Dentist-Patient Communication of Treatment Outcomes in Periodontal Practice: A Need for Dental Patient-Reported Outcomes

Perception of Periodontitis Patients about Treatment Outcomes: A Cross-Sectional Study in Saudi Arabia

Patient compliance following periodontal therapy is extremely important in predicting the prognosis of the disease and maintaining treatment outcomes. Therefore, this study aimed to investigate the perception of periodontitis patients about treatment outcomes. A cross-sectional study was conducted among periodontitis patients in a single dental center through a pre-validated questionnaire that was distributed to each participant in the waiting area of periodontal clinics by utilizing a convenience sampling technique. Median and interquartile ranges were used in addition to frequency and percentages. Bivariate analyses were performed using the Mann-Whitney U and Kruskal-Wallis test. Among the 300 male and female participants, the median score (interquartile range) of the current level of pain revealed that males experienced more pain than females, with a median score of 5 (0-7) for males and 4 (0-6) for women. However, the median (interquartile range) for desired and expected pain levels in both genders was 0 (0-1), 0 (0-4). There were significant differences in median score ratings between males and females for expected, distress, success, and importance levels (p-value < 0.05). Patients with periodontitis provided valuable insights into the experiences of individuals undergoing treatment for periodontal disease, indicating overall patient satisfaction with the expected levels of periodontal outcomes.

Correcting mucogingival deformities for pescatarian patients: A clinical case study

AIM

This clinical case study is to highlight the improvement of periodontal health of mandibular canines using a soft tissue alternative of fish origin, a piscine graft.

METHODS

A 37-year-old female patient was referred to a periodontal practice for evaluation of mucogingival deformities around teeth #22 and #27 that were also diagnosed with recession, lack of keratinized tissue (KT), and bilateral high frenum attachment. Multiple soft tissue treatment options were presented to the patient, including autogenous, allograft, or xenograftporcine or piscine.

RESULTS

Given the patient's dietary preference, piscine option was preferred. The procedures were completed one at a time, first #22 and later #27, using the standard of care procedures for correcting mucogingival deformities using soft tissue alternatives. Post-surgical visits were scheduled at regular intervals (2, 4, 12, 24, 52 weeks) to evaluate the clinical outcomes. Healing was uneventful and clinical outcomes reveal correction of the mucogingival deformities. The amount of KT at the 52 weeks healing time, measured using an intraoral scanner was 2.12 mm on #22 and 1.78 mm on #27.

CONCLUSION

Within this clinical case's scope, piscine xenograft demonstrates to be a safe and effective soft tissue alternative to correct mucogingival deformities, increasing the KT width and achieving recession coverage. In addition, integration of patient's preference may lead to increased case acceptance and patient compliance.

KEY POINTS

What new information is this case providing? The use of a soft tissue alternative of piscine origin that was selected based on the patient's preference to correct bilateral combined mucogingival deformities (recession, lack of KT, and aberrant frenum attachment) around teeth. What is a key step to integrating this soft tissue alternative in clinical practice? The pre-hydration of the soft tissue alternative is preferred, compared to other soft tissue alternatives that might not require hydration (xenograft bovine origin). What are the limitations to success in this case? Confirming with the patient no pre-existing fish allergies.

Psychometric properties of the Arabic version of the perceived prosthodontic treatment need scale: Exploratory and confirmatory factor analyses

BACKGROUND

It is crucial to take into account the concerns of dental patients about their prosthodontic needs when planning the course of treatment. However, there is a dearth of research that examines these needs among adult dental patients.

OBJECTIVES

This study aims to translate and validate the perceived prosthodontic treatment need scale (PPTN) in Arabic.

METHODS

The 17-item PPTN scale was translated from English into Arabic and completed by 206 patients seeking prosthodontic treatment in a dental hospital in Saudi Arabia. Data collection was carried out in September and October 2023. Exploratory factor analysis (EFA) was used to ascertain the underlying factor structure; a unidimensional scale was hypothesised and tested using confirmatory factor analysis (CFA), including several multiple model fit indices. The assessment of reliability was conducted using Cronbach's alpha. The convergent and discriminant validity of the final scale were examined.

RESULTS

EFA produced an 11-item scale distributed into three factors that explain 65.43% of the total variance with eigenvalues > 1. All items showed acceptable reliability, ranging from 0.65 to 0.84. The first factor pertained to social issues, while the second item was concerning dental appearance. Lastly, the third factor included functional difficulties associated with tooth loss or dental problems. The results of the CFA demonstrate a satisfactory level of model fit, with the standardised factor loadings ranging from 0.51 to 0.89. Convergent and discriminant validity of the model factors were established.

CONCLUSION

The translated questionnaire was deemed legitimate and would be useful in comprehending patients' perceived treatment requirements, hence contributing to the advancement of prosthodontic research and practical implementation.

THE CONTENTS, METHODS, AND ASSESSMENT OF EVIDENCE-BASED DENTISTRY EDUCATION: A SCOPING REVIEW

OBJECTIVE

With evidence-based dentistry (EBD) having a far-reaching influence on oral healthcare, dental educators worldwide have made joint efforts to integrate EBD-related knowledge and skills into dental education. The present scoping review aims to identify and summarize the existing teaching contents, teaching methods, and assessment strategies of EBD education.

METHODS

Electronic (PubMed and Embase) and manual searches were performed to identify articles related to both "dental education" and "evidence-based practice." Based on predetermined eligibility criteria, articles were selected by 2 reviewers, independently and in duplicate. Data synthesis was conducted based on teaching contents, teaching strategies, and teaching assessment.

RESULTS

Of the 1758 articles found in the literature searches, 74 were deemed eligible and included in this review. A total of 4 basic skills (problem formulation, literature searching, critical appraisal, and research methodology), 5 teaching methods, and 6 assessment strategies were identified. In most of the articles, 2, or more skills were taught, and a combination of traditional strategies for teaching and its assessment (eg, courses and questionnaire survey) was involved. Other teaching methods, such as journal clubs and workshops, were seldom used, and validated assessment tools accounted for a relatively small proportion of the assessment strategies involved.

CONCLUSIONS

The contents, methods and assessment of EBD education have been widely studied and discussed. However, the current literature focuses mainly on teaching of critical appraisal skills, traditional teaching methods, and short-term outcome assessments. Future research in this area can be aimed at integrating all EBD-related skills into educational models, studying multifaceted teaching approaches, and developing comprehensive teaching outcome assessment methods based on validated tools and dental patient-reported outcomes.

Factors Influencing Patient Satisfaction and Loyalty as Perceived by Dentists and Their Patients

OBJECTIVE

This study aimed to identify the key aspects of patients' dental care experience that influenced their self-perceived satisfaction and loyalty. Also examined was the agreement between patients and dentists regarding these factors.

METHODS

Questionnaires were administered to 1121 patients and 77 dentists, focusing on demographic information and 15 selected items related to the patients' last dental visit. Descriptive and linear regression analyses were conducted.

RESULTS

The study included participants from 41 practices. Factors significantly influencing satisfaction and loyalty included location convenience, treatment quality, trust in dentists' decisions, visit frequency satisfaction, clear treatment explanations, dentist's interest in symptoms, patient-dental personnel attachment, and dentist's knowledge of the patient and their medical records. While overall agreement between patients and dentists was high, some areas exhibited notable disagreement.

CONCLUSIONS

The findings mostly align with existing literature, underscoring the importance of communication, trust, and a personal patient-dentist relationship in promoting satisfaction and loyalty. However, they also show that local, generally not reported factors might be at play, which necessitates dentists' awareness and consideration of the local context for optimal outcomes.

Outcomes of periodontal therapy: Strengthening the relevance of research to patients. A co-created review

Periodontitis is a long-term condition affecting up to half of the population globally and causing significant impacts on life quality. Successful management depends on taking life-long ownership of the condition by those affected. There is a wealth of research to inform on management options. However, most of the research has been designed by professional experts with outcomes to gauge benefits and harms based on parameters that inform on the disease process but which might not be informative to support decision-making in people with lived experience (PWLE) of periodontal ill-health (including both patients and carers). The importance of relevant outcomes is highlighted in the concept of the "expert patient" which aims to strengthen the capacity of PWLE to make health-care choices that are important for them, elements of which are likely to be already familiar to many clinicians delivering periodontal health care. Therefore, the voice and collaboration of PWLE in research are recognised as crucial to developing high quality, relevant evidence especially for long-term conditions. In this paper, we review what is known about the relevance of treatment outcomes to PWLE. We also examine the degree to which PWLE have been involved in identifying outcomes that are important to them as well as the diversity and therefore representativeness of PWLE recruited for studies. We consider why having more relevant outcomes could enhance the expertise of PWLE in managing their periodontitis. We then conclude with key learnings from our review which we hope will encourage more rapid development of these initiatives in periodontology for the benefit of global health and wellbeing.

MEASURING PATIENT EXPERIENCE OF ORAL HEALTH CARE: A CALL TO ACTION

BACKGROUND

Surveys to measure patients' experiences of health care are common practice in general medical care to improve patient centered care. However, such questionnaires are not consistently used to capture the patient's experience of oral health care. Because patient experience is an important component of oral health care, there is an urgent need to measure it in the oral health care setting.

PURPOSE

The purpose of this article is to illustrate the need for patient experience measurement in oral health care, highlight the challenges such measurement in this setting faces, and provide a set of next steps to advance care experience measurement for dental patients.

BASIC PROCEDURES

We conducted a comprehensive review of the literature examining patient experience measurement in medical and oral health care. This focused on studies aimed at understanding the current measurement landscape and existing measurement tools. We also gathered additional information and perspectives through discussions with key informants and stakeholders.

MAIN FINDINGS

There is a critical need for patient experience measurement in oral health care. To develop a program to measure patient experiences of oral care, the following should be done: (1) convene stakeholders and get their buy-in; (2) develop a patient experiences of oral health conceptual framework; (3) develop a survey tool that captures key aspects of patient experiences of oral health; (4) pilot the survey tool; (5) assess the survey tool...s psychometric properties; and (6) refine and finalize the survey tool.

PRINCIPLE CONCLUSIONS

To advance the measurement of the quality of oral health care, we outline a stepwise methodology that captures dental patient experiences of oral health care.

APPLICABILITY of DENTAL PATIENT REPORTED OUTCOMES in LOW RESOURCE SETTINGS -A CALL to BRIDGE the GAP in CLINICAL and COMMUNITY DENTISTRY

Low resource settings (LRSs) are typically regions where inadequate healthcare resources exist and the healthcare system does not meet the acceptable global standards. The problems encountered in LRS in oral and dental medicine could be related to lack of human personnel, e.g., insufficient numbers of dentists and other dental professionals, poor infrastructure, limited or remote treatment/care facilities, lack of dental materials and supplies as well as inadequate monitoring and evaluation of public health programs. Despite the limited human resources in LRS, such settings are currently experiencing a brain drain, a situation where there is massive emigration of highly trained and qualified healthcare professionals including dentists to other countries for better living conditions. To allocate health resources judiciously, exploration of alternatives to traditional oral health assessments, which are cheap, easily available, and patient-oriented, becomes pertinent. Thus, there is a need to consider the applicability of oral assessment tools such as dental patient-reported outcomes (dPROs) in general, and oral health-related quality of life (OHRQoL) in particular. Therefore, the aim of this narrative review was to describe opportunities for the applicability of dPROs in LRSs with a focus on Nigeria, based on empirical data. The applicability of dPROs and OHRQoL in LRS includes prevention, screening, diagnosis, assessment of oral health impact, application of the first step of targeted treatment, treatment evaluation, planning, and monitoring of public health programs, as well as research needs. dPROs could be very useful in LRS because their practical advantages may be utilized to improve patient and population health.

THE USE OF DENTAL PATIENT-REPORTED OUTCOMES AMONG RANDOMIZED CONTROLLED TRIALS IN ORTHODONTICS: A METHODOLOGICAL STUDY

OBJECTIVE

To identify and summarize the use and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within randomized controlled trials (RCTs) published in 5 leading orthodontic journals.

METHODS

A manual search was conducted to identify intervention (therapeutic or preventive) related RCTs published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included trial, as well as all outcomes and outcome measures used in these trials independently and in duplicate. Thereafter, the use of dPROs and dPROMs was identified and summarized. We classified all dPROs into 2 general types (oral health-related quality of life [OHRQoL] and others) and dPROMs into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). We also identified whether these dPROMs assessed 4 dimensions of OHRQoL (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact).

RESULTS

From 4631 examined articles, a total of 315 RCTs were included, of which 76 (24.1%) used dPROs and dPROMs. Eight different dPROs (OHRQoL, patients' satisfaction with treatment, difficulty, compliance, preference, efficacy, duration, and unwanted events) and 34 different dPROMs (including 13 single-item questionnaires, 7 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these trials. OHRQoL was the most commonly used dPRO (n = 71; 93.4%), followed by patients' satisfaction with treatment (n = 10; 13.2%), patient-reported difficulty (n = 5; 6.6%), and patient-reported compliance (n = 4, 5.3%). The 4 most frequently used dPROMs were pain measured with 10 mm Visual Analogue Scale (n = 20; 24.1%), pain measured with Numerical Rating Scale (n = 11; 13.3%), the Feldmann's Questionnaire (2007) (n = 6; 7.2%), and the Oral Health Impact Profile 14 (n = 5; 6.0%).

CONCLUSION

Only about one-fourth of RCTs published in leading orthodontic journals can reflect patients' perspectives. OHRQoL was the most commonly used dPRO in these trials. Substantial heterogeneity exists among dPROMs used for OHRQoL assessment. Efforts are needed from researchers, reviewers, editors and other stakeholders to promote the wide and standardized use of dPROs in orthodontic research.

A Bibliometric Mapping Study of the Literature on Oral Health-related Quality of Life

BACKGROUND

Oral health is an indispensable component of overall health, and oral health status significantly influences people's physical, mental, and social well-being. Oral health-related quality of life (OHRQoL), an important and widely used dental patient-reported outcome (dPRO), is attracting more and more researchers' attention and interest. This study aimed to analyze and map the existing scientific literature regarding OHRQoL through a bibliometric approach, including a summary of the characteristics of OHRQoL-related publications, the identification of prolific entities, high-frequency keywords analysis, and research trend analysis via periodic high-impact keywords.

METHODS

A literature search was conducted in the Web of Science Core Collection to collect OHRQoL-related original research and review articles. After examination and deduplication, the following bibliometric information was extracted from each article: title, abstract, keywords, authors, affiliations, geographic origin (countries/regions), year of publication, journal name, and references. Various scientometric mapping tools including Microsoft Office spreadsheet, VOSviewer, Biblioshiny R-package software, and Scimago Graphica were used to analyze basic bibliometric parameters, leading producers, high-impact keywords, and research trends.

RESULTS

A total of 3324 OHRQoL-related articles (3119 original research articles and 205 review papers) were collected, which received 65,704 citations. A total of 9950 authors from 2429 organizations contributed to this body of research. Prolific authors from Europe, USA, Brazil, New Zealand, China, and Canada were identified, and they also centered collaboration clusters in the co-author network. Community Dentistry and Oral Epidemiology was the most prolific journal. Twenty-one keywords with more than 200 occurrences, and 23 keywords with more than 150 occurrences, were identified for publications of 1994-2021 and 2012-2021, respectively. Keyword analysis revealed hot topics such as instrument development and validation, studies targeting children and adolescents, as well as clinical studies in operative dentistry, implantology, orthodontics, and community dentistry. Oral Health Impact Profile is the most commonly used instrument in OHRQoL-related research.

CONCLUSIONS

OHRQoL is an impactful topic in dental health care as it is not only useful in dental research and patient-centered clinical outcome measures but also provides valuable guidance in dental public health administration and policy making. OHRQoL-related research presents a dynamic landscape and is expected to continue presenting high productivity and broad application in the future.

HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH

BACKGROUND

When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets.

AIM

Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA).

METHODS

This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns.

RESULTS

Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated.

CONCLUSIONS

Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

LESSONS LEARNED FROM the FIRST STEPS of IMPLEMENTING VALUE-BASED ORAL HEALTH CARE: A CASE STUDY FROM the MEDICAL UNIVERSITY of VIENNA

BACKGROUND

Value-based oral healthcare (VBOHC) has two fundamental components, the assessment of patients' dental outcomes and the measurement of the costs to achieve those outcomes. The aim of this article is to describe challenges and opportunities of implementing dental patient-reported outcomes (dPROs) in clinical care at the University Clinic of Dentistry, Medical University of Vienna, in Austria, to determine lessons learned and describe next steps forward to VBOHC implementation.

METHODS

A case study determining lessons learned based on an implementation process to incorporate a dental patient-reported outcome measure (dPROM) in routine clinical care was conducted. The German version of the five items Oral Health Impact Profile (OHIP-5), a dPROM was selected and integrated into the general anamnesis including dental and medical history for patients aged ≥16 years. The anamnesis is paper based and is to be completed by each new patient during the registration process. Thereafter, it is uploaded to the patients' dental record via scan by the main central admission. However, it is then the treating dentist's task to transfer the data into the digital system. Data accuracy between digital and paper forms was investigated, and lessons learned regarding the first steps of implementing VBOHC were summarized based on the implementation process findings.

RESULTS

To date, 8,147 patients were approached to fill in OHIP-5. However, only 266 patients´ OHIP- 5 files were transferred into the digital system by the dentist. To explore the accuracy between the manual transfer of data from paper forms to digital format, the data of 89 randomly selected patients was compared. Of this sample, 74 (83.1%) patient's data sets were found to be identical. Lessons learned included the importance of institutional dedication, stakeholders' engagement, dPROMs integration in follow up visits, the significance of digital solutions, and the continuous monitoring and evaluation.

CONCLUSION

Integrating dPROMs in clinical settings is achievable and is the first important step to move forward with VBOHC implementation.

Comparison of two rating scales with the orofacial esthetic scale and practical recommendations for its application

Purpose

We compared measurement properties of 5-point and 11-point response formats for the orofacial esthetic scale (OES) items to determine whether collapsing the format would degrade OES score precision.

Methods

Data were collected from a consecutive sample of adult dental patients from HealthPartners dental clinics in Minnesota (N = 2,078). We fitted an Item Response Theory (IRT) model to the 11-point response format and the six derived 5-point response formats. We compared all response formats using test (or scale) information, correlation between the IRT scores, Cronbach’s alpha estimates for each scaling format, correlations based on the observed scores for the seven OES items and the eighth global item, and the relationship of observed and IRT scores to an external criterion using orofacial appearance (OA) indicators from the Oral Health Impact Profile (OHIP).

Results

The correlations among scores based on the different response formats were uniformly high for observed (0.97–0.99) and IRT scores (0.96–0.99); as were correlations of both observed and IRT scores and the OHIP measure of OA (0.66–0.68). Cronbach’s alpha based on any of the 5-point formats (α = 0.95) was nearly the same as that based on the 11-point format (α = 0.96). The weighted total information area for five of six derived 5-point response formats was 98% of that for the 11-point response format.

Conclusions

Our results support the use of scores based on a 5-point response format for the OES items. The measurement properties of scores based on a 5-point response format are comparable to those of scores based on the 11-point response format.

Patient-Reported Outcome Measures on Oral Hygiene, Periodontal Health, and Treatment Satisfaction of Orthodontic Retention Patients up to Ten Years after Treatment-A Cross-Sectional Study

Background: This cross-sectional study evaluated patient-reported outcome measures (PROMs) on (1) oral hygiene, (2) periodontal health, (3) retainer failure, (4) orthodontic treatment satisfaction, and (5) outcome satisfaction in orthodontic retention patients. The purpose of the study was to evaluate whether orthodontic retention treatment is associated with patient-reported outcome measures on oral hygiene, periodontal health, and treatment satisfaction. Methods: A ten-item questionnaire on the five PROMs was conducted among 211 consecutive retention patients up to ten years following orthodontic treatment. Linear regression models were computed to detect possible associations between the PROMs and retention treatment or patient characteristics. Results: The presence of a fixed lingual retainer was not associated with the reduced ability to perform oral hygiene, self-perceived periodontal health, or orthodontic outcome satisfaction. Older patients were more content with the orthodontic treatment result (p < 0.05). Patients with fixed lingual retainers in the mandible were less satisfied with the course of orthodontic treatment (p < 0.05). Smokers more often reported gingival bleeding (p < 0.05). Females reported increased gingival recessions (p < 0.05) and perceived their teeth as longer than before treatment (p < 0.05). Longer orthodontic treatment duration corresponded to retainer failure (p < 0.05). Conclusions: In general, long-term orthodontic retention patients were satisfied with orthodontic treatment. These patients reported the satisfactory ability to perform adequate oral hygiene and periodontal health, and they communicated a high degree of treatment and outcome contentment. However, patients with a retainer in the mandible were less satisfied with orthodontic treatment.

RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS

BACKGROUND

OHIP's original seven-domain structure does not fit empirical data, but a psychometrically sound and clinically more plausible structure with the four OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact has emerged. Consequently, use and scoring of available OHIP versions need to be revisited.

AIM

We assessed how well the overall construct OHRQoL and its four dimensions were measured with several OHIP versions (20, 19, 14, and 5 items) to derive recommendations which instruments should be used and how to score them.

METHODS

Data came from the "Dimensions of OHRQoL Project" and used the project's learning sample (5,173 prosthodontic patients and general population subjects with 49-item OHIP data). We computed correlations among OHIP versions' summary scores. Correlations between OHRQoL dimensions, on one hand, and OHIP versions' domain scores or OHIP-5's items, on the other hand, were also computed. OHIP use and scoring recommendations were derived for psychometrically solid but also practical OHRQoL assessment.

RESULTS

Summary scores of 5-, 14-, 19- and 49-item versions correlated highly (r = 0.91-0.98), suggesting similar OHRQoL construct measurement across versions. The OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were best measured by the OHIP domain scores for Physical Disability, Physical Pain, Psychological Discomfort, and Handicap, respectively.

CONCLUSION

Recommendations were derived which OHIP should be preferably used and how OHIP versions should be scored to capture the overall construct and the dimensions of OHRQoL. Psychometrically solid and practical OHRQoL assessment in all settings across all oral health conditions can be achieved with the 5-item OHIP.

Should the frequency, severity, or both response scales be used for multi-item dental patient-reported outcome measures?

BACKGROUND

The Oral Impacts on Daily Performances (OIDP) index asks the respondents to indicate both, the frequency and severity of the impact. However, it is not clear if the two scaling methods are correlated, and if using one scale is sufficient. The purpose of the study was to investigate the correlation between frequency and severity rating scales of the OIDP instrument, and whether only one of the rating scales can be used instead of both.

METHODS

A battery of patient-reported outcome questionnaires were administered to a consecutive sample of adult dental patients from HealthPartners dental clinics in Minnesota (N = 2,115). Only those who responded to any of the OIDP items were included in the analysis for this study (N = 873). We assessed correlations between the frequency and severity scales for all OIDP items, and for the summary scores of the two OIDP response scales. We additionally fit a categorical structural equation model (SEM) (or an item factor analysis model) and examined the correlation between two latent variables (Frequency and Severity).

RESULTS

The correlation estimates for all OIDP items were greater than 0.50, indicating large correlations between the frequency and severity scores for each OIDP item. The correlation estimate between the two summary scores was 0.85 (95% CI [0.82-0.86]). When we calculated the correlation coefficient using a latent variable model, the value increased to 0.96 (95% CI [0.93-1.00]).

CONCLUSION

Our study findings show that OIDP frequency and severity scores are highly correlated, which indicates the use of one scale only. Based on previous evidence, we recommend applying the frequency rating scale only in research and clinical settings.

STANDARDIZATION OF DENTAL PATIENT-REPORTED OUTCOMES MEASUREMENT USING OHIP-5 - VALIDATION OF "RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS"

BACKGROUND

Recently, "Recommendations for use and scoring of Oral Health Impact Profile versions" (here abbreviated as Recommendations Project) were proposed by an international group of oral health researchers to standardize assessment of perceived oral health. They recommended a four-dimensional measurement approach consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact as the set of dental patient-reported outcomes to be measured with the 5-item Oral Health Impact Profile (OHIP-5).

AIM

This study aimed to validate the "Recommendations for use and scoring of Oral Health Impact Profile versions" by replicating the findings they are based on.

METHODS

OHIP data came from the "Dimensions of OHRQoL Project." Its Validation Sample (5,022 prosthodontic patients and general population subjects) as well as its Additional Sample (N = 583 prosthodontic patients and general population subjects) were used. Validation of the Recommendations Project's findings was performed in two steps. First, correlations among OHIP versions presented in the Recommendations Project were replicated in the Validation Sample. Second, participants of the Additional Sample were subjected to a hypothetical treatment program that assigned two treatments to them according to their level of perceived oral health impact using OHIP versions. The performance of abbreviated OHIP versions was evaluated.

RESULTS

The high correlations among summary scores of 5-, 14-, 19-, and 49-item OHIP versions (r = 0.91-0.98), found in the Recommendations Project, were replicated. All short OHIP versions performed similarly when classifying participants for a hypothetical tailored treatment program.

CONCLUSIONS

Findings reported in "Recommendations for use and scoring of Oral Health Impact Profile versions" were validated, thus supporting the feasibility of a standardized assessment of perceived oral health in all settings across all oral diseases. Psychometrically solid and practical assessment can be performed with OHIP-5.

IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE

BACKGROUND

A shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars.

OBJECTIVE

Purpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement.

METHODS

Patients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed.

RESULTS

After an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions.

CONCLUSIONS

In patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients' preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

Frequency of Four-dimensional Oral Health Problems across Dental Fields - a Comparative Survey of Slovenian and International Dentists

OBJECTIVES

To compare the frequency of patients' oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions.

METHODS

An anonymous electronic survey in the English language was designed using Qualtrics software. A probability sampling for Slovenia and a convenience sampling strategy for dentist recruitment was applied for 31 countries. Dentists engaged in six dental fields were asked to categorize their patients' oral health problems and prevention needs into the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). Proportions of patients' problems and prevention needs were calculated together with the significance of Slovenian and international dentists' differences based on dental fields and WHO regions.

RESULTS

Dentists (n=1,580) from 32 countries completed the survey. There were 223 Slovenian dentists (females: 68%) with a mean age (SD) of 41 (10.6) years and 1,358 international dentists (females: 51%) with a mean age (SD) of 38 (10.4). Pain-related problems and prevention needs were the most prevalent among all six dental fields reported by dentists; Slovenian (37%) and 31 countries (45%). According to Cohen, differences between Slovenia, the broader European Region, and 31 countries were considered non-significant (<0.1).

CONCLUSION

According to the dentists' responses, the frequency of patients' oral health problems and prevention needs are proportionate between Slovenia and 31 countries, regionally and globally. The four OHRQoL dimensions can be considered universal across all dental fields.

Development of a one-item version of the Orofacial Esthetic Scale

OBJECTIVES

Orofacial appearance is increasingly recognized as an important dental patient-reported outcome making instrument development and refinement efforts to measure the outcome better necessary. The aim of this study was to derive a one-item version of the Orofacial Esthetic Scale (OES).

MATERIALS AND METHODS

OES data were collected from a consecutive sample of a total of 2113 adult English- or Spanish-speaking dental patients from HealthPartners dental clinic in Minnesota. Participants with missing data were excluded and analysis were performed using data from 2012 participants. Orofacial appearance was assessed with the English and the Spanish language version of the OES. Linear regression analysis was performed, with the OES item 8 ("Overall, how do you feel about the appearance of your face, your mouth, and your teeth?") as the predictor variable and the OES summary score as the criterion variable, to calculate the adjusted coefficients of determination (R²).

RESULTS

The value of adjusted R² was 0.83, indicating that the OES item 8 score explained about 83% of the variance of the OES summary score. The difference in R² scores between the two language groups was negligible.

CONCLUSION

The OES item 8 can be used for the one-item OES (OES-1). It is a psychometrically sound instrument for measuring orofacial appearance.

CLINICAL RELEVANCE

Due to its easy application and sufficient psychometric properties, the OES-1 can be used effectively as an alternative to longer OES instruments in all areas of dental practice and research.

Role of thin gingival phenotype and inadequate keratinized mucosa width (<2 mm) as risk indicators for peri-implantitis and peri-implant mucositis

BACKGROUND

There is growing evidence on the impact of thin gingival phenotype (TnP) and inadequate keratinized mucosa width (KMW <2 mm) around dental implants on peri-implant health. This study investigated the role of TnP and inadequate KMW (<2 mm) as risk indicators for peri-implantitis and mucositis and on dental patient-reported outcomes.

METHODS

Sixty-three patients with 193 implants (mean follow-up of 6.9 ± 3.7 years) were given a clinical and radiographic examination and a questionnaire to assess patient awareness of food impaction and pain/discomfort. Chi-squared tests and regression analysis for clustered data were used to compare outcomes.

RESULTS

Implants with TnP had a statistically higher prevalence of peri-implantitis (27.1% versus 11.3%; PR, 3.32; 95% confidence interval (CI), 1.64-6.72; P = 0.001) peri-implant mucositis (42.7% versus 33%; PR, 1.8; 95% CI, 1.12-2.9; P = 0.016) and pain/discomfort during oral hygiene (25% versus 5%; PR, 3.7; 95% CI, 1.06-12.96; P = 0.044) than thick phenotype. Implants with inadequate KMW had a statistically higher prevalence of peri-implantitis (24.1% versus 17%; PR, 1.87; 95% CI, 1.07-3.25; P = 0.027) and peri-implant mucositis (46.6% versus 34.1%; PR, 1.53; 95% CI, 1-2.33; P = 0.05) and pain/discomfort during oral hygiene (28% versus 10%; PR, 2.37; 95% CI, 1.1-5.1; P = 0.027) than the adequate KMW. TnP was strongly associated with inadequate KMW (PR = 3.18; 95% CI, 1.69-6.04; P <0.001).

CONCLUSION

TnP and inadequate KMW (<2 mm) may be significant risk indicators for peri-implant disease and pain/discomfort during brushing.

DENTAL PATIENT-REPORTED OUTCOMES -- THE PROMISE OF DENTAL IMPLANTS

In general dental practice, the use of implants is focused mostly on prosthodontic issues. That is, the replacement of missing teeth or the support of dental prostheses. However, there are other dental fields using implants such as orthodontics or maxillofacial prosthodontics. A classic way to measure success in implant dentistry is to look how long implants and the corresponding superstructure survive and are in function. Nevertheless, this alone is a very crude parameter. Therefore, biological and technical complications are taken in account additionally. Nonetheless, these objective measures do not well replicate the perception of the patient. That why, subjective measures, reflecting the perception of the patient are recommended to complement objective parameters. If these dental patient-reported outcome measures (dPROMs) are wisely chosen, they offer a wide variety of options. Besides comparing therapeutic effects by using the instruments' summary score only, dPROMs such as the Oral Health Impact Profile (OHIP) provide the opportunity to additionally assess patients` perceptions in the 4 dimensions of oral health-related quality of life. These are functional limitations, pain, esthetic issues as well as psychosocial impairment. Even the 5-item short form of the OHIP captures these dimensions and provides an efficient way to assess patients' perception with low administrative burden. This in turn offers new insights into the patient perspective and therefore helps improving shared decision making.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

Assessment of differential item functioning across English and Spanish versions of the Orofacial Esthetic Scale

OBJECTIVES

To investigate differential item functioning across the Spanish and English versions of the Orofacial Esthetic Scale (OES).

METHODS

OES data were collected from a consecutive sample of a total of 622 adult dental patients (311 English- and 311 Spanish-speaking adults) from HealthPartners dental clinics in Minnesota. We inspected boundary characteristic curves (BCCs) based on item response theory (IRT) in English speakers and Spanish speakers to examine differential item functioning (DIF). Using the Samejima's graded response model, we used the item response theory log-likelihood ratio (IRTLR) approach to test whether DIF was statistically significant.

RESULTS

Inspection of the BCCs did not reveal substantial differences in item difficulty and discrimination between English speakers and Spanish speakers. When IRTLR tests were performed for the seven OES items, no item was flagged with significant DIF after P-values were adjusted for multiple comparisons.

CONCLUSIONS

Pooling of Orofacial Esthetic Scale (OES) data from English and Spanish-speaking dental patients for analysis and interpretation is supported by the absence of differential item functioning (DIF) across the two language groups.