Effect of a comprehensive plan for periodontal disease care on oral health-related quality of life in patients with periodontal disease in Taiwan

Knowledge, attitudes, and practice related to tooth loss and dentures among patients with dental arch deficiencies

BACKGROUND

Tooth loss is a common problem that affects many people worldwide. Exploring knowledge, attitude, and practice (KAP) among patients can identify barriers and challenges in following recommended practices, providing valuable insights for dental healthcare providers, policymakers, and researchers. This study aimed to explore the KAP of patients with dental arch deficiencies regarding tooth loss and dentures.

METHODS

This web-based, cross-sectional study was conducted among patients with dental arch deficiencies using a self-designed questionnaire.

RESULT

3166 valid questionnaires were included. Participants' mean KAP scores were 6.84 ± 2.27 (possible range: 0 ~ 12), 39.4 ± 3.72 (possible range: 9 ~ 45), and 27.7 ± 4.36 (possible range: 8 ~ 40), respectively. Multivariable logistic regression analysis showed that knowledge (OR = 1.383), employed (OR = 1.805), family history (OR = 2.158), and treatment (OR = 1.683) were independently associated with attitude. Moreover, knowledge (OR = 1.239), attitude (OR = 1.250), female (OR = 0.619), age (OR = 0.967), college/bachelor (OR = 0.373), and master and above degree (OR = 0.418), employed (OR = 0.554) or student (OR = 0.434), with 10,001-20,000 Yuan household income per month (OR = 0.492), have been married (OR = 0.609), smoking (OR = 0.595), drinking (OR = 0.397), disease duration (OR = 0.972), with family history (OR = 1.676), and with treatment (OR = 3.492) were independently associated with practice (all P < 0.05).

CONCLUSION

Patients with dental arch deficiencies have insufficient knowledge, positive attitudes, and moderate practice toward tooth loss and dentures, which might be affected by multiple demographic factors.

The oral health impact of dental hygiene and dental therapy populations: a systematic review

OBJECTIVES

Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals.

METHODS

The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review.

RESULTS

After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60.

CONCLUSIONS

This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.

The Influence of Periodontal Disease on Oral Health Quality of Life in Patients with Cardiovascular Disease: A Cross-Sectional Observational Single-Center Study

Background and Objectives: Cardiovascular disease is a leading cause of global death with a rising prevalence and a heavy economic burden. Periodontal disease has been associated with cardiovascular diseases—including incident coronary heart disease, peripheral artery disease and ischemic stroke. The study evaluates the quality of life of patients with cardiovascular and periodontal disease from the point of view of oral health by using the short version of the Oral Health Impact Profile (OHIP-14) questionnaire. Materials and Methods: This study included a total of 221 patients (61.86 ± 15.03 years old) selected from the Emergency Hospital of Sibiu, Romania. The participants self-completed the OHIP-14 questionnaire and they benefited from an oral health examination conducted to assess the presence and the severity of periodontal disease. Results: Out of the 147 patients with cardiovascular disease, 77.5% had periodontal disease (32.6% stage I, 29.2% stage II, and 15.6% stage III and IV). The presence of periodontal disease was associated with a lower oral-health-related quality of life (p < 0.001, ANOVA) and with a higher OHIP-14 score in patients with cardiovascular disease (18.67 ± 8.17, p < 0.001 ANOVA). No significant difference was observed concerning patient sex and background; however, age, body mass index and the lack of an appropriate oral hygiene routine had a strong association with the individual quality of life. The general OHIP-14 score was higher in patients with periodontal disease and associated cardiovascular disease, the presence of both cardiovascular and periodontal disease being associated with a lower quality of life. Conclusions: By increasing the patients’ awareness to oral healthcare measures, better outcomes and improved oral-health-related quality of life could be observed.

Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology

BACKGROUND/PURPOSE

Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology (EFP), this consensus report aimed to develop treatment recommendations for treating periodontitis in the Taiwanese population.

METHODS

The report was constructed by experts from the Taiwan Academy of Periodontology. The following topics were reviewed: (a) the prevalence of periodontitis in Asia and current status of treatment in Taiwan; (b) specific anatomical considerations for treating periodontitis in Asians; (d) educational and preventive interventions and supragingival plaque control; (d) subgingival instrumentation and adjunctive treatment; (e) surgical periodontal therapy; and (f) maintenance and supportive periodontal care. Recommendations were made according to the evidences from the EFP CPG, the published literature and clinical studies in Asians, and the expert opinions.

RESULTS

The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population.

CONCLUSION

The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population, and anatomical variations should be cautious when the treatment is delivered.

A retrospective study of orthodontic treatment on anterior tooth displacement caused by periodontal disease

This retrospective study aimed to explore the effect of orthodontic treatment (ODT) on anterior tooth displacement (ATD) caused by periodontal disease (PD).A total of 72 patients were selected and were divided into a control group (n = 36) and an experimental group (n = 36). Patients in both groups received conventional periodontal treatment. In addition, patients in the experimental group also received ODT. Outcomes include probing depth, percentage of bleeding sites, clinical attachment loss, clinical crown length, tooth root length, and periodontal tissue of the affected tooth (alveolar bone height, periodontal pocket depth, bleeding index).After treatment, the patients in the experimental group achieved more improvements in probing depth (P < .01), percentage of bleeding sites (P < .01), clinical attachment loss (P < .01), clinical crown length (P = .04), and periodontal tissue of the affected tooth (periodontal pocket depth (P < .01), and bleeding index (P < .01)), than those of patients in the control group.This study suggests that ODT is beneficial for ATD caused by PD. Future studies are still needed to verify the findings of this study.

Periodontal disease and quality of life: Umbrella review of systematic reviews

This umbrella review appraised existing systematic reviews and meta-analysis to establish the impact of periodontal disease and therapy on general and oral health-related quality of life. A systematic electronic literature search was carried out in accordance with the PRISMA guideline up to January 2020 using PubMed, LIVIVO, EMBASE and OpenGrey (PROSPERO CRD 42020163831). Hand searching was performed through the reference lists of periodontal textbooks and related journals. All English language-based systematic reviews and meta-analysis that assessed the impact of periodontal disease and treatment interventions on general and oral health-related quality of life were included. Overall, eight articles met the inclusion criteria and their methodological quality was assessed using the AMSTAR2 criteria. Two systematic reviews showed a significant impact of oral conditions on general health-related quality of life, although the specific impact of periodontal disease remains inconclusive. Three systematic reviews established a negative impact of periodontal disease on oral health-related quality of life. Another three systematic reviews concluded that periodontal treatment can improve oral health-related quality of life. Oral conditions, like periodontal disease, can impact the general health-related quality of life. Periodontal disease is negatively correlated with oral health-related quality of life, although treatment interventions can improve self-reported quality of life. In view of the heterogeneity of generic instruments currently utilized to assess the self-reported quality of life of periodontal patients, the development of a general and oral health-related quality of life instrument specific for periodontal disease is strongly recommended.

Non-surgical periodontal therapy effectively improves patient-reported outcomes: A systematic review

AIM

Modern lifespan oral health research focuses on understanding the impact of periodontitis (or therapy) on clinical and patient-based outcome measures to provide effective care, improve patient safety according to the quality standards. For better targeted intervention and effective disease management, this systematically review aimed to investigate the relationship between non-surgical periodontal therapy and patient-based outcomes using OHIP-14.

METHODS

Seven Databases were searched for studies on patient-based outcomes responses to periodontal treatment. The time-period defined from search was from January 1977 to January 2019. Two independent reviewers carried out data search, selection of studies, data extraction and quality assessment using Mixed Method Appraisal Tool. Prospective cohort studies, intervention studies and observational studies written in English demonstrating non-surgical periodontal therapy response on the patient-reported outcomes (using Oral Health Impact Profile 14) were included in the review.

RESULTS

Thirteen studies were included in the review, which comprised of three randomised control trials, nine case series, and one was a quasi-experimental study. Eleven out of the 13 studies reported significant improvement in OHIP-14 scores amongst participants who had undergone non-surgical periodontal therapy. Physical disability, psychological discomfort and functional limitation were domains that improved significantly after non-surgical periodontal therapy in these studies. Physical pain was a common finding in short-term follow-up but improved significantly in long-term follow-up studies.

CONCLUSION

Based on clinical and patient-based outcomes measurement, it is recommended that non-surgical periodontal therapy is a "gold standard" approach towards improving patient-based outcomes, reducing co-morbidities and enhancing patient safely immediately and in long term.

The impact of nonsurgical periodontal treatment on oral health-related quality of life: a systematic review and meta-analysis

OBJECTIVE

To estimate the impact of nonsurgical periodontal treatment (NSPT) on patients' oral health-related quality of life (OHRQoL). The focused question for this systematic review was: in adults patients with periodontitis, does NSPT improve oral health-related quality of life?

MATERIAL AND METHODS

Five databases (PubMed, CIHNL, EMBASE, LILACS and CENTRAL) were searched up to April 2019 (PROSPERO CRD42018103393). Intervention trials and cohort studies assessing the OHRQoL data of adults with periodontitis, enduring non-surgical periodontal treatment (NSPT) were eligible for inclusion. Subgroup random-effects meta-analysis was conducted methodically.

RESULTS

Overall, 491 studies were retrieved, out of which 19 met the inclusion criteria. Two randomized clinical trials (RCTs) and ten cohort studies were further analysed. Seven cohort studies were included in the statistical analysis. Subgroup meta-analyses of cohort studies revealed that NSPT improves in average 2.49 (95% CI 0.95-4.02), 8.94 (95% CI 6.89-10.99) and 6.49 (95% CI 5.11-7.88) OHRQoL levels at 1-2 weeks, 3-4 weeks and 6-12 weeks of post-treatment, respectively.

CONCLUSIONS

NSPT procedures greatly improve the oral health-related quality of life within a short time, remaining stable after 3 months of treatment.

CLINICAL RELEVANCE

This systematic review brings forward summary evidence that NSPT improves the OHRQoL in adults with periodontitis from a patient-centred perception and remain stable in the short term.

Impact of One-Stage Full Mouth Disinfection and Periodontal Surgery on Oral Health-Related Quality of Life

Statement of the Problem

Information on patient-centered outcomes of periodontal disease and the impact of different periodontal treatment phases on the life quality of periodontal patients is limited.

Purpose

This study sought to compare patients' perception of their oral health-related quality of life (OHQoL) following one-stage full mouth disinfection (OSFMD) and surgical periodontal treatment.

Materials and Method

A pre-and post-interventional study design was conducted in two phases on a single group of patients. Subjects were recruited from moderate to severe chronic periodontitis patients referred to a private clinic. At baseline and after each treatment phase, periodontal parameters were recorded by a blind examiner. Patients received OSFMD, followed by periodontal flap surgeries and completed the validated Iranian version of the OHIP-49 questionnaire (OHIP-35-IR) at three time points (baseline, two weeks post-initial therapy and after completion of surgical phase). Data were analyzed using repeated measure ANOVA, paired and independent t-tests, and multivariate regression analysis by SPSS software version 21.

Results

38 patients (14 men, 24 women, mean age 40.30±11.93) completed the study. Periodontal parameters showed progressive improvement from baseline to the end of the study (p< 0.05). The total mean OHIP-35-IR score at baseline (89.25±19.26) was significantly improved (reduced) compared to each treatment phase (75.63±17.15 and 74.22±15.46, respectively; p< 0.001), with no significant difference between treatments. Improvements in subdomains of psychological discomfort, functional limitation, physical pain, and handicap accounted for the changes. The effect size was calculated to be 0.80 for the first and 0.66 for the second treatment phases.

Conclusion

Within limits, OSFMD and periodontal surgical treatment have positive impacts on the OHQoL of patients. Intensive periodontal non-surgical treatment is as effective as surgical intervention for achieving desirable patient-centered outcomes.

Impact of One-Stage Full Mouth Disinfection and Periodontal Surgery on Oral Health-Related Quality of Life

STATEMENT OF THE PROBLEM

Information on patient-centered outcomes of periodontal disease and the impact of different periodontal treatment phases on the life quality of periodontal patients is limited.

PURPOSE

This study sought to compare patients' perception of their oral health-related quality of life (OHQoL) following one-stage full mouth disinfection (OSFMD) and surgical periodontal treatment.

MATERIALS AND METHOD

A pre-and post-interventional study design was conducted in two phases on a single group of patients. Subjects were recruited from moderate to severe chronic periodontitis patients referred to a private clinic. At baseline and after each treatment phase, periodontal parameters were recorded by a blind examiner. Patients received OSFMD, followed by periodontal flap surgeries and completed the validated Iranian version of the OHIP-49 questionnaire (OHIP-35-IR) at three time points (baseline, two weeks post-initial therapy and after completion of surgical phase). Data were analyzed using repeated measure ANOVA, paired and independent t-tests, and multivariate regression analysis by SPSS software version 21.

RESULTS

38 patients (14 men, 24 women, mean age 40.30±11.93) completed the study. Periodontal parameters showed progressive improvement from baseline to the end of the study (p< 0.05). The total mean OHIP-35-IR score at baseline (89.25±19.26) was significantly improved (reduced) compared to each treatment phase (75.63±17.15 and 74.22±15.46, respectively; p< 0.001), with no significant difference between treatments. Improvements in subdomains of psychological discomfort, functional limitation, physical pain, and handicap accounted for the changes. The effect size was calculated to be 0.80 for the first and 0.66 for the second treatment phases.

CONCLUSION

Within limits, OSFMD and periodontal surgical treatment have positive impacts on the OHQoL of patients. Intensive periodontal non-surgical treatment is as effective as surgical intervention for achieving desirable patient-centered outcomes.

Application of the Integrated Behavioral Model to oral self-care behavior of community-dwelling middle-aged and older people in Taiwan

OBJECTIVES

This study evaluated the Integrated Behavioral Model and examined oral self-care behavior of community-dwelling middle-aged and older people.

DESIGN

A cross-sectional design was used.

SAMPLE

Purposive sampling was employed to recruit middle and older age community-dwelling individuals, with research locations in public health centers in northern Taiwan.

MEASUREMENTS

Structured questionnaires comprised: participant demographics, oral health literacy, oral self-care attitude, self-efficacy, intention, and behavior, and significant others' perceptions and beliefs as well as environmental constraints. The Model verification was evaluated by path analysis.

RESULTS

Two hundred and sixty-three participants (N = 263) completed the questionnaire survey. Results identified significant direct effects of the independent variables of oral health care literacy, intention of oral self-care, and perception of environmental constraints on the dependent variable of oral self-care behavior; and significant indirect effects on attitude of oral self-care, perception of significant other beliefs, self-efficacy of oral self-care.

CONCLUSION

Public health nurses work with the whole community and can potentially improve the oral self-care behavior of middle-aged and older adults by enhancing their oral health knowledge, maintaining their positive attitudes, assisting acceptance of recognition and support from others, increasing their ability to perform oral self-care, reducing environmental constraints, and thereby enhancing their oral self-care awareness.