Psychometric Properties of the 14 Items Oral Health Impact Profile Questionnaire Translated into the Macedonian language

Objective

Due to the consideration that oral/dental health is an important part of general health, well-being, and an individual's quality of life, the need for appropriate instruments assessing oral health-related quality of life is emphasized. This study aimed to evaluate the psychometric properties of the Oral health-related quality of life questionnaire consisting of 14 questions among the Macedonian language-speaking adults (OHIP-MAC 14).

Material and methods

A total of 270 adults participated in the study. The reliability of the questionnaire was examined by testing the internal consistency and reproducibility (test-retest). The responsiveness of the instrument was tested by computing the pre-intervention and post-intervention OHIP-14 scores using the paired t-test followed by the determination of the effect-size. The two aspects of the construct validity were evaluated: concurrent validity and discriminative validity.

Results

A concurrent validity analysis confirmed that the instrument performed well. Discriminative validity also confirmed good psychometric properties (P<0.01). The ICC statistics and the Cronbach alpha coefficients indicated the appropriate reliability of the instrument for the included groups of participants. The responsiveness of the questionnaire was also acceptable (P<0.01) demonstrating the large effect-size of 1.43.

Conclusion

The OHIP 14 MAC showed acceptable psychometric properties and can be recommended as a valuable instrument in assessments of the Oral health-related quality of life in the Republic of North Macedonia.

Pediatric patients' reasons for visiting dentists in all WHO regions

BACKGROUND

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct.

METHODS

Dentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients' oral health problems and prevention needs were computed.

FINDINGS

Data from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories.

CONCLUSIONS

The study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

Prevalence of Work-related Musculoskeletal Symptoms among Dental Students at Ss. Cyril and Methodius University Dental School in Skopje

AIM: The aim of the study was to investigate the prevalence of work-related musculoskeletal problems in 3rd, 4th, and final year of study in Ss. Cyril and Methodius University Dental School. METHODS: All 3rd, 4th, and final year regular dental students were invited to take part in the study, which involved completing the extended Nordic Musculoskeletal Questionnaire. This questionnaire facilitates an assessment of troubles (ache, pain, or discomfort) with neck, shoulders, upper back, elbows, wrists/hands, low back, hips/thighs, knees, and ankles/feet. RESULTS: Out of a maximum possible number of 146 students, 116 agreed to participate and completed the questionnaire (33 males and 83 females). The response rate was 79.5%. The mean age of students was 22.6 years (SD = 1.52), ranging from 20 to 26 years. During the past 12 months, students have problems mostly with neck 48 (41.4%), upper back 43 (37.1%), and low back 43 (37.1%). Working hours/week was 12 h for 3rd year, 20 h for 4th, and 30 h for 5th-year students. There is a significant difference between the students from third study year with these from 4th and 6th study year regarding the neck (χ2 (2)= 6.46, p < 0.05), upper back (χ2 (2) = 7.38, p < 0.05), and low back (χ2 (2)= 13.79, p < 0.05). CONCLUSIONS: This study reported high prevalence of musculoskeletal symptoms among the dental students. Preventive measures and more ergonomic recommendations are indicated.

Why Patients Visit Dentists - A Study in all World Health Organization Regions

OBJECTIVE

The dimensions of oral health-related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions.

METHODS

Dentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated.

RESULTS

For every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering.

CONCLUSION

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.

Motivation to Follow a Career in Dentistry of Students in Three South-East European Countries

Objective

To investigate and compare the factors that motivated students to study dentistry in countries with similar background (Albania, Croatia and the Republic of Northern Macedonia) and to assess whether or not their motivation changed during time.

Material and methods

In 2014/2015, cross-sectional studies were conducted in state funded dental schools in Tirana (Albania), Zagreb (Croatia) and Skopje (Macedonia) to assess student views on their career motivation. All dental students from the first, third and final years of study were invited to participate. The participation was voluntary and anonymous. A five-item questionnaire was translated into languages of the participating countries. Ethics approval was granted by the Ethics Committee of the University of Saints Cyril and Methodius, Skopje. The Chi square test was used to test if there were statistically significant differences in answers between students in 3 countries, furthermore between years of the study.

Results

The total number of respondents was 739 (319 in Tirana, 211 in Zagreb and 208 in Skopje) The differences in the answers between the first-year students from all three countries were statistically significant (χ²=82.65; p<.01). The most striking answer was to the question on parents' pressure to study dentistry, which was far more frequent in Tirana (up to 27.7%). A "positive image" was the most frequent response from students from Zagreb (up to 79.7%), but it declined from the first to the final year in Skopje. There were also significant differences between the schools within the 3^rdand final years of study.

Conclusions

A positive image of dental profession was the main reason for students studying dentistry at all three schools; as many as 97% of the students of the final year in Croatia, a member of the European Union (EU). In the two non-EU countries (Albania, Macedonia) it seemed that dental profession does not have such good status and student expectations are not being fulfilled, especially in Skopje (up to 33.9% willing to change their vocation and up to 64.5% lost their motivation to study) One of the strategies to improve the situation could be to include more clinical practice and to better organize the study..

Self-reported psychological problems amongst undergraduate dental students: A pilot study in seven European countries

AIM

To map psychological problems amongst undergraduate dental students with a focus on different time points in clinical work in seven Eastern European and Scandinavian countries.

MATERIALS AND METHODS

A total of 1063 3rd- and 5th-year dental students (response rate 70%) participated in this pilot study and completed a pre-tested, structured questionnaire, which collected information on sociodemographic characteristics and self-reported psychological problems. Data were analysed by bivariate and multivariate methods.

RESULTS

The majority of participants were female and were younger than male participants. Most participants, though more females than males, agreed that the clinical work of dentistry was psychologically difficult. Almost half of participants felt nervous before working with patients (N = 506, 48%) and experienced a lot of stress whilst working with patients (N = 488, 46%); almost one-third (N = 287, 27%) felt anxious/worried after working with patients. Being a 3rd- and 4th-year student (vs 5th-year) reduced the odds for anxiety after working with patients; being a 3rd-year student (vs 5th-year) increased the odds for stress whilst working with patients. Studying in countries other than Norway reduced the odds for stress whilst working with patients. Less than good self-perceived health, presence of psychological health complaints before starting dental education, female gender and lack of physical activity increased the odds for psychological problems.

CONCLUSION

A high number of undergraduate dental students reported psychological problems in connection with clinical work. It is unlikely that "one size fits all"; therefore, further qualitative investigations on stressors in clinical learning environments should be done in order to design tailor-made supportive strategies.

Knowledge, dentist confidence and management of periodontal patients among general dentists from Belarus, Lithuania, Macedonia, Moldova and Romania

BACKGROUND

Evidence concerning periodontal practice in Eastern European countries is scarce. The aim of the present study was to investigate periodontal risk knowledge, patient management and self-perceived confidence among General Dentists (GDs) from five Eastern European regarding their provision of periodontal care.

METHODS

GDs from Belarus, Lithuania, Macedonia, Moldova and Romania participated in a questionnaire survey. Power calculations were used to identify the sample size for each country. The structured questionnaire included several domains of inquiry. The socio-demographic domain inquired about dentist's age, gender and years of clinical experience. The dental practice domain inquired about practice location, practising or not practising in a group practice and having or not having a periodontist or a dental hygienist in the practice. The distributions of answers across-countries were compared employing one way ANOVA (comparison of means) or Chi square test (comparison of proportions). For each country, the predictors of the study outcomes: a summative knowledge score for periodontal risks and dentist's confidence level were identified employing either linear or logistic multiple regression models.

RESULTS

The sample comprised 390 Belarussian, 488 Lithuanian, 349 Macedonian, 316 Moldovan, and 401 Romanian GDs. The majority of GDs (~ 80%) practiced in urban areas. Age and gender distributions differed significantly among countries. Significant across-country differences were found regarding working/not working in a group practice, having/not having access to a periodontist/dental hygienist and in proportions of patients receiving periodontal treatments or being referred to specialists. None of Macedonian patients nor the majority of Moldovan patients (78%) were referred to periodontists. There were also significant across-country differences in diagnosis, patient management and periodontal knowledge. Only in the Lithuanian cohort were dentists' confidence levels associated significantly with their knowledge. In all countries, taking a medical history was a consistent and significant predictor of having higher periodontal knowledge score. Except in Belarus, periodontal risk assessment was a significantly consistent predictor of certainty levels associated with the provision of periodontal treatments.

CONCLUSIONS

There were substantial differences among GDs in the five countries regarding diagnosis, dentist's confidence and management of periodontal patients.

Prosthodontics Status and Treatment Needs among the Elderly in the Republic of Macedonia

BACKGROUND

Oral health care management among the elderly differs from the rest of the population, due to some specific physiological changes and general health status related to age. We know very little about the oral health in elderly in the Republic of Macedonia, because there are only a few articles published about dental health status and edentulism of this population.

AIM

The study aimed to evaluate the prosthodontic status of older adults over 65 years in the Republic of Macedonia, about their socio-economic status and individual factors.

MATERIAL AND METHODS

A cross-sectional study was conducted in 8 regions, in rural and urban areas of Macedonia and a representative sample of 432 people (age > 65 years) was examined. Statistical analyses of the data were made by chi-square tests and the corresponding C-coefficient.

RESULTS

Only 6% of all participants had not any prosthetic appliance, 9.5% had more than one bridge, 28.7% of examinees had partial dentures, both bridge(s) and partial denture(s) had 10.7% participants, and 45.1% of examinees were toothless. There was a significant difference between patients who visited the dentist more than once a year and those who did not (χ² = 14.2; df = 4, p < 0.01). From all of the participants, 40.3% used public dental care organisations.

CONCLUSIONS

We found a high prevalence of edentulousness among older adults over 65 years in Macedonia. The study confirmed the necessity for establishing healthcare educational programs for the dental treatment of elderly in Macedonia.

Prosthodontic Rehabilitation of Patient with Anterior Hyper Function Syndrome

BACKGROUND:

The success of prosthetic rehabilitation in patients with removable dentures depends on the achievement of the aesthetics, phonetics and most of all, proper use in the mastication process. All the patients that receive removable prostheses need a feeding education program. They must cut the food into smaller pieces, extend the length of time necessary for chewing and place the food upon both the right and left sides of the mouth at once. Bilaterally chewing with dentures will contribute to increased efficiency and denture stability during mastication. Using the anterior teeth for biting, as a result of increased pressure on the anterior ridge may lead to the anterior hyperfunction syndrome.

CASE REPORT:

The patient requested dental rehabilitation in our clinic for prosthetic dentistry two and a half years ago. We examined him and made therapy plan, for complete removable maxillary denture and partial mandibular denture. Besides our instructions for proper use of dentures and necessity for regular controls, his next visit was after two and a half years. He came with enlarged tuberosity and papillary hyperplasia in the pre-maxillary region. After oral surgery treatment (laser removing of hyperplastic tissue) and a healing period of four weeks, we made indirect relining on the upper denture, re-occlusion and re-articulation achieving weak contacts between the lower natural teeth and upper teeth of the complete denture. The patient was advised not to bite food with his anterior teeth, and avoid chewing very hard food which tends to imprint and displace dentures.

CONCLUSION:

Anterior hyperfunction syndrome with its high incidence is a disease with the need of interdisciplinary therapy approach. Fast diagnosis, thorough clinical examination using all available diagnostic tools, and choosing the right treatment is very challenging.

Overdentures on Implants for Better Quality of Life Among the Fully Edentulous Patients - Case Reports

Global aging population has brought several challenges for their medical systems and total edentulism is one of them. The fabrication of removable acrylic dentures seems to be a simple and cheap treatment solution, but a majority of patients is not satisfied with their functional instability, causing limited diets, mouth soreness, speech and psycho-social problems etc. The results in many studies indicate an impact of oral conditions associated with the full denture wearing on oral-health related quality of life, especially in lower jaw. The reason for improper denture retention could be alveolar ridge bone resorption and numerous studies about this problem are plausible. Bone resorption in lower jaw may turn the alveolar ridge into a flabby soft tissue which is unable to sustain proper denture retention. The implant-retained prosthesis is an alternative treatment option in these situations. Implants will provide retention, stability, function and aesthetics and they are not so expensive solution. The aim of this article is to show solving of retention problems of a lower denture in two different clinical cases using implants and without any special technology.

Oral health related quality of life (OHRQoL) in patients wearing fixed partial dentures

The objective of this longitudinal study was to find out patients self-perception about their oral health condition before treatment, one week and one year after the prosthodontics treatment with fixed partial dentures (FPD) as well as to compare the outcomes with healthy patients, by identifying the changes in relevant aspects of quality of life. A total of 70 subjects-35 with necessity of fixed partial dentures (FPD) and 35 healthy individuals without any need for prosthetic treatment as a control group (CG) participated on a voluntarily base by responding the OHIP-MAC49 questionnaire for determining the oral health related quality of life (OHRQoL). The FPD group responded in three time intervals--before the FPD intervention, one week after and finally, one year after it. In order to examine the extent in the improvement of the self-rated quality of life, these three measures taken over different periods of time were compared. This set of three assessments from the FPD group was also compared with the average scores of the CG. The results have shown very fast improvement in almost all domains of OHRQoL defined by the instrument after applying FPD. The overall mean of experienced or perceived difficulties after the FPD intervention dropped from X=57.1 (SD=22.4) to X=40.3 (SD=17.2) only one week after the treatment, whereas one year later it was reduced to X=6.5 (SD=4.4). Exceptions of the quick recovery were only two domains, mainly connected with the difficulties caused by dental pain. One year after the treatment, the scores of each of the domains of OHRQoL of the FPD patients were the same with those of the healthy individuals. The results indicated very satisfactory impact of this kind of dental appliance on oral health related to quality of life of FPD wearers.

An assessment of career satisfaction among Macedonian dentists

AIM

The aim of this study was to assess the level of overall career satisfaction in relation to various personal and work-related factors among the dentists in the Republic of Macedonia.

MATERIALS AND METHODS

The sample comprised 118 registered dentists, working in different conditions (34 public practice dentists, 32 completely private, 42 private dentists who work with a health insurance fund and 10 concessioners). All of them filled in a questionnaire which contained 16 items, divided into five groups. The different clusters of questions were related to various working conditions and personal factors. The first four groups of questions were answered with a--point Likert format with a score range from 1 (very dissatisfied) to 4 (very satisfied). In the fifth group, dentists chose one of four offered answers. The statistical analyses were made by one-way ANOVA and chi-square tests.

RESULTS

Significant differences related to working conditions were found between public practitioners (moderately dissatisfied) and private practitioners (very satisfied) (F=41.41 (df=3); p<0.01). A high prevalence of dentists (89.83%) had felt stressed on their work place and 61.8% of public dental health practitioners had felt stressed at work "very often". The main sources of job-related stress for public dental practitioners were their supervisors (50%) and patients (26. 47%), while private practitioners were mostly stressed by inspectors (76.19%) and patients (21.87%) (χ2=44.5 (df=9); p<0.01).

CONCLUSION

The findings in our study showed overall low levels of career satisfaction among the dentists (public and private) in the Republic of Macedonia. The finding that high percentages of dentists feel stress at their work place very often requires further exploration.

Oral health care provision systems in the black sea countries part 14: the Republic of Macedonia

This paper gives an overview of the development of health insurance and some aspects of the oral health care in the Republic of Macedonia since it became independent in 1991. First, it describes the provision of oral health care and treatments funded by the public health care system. The dental educational system and available epidemiological data are then described. Generally, few data are available about the dental workforce in recent years, especially regarding dental epidemiology. There are various specialisations in dentistry recognised in Macedonia, as well as three subspecialisations: implantology, maxillofacial and reconstructive prosthodontics, and prosthodontics for children. One aspect of particular interest is that there are many dental faculties in Macedonia and many dentists, relative to the population and the country's requirements.

Bruxism and TMD disorders of everyday dental clinical practice

Bruxism, as an etiological factor for the development of TMD, includes different disorders of the TMJ and the masticatory muscles, exhibiting pain and disruption of the stomatognathic functions. Our goal was to study patients with bruxism and TMD from everyday dental clinical practice, in terms of diagnosis, identification of etiological factors, classification and treatment of these disorders. We treated 120 patients, divided into 2 groups of 60 patients. The first group had disorders of the TMJ, and the second of the masticatory muscles. The groups were divided into subgroups of 20 patients with dislocation of the articular disk with or without reduction and inflammation of TMJ. The second group was organized from patients with myofascial pain, myositis and muscular trismus. Our conservative treatment consisted of patient education, NSAID, myorelaxants, fabrication of prosthetics, repositioning and stabilization splints. The progress of the patients was followed immediately after the delivery of the prosthetics and the splint, after 1, 6 and 12 months. The results showed that in patients with disorders of the TMJ there were visible signs of recovery after 6 months in 68.3% patients, and in 85% after 12 months. In the second group we achieved faster results with the elimination of symptoms. Patients with afflictions of the muscles in 88.3% of cases noticed relief of symptoms even after 6 months and in 98.3% after 12 months. As therapists we concluded that timely treated complications of bruxism and TMD prevent the destruction of the TMJ, masticatory muscles and the entire stomatognatic system.

Technology and the use of acrylics for provisional dentine protection

Acrylics are compounds polymerized from monomers of acrylic, metacrylic acid or acrylonitrates. The purpose of this paper is to present the technology and use of acrylics for provisional dentine protection in the practice of dental prosthodontics. For this reason, we followed 120 clinical cases from the everyday clinical practice, divided into 4 groups of 30 patients who needed prosthetic reconstruction. The first group included cases in which we applied celluloid crowns for dentine protection, for the second group we used acrylic teeth from a set of teeth for complete dentures; in the third and fourth groups the fabrication was done with the system of an impression matrix and the acrylic resin block technique respectively. In all the examined patients, the gingival index by Silness and Loe and the vitality of the dental pulp were verified clinically, after preparation and 8 days from the placement of the provisional crown. The value for dental sensitivity measured after preparation was 2.59, and 8 days after the placement of the provisional crown it bwas 3.1. From these results we can conclude that after the 8th day from the placement of the provisional crown, there was an adaptation period, characterized by a decrease in the painful sensations. The value of the Silness and Loe gingival index measured after the preparation was 1.34, and 8 days from the placement of the provisional crown was 0.94. The results inclined us to the fact that the provisional acrylic crowns facilitated the reparation of the periodontal tissue.

Assessing the psychometric characteristics of the Macedonian version of the Oral Health Impact Profile questionnaire (OHIP-MAC49)

AIM

The aim of this study was to adapt the Oral Health Impact Profile-49 (OHIP-49) for use by the Macedonian-speaking population and to assess its psychometric properties.

METHODS

After piloting a back-translated version of the OHIP-49 questionnaire in Macedonian, the resulting Macedonian version of the Oral Health Impact Profile questionnaire (OHIP-MAC49) was administered to 247 patients who had been recruited in four groups: Group 1 was composed of 163 randomly chosen blood donors representing the general population; Group 2 was a convenience sample of 20 patients who attended a clinic for relief of dental pain; Group 3 was a sample of 29 prosthodontic patients; and Group 4 was composed of 35 students. In order to ensure that all questions were answered, data were gathered from participants in the four groups by trained and experienced interviewers. The internal reliability of the OHIP-MAC49 scale and its constituent seven subscales was calculated for Groups 1, 3, and 4 by using Cronbach's alpha coefficient and average inter-item correlations. The test-retest stability of the instrument was estimated by calculating the intra-class correlation coefficients and the limits of agreement of the scores obtained from the participants in Groups 3 and 4 in a repeat interview three to four weeks after the first interview. Convergent validity was evaluated by comparing OHIP-MAC49 scores-both total (0-4) and subscores (2-4) with self-reported health for Group 3 patients-using the Spearman coefficient of correlation. For the purpose of evaluating group validity, the OHIPMAC49 scores of Group 3 patients were compared by using Spearman's correlation coefficient. In addition, comparisons were made between patients with and without burning-mouth symptoms, temporomandibular pain, joint clicking, and oral habits (point-biserial correlation). The OHIP-MAC49 scores of subjects with and without dentures in Group 1 were compared by using point-biserial correlation. The responsiveness of the instrument was assessed by calculating the difference in OHIP-MAC49 means (total subscores) in Group 2 patients prior to and after treatment for relief of pain.

RESULTS

The internal consistency of each subscale and the whole scale estimated was excellent. Cronbach's alpha coefficients for whole scale ranged from 0.92 to 0.95. The intra-class correlation coefficients ranged from 0.83 to 0.99, suggesting that the instrument had satisfactory reliability in terms of time stability. The questionnaire had acceptable responsiveness, confirmed by a significant differences (P<0.01) between the mean OHIP-MAC49 score at baseline and follow-up, both for the total sum (0-4) and the sum scores (2-4). Convergent validity, evaluated by comparing OHIP-MAC49 scores with self-reported oral health in Group 1 and Group 3 patients, was confirmed, because all correlation coefficients were significant (P<0.01). The results from testing the anticipated differences on the basis of seven self-reported indicators of oral health in Group 3 patients, as well as the differences in OHIP-MAC49 scores between subjects in general population who wore and did not wear dentures, strongly suggest that the instrument has satisfactory group validity.

CONCLUSION

The Macedonian version of the OHIP-49 demonstrated satisfactory validity, excellent reliability, and sufficient responsiveness and therefore can be used for assessing the impact of oral health on different aspects of quality of life in Macedonia.