Functional oral health-related quality of life impact: A systematic review in populations with tooth loss

Mediation of nutritional status between the number of teeth and depressive symptoms in multi-ethnic older adults from Western China

Background

Depression is a prevalent issue among older adults, affecting the quality of life and overall health of individuals. This study aimed to investigate the role of nutritional status in mediating the number of teeth and depressive symptoms.

Method

A prospective multi-ethnic baseline data of 6,632 adults aged 50 years and older was derived from the 2018 West China Health and Aging Trend study. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale, and nutritional status was evaluated with the Mini Nutritional Assessment-Short Form. A multiple linear regression was performed to assess the associations among the number of teeth, nutritional status, and depressive symptoms. Mediation models and pathway analysis were employed to investigate the mediating role of nutritional status.

Results

The sample comprised 18 ethnic groups from western China. The percentage of depressive symptoms among participants was 17.3%. Multiple linear regression indicated a significant correlation between the number of teeth and depressive symptoms. The association remained statistically significant (β = -0.089; 95% CI -0.158, -0.020) after adjusting for MNA-SF scores. Mediation analysis confirmed nutritional status partially mediated the relationship between the number of teeth and depressive symptoms (indirect effect estimate = -0.059; 95% CI -0.076, -0.044, direct effect estimate = -0.089; 95% CI -0.158, -0.020). Furthermore, structural equation model for pathway analysis verified the correlation between the number of teeth, nutritional status, and depressive symptoms (p < 0.05).

Conclusion

Nutritional status partially mediated the association between the number of teeth and depressive symptoms, revealing significant direct and indirect effects. Early identification of nutritional deficits and the maintenance of oral health are essential for preventing depression in older adults.

Association between tooth loss and geriatric syndromes in older adults: a cohort study from a rural area in eastern China

BACKGROUND

Tooth loss was linked to health status, with substantial implications for malnutrition and chronic inflammation risks in older adults, especially among vulnerable groups. This study aimed to explore the associations between tooth loss severity, denture status, and geriatric syndromes.

METHODS

In 2019, 1094 participants were recruited and subjected to face-to-face interview to assess tooth loss severity, along with grip strength and body composition. In 2023, a follow-up was conducted with a subsample of the participants. Logistic regression analysis was utilized to explore the association between tooth loss severity at baseline and geriatric syndromes (sarcopenia, malnutrition risk, frailty, fall) at fourth year follow-up, as well as association between denture status and geriatric syndromes.

RESULTS

The multivariate analyses showed that having tooth loss affecting daily life at baseline was associated with a 1.80-fold higher prevalence of sarcopenia and 2.31-fold higher prevalence of malnutrition risk after four years. Participants with fewer than 10 teeth had significantly higher odds of geriatric syndromes compared to those with 21 or more teeth: 1.87-fold for sarcopenia (95% CI: 1.07 to 3.26), 2.99-fold for malnutrition risk (95% CI: 1.93 to 4.62), and 1.68-fold for frailty (95% CI: 1.10 to 2.56). Older adults with tooth loss who did not have dentures exhibited a significantly higher odds of sarcopenia, malnutrition risk, frailty, and falls, more number of geriatric syndromes.

CONCLUSION

Higher severity level of tooth loss at baseline were associated with higher odds of geriatric syndromes at fourth year in older adults. Dentures partially mitigate the association between tooth loss and the higher odds of geriatric syndromes. Screening and intervening oral health is important for the prevention of geriatric syndromes in older adults.

CLINICAL TRIAL NUMBER

Not applicable.

Global and Regional Patterns in Edentulism (1990-2021) With Predictions to 2040

AIMS

Edentulism's impact on overall well-being is widely recognized, but there is limited information on regional and sex disparities in its global burden. This study aims to fill this gap by providing an updated picture of edentulism's burden by region and sex and predicting its global trend for the next 2 decades.

METHODS

This study analyzed and reported Global Burden of Disease (GBD) data on the prevalence, incidence, and disability adjusted life years (DALYs) of edentulism, with a breakdown by sex and sociodemographic index (SDI). Epidemiological trends from 1990 to 2021 were characterized using Joinpoint regression analysis. An Autoregressive Integrated Moving Average (ARIMA) model was used to forecast edentulism prevalence trends from 2022 to 2040.

RESULTS

A double increase was found in the number of people with edentulism during the last 30 years. A decrease in the incidence rate of edentulism was found in younger age groups, and a shift in the peak age of prevalence from 70-74 in 1990 to 75-79 in 2021. Females had a higher prevalence rate of edentulism than males globally, with a disproportionate burden in regions of high SDI countries. The global prevalence rate is projected to increase to 5,004 individuals per 100,000 in 2040.

CONCLUSION

These results indicate that edentulism continues to be a significant global public health concern, particularly as its prevalence is expected to rise with the aging population.

CLINICAL RELEVANCE

Public and clinical preventative measures against edentulism is imperative for the welling being of the population, especially in female group.

Efficiency of periodontal treatment to improve type 2 diabetes mellitus outcomes: A systematic review and meta-analysis of economic evaluations

BACKGROUND

To assess the efficiency of periodontal treatment (PT) in improving diabetes-related outcomes in adults with type 2 diabetes mellitus (T2DM) and periodontitis, providing an updated and comprehensive synthesis from economic evaluations (EE).

METHODS

Seven databases and one register were independently searched by two reviewers for articles published up to 8 May 2024. Studies that assessed the efficiency of PT versus no treatment or other dental treatments were included. Risk of bias was assessed using the Cochrane RoB 2, ROBINS-I and ECOBIAS tools for the first stage of EE and the CHEERS checklist and NICE quality appraisal tool for overall EE. Qualitative and quantitative syntheses of the articles were conducted and assessed using the GRADE approach.

RESULTS

Eleven studies were included. PT reduces total healthcare costs, including inpatient and outpatient, diabetes-related costs and other drug costs (low to moderate certainty). A total incremental net benefit of USD 12 348 (2022 currency, 95% CI 12 195-12 500) was estimated from three high-quality model-based cost-utility analyses (high certainty).

DISCUSSION

The inclusion of PT in the comprehensive treatment of patients with T2DM and periodontitis is cost-effective. Future research is required to ensure the transferability of these findings and inform decision makers from different countries.

REGISTRATION

PROSPERO CRD42023443146.

Association between dietary patterns and existing natural teeth in Chinese elderly: a national community-based study

Objective

To promote healthy aging, we aimed to evaluate the independent and joint effects of protein, sugar-salt, and anti-inflammatory diets on existing natural teeth among the Chinese elderly, and further explore the mediating role of body mass index (BMI).

Methods

Based on the 2017-2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS), 11,608 participants aged 65 and above were recruited in this cross-sectional study. Protein, sugar-salt, and anti-inflammatory diets were measured via a simplified 13-item dietary frequency questionnaire (dietary frequency around age 60). Restricted cubic spline and multiple linear regression analyses evaluated associations between dietary patterns and existing natural teeth, and mediation analysis explored BMI's role.

Results

Protein and anti-inflammatory diets were positively and linearly associated with existing natural teeth, while sugar-salt diets were negatively and linearly associated. Compared with the low dietary patterns (Q1), high protein and anti-inflammatory diets (Q4) were associated with a higher number of teeth (β: 1.70, 95%CI: 1.14, 2.25; β: 1.98, 95%CI: 1.45, 2.51, respectively; and 28% and 38% risk decreased for fewer than 20 teeth, respectively), whereas high sugar-salt diets had the lowest number (β: -1.14, 95%CI: -1.61, -0.67; 44% risk increased for fewer than 20 teeth). We further found a joint effect of low protein, high sugar-salt, and low anti-inflammatory diets on existing natural teeth (β: -1.97, 95% CI: -2.61, -1.33). Moreover, BMI mediated 10.88%, 19.69%, and 10.74% of the effects of the protein, sugar-salt, and anti-inflammatory diets with existing teeth, respectively.

Conclusion

Promoting high protein and anti-inflammatory diets and reducing sugar-salt intake in elderly individuals may reduce tooth loss, possibly partly mediated through overweight or obesity.

ORAL HEALTH IMPACT OF DENTAL HYGIENE AND DENTAL THERAPY PATIENT POPULATIONS-AN EVIDENCE UPDATE IN 2024

OBJECTIVES

Dental patient-reported outcomes, especially the Oral Health-Related Quality of Life (OHRQoL) construct, are vital for evidence-based dentistry. This construct includes four dimensions (4D): Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. This study updates previous work characterizing 4D OHRQoL impairment among patients in dental hygiene (DH) and dental therapy (DT) settings.

METHODS

An expert panel revised previously determined DH and DT patient population groups to align them with current scopes of practice. An updated systematic review was then conducted to incorporate recent studies using the Oral Health Impact Profile (OHIP) to assess 4D OHRQoL in these populations. The search spanned 6 databases from January 1, 2023, to April 16, 2024.

RESULTS

The panel identified 20 patient populations, representing the scope of DH and DT practice. The systematic review contained 19 studies (17 from the previous review and 2 new ones). Studies' OHRQoL data covered only 30 % of dental hygiene and dental therapy patient populations identified by the panel. The most frequently studied group was "therapeutic periodontal treatment-patients with periodontitis" (n = 17, 89 %), followed by "oral hygiene instructions-all patients" (n = 13, 68 %). Only four studies provided 4D OHRQoL data, showing the greatest impacts in Orofacial Pain (baseline OHIP: 3.10-4.20; follow-up: 1.52-3.60) and Orofacial Appearance (baseline OHIP: 0.44-2.50; follow-up: 0.91-2.25). Among studies reporting summary OHIP scores only (n = 15), overall OHRQoL impairment ranged from 1.40 to 42.35 at baseline and 1.50-40.56 at follow-up. All studies demonstrated a general trend of reduced OHRQoL impairment over time with treatment. Risk of bias was low, with no evidence of publication bias.

CONCLUSION

Current evidence on OHRQoL impairment in DH and DT patient populations is limited, covering only a third of those treated by dental hygienists and therapists. Especially, scarce 4D OHRQoL data prompts the need for more research in this format. Despite these limitations, the findings show promising trends of reduced OHRQoL impairment over time for DH and DT patient populations.

Exploring the link between tooth loss, cognitive function, and brain wellness in the context of healthy aging

AIMS

The aim of this study was to evaluate the utility of using MRI-derived tooth count, an indirect and nonspecific indicator of oral/periodontal health, and brain age gap (BAG), an MRI-based measure of premature brain aging, in predicting cognition in a population of otherwise healthy adults.

METHODS

This retrospective study utilized data from 329 participants from the University of South Carolina's Aging Brain Cohort Repository. Participants underwent neuropsychological testing including the Montreal Cognitive Assessment (MoCA), completed an oral/periodontal health questionnaire, and submitted to high-resolution structural MRI imaging. The study compared variability on cognitive scores (MoCA) accounted for by MRI-derived BAG, MRI-derived total tooth count, and self-reported oral/periodontal health.

RESULTS

We report a significant positive correlation between the total number of teeth and MoCA total scores after controlling for age, sex, and race, indicating a robust relationship between tooth count and cognition, r(208) = .233, p < .001. In a subsample of participants identified as being at risk for MCI (MoCA <= 25, N = 36) inclusion of MRI-based tooth count resulted in an R2 change of .192 (H0 = 0.138 → H1 = 0.330), F(1,31) = 8.86, p = .006. Notably, inclusion of BAG, a valid and reliable measure of overall brain health, did not significantly improve prediction of MoCA scores in similar linear regression models.

CONCLUSIONS

Our data support the idea that inclusion of MRI-based total tooth count may enhance the ability to predict clinically meaningful differences in cognitive abilities in healthy adults. This study contributes to the growing body of evidence linking oral/periodontal health with cognitive function.

Unfavourable Outcomes in Older Adults with Oral Frailty: A Scoping Review

BACKGROUND

The significant occurrence of oral frailty (OF) in older patients highlights the necessity of addressing this concern. OF is associated with complications and mortality in elderly patients. The objective of this study is to identify unfavorable outcomes in older patients with OF to increase awareness and mitigate risks.

METHODS

This review employed specific MeSH terms to perform an extensive literature search on OF and its unfavorable outcomes across PubMed, Web of Science, Embase, Cochrane Library, Scopus, and CINAHL databases. The review included English-language papers published from inception to March 31, 2024, focusing on individuals aged 60 and above, adverse outcomes related to OF, and studies employing cross-sectional or cohort designs.

RESULTS

The review comprised 28 articles: 20 cross-sectional and 8 prospective cohort studies. Among these articles, 10 were rated as "Good" and 18 as "Fair", reflecting the high quality of the literature. Next, 20 OF assessment tools were summarized, and the most frequently used methods for assessing OF were the methods of Tanaka et al and Oral Frailty Index-8 (OF-8). The most frequently unfavorable outcomes related to OF in the elderly were physical frailty, malnutrition, low dietary variety, social withdrawal, disability, and low gait speed.

CONCLUSION

High levels of OF significantly increase the risk of adverse outcomes in older adults, including physical frailty, malnutrition, low dietary variety, social withdrawal, disability, and low gait speed. Effective risk stratification and management are essential to reduce these outcomes.

PANoptosis: a new insight for oral diseases

PANoptosis, a burgeoning area of research, is a unique type of programmed cell death typified by pyroptosis, apoptosis, and necroptosis, yet it defies singular classification by any one mode of death. The assembly and activation of PANoptosomes are pivotal processes in PANoptosis, with several PANoptosomes already identified. Linkages between PANoptosis and the pathophysiology of various systemic illnesses are established, with increasing recognition of its association with oral ailments. This paper aims to deepen understanding by conducting a comprehensive analysis of the molecular pathways driving PANoptosis and exploring its potential implications in oral diseases.

Knowledge, attitudes, and practice related to tooth loss and dentures among patients with dental arch deficiencies

BACKGROUND

Tooth loss is a common problem that affects many people worldwide. Exploring knowledge, attitude, and practice (KAP) among patients can identify barriers and challenges in following recommended practices, providing valuable insights for dental healthcare providers, policymakers, and researchers. This study aimed to explore the KAP of patients with dental arch deficiencies regarding tooth loss and dentures.

METHODS

This web-based, cross-sectional study was conducted among patients with dental arch deficiencies using a self-designed questionnaire.

RESULT

3166 valid questionnaires were included. Participants' mean KAP scores were 6.84 ± 2.27 (possible range: 0 ~ 12), 39.4 ± 3.72 (possible range: 9 ~ 45), and 27.7 ± 4.36 (possible range: 8 ~ 40), respectively. Multivariable logistic regression analysis showed that knowledge (OR = 1.383), employed (OR = 1.805), family history (OR = 2.158), and treatment (OR = 1.683) were independently associated with attitude. Moreover, knowledge (OR = 1.239), attitude (OR = 1.250), female (OR = 0.619), age (OR = 0.967), college/bachelor (OR = 0.373), and master and above degree (OR = 0.418), employed (OR = 0.554) or student (OR = 0.434), with 10,001-20,000 Yuan household income per month (OR = 0.492), have been married (OR = 0.609), smoking (OR = 0.595), drinking (OR = 0.397), disease duration (OR = 0.972), with family history (OR = 1.676), and with treatment (OR = 3.492) were independently associated with practice (all P < 0.05).

CONCLUSION

Patients with dental arch deficiencies have insufficient knowledge, positive attitudes, and moderate practice toward tooth loss and dentures, which might be affected by multiple demographic factors.

Knowledge of and Attitude Toward Preventive Care Among Iraqi Dentists and Senior Dental Students: A Cross-Sectional Study

OBJECTIVES

Acquiring knowledge and maintaining a positive mindset are essential for dental care providers to offer optimal dental services. Dental professionals are expected to follow preventive dentistry principles to ensure the best oral health maintenance for their patients, as prevention is a key component of public health initiatives. This study aims to assess the knowledge and attitudes toward preventive dental care among Iraqi dentists and senior dental students.

METHODOLOGY

A cross-sectional study, conducted from June to August 2023, involved 876 Iraqi dentists and 587 senior dental students in Baghdad, utilizing a physically paper-based self-administered questionnaire. Participants' level of knowledge was assessed based on a 5-point Likert scale to 12 statements on preventive dental care. Their attitudes were inquired by selecting one option from a 7-point Likert scale on four pairs of bipolar adjectives describing preventive dentistry. Higher scores were considered more accurate knowledge and more positive attitudes. Statistical evaluation included the Chi-square test and regression analysis.

RESULTS

In total, data from 841 dentists and 567 students were analyzed (response rate: 96%). Around 90% of dentists (N=745) and students (N=502) acknowledged the impact of sugar, sealant, and water fluoridation on dental caries, but about 80% of dentists (N=662) and students (N=446) undervalued the role of fluoridated toothpaste. Women (OR=1.4, 95% CI: 1.02-2.1) and dentists, within one year of their graduation (OR=1.9, 95% CI: 1.1-3.5), exhibited higher levels of knowledge. More favorable attitudes towards preventive dentistry were associated with a higher level of knowledge among dentists (OR=1.6, 95% CI: 1.2-2.3). Regarding dental students, those from private dental schools showed higher scores of knowledge than their counterparts from public schools (OR=2.1, 95% CI: 1.3-3.4). The majority of participants held the belief that preventive dentistry is beneficial for the community but just about 60% of dentists (N=477) and students (N=300) exhibited a positive attitude toward the economic advantages of preventive dentistry for dentists, as well as the ease of engaging in preventive dental practices.

CONCLUSIONS

The dentists and dental students in this study demonstrated satisfactory knowledge and a favorable attitude toward most aspects of preventive dentistry. However, deficiencies were noted in certain areas, such as the application of topical fluoride for preventing dental caries, as well as a substantial proportion of individuals who lacked a positive perspective on the economic benefits of preventive dentistry. Hence, there is a clear need for educational interventions during their undergraduate training and postgraduate continuing education to enhance their knowledge levels and cultivate a more positive attitude towards preventive dentistry.

Prevalence of oral frailty and its association with dietary variety, social engagement, and physical frailty: Results from the Oral Frailty 5-Item Checklist

AIM

This cross-sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5-Item Checklist (OF-5), among community-dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty.

METHODS

We pooled data from two population-based studies (the Otassha Study and the Itabashi Longitudinal Study on Aging). With the OF-5, OF is characterized by the presence of two or more of the following: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. We calculated the OF prevalence for each sex. We assessed dietary variety, social engagement, and physical frailty. Generalized structural equation modeling was employed to investigate the associations among oral frailty, low dietary variety (dietary variety score ≤3), social isolation (Lubben Social Network Scale score <12), and physical frailty (Japanese version of the Cardiovascular Health Study score ≥3).

RESULTS

A total of 1206 individuals (626 women and 580 men) with a mean age of 74.7 years were included. The prevalence of OF was 36.7%, and it increased with age; however, there was no significant sex difference. OF was significantly indirectly associated with physical frailty via low dietary variety (odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and social isolation (odds ratio, 1.42; 95% confidence interval, 1.04-1.94).

CONCLUSIONS

Two of five community-dwelling older adults exhibited OF. Low dietary variety and social isolation are potential underlying mechanisms through which OF is indirectly associated with physical frailty. Geriatr Gerontol Int 2024; 24: 371-377.

Oral health related quality of life in head and neck cancer survivors within the first year following treatment: a cross-sectional study in Karachi, Pakistan

After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N - 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46-28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p < 0.05). These findings suggest that Quality of Life (QoL) among HNC treated patients is negatively impacted by their poor oral health, post cancer treatment. Therefore, it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.

Measuring Quality of Life: Incorporating Objectively Measurable Parameters within the Cross-Sectional Bern Cohort Study 2014 (BeCS-14)

Up until now, the measurement of Quality of Life (QoL) was based on validated subjective rating tools rather than objective measurement. To become more independent of the self-assessment of probands, a way to objectively measure QoL should be found. A monocenter, cross-sectional, observational, non-interventional trial was performed from 2012 to 2014 at Inselspital Bern to evaluate the bio-functional status (BFS), a complex, generic, non-invasive, sex- and age-validated assessment tool, in a wide range of areas. A standardized battery of assessments was performed on 464 females and 166 males, ages 18 to 65 (n = 630). In addition to the survey of the BFS, participants replied-among others-to the validated questionnaire SF-36 for health-related QoL (n = 447, subgroup 1). Since the accepted cut-off value for BFA calculation is age ≥ 35 years, subgroup 2 included 227 subjects (all participants aged ≥ 35 years out of subgroup 1). In order to be able to compare the eight SF-36 subscales to BFS parameters, a comparable score set of single BFS items had to be constructed. Subsequently, we aimed to statistically identify BFS item combinations that best represented each SF-36 subscale. All eight SF-36 subscales were significantly represented by various different combinations of BFS items. A total of 24 single BFS items significantly correlated with SF-36 subscales, of which 15 were objective and nine were subjective. All eight SF-36 subscales were significantly represented by various different combinations of BFS items leading to stronger correlations (range five to nine BFS items), and overall, sex and age did not affect these associations, but in the SF-36 subscales 'bodily pain' (sex) and 'role limitations due to physical health problems' (age in men). To our knowledge, we are the first to correlate a validated set of 34 objective and 9 subjective parameters with subjectively evaluated SF-36 subscales. This first study on the objectifiability of the SF-36 questionnaire demonstrated that questions on quality of life can be answered independently of a subjective assessment by subjects in future scientific studies.

Current scientific evidence for why periodontitis should be included in diabetes management

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.

The oral health impact of dental hygiene and dental therapy populations: a systematic review

OBJECTIVES

Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals.

METHODS

The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review.

RESULTS

After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60.

CONCLUSIONS

This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.

Three-dimensional eco-friendly bacterial nanocellulose (BNC) scaffold for regenerative dentistry: Characterization, cytocompatibility and differentiation potential

OBJECTIVE

Regenerative dentistry (RD) is an innovative strategy for treating necrotic teeth and regenerating damaged dental tissue. Biocompatible materials are pivotal for the advancement of RD, and the rising interest in environmental sustainability drives exploration of sustainable materials for dentistry. Bacterial nanocellulose (BNC) has emerged as a promising eco-friendly option and this study aims to assess BNC's suitability as scaffolds for regenerative dentistry applications.

METHODS

Different in vitro methods have been utilized to characterize the properties of BNC scaffolds in regenerative dentistry, such as scanning electron microscopy (SEM) to analyse surface property and porosity, as well as examining their absorption behaviour using phosphate-buffered saline and bovine serum. Dental pulp stem cell (DPSCs) attachment, viability, and proliferation were evaluated using SEM, live and dead, and tetrazolium reduction assays. The odontogenic potential of the scaffold was evaluated using Alizarin Red staining and qPCR (14 and 21 days).

RESULTS

Scanning electron microscopy (SEM) images and ethanol displacement method demonstrated the porous architecture of the BNC scaffold with an average porosity of 70.02 ± 4.74% and 50.26 ± 1.43% respectively. The scaffold absorbed 2846.54 ± 258.95 of BSA and 1648.63 ± 50.37% PBS after immersion in solution for 1 h, following pseudo first and second order kinetics. The biocompatibility assay indicated that cell density increased with time and that the scaffold was appropriate for cell adhesion and migration. Moreover, the BNC led to significantly higher mineralization and odontogenic expression compared to the control (BNC in conditioned media).

SIGNIFICANCE

BNC showed fast adsorption of bovine serum, allowed DPSC attachment, migration, and odontogenic differentiation. This suggests its suitability as a biocompatible scaffold for triggering in situ mineralized tissue regeneration for regenerative dental applications.

Can patients detect peri‑implant mucosal inflammation? Results from a multicentre randomized trial

PURPOSE

The objective of this study was to compare patient-reported outcomes (PROs) of peri‑implant soft tissue inflammation and aesthetics around single-tooth implants in the anterior maxillary region with three different implant-abutment interface designs.

METHODS

Participants were randomized to one of three different types of implant-abutment interface designs [Conical (CI), flat-to-flat (FI), and Platform Switched (PS)]. Implants and provisional crowns with prefabricated titanium abutments were placed 5 months following extraction and/or ridge augmentation. Permanent ceramic crowns with zirconia abutments were placed after 12 weeks. To assess PROs, appearance and inflammation questionnaires were completed from provisional crown placement to the 3-year follow-up.

RESULTS

Tooth appearance at the 3-year follow-up revealed a difference amongst CI, FI and PS implants (p=0.049; Kruskal-Wallis test). PS was rated better than FI (p=0.047) at 1 year for appearance of soft-tissue and satisfaction with colour. There were no differences for self-consciousness, smile and pain/discomfort while eating/hard food items.

CONCLUSIONS

Although participants tended to rate the health of mucosa around PS implants as slighty better than the other two implant systems, the differences were minimal and inconsistent. Thus, patient satisfaction in terms self-perceived gingival health and esthetics was high for all 3 systems tested, suggesting that patients are unable to detect mucosal inflammation.

CLINICAL SIGNIFICANCE

Patients find it difficult to perceive mucosal inflammation; hence, it is recommended that patients attend implant follow-up visits, even if they do not perceive inflammation. The study suggests that there is a relationship between the PROs and the clinical outcomes of tested implants.

Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.

The Association between Tooth Loss and Cognitive Decline in the Aged Population: the Mediating Role of HDL-cholesterol

OBJECTIVE

Tooth loss and its impact on cognitive impairment have become a heated topic over the past decade as the global population continues to age. Despite the proliferation of research in this area, the underlying mechanism linking tooth loss and cognitive decline remains poorly understood. Limited investigation has been conducted to explore the potential role of lipid metabolism and its impact on the association between tooth loss and cognitive function. This study endeavored to identify the role of high-density lipoprotein cholesterol (HDL-C) concentration among older adults and its contribution to the link between tooth loss and cognitive impairment.

METHODS

Data were retrieved from a public database, namely, the National Health and Nutrition Examination Survey (NHANES). Among 1,124 included participants who were aged above 60 years old, linear regression was performed to determine the association between tooth loss (moderate and severe tooth loss) and cognitive function [Consortium to Establish a Registry for Alzheimer's Disease-Immediate Recall (CERAD-IR), Delayed Recall (CERAD-DR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST)]. Mediation analysis was used to test the effect of HDL-C on the association of tooth numbers and four cognitive tests.

RESULTS

Participants with moderate and severe tooth loss had lower scores on cognitive performance (p<0.001) and lower levels of HDL-C (p<0.05). The HDL-C levels were highly correlated with CERAD-IR and DSST, which mediated 2.11% to 5.24% of the total effect between tooth numbers and cognitive function.

CONCLUSION

Tooth loss was negatively associated with cognitive function which was mediated by serum HDL-C levels.

Gelatin methacryloyl hydrogel as an injectable scaffold with multi-therapeutic effects to promote antimicrobial disinfection and angiogenesis for regenerative endodontics

Regenerative endodontics represents a paradigm shift in dental pulp therapy for necrotic young permanent teeth. However, there are still challenges associated with attaining maximum root canal disinfection while supporting angiogenesis and preserving resident stem cells viability and differentiation capacity. Here, we developed a hydrogel system by incorporating antibiotic-eluting fiber-based microparticles in gelatin methacryloyl (GelMA) hydrogel to gather antimicrobial and angiogenic properties while prompting minimum cell toxicity. Minocycline (MINO) or clindamycin (CLIN) was introduced into a polymer solution and electrospun into fibers, which were further cryomilled to attain MINO- or CLIN-eluting fibrous microparticles. To obtain hydrogels with multi-therapeutic effects, MINO- or CLIN-eluting microparticles were suspended in GelMA at distinct concentrations. The engineered hydrogels demonstrated antibiotic-dependent swelling and degradability while inhibiting bacterial growth with minimum toxicity in dental-derived stem cells. Notably, compared to MINO, CLIN hydrogels enhanced the formation of capillary-like networks of endothelial cells in vitro and the presence of widespread vascularization with functioning blood vessels in vivo. Our data shed new light onto the clinical potential of antibiotic-eluting gelatin methacryloyl hydrogel as an injectable scaffold with multi-therapeutic effects to promote antimicrobial disinfection and angiogenesis for regenerative endodontics.

Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.

Clinical and Technical Validation of Novel Bite Force Measuring Device for Functional Analysis after Mandibular Reconstruction

Bite force measuring devices that are generally suitable for edentulous patients or patients undergoing mandibular reconstruction are missing. This study assesses the validity of a new bite force measuring device (prototype of loadpad^®, novel GmbH) and evaluates its feasibility in patients after segmental mandibular resection. Accuracy and reproducibility were analyzed with two different protocols using a universal testing machine (Z010 AllroundLine, Zwick/Roell, Ulm, Germany). Four groups were tested to evaluate the impact of silicone layers around the sensor: no silicone ("pure"), 2.0 mm soft silicone ("2-soft"), 7.0 mm soft silicone ("7-soft") and 2.0 mm hard silicone ("2-hard"). Thereafter, the device was tested in 10 patients prospectively who underwent mandibular reconstruction using a fibula free flap. Average relative deviations of the measured force in relation to the applied load reached 0.77% ("7-soft") to 5.28% ("2-hard"). Repeated measurements in "2-soft" revealed a mean relative deviation of 2.5% until an applied load of 600 N. Maximum bite force decreased postoperatively by 51.8% to a maximum mean bite force of 131.5 N. The novel device guarantees a high accuracy and degree of reproducibility. Furthermore, it offers new opportunities to quantify perioperative oral function after reconstructive surgery of the mandible also in edentulous patients.

A longitudinal assessment of chronic periodontitis in Australian adults

AIM

The study aimed to estimate the incidence/progression and reversal of chronic periodontitis and to identify factors associated with chronic periodontitis in Australian adults over a 12-year period.

MATERIALS AND METHODS

Data were obtained from the longitudinal component of the National Study of Adult Oral Health (NSAOH) in 2004-2006, and repeated data, among the same adults, in 2017-2018. NSAOH 2004-2006 was a population-based study of Australian adults aged 15+ years. The American Academy of Periodontology/European Federation of Periodontology case definitions were used, and then compared with two other case definitions. Multivariable Poisson regression models were used to estimate incidence rate ratios (IRRs) and reversal rate ratio (RRRs) of periodontitis.

RESULTS

A total of 775 dentate Australian adults had dental examinations at both times. The proportion of incidence/progression and reversal among Australian adults was 56.4% and 11.0%, respectively. Tobacco smokers presented with more than three times higher incidence (IRR: 3.32, 95% CI: 1.50-7.60) and lower reversals (RRR: 0.94, 95% CI: 0.39-0.98) than those who had never smoked. Cessation of smoking was positively associated with periodontitis reversal. The total incidence/progression was 471.7/10,000 person-years, with reversal being 107.5/10,000 person-years. The average number of teeth lost due to periodontal disease was 1.9 in 2017-2018. Being male and not having periodontal treatment were significant risk markers for the incidence/progression of periodontitis.

CONCLUSION

Smoking is a risk factor for periodontitis. Cessation of smoking is an effective means of reducing the incidence and progression of chronic periodontitis, to reduce the risk of tooth loss, and to improve overall periodontal health.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

Prevalence, extent, and severity of periodontitis among Australian older adults: Comparison of two generations

BACKGROUND

Chronic periodontitis is highly prevalent among older adults. The study aimed to compare periodontal disease among Australian older adults in two generations. We hypothesized that the prevalence and severity of periodontitis would decrease from the previous generation to the recent generation.

METHODS

Data were obtained from the South Australian Dental Longitudinal Study (SADLS) in 1991 to 1992 (SADLS I) and 2013 to 2014 (SADLS II); population-based longitudinal surveys of Australian older adults aged ≥60 years. American Academy of Periodontology, the US Centers for Disease Control and Prevention (AAP/CDC), and the 2018 European Federation of Periodontology (EFP/AAP) classification case definitions were used to define and calculate prevalence of chronic periodontitis. Multivariable log-Poisson regression models were used to identify risk indicators for severe periodontitis after adjusting for other covariates.

RESULTS

There were a total of 801 and 355 participants that underwent a periodontal exam in SADLS I and II, respectively. The prevalence of severe periodontitis was higher in the recent generation (88% and 56%) than the previous generation (75% and 46.7%) under the CDC/AAP and EFP/AAP case definitions, respectively. The mean number of missing teeth was lower in the recent generation (6) than the previous generation (13). The prevalence ratio of severe periodontitis was around two times higher in the younger age group, men, those not born in Australia, and current smokers across both generations.

CONCLUSIONS

Our findings indicated that the recent generation of older adults has higher prevalence and severity of chronic periodontitis than the previous generation. Our findings indicated that aging, being male, born overseas, low household income, no dental insurance, and being a current smoker are significant risk factors associated with severe periodontitis among older Australians.

Probiotic Monotherapy with Lactobacillus reuteri (Prodentis) as a Coadjutant to Reduce Subgingival Dysbiosis in a Patient with Periodontitis

(1) Background: Probiotics can be considered a non-invasive periodontal monotherapy for the modulation of microbiota when periodontal treatment is not accessible. The aim was to evaluate the ability of Lactobacillus reuteri Prodentis as monotherapy to modulate periodontal parameters and subgingival biofilm dysbiosis. (2) Methods: A 30-year-old patient with periodontitis was followed longitudinally after one month of daily consumption of L. reuteri Prodentis (T0). Periodontal measurements and microbial identification by Checkerboard DNA−DNA hybridization of 40 bacteria were compared between baseline (T0) and 30 days (T1) or 90 days (T2), using the Kruskal−Wallis (KW) and Mann−Whitney U (MW) tests. (3) Results: Low values of pocket depth, attachment level, dental plaque, gingival erythema (GE), and suppuration were observed at T0 vs. T1, with the clinical improvement of GE (p < 0.05, MW) and the recovery of tooth 46 fistulation. T1 vs. T0 comparisons showed lower levels (Lev) or proportions (Prop) of Parvimonas micra (Lev: p < 0.05, MW; Prop: p < 0.01, MW) and Streptococcus gordonii (Prop: p < 0.05, MW), and a predominance (Lev/Prop) of Actinomyces odontolyticus and Streptococcus mitis; lower levels and proportions of P. micra, Eubacterium saburreum, Porphyromonas gingivalis, and Tannerella forsythia were observed in tooth 46 (T1/T2 vs. T0). (4) Conclusions: Under monotherapy with L. reuteri Prodentis, periodontal measurements of the patient were maintained, with selective changes in the subgingival microbiota that were proportional to the time of probiotic administration, with any additional periodontal treatment.

Immediate versus Delayed Implantation for Single-Tooth Restoration of Maxillary Anterior Teeth: A Comparative Analysis on Efficacy

Objective

The present research is aimed at determining the efficacy of immediate implantation (II) and delayed implantation (DI) for single-tooth restoration of maxillary anterior teeth.

Methods

From February 2019 to June 2020, 80 patients who received single-tooth restoration of maxillary anterior teeth in Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, were included, among which 38 cases with DI restoration were used as the control group (CG), and the remaining 42 cases with II were used as the research group (RG). The complications that occurred were recorded. Besides, subjective satisfaction (Visual Analogue Scale (VAS)), aesthetic effect after anterior teeth trauma restoration (Pink Esthetic Score (PES)), aesthetics of dental hard tissue (White Esthetic Score (WES)), pocket depth assessed by pure titanium periodontal probe, implant stability (Implant Stability Quotient (ISQ)), and oral health-related quality of life (Oral Health Impact Profile- (OHIP-) 14) were evaluated. Attachment height, general look, color, and chewing function were all much higher in RG than in CG, according to the evaluation results. Furthermore, at 3 months, 6 months, and 12 months after surgery, RG had greater PES, WES, ISQ, and OHIP-14 scores, while the periodontal depth was decreased. In both groups of patients, the incidence of complications was similar, with no discernible differences.

Radiographically screened periodontitis is associated with deteriorated oral-health quality of life: A cross-sectional study

Periodontitis is greatly related to worse perceived oral health-related quality of life (OHRQoL), yet this association has never been explored using radiographically screened periodontal bone loss. Here we have radiographically screened patients for periodontitis via a validated method and assessed its association with measures of OHRQoL. From a total of 10,267 participants (6,112 females and 4,155 males), self-reported general health questionnaire, body mass index, self-reported oral health behaviours, panoramic x-rays and the oral health impact profile (OHIP-14) were gathered. Radiographically screened periodontitis was measured through a radiographic-based periodontal bone loss (R-PBL) approach. We compared the respective variables according to the R-PBL status and explored using multiple logistic regression adjusted for the significant variables. Overall, patients with periodontitis shown significantly different sociodemographic, health measures and oral hygiene characteristics. All domains of the OHIP-14 were significantly worsened in the periodontitis group, and further confirmed through adjusted logistic regression (p<0.001). Active smoking, number of missing teeth, sex and age were the most impactful variables in this relationship. Our results demonstrate the existence of a link between radiographically screened periodontitis and OHRQoL, mostly upheld by active smoking, number of missing teeth, sex and age.

Influence of Matrix Type on Marginal Gap Formation of Deep Class II Bulk-Fill Composite Restorations

Background: To test the hypothesis that transparent matrices result in more continuous margins of bulk-fill composite (BFC) restorations than metal matrices. Methods: Forty standardized MOD cavities in human molars with cervical margins in enamel and dentin were created and randomly assigned to four restorative treatment protocols: conventional nanohybrid composite (NANO) restoration (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (NANO-METAL) versus transparent matrix (NANO-TRANS), and bulk-fill composite restoration (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (BFC-METAL) versus transparent matrix (BFC-TRANS). After artificial aging (2500 thermal cycles), marginal quality was evaluated by scanning electron microscopy using the replica technique. Statistical analyses were performed using the Mann−Whitney U-test and Wilcoxon test. The level of significance was p < 0.05. Results: Metal matrices yielded significantly (p = 0.0011) more continuous margins (46.211%) than transparent matrices (27.073%). Differences in continuous margins between NANO (34.482%) and BFC (38.802%) were not significant (p = 0.56). Matrix type did not influence marginal gap formation in BFC (p = 0.27) but did in NANO restorations (p = 0.001). Conclusion: Metal matrices positively influence the marginal quality of class II composite restorations, especially in deep cavity areas. The bulk-fill composite seems to be less sensitive to the influence of factors such as light polymerization and matrix type.

Oral Health-Related Quality of Life in Patients after Stroke-A Systematic Review

OBJECTIVES

Aim of this systematic review was to assess oral health-related quality of life (OHRQoL) of patients after stroke.

METHODS

The systematic literature search was performed on December 2021 based on PubMed, Medline, Web of Science, and Scopus, with the search terms: "oral health-related quality of life" AND stroke OR apoplexy OR ischemic stroke OR apoplectic insult. Articles exclusively examining patients after stroke and reporting a well-documented and valid OHRQoL measurement were included.

RESULTS

Out of 68 findings, 8 studies were included. The number of patients ranged between 31 and 549 individuals, mean age between 55.7 and 73.9 years, and 49-72% of individuals were male. Two studies included a healthy control group. Oral health parameters were rarely reported across studies. Five studies reported on the Oral Health Impact Profile (OHIP) 14 for OHRQoL, showing means between 2.87 and 33.0 in sum score. Three studies applied Geriatric Oral Assessment Index (GOHAI), with sum scores between 45.6 and 55.0. Only one study found worse OHRQoL in stroke patients compared to healthy controls. Two studies reported on an association between OHRQoL and general quality of life. Three studies found OHRQoL to be associated with different oral health parameters. Only one study found OHRQoL to be associated with stroke-related parameters.

CONCLUSIONS

Patients after stroke show a reduced OHRQoL. Medical staff and caregivers should support oral hygiene and dental visits, to foster patients' oral health and OHRQoL.

RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS

BACKGROUND

OHIP's original seven-domain structure does not fit empirical data, but a psychometrically sound and clinically more plausible structure with the four OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact has emerged. Consequently, use and scoring of available OHIP versions need to be revisited.

AIM

We assessed how well the overall construct OHRQoL and its four dimensions were measured with several OHIP versions (20, 19, 14, and 5 items) to derive recommendations which instruments should be used and how to score them.

METHODS

Data came from the "Dimensions of OHRQoL Project" and used the project's learning sample (5,173 prosthodontic patients and general population subjects with 49-item OHIP data). We computed correlations among OHIP versions' summary scores. Correlations between OHRQoL dimensions, on one hand, and OHIP versions' domain scores or OHIP-5's items, on the other hand, were also computed. OHIP use and scoring recommendations were derived for psychometrically solid but also practical OHRQoL assessment.

RESULTS

Summary scores of 5-, 14-, 19- and 49-item versions correlated highly (r = 0.91-0.98), suggesting similar OHRQoL construct measurement across versions. The OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were best measured by the OHIP domain scores for Physical Disability, Physical Pain, Psychological Discomfort, and Handicap, respectively.

CONCLUSION

Recommendations were derived which OHIP should be preferably used and how OHIP versions should be scored to capture the overall construct and the dimensions of OHRQoL. Psychometrically solid and practical OHRQoL assessment in all settings across all oral health conditions can be achieved with the 5-item OHIP.

The MOHIP-14PW (Modified Oral Health Impact Profile 14-Item Version for Pregnant Women): A Real-World Study of Its Psychometric Properties and Relationship with Patient-Reported Oral Health

Background: The 14-item version of the Oral Health Impact Profile (OHIP-14) has been widely used as a measure for oral health-related quality of life (OHQoL) since its publication in 1997. However, few studies have examined its psychometric properties and relationship with patient-reported oral health in pregnant women. Aim: To offer empirical evidence for appropriate use of the OHIP-14 among pregnant women in research and clinical practice. Objectives: (1) to empirically investigate the psychometric properties of the OHIP-14, (2) to modify it into the MOHIP-14PW (modified OHIP-14 for pregnant women), and (3) to compare their relationships with patient-reported oral health in pregnant women. Methods: In this real-world study (RWS) from suburban New York clinics, we collected OHIP-14 data from 291 pregnant women and assessed its psychometric properties at the item-, dimension-, and measure-level, including confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Accordingly, we modified the OHIP-14 into the MOHIP-14PW. Finally, we compared their correlations with patient-reported oral health scores. Results: All OHIP-14 items had severely skewed distributions, and two had a correlation with the patient-reported oral health < 0.1. All seven pairs of items correlated well (0.47 to 0.62), but the Cronbach’s alphas indicated suboptimal reliability, with two below 0.70. CFA results offered suboptimal support to the original structure, and EFA found a three-dimensional structure best fitted the data. Therefore, we modified the OHIP-14 into the MOHIP-14PW. CFA on the MOHIP-14PW offered stronger supports, and the Cronbach’s alphas increased to 0.92, 0.72, and 0.71. The MOHIP-14PW’s dimensions were more meaningful to pregnant women and had stronger relationships with patient-reported oral health than the OHIP-14; the average correlation coefficients increased by 26% from 0.19 in OHIP-14 to 0.24 in the MOHIP-14PW. Conclusions: The original OHIP-14 required modifications at the item-, dimension-, and measure- level, and the MOHIP-14PW had better psychometric properties, easier interpretation, and stronger correlation with patient-reported oral health in low-income pregnant women. Through an interdisciplinary RWS on a large sample of pregnant women, this study offers concrete empirical evidence for the advantages of the MOHIP-14PW over the original OHIP-14.

Long-term impact of implant-supported oral rehabilitation on quality of life: A 5 years prospective study

BACKGROUND

This study analyzed the impact of oral rehabilitation with implant-supported fixed complete dentures (IFCDs) on the oral health-related quality of life (OHRQoL) and its relationship with self-esteem and gratitude.

METHODS

66 patients were interviewed to collect data on OHRQoL (OHIP-14), gratitude, and self-esteem, after denture delivery. OHIP-14 scores were analyzed over time and contrasted between groups with IFCD complication or not.

RESULTS

OHIP-14 changed from 22.1 ± 13.8 at baseline to 1.8 ± 2.3 after rehabilitation. Gratitude and self-esteem mean scores were 38.6 ± 3.0 and 36.9 ± 3.8, respectively. OHIP-14 was statistically different from baseline (22.1 ± 13.8) and 1, 3 and 5 years after rehabilitation (2.3 ± 3.7; 1.9 ± 3.1, and 1.8 ± 2.3). No difference was found between the follow-up times and among OHIP-14 domains. Thirteen out of 66 patients (19.7%) had repairable prosthetic complications, but OHIP-14 did not differ between patients with or without complications. Gratitude and self-esteem showed a moderate association (rs = 0.36; p = 0.003), but no association with OHIP-14.

CONCLUSIONS

IFCD treatment has a long-term positive impact on patient's OHRQoL, even among patients who had prosthetic complications. The long-term stability in improved OHRQoL is not associated with self-esteem and gratitude. © 2022 Australian Dental Association.

Perda de função mastigatória e risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo

Resumo Objetivo Verificar se a perda de função mastigatória aumenta o risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo. Métodos Foi adotado um delineamento de coorte prospectivo sobre a base de dados do estudo FIBRA (Fragilidade em Idosos Brasileiros), com linha de base realizada em 2008-2009 e seguimento em 2016-2018, transcorrendo em média 100,2 ± 9,2 meses. A variável desfecho foi a incidência de fragilidade, a variável de exposição foi a função mastigatória conforme a condição de edentulismo e autorrelato de dificuldade mastigatória. As variáveis de ajuste foram condições sociodemográficas, comportamentais e de saúde geral. Foi utilizado um modelo de regressão de Poisson, com variância robusta, estimando o risco relativo Resultados a incidência acumulada de fragilidade aos oito anos em média foi de 30 casos a cada 100 participantes edêntulos com dificuldade mastigatória, que apresentaram maior risco de desenvolver fragilidade (RR:1,75 IC 95% 1,09-2,81) do que os idosos dentados sem dificuldade mastigatória, independentemente de tabagismo (RR: 1,71 IC 95% 1,07-2,73) e de condição socioeconômica (RR: 1,72 IC 95% 1,13-2,62). Conclusão A perda de função mastigatória aumentou o risco de fragilidade em idosos.Futuras pesquisas deverão estudar se a reabilitação da função mastigatória contribui para diminuir esse risco.

Masticatory function loss and frailty risk in community-dwelling older people in the State of São Paulo

Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.

USING DENTAL PATIENT-REPORTED OUTCOMES (dPROs) IN META-ANALYSES: A SCOPING REVIEW AND METHODOLOGICAL INVESTIGATION

Many studies use dental patient-reported outcomes (dPROs) to evaluate treatments and interventions. However, the consensus on the methodology for combining results of dPROs for meta-analysis has not yet been fully established or widely discussed. The aim of this study is to conduct a scoping review for the methodological issues and difficulties specific to meta-analysis of dPROs and to put forward recommendations for improving quality of meta-analyses of dPRO. We searched the Google Scholar and PubMed databases and identified meta-analysis with dPROs in English. A total of 22 meta-analyses were included in our scoping review, and their characteristics, such as reported outcomes, questionnaires, and effect measures, were extracted. We identified several methodological issues within current literature: (1) synthesizing results from studies with different rating scales; (2) meta-analyses with few studies; (3) the interpretation of standardized mean difference; (4) including studies of different cut-off values in a meta-analysis; and (5) systematic errors due to different instruments. According to each issue mentioned, we provided guidance and recommendations on how to resolve those issues, including using the same Likert scale, conducting an overall and subgroup meta-analysis, using a random-effects model in a meta-analysis, etc. More efforts are required to improve the conduct and interpretation of meta-analyses on dPROs.

STANDARDIZATION OF DENTAL PATIENT-REPORTED OUTCOMES MEASUREMENT USING OHIP-5 - VALIDATION OF "RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS"

BACKGROUND

Recently, "Recommendations for use and scoring of Oral Health Impact Profile versions" (here abbreviated as Recommendations Project) were proposed by an international group of oral health researchers to standardize assessment of perceived oral health. They recommended a four-dimensional measurement approach consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact as the set of dental patient-reported outcomes to be measured with the 5-item Oral Health Impact Profile (OHIP-5).

AIM

This study aimed to validate the "Recommendations for use and scoring of Oral Health Impact Profile versions" by replicating the findings they are based on.

METHODS

OHIP data came from the "Dimensions of OHRQoL Project." Its Validation Sample (5,022 prosthodontic patients and general population subjects) as well as its Additional Sample (N = 583 prosthodontic patients and general population subjects) were used. Validation of the Recommendations Project's findings was performed in two steps. First, correlations among OHIP versions presented in the Recommendations Project were replicated in the Validation Sample. Second, participants of the Additional Sample were subjected to a hypothetical treatment program that assigned two treatments to them according to their level of perceived oral health impact using OHIP versions. The performance of abbreviated OHIP versions was evaluated.

RESULTS

The high correlations among summary scores of 5-, 14-, 19-, and 49-item OHIP versions (r = 0.91-0.98), found in the Recommendations Project, were replicated. All short OHIP versions performed similarly when classifying participants for a hypothetical tailored treatment program.

CONCLUSIONS

Findings reported in "Recommendations for use and scoring of Oral Health Impact Profile versions" were validated, thus supporting the feasibility of a standardized assessment of perceived oral health in all settings across all oral diseases. Psychometrically solid and practical assessment can be performed with OHIP-5.

IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE

BACKGROUND

A shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars.

OBJECTIVE

Purpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement.

METHODS

Patients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed.

RESULTS

After an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions.

CONCLUSIONS

In patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients' preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

The association between halitosis and oral-health-related quality of life: A systematic review and meta-analysis

AIM

To investigate whether halitosis is associated with impaired oral-health-related quality of life (OHRQoL).

MATERIALS AND METHODS

This is a systematic review of the literature. Electronic searches were performed in PubMed via Medline, Web of Science, Scopus, and EMBASE up to and including June 2021. Observational studies that assessed halitosis in association with OHRQoL were included. The pooled standardized mean difference (SMD) was estimated by meta-analysis.

RESULTS

Thirteen studies were included in the review; however, the meta-analysis included only 10 studies, all cross-sectional, comprising 2692 individuals. The overall meta-analysis showed an association between halitosis and impaired OHRQoL (SMD 0.51; 95% confidence interval 0.27-0.75). Subgroup analyses, however, indicated that this association remained only among adults. Neither the OHRQoL instrument nor the halitosis assessment method, or the cultural background, influenced the pooled estimates. Meta-regression analyses revealed that the OHRQoL instrument, the halitosis assessment method, and the sample composition did not explain the between-study heterogeneity. Methodological quality appeared to explain 20% of the overall heterogeneity, as studies with high risk of bias overestimated the magnitude of the association.

CONCLUSION

Our findings suggest that halitosis is associated with impaired OHRQoL.

Validation of a self-report questionnaire for periodontitis in a Japanese population

We aimed to assess the validity of the self-report questionnaire for periodontitis in a Japanese population. A Japanese 9-item self-report questionnaire, developed by translating English-version questions that were used to detect periodontitis, was validated against full-mouth clinically-assessed periodontitis in 949 Japanese adults (average age = 43.2 years). Multivariable logistic regression modeling was used to calculate the area under the receiver operating characteristic curve (AUC), wherein the periodontitis case definition of the Centers for Disease Control and Prevention/American Academy of Periodontology was considered the gold standard. Severe, moderate, and mild periodontitis were identified in 6.2%, 30.0%, and 6.7% of the study population, respectively. Self-reported oral health questions combined with socio-demographic and health-related variables had an AUC > 0.70 (range, 0.71-0.87) for any periodontitis category. Four oral health questions ("have gum disease," "loose tooth," "lost bone," and "bleeding gums") were selected in the parsimonious model for severe periodontitis. The periodontitis screening score generated by the responses to these four questions had an AUC, sensitivity, and specificity of 0.82, 73.1%, and 74.3%, respectively, where the cut-off was set at 2 points. In conclusion, a locally adapted version of the self-report questionnaire had an acceptable diagnostic capacity for the detection of periodontitis in this study population.

Including the patient's oral health perspective in evidence-based decision-making

BACKGROUND

How to approach the assessment of patient-perceived oral health is of fundamental importance for the evaluation of clinical and public health interventions because the patient's assessment should be used as an adjunct to objective dental findings in order to decide which interventions work.

AIM

This review article aims to provide an overview of the principles, current status, and future outlook for how a patient's oral health perception can and should be assessed.

REVIEW FINDINGS

The hierarchical position of dental patient-reported outcomes, oral health-related quality of life (OHRQoL), and dental patient-reported outcome measures within the hierarchical concepts of quality of life and its component, health-related quality of life, is presented. The Mapping Oral Disease Impact with a Common Metric project is outlined as an international effort to describe current approaches to standardize the measurement of oral impact using the four OHRQoL dimensions of oral function, orofacial pain, orofacial appearance, and psychosocial impact.

CONCLUSION

Ultimately, these four dimensions of OHRQoL provide a practical and psychometrically solid way to collect and analyze OHRQoL data for all oral diseases in all settings, and eventually for all treatments through the use of a standardized, universal measurement tool. This universal impact metric capturing the patient's oral health perspective is the key to moving evidence-based dentistry and value-based oral health care forward.

Predictors of tooth loss: A machine learning approach

Introduction

Little is understood about the socioeconomic predictors of tooth loss, a condition that can negatively impact individual’s quality of life. The goal of this study is to develop a machine-learning algorithm to predict complete and incremental tooth loss among adults and to compare the predictive performance of these models.

Methods

We used data from the National Health and Nutrition Examination Survey from 2011 to 2014. We developed multiple machine-learning algorithms and assessed their predictive performances by examining the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and positive and negative predictive values.

Results

The extreme gradient boosting trees presented the highest performance in the prediction of edentulism (AUC = 88.7%; 95%CI: 87.1, 90.2), the absence of a functional dentition (AUC = 88.3% 95%CI: 87.3,89.3) and for predicting missing any tooth (AUC = 83.2%; 95%CI, 82.0, 84.4). Although, as expected, age and routine dental care emerged as strong predictors of tooth loss, the machine learning approach identified additional predictors, including socioeconomic conditions. Indeed, the performance of models incorporating socioeconomic characteristics was better at predicting tooth loss than those relying on clinical dental indicators alone.

Conclusions

Future application of machine-learning algorithm, with longitudinal cohorts, for identification of individuals at risk for tooth loss could assist clinicians to prioritize interventions directed toward the prevention of tooth loss.

Dental patients' functional, pain-related, aesthetic, and psychosocial impact of oral conditions on quality of life-Project overview, data collection, quality assessment, and publication bias

BACKGROUND

Knowledge about the magnitude of Oral Health-Related Quality of Life (OHRQoL) impairment across dental patient populations is essential for clinical practice, public health and research. Within the project Mapping Oral Disease Impact with a Common Metric, this systematic review aimed to describe functional, pain-related, aesthetic and broader psychosocial impact of oral conditions with a single metric using OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact.

METHODS

A search using PubMed, EMBASE, Cochrane, CINAHL and PsycINFO was performed on 8 June 2017, and updated on 14 January 2019. Only publications in the English language were considered. To characterise the extent of available standardised and clinically relevant OHRQoL information, we determined the number of publications, dental patient populations, which are clinically similar, and patient samples within each population with four-dimensional OHRQoL information using the Oral Health Impact Profile (OHIP) questionnaire. A quality assessment and a publication bias assessment were performed.

RESULTS

We identified 171 publications that characterised 199 dental populations and 329 patient samples with four-dimensional OHRQoL information. The vast majority of populations were only characterised by one patient sample. Study quality was not related to OHRQoL magnitude, and substantial publication bias could be excluded.

CONCLUSIONS

Standardised and clinically relevant information using the four OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact was available for a significant number of dental patient populations. Findings can provide a framework to interpret OHRQoL impairment of individual patients, or groups of patients, for clinical practice, public health and research.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.