were determined. Discriminant validity was tested between groups, which were divided into children with no cavities and no malocclusion; children with cavities and without malocclusion; and children with malocclusion and without cavities.

RESULTS

The mean total score was 6.8 [standard deviation (SD) 4.2] for the ISF:8 and 11.9 (SD 7.6) for the ISF:16 (p < 0.001). Statistically significant associations were found between oral abnormalities and the subscales of the ISF:8 and ISF:16 (p < 0.05). Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (ICC) (ISF:8 = 0.98 and ISF:16 = 0.97) and Cronbach's alpha (ISF:8 = 0.70 and ISF:16 = 0.84) proved to be adequate. Construct validity was confirmed from the correlation between the short form scores and oral health and overall well-being ratings. The score on the short forms of the CPQ(11-14) was able to discriminate between different oral conditions. Criterion validity was satisfactory (p < 0.05).

CONCLUSION

The Brazilian versions of CPQ(11-14) ISF:8 and ISF:16 have satisfactory psychometric properties, similar to those of the original instrument.

Using written vignettes in focus groups among older adults to discuss oral health as a sensitive topic

When the mouth yields pain and distress, it can impact psychosocially the lives of older adults and might constitute a sensitive topic for open disclosure. In this article, we describe our use of a written vignette in focus groups for discussion of oral health and disablement. Six focus groups were conducted with 42 older men and women with an average age of 75 years who were purposefully selected through advertisements posted in community centers and retirement homes. In discussions lasting for an average of 90 min, groups of up to 9 participants commented positively and negatively on the vignette's story and voluntarily discussed their personal experiences, family histories, and testimonies about the mouth and coping and adapting strategies to disabilities. The discussion about oral health can be sensitive, but the vignette shifted the focus away from the participants and allowed them to share personal experiences with oral health and disablement.

Do oral lesions associated with HIV affect quality of life?

OBJECTIVE

To assess the impact of oral lesions on quality of life (QOL) in HIV-positive (HIV+) individuals using the Oral Health Impact Profile (OHIP).

STUDY DESIGN

This was a cross-sectional analytic study that compared 2 groups of HIV+ patients. Group 1 (n = 71) consisted of patients who presented with oral manifestations of HIV infection. Patients in group 2 (n = 79) were also HIV positive but had no oral lesions. The QOL measures were assessed by either simple frequency counts or the use of item weights.

RESULTS

Oral candidiasis was the most common oral lesion diagnosed. Patients in group 1 reported significantly greater impacts (P < .05) for all 7 subscales in OHIP.

CONCLUSIONS

Oral lesions associated with HIV infection negatively affect the oral health-related QOL in infected patients.

Oral health status and health-related quality of life: a systematic review

This study was conducted in order to identify the literature on oral health status and health-related QOL, review the findings systematically, and assess the association between them. We performed a literature search of reports published between January 1973 and June 2004, using five databases including MEDLINE. Only studies that used validated generic health-related QOL instruments were selected. The reviewers evaluated selected articles independently and resolved disagreements by consensus. A total of 1,726 articles were retrieved and seven were selected for the review; five observational studies and two intervention studies. Four studies showed significant associations between oral health status and health-related QOL. Temporomandibular disorders were highly associated with reduced health-related QOL. Poor oral status linked to both craniomandibular and cervical spinal pain was associated with increased impairment of health-related QOL. Dissatisfaction with the teeth and mouth, and a sensation of dry mouth contributed to reduce health-related QOL. Providing edentulous patients with implant-supported full dentures contributed to improve health-related QOL. Assessment of health-related QOL in relation to oral health with validated instruments remains insufficient. The present findings suggest that oral health status could affect health-related QOL in some settings; however, further evidence is needed to support this interpretation.

Health-related quality of life of children aged 11 to 14 years with orofacial conditions

OBJECTIVE

To assess the health-related quality of life (HRQoL) of 11- to 14-year-old children with orofacial conditions.

DESIGN

Thirty-nine patients with orofacial conditions were compared with 32 patients with dental caries.

OUTCOME MEASURE

The multidimensional 37-item Child Perceptions Questionnaire for 11- to 14-year-old children (CPQ(11-14)). This forms one component of the Child Oral Health Quality of Life Questionnaire.

RESULTS

The orofacial group had slightly higher scores on the CPQ(11-14) than the dental group (p < .05). The scores were slightly to moderately higher on the functional limitations (p < .01) and social well-being (p < .01) domains. The groups did not differ with respect to oral symptoms or emotional well-being. Mouth breathing, problems with speech, missing school, being teased, and being asked questions about their condition were the only issues reported more frequently by the orofacial group (p < .01). There was no evidence of social inhibition or withdrawal in the orofacial group. The children with orofacial conditions rated their oral health better than the children with dental decay (p < .05). In both groups, the majority of children reported that their condition had little impact on their life overall.

CONCLUSIONS

Based on CPQ(11-14) scores, there were few differences in the HRQoL of 11- to 14-year-old children with orofacial conditions, compared with children with dental caries. This suggests that the majority of these children are well adjusted and able to cope with the adversities they experience as a result of their conditions. This may reflect the quality of the team approach used at the treatment setting at which they were recruited.

The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome

OBJECTIVE

To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services.

BASIC DESIGN

Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status.

SETTING

Two health authorities in South Wales, UK.

SUBJECTS

A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires.

RESULTS

For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care.

CONCLUSIONS

Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.

The impact of attendance patterns on oral health in a general dental practice

OBJECTIVE

The aim of this study was to examine the impact of attendance patterns on oral health in the context of government policy on dental care and registration in the UK.

METHOD

The data involved 643 consecutive patient responses to a questionnaire on dental health taken from a survey that was conducted during 1998 in an urban area of Swansea. The survey continued for a period of six months and covered patients of 18 years of age and over, responding to a questionnaire on the subjective oral health status indicators including the pattern of their attendance to dental practices.

RESULTS

Regular dental care attendance has a significant positive impact on dental health while its impact on the number of teeth present is insignificant. Regular attendees also suffer significantly less from the severity, prevalence, social and psychological impacts of dental health problems.

CONCLUSION

Regular dental attendance is associated with better oral health when regularity of care is defined as a visit within a two-year period. The rationality of a 15 month registration period is therefore debatable in the context of developing equitable services.

Oral ill-health and deprivation among patients of a general dental practice in South Wales

PURPOSE OF STUDY

This study aims to establish and report on whether individuals from deprived areas suffer more ill health than adults from areas considered not to be deprived when visiting a general dental practice.

BASIC PROCEDURES

Between December 1998 and June 1999 registered dental patients over 18 years of age attending for routine care completed a questionnaire measuring functional, experiential and psychosocial impact of oral ill health. In addition the clinical impact of ill health was established from the patient examination and record card. Clinical outcome was assessed by numbers of standing teeth, oral health was assessed using the Subjective Oral Health Status Indicators (SOHSI). The patient's postcode was used to categorise individuals from areas of different deprivation states.

MAIN FINDINGS

99% were dentate with 88.4% having more than 20 teeth. A total of 71.8% were able to eat satisfactorily, 88.2% were able to speak satisfactorily, 54.6% were discontent, 99.4% were worried about their oral health and appearance, 62.8% were satisfied with their oral health, 44.8% experienced discomfort, 65.8% experienced other symptoms, and 86.8% experienced 'general well-being'. No differences were observed for clinical measures between the deprived groups. Only three out of eight oral health measures showed any differences between the deprived groups, namely, ability to speak, discontent and general well-being. More individuals from deprived areas experienced these impacts.

PRINCIPAL CONCLUSIONS

It was anticipated that individuals from deprived areas would experience greater ill-health: this outcome was not as marked as expected.

Quality of life in adults with repaired complete cleft lip and palate

OBJECTIVE

This study evaluated the quality of life in adult Swedish subjects with repaired complete cleft lip and palate (CLP).

DESIGN/PATIENTS

Sixty-eight adults with repaired CLP were compared with a group of 66 adults without cleft matched by gender and age.

OUTCOME MEASURES

The outcome measures included a self-report questionnaire concerning quality of life in general, well-being, and health-related quality of life.

RESULTS

The CLP group rated their quality of life significantly lower than did the control group in the areas of life meaning (p <.05), family life (p <.0001), and private economy (p <.01). There were no significant differences between the groups concerning well-being. In the CLP group, the health-related quality of life was significantly lower concerning global life (p <.0001), disturbance to life (p <.01), well-being (p <.0001), social contacts (p <.0001), and family life (p <.05) but significantly higher concerning ability to make the most of leisure time (p <.001) and to be active (p <.001).

CONCLUSIONS

The CLP group perceived a marked impact of the handicap on their lives concerning global aspects, well-being, and social life. More practical and tangible aspects of their daily living, however, were not affected, and only some minor aspects of their quality of life in general were poor in comparison with the control group, which indicates a fairly good life adjustment in spite of the handicap.

Quality of life and its importance in orthodontics

Over the last 10-15 years, the terms quality of life (QOL) and health-related quality of life (HRQL) have been seen increasingly in medical literature. Much of the orthodontic treatment that is undertaken is justified on the basis of improving health-related quality of life. With this in mind, studying HRQL in orthodontic patients has the potential to provide information about treatment needs and outcomes, and may also facilitate improved care. Clinicians should therefore be aware of some of the ways in which health-related quality of life may be assessed. The first part of this review article looks at the general concepts of health-related quality of life, whilst the second section focuses on dentistry and orthodontics.