An evaluation of a new measure of oral health related quality of life--OHQoL-UK(W)

OBJECTIVE

The aim was to test the reliability and validity of an instrument used to measure the impact of oral health on quality of life.

BASIC RESEARCH DESIGN

The instrument tested was the indicator OHQoL-UK(W), which was developed, based on a general UK population's perceptions of how oral health affects life quality. OHQoL-UK(W) consists of a battery of 16 questions, which takes into account both 'effect' and 'impact' of oral health on life quality, incorporating dimensions and an individualised weighting system. A questionnaire containing the indicator was administered to a sample of 500 adults. Determining associations between OHQoL-UK(W) scores, socio-demographic and self-reported oral health status assessed its construct validity. The criterion validity of the indicator was assessed in the absence of a 'gold standard' by correlating OHQoL-UK(W) scores to self-rating of oral health status. The internal reliability of the indicator was assessed using Cronbach's alpha.

RESULTS

The response rate was 78%. Associations between OHQoL-UK(W) scores and self-reported number of natural teeth (P<0.01) and denture status (P<0.01) supported the construct validity of the indicator. In addition, OHQoL-UK(W) scores were associated with socio-demographic factors; age (P<0.05), employment status (P<0.01) and ethnicity (P<0.05). The instrument was also associated with self-rating of oral health status (P<0.01), supporting the criterion validity of the indicator. The internal reliability was high with a Cronbach alpha value of 0.94.

CONCLUSION

OHQoL-UK (W) appears to be a valid and reliable measure for assessing the impact of oral health on life quality.

Caries experience and oral health behavior in Chinese children with cleft lip and/or palate

PURPOSE

The aims of this study were to investigate whether there were different caries levels in 3- to 6-year-old Chinese children who had a cleft lip compared to those with a cleft lip/palate. The goal also was to evaluate parental attitudes toward the feeding habits and oral health care for their children.

METHODS

A cross-sectional study was carried out through a dental examination of a sample of children and a questionnaire to their parents. A sample of 104 3- to 6-year-old children (66 boys and 38 girls) with cleft lip, cleft palate or both were selected from those receiving pre-surgical treatment. Each child was examined and a short questionnaire was given to parents of the children. The form included questions about infant feeding practices, frequency consumption of specific drinks and, children's toothbrushing frequency.

RESULTS

One hundred and four children were examined. Seventy-five percent had some caries experience and rampant caries was present in 26%. Children with cleft palate had a higher prevalence of rampant caries (30%) compared to those with cleft lip (12%). A multivariate analysis yielded feeding practices and mother's education as the variables significantly associated with caries and rampant caries.

CONCLUSIONS

The results of this study show that: 1. Children with a cleft lip/palate have higher levels of dental caries compared to those with a cleft lip alone; 2. The two most important factors for dental caries were: a. whether the child had been bottle-fed and; b. the educational attainment level of the mother.

Perceptions of vocational trainees on gender and racial disadvantage within the Thames vocational training programme

BACKGROUND

A recent report has suggested that vocational trainees within London experienced racial or gender disadvantage during their selection. This exploratory study did not investigate the extent or the nature of this disadvantage.

AIM

To undertake a survey using a pre-tested questionnaire with dental vocational trainees on the Thames Scheme. The questionnaire explored perceived and experienced aspects of gender and racial disadvantage during their vocational training programme.

RESULTS

127 trainees completed the questionnaire (response rate 92%). Minority ethnic respondents were more than twice as likely to feel their selection was influenced by gender (odds ratio [OR] 2.25, 95% Confidence Interval [CI] 1.02, 5.10) and more than three times likely to feel selection was influenced by their race when compared with their white colleagues (OR 3.05, 95%; CI 1.01,11.45). The majority of trainees did not perceive any disadvantage whilst on the vocational training course. For example, only five respondents (4%) felt that minority ethnic individuals were treated less favourably during the vocational training course.

CONCLUSION

In conclusion, this preliminary study has attempted to explore inter-ethnic differences within the profession on perceived racial disadvantage and possible strategies for change. It is clear that the perception of disadvantage is greater than the reality within the experience of most trainees.

Oral submucous fibrosis in a 11-year-old Bangladeshi girl living in the United Kingdom

A case of oral submucous fibrosis occurring in a 11-year-old Bangladeshi girl is presented. This paper reviews the aetiology, clinical presentation and treatment modalities of oral submucous fibrosis. This case highlights the link between oral submucous fibrosis and the regular use of areca-nut (paan) and the newer transcultural oral tobacco products. This association has been reported among children resident in the Indian sub-continent but is unrecorded for United Kingdom residents. The case report underlines the danger that children face with products which are clearly targeted at them by the tobacco industry.

Attitudes of the dental team to the provision of care for people with learning disabilities

The aim of this study was to report on the evaluation of an attitude scale for General Dental Practitioners (GDPs) and Dental Auxiliaries/Professionals Complementary to Dentistry (PCDs), to determine the reliability of the scale with these two groups and to note any inter-group differences. Seventy-four GDPs and 89 PCDs completed the self-administered questionnaires. The main outcome measures were reliability statistics, attitude scores, and factor analysis statistics. Reliability was satisfactory for both groups. PCDs scored consistently higher than GDPs on this attitude scale. Six factors were found to underlie the responses of GDPs, accounting for 62% of the variance. Seven factors were found to underlie the responses of PCDs, accounting for 65% of the variance. PCDs expressed more positive views about provision of care for patients with learning disabilities than did GDPs. Factor analysis revealed that GDPs were concerned about effectiveness of treatment and the stress related with treating patients with disabilities. PCDs appeared to be more concerned with the human rights of people with learning disabilities and how they fit into society.

Gender variations in the social impact of oral health

BACKGROUND

There is a growing interest in gender related health issues, however, there is little data concerning the relationships between oral health and gender other than on tooth loss. In particular, there is little information on differences in the social impact of oral health between men and women.

AIM

The aim of this study was to identify gender variations in the social and psychological impacts of oral health.

DESIGN

A random probability sample of 1,865 adults (1,049 women and 816 men) took part in the study to determine how oral health "reduces" and "adds to" quality of life in a nation-wide survey.

RESULTS

Women perceived oral health as having a greater impact than men on their quality of life in general, having a greater negative impact (p < 0.01) and a greater positive impact (p < 0.05). Specifically women perceived oral health as causing them more pain (p < 0.05), embarrassment (p < 0.05) and being detrimental to their finances (p < 0.05) compared to men. Women also more frequently perceived oral health as enhancing their life quality (p < 0.05), their moods (p < 0.05), their appearance (p < 0.01) and their general well being (p < 0.01) than men.

CONCLUSION

There are gender variations in the social and psychological impacts of oral health. These findings may help in understanding gender differences in oral health needs and behaviour and have implications in assessing oral health needs.

Oral health status of heroin users in a rehabilitation centre in Hubei province, China

OBJECTIVE

To report on the oral health of heroin users and to determine risk factors for oral health status.

DESIGN

All heroin users at one rehabilitation camp received an interview using a pre-tested questionnaire from one of three trained interviewers and a dental examination using World Health Organization recommended procedures from one of three calibrated dentists.

SETTING

Interviews and examinations were carried out at Hubei Province camp.

PARTICIPANTS

All 520 resident heroin users at the camp participated in the study.

OUTCOME MEASURES

Oral hygiene expressed using the Debris Index; caries status by DMFT; periodontal status by percentage with bleeding, pocketing and calculus; mucosal status using standard World Health Organization criteria.

RESULTS

One hundred (19%) of the heroin users were caries free; their mean DMFT was 4.2. The majority (92%) of the DMFT was decay and only a small proportion (8%) was treatment related. The proportion of heroin users with bleeding, calculus, shallow pocketing and deep pocketing was 42%, 95%, 42% and 8% respectively. The mean Debris Index score was 3.2. Mucosal lesions were present in 31 subjects (6%). Using multivariate analysis, duration of heroin use and education were risk factors for DMFT, route of drug administration was a risk factor for calculus and gender was a risk factor for deep pocketing.

CONCLUSIONS

There are indications of poorer periodontal health as well as higher caries experience in this group when compared to provincial dental epidemiological data. Mucosal lesions were not widely prevalent. Both social factors and characteristics of drug use were related to oral health in this group.

Attitudes of dentists, working in Riyadh, toward people with a sensory impairment

This study was conducted to determine the attitudes of dentists, working in Riyadh, toward people with a sensory impairment (SI), according to the Scale of Attitude Towards Disabled Persons (SADP). The SADP scale was modified to focus solely upon sensory impairment. The modified scale was pre-tested and then incorporated into a self-administered questionnaire. This was then administered to 600 dentists (response rate, 73.7%) working in the city of Riyadh, Saudi Arabia. The modified scale showed itself to be reliable, with a Chronbach's coefficient alpha 0.616 and four-factor analysis, which accounted for 38.5% of the variance. Ninety-four percent of the dentists were generally positive toward SI in the society. There were, however, significant variations in attitudes, with a more positive score for dentists who had worked for 30 years or more (p < 0.005), were specialists (p < 0.005), received little or no undergraduate training in this subject (p < 0.05), and who received their undergraduate training in Europe/North America (p < 0.001). However, in a stepwise regression model, all these variables were significant except for the years of practice. The modified SADP showed dentists, working in Saudi Arabia, having a positive attitude toward people with SI.

Can dentures improve the quality of life of those who have experienced considerable tooth loss?

OBJECTIVES

The aim of this study was to identify variations in the impact of oral health on quality of life (OHQOL) among UK residents in relation to self-reported number of teeth possessed and denture status. In addition, to determine whether recourse to a removable prosthesis for those who claimed that they had experienced considerable tooth loss (having <20 teeth) was associated with quality of life.

METHODS

The vehicle for this was the Office for National Statistics Omnibus survey in Great Britain. A random probability sample of 2667 addresses was selected in a multistage sampling process. Participants were interviewed about their oral health status. The impact of oral health on quality of life was measured utilising the OHQoL-UK(W) measure.

RESULTS

The response rate was 68%. Variations in OHQoL-UK(W) scores were apparent in relation to self-reported number of teeth possessed (P < 0.001) and denture status (P < 0.001). Moreover, disparities in OHQOL were apparent among those who experienced considerable tooth loss who didn't have recourse to a denture (P < 0.001). In regression analysis, those who claimed that they had <20 natural teeth but had no recourse to a denture were less than half as likely to enjoy enhanced oral health related quality of life compared to others in the population (OR = 0.46, 95% Cl 0.30, 0.71), controlling for socio-demographic factors.

CONCLUSIONS

Experience of considerable tooth loss without recourse to a removable dental prosthesis is an important predictor of oral health related quality of life, as captured by OHQoL-UK(W), and associated with reduced quality of life.

Is the current access to health information helping or hindering effective decision-making for dentists and patients? Guidelines for dental practice

With the introduction of the Internet there has been a growth both in the quantity and accessibility of information to the public concerning health issues. This improved availability of information does not always lead to a more informed public since there is no quality control of information but it can lead to a public that takes a more active role in their own health and thus is involved in shared decision-making. In order to develop a more informed public in the future, systems for quality control of information have been addressed. These systems can range from the present state of uncontrolled information (no quality control) to full-centralised control (censored information). Between these extremes lie two, more appropriate, decentralised filtering approaches--'upstream filtering' (where third parties set quality criteria and evaluate information) and 'downstream filtering' (where data are rated, labelled and weighted according to consumers' criteria). These systems of filtering are discussed along with recommendations for those using the Internet as a source of information. The paper also documents reliable sources of information for the public, highlights the current concepts of shared decision-making, and provides some guidelines for developing an effective decision-making strategy.

Can dental attendance improve quality of life?

OBJECTIVE

The aim of this study was to determine the relationship between reported dental attendance patterns and the public's perception of how oral health impacts on quality of life (QoL).

METHOD

A national UK study involving a random probability sample of 2,668 adults. Respondents were interviewed in their homes about how oral health affects their QoL and about their dental attendance pattern. Responses were coded as oral health having a negative impact, positive impact or impact in general (either positive and/or negative) on QoL.

RESULTS

The response rate was 70% with 1,865 adults participating in the study. 72% (1,340) reported that their oral health affected their QoL in general, 57% (1,065) reported that it had a positive effect, and 48% (902) that it had a negative effect. 61% (1,136) reported to have attended the dentist within the last year- 'regular attenders'. Bivaraite analysis identified association between perception of how oral health impacts on QoL and dental attendance pattern (P < 0.01). When socio-demographic factors (age, gender, and social class) were taken into account in the analysis, 'regular attenders' reported that oral health had greater impact in general on QoL (OR = 1.30, 95% CI = 1.04, 1.63) and, specifically, a greater positive impact (OR = 1.49, 95% CI=1.44, 1.77).

CONCLUSION

Dental attendance is associated with perceptions of how oral health impacts on QoL, specifically enhanced life quality. This may have implications for understanding the health gain of regular dental attendance.

Investigation of an index to measure tooth wear in primary teeth

Tooth wear, in particular erosion, has been reported to be widespread in children in the UK. Wear may affect either dentition, but epidemiological measurement has proved difficult.

OBJECTIVES

The objectives of this study were: (a) to investigate use of a simple index of wear in primary teeth; and (b) to compare findings from visual examination and from photographs with those at histological examination of the same teeth.

SAMPLE AND METHODS

Forty-one exfoliated or extracted primary anterior teeth were assessed visually and using photographs. Ground sections of the teeth were prepared and examined using polarised light microscopy.

RESULTS

On visual examination, 31 of the 41 teeth had evidence of wear. In 14 teeth, tissue loss was confined to enamel and in 17 it extended into dentine. Findings on photographs were very similar to those on visual examination. Of the 10 teeth without erosion visually, two had evidence of loss on histological examination. Of the 14 with visual evidence of erosion confined to enamel, dentine was exposed in 11 cases. Diffuse demineralisation was evident histologically in 11 of the 31 teeth with evidence of erosion.

CONCLUSIONS

It was concluded that clinical assessment of erosion may underestimate the extent of the condition. Under the conditions of the study, photographs gave results similar to those on visual examination.

Transcultural oral health care: 6. The oral health of minority ethnic groups in the United Kingdom--a review

The 1991 census of England and Wales estimated that the minority ethnic population was almost 2.95 million, or 6% of the total population of the UK. The aim of this paper is broadly to describe the oral health status and trends among minority ethnic groups to enable a clearer formulation of strategies to improve their oral health.

Transcultural oral health care: 5. Diet and minority ethnic groups in the United Kingdom

Dietary behaviours of minority ethnic groups vary considerably, not only between groups but also within communities and families. The aim of this article is to consider the information on diet and eating habits of members of minority ethnic groups, especially with regard to sugar consumption.

Caries patterns and their relationship to infant feeding and socio-economic status in 2-4-year-old Chinese children

AIMS

To describe the prevalence, severity and patterns of caries in 2-4-year-old children and to evaluate the association between caries experience of the children and their feeding patterns and socio-economic background in terms of mothers' education and family income.

DESIGN

Cross-sectional survey.

SETTING

Suburban area of Hanchuan in Hubei province, China.

PARTICIPANTS

A sample of 426 children (250 boys and 176 girls).

METHODS

Dental-examinations were undertaken in kindergartens using World Health Organization diagnostic criteria for dental caries. Mothers completed a short questionnaire.

OUTCOME MEASURES

Prevalence of caries; rampant caries; caries in incisors; caries in incisors and/or canines and molars; mean number of decayed, missing and filled teeth/surfaces (dmft/s).

RESULTS

36% of the children had caries, 7% had rampant caries. The more extensive pattern of caries involving primary molars as well as incisors and/or canines was seen in 12% of children. Children who had been wholly bottle-fed had five times the risk of having rampant caries compared to children who were breast-fed.

CONCLUSIONS

The results indicated that infant feeding practice might be a key risk factor for the development of caries at an early age in this country as elsewhere.

Factors associated with dental anxiety among older people in Britain

OBJECTIVE

This paper reports on a study of dental anxiety among adults aged 60 years living independently in Britain.

DESIGN

A national cross-sectional study carried out with the assistance of the Office for National Statistics' Omnibus Surveys in 1999.

SETTING

Data was collected by face to face interviews with older people in their homes.

MEASUREMENTS

Data on dental anxiety were collected from 973 subjects by means of face to face interviews and was measured by the Dental Anxiety Scale (DAS) (Corah, 1969). In addition, data on dental service use and oral health status (self-reported) was collected.

RESULTS

The mean DAS score was 8.4 (sd 3.5), and 13% (129) of subjects were classified as dentally anxious (DAS > or = 13). DAS scores were associated with numerous socio-demographic factors (P < 0.01), self-reported oral health status (P < 0.01) and dental service (P < 0.01) factors. A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioural and oral health outcomes.

CONCLUSION

One in eight older people in Britain are dentally anxious and this is associated with their use of services and oral health status (self-reported).

Is modelling dental caries a 'normal' thing to do?

OBJECTIVE

To introduce and encourage the use of generalised linear models (GLMs) in analysing caries data that do not require the response to be treated necessarily as a sample from a normal distribution.

BASIC RESEARCH DESIGN

At the present time, it is most likely that the sampling distribution of dmf/DMF in industrialised countries will not approximate normality. Generalised linear modelling can be conducted assuming many underlying distributions which, in fact, includes the normal distribution. In this paper three GLMs are employed (normal, Poisson, negative binomial) for modelling an example caries data set. In addition, a binomial model is used to model the dichotomous outcome of caries-free/caries-present.

CLINICAL SETTING

The data comprised 871 Old Trafford, Manchester primary school children aged between 4 years 0 months and 5 years 11 months.

RESULTS

The effect of one study covariate was prominent in a normal model applied to all available dmf data but not in two non-normal models which used dmf > 0 data only. Furthermore, the same covariate was significant at the 5% level in a binomial model indicating that it influenced whether or not caries was present and not the level of dmf.

CONCLUSION

A suitable modelling approach for caries data is to employ a Poisson or a negative binomial model for the dmf/DMF response and a binomial model for the caries-free/caries-present outcome. This allows separate estimation of those factors which influence the magnitude of caries and those factors which influence whether caries is actually present or not.

Transcultural oral health care: 4. Dental medication for Muslim patients

The aim of this paper is to provide a guide for general dental practitioners who may need to prescribe medication to Muslim patients, particularly during the month of Ramadan. An understanding and appreciation of the patient's religious background will aid treatment compliance and allow dentists to provide a culturally sensitive service for their Muslim patients. Drug therapy compliance is important, but it is likely to be poor among Muslim patients during the month of Ramadan, when fasting and religious practices may cause problems. The authors provide guidelines on good clinical practice and prescribing regimens for general dental practitioners treating Muslim patients, particularly during Ramadan.

Transcultural oral health care: 3. Dental care and treatment during the fast of Ramadan

The aim of this paper is to highlight issues that may affect dental treatment and care of Muslim patients when they are fasting during Ramadan. Recommendations are provided on how to provide culturally sensitive oral health care for this community. By taking into account the beliefs and wishes of the individual, dentists will provide a service that is acceptable and appropriate to both the Muslim community and individual Muslims.

Ethnicity and oral cancer

Oral squamous-cell carcinoma, the main type of oral cancer, is among the ten most common cancers in the world. The aims of this paper were first, to consider whether there was evidence of marked ethnic variations in the incidence, management, and survival of oral cancer, and then, to review possible explanations for these variations. Evidence from the literature suggests that there is marked, inter-country variation in both the incidence and mortality from oral cancer. There is also growing evidence of intracountry ethnic differences, mostly reported in the UK and USA. These variations among ethnic groups have been attributed mainly to specific risk factors, such as alcohol and tobacco (smoking and smokeless), but dietary factors and the existence of genetic predispositions may also play a part. Variations in access to care services are also an apparent factor. The extent of ethnic differences in oral cancer is masked by the scarcity of information available. Where such data are accessible, there are clear disparities in both incidence and mortality of oral cancer between ethnic groups.

Ethnic and gender variations in university applicants to United Kingdom medical and dental schools

AIM

To explore ethnic and gender variations amongst applicants to undergraduate United Kingdom medical and dental schools.

METHOD

Retrospective analyses of University and College Admissions Services (UCAS) data on all students applying to study pre-clinical medicine and dentistry, during the academic years 1994/5, 1995/6 and 1996/7. Information for each medical and dental applicant included age, gender, social class and ethnic group.

RESULTS

Of all applicants, just over half (50.2%) were male, though a greater proportion of applicants to dentistry were male (54.1%) than for medicine (49.3%) (OR = 1.21, 95% CI = 1.15, 1.28). Over one third (36.4%) of all students were from minority ethnic groups, a larger proportion of which were dental students (48.3%) than were medical students (33.8%) (OR = 1.83, 95% CI = 1.73, 1.94). There were also marked differences between medicine and dentistry when the ethnic groups were examined separately. The largest number of applicants from minority ethnic groups came from the Indian community, and this group increased in size annually by 4.1% (P < 0.05) for medicine, and 29% (P < 0.05) for dentistry.

CONCLUSIONS

Significant inter-ethnic and gender differences are observed amongst applicants to medicine and dentistry. Dentistry appears to be relatively more attractive to minority ethnic applicants.