Measuring the impact of oral health on life quality in two national surveys - functionalist versus hermeneutic approaches

Tools Evaluating Child Oral Health-Related Quality of Life

OBJECTIVES

This study aimed to systemically review the tools developed for evaluating oral health-related quality of life (OHRQoL) in preschool children.

METHODS

Two reviewers systematically searched English-language publications within PubMed, Embase, Scopus, and Web of Science. They screened the titles and abstracts and retrieved the full texts of the selected publications. Studies which developed, validated, or culturally adapted an OHRQoL tool used in preschool children were included. They recorded information regarding tool characteristics, item configuration, discriminative validation, the aim of assessment, and the target group.

RESULTS

The study included 59 publications and identified 12 tools for assessing OHRQoL in preschool children. Seven tools were tailored for preschool ages. Most of the scales were generic oral health measures. Dental caries was the most commonly used oral condition for assessing a tool's discriminative validity. Eight tools required parental proxy reports. Three tools were both child-administrated and parent-administrated. One tool was designed to be answered solely by children. Ten tools assessed the oral health-related impact on children, including oral condition-related, functioning, environmental, and emotional/social domains. Four tools included items regarding the impact on both children and family.

CONCLUSIONS

This review identified 12 tools developed for evaluating OHRQoL in preschool children, 7 of which were tailored for preschool age. The 12 tools were validated but incomprehensive due to the subjective and multidimensional nature of the OHRQoL concept. Researchers can choose a suitable tool for their studies by understanding the basic characteristics and item setting of the tools. Researchers can have an overview of the tools developed for evaluating OHRQoL in preschool children. They can use the findings from this review to choose a suitable tool for their studies regarding the OHRQoL in preschool children.

Do residential care and low social capital negatively influence oral health-related quality of life (OHRQoL) among older adults? A cross-sectional study

OBJECTIVES

To compare oral health status, OHRQoL and social capital between dependent older adults living in a residential care setting (RC) and community dwellers living independently (CD) and to assess the possible role of social capital and residential status as independent predictors of OHRQoL in a sample of older adults in the Udupi region of Karnataka, South India.

BACKGROUND

As the global population ages, a greater number of older adults are now living in residential care settings than ever before. This study provides insights into the role of residential care and social capital in influencing the oral health-related quality of life (OHRQoL) among older adults.

MATERIALS AND METHODS

A total of 296 older adults, comprising 148 dependent older adults living in residential care (RC) and 148 community dwelling older adults living independently (CD), completed the General Oral Health Assessment Index (GOHAI) and a Social Capital Scale after undergoing clinical oral examination for dentition and periodontal status.

RESULTS

The caries experience in both the residential care group (RC) and the community dwelling group (CD) was high with mean DMF scores of 21.6 (SD = 9.6) and 20.1 (SD = 10.7) respectively. The Mean Social Capital score was significantly higher (P = .01) among the RC group (33.2, SD = 5.1) than the CD group (31.5, SD = 5.7), whereas the mean GOHAI score was significantly higher (P = .02) among the CD (61.5, SD = 6.8) than the RC group (59.5, SD = 7.9). Linear regression showed lower DMFT scores (β: -0.26, P ˂ .001), being a community dweller (β: 0.14, P = .01) and having higher social capital (β: 0.11, P = .04) were associated with better OHRQoL (higher GOHAI scores) after adjusting for possible confounders.

CONCLUSION

Dependent older adults living in residential care had higher social capital but poorer OHRQoL. Caries experience, residential status and social capital were independently associated with OHRQoL.

Comparing Masticatory Performance of Maxillary Mini Dental Implant Overdentures, Complete Removable Dentures and Dentate Subjects

Background: Mini dental implant (MDI) overdenture rehabilitation for the edentulous maxilla is a valuable, less invasive and affordable treatment alternative for complete removable dentures (CRD). However, comparative quantification of masticatory performance in different oral conditions are scarce. Purpose: This study compares objective masticatory performance of dentate groups, maxillary CRD and MDI overdentures and subjective masticatory performance in maxillary CRD and MDI overdentures. Materials and Methods: Four groups were defined, age 20+ dentate dental students (DS), age 50+ complete dentate subjects (DP), age 50+ maxillary CRD or MDI overdentures/dentate mandible. Objective masticatory performance was evaluated by measuring circular Variance of Hue (VOH) or the mixture degree of two-color chewing gum (Hue-check View Gum^® Test). Additionally, subjective masticatory comparison was investigated in the CRD and MDI groups, with a visual analogue scale (VAS) for different food consistencies and the Oral Health Related Quality of Life (OHRQL) OHIP-14 questionnaire. Results: The mean VOH was 0.11 (SD 0.50, range 0.05–0.27) for the dentate dental 20+ students, 0.13 (SD 0.08, range 0.03–0.31) for the 50+ dentate group (p = 0.774), 0.41 (SD 0.41, range 0.14–0.76) for the CRD group and 0.39 (SD 0.18, range 0.07–0.76) for the MDI group (p = 0.725). Based on the VAS scores, no improvement was found between the CRD and the MDI overdenture group (p > 0.050). The mean OHIP-14 total score was 12.10 (SD 15.87, range 0–56) for CRD, while the MDI group (p = 0.039) saw a significant improvement to 2.85 (SD 2.85, range 0–15). Conclusion: Comparable results in objective masticatory performance were registered in dentate 20+ and 50+ subjects with a remarkable inferior outcome for the CRD and MDI group. Compared to CRD, MDI overdentures revealed no substantial improvement in subjective and objective masticatory performance. However, for MDI a significant increase in OHRQL was apparent.

Esthetic Outcome and Oral Health-Related Quality of Life after Restoration with Single Anterior Maxillary Implants

Background/Aim: To evaluate the esthetic outcome of single implant restorations and the correlation of these esthetic results between patient satisfaction and oral health-related quality of life (OHRQoL).

Material and Methods: 15 patients with single-tooth implants in the anterior maxilla region were included in this study. Patients were clinically followed to evaluate the esthetic outcomes of implant prostheses and photographs of the implant site were obtained using a digital camera. A researcher evaluated the photographs according to the pink esthetic score/white esthetic score (PES/WES) index. Patients were asked to complete a questionnaire including 13 questions to evaluate their satisfaction with the overall implant and restoration treatments using by visual analogue scale (VAS). OHRQoL was evaluated by patients with the questionnaire Oral Health Impact Profile-14 (OHIP-14).

Results: The mean PES/WES was 13.6. In Ohip-14 questionnaire, the questions were answered ‘never’ generally. The mean VAS score was 9.01±0.9 and ranged from 7.6 to 9.7. There was no correlation between VAS and PES/WES (p= 0.484), similarly, there was no correlation between OHIP-14 and PES/WES (p= 0.763).

Conclusions: All of the implant restorations’ PES/WES scores were clinically acceptable. Professionals evaluated the esthetic outcome more suspicious than patients. Patients were satisfied with the esthetic results.

Estimation and change of edentulism among the Korean population: Korea National Health and Nutrition Examination Survey 2007-2018

OBJECTIVES

To estimate the prevalence of edentulism according to the socio-demographic variables of Korean adults between 2007 and 2018 and to analyze the trends.

METHODS

This study was conducted using raw data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2018. Edentulism was defined as the absence of upper and lower teeth or the retained root of the missing teeth. To obtain the prevalence of edentulism, complex sample frequency analysis and regression analysis were performed according to the socio-demographic variables to represent the national population. The Korean population structure in 2005 was exploited as a standard population to calculate age-standardized edentulism.

RESULTS

The prevalence of edentulism in 2016-2018 was 9.7% in the Korean elderly, and the change of age-standardized edentulism steadily declined over time from 2007, 12.8%. In particular, it decreased by approximately 20% in the period between 2016 and 2018 compared to that in 2007 for those in their 80s. The trend of the prevalence according to gender decreased significantly in women. According to the level of education, the greatest decrease was seen in the group with the lowest education, although the prevalence itself was higher than that seen in those who were more educated.

CONCLUSIONS

The prevalence of edentulism among the older Korean population has decreased over time. However, the concern is on those with lower education and men as these groups are still at higher risk for edentulism.

"Longitudinal Oral Health-Related Quality of Life in maxillary mini dental implant overdentures after 3 years in function"

OBJECTIVES

Longitudinal evaluation of Oral Health-Related Quality of Life (OHRQoL) during treatment of flaplessly placed, one-piece mini-dental-implants (MDIs) for maxillary overdentures is rarely investigated, nor is the impact of MDI failures.

MATERIAL AND METHODS

This multicenter prospective cohort study evaluated the 3-year outcome of 5-6 MDIs in the edentulous maxilla in patients above 50 years with dentate mandible. Provisional dentures were provided before final prosthetic connection was established at 6 months. Postoperative discomfort was assessed using a visual analogue score (VAS). OHRQoL was investigated using the Oral Health Impact Profile (OHIP)-14 at baseline (preoperatively), postoperatively, post-prosthetic connection and after 3 years in function.

RESULTS

164 (78.4%) of the 204 placed MDIs were still in situ after 3 years, in 29/31 patients. Two patients lost 5/6 MDIs resulting in two prosthetic failures (6.45%). With regard to pain, a score of 4.1/10 (SD 2.8) was recorded on day 1, and 1.1/10 (SD 1.7) on day 7. A decrease in total OHIP-14 scores was observed postoperatively (15.6; SD 12.8) as compared to baseline (21.3; SD 13.1), with improvement of OHRQoL. Furthermore, this was statistically significant at connection of the final prosthesis (7.3; SD 6.7) (p = .006). The OHIP-14 improved less (p = .011) when experiencing one or more implant losses (9.5; SD: 9.85), in comparison with no implant loss (20.7; SD: 13.97). A failure of one MDI did not affect OHIP-14 score (p = .658); however, multiple failures did (p = .007).

CONCLUSION

Maxillary MDI overdenture treatment yields significant OHRQoL improvement when at least 5 MDIs survive, preserving functional comfort.

Oral health-related quality of life and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment

PURPOSE

Loss of teeth is associated with a significant reduction in quality of life. The aim of this prospective multicenter study was to assess the impact of dental implants on oral health-related quality of life (OHRQoL).

MATERIAL AND METHODS

Patients with various kinds of indications for dental implants ranging from single-tooth loss to edentulous jaws were included. Quality of life related to dental implants was assessed through the Oral Health Impact Profile (OHIP-G 21), which has a score from 0 to 20 in healthy patients.

RESULTS

In total, 8689 patients from 17 centers from 2009 to 2014 were enrolled in the study. The sex distribution was almost even (53.3% men, 46.7% women). The most frequent indications for the insertion of dental implants were free-end gaps (30.6%) and posterior single-tooth gaps (27%). In all, 12.4% of patients had an edentulous jaw. For all indications, patients reported significant changes in mean OHIP scores after prosthetic reconstruction. The most significant improvements in the OHIP score occurred in the groups of patients with edentulous jaws (pretreatment score: 42.3) after prosthodontic reconstruction (score: 24.8) and in the patient group with an anterior single-tooth gap (pretreatment score: 36.4) after prosthodontic reconstruction (score: 24.8).

CONCLUSION

The insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants, with the most significant improvements in patients with edentulous jaws and anterior single-tooth gaps.

Income-related inequalities in inadequate dentition over time in Australia, Brazil and USA adults

OBJECTIVE

To assess changes over time of the absolute and relative household income-related inequalities in inadequate dentition (ID) among Australians, Brazilians and USA adults.

METHODS

This study used nationwide oral health survey data from Australia (n = 1200 in 1999; n = 2729 in 2005), Brazil (n = 13 431 in 2003; n = 9779 in 2010) and USA (n = 2542 in 1999; n = 1596 in 2005). Absolute income inequalities were calculated using Absolute Concentration Index (ACI) and Slope Index of Inequality (SII), while relative inequalities were calculated using Relative Concentration Index (RCI) and Relative Index of Inequality (RII).

RESULTS

Prevalence of ID in the studied period dropped from 8.7% to 3.1% in Australia; from 42.1% to 22.4% in Brazil; and remained stable in USA, nearly 8.0%. Absolute income inequalities were highest in Brazil, followed by the USA and Australia; relative inequalities were lower in Brazil than in Australia and the USA. ID was higher among Brazilian females (2010) and for the poorest group in all countries and periods. A remarkable reduction in absolute inequalities were found in Australia [Slope Index of Inequality (SII) and AIC 60%] and in Brazil (SII 25%; ACI 33%) while relative inequalities increased both in Australia (RCI and RII 40%) and in Brazil (RCI 24%; RII 38%). No changes in absolute and relative income inequalities were found in the USA.

CONCLUSION

There were still persistent absolute and relative income inequalities in ID in all examined countries. There has been a reduction in absolute income inequalities in ID but an increase in relative income inequalities.

The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population

OBJECTIVE

The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population.

METHODS

SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed. Oral HRQoL was measured with the Oral Health Impact Profile (OHIP). Multivariate regression analyses were performed to identify associations between SSc, oral abnormalities and oral HRQoL.

RESULTS

We assessed 163 SSc patients and 231 controls. SSc patients had more decayed teeth (SSc 0.88, controls 0.59, P = 0.0465) and periodontal disease [number of teeth with pocket depth (PD) >3 mm or clinical attachment level (CAL) ≥5.5 mm; SSc 5.23, controls 2.94, P < 0.0001]. SSc patients produced less saliva (SSc 147.52 mg/min, controls 163.19 mg/min, P = 0.0259) and their interincisal distance was smaller (SSc 37.68 mm, controls 44.30 mm, P < 0.0001). SSc patients had significantly reduced oral HRQoL compared with controls (mean OHIP score: SSc 41.58, controls 26.67, P < 0.0001). Multivariate regression analyses confirmed that SSc was a significant independent predictor of missing teeth, periodontal disease, interincisal distance, saliva production and OHIP scores.

CONCLUSION

Subjects with SSc have impaired oral health and oral HRQoL compared with the general population. These data can be used to develop targeted interventions to improve oral health and HRQoL in SSc.

A systematic review of the impact of parental socio-economic status and home environment characteristics on children's oral health related quality of life

Childhood circumstances such as socio-economic status and family structure have been found to influence psychological, psychosocial attributes and Oral Health Related Quality of Life (OHRQoL) in children. Therefore, the aim of this study was to conduct a systematic review of the published literature to assess the influence of parental Socio-Economic Status (SES) and home environment on children's OHRQoL. A systematic search was conducted in August 2013 using PubMed, Medline via OVID, CINAHL Plus via EBSCO, and Cochrane databases. Studies that have analysed the effect of parental characteristics (SES, family environment, family structure, number of siblings, household crowding, parents' age, and parents' oral health literacy) on children's OHRQoL were included. Quality assessment of the articles was done by the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative studies. Database search retrieved a total of 2,849 titles after removing the duplicates, 36 articles were found to be relevant. Most of the studies were conducted on Brazilian children and were published in recent two years. Early Childhood Oral Health Impact Scale and Children's Perception Questionnaire were the instruments of choice in preschool and school aged children respectively. Findings from majority of the studies suggest that the children from families with high income, parental education and family economy had better OHRQoL. Mothers' age, family structure, household crowding and presence of siblings were significant predictors of children's OHRQoL. However, definitive conclusions from the studies reviewed are not possible due to the differences in the study population, parental characteristics considered, methods used and statistical tests performed.

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

OBJECTIVE

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Impact of complications of single tooth restorations on oral health-related quality of life

OBJECTIVE

To compare oral health-related quality of life (OHRQoL) among subjects who received implant-supported crowns (ISC) and 2-unit cantilevered resin-bonded bridges (cRBB) in a bounded single tooth space (BSTS) after at least 5 years and to investigate factors associated with their OHRQoL.

METHODS

A case-control study among 78 subjects who received ISC or cRBB rehabilitation at a teaching hospital (39 ISCs and 39 cRBBs). OHRQoL was measured using the Oral Health Impact Profile (OHIP-49) and compared between treatment modality. Variations in OHIP scores with respect to "minor complications" (repair of the original "survived" restorations) and "major complications" (replacement of "failed" restorations); and number of complications were determined in bivariate and multivariate analyses (negative binominal regression) controlling for socio-demographic and clinical factors.

RESULTS

Oral Health Impact Profile scores were similar among those who received ISC and cRBB (P = 0.53). Among subjects with complicated restorations, those with major complications reported significantly higher OHIP scores (poorer OHRQoL) than those with minor complications (P = 0.02). Subjects who experienced multiple complications had significantly higher OHIP scores (poorer OHRQoL) than those with a single complication (P = 0.04). In regression analyses (which considered OHIP scores of those with complications), the nature of complications (P < 0.01), treatment modality (P = 0.04), and gender (P = 0.02) emerged as significant factors.

CONCLUSION

In the rehabilitation of a BSTS patients, OHRQoL was similar irrespective of treatment modality (ISC or cRBB). Among those who experienced complications their OHRQoL was associated with the nature of complications, treatment modality and gender.

Oral health-related quality of life of greek adults: a cross-sectional study

Purpose. The aim of the present study was to investigate the impact of oral health status on the quality of life of adults in different regions of Greece, using the Oral Health Impact Profile-short form (OHIP-14). Methods. A random sample consisting of a total of 504 Greek adults between the ages of 35-44 years (mean 39.1 ± 3.5) was selected from different urban and rural areas, and face-to-face interviews were conducted using the validated Greek language OHIP-14. Associations of the total OHIP-14 score and its 7 sub-scales along with the self-perceived quality of life were evaluated with Spearman's correlations. Results. The subjects had an overall weighted OHIP-14 score of 1.1 (sd 1.9). No significant differences were found for either rural or non-metropolitan areas when compared to urban or metropolitan regions. High scores of above 2 were determined for functional limitation, physical pain, handicap, and the psychological discomfort scales. The education level of the subjects had a significant positive impact on the quality of life of the subjects. Conclusions. Dental and oral health conditions are factors that do impact on the quality of life of individuals.

Quality of life related to oral health: contribution from social factors

Sociodental indicators have been widely used in epidemiological research related to oral health, as they add the dimension of the impact of oral health on the quality of life of individuals and populations. Various studies have been done in order to validate new instruments to assess these subjective perceptions, however, the association between social parameters and impact on oral health-related quality of life (OHRQoL) has not been systematically studied, thus there is still doubt as to the role of the main social variables as OHRQoL impact modulators. This study aims to systematically review the literature in order to evidence the association between six social parameters and OHRQoL. Based on six exclusion criteria, the literature search revealed 40 eligible publications for analyses. The frequency of expected (positive) association between the social parameters and OHRQoL was greater than the non-expected (negative) associations for the six parameters.

CONCLUSIONS

The social conditions most clearly associated with the perception of negative impact on OHRQoL were: women, with poor education and low income, immigrants or people belonging to minority ethnic groups.

Oral health-related quality of life and associated factors in Norwegian adults

OBJECTIVE. To investigate associations between oral health-related quality of life assessed with the Oral Health Impact Profile (OHIP)-14 and demographic factors, number of teeth present, dental visits, dental health behaviour and self-rated oral health in a representative sample of 20-80-year-old Norwegians. MATERIAL AND METHODS. The study was conducted in a stratified random sample of 3538 individuals. Questionnaires including questions on demographic factors, number of remaining teeth, dental visits, dental health behaviour, self-rated oral health and OHIP-14 were mailed to the sample. Bivariate and multivariate analyses were performed. RESULTS. The response rate was 69%. The mean OHIP-14 score was 4.1 (standard deviation = 6.2). No problem was reported by 35% of the respondents. The most frequently reported problems were: physical pain (56%), psychological discomfort (39%) and psychological disability (30%). When the effect of all independent variables was analysed in multivariate analysis, self-rated oral health, frequency of dental visits, number of teeth, age and sex were significantly (P < 0.05) associated with the prevalence of having problems and frequent problems. Self-rated oral health had the strongest association with having problems [odds ratio (OR) 4.5; 95% confidence interval (CI) 3.4-6.0] and with having frequent problems (OR 4.0; 95% CI 2.7-5.8). Dental health behaviour, use of floss and toothpicks and oral rinsing were not associated with having problems related to oral quality of life in multivariate analyses. CONCLUSION. In this Norwegian adult sample, self-rated oral health, frequency of dental visits, number of teeth, age and sex were associated with having problems as estimated using the OHIP-14.

Temporomandibular disorders and oral health-related quality of life. A systematic review

OBJECTIVE

Oral health-related quality of life (OHRQoL) is considered an important aspect of different oral conditions. It has also gained increased attention in temporomandibular disorders (TMDs) in recent years. The purpose of this study was to systematically review the literature on OHRQoL and TMDs.

MATERIAL AND METHODS

A systematic search of the dental literature was performed using the Medline and Cochrane Library databases, supplemented by a hand search. Various combinations of search terms related to OHRQoL and TMDs were used. Among numerous titles found in Medline, abstracts and eventually full papers of potential interest were reviewed. Twelve papers fulfilled the inclusion criteria and were included in the review.

RESULTS

Most studies used the Oral Health Impact Profile, an instrument with good psychometric properties, for evaluation. All articles described a substantial impact on OHRQoL in TMD patients. Only a small proportion of all patients, a few percent, reported no impact at all. The difference between men and women was small and not significant. The impact appeared to be more pronounced in patients with more signs and symptoms. The perceived impact of pain on OHRQoL seems to be substantial. Two studies found that the impact increased with age among TMD patients.

CONCLUSIONS

The reviewed studies convincingly demonstrated that OHRQoL was negatively affected among TMD patients.

The meaning of oral health-related quality of life for elderly persons with dementia

OBJECTIVE

Studies of oral health developments increasingly include self-reported assessments of how oral health affects quality of life (QoL), referred to as "oral health-related QoL". People with dementia are often excluded in studies of oral health-related QoL and thus our aim in this study was to explore this area in elderly persons with dementia.

MATERIAL AND METHODS

Eighteen elderly individuals (aged between 78 and 94 years) with dementia of varying degrees of severity were interviewed with the aid of an interview guide; pictures and objects were used as stimulus material (triggers). The material was analyzed using grounded theory as point of departure, and a professional assessment of the oral health of the participants was used as reference.

RESULT

Four categories were identified: the ability to chew and eat, independence, oral problems, and teeth are important. These factors are largely consistent with those that have emerged in earlier studies of the elderly, but in some cases less pronounced in persons with dementia.

CONCLUSION

The use of triggers is a positive way to communicate oral health-related QoL among persons suffering from dementia, although the material used in this study needs further evaluation and development.

Oral health impact on quality of life in an adult Swedish population

OBJECTIVES

Oral health has a major impact on general quality of life. The aspects of oral health that are most important for each individual vary, and quality of life is a construct and not a measurable variable. The aim of this study was to describe the impact of oral health on quality of life in an adult Swedish population.

MATERIAL AND METHODS

The study comprised a stratified random sample of 519 individuals. The OHIP-14 questionnaire was used and the answers were rated on a scale of 0-4.

RESULTS

Twenty-one percent of the respondents stated that they had no oral problems related to well-being, and 79% had some form of problem related to quality of life. The mean value for the entire population was 6.4 (SD = 7.1); 5.9 (SD = 7.1) for men and 6.8 (SD = 7.2) for women. Of individuals who stated that they had oral problems, the majority were women aged 20 years. Nineteen percent of 30-year-old men and 53% of 70-year-old women stated that they had had problems that had made life less satisfactory. Individuals who frequently experienced problems related to oral health, with scores of 16-41 points, accounted for 10%.

CONCLUSION

In this Swedish population, a number of individuals, young and old, experienced oral problems that had an impact on their well-being.

Attitudes to oral health among adolescents with high caries risk

OBJECTIVE

To explore and describe attitudes to oral health among adolescents with high caries risk.

MATERIAL AND METHODS

A strategic selection of 45 subjects (15 to 19 years of age) assessed with high caries risk were invited to participate in the study, and 7 girls and 10 boys gave their informed consent. Semi-structured interviews performed, recorded, and transcribed verbatim were evaluated using qualitative content analysis.

RESULTS

Three categories and seven associated subcategories could be determined, and cognitive consistency in parallel with emotional inconsistency in relation to oral health was disclosed. On a cognitive level, attitudes to oral health were characterized by an awareness of the determinants (diet, plaque, fluoride) for caries. Fresh breath and even, white, teeth were considered signs of good oral health. Breath and esthetic appearance were important inducements for home care. Although toothbrushing was considered the most important activity for maintaining good oral health, forgetfulness and lack of time were the main reasons for not brushing. The provision of adequate information on caries risk was perceived as important. On the emotional level, the three subcategories were: (i) a positive attitude to oral health and clear self-confidence that improved health would be achieved, (ii) an impassive attitude that everything would be all right and fixed by the dentist, and (iii) a negative attitude characterized by frustration and a tendency to give up.

CONCLUSIONS

Allowing adolescents with high caries risk to relate their views on oral health is important for dental professionals when encouraging patients at caries risk towards healthy behavior.

The concept of positive health: a review and commentary on its application in oral health research

Although the concept of positive health has been around for more than 60 years, acceptable measures of this construct have yet to emerge. Potential explanations are that there is no consensus on how it is to be defined and its ambiguous status with respect to medical and socioenvironmental models of health. In this paper we review definitions of positive health, the origins of these definitions, the way the concept of positive outcomes has been used in research on the outcomes of oral and orofacial conditions and assess whether the concept of positive health has any merit in terms of applied oral health research. This literature reveals many competing and imprecise definitions, many of which are similar to other constructs, such as well-being. Most are lacking empirical referents or indicators. In examining the literature on oral health we found five distinct, although overlapping, ways in which the concept of positive health has been framed: (i) positive health as the absence of negative health states; (ii) positive health as positively worded items; (iii) the positive outcomes of oral health; (iv) positive oral health as a set of psychological and social attributes, and (v) the positive outcomes of chronic conditions such as oro- and craniofacial differences. Each of these ways can be challenged on conceptual or methodological grounds. For example, the states that comprise the upper end of the negative-positive health continuum have not been defined and health states and determinants of health are often confused. Moreover, the meaning of responses to health status questionnaires and the interpretation of accounts of the illness experience is often unclear. Nevertheless, the notion of positive health, irrespective of its merits and public policy implications, provides a context for methodological and theoretical debate that can only serve to enrich theory and practice with respect to measures of health and quality of life and therapeutic interventions at the individual and population.

Spanish version of the Oral Health Impact Profile (OHIP-Sp)

Background

The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aims of this study were to develop a Spanish version (OHIP-Sp) of the Oral Health Impact Profile and to evaluate its convergent and discriminative validity, and its internal consistency.

Methods

The original 49-items OHIP was translated to Spanish, revised for understanding and semantics by two independent dentists, and then translated back to English by an independent bilingual dentist. The data originated in a cross sectional study conducted among high school students from the Province of Santiago, Chile. The study group was sampled using a multistage random cluster procedure yielding 9,203 students aged 12–21 years. All selected students were invited to participate and all filled a questionnaire with information on socio-demographic factors; oral health related behaviors; and self-reported oral health status (good, fair or poor). From this group, 9,163 students also accepted to fill a detailed questionnaire on socio-economic indicators and to receive a clinical examination comprising direct recordings of clinical attachment levels (CAL) in molars and incisors, tooth loss, and the presence of necrotizing ulcerative gingival lesions.

Results

The participation rate and the questionnaire completeness were high with OHIP-Sp total scores being computed for 9,133 subjects. Self-perceived oral health status was associated with the total OHIP-Sp score and all its domains (Spearman rank correlation). The OHIP-Sp total score was also directly associated with the 4 dental outcomes investigated (Mann-Whitney test) and the largest impact was found for the outcomes, 'tooth loss' with a mean OHIP-Sp score = 13.5 and 'CAL >= 3 mm' with a mean OHIP-Sp score = 13.0.

Conclusion

The OHIP-Sp revealed suitable convergent and discriminative validity and appropriate internal consistency (Cronbach's α). Further studies on OHIP-Sp warrant the inclusion of populations with a higher disease burden; and the use of test-retest reliability exercises to evaluate the stability of the test.

Oral health related quality of life is affected by disease activity in Behçet's disease

OBJECTIVES

This study aimed to investigate oral and general health related quality of life (QoL) in patients with Behçet's Disease (BD) and to assess the performance of Turkish versions of oral health related quality questionnaires.

SUBJECTS AND METHODS

Ninety-four BD patients, 24 patients with recurrent aphthous stomatitis (RAS), 113 healthy controls (HC) and 44 dental patients were investigated. QoL was assessed by oral health impact profile-14 (OHIP-14), oral health related quality of life (OHQoL) and short form-36 (SF-36) questionnaires.

RESULTS

OHQoL, OHIP-14 and SF-36 subscale scores were significantly worse in patients with BD compared with those in HC (P < 0.05). Both OHIP-14 and OHQoL scores were significantly worse in active patients compared with inactives in BD and RAS (P < 0.05). Scores of SF-36 Role physical, Role emotional and Vitality were also lower in active patients than in inactives in BD (P < 0.05). Scores of OHIP-14 and OHQoL were significantly worse in patients treated with colchicine compared with those treated with immunosuppressives (P < 0.05).

CONCLUSIONS

Both oral and general QoL was impaired in BD and associated with disease activity and treatment modalities. Translated Turkish versions of OHIP-14 and OHQoL were also observed to be valid and reliable questionnaires for further studies.

Factors associated with oral health-related quality of life in institutionalized elderly

OBJECTIVE

The aim of this study was to investigate factors associated with the oral health-related quality of life (OHRQoL) of institutionalized elderly in Germany.

MATERIAL AND METHODS

One-hundred-and-fifty-eight subjects from old people's homes were selected (mean 82.8 years). OHRQoL was measured using the Oral Health Impact Profile (OHIP). Denture characteristics (kind and age of denture, retention of removable denture, number of teeth in static occlusion) and general issues (age, gender, education level, and general pain status) were assessed. All factors were subjected to bivariate testing for their effects on the OHIP summary score (OHIP-SC) and to multivariate testing in subjects with removable dentures (n = 128); a linear regression model with backward elimination was used, with OHIP-SC as the dependent variable.

RESULTS

In the context of other studies, a median OHIP-SC of 29 indicated highly impaired OHRQoL. According to the bivariate analysis, retention, age of denture, number of teeth in static occlusion, general pain status, and education all exhibited significant influence on OHIP-SC. In the final linear regression model, general pain status, education level, and retention of denture remained at a statistically significant level. The model explained 34% (R2 = 0.34) of the variance of the OHIP-SC. The kind of denture had no significant impact on OHIP-SC.

CONCLUSIONS

In contrast to other groups, the kind of denture exhibited little impact on OHIP-SC for this highly specific collective. However, there were functional aspects of dentures which seemed to be important. Non-dental factors had a striking effect on OHRQoL.

Assessing the impact of oral health on the life quality of children: implications for research and practice

Traditionally, child oral health has been assessed using clinical parameters of disease and deformity. However, there is a growing interest in the psychosocial impact of oral health among children. This commentary outlines the value and need for assessing child oral health-related quality of life (COHQoL). COHQoL has implications for oral health needs assessment (at an individual and population level) and for evaluating outcomes from specific treatments, initiatives and dental services overall. In addition, it could prove to be a useful adjunct tool for evidence-based dentistry research and practice. Theoretical and practical considerations in assessing the complex psychosocial construct of oral health among children are discussed: the use of general versus oral health-specific measures, the development of tools for children, the use of generic versus condition-specific measures, and the measurement of 'positive' oral health. Recommendations for research and practice are presented.

How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples

Age and loss of teeth can be expected to have a complex relationship with oral health-related quality of life. This study aimed to explain how age and tooth loss affect the impact of oral health on daily living using the short form, 14-item Oral Health Impact Profile (OHIP-14) on national population samples of dentate adults from the UK (1998 UK Adult Dental Health Survey) and Australia (1999 National Dental Telephone Interview Survey). After correcting for key covariables, increasing age was associated with better mean impact scores in both populations. Those aged 30-49 years in Australia showed the worst (highest) scores. In the UK, those aged under 30 showed the highest scores. In both countries, adults aged 70+ showed much better scores than the rest (P < 0.001). When corrected for age, the independent effect of tooth loss was that the worst scores were found where there were fewer than 17 natural teeth in the UK and fewer than 21 teeth in Australia. People with 25 or more teeth averaged much better scores than all other groups (P < 0.001), although there were differences in pattern between countries. When Australians were analysed by region of birth, the pattern of scores by tooth loss for British/Irish immigrants was strikingly similar to that for the UK sample. First-generation immigrants from elsewhere showed much worse overall scores and a profoundly different pattern to the Australian- and British-born groups. Age, number of teeth and cultural background are important variables influencing oral health-related quality of life.