'It's like being in a tunnel': Understanding the patient journey from tooth loss to life with removable dentures

INTRODUCTION

The aim of this study was to conceptualise the key stages of the patient journey in the provision of a new denture and examine the factors leading to successful patient-related outcomes.

METHODS

Two partially dentate patient samples were included: (i) Denture wearers - patients who had a denture fitted within the previous five years and (ii) New dentures - patients receiving treatment for a new or replacement denture. The methods involved direct targeted participant observations of the denture fitting process, debriefing interviews and a follow-up focus group exploring the patient journey. Data were analysed through the use of phenomenology and grounded theory.

RESULTS

Interviews were completed with twenty participants of the denture-wearing sample (11 males and nine females, age range 22 to 86 years). Thirteen participants were included in the treatment journey sample in two primary care settings (six males and seven females, age range 55 to 101 years). Tooth loss and recovery was described as being in an 'emotional tunnel' resulting from 'bodyphonic processes' associated with tooth loss. 'Bodyphonia' subsequently became the context for 'taking control' and 'managing disclosure' when living with a removable denture. Different courses through this process can be readily observed, moderated by different variables (i.e., previous experience, working knowledge, a good fit, the treatment alliance, negotiated compromises and bounded responsibility).

CONCLUSIONS

An'integrating framework' that seeks to describe the patient journey from the experience of tooth loss to recovery with a denture is proposed. This framework could be used to aid development of a clinical pathway to guide treatment options.

CLINICAL SIGNIFICANCE

This paper conceptualises the patient journey. It stresses the importance of understanding the stages patients go through and highlights that for the dental team, the try-in stage is perhaps the best stage to give information about the denture and plans for continued care.

Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study

BACKGROUND

Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults.

METHODS

An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption.

RESULTS

The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms.

CONCLUSIONS

The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

Association among the number of teeth, dental prosthesis use, and subjective happiness: A cross-sectional study from the Japan Gerontological Evaluation study (JAGES)

STATEMENT OF PROBLEM

Little is known about the association between the number of teeth and self-rated happiness or the association between dental prosthesis use and self-rated happiness in an older population.

PURPOSE

The purpose of this cross-sectional study was to examine the association between the number remaining of teeth with and without dental prosthesis use and self-rated happiness in an older population.

MATERIAL AND METHODS

The survey data from the 2016 Japan Gerontological Evaluation Study (JAGES) on independent participants aged 65 years or older were assessed. The Poisson regression and multiple imputation methods were used for analyses. Covariates were age, sex, marital status, educational attainment, self-rated health, self-rated economic situation, and symptoms of depression.

RESULTS

The data from 178 090 participants, 81 489 men (45.8%) and 96 601 women (54.2%), were analyzed, with a mean ±standard deviation age of 73.6 ±6.1 years. Overall, 66.4% of the participants were happy, declining to 45.7% in those who had 0 to 9 teeth and no dental prosthesis (n=3102). It was 61.5% in those who had 0 to 9 teeth and used a dental prosthesis (n=41 424), 56.8% in those who had 10 to 19 teeth and no dental prosthesis (n=6719), 65% in those who had 10 to 19 teeth and used a dental prosthesis (n=31 592), 70.5% in those who had ≥20 teeth and no dental prosthesis (n=52 525), and 70.1% in those who had ≥20 teeth and used a dental prosthesis (n=42 728). The interaction analysis showed that the reduction in the probability of being happy among those with fewer teeth was smaller among those who used a dental prosthesis.

CONCLUSIONS

Having a higher number of teeth and using a dental prosthesis were independently associated with being happy. A significant interaction suggested that dental prosthesis use improves happiness among those with moderate to severe tooth loss (<20 remaining teeth).

Does remaining teeth and dental prosthesis associate with social isolation? A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES)

OBJECTIVES

Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined.

METHODS

Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms.

RESULTS

The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated.

CONCLUSION

Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.

Oral health status and oral health-related quality of life among patients with type 2 diabetes mellitus in the United Arab Emirates: a matched case-control study

BACKGROUND

Nearly a quarter of the population in the UAE has type 2 diabetes mellitus (T2DM), and this medical condition is associated with poorer oral health. The effects on oral health-related quality of life (OHRQoL), however, have not been examined in this population. Therefore, the objective of this study was to assess the impact of oral health problems, such as caries and periodontitis, on OHRQoL among Arab patients with and without T2DM.

METHODS

This matched case-control study included 88 diabetic and 88 non-diabetic participants recruited from University Dental Hospital Sharjah and University Hospital Sharjah, UAE. Participants completed a sociodemographic questionnaire as well as the Oral Health Impact Profile short form (OHIP-14), which measures OHRQoL. Clinical examinations were conducted to assess participants' dental caries status, using the Decayed Missing Filled Teeth (DMFT) Index, and periodontal condition, via clinical attachment loss (CAL) dichotomized to CAL < 3 mm and CAL ≥3 mm. Linear regression models were used to identify the association among OHIP domains, clinical attachment loss, DMFT scores, and diabetes status.

RESULTS

The mean age of participants was 43.0 years. A significantly (p = 0.01) higher proportion of diabetic patients (23%) had a CAL ≥3 mm than non-diabetic patients (10%). No significant differences in OHIP scores were observed between diabetic and non-diabetic patients. The results of the linear regression suggested that irrespective of diabetic status, DMFT scores were significantly associated with physical disability, physical pain, psychological discomfort, and psychological disability, as well as total OHIP scores. CAL was significantly associated with the handicap domain. Among non-diabetic patients, OHIP scores were significantly associated with DMFT scores in five OHIP domains (functional limitation, physical disability, physical pain, psychological discomfort, psychological disability), as well as total OHIP scores. Among diabetic patients, CAL was significantly associated with both the social disability and handicap domains, while only the handicap domain reached statistical significance among non-diabetic patients.

CONCLUSIONS

Participants who had decayed teeth, irrespective of their diabetic status, reported substantial physical and psychological impacts on OHRQoL. CAL also had a significant impact on OHRQoL, being primarily associated with the OHIP handicap domain in both diabetic and non-diabetic patients.

Impact of Oral Health and Sociodemographic Factors on Quality of Life: A Cross-sectional Study

Aim: The aim of this study was to determine the impact of oral health and socioeconomic variables on the quality of life in a sample of low-income Brazilians. Materials and methods: The sample consisted of 400 adults assisted by the Rescuing Smiles Social Program (Pernambuco University) in June 2014 in the town of Arcoverde, Pernambuco. Two 18+ physically and mentally healthy people were chosen to participate in the study per household. The data obtained were analyzed using Kruskal-Wallis and Mann-Whitney tests. Results: About 75% of participants were female, averaging 42.65 years; 59% had elementary schooling and 27% were illiterate; 63% of them needed dental restorative treatment, 59.5% periodontal, and 43.3% surgical procedures; and 68.2% of the respondents showed partial tooth loss, 22.8% were totally edentulous, and 9% had full dentition. Oral health impact profile (OHIP)-14 average score was 14.91, considered low. The highest averages were observed in low-income individuals (16.25). Individuals with total or partial tooth loss had an average 14.26 and 15.79, respectively, thus showing a statistically significant difference as compared with total dentate (9.86). Conclusion: Although low-income individuals with tooth loss showed the highest OHIP-14 averages, it could be concluded that oral condition did not affect the quality of life of most individuals in the population studied. Clinical significance: Thus, oral health did not have a significant impact on respondent health awareness. This study showed the need to better inform the public of the relevance of oral health to quality of life. Keywords: Oral health, Oral health impact profile-14, Quality of life.

Patients' Knowledge and Perceived Barriers toward Replacement of Missing Teeth among Respondents of Hail City, Kingdom of Saudi Arabia

AIM

Teeth maintain the functionality and esthetic of oral cavity, they are also important for psychological and social well-being. This study aims to assess awareness of patients toward replacement of missing teeth. People with unrestored or missing teeth tend to have poor self-esteem and oral health-related quality of life; hence, their knowledge toward restoring and replacing teeth is an important aspect to be measured.

MATERIALS AND METHODS

It was an observational study having a cross-sectional design. Face- and content-validated questionnaire was used as study tool. Nonprobability, convenient sampling technique was employed that yielded information from 183 respondents residing in various areas of Hail city. Data were collected after written informed consent. The study was approved by the University of Hail ethical committee.

RESULTS

Two hundred questionnaires were distributed, out of which 183 were returned. Regarding knowledge of restoring missing teeth, 145 (79.2%) respondents know that function and esthetic can be maintained by replacing missing teeth. Information about the availability of various types of prosthesis was mostly obtained by them through their dentist (70; 48.3%), while books/magazines/Internet was the second source (38; 26.2%) and 37 (25.5%) heard it from someone who has already undergone the replacement of teeth.

CONCLUSION

The present study indicated that a good number of respondents have the knowledge of teeth replacement, and dentists were the most common source of information to the patients in terms of education about different treatment options.

CLINICAL SIGNIFICANCE

Evaluate and plan treatment options based on patients' expectations and perceptions.

Awareness, attitudes, need and demand on replacement of missing teeth among a group of partially dentate patients attending a University Dental Hospital

OBJECTIVE

Our objective was to assess awareness, attitudes, need and demand on replacement of missing teeth according to edentulous space, age, gender, ethnicity, educational level and socio-economical status of the patient.

RESULTS

76.2% of the study group was opined that the missing teeth should be replaced by prosthetic means. Majority were keen in getting them replaced mainly for the comfort in mastication. Although 77.9 and 32.9% were aware of the removable prostheses and implants respectively, only 25.2% knew about tooth supported bridges as an option of replacement of missing teeth. Participants' awareness on tooth and implant supported prostheses is at a higher level. Participants' opinion on need of regular dental visit was statistically significant when gender, ethnicity and education level were considered. The highest demand for replacement of missing teeth was observed in Kennedy class I and II situations in both upper and lower arches. Demand for fixed prostheses was significantly highest in Kennedy class II in upper and lower arches. In conclusion, although removable prosthodontic options are known to most of the patients, their awareness on tooth and implant supported prostheses is also at a higher level. The highest demand for replacement of missing teeth is by patients with Kennedy class I and II situations whereas Kennedy class II being the category with highest demand for fixed prostheses. We recommend that the location of missing teeth to be considered as a priority when educating patients on the most appropriate prosthetic treatment options. Dentists' involvement in educating patients on prosthetic options needs to be improved.

Exploring Oral Health Beliefs and Behaviour Among Tibetan Immigrants of Bylakkupe

PURPOSE

To explore the oral health beliefs and behaviour among Tibetan immigrants of Bylakkupe village.

MATERIALS AND METHODS

A stratified random sampling technique involving 366 Tibetan monks in Bylakkupe monasteries was used in this study. The oral health beliefs were measured using a pre-tested questionnaire.

RESULTS

The results showed that seriousness was higher compared to other domains in the health belief model. Further, as the duration of the stay increased, the perceived importance was also higher among the population studied.

CONCLUSION

The results show that in general, although the seriousness of oral health was high among the participants, the perceived benefit of dental treatment was relatively low.

Predictors of Prosthodontic Treatment-Related Behavior Using the Theory of Planned Behavior Framework

The Theory of Planned Behavior (TPB) was used to assess subjects' intentions and behavior to predict willingness to undergo prosthodontic care. A questionnaire was administered to 225 adults with history of teeth loss who currently were not under prosthodontic treatment. The questionnaire comprised TPB components (attitude toward behaviour [ATB], subjective norm [SN], and perceived behavioral control [PBC]) containing items with potential influence on the intentions and behavior of individuals toward prosthodontic care. Clinical and socioeconomic data were also assessed. A path regression model was constructed explaining two dependent variables simultaneously: one explained the influence of PBC on intention (R2=0.04) and another explained the influence of dental arch, position of lost teeth, socioeconomic status, and PBC on behavior (R2=0.31). It was concluded that PBC was a relevant TPB component that encompasses perception of costs, opportunity cost, perceived need, and access to dental care. Clinical and socioeconomic factors were also major determinants of behavior toward prosthodontic treatment.

Oral Implant-Prostheses: New Teeth for a Brighter Brain

Several studies have demonstrated that chewing can be regarded as a preventive measure for cognitive impairment, whereas masticatory deficiency, associated with soft-diet feeding, is a risk factor for the development of dementia. At present the link between orofacial sensorimotor activity and cognitive functions is unknown. In subjects with unilateral molar loss we have shown asymmetries in both pupil size and masticatory muscles electromyographic (EMG) activity during clenching: the molar less side was characterized by a lower EMG activity and a smaller pupil. Since implant-prostheses, greatly reduced both the asymmetry in EMG activity and in pupil's size, trigeminal unbalance, leading to unbalance in the activity of the Locus Coeruleus (LC), may be responsible for the pupil's asymmetry. According to the findings obtained in animal models, we propose that the different activity of the right and left LC may induce an asymmetry in brain activity, thus leading to cognitive impairment. According to this hypothesis, prostheses improved the performance in a complex sensorimotor task and increased the mydriasis associated with haptic tasks. In conclusion, the present study indicates that the implant-prosthesis therapy, which reduces the unbalance of trigeminal proprioceptive afferents and the asymmetry in pupil's size, may improve arousal, boosting performance in a complex sensorimotor task.

Relationship Between Psychological Factors and Oral Health Status and Behaviours

PURPOSE

To examine oral health related behaviours in relation to anxiety, depression and attention deficit hyperactivity disorder (ADHD).

MATERIALS AND METHODS

This study included 364 subjects (195 female, age range 19-65 years; 169 male, age range 18-64 years). A psychological evaluation was performed using Beck's anxiety, Beck's depression and ADHD scales. A separate questionnaire covering oral health behaviours, including parafunctional habits, dental visits and toothbrushing frequency, was given to the subjects and completed before the clinical examination. The numbers of decayed, missing and filled teeth were recorded and the status of the subject's periodontal health was determined clinically using periodontal probes and panoramic radiographs.

RESULTS

There were significant differences in the gender, level of education, level of income, household size, parafunctional habits and number of missing teeth in those with anxiety and depression (p<0.05) vs those without. Females and subjects with parafunctional habits and lower education and income level presented higher anxiety and depression scores. ADHD was associated negatively with household size and positively with dental visits and toothbrushing frequency (p<0.05). The results of structural equation modeling (SEM) revealed that anxiety, depression and ADHD were indirectly related to missing teeth and periodontal status: subjects with higher depression and anxiety scores had more missing teeth and worse periodontal health. However, there was no association between psychological factors and decayed teeth or toothbrushing frequency.

CONCLUSIONS

Anxiety, depression and ADHD can result in poor oral hygiene, thereby having indirect, adverse effects on the periodontal health status of affected individuals. Although the frequency of dental visits seemed to be related to anxiety and ADHD, the frequency of toothbrushing showed no such association.

Is the value of oral health related to culture and environment, or function and aesthetics?

OBJECTIVE

To examine the disutility of tooth loss. It compared how people value their teeth in two countries which are culturally similar in order to explore the effect of culture on self-perceptions of oral health.

BASIC RESEARCH DESIGN

Cross sectional study.

PARTICIPANTS

Participants were recruited from subjects attending two hospitals in Turkey and in Iran.

INTERVENTIONS

Nineteen descriptions of mouths with varying degrees and types of tooth loss were presented to the participants. They were shown mouth models of partially edentate dentitions and the teeth missing were explained in relation to the participants own mouth. The participants were specifically asked to consider the role their teeth played in function (chewing), communication (speech) and aesthetics (looks) along with "all the other things that make your mouth important".

MAIN OUTCOME MEASURES

The participants were asked to indicate on a visual analogue scale how they would value the health of their mouth if they lost the tooth/teeth described and the resultant space was left unrestored.

RESULTS

Overall 152 subjects participated, 78 in Turkey and 74 in Iran with 83 being female and 69 male. Their mean age was 29.5 years (SD 9.3), 62.5% had experienced tooth loss and 37.5% had complete (or completely restored) dentitions. Although there were no differences between the two countries in the degree of utility people attached to anterior teeth, Turkish participants attached significantly more disutility than Iranians to the loss of premolar and molar teeth (p < 0.003).

CONCLUSION

Country of origin had an influence on the value placed on certain parts of the dentition and this effect is independent of the number of missing teeth, gender and age. This implies that attitudes to oral health are influenced by prevalent cultural attitudes more than by function.

Root Caries in Older Adults

Older adults are retaining an increasing number of natural teeth, and nearly half of all individuals aged 75 and older have experienced root caries. Root caries is a major cause of tooth loss in older adults, and tooth loss is the most significant negative impact on oral health-related quality of life for the elderly. The need for improved preventive efforts and treatment strategies for this population is acute.

[Impact of the edentulousness on the quality of life related to the oral health of the Congolese]

BACKGROUND

No studies on the perception of tooth loss effects in their daily lives of edentulous were performed in Congolese Bantu.

OBJECTIVES

To assess the severity of the impact of edentulism on the quality of life of partially edentulous Congolese and analyze the influence of age, sex, missing teeth, the location of gaps and pairs of posterior dental occlusion in this impact.

METHOD

This descriptive cross-sectional study was conducted in the University Clinics of Kinshasa (CUK) and the Centre Boyambi Army Hi Kinshasa/Gombe. One hundred and eighty one edentulous adults and non-denture wearers clinically examined were asked to complete the questionnaire OHIP 14.

RESULTS

Average severity was 11.67 ± 8.74 on a scale of 0-56. Statistically missing teeth, location of gaps and pairs of posterior dental occlusion residual alter this severity. The poor quality of life was noted in patients who had lost more than 5 teeth (17.04 ± 7.26), anterior losses (17.32 ± 9.42) and less than 4 pairs of posterior occlusion (17.84 ± 6.13). Difficult chewing and concern were the most reported items.

CONCLUSION

Severity of the influence of tooth loss on the daily life of Congolese people is low. All edentulous does not necessarily cause a very poor quality of life. Increasing the number of lost teeth, presence of anterior gaps and reduction of posterior occlusion pairs below 4 disrupt the quality of life of partially edentulous.

The relationship between tooth loss and psychological factors

OBJECTIVES

Limited evidence is available regarding mutual interactions between psychological factors and tooth loss. This study aimed to investigate the association between these two issues.

METHOD

In this 2011 cross-sectional study we obtained data from 4,585 adults who had completed information in 20 counties across Isfahan province, Iran, regarding tooth loss and psychological factors (depression, anxiety and stress level). To analyse the data ANOVA and multiple ordinal regression were applied.

RESULTS

After adjusting socio demographic factors, the association between depression (OR 1.23; 95% CI = 1.01,1.49), anxiety (OR 1.19; 95% CI = 1.03,1.38), and high stress level (OR 95% CI = 1.19; 1.01,1.39) remained significant.

CONCLUSION

We confirm the interaction between psychological factors and tooth loss, but recommend further studies on a national Iranian population.

Impact of early childhood caries on oral health-related quality of life of preschool children

AIM

Child oral health-related quality of life (COHRQoL) has been assessed in developed areas; however, it remains unstudied in mainland China. Studies on COHRQoL would benefit a large number of children in China suffering from oral health problems such as dental caries. This study explored the relationship between COHRQoL and early childhood caries, adjusted by socioeconomic factors, in 3- to 4-year-old children in a region of southern China.

MATERIALS AND METHODS

In this study, 1062 children aged 3-4 years were recruited by cluster sampling and their oral health statuses were examined by a trained dentist. The Chinese version of the Early Childhood Oral Health Impact Scale (ECOHIS) and questions about the children's socioeconomic conditions were completed by the children's parents. A negative binomial regression analysis was used to assess the prevalence of early childhood caries among the children and its influence on COHRQoL.

RESULTS

The total ECOHIS scores of the returned scale sets ranged from 0 to 31, and their average scores was 3.1±5.1. The negative binomial analysis showed that the dmfs indices were significantly associated with the ECOHIS score and subscale scores (P<0.05). The multivariate adjusted model showed that a higher dmft index was associated with greater negative impact on COHRQoL (RR = 1.10; 95% CI = 1.07, 1.13; P < 0.05). However, demographic and socioeconomic factors were not associated with COHRQoL (P>0.05).

CONCLUSION

The severity of early childhood caries has a negative impact on the oral health-related quality of life of preschool children and their parents.

Quality of life measured by OHIP-14 and GOHAI in elderly people from Bialystok, north-east Poland

BACKGROUND

The Oral Health Impact Profile-14 (OHIP-14) and the Geriatric/General Oral Health Assessment Index (GOHAI) have never been compared for a group of the same subjects in the Polish population. The aim of the study was to compare the OHIP-14 and GOHAI measures.

METHODS

178 independently living people over the age of 55 were included in the study. The GOHAI and OHIP-14 measures were used. Other variables included age, gender, self-ratings of oral general health, education, number of missing teeth, chewing problems and dry mouth.

RESULTS

The mean age of respondents was 70.8 years. The internal reliability (Cronbach's alpha) showed a high internal consistency for both measures. Spearman's rank correlation coefficient between the GOHAI and OHIP-14 scores was 0.81. Using the additive method of creating scores, 1.1% of respondents had the GOHAI score of zero, indicating no impact from oral conditions, while 13.5% of them had an OHIP-14 score of zero. Dental status, partial dentures, chewing problems, dry mouth and self-rated oral health were significantly associated with the results of the GOHAI and the OHIP-14 (Kruskal-Wallis test, Mann-Whitney U test). The numbers of preserved and missing teeth significantly correlated with the GOHAI and the OHIP-14, while DMF was significantly associated with the GOHAI only. 6 individuals with discrepant results were revealed. After the exclusion of the abovementioned patients, the internal reliability (Cronbach's alpha) still showed a high internal consistency, and the correlation between the GOHAI and OHIP-14 scores using Spearman's rank-correlation coefficient increased to 0.87. This phenomenon was identified as a "fatigue effect".

CONCLUSIONS

There was a strong correlation between the GOHAI and the OHIP-14. Both instruments demonstrated good discriminant properties and helped capture the respondents' oral health problems. The questionnaires should be randomly distributed to avoid the influence of "fatigue effect" on the results of a comparison of different measures.

Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden

BACKGROUND

Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.

METHODS

In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.

RESULTS

Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p < 0.05). Stratified analysis revealed that the mean OIDP frequency score worsened in participants who became dissatisfied- and improved in participants who became satisfied with oral health. Compared to participants who maintained all teeth, those who lost teeth were more likely to experience improvement and worsening of OIDP across both countries. The two-way interaction between country and tooth loss was not statistically significant.

CONCLUSIONS

Changes in OIDP at the individual level were more pronounced than the percentage distribution of OIDP at each point in time would suggest. The OIDP frequency score showed promising evaluative properties in terms of acceptable longitudinal validity, responsiveness and reproducibility among older people in Norway and Sweden. This suggests that the OIDP instrument is able to detect change in the oral health status that occurred over the 5 year period investigated. Norwegian elderly were more likely to report worsening in OIDP than their Swedish counterparts. Disease prevention should be at focus when formulating the health policy for older people.

Self-reported attitudes and beliefs towards dental care among a South Indian population

PURPOSE

To investigate the attitudes and beliefs towards oral health care based on gender, age and educational levels of a cross section of a South Indian population in Hyderabad city.

MATERIALS AND METHODS

The study comprised a convenience sample of the general population of Kamalanagar area, Kothapet ward, Hyderabad city, Andhra Pradesh. The questionnaire consisted of close-ended questions and was divided into three sections to gather the demographic details, self-reported attitudes (A1-A9) and beliefs (B1-B16) about dentistry. For all these questions, a 'yes' response denoted a negative/unfavourable attitude/belief and 'no' response a positive/favourable attitude/belief towards dentistry.

RESULTS

The mean age of the respondents was 33.21 ± 13.39 years with the majority possessing a university degree (672; 60%). Based on the age groups, statistically significant differences were noted for preferring to go to a traditional healer first (A1) (P = 0.01) and with regard to the cleanliness of dental clinics (A9) (P = 0.003). Likewise, education also influenced the attitudes of the respondents, where the more well-educated respondents significantly more often answered 'no' to the items 'dental visit only when in pain' (A2) (P = 0.001) and 'visit only with family, friends and neighbours' (A3) (P = 0.02) and concerning cleanliness of the dental clinics (A9) (P = 0.05). Statistically significant differences was documented for most of the questions according to educational levels except for 'dental treatment is very expensive' (B4), 'tooth lost anyhow' (B6) and 'regular dental check-up not required' (B14). The overall comparison of attitude scores revealed no significant difference for the variables. Nevertheless, educational level showed significant differences for belief score with a higher mean score for university graduates (9.82 ± 3.36) (P = 0.001).

CONCLUSION

Within the limits of the study, it can be concluded that a higher educational level led to a significantly more positive response to dentistry as compared to gender and age groups. In addition, the influence of traditional, social and cultural factors on dental care among this population cannot be ruled out.

'Your whole life is lived through your teeth': biographical disruption and experiences of tooth loss and replacement

The experience and meaning of tooth loss and replacement has varied historically and culturally but has received relatively little attention from social scientists. Our study set out to understand these experiences in the context of the arrival of newer, dental implant treatments. Semi-structured qualitative interviews were carried out with 39 men and women who had experienced tooth loss and replacement. A thematic analysis was sensitised by previous sociological work on chronic illness, particularly Bury's notion of biographical disruption. We found that while for some individuals the loss of a tooth was relatively insignificant, for others it was devastating and disruptive. In seeking to understand this difference, the concept of biographical disruption was a helpful analytical tool. Our analysis identified two forms of disruption. The first related to the meanings of tooth loss (the neglected mouth) and denture wearing (a marker of old age). The second, embodied, disruption concerned the relationship between the self and mouth in those wearing dentures (the invaded, unreliable mouth) and could occur even where tooth loss and denture wearing had been biographically anticipated.

Oral health-related quality of life and its relationship to self-reported oral discomfort and clinical status

The impact of oral health on quality of life is one aspect when it comes to understanding the significance of oral health. The aim of this study was to analyse the self-reported oral discomfort and clinical status of individuals reporting oral problems never/very seldom affecting quality of life during the last year and compare them with individuals who reported oral problems hardly ever/occasionally or often/very often during the the same period. The study comprised a stratified random sample of 515 individuals who lived in four parishes in the City of Jonköping, Sweden, and turned 20, 30, 40, 50, 60, 70 and 80 years of age in 2003. The impact of oral health on quality of life was examined using the OHIP-14 questionnaire. The individuals were also examined clinically and radiographically. Of the participants, 21% reported no experience of impaired quality of life and 20% of the individuals reported that they had experienced impaired quality of life often or very often during the last year. The highest frequency of oral problems was found among individuals aged 20 and 80 years. Subjective symptoms, such as grinding/clenching and headache, were found among 20- and 30-year-olds. Edentulous individuals and individuals with many missing teeth, individuals with severe periodontal disease or subjective dry mouth answered that they experienced problems according to the OHIP-14 often or very often. A number of individuals, young and old, had thus experienced subjective or clinically verified oral conditions associated with a negative experience of quality of life. This complementary information will provide a deeper understanding of the importance of oral health in the population.

An analysis of the attitudes of dental patients attending general dental practice in Galway

AIM

To describe the patterns of dental attendance and attitudes towards tooth loss of general dental practice patients in Galway.

OBJECTIVES

1. To determine the pattern of adult dental attendance in general practices in Galway; and, 2. To examine the oral health attitudes of these patients.

METHOD

Questionnaires were distributed to 311 consecutive adult patients in the waiting rooms of ten general dental practices in Galway, which were randomly selected from the telephone directory.

RESULTS

A total of 254 of the 311 questionnaires distributed were fully completed, returned and included in the results, giving a response rate of 81.7%. A total of 59% of dentate participants attended their dentist for annual or biannual examinations compared to 23% of edentate patients. Some 10.5% of medical card holders and 0.5% of non-medical card holders were edentulous.

CONCLUSIONS

The data from the survey indicated that medical card holders in Galway were more likely to be edentulous than nonmedical card holders. Edentate patients were less likely to be regular dental attenders than dentate patients.

Sociodemographic differences in oral health-related quality of life related to dental caries in thai school children

OBJECTIVE

This study aimed to assess associations between sociodemographic and oral health behavioural factors with dental caries and oral health-related quality of life (OHRQoL) attributed to dental caries in a national representative sample of 12- and 15-year-old Thai children.

METHOD

A representative subsample from the sixth Thailand National Oral Health Survey, 1,063 12-year-olds and 811 15-year-olds, completed a questionnaire on sociodemographic and behavioural information and were orally examined and interviewed about OHRQoL using the Child-OIDP or OIDP indexes. Associations of sociodemographic and behavioural factors with DMFT and Condition-Specific impacts (CS-impacts) attributed to dental caries were investigated using Chi-square tests and regressions.

RESULTS

For both groups, DMFT scores were associated with gender, geographic area and recently receiving dental treatment. Geographic area was the only sociobehavioural factor independently associated with CS-impacts. Dental caries accounted for the significant associations of sugary snacks and drinks consumption with CS-impacts. Significant associations of CS-impacts with consuming crispy snacks in 12-year-olds and fizzy drinks in 15-year-olds became non-significant when DT was entered into models.

CONCLUSIONS

There were considerable geographic differences in DMFT and CS-impacts attributed to dental caries among Thai children.

Qualitative studies of patients' perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: a systematic review with meta-synthesis

OBJECTIVE

To conduct a systematic review and meta-synthesis of qualitative studies addressing patients' perceptions of loss of teeth, edentulism and oral rehabilitation.

BACKGROUND

Qualitative studies can complement quantitative studies by achieving deep understanding of patients' subjective experiences of losing teeth and coping with edentulism. They can also explore the perception that the benefits of prosthetic rehabilitation extend far beyond primary clinical treatment goals of restoration of oral function.

MATERIALS AND METHODS

The major data bases were searched extensively for relevant qualitative and quantitative studies, followed by manual searching of the reference lists of included publications. Two authors independently read all abstracts. Relevant papers were retrieved in full-text and included or excluded according to a specially designed protocol. The included articles were then appraised and rated for quality: high, moderate or low. Articles of low quality were excluded.

RESULTS

The database search yielded 36 abstracts of qualitative studies; manual search disclosed one further article. All were read in full-text by two independent authors: 28 were excluded. Of the remaining nine, two (assessed as of low quality) were excluded for further analysis. Meta-synthesis, based on seven studies, disclosed two major themes: loss of quality-of-life associated with losing teeth and restored quality-of-life after oral rehabilitation.

CONCLUSIONS

In this relatively new field of research, there are few published papers. Nevertheless, the studies to date show that loss of teeth is associated not only with compromised oral function, but also loss of social status and diminished self-esteem. Oral rehabilitation has broad positive implications, restoring quality of life and self-worth.

Rare diseases with oral components: care course and quality of life

AIM

To describe links between the care course of individuals suffering from rare diseases and socio-behavioural risk factors and to ascertain the impact of dental conditions on the quality of life.

DESIGN

A cross-sectional comparative study involving self-reported questionnaire was performed. Care course was evaluated using predisposing, enabling and needs factors. The impacts of dental conditions on quality of life were measured with the OHIP 14 questionnaire. Proportions were compared by Chi-square test. Logistic regression for multivariate analysis assessed statistical association between variables.

RESULTS

Responses were received from 355 subjects (mean age 36.9 years, 67.6% females). Thirty-three rare diseases were recorded. Respondents were classified as group A, individuals suffering from rare diseases with a dental component (n=207, 58.3%), and group B, without dental component. Group A reported earlier diagnosis, more positive attitude toward dentists, functional limitation and higher prosthetic treatment needs. Only 17.4% of subjects having fewer than 20 teeth wear prosthetics. A higher percentage of individuals claiming pain, physical disability, psychological discomfort and social disability, was found among group B (p<0.001). Logistic regression analysis retained two impact factors: psychological disability (Exp(B)=8.66; 95% CI 1.86-40.34) and social wellbeing (Exp(B)=0.06; 95% CI 0.02-0.215).

CONCLUSION

Rare diseases with a dental component benefited from earlier identification of symptoms. Dentists could contribute to patients' quality of life by helping in early diagnosis, reducing functional limitation and improving social wellbeing.

Validation of a Romanian version of the short form of the oral health impact profile (OHIP-14) for use in an urban adult population

PURPOSE

To obtain a valid Romanian version of the OHIP-14 for use among Romanian adults, either in Romania or abroad.

MATERIALS AND METHODS

The Romanian version of the OHIP-14 was obtained through the back translation technique and pre-tested in a pilot study. Subsequently, it was self-administered to 187 adults who also underwent a clinical examination. Cronbach alpha was used to check the internal consistency and reliability analysis and validity tests were used to determine the psychometric properties of the questionnaire.

RESULTS

The Cronbach alpha coefficient obtained was 0.88. Inter-item correlation coefficients were between 0.01 and 0.74; item-total correlation values ranged between 0.25 and 0.77. There were statistically significant associations (p <= 0.001) between the respondents' self-perceived oral health (r = 0.41), the dental treatment need (r = 0.35) and the mean of the OHIP-14 total scores. Similar statistically significant associations (p <= 0.001) existed between the OHIP-14 total scores mean and the clinical data - the number of decayed (D) and of missing (M) teeth and the prosthetic treatment need - proving the construct validity of the questionnaire. The subscales 'physical pain' and 'psychological disability' have the most important impact on the overall OHIP-14 score. The subscales 'social disability' and 'handicap' seem to make the least contribution to the overall OHIP-14 score.

CONCLUSION

The Romanian version of the OHIP-14 is a valid and reliable questionnaire that can be used in future studies.

Oral health, sense of coherence and dental anxiety among middle-aged women

AIMS

The specific aims of this investigation were to analyze the relationship between sense of coherence (SOC), dental anxiety (DA) and oral health status among middle-aged women, measured both subjectively and objectively and adjusted for socioeconomic status (SES).

MATERIALS AND METHODS

Randomly selected women, 38 (n = 206) and 50 (n = 287) years of age, were included in a cross-sectional health examination. The participants underwent a series of examination stages, including a clinical and dental radiographic examination. The women responded to questionnaires concerning SES, oral health, DA and SOC.

RESULTS

The number of teeth was significantly related to SOC, where more missing teeth revealed a lower SOC level among 50-year-olds. The variables of caries, apical periodontitis and filled surfaces were not statistically significantly associated with SOC. However, the self-reported measure of oral health was associated with SOC in both age groups. High DA was significantly related to self-perceived poor oral health regardless of age. Individuals with high DA also had fewer teeth, more filled surfaces and more approximal caries. The multivariate models showed that higher SOC levels were associated with better oral health, as estimated by objective or subjective measures, while the inverse results were seen for DA. Thus, individuals reporting high DA were more likely to have fewer teeth and poor perceived oral health, taking SES into account.

CONCLUSIONS

Sense of coherence and dental anxiety are psychological aspects with respect to health- and risk-factors of oral health.

Oral health-related quality-of-life in patients to be treated with fixed or removable partial dental prostheses

OBJECTIVES

The aims of this study were to measure and describe the Oral Health-Related Quality-of-Life (OHRQoL) in a population about to receive removable dental prostheses (RDP) or fixed dental prostheses (FDP).

MATERIALS AND METHODS

The Oral Health Impact Profile 49 (OHIP-49) was completed by 410 patients about to receive treatment with either RDP or FDP. Objective variables were: gender, age, number of teeth, type of replacement planned (FDP/RDP) and location (one jaw or both) and zone (aesthetic/masticatory/both) of missing teeth to be replaced.

RESULTS

Women had a worse OHRQoL than men in the RDP group. Higher age was significantly correlated with a better OHRQoL independent of treatment modality. Participants about to receive FDP in one jaw in the masticatory zone only had a better OHRQoL than RDP participants in the same group. The most frequently reported problems in all groups concerned functional limitations, discomfort and physical disabilities. Little variance in reported items was seen between the sub-groups and social handicap was not frequently reported.

CONCLUSIONS

The difference in OHRQoL between participants about to receive RDP and FDP was limited. The most frequently reported problems concerned functional limitations, discomfort and physical disabilities. Social handicap was not frequently reported.

Knowledge and attitude of patients toward dental implants as an option for replacement of missing teeth

OBJECTIVE

The present study was undertaken to access the level of knowledge and attitude of patients toward implant treatment as an option for replacement of missing teeth.

MATERIALS AND METHODS

An epidemiological study was conducted among 440 subjects who attended the OPD of two Departments (Prosthodontics and Oral and Maxillofacial Surgery). A self-administered structured closed ended questionnaire pretested through a pilot survey was used in the study. The data were analyzed using the SPSS version 15.0. The Student's t-test and ANOVA test were used as test of significance.

RESULTS

Out of 440 subjects asked about the knowledge and attitude about implants, only 33.3% had heard of implants as a treatment modality and dentists were the main source of information. Very few people had undergone implant surgery. The level of awareness increased with education. The main factor for not having implants was due to its high treatment charges. However, they were interested to know more about the implant treatment modality.

CONCLUSION

The survey was conducted in a dental institute and majority of the participants were unaware about dental implants. It also showed that need for providing more information to the patients about this treatment modality.

Patient-centered outcomes after subepithelial connective tissue grafts and coronally advanced flaps

OBJECTIVE

The use of a coronally advanced flap (CAF) and connective tissue graft (CTG) is a well-established procedure to cover single and multiple recessions and improve soft tissue esthetics. However, until now, there are still limited data evaluating patient morbidity, the fear of imminent tooth loss, and modification of sensitivity in surgical areas. The aim of the present study was to evaluate the patient-centered outcomes associated with CAF + CTG.

METHOD AND MATERIALS

Thirty-four patients (mean age, 30.76 ± 6.88 years) with single or multiple Class I and II gingival recessions were treated using a CAF + CTG. The following parameters were evaluated at 14 days and 1, 3, 6, and 12 months after surgery: esthetics, root hypersensitivity, fear of imminent tooth loss, daily activities or nutritional habits, and the levels of postsurgical morbidities. A visual analog scale was used to evaluate patient-centered outcomes. The percentage of patients belonging to each of the severity scales, the mean values associated with each parameter, and the statistical significance of the modification of the monitored parameters were calculated. The parametric F (Fisher) test and the least significant difference post hoc pair-wise comparisons were computed.

RESULTS

There were statistically significant differences between baseline and all follow-up time points in root hypersensitivity and in fear of tooth loss. Preoperative prevalence of fear of tooth loss was 99%. Esthetics were statistically significantly improved at the 1-, 3-, 6-, and 12-month visits compared with the evaluation at 14 days. No palatal bleeding was recorded. The pain perception in the donor area was mild: Only 3% of patients reported severe palatal pain, and the mean VAS score for palatal pain was 3.79 ± 1.49.

CONCLUSION

Treatment of single and multiple gingival recessions with CAF + CTG resulted in predictable improvements of soft tissue esthetics and root hypersensitivity but was associated with a slight increase in patient morbidity, mainly related to the harvesting of CTG. This should be considered when treating patients with esthetic demands.

Impact of oral conditions on the quality of life of secondary schoolchildren in Nigeria

PURPOSE

Oral health problems have been increasingly recognized as important factors causing a negative impact on daily performance and quality of life. The purpose of this study was to assess the impact of tooth extraction with no replacement, untreated fractured anterior teeth, malocclusion, dental restorations, and orthodontic braces on the quality of life in Nigerian schoolchildren.

METHODS

A total of 197 9- to 17-year-old schoolchildren completed the Oral Health Impact Profile (OHIP) index/questionnaire.

RESULTS

Students who had tooth extraction with no replacement and untreated fractured incisors had significantly higher mean OHIP scores for functional limitations, physical pain, psychological discomfort, physical, psychological, and social disabilities, and handicaps (P<.001) when compared to other groups and the control. The mean OHIP scores of students with features of malocclusion were significantly higher for functional limitations, psychological discomfort, and psychological disability compared to the control group (P<.001).

CONCLUSIONS

Untreated dental problems had some negative impact on the quality of life on the 7 subscales of the OHIP.

Prevalence of dental myths, oral hygiene methods and tobacco habits in an ageing North Indian rural population

BACKGROUND AND OBJECTIVES

Though increased emphasis is being given to expanding dental care facilities and awareness in Indian villages, the target population is unfortunately less literate and financially-equipped compared to their urban counterparts. This study attempted to evaluate dental myths, oral hygiene methods and beliefs, and tobacco habits present in a rural ageing population.

MATERIAL AND METHODS

The study area consisted of a group of 10 villages, situated in the district of Lucknow, Uttar Pradesh, India. The sample comprised 681 people aged 50 years or above. The subjects were questioned about dental myths, tobacco habits and oral hygiene methods and then divided into groups on the basis of age, gender, and educational status. Mean values, standard deviation, chi-square test, t-test and p values were used to obtain inter-group comparisons.

RESULTS

Forty percent of the subjects considered oral hygiene unnecessary, with 61% relying on simple mouth rinsing for maintaining oral hygiene, 48% either smoked and chewed tobacco or both and 81% had one or more dental myth.

CONCLUSION

The results showed that the rural ageing population is deprived and a targeted programme to spread scientific dental practices to them is necessary.

The impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions

OBJECTIVE

To investigate the impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions and to identify components of malocclusion that may contribute to these outcomes.

MATERIALS AND METHODS

The sample comprised 704 secondary school adolescents aged 12 to 13 years from Balneário Camboriú, Brazil. A trained and calibrated orthodontist examined the severity of malocclusion using the Dental Aesthetic Index (DAI). A pretested questionnaire was used to assess reported dental appearance, self-perception of speech, and self-perception of masticatory function using a 5-point scale of oral health status. The outcomes of the present study were dissatisfaction with dental appearance and dissatisfaction with oral functions. Simple and multivariate logistic regression analysis was performed to explore the association between DAI and outcomes and to quantify the effect of DAI components on dissatisfaction with dental appearance.

RESULTS

Each DAI unit increase led to a significant increase of 5% in the likelihood of dissatisfaction with dental appearance (OR: 1.05; 95% CI 1.01-1.08). DAI components that exerted influence on dissatisfaction with dental appearance were: missing teeth (P  =  .010), largest maxillary anterior irregularity ≥3 mm (P  =  .013), and largest mandibular anterior irregularity ≥2 mm (P  =  .008). There was no association between severity of malocclusion and dissatisfaction with oral functions.

CONCLUSIONS

Severity of malocclusion interfered with satisfaction of dental appearance in this population. Missing teeth and anterior irregularity were identified as factors influencing this outcome.

Association of clinical oral health status with self-rated oral health and GOHAI in Japanese adults

OBJECTIVE

The objective of this study was to investigate clinical oral health status relationships that affect quality of life (using the 12-item General Oral Health Assessment Index (GOHAI)) and self-rated oral health in a community of Japanese residents.

METHODS

459 residents of Yokote City, Japan aged 40-55 years had oral health examinations and completed self-administered questionnaires collecting data on age, gender, GOHAI items and self-rated oral health. Linear regression analysis was performed with GOHAI or self-rated oral health as a dependent variable and gender, age and indicators of oral health status as independent variables.

RESULTS

The GOHAI indicated 42.7% of subjects were concerned about the appearance of their teeth, 30.1% were worried about teeth problems and 27.5% concerned about sensitive teeth. Analyses showed that gender, decayed teeth, oral dryness and missing teeth were significantly associated with variation in GOHAI scores, and that gender, decayed teeth, oral dryness and oral hygiene were significantly associated with variation in self-rated oral health.

CONCLUSION

This study revealed that in this sample of Japanese adults aged 40-55 years, decayed teeth and oral dryness affected both GOHAI and self-rated oral health, whereas missing teeth affected GOHAI and oral hygiene affected self-rated oral health. Subjects did not recognise periodontal disease as a quality of life impacting condition or as a health problem.

Clinical and socio-demographic factors influencing the oral health-related quality of life of Chinese elders

OBJECTIVES

The objective of this study was to explore the clinical and socio-demographic factors influencing oral health-related quality of life (OHRQoL) of the Chinese elderly.

METHODS

Two urban districts in Binzhou, Shandong Province, Eastern China were selected and 300 elders aged 60-80 years were recruited. The study subjects completed a structured questionnaire in an interview and underwent a clinical examination. The questionnaire included questions on socio-economic information and a Putonghua version of the General Oral Health Assessment Index (GOHAI) which had been validated for use in Chinese elders to evaluate their OHRQoL. Clinical examination was performed using the criteria recommended by the World Health Organization. Tooth status, periodontal health status, loss of attachment (LOA), and number of occluding tooth pairs were recorded. Duplicate examinations were conducted on 10% of the subjects.

RESULTS

The mean GOHAI score of the subjects was 46.0 (SD 8.5). Result of an ANCOVA showed that subjects who were older, had no root caries, had no tooth with LOA > or = 6mm, or had more occluding pairs had higher GOHAI scores indicating better OHRQoL.

CONCLUSION

The OHRQoL of the study elders was fair and was influenced by age and a number of clinical factors. With limited resources and dental manpower in China, higher priority should be given to the elders who are relatively younger, who have or are at high risk of developing root caries and advanced periodontal diseases, and who have few occluding tooth pairs.

Chewing ability and dental functional status

PURPOSE

The aim of this research was to explore the relationship between chewing ability and dental functional status, perceived oral health-related quality of life, and a number of background variables in a Vietnamese population.

MATERIALS AND METHODS

The cluster stratified sample consisted of 2,805 dentate subjects aged ⋝ 20 years from urban and rural areas in Southern Vietnam. Chewing ability was assessed using a questionnaire that included questions on perceived difficulty with respect to eight foods and three questions of the Oral Health Impact Profile that were considered relevant.

RESULTS

Only a minority reported serious problems with chewing ability (reporting difficult or very difficult to chew). The logistic regression analysis on chewing ability outcomes showed significant relationships between chewing ability and having ⋝ 10 teeth in each arch, having sufficient molar regions (⋝ 1 molar posterior occlusal pair [POP] bilaterally) for hard and soft foods, and having sufficient premolar regions (⋝ 3 POPs), especially for hard foods. In the hierarchical functional classification system, likelihood to report complaints on chewing ability appeared to discriminate in the branch "⋝ 10 teeth in each arch." Likelihood at subsequent levels ranged from approximately 1.5 to 3. In the branch "< 10 teeth in each arch," likelihood did not discriminate because the groups lacked sufficient homogeneity.

CONCLUSIONS

Chewing ability and oral health-related quality of life were positively correlated. Among all dental and other variables, decreased chewing ability was strongest when correlated with older age categories and not correlated or weakly correlated with sex, socioeconomic status, and residence.

Factors explaining desire for dental implant therapy: analysis of the results from a longitudinal study

PURPOSE

The aim of this research was to investigate possible factors behind the desire for and changes in attitude toward implant treatment in a population of middle-aged and older individuals in Sweden.

MATERIALS AND METHODS

In 1989 and 1999, questionnaires were sent to 3,000 residents in Orebro County, Sweden. Response rates were 79% and 68%, respectively. Those responding to both questionnaires yielded a longitudinal study panel. Logistic regression models were done with "desire of implant treatment" and "changes in desire of implant treatment" as dependent variables.

RESULTS

Older people, non-city residents, and those with one or several missing and unreplaced teeth changed their desire for implant treatment between study years. Effects of age, residence, and better dental status disappeared during the 10-year study period. Those who were edentulous and those with removable dentures (pseudo R2: 0.17) expressed lower desire for treatment than those with all teeth remaining or only one or a few teeth missing (pseudo R2: 0.24) in 1989. High income significantly increased the probability to desire implant treatment for the study panel at both study occasions (P = .016 and P = .034 for 1989 and 1999, respectively).

CONCLUSIONS

Factors influencing desire for implant treatment were primarily income and dental status. The influence of young age, urban living, and dental status regarding the subgroup with one or several teeth missing in relation to those with all their teeth disappeared during the 10-year study period.

Oral Health-Related Quality of Life among a large national cohort of 87,134 Thai adults

BACKGROUND

Oral health has been of interest in many low and middle income countries due to its impact on general health and quality of life. But there are very few population-based reports of adult Oral Health Related Quality of Life (OHRQoL) in developing countries. To address this knowledge gap for Thailand, we report oral health findings from a national cohort of 87,134 Thai adults aged between 15 and 87 years and residing all over the country.

METHODS

In 2005, a comprehensive health questionnaire was returned by distance learning cohort members recruited through Sukhothai Thammathirat Open University. OHRQoL dimensions included were discomfort speaking, swallowing, chewing, social interaction and pain. We calculated multivariate (adjusted) associations between OHRQoL outcomes, and sociodemographic, health behaviour and dental status.

RESULTS

Overall, discomfort chewing (15.8%), social interaction (12.5%), and pain (10.6%) were the most commonly reported problems. Females were worse off for chewing, social interaction and pain. Smokers had worse OHRQoL in all dimensions with Odds Ratios (OR) ranging from 1.32 to 1.51. Having less than 20 teeth was strongly associated with difficulty speaking (OR = 6.43), difficulty swallowing (OR = 6.27), and difficulty chewing (OR = 3.26).

CONCLUSIONS

Self-reported adverse oral health correlates with individual function and quality of life. Outcomes are generally worse among females, the poor, smokers, drinkers and those who have less than 20 teeth. Further longitudinal study of the cohort analysed here will permit assessment of causal determinants of poor oral health and the efficacy of preventive programs in Thailand.

Impact of oral health on the quality of life of 3-6-years old HIV-infected children. Quality of life in HIV+ children

AIM

The objective was to assess the impact of oral health on the quality of life of HIV-infected patients aged 3-6 years based on their caregivers' perceptions.

METHODS

A questionnaire for measuring the perception and the instrument Early Childhood Oral Health Impact Scale (ECOHIS) were applied to 31 caregivers whose children were being treated in a public hospital. Results The mean age of the children was 4.52 years (SD 1.22). The total ECOHIS score ranged from 0 to 26, with a mean value of 4.13 (SD 6.66). Seventeen children (54.8%) were found to have at least one impact: toothache (64.7%), herpetic gingivostomatitis (23.5%) or both (11.8%). Statistically significant difference was found between the ECOHIS score and presence of restored teeth, prior dental treatment, AIDS, and viral load. With respect to the caregivers' perception, it resulted to be adequate, as those caregivers whose children had a greater number of decayed teeth and higher biofilm index also considered the oral health to be bad (P<0.001). However, the children's general health was found to be good despite the worse immunological classification (P<0.017).Conclusion The quality of life of the HIV- infected children has been negatively affected by the oral health.

Non-biological factors associated with tooth retention in Irish adults

OBJECTIVES

To identify non-biological factors associated with retention of natural teeth and sound untreated natural teeth among adults in Ireland.

DESIGN

Data were collected in the 2000/'02 epidemiological survey of the oral health of Irish adults.

CLINICAL SETTING

Participants underwent a clinical oral examination in health board dental clinics and a detailed interview pertaining to oral and general health.

PARTICIPANTS

The analysis is based on a random sample of adults aged 16-24 years (n = 1,196), 35-44 years (n = 978), and 65 years and older (n = 714).

MAIN OUTCOME MEASURES

Dependent variables were number of natural teeth present (NT), number of sound untreated natural teeth (SUNT), likelihood of being dentate, having 21 or more NT (21+NT), 28 or more NT (28+NT), and 18 or more SUNT (18+SUNT). Socioeconomic status (SES) was based on being disadvantaged, occupation status and educational attainment. Behavioural factors included smoking, snacking, brushing frequency and dental visiting patterns. Bivariate and multivariate regression analyses were performed.

RESULTS

Tooth retention decreased with increasing age group. Level of education, disadvantage status, being in employment, frequent brushing and visiting the dentist for a check-up (instead of when in need or pain) were associated with tooth retention. Attending for a check-up moderated the impact of disadvantage on tooth retention among 35-44 year-olds.

CONCLUSIONS

The results of this study indicate that several non-biological determinants are important for dental health in this adult population.

Patients' attitude towards anterior teeth extraction an prosthetic replacement at the UPTH Dental Center, Port Harcourt

AIM

The purpose of this study was to assess the attitude of patients towards anterior teeth extraction and prosthetic replacement of same at the Dental center of the University of Port Harcourt Teaching Hospital (UPTH).

METHODS

A retrospective review of the data of patients who presented for anterior teeth extraction and prosthetic replacement or anterior teeth extraction only over a two-year period was done using the records of the oral surgery and prosthetic clinics of UPTH Dental centre. Demographic and clinical information were retrieved and analyzed using the SPSS version 15.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

Ninety-two patients comprising 58 males(63%) and 34 females (37%), giving a male to female ratio of 1.7:1, were involved. The age range was 6 to 86 years with a median age of 34.5 years. Forty- three patients (46.7%) had both extraction and replacement within the study period while 49 patients (53.3%) had extraction without replacement. Trauma was the major cause of anterior tooth loss, especially among males and young individuals. Plastic removable partial denture was the main type of replacement offered. Fifty percent of the females (17/34) had replacement compared to 44.8% of the males (26/58). Among those who had both extraction and replacement, majority (74.4%, 32/43) requested for replacement within a month post extraction. Also, 86.2%t of the patients below 40 years either had immediate dentures or replacement within a month compared to 50% of those above 40 years.

CONCLUSION

Most of the patients, surprisingly, tolerated anterior edentulousness. However, it appears that anterior edentulousness was more abhorent to female patients and younger individuals.

The voice of the elderly in accepting alternative perspectives on oral health

BACKGROUND

As we age, the dynamic balance between gains and losses has been acknowledged by current portrayals of health. Oral health research has yet to fully incorporate such dynamism in understanding the impact of oral disorders on the life of elders.

OBJECTIVE

to explore the existence of alternative views on oral health through values, beliefs and behaviors of older adults.

METHODS

Focus group discussions occurred among 42 men and women between the ages of 64 and 93 years old. Participants were from community and seniors centres and retirement homes. Each discussion lasted for about 90 minutes and was tape-recorded for verbatim transcription. Data were analyzed systematically and comparatively using a thematic approach to explore the depth of opinions and understandings of oral health and disability.

RESULTS AND CONCLUSIONS

Participants shared the acceptance of some oral impairment and disability as an alternative view of a 'healthy' mouth as they balanced gains and losses, adjusted expectations, and sought social support. Participants discussed that an edentulous mouth might not always be disruptive to daily functioning for all. As a result, a full set of new dentures may not always be the ultimate goal.

Patient-generated aspects in oral rehabilitation decision making. II. Comparison of an individual systematic interview method and the oral health impact profile

PURPOSE

The effect of impaired oral functions is best described by the patient, and a shift toward a patient-oriented decision-making process in oral rehabilitation is evident. The Oral Health Impact Profile-49 (OHIP-49) questionnaire has been the most commonly used method to measure oral health-related quality of life (OHRQoL) in dentistry. An individualized method, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighing (SEIQoL-DW), has proven to fulfill most of the criteria for a method to assist in the decision-making process. The purpose of this study was to compare the ability of the OHIP-49 questionnaire and the SEIQoL-DW method in measuring OHRQoL and generating useful information for decision making in oral rehabilitation.

MATERIALS AND METHODS

Sixty participants in need of oral rehabilitation were enrolled in the study. Patients received a clinical examination, were interviewed using the SEIQoL-DW, filled out the OHIP-49 questionnaire, and answered two global oral health-rating questions.

RESULTS

The SEIQoL-DW generated additional information compared to the OHIP-49. The information was more oral- and treatment-specific, including consultation issues and the patient-practitioner relationship. The overall SEIQoL-DW and OHIP-49 scores were significantly correlated. The OHIP-49 and SEIQoL-DW scores were related to oral health subjectively.

CONCLUSIONS

The SEIQoL-DW method proved a useful aid in clinical decision making for oral rehabilitation. The SEIQoL-DW was more appropriate for generating information useful for decision making than measuring OHRQoL; the OHIP-49 was more appropriate for measuring OHRQoL than generating information.

Unmet need for education by professionals and inconsistency in knowledge and behavior of dental patients

In order to identify what knowledge dental patients have of oral health and to analyze the potential relationship between knowledge, behavior and oral health status, 250 randomly selected patients were asked to complete a self-administered questionnaire. Responses were analyzed based on the age, gender and educational status of participants. It was determined that oral health-related behavior and knowledge were generally inadequate. Although knowledge had some influence on behavior, this was not constantly observed. The unmet need of patients with regard to getting information from professional resources emphasizes the need for dental professionals to dedicate more time to prevention and the promotion of oral health through efficient strategies.

The impact of early-in-life periodontal infection on the smiles of children: a worldwide view

Little attention has been directed toward evidence that an early-in-life oral infection with the potential to reach epidemic proportions is threatening the health of youths throughout world. Health professionals and the public seem unaware that the silent disease process of early-in-life periodontal infection is targeting thousands of children and young adults, their smiles, and, consequently, their emotional and psychologic lives. Yet, the literature is replete with reports that many periodontopathic microorganisms are multiplying at an alarming rate with a serious impact on youths in many cities, towns, and villages throughout the globe. However, clinical measurement of reported periodontal disease has been fraught with problems that have confused and clouded messages to policymakers in government and health professionals in treatment settings. The aim of this article is to help raise the level of awareness so that those who have the power and knowledge can appropriately address the suffering of the youngest members of societies.

Patients' ranking of interdental "black triangles" against other common aesthetic problems

The purpose of this study is to assess patients' aesthetic perceptions of interdental "black triangles", both in terms of the number of triangles visible and their severity; and to ascertain how patients rank the presence of "black triangles" against other aesthetic problems. It is based on a questionnaire of 80 randomly selected individuals who were asked to rate the aesthetics of digitally-manipulated images. Patients'perceptions of interdental "black triangles" were compared with their perceptions of other 'non-aesthetic' features. Interdental "black triangles" were rated as the third most disliked aesthetic problem below caries and crown margins. This study demonstrates the importance of interdental "black triangles" to patients, and therefore, as they can occur during prosthetic treatment, must be discussed with patients prior to commencing therapy.

Impacts of missing upper anterior teeth on daily living

BACKGROUND

Aesthetics and function of the orofacial region are very important aspects of human life which may be affected by tooth loss and impact on the quality of life. The aim of this study was to identify the effects of anterior tooth loss on patients' quality of life and satisfaction with their dentition.

METHODS

Fifty partially edentulous patients with missing anterior teeth and 50 control subjects who had no missing teeth were recruited into the study. The control subjects matched the patients by age, gender, and level of education. A Dental Impact on Daily Living questionnaire was used to assess dental impacts on daily living and satisfaction with the dentition.

RESULTS

Tooth loss has a definite measurable impact on patients' daily living and satisfaction with their appearance, pain levels, oral comfort, general performance, and eating capacities (p = 0.000). Age and level of education had no effect on patients' total satisfaction with their dentition and daily living. However, females were less satisfied with appearance, general performance and eating (p = 0.003, 0.005 and 0.007 respectively) than males. There were significant correlations between the number of missing anterior teeth and patients' total satisfaction (p = 0.028) and patients satisfaction with appearance, oral comfort, general performance, and eating dimensions (p = 0.001, 0.048, 0.011 and 0.009 respectively).

CONCLUSION

Tooth loss has definitive impact on patients' satisfaction with their dentition regardless of personal factors such as age, gender and level of education. The higher the number of missing teeth the lower the levels of satisfaction with the dentition and daily living.

Effect of tooth loss and denture status on oral health-related quality of life of older individuals from Sri Lanka

OBJECTIVE

To determine the effect of tooth loss and denture status on oral health-related quality of life of older individuals.

BASIC RESEARCH DESIGN

A cross-sectional study where the data were collected by means of an interviewer administered questionnaire and a clinical oral examination.

PARTICIPANTS

The sample consisted of 630 free-living older individuals who were 60 years and above. The present analysis is limited to 619 individuals who had at least one missing tooth.

MAIN OUTCOME MEASURES

The impact of tooth loss and denture status on oral health related quality of life was assessed using a Sinhalese translation of the Oral Health Impact profile-14 (OHIP-14).

RESULTS

In the edentate group, overall prevalence of oral impacts was significantly higher in non-denture wearers (53%) compared to denture wearers (32%). In both dentate and edentate groups, the most commonly reported impact item was "uncomfortable to eat". According to the logistic regression analysis having 25-31 missing teeth with an odds ratio of 4.21 had the strongest association with the OHIP score. Those with anterior dental spaces were 2.76 times more likely to have an impact score of >2 than those without such spaces. Compared to denture wearers, non-denture wearers were 2.81 times more likely to have an impact score of >2.

CONCLUSIONS

Oral health-related quality of life of older individuals was significantly affected by tooth loss, position of missing teeth and denture status.