A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures in England and Scotland

OBJECTIVE

To assess the oral health impact profile (OHIP) on edentulous subjects in Scotland and England who needed to have their dentures replaced, and to determine whether any change in the subjects' assessment of their original and replacement dentures impacted on oral health related quality of life parameters.

BACKGROUND

The loss of all teeth may impact on functional activities. The OHIP is an instrument used to measure subjects' perception of the social impact of oral disorders on their well being.

METHODS

A total of 58 edentulous subjects were studied. Subjects completed the OHIP-14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale.

RESULTS

For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were significant improvements in four of the 14 OHIP parameters assessed after treatment. With the new dentures, subjects expressed improved satisfaction, particularly for the lower prosthesis. There were no major differences between the responses of the subjects in Scotland and England.

CONCLUSION

For this group of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant social impacts. For this reason the provision of new dentures did not result in major changes to the OHIP.

The association between oral health and general health and quality of life in older male cancer patients

OBJECTIVES

To describe the long-term effects of oral health problems on quality of life (QoL), functional status, pain, and general health in older male cancer patients.

DESIGN

Secondary analysis of a prospective observational study.

SETTING

Community dwelling cancer patients served by a Department of Veterans Affairs hospital.

PARTICIPANTS

One hundred fifty male cancer patients responded to the question "Do you have tooth or mouth problems making it hard to eat?" The relationship between patients answering "yes" and the following parameters was assessed: demographics, comorbid conditions, habits, activities of daily living, pain, anxiety, depression, social support, spirituality, QoL, and overall health ratings.

MEASUREMENTS

Chi-square contingency tables for dichotomous variables, Cochran-Mantel-Haenszel for ordered categorical variables, and t tests for associations with continuous variables.

RESULTS

The median age of respondents was 67. Those reporting tooth or mouth problems had had their cancer diagnosed on average 2.9 years before, and 83.3% were found clinically to be cancer free. Patients with these problems had significantly lower global (P=.003) and subscale scores on QoL analysis and higher levels of anxiety (P<.001) and depression (P=.01) than those without tooth or mouth problems; they also had significantly more pain (P<.001) and lower physical functioning (P<.001) and were more impaired in activities of daily living (P<.001). Those with tooth or mouth problems were more likely to describe their overall health as fair or poor (P=.01). Having cancer located in the head and neck region related significantly to having mouth or tooth problems (P=.005), but these problems were not associated with race, education, income, insurance coverage, age, comorbid conditions, alcohol consumption, tobacco or medication usage, type of cancer treatment, tumor stage at diagnosis or follow-up, perceived social support, or spirituality.

CONCLUSION

Older male cancer patients with mouth or tooth problems making it hard to eat are more likely to have a lower QoL, poorer emotional health, lower levels of physical functioning, and greater pain than patients without these problems.

The effectiveness of three oral health indicators in monitoring a program (OHPP)

The purpose of this study was to assess the effectiveness of three oral health indicators in monitoring a Program, compare them with each other and select the most indicated in epidemiological surveys. A dental plaque index, interdental bleeding index, and saliva test were used to evaluate 325 children (6.1 to 11.3 years-old). The results indicated a decrease in all indexes (p < 0.001). The indicators were effective although the saliva test was simpler and faster than the other indexes.

Oral self-care behaviours: comparing Greek and Japanese dental students

AIM

This study explored cross-cultural differences of self-reported oral health behaviours between Greek and Japanese dental students.

PARTICIPANTS

The sample population included 877 dental students, 539 students registered at the University of Athens Dental School, and 338 registered at the Hiroshima University Dental School.

MATERIAL AND METHODS

Oral health behaviour was assessed using the Greek and Japanese versions of a 20-item questionnaire entitled Hiroshima University-Dental Behavioural Inventory (HU-DBI).

RESULTS

The mean questionnaire score of the Japanese students (7.40) was significantly greater than that of the Greek peers (6.86, P = 0.001), indicating better oral self-care behaviour amongst the Japanese students; however, the overall difference was mainly attributed to their additional sixth study year. Greek and Japanese students provided significantly different answers to 14 of 20 HU-DBI items. Greeks significantly more often were required by their dentist to evaluate their brushing technique (OR = 14.4, P < 0.01), checked their teeth in the mirror after brushing (OR = 8.1, P < 0.01), worried about bad breath (OR = 6.7, P < 0.01), and believed that gum disease is preventable by tooth brushing alone (OR = 2.1, P < 0.05), whereas their Japanese peers significantly more often felt comfortable to clean their teeth without the use of a toothpaste (OR = 0.3, P < 0.01), believed that they take much time to brush their teeth (OR = 0.3, P < 0.01), used a child-sized toothbrush (OR = 0.2, P < 0.01), and put off going to the dentist until having toothache (OR = 0.4, P < 0.01).

CONCLUSIONS

Considerable differences in dental health attitudes/behaviour exist amongst students in the two countries reflecting the different culture and the health education system of the students; moreover, it is possible to distinguish Greek dental students from Japanese peers with a probability of more than 89% by using the HU-DBI instrument.

Success or failure of dental implants? A literature review with treatment considerations

This study reviews the literature concerning the success or failure of dental implants and provides the general dentist with information to decide whether to recommend dental implant therapy to a patient. The authors conducted an extensive literature search for articles relating to dental implant failure. Metaanalyses and multi-center studies were predominant in the selection. Predictors of dental implant success or failure were gleaned from various articles and presented in the form of text and tables. The main predictors for implant success are the quantity and quality of bone, the patient's age, the dentist's experience, location of implant placement, length of the implant, axial loading, and oral hygiene maintenance. Primary predictors of implant failure are poor bone quality, chronic periodontitis, systemic diseases, smoking, unresolved caries or infection, advanced age, implant location, short implants, acentric loading, an inadequate number of implants, parafunctional habits and absence/loss of implant integration with hard and soft tissues. Inappropriate prosthesis design also may contribute to implant failure.

The Influence of Dental Insurance on Institutionalized Older Adults in Ranking Their Oral Health Status

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as "good," "very good" or "excellent" by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI = 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting "good," "very good" or "excellent" oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.

Intra-oral findings and general health conditions among institutionalized and non-institutionalized elderly in Greece

BACKGROUND

The aim of the study was to record the findings from intra-oral examination and the general health conditions encountered in a group of Greek individuals 65 years of age or older.

PATIENTS AND METHODS

The study subjects were derived from the elderly attending 12 randomly selected community centres located in Athens and neighbouring municipalities, consisting the non-institutionalized study group and from the elderly living in three ecclesiastical nursing homes, consisting the institutionalized study group. The research data comprised information from the subjects' interviews, self-defined health status, medical records and intra-oral examination on the following variables: sex, age, general health condition, dentate or not, use of dentures and oral conditions. Fisher's exact two-sided test was used for statistical analysis.

RESULTS

Overall, 316 patients were examined; 120 male (38%), 196 female (62%), mean age 78 years (range: 65-99). Of those, 150 were non-institutionalized (59 male, 91 female) and 166 institutionalized (61 male and 105 female). The vast majority (90%) of the patients had at least one general health problem, for which they were taking daily medication. Twenty-three different medical conditions were recorded. The most frequent medical problems were hypertension (56%), cardiovascular problems (41%), depression/anxiety (39%), arthritis (18.5%) and visual problems (16%). The vast majority of the study patients (79%) were edentulous, while 33% were not wearing or using their dentures. Almost half of them (47%) had at least one oral condition. Twenty-seven different oral conditions were recorded. The most frequent oral findings were denture-induced stomatitis (17.2%), dry mouth (14.6%), atrophy of tongue papillae (10.5%), fissured tongue (9.8%) and haemangioma (6.8%). No cases of malignant lesions were observed.

CONCLUSIONS

The present study confirms that in this particular age group, general health problems are frequent, variable, coexistent, necessitating the daily administration of multiple medications, while oral examination by a specialist is an essential part of the multidisciplinary medical care in this group of individuals.

Self-assessed dental health, oral health practices, and general health behaviors in Chinese urban adolescents

The objectives of this study were: to describe perceived dental health status and oral health-related knowledge, attitudes, and behavior in Chinese urban adolescents; to assess the associations of oral health variables with socio-economic status and school performance; and to analyse the relative effect of socio-behavioral risk factors on perceived dental health, perceived need for dental care, and experience of dental symptoms. A cross-sectional survey of 2662 adolescents was conducted in eight capital cities in China; the response rate was 92%. The study population was chosen by multistage cluster sampling and covered three age groups: 11, 13, and 15 years. Data on dental and general health were collected by self-administered questionnaires. Self-assessment of dental health of Chinese adolescents was generally good, only 12% of the students answered that their teeth were "poor" or "very poor", and 9% claimed having "poor" or "very poor" gums. Eleven percent of participants said that other students made fun of their teeth; 24% of the respondents were dissatisfied with the appearance of their teeth, and 41% claimed that they had experienced toothache or symptoms during the previous 12 months. Positive attitudes towards dental care were found in all age groups; 67% of adolescents brushed their teeth at least twice a day and 48% of the students used fluoridated toothpaste. Only 26% of the students visited a dentist during the previous 12 months. In all, 6% of the adolescents had tried cigarette smoking at least once, while 41% reported having tasted alcohol drinks. Multivariate regression analyses showed that perceived dental health status and needs were associated with gender, age, unhealthy lifestyles, poor school performance, and socio-economic status. The establishment of school-based health promotion programs in China is urgently needed, and promotion of oral health lifestyles should be integrated with other general health actions.

Oral hygiene care for residents with dementia: a literature review

AIM

This paper presents a literature review of oral hygiene care for adults with dementia in residential aged care facilities, including evidence for: (1) prevalence, incidence, experiences and increments of oral diseases; (2) use of assessment tools to evaluate residents' oral health; (3) preventive oral hygiene care strategies; and (4) provision of dental treatment.

BACKGROUND

The impact of dementia on residential care is ever-increasing and regular oral hygiene care provision is challenging for cognitively impaired residents. Although an abundance of oral hygiene care recommendations for older people have been published, the supporting evidence has not been clearly delineated.

METHODS

A review was conducted of English language publications (1980-2002), using a two-step approach (keyword electronic database search, supplemented with secondary search of cited references). All 306 selected articles were critically reviewed and systematically categorized.

RESULTS

Evidence confirmed clinicians' observations of poor oral health in older residents with dementia. Possible risk factors identified were: salivary dysfunction, polypharmacy, medical conditions, swallowing and dietary problems, functional dependence, oral hygiene care assistance and poor use of dental care. One comprehensive, reliable and validated oral assessment screening tool for residents with dementia had been published. Expert opinion indicated that oral assessment screening by staff and a dentist would be ideal at admission and regularly thereafter. Clinicians and researchers suggested that oral hygiene care strategies were effective in preventing oral diseases and appropriate for residents with dementia.

CONCLUSION

These literature review findings supported the use of oral assessment screening tools by staff and efficacious preventive oral hygiene care strategies/products for adults with dementia in residential care facilities. Further research with this population is needed to develop and validate oral assessment tools and staff education programmes, trial preventive oral hygiene care strategies/products and trial dementia-focused behaviour management and communication strategies.

Dimensions of oral health-related quality of life in an adult Swedish population

The concept of oral health-related quality of life (OHRQOL) is investigated in this study. The aim was to explore the dimensionality of variables measuring OHRQOL in an adult Swedish population and to discuss the findings in relation to existing indices. The study was based on responses to a 1998 questionnaire sent to a random sample of 1974 persons aged between 50 and 75 years. There were 22 variables based on questions concerning oral situation and the impact on 7 theoretically different dimensions of QOL. The majority were satisfied with their oral health situation. During the previous 12 months, 16% of the population had experienced problems with their mouth or teeth on at least one occasion per mouth. Principal components analysis was used to analyze the dimensionality of the variables. Three factors accounted for 59% of the variance: (1) Physical and social disability, (2) psychological discomfort and disability, and (3) functional limitation and physical pain. The perception of OHRQOL is multidimensional, but the dimensions are not equally important. The dimensions of OHRQOL found in the present study are similar to those of existing instruments.

Access to dental care for young children in North Carolina: history and current status of workforce issues

The 2000 North Carolina IOM report contained 23 recommendations. To date 16 have been fully or partially implemented. This represents progress, but accomplishing full compliance remains a goal. Absent new training programs in our state, as current federal training grants phase-out, identifying financial support to continue training an adequate number of pediatric dentists for North Carolina will be a challenge.

Attitudes of Chinese parents toward the oral health of their children with caries: a qualitative study

PURPOSE

The purpose of this study was to investigate Chinese parents' beliefs and perspectives regarding extensive caries (EC), oral care habits, and dental treatment. An overview of qualitative research methods is provided.

METHODS

In this qualitative study, 20 in-depth interviews were conducted with parents of children diagnosed with EC. Parents lived in a major metropolitan area, and many were newly immigrated. Parents who accepted or refused dental treatment for their children under general anesthesia or sedation were included. Transcribed interviews were analyzed using standard thematic analysis.

RESULTS

Negative themes were: (1) fear of dental anesthesia and its adverse effects; (2) parents' own lack of dental education as children; (3) lack of social support in seeking dental treatment; (4) inadequate knowledge of oral hygiene; and (5) cultural beliefs that did not support the preservation of the primary dentition. Positive themes were: (1) trust in the providers and in Western medicine; and (2) satisfaction with outcomes of dental treatment.

CONCLUSIONS

Several factors were found that could contribute to a higher rate of EC in this population. Providers can benefit from this study by anticipating what practices and attitudes are common in this community. Earlier intervention and delivery of culturally sensitive care can prevent or delay progression of this dental disease.

Oral findings and health status among hospitalized patients with physical disabilities, aged 60 or above

The purpose of the study was to determine oral health status and the prevalence of oral mucosal lesions among hospitalized elderly patients with physical disabilities. The study group consisted of 111 (43 male and 68 female) elderly patients with physical disabilities. Clinical examination and interview methods were employed. Clinical examination revealed that 45.9% of the elderly patients had one or more oral mucosal lesions. Xerostomia (58.6%), coated-hairy tongue (54.1%) and halitosis (46.8%) were the most frequently encountered oral findings and mucosal lesions. As the most interesting finding discovered in elderly patients, macroglossia (30.6%) seems to depend on physical disability. Coated or hairy tongue was commonly related to poor oral hygiene, with both crude odds ratio (OR) of 3.25 (95% CI: 1.26-8.36) (P=0.021) and the logistic regression OR of 3.36 (95% CI: 1.21-9.33) (P=0.020). Halitosis and bruxism were commonly related to dentate patients [logistic regression OR of 0.29 (95% CI: 1.12-0.74) (P=0.009) and 0.21 (95% CI: 0.06-0.74) (P=0.016); respectively]. Increase in dental problems may have negative impacts on chewing, nutrition, aesthetics and phonation in elderly patients. It is particularly noteworthy that physical disability in elderly patients limits their ability to effectively follow oral hygiene procedures.

Barriers to care-seeking for children's oral health among low-income caregivers

OBJECTIVES

We identified psychosocial, structural, and cultural barriers to seeking dental care among nonutilizing caregivers of Medicaid-enrolled children.

METHODS

We used Medicaid utilization records to identify utilizing and nonutilizing African American and White caregivers of Medicaid-enrolled children in Jefferson County, Kentucky. We conducted 8 focus groups (N=76) with a stratified random sample of responding caregivers; transcripts were qualitatively analyzed.

RESULTS

Psychosocial factors associated with utilization included oral health beliefs, norms of caregiver responsibility, and positive caregiver dental experiences. Utilizing groups reported higher education; health beliefs included identifying oral health with overall health and professional preventive dental care with caregiver responsibility for children's overall health. These beliefs may mediate shared structural barriers, including transportation, school absence policies, discriminatory treatment, and difficulty locating providers who accept Medicaid. Expectation of poor oral health among some low-income caregivers was among factors identified with nonutilization.

CONCLUSIONS

Disadvantaged caregivers reported multiple barriers to accessing dental care for their children. Providers, Medicaid administrators, and schools must coordinate steps to encourage caregiver-controlled dental care, build trust, and link professional preventive dental care with caregiver responsibility for children's overall health.

The ABCDs of treating the most prevalent childhood disease

Dental caries is a potentially preventable infectious disease that, untreated, can cause significant morbidity requiring costly treatment. The Access to Baby and Child Dentistry (ABCD) program increases access to prevention and early treatment for Medicaid-eligible children aged younger than 6 years in Washington State. The program is a partnership of Washington Dental Service Foundation, the University of Washington School of Pediatric Dentistry, the state Medical Assistance Administration, and local stakeholders. Through training in pediatric dental techniques and enhanced reimbursement, ABCD equips and encourages dentists to serve young Medicaid patients. Family counseling increases oral care compliance and reduces no-show rates. Program evaluation demonstrates changing attitudes and behavior among participating families and dentists, with more young, low-income Washington children receiving oral health care.

Derivation and validation of the short version of the Malaysian Oral Health Impact Profile

OBJECTIVES

This paper describes the development of a short version of the Malaysian Oral Health Impact Profile.

METHODS

The 45-item OHIP(M) was shortened using a method known as the 'item frequency method'. Here, the two most frequently reported items from each of the seven OHIP(M) subscales were chosen to form the short version, designated as the S-OHIP(M). Field testing was conducted to assess the effect of different modes of administration (mail versus interview) of the short form and to test its measurement properties (reliability and validity). A total of 206 respondents completed the questionnaire. In order to carry out test-retest analysis, a second administration was carried out 15 days after the first administration on a selected subsample.

RESULTS

The mail questionnaire had a lower response rate and a higher percentage of missing data than the interview administered questionnaire. However, the mail mode of administration resulted in higher scores than interview. Cronbach's alpha was 0.89 and the ICC was also 0.89. All hypotheses developed to assess validity were confirmed.

CONCLUSION

The S-OHIP(M) was found to be valid and reliable and appropriate for use in the cross-sectional studies in Malaysian adult populations.

Oral microbial communities in sickness and in health

The relationship between humans and their oral microflora begins shortly after birth and lasts a lifetime. Up until fairly recently, the associations between the host and oral bacteria were considered in terms of a multiplicity of single species interactions. However, it is becoming more apparent that the oral microbes comprise a complex community, and that oral health or disease depends on the interface between the host and the microbial community as a whole. Although it is important to continue studies of the pathogenic properties of specific microbes, these are relevant only in the context of the properties of the community within which they reside. Understanding the microbial communities that drive sickness or health is a key to combating human oral diseases.