Long-term follow-up indicates unimpaired oral health-related quality of life for people having shortened dental arches

Effect of treatment with implant-supported fixed partial dentures on oral health-related quality of life in patients with unilateral shortened dental arch

Background/purpose

Implant-supported fixed partial dentures (IFPDs) are a treatment option for partially edentulous dentition with missing posterior-most molars despite the concept of a shortened dental arch (SDA). This study aimed to evaluate the effect of IFPD treatment on oral health-related quality of life (OHRQoL) in patients with unilateral SDA missing two adjacent molars and to compare the effects of single- and two-unit IFPDs.

Materials and methods

Forty patients with unilateral SDA missing two adjacent molars (Kennedy Class II) participated in this study; 11 patients received one implant placement in the first molar and were treated with a single-unit IFPD (single-unit group), and 29 received two implant placements and were treated with a two-unit IFPD (two-unit group). The Oral Health Impact Profile (OHIP) questionnaire for OHRQoL assessment and the gummy jelly test for objective masticatory performance were administered before and after IFPD treatment. The Wilcoxon signed-rank test for all patients and Mann-Whitney U test were performed for pre- and post-treatment comparisons and between-group comparisons, respectively.

Results

The OHIP summary score and gummy jelly glucose concentration in all patients showed significant improvements after treatment (all P < 0.05). No significant differences were observed between the single- and two-unit groups for any of the items. Using the minimal important difference in the OHIP summary score, 63.6 % and 58.6 % of patients in the single- and two-unit groups, respectively, showed improvement by 6 points or more.

Conclusion

IFPD treatment for patients with SDA missing two adjacent molars may provide clinically meaningful improvements in OHRQoL.

Association between the treatment choice of implant-supported fixed partial dentures and oral health-related quality of life in patients with a shortened dental arch: A preliminary observational study

Background/purpose

In cases of missing posterior teeth, treatment modalities based on the shortened dental arch (SDA) concept may be a viable alternative. However, the association between oral health-related quality of life (OHRQoL) and patients' treatment decisions remains unclear. This study aimed to investigate the association between OHRQoL and the decision to be treated with implant-supported fixed partial dentures (IFPDs) or take a wait-and-see approach in patients with an SDA missing a single second molar and to clarify the impact of IFPD treatment on the OHRQoL.

Materials and methods

The Oral Health Impact Profile (OHIP) questionnaire was administered twice (pre- and post-treatment) and once to 41 patients with a unilateral SDA missing a single second molar who chose IFPD treatment (IFPD group, n = 22) and the wait-and-see approach (no treatment group, n = 19), respectively. Logistic regression analysis was performed with IFPD treatment choice as the objective variable and the four OHIP dimension scores, age, and sex as covariates. The pre- and post-treatment values of the OHIP summary and four-dimension scores were compared using a paired t-test.

Results

The IFPD treatment choice was significantly associated with sex (male), higher Oral Function dimension scores, and lower Psychosocial Impact dimension scores (all P < 0.05). The OHIP summary and four-dimension scores were significantly lower following IFPD treatment (all P < 0.05).

Conclusion

IFPD treatment for a single missing second molar may be clinically beneficial for improving the OHRQoL of patients with an SDA who experience a decline in masticatory function.

Anterior occlusion in shortened dental arches

Objectives

The aim of this study was to examine the occlusion of anterior teeth in individuals with shortened dental arch (SDA).

Material and methods

In a case–control clinical study, 41 individuals with SDA and 41 individuals with complete dental arch (CDA) participated. The CDA control group was matched for age and gender. Testing for occlusal contacts of anterior maxillary teeth was conducted by biting on foil strips (8 µm) with subjectively normal bite force (NBF) and maximal bite force (MBF). The data was analyzed on individual and tooth levels.

Results

The median rates of anterior maxillary teeth with occlusal contacts were 0.67 (NBF) and 0.83 (MBF) in the SDA group and 0.50 (NBF) and 0.83 (MBF) in the CDA group. Within both groups, the contact rates were significantly higher in MBF. The group difference with NBF was significant. A generalized linear model showed that the odds of an anterior maxillary tooth to have an occlusal contact were greater in the SDA both for NBF with an odds ratio (OR) 2.277 and MBF with an OR 1.691.

Conclusions

The findings suggest effective compensatory mechanisms relative to the occlusal function in individuals with SDA.

Clinical relevance

The study delivers further evidence regarding the SDA concept as a viable option in the management of posterior tooth loss.

Determining the factors associated with oral health-related quality of life in Chinese elders: Findings from the fourth national survey

OBJECTIVE

The purpose of this study was to assess the associations between the self-reported oral health-related quality of life (OHRQoL) of older Chinese people and their socio-economic status and oral health using data collected in the 4th National Oral Health Survey.

METHODS

After multistage stratified cluster sampling, 4332 adults aged 65-74 years participated in the study. After a clinical examination, the participants completed a structured questionnaire. A Mandarin version of the General Oral Health Assessment Index (GOHAI) was included in the questionnaire. Clinical examinations were carried out using the criteria recommended by the World Health Organization. Multivariate analysis was used to evaluate the associations of the clinical and socio-demographic variables with the GOHAI scores of the participants.

RESULTS

The weighted mean (SE) GOHAI score was 51.6 (0.0). Female sex and having more than 10 missing teeth, unrestored tooth spaces, more than 10 decayed teeth and a periodontal pocket ≥6 mm were negatively associated with the GOHAI score, while having a higher education level and living in the Eastern region of China were positively associated with the GOHAI score.

CONCLUSION

After adjustment for confounders, the OHRQoL of older Chinese individuals was mainly affected by untreated dental caries and the loss of teeth. Older Chinese individuals who were male, had a higher education level, were from the Eastern region, had no unrestored tooth spaces or deep periodontal pockets and had fewer decayed or missing teeth had higher GOHAI scores, indicating better OHRQoL.

Tooth replacement options for partially dentate older adults: a survival analysis

OBJECTIVES

To compare the success of two different tooth replacement strategies for partially dentate older adults; namely resin bonded bridgework (RBB) provided to restore patients according to the principles of the shortened dental arch concept (SDA) and conventional full-arch rehabilitation with removable dental prostheses (RDPs).

METHODS

A randomised controlled clinical trial (RCT) was conducted with partially dentate adults aged 65 years or older. Each patient from the RDP group had all missing natural teeth replaced with cobalt-chromium framework RDPs. Each patient from the SDA group was restored to 10 occluding pairs of natural and replacement teeth using RBB. Patients were followed-up at 6, 12, 24, 36 months. Success rates were generated according to defined success criteria. Log-rank tests and Cox's proportional hazard models were used to compare the success of the two treatment strategies.

RESULTS

After 36 months, 89 patients completed the RCT; n = 45 in the RDP group and n = 44 in the SDA group. The overall success rate of the SDA treatment was 90.4% compared to 73.0% for RDPs (p = 0.005). In the upper arch SDA treatment was 100% successful compared to 86.4% for RDPs (p = 0.019). In the lower arch, lower success rates were reported for both the SDA treatment (80.0%) and RDPs (60.0%) (p = 0.054). Further analyses with cox's proportional hazard models demonstrated that SDA treatment was significantly more successful than RDPs (Hazard Ratio: 2.47, p = 0.04).

CONCLUSIONS

After 36 months SDA treatment using RBB was significantly more successful than RDPs used for conventional full-arch rehabilitation in partially dentate older adults.

CLINICAL SIGNIFICANCE

Functionally orientated treatment according to the principles of the SDA is a feasible alternative to RDPs for partially dentate older patients. SDA treatment using RBB can achieve higher success rates compared to RDPs in this patient group.

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

Patients perceive the impact of oral disorder in four major areas, the dimensions of oral health-related quality life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. The functional aspect is essential given the need of chewing, biting, speech and swallowing. The objective of this study was to identify OHRQoL information for dental subjects with functional oral health problems. In a systematic review, distinct and clinically relevant groups of dental subject samples, in this study called "population groups," with such functional OHRQoL information based on the Oral Health Impact Profile (OHIP) were identified (PROSPERO registration: CRD42017064033). The search strategy was "Oral Health Impact Profile" or OHIP. Searches were conducted in the PubMed interface of the Medline database, EMBASE, Cochrane, CINAHL and PsyINFO on 8 June 2017 and updated on 14 January 2019. Published OHIP domain data of different versions were recalculated into OHIP-14`s Physical Disability domain score, characterising the subject's Oral Function impact. 3,653 potentially abstracts were screened. We identified 78 publications reporting dimensional information on 154 subject samples with 52 populations. A typical mean functional impact for partially dentate subjects was 1.6 units on a 0 to 8 unit metric, while for edentate subjects, the mean functional impact was 2.6 units. The functional impact score ranged from 0 to 7.9 units with 50% of the patient samples located between 0.8 and 2.6 units. For the first time, we provide normalised and therefore comparable metric information about the functional OHRQoL impact for a substantial number of functional oral conditions.

Oral health and healthcare utilization in Belgian dentate adults

OBJECTIVES

In 2012-2014, the Belgian National Oral Health Data Registration and Evaluation Survey, integrated in the Health Interview Survey (HIS), was carried out. The present study investigated, in a sample of 1340 dentate adults (≥25 years), the association between oral healthcare utilization, oral health status and sociodemographic status.

METHODS

A multistage, stratified cluster sampling procedure was used. Oral examination for caries experience (World Health Organization, D₃ MFT-Index), periodontal status (Dutch Periodontal Screening Index, DPS-Index), number of teeth present and occlusal contacts without wearing removable dentures was performed by calibrated examiners. Oral healthcare utilization data were retrieved from the records of the Belgian Intermutualistic Agency. Participants' oral health and sociodemographic data were linked to registered oral care utilization in the previous 5-year period. Regular attenders (annual attenders and those with at least one registered contact in three different years) were compared with irregular attenders (those having had dental visits but not according to the definition of regular attenders) and nonattenders. Data were weighted to compensate for sampling and participation bias.

RESULTS

Six hundred and seventy-nine participants attended regularly, of whom 276 annually; 256 did not attend in the reference period. The overall D₃ MFT-Index was not noticeably different between attendance patterns (varying between 11 and 13), although regular attenders had more restored teeth than nonattenders (P < 0.01). No difference was seen for DPS-Index and number of teeth/occluding pairs (χ² test, P > 0.05). Females, participants with higher education, older participants and those in employment had higher rates of regular attendance.

CONCLUSIONS

Regular attenders had fewer untreated caries lesions, but neither lower caries experience nor lower DPS-Index than irregular attenders. Regular attendance was associated with sociodemographic variables.

Is reduced dentition with and without dental prosthesis associate with oral health-related quality of life? A cross-sectional study

BACKGROUND

Oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research and should contribute to professional judgment about restorative treatments and prosthetic replacement in patients who had reduced dentitions. The aim was to compare the OHRQoL among adults (35-44 years) categorized according to different definitions of reduced dentition and considering the use (or non-use) of dental prosthesis.

METHODS

This study used data from a probabilistic sample of adults in Sao Paulo, Brazil, 2015. OHRQoL was based on none items of Oral Impacts on Daily Performance (OIDP) index, as prevalence (at least one impact) and extent (the number of items with non-zero score). We used different criteria to assess dentition status: (1) Shortened Dental Arch (SDA): having 3-5 natural occlusal units (OUs) in posterior teeth and intact anterior region; (2) hierarchical functional classification system: a five-level stepwise classification of dentition; and (3) presence of ≥21 teeth. The use or nonuse of dental prosthesis was recorded. Negative binomial regression models involved the adjustment for social determinants of health.

RESULTS

Nearly half (53.1%) of the 5753 participating adults had at least one oral health issue impacting OHRQoL. OIDP prevalence in adults with SDA did not differ from those with more OUs (PR = 1.02; 95%CI 0.91-1.13). Individuals with non-functional dentition had worse OHRQoL regardless of their use of a dental prosthesis. Adults with fewer than 21 remaining teeth, ranked significantly higher in OIDP extent, regardless of dental prosthesis use (PR = 1.38; 95%CI 1.16-1.63 with prosthesis; PR = 1.62; 95%CI 1.19-2.20 without dental prosthesis).

CONCLUSIONS

Individuals with more missing teeth reported worse OHRQoL regardless of using a dental prosthesis. Preserving a functional dentition, even with missing teeth, is compatible with OHRQoL.