Discrepancies between self-ratings of and satisfaction with oral health in two older adult populations

Tooth loss and depression in Chilean participants of the National Health Survey 2016-2017: Oral and social functions mediation analysis

BACKGROUND

Previous studies have indicated the association between poor oral health and depression in adults. This study evaluated oral and social functions contribution to the association between tooth loss and depressive symptoms in Chilean individuals.

METHODS

We used data from the Chilean National Health Survey. The number of remaining teeth (≤19 versus ≥20 teeth) and anterior tooth losses were the exposure variables. Outcome was depression, measured through a self-report question and with the Composite International Diagnostic Interview - Short Form (CIDI SF). Mediating variables were determined by five questions, including problems regarding "speaking", "pain and suffering", "eating", "daily activities", and "social relationships". We performed logistic regression models adjusted by multiple confounders variables. Finally, we calculated indirect, direct effect, total effect, and the proportion mediated (PM).

RESULTS

We included 5383 participants. The self-reported depression and suspected depression prevalence were 22,1 % and 14,0 % respectively. The total effect of fewer remaining teeth (≤19) on self-reported depression was 1.21 (95 % CI 1.02-1.44), and 1.09 (95 % CI 0.90-1.33) for suspected depression. All five variables of oral and social functions significantly mediated the association between tooth loss and depression. Feeling uncomfortable when speaking or eating discomfort were the most significant mediators.

LIMITATIONS

The mediation analysis should be interpreted with caution due to the cross-sectional design.

CONCLUSIONS

Deterioration of oral and social functions was a significant mediator in the association between tooth loss and depression, in particular feeling uncomfortable when speaking or eating. This mechanism should be considered in interventions to improve mental health.

Preventive dental service use and oral health-related quality of life in Brazilian older adults

BACKGROUND

Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL).

OBJECTIVE

To investigate the association between preventive dental service use and OHRQoL by older Brazilians.

MATERIALS AND METHODS

This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders.

RESULTS

The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]).

CONCLUSION

Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.

Establishing an empirical conceptual model of oral health in dependent adults: Systematic review

AIM

This qualitative evidence synthesis was performed to establish a conceptual model of oral health in dependent adults that defines the construct of oral health and describes its interrelationships based on dependent adults' and their caregivers' experiences and views.

METHODS

Six bibliographic databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, OATD, and OpenGrey. Citations and reference lists were manually searched. A quality assessment of included studies was conducted independently by two reviewers using the Critical Appraisal Skills Programme (CASP) checklist. The 'best fit' framework synthesis method was applied. Data were coded against an a priori framework and data not captured by this framework were thematically analyzed. To assess the confidence of the findings from this review, the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used.

RESULTS

Twenty-seven eligible studies were included from 6126 retrieved studies. Four themes were generated to further understand oral health in dependent adults: oral health status, oral health impact, oral care, and oral health value.

CONCLUSION

This synthesis and conceptual model offer a better understanding of oral health in dependent adults and subsequently provide a starting point to guide establishment of person-centred oral care interventions.

Residual dentition, prosthesis type and oral health-related quality of life in Uruguayan adults

OBJECTIVES

To investigate the association between different types of dental prostheses (and residual dentition) and oral health-related quality of life (OHRQoL).

METHODS

A population-based study with a representative sample of adults and older adults in Uruguay (2010-2011). The dependent variable was the score on the oral impact on daily performance (OIDP), and the main predictor was the pattern of tooth loss and prosthesis use. Covariates included sex, age, socioeconomic status, education, missing teeth, pain and decayed teeth. Negative binomial regression was used.

RESULTS

The sample comprised 762 participants. Those participants not wearing a prosthesis and with extensive tooth loss had a mean OIDP of 3.1 (95% CI = 1.6-6.2), while those wearing removable partial dentures (RPD) and having <12 missing teeth had a mean OIDP of 3.6 (95% CI = 1.3-10.0). Participants with a free-end saddle had the highest mean OIDP, at 4.9 (95% CI = 2.0-12.1). For participants with ≤12 missing teeth, any additional missing tooth was associated with an 11% higher OIDP score. Participants who wore RDPs reported fewer impacts on OHRQoL if they had extensive tooth loss or anterior tooth loss than those with a free-end saddle, or who had lost fewer teeth.

CONCLUSIONS

The use of RPDs is associated with better OHRQoL. These findings may be valuable in clinical practice and prosthetic planning.

Adverse Impacts of Temporomandibular Disorders Symptoms and Tooth Loss on Psychological States and Oral Health-Related Quality of Life During the COVID-19 Pandemic Lockdown

Background

Emotion and quality of life may have been impacted by the coronavirus disease 2019 (COVID-19) crisis, especially in the lockdown. The impact of temporomandibular disorders (TMD) symptoms and tooth loss on mental status and Oral Health-Related Quality of Life (OHRQoL) are not fully understood in a stressful situation.

Objectives

We aimed to investigate whether TMD and tooth loss were the impaired risks of psychological states and OHRQoL in COVID-19 lockdown, and attempt to explore other potential risk factors.

Methods

This cross-sectional study surveyed residents via an online self-reported questionnaire, when Yangzhou was in lockdown. Demographic data, clinical information, the level of anxiety, depression and OHRQoL were collected and analyzed.

Results

Painful TMD symptoms and tooth loss are the risks of more severe anxiety and depression. TMD symptoms and tooth loss worsened OHRQoL. Lower education degree (OR: 6.31, P = 0.019), TMD-related pain symptoms (OR: 10.62, P = 0.005), tooth loss (OR: 3.12, P = 0.035), sleep disorders (OR: 2.92, P = 0.049) and relatively close contacts (OR: 3.95, P = 0.020) were verified as risk factors for increased level of anxiety. With respect to depression, low socio-economic status (OR: 6.22, P = 0.021), TMD-related pain (OR: 7.35, P = 0.012), tooth loss (OR: 4.48, P = 0.009), sleep disorders (OR: 5.13, P = 0.007) and relatively close contacts (OR: 12.94, P = 0.001) were identified as independent factors for developing depression. Additionally, drinking (B: −2.584, P = 0.013) and never going to the dental clinic (B: −3.675, P = 0.024) were relevant to better OHRQoL, while TMD without pain (B: 2.797, P = 0.008), TMD-related pain (B: 12.079, P < 0.001), tooth loss (B: 2.546, P = 0.006), sleep disorders (B: 2.598, P = 0.003) were independent factors for impaired OHRQoL.

Conclusion

Painful TMD symptoms, tooth loss and sleep disorders were the impaired risks of psychological states. TMD symptoms and tooth loss damaged OHRQoL when the city was in lockdown. Therefore, individualized psychological counseling is supposed to maintain control of mental health and OHRQoL under the stressful event.

The use of Oral Health Impact on Daily Living (OHIDL) transition scale in measuring the change in oral health-related quality of life among older adults

Background

This longitudinal study aimed to evaluate the longitudinal validity and reliability of the Oral Health Impact on Daily Living (OHIDL) transition scale and measure the perceived change in oral health-related quality of life (OHRQoL) after dental treatments among older adults.

Methods

OHIDL was administered to older adults who sought dental treatments. Participants were asked to assess changes in impact for each OHIDL item retrospectively compared with that before the treatment. The responsiveness, minimal clinically important difference (MCID), internal consistency and test–retest reliability of the OHIDL transition scale were evaluated. Multiple linear regression was employed to predict the change in oral health impacts after dental treatment. Beta coefficients (β) and 95% confidence intervals (CI) were reported.

Results

One hundred and seventy-six participants were followed-up with upon completing their dental treatments. The follow-up rate was 70.4% (176/250). The OHIDL transition score strongly correlated with the global rating of change (r_s = 0.76, P < 0.01). MCID was determined by participants who reported “a little improved” in the perceived oral health impacts, and their mean transition score was 3.3. Cronbach’s alpha of the transition scale was 0.87, and many items had a test–retest correlation of at least 0.60. Patients who perceived more oral health impacts at baseline as measured by the total intensity score (β = 0.32, 95% CI: 0.20, 0.44, P < 0.001) and those who had received endodontic treatment (β = 8.04, 95% CI: 4.36, 11.71, P < 0.001) would have more improvement in perceived oral health impacts.

Conclusions

The OHIDL transition scale has good psychometric properties and is sensitive to change over time. After receiving dental treatment, most of the study’s older adults perceived a lower intensity of OHIDL.

Clinical relevance

The OHIDL transition scale is a valid and reliable instrument to measure the change in OHRQoL after dental treatments.

The Association of Oral Health Status and socio-economic determinants with Oral Health-Related Quality of Life among the elderly: A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to determine the relationship between poor Oral Health-Related Quality of Life (OHRQoL) and oral health determinants (eg being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, decayed, missing filled teeth (DMFT) scores and periodontal diseases) among the elderly.

METHODS

Formal search strategies in PubMed, Scopus, Cochrane and Web of Science were performed to identify studies in English published before 1 December 2019. We assessed the impacts of the oral health determinants including being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, DMFT scores and periodontal diseases) on OHRQoL among elderly individuals. The data were analysed using Stata 12.0 software.

RESULTS

In total, 19 publications met the inclusion criteria of this meta-analysis. Findings indicate a positive association between low educational level (ie ≤8th grade), marital status, depression, smoking status, denture wearing, poor general health, tooth-induced pain, periodontal diseases and poor OHRQoL among the elderly. We also observed a negative association between DMFT, being older than 75 years of age on poor OHRQoL among the elderly.

CONCLUSIONS

This review identified that several oral health determinants were associated with poor OHRQoL. The efficacy of preventive measures and the economic aspects of tooth replacement approaches should be explored in the future. Developing oral healthcare plans and policies with the specific aim of improving OHRQoL among this group is essential.

Social capital and self-reported oral health at baseline of the brazilian longitudinal study of aging

OBJECTIVES

This cross-sectional study aimed to estimate the association between the structural and cognitive dimensions of social capital and self-reported oral health.

METHODS

This study conducted individual assessments of 9,365 individuals aged 50 years or older from Brazil. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical Poisson regression models to estimate the prevalence ratio of self-reported oral health with individual structural and cognitive social capital variables adjusted for associated factors.

RESULTS

Cognitive social capital was associated with self-reported oral health. Individuals who reported lack of neighbourhood trust and not having friends presented 14% (RP: 1.14; 95% CI: 1.07-1.21) and 9% (RP: 1.09; 95% CI: 1.01-1.19), respectively, higher prevalence of poor self-reported oral health, relative to those who trust in their neighbourhood and reported having friends.

CONCLUSION

The cognitive dimension of social capital may be linked with self-reported oral health. Therefore, social capital can be stimulated in the context of social policies as its encouragement can be an efficient tool for improving individuals' health and, consequently, the oral health of the older people.

Prevalence, Extent, and Severity of Oral Health Impacts Among Adults in Rural Karnataka, India

INTRODUCTION

Oral health affects quality of life. Many studies have investigated the factors associated with oral health-related quality of life (OHRQoL). Little is known about OHRQoL of adults living in rural and remote areas of India, where many have lower levels of education and limited availability of oral health care services.

OBJECTIVES

To determine the prevalence, extent, and severity of OHRQoL impacts associated with psychosocial factors, functional dentition, and patterns of dental visits among rural Indian adults between the ages of 35 and 54 y.

METHODS

A cross-sectional study was conducted with a multistage stratified sampling strategy targeting 35- to 54-year-olds. Interviews and oral examinations were performed to collect data on sociodemographic variables, Oral Health Impact Profile-14 (OHIP-14), patterns of dental visits, stress, tobacco and alcohol use, and dentition status. Univariate, bivariate, and multivariable analyses were done to determine the factors associated with prevalence, extent, and severity of OHIP-14 using SAS version 9.3.

RESULTS

There were 873 participants. Prevalence, extent, and severity of OHIP-14 were 13.4%, 0.5 (0.4-0.7), and 11.8 (11.2-12.5), respectively. The OHIP-14 impacts reported were not severe and mostly affected physical functioning. Levels of education, income, and number of functional teeth (FT) were inversely associated and last dental visit within the previous year was positively associated with prevalence, extent, and severity of OHIP-14. The prevalence of 1 or more oral health impacts was nearly 13% among rural middle-aged adults in India.

CONCLUSIONS

Low socioeconomic conditions, dental visits, and FT ≤19 were positively associated with prevalence, extent, and severity of oral health impacts.

KNOWLEDGE TRANSFER STATEMENT

This article provides data regarding OHRQoL of people in rural areas of a developing country. The study was intended to determine the factors associated with OHRQoL in rural people who are less educated and living in areas with minimal oral health care facilities. The findings of this study could potentially facilitate further research and health promotional activities for rural people of developing countries.

Quality of life related to tooth loss and prosthetic replacements among persons with dependency and functional limitations

Objectives: To examine if tooth loss or treatment with different prosthetic replacements are associated with oral health-related or health-related quality of life (OHRQoL or HRQoL) among persons with dependency and functional limitations.Material and Methods: Comparisons between results of questionnaires and clinical data (number of teeth, Eichner index, presence, type, and condition of prosthetic replacements) from a population of 180 individuals with dependency and functional limitations sampled from the register of increased financial support in Norrbotten County, Sweden.Results: The associations between clinical variables and the questionnaire responses were weak overall, e.g. Spearman's rho was 0.162 (p = .033) for correlation between number of teeth and GOHAI, 0.094 (p = .249) for number of teeth and OHIP, -0.070 (p = .356) for complete dentures and GOHAI, and -0.108 (p = .185) for complete dentures and OHIP.Conclusions: The weak associations between clinical variables and questionnaire results in the present study suggest that good results on measured QoL do not necessarily indicate good oral health. As we cannot expect this specific population to report oral disorders by themselves, regular check-ups are necessary.

Low concern rate with oral health and associated factors among older persons: a cross-sectional study

OBJECTIVE: This study aimed to assess the prevalence of concern with oral health and associated factors among older adults. METHODS: Individuals aged ≥60 years were included from the cities Cruz Alta and Veranópolis, Brazil. Oral health examination and a structured questionnaire were applied in 569 individuals. The main outcome was concern with oral health (yes or no), which was determined by a validated questionnaire. Uni- and multivariate analyses were conducted by Poisson regression with robust variance to assess the association between outcome and independent variables. RESULTS: The prevalence of concern with oral health was 30.58% (n = 174). Non-white individuals presented significantly higher prevalence ratio (PR) of being concerned about their oral health (PR = 1.28; 95% confidence interval [CI] 1.01–1.62). Individuals with medium or high level of education, not retired and without any health problems presented higher PR of being concerned with their oral health when compared to their controls (p < 0.05). Moreover, those that reported toothbrushing frequency ≥ 2 times/day (PR = 1.58; 95%CI 1.01 – 2.48) and non-edentulous (PR = 1.50; 95%CI 1.12 –2.01) also presented higher PR of being concern with their oral health. Older adults that were not concerned with tooth alignment (PR = 0.57; 95%CI 0.44 – 0.74) or tooth color (PR = 0.41; 95%CI 0.31 – 0.54) demonstrated lower concern with their oral health. CONCLUSION: Prevalence of concern with oral health among the older adults was low and associated with non-white individuals, medium and high level of education, individuals not retired, absence of health problems, higher toothbrushing frequency, mild temporomandibular disorder (TMD) and non-edentulism. Additionally, concern with esthetical aspects may be related with this outcome.

Dental Caries Experience and Oral Health Related Quality of Life in Working Adults

Objective

To evaluate effect of dental caries experience and untreated dental decay on Oral Health-Related Quality of Life (OHRQoL) in working adults.

Methods

The clinical records of 160 patients were reviewed. Dental health indicators were derived from individual tooth- and surface-level data allowing for calculating the number of decayed surfaces (D), number of decayed missed filled surfaces (DMFS), and significant caries (SiC) indices. A questionnaire was administered to verify demographic factors and OHRQoL. The questionnaire was administered via face-to-face interview, for patients in the hospital; or via telephone interview, for those who could not complete it during their hospital visit. Models were developed using multivariable linear regression to predict total OHIP-14 scores and examine the simultaneous association of independent and outcome variables. The model was adjusted for age, gender, and nationality..

Results

Physical limitation and psychological discomfort were the most frequent impacted domains, affecting 17.1% and 7.5% of subjects, respectively. Painful aching was the most frequent item to have any impact, affecting 64.4% of the subjects. The results of multivariable analysis indicated that the SiC score could statistically significantly predict the Oral Health Impact Profile (OHIP) score, P=0.0003. In the linear regression model, for participants with DMFS equal to or higher than the SiC, on average, OHIP scores were almost 10 points higher than for participants with DMFS below the SiC.

Conclusion

The more the dental decay the higher the impact on OHRQoL. From a dental public health perspective, using OHRQoL as a need assessment tool, along with dental clinical indicator, can be helpful in planning and targeting public health programs for the most in-need adult populations.

Clinical Significance

This study identified that patients with severe dental caries report poorer OHRQoL. Clinicians should be aware of impacts that dental decay may have on OHRQoL, including physical, psychological concerns, and pain.

Influence of oral health literacy on dissatisfaction with oral health among older people

OBJECTIVE

To investigate the influence of oral health literacy (OHL) and associated factors on dissatisfaction with oral health (DOH) among older people.

BACKGROUND

Oral health literacy is a recent field of research that has been considered an important mediator between socioeconomic variables and oral health outcomes. However, there are few studies with older people.

MATERIALS AND METHODS

A cross-sectional study was conducted with 535 non-institutionalised older people aged 60-100 years from Brazil. Individuals completed a questionnaire on general health, sociodemographic information and usual reason for dental visit. OHL was assessed using the Health Literacy in Dentistry questionnaire (HeLD-14), validated in Brazil. DOH was the outcome of interest. Poisson regression with robust standard errors was applied as a statistical model to estimate bivariate and multivariable relationships of DOH with OHL after adjusting for sex, age, social characteristics and general health using the P-value of ≤ .05.

RESULTS

The overall prevalence of DOH was 21.1%. Multivariable regression analysis showed that older people with low OHL (HeLD-14 score ≤35) had 1.28 times the odds of having DOH than those with high OHL (HeLD14 score >46), after adjusting for sociodemographic, economic and health outcomes.

CONCLUSIONS

Dissatisfaction with oral health in older people is a complex issue associated with OHL, social and behavioural factors. Health services should give greater attention to developing health literacy competences in older adults in order to empower them to achieve optimal oral health.

Validation of the Oral Health Impact on Daily Life Questionnaire (OHIDL) among Hong Kong older adults

BACKGROUND

The Oral Health Impact on Daily Life Questionnaire (OHIDL) was developed through a qualitative study to measure oral health-related quality of life, including intensity and bother measurements, among older adults in Hong Kong. The instrument comprises 20 items divided into eight domains.

OBJECTIVES

This study describes the psychometric properties of the OHIDL and refines the instrument through validity and reliability testing.

MATERIALS AND METHODS

The OHIDL was administered to older adults who attended dental clinics for general dental treatments. Items with low discriminant ability were to be eliminated. Construct validity was assessed through convergent, divergent and factorial validity. Criterion validity was investigated by assessing the correlation between the measurements and the global questions. Reliability was assessed with Cronbach's alpha.

RESULTS

In total, 306 participants (mean age: 69.6 years) completed the interviews. Two items for which over 90% of the participants reported no impact and two items with poor discriminant validity were eliminated. Both intensity and bother measurements demonstrated good construct and criterion validity, with the intensity measurement showing better performance being selected for the OHIDL to reduce the respondents' burden. The intensity measurement also showed satisfactory internal consistency.

CONCLUSIONS

The refined OHIDL with 16 items in seven domains is valid and reliable in measuring the oral health impacts on daily life among Hong Kong older adults.

A systematic scoping review of oral health models

PURPOSE

The purpose of this systematic scoping review was to identify, analyze, and compare existing generic oral health models in English scientific dental literature.

METHODS

We conducted a literature search in five databases, Ovid Medline, Embase, PsycINFO, Cochrane, and Web of Science, using pre-determined inclusion and exclusion criteria and calculated the interrater agreement coefficient "prevalence-adjusted bias-adjusted kappa" (PABAK). We identified, reviewed, and displayed the generic oral health models in review tables.

RESULTS

Of the 3498 references identified, 13 oral health models from seven countries met the inclusion criteria. The interrater agreement coefficient resulted in a ''substantial agreement'' (PABAK = 0.80). Ten of the 13 (77%) generic oral health models were developed in English-speaking countries. All models were multidimensional and contained from two to 12 dimensions. Four models presented linear conception, and we observed non-linear conception in six models. Authors presented the unidirectional or reciprocal relations between dimensions in six models, and five models, respectively. Two models did not show models' relation or conception. Researchers used only experts (N = 1), literature (N = 2), dental patients (N = 2), or general population subjects (N = 3), or a combination of these sources (N = 5) for development of their generic oral health models. Statistical analyses supported the majority of the models (N = 8).

CONCLUSIONS

The identified 13 oral health models vary substantially in their characteristics. This systematic scoping review of generic oral health models provides a toolbox, from which dental researchers can choose the theoretical model they consider fit best their oral health concept they want to investigate. Ideally, the international dental community will come soon to an agreement of accepting one oral health model, and this will provide an opportunity for comparison of outcomes across studies and populations and thus elevate dentistry to a higher evidence-based level.

[The association between normative and subjective oral health conditions and dissatisfaction with dental services among adult Brazilians]

The prevalence of dissatisfaction with dental services and its association with normative and subjective oral health conditions among adult Brazilians was evaluated. This cross-sectional study used data from the last Brazilian National Oral Health Survey (SBBrasil), conducted in 2010. It was considered a representative sample of the adult Brazilian population. Data were analyzed by descriptive, univariate and multiple statistics (OR / 95% CI), with correction by the design effect. Among the 4539 adults included in the study, 614 (13.4%) reported dissatisfaction with dental services. Dissatisfaction was higher among adults who had any decayed teeth (1.61 / 1.06; 2.44), adults who were dissatisfied with their teeth and mouth (2.36 / 1.39; 4.02) and adults who had reported toothache in the previous six months (1.99 / 1.29, 3.07). The conclusion drawn was that the prevalence of dissatisfaction with dental services among Brazilian adults was low and associated to normative and subjective oral health conditions.

Validation and comparison of the Arabic versions of GOHAI and OHIP-14 in patients with and without denture experience

BACKGROUND

The assessment of oral heath related quality of life (OHRQoL) for complete denture wearers according to a participant's subjective perception may provide an indication of the adaptive capacity of the individual. The aim of this study was to compare and assess the validation of two quality of life measures, the Oral Health Impact Profile-14 (OHIP-14) and Geriatric Oral Health Assessment Index (GOHAI), in patients with and without previous denture experience.

METHODS

A total of 69 elders (36 male and 34 female; mean age, 63 years) from Dental Clinics of the University of Khartoum and the National University in Sudan, with and without previous denture experience, were included in the study. OHRQoL was assessed using two Arabic-translated questionnaires (OHIP-14 and GOHAI) before and after complete denture therapy. Global self-ratings of oral and general health were obtained, and denture satisfaction was assessed using the Denture Satisfaction questionnaire.

RESULTS

Both tools had significant correlations with self-rating oral health in patients without denture experience (P < 0.05). However, no significant correlations were found in patients with denture experience. There were significant differences between pre-and post-treatment total scores with both the GOHAI and OHIP-14 (P < 0.001). Responsiveness to treatment using GOHAI and OHIP-14 revealed overall mean effect size higher in patients without (1.49) and (0.83) than those with previous denture experience (0.89) and (0.60), respectively. However, neither tool could detect significant differences between patients with and without denture experience (P > 0.05).

CONCLUSION

Greater improvements of OHRQoL after complete denture therapy were observed in participants without than those with previous denture experience. The Arabic-translated versions of GOHAI and OHIP-14 can be regarded as effective measures for assessing treatment outcomes of complete denture therapy.

Factors influencing the impact of oral health on the daily activities of adolescents, adults and older adults

OBJECTIVE:

Analyze if clinical, sociodemographic and access to dental services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

METHODS:

A cross-sectional study with secondary data from the State Oral Health Survey (SB São Paulo 2015) conducted in 163 cities of São Paulo. A total of 17,560 individuals from three age groups: 15–19-year-old (n = 5,558), 35–44-year-old (n = 6,051), and older people of 65 years or more (n = 5,951) participated in the survey. The selection was made by probabilistic sample by conglomerates in two stages. The endpoint variable was the impact of oral health on daily activities, evaluated by the Oral Impacts on Daily Performances questionnaire, containing questions about eating, talking, oral hygiene, relaxation, sports practice, smile, study or work, social contact, and sleep. Oral Impacts on Daily Performances was dichotomized with and without impact. The independent variables were sociodemographic, clinical and access variables, divided into three blocks. A hierarchical multiple logistic regression analysis was performed considering the complex sampling plan of clusters. Each observation received a specific weight, depending on the location that resulted in weighted frequencies and adjusted for the design effect.

RESULTS:

The presence of oral health impact was observed in 27.9% of the individuals. In block 1, female gender and black/brown ethnic group had a greater chance of impact of oral health on quality of life, as well as the adults and the older adults in relation to adolescents. In block 2, family income up to R$1,500 was associated with the presence of impact. In block 3, individuals who reported toothache, used the public service and sought dental treatment had a greater chance of impact.

CONCLUSIONS:

Sociodemographic, clinical and access to health services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

Oral Health-Related Quality of Life in Young Adults: A Survey of Russian Undergraduate Students

Background: Oral health (OH) is poor among young adults in Russia, but there is little information on OH-related quality of life (OHRQoL) in this population. We investigated how socio-demographic factors, self-reported OH characteristics, oral health behaviour, and clinically-assessed OH are related to OHRQoL in medical and dental students in North-West Russia. Methods: This cross-sectional study included 391 medical and 275 dental Russian undergraduate students aged 18–25 years. Information on socio-demographic, self-reported OH characteristics, and oral health behaviour was obtained from a structured, self-administered questionnaire. A clinical examination was performed to assess dental caries experience based on the decayed (D) missing (M) filled (F) teeth (T) index; Simplified Oral Hygiene Index; and Gingival Index. OHRQoL was measured by the OH Impact Profile (OHIP-14). Results: 53.6% of students reported low OHRQoL during the last 12 months. Female sex (odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.00–2.19), rural place of childhood residence (OR = 1.56, 95% CI: 1.06–2.28), poor self-assessed dental aesthetic (OR = 1.75, 95% CI: 1.16–2.64), dissatisfaction with mouth and teeth (OR = 2.51, 95% CI: 1.68–3.77), and DMFT index (OR = 1.05, 95% CI: 1.01–1.09), were all significantly, independently associated with low OHRQoL. Conclusion: Socio-demographic factors (rural place of childhood residence, female sex), poor self-reported OH characteristics, and high DMFT index were associated with low OHRQoL.

Oral Health Indicators for Risk of Malnutrition in Elders

OBJECTIVES

Using both clinical parameters and subjective measures of oral health, this study aimed to identify useful oral health indicators for the risk of malnutrition in elders.

DESIGN

Cross-sectional study.

SETTING

Five community centers run by non-government organizations (NGOs).

PARTICIPANTS

195 community dwelling elders (65 or above).

MEASUREMENTS

An interviewer-administered questionnaire was completed to collect information on elders' socio-demographic background and oral health perception and practice. Their number of teeth, number of occluding tooth pairs, dental caries, and periodontal condition were examined. General Oral Health Assessment Index (GOHAI), an instrument for assessing oral health related quality of life (OHQoL), was used as a subjective measure of oral health. The elders' nutritional status was evaluated by using the Mini-Nutritional Assessment (MNA).

RESULTS

The mean (SD) DFT was 3.3 (3.1). Over 60% of elders had periodontal pockets; 33% had fewer than 20 teeth and 6% were edentulous. The mean (SD) of occluding tooth pairs was 7.1 (4.8). The mean (SD) total GOHAI score was 56.4 (8.0); 60% reported negative impact of oral health on their quality of life. The mean (SD) MNA score was 25.0 (2.9); 30% had malnutrition or were at risk. After controlling for socio-demographic factors, none of the clinical indicators (dental caries, periodontal status, number of teeth, and number of occluding tooth pairs) were associated with risk of malnutrition (all p>0.05). Poorer OHQoL indicated a higher chance for malnutrition in both adjusted models (OR of 0.914; 95% CI of 0.850-0.982; p=0.014 and OR of 0.915; 95% CI of 0.852-0.984; p=0.017). Tooth loss and untreated decayed teeth (DT) were significant/marginally significant determinants of poor OHQoL.

CONCLUSION

Elders' tooth loss and unmet treatment need for dental caries were associated with compromised quality of life, which indicated increased likelihood for malnutrition.

Rural-urban disparity in oral health-related quality of life

OBJECTIVES

The objective of this population-based cross-sectional study was to estimate rural-urban disparity in the oral health-related quality of life (OHRQoL) of the Quebec adult population.

METHODS

A 2-stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)-14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression.

RESULTS

The prevalence of poor oral health-related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily-life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural-urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1-2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7-15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8-15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8-3.9; P < .001).

CONCLUSION

The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes, specifically for rural residents. Further studies are needed to confirm these results.

Validation of a Dutch version of the Geriatric Oral Health Assessment Index (GOHAI-NL) in care-dependent and care-independent older people

BACKGROUND

The GOHAI is a frequently used instrument to measure oral health-related quality of life (OHRQoL) of adults, in particular older people. The aim of this study was to translate the original English version of the GOHAI into a Dutch version (GOHAI-NL), and to test the validity and reliability of the GOHAI-NL in care-independent and care-dependent older people.

METHODS

The GOHAI questionnaire was translated into Dutch, discussed by an expert panel, back-translated to the original, pilot-tested and assessed for cognitive and conceptual equivalence. The resulting GOHAI-NL was tested in a groups of care-independent (Group A, n = 109, mean age 73.1 ± 5.4 years) and care-dependent (Group B, n = 118, mean age 85.6 ± 7.0. years) cognitively alert people of 65 years and over. Psychometric properties including reliability (internal consistency, item-total, item-dimension, dimension-total, inter-item correlation, and test-retest stability), and validity (convergent, discriminant, known-group), and floor and ceiling effects were assessed.

RESULTS

Internal consistency was confirmed by Cronbach's alphas of 0.86 (group A) and 0.80 (group B). Item-total score correlations were between 0.4 and 0.7 except for item 3 in group A (0.34) and B (0.08) and for item 12 in group A (0.20). Item-dimension and dimension-total correlations were between 0.30 and 0.78 and around 0.7 respectively for the dimensions 'physical functioning' and 'psychosocial functioning', but lower for the dimension 'pain and discomfort' with item-dimension correlations between 0.13 and 0.44. Average inter-item correlations were 0.34 ± 0.11 (group A) and 0.33 ± 0.08 (group B). Test-retest correlation of the total score (GOHAI-ADD) was 0.88 in group A (ICCs: 0.62 - 0.88) and 0.93 in group B (ICCs: 0.64 - 0.91). Significant correlations in the expected direction were found between GOHAI and most oral health-related variables except for presence of caries in group A, and perceived general health, prosthodontic status and number of natural teeth in group B. No floor or ceiling effects were detected at GOHAI-ADD level; however ceiling effects did occur at dimension level.

CONCLUSION

The GOHAI-NL has satisfactory reliability and validity and can be used to measure OHRQoL in Dutch care-dependent and care-independent older people.

Social, economic, and behavioral variables associated with oral health-related quality of life among Brazilian adults

The aim of this study was to investigate the association between sociodemographic, socioeconomic, psychosocial, and behavioral variables and oral health as assessed using the 14-question short version of the Oral Health Impact Profile (OHIP-14). A cross-sectional study was performed with 1095 adult residents from 38 census tracts in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. Responses to the OHIP-14 were dichotomized, and bivariate (Chi-square) and multivariate analysis (logistic regression and Wald's test) were performed. In the bivariate analysis, the worse effects were reported by female individuals, the elderly, those with low family income, less schooling, those reporting a lower quality of life and social support, and smokers. In the multivariate analysis the following variables maintained their statistical significance: gender (female), age (50-59 years), family income (low), quality of life (low), social support (low, moderate), and smoking (smokers). Individuals' self-perception of their oral health was related to sociodemographic, socioeconomic, psychosocial, and behavioral variables, thus confirming that emphasis should be placed on social factors when addressing oral health problems.

Does different wording of a global oral health question provide different results?

OBJECTIVE

Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions.

BACKGROUND

It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the 'global oral health question' is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is.

MATERIALS AND METHODS

In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Örebro (T) and Östergötland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression.

RESULTS

The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR=5.6 and 5.2), chewing capacity (OR=6.9 and 4.2), satisfaction with dental appearance (OR=19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR=3.5 and 3.9).

CONCLUSION

Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants.

Oral health impacts on self-rated general and oral health in a cross-sectional study of working age adults

OBJECTIVES

The aims were to assess the joint effects of oral health and general health functional problems on self-ratings of general and oral health among adults.

METHODS

Data were collected from adults aged 30-61 years in Australia by mailed survey in 2009-2010. Self-rated health of 'very good/excellent' was analysed by oral health impact (OHIP-14) and number of health problems (EQ-5D) controlling for socio-demographics.

RESULTS

Responses were collected from n = 1093 persons (response rate = 39.1%). General health self-ratings were higher in the high-income group (prevalence ratio [PR] = 1.06, 1.00-1.12) but lower for those with a higher number of health problems (PR = 0.84, 0.76-0.93). The interaction of health problems with oral health impact indicated that self-rated general health was worst when both the number of health problems and OHIP score were higher. Oral health self-ratings were lower for males (PR = 0.92, 0.87-0.98), those aged 50-61 years (PR = 0.92, 0.85-0.99), for those with more health problems (PR = 0.82, 0.71-0.95) and higher oral health impact scores (PR = 0.54, 0.46-0.64).

CONCLUSIONS

For working age adults, oral health impact was associated with general health for those with more health problems indicating those in worse health suffer more impact from oral health problems.

Multilevel analysis of self-perception in oral health and associated factors in Southern Brazilian adults: a cross-sectional study

The aim of this study was to evaluate the association between individual and contextual variables related to self-perception in oral health among residents in the municipality of São Leopoldo, Rio Grande do Sul State, Brazil. The cross-sectional design involved 1,100 adults in 38 census tracts. The self-perception was evaluated using the Oral Health Impact Profile (OHIP-14) tool. A logistic multilevel analysis was performed. The multivariate analysis revealed that those who are of the female gender, older, with lower scores of quality of life and less social support, with poor healthy eating habits, smokers and those living in low-income census tracts presented higher odds of reporting worse oral health self-perception (OHIP-1). We concluded that individual and contextual variables are associated with oral health self-perception. This is essential information for planning health services wishing to meet the health needs of the population.

Determinants of oral health-related quality of life of the institutionalized elderly

BACKGROUND

Diminished oral health of the institutionalized elderly has frequently been reported. This is not only of significance with regard to nutrition and general health, but it can also affect oral health-related quality of life. This paper evaluates the effects of oral and general conditions on oral health-related quality of life for the institutionalized elderly, as measured by the Geriatric Oral Health Assessment Index (GOHAI).

MATERIALS AND METHODS

Ninety-four residents of four long-term care homes in southern Germany agreed to participate in this study, and interviews were conducted using the GOHAI questionnaire. The Revised Oral Health Assessment Guide was applied to allocate participants into two groups: satisfactory oral health and poor oral health. To evaluate the effects of age, gender, number of chronic diseases, frequently taken drugs, care level, Mini-Mental State Examination score, periodontitis (for participants with their own teeth), pressures caused by prostheses, and type of denture worn, a linear regression model with the total GOHAI score was calculated with these determinants.

RESULTS

The mean ± SD GOHAI score was 53.3 ± 6.2 in the satisfactory oral health group and 48.7 ± 7.3 in the poor oral health group. Statistical analysis showed that the GOHAI scores were significantly different in satisfactory oral health and poor oral health groups (P = 0.030) and were affected by care level (P = 0.008) and type of dentures worn (P = 0.006).

CONCLUSIONS

Within the limitations of this study, it can be concluded that oral health-related quality of life of the institutionalized elderly is low and is positively associated with better oral health.

Factors associated with self-rated oral health among community-dwelling older Japanese: A cross-sectional study

OBJECTIVES

A cross-sectional study was carried out to investigate the determinants of self-rated oral health among community-dwelling older people in Japan.

METHODS

The participants were 897 (357 men and 540 women) aged 65 years and over who participated in a comprehensive geriatric health examination, which included an oral examination, a face-to-face interview assessing cognitive function, questionnaires regarding depressive symptoms and functional capacity, and a medical examination. The oral examination measured indices of oral health status: number of present teeth, number of functional teeth, occlusal force and amount of resting saliva. Multiple logistic regression analyses were carried out to determine the factors associated with poor self-rated oral health.

RESULTS

The mean age of the participants was 73.5 ± 5.0 years. The prevalence of poor and rather poor self-rated oral health was 11.5% and 29.5%, respectively. Multiple logistic regression analyses showed that the number of present teeth (odds ratio [OR] 0.97, 95% confidence intervals [CI] 0.95-0.99), difficulty in mastication (OR 3.20, CI 2.18-4.70), presence of xerostomia (OR 1.43, CI 1.02-2.01), total score on the MoCA-J (OR 1.06, CI 1.01-1.11), and reduction in frequency of leaving the house (OR 1.64, CI 1.12-2.41) were significantly associated with poor self-rated oral health.

CONCLUSIONS

The present results suggested that self-rated oral health was a significant factor in oral health status as well as overall well-being among community-dwelling older Japanese people.

Impacto das condições bucais na qualidade de vida em servidores públicos municipais

O objetivo deste artigo é avaliar a prevalência de impactos produzidos por condições bucais na qualidade de vida de funcionários públicos e possível associação com variáveis sociodemográficas, utilização de serviços odontológicos, dor dentária e necessidade de prótese. Este estudo transversal avaliou uma amostra de 286 funcionários. Foram utilizados quatro roteiros para a coleta de dados incluindo o Oral Health Impact Profile . A associação entre as variáveis foi verificada pelo teste exato de Fisher; o Odds Ratio avaliou a magnitude da associação entre o desfecho e a exposição. Foram ajustados modelos de regressão logística para cada dimensão. O número de indivíduos que declararam impacto foi de 93 (32,5%). A maior predição de impacto esteve associada à idade, condição socioeconômica, escolaridade, utilização de serviço odontológico, necessidade de prótese e dor de dente. Grande número de indivíduos declararam impacto na qualidade de vida devido a problemas bucais.

Quality of life measured by OHIP-14 and GOHAI in elderly people from Bialystok, north-east Poland

BACKGROUND

The Oral Health Impact Profile-14 (OHIP-14) and the Geriatric/General Oral Health Assessment Index (GOHAI) have never been compared for a group of the same subjects in the Polish population. The aim of the study was to compare the OHIP-14 and GOHAI measures.

METHODS

178 independently living people over the age of 55 were included in the study. The GOHAI and OHIP-14 measures were used. Other variables included age, gender, self-ratings of oral general health, education, number of missing teeth, chewing problems and dry mouth.

RESULTS

The mean age of respondents was 70.8 years. The internal reliability (Cronbach's alpha) showed a high internal consistency for both measures. Spearman's rank correlation coefficient between the GOHAI and OHIP-14 scores was 0.81. Using the additive method of creating scores, 1.1% of respondents had the GOHAI score of zero, indicating no impact from oral conditions, while 13.5% of them had an OHIP-14 score of zero. Dental status, partial dentures, chewing problems, dry mouth and self-rated oral health were significantly associated with the results of the GOHAI and the OHIP-14 (Kruskal-Wallis test, Mann-Whitney U test). The numbers of preserved and missing teeth significantly correlated with the GOHAI and the OHIP-14, while DMF was significantly associated with the GOHAI only. 6 individuals with discrepant results were revealed. After the exclusion of the abovementioned patients, the internal reliability (Cronbach's alpha) still showed a high internal consistency, and the correlation between the GOHAI and OHIP-14 scores using Spearman's rank-correlation coefficient increased to 0.87. This phenomenon was identified as a "fatigue effect".

CONCLUSIONS

There was a strong correlation between the GOHAI and the OHIP-14. Both instruments demonstrated good discriminant properties and helped capture the respondents' oral health problems. The questionnaires should be randomly distributed to avoid the influence of "fatigue effect" on the results of a comparison of different measures.

Validation of the Spanish version of the Oral Health Impact Profile (OHIP-14Sp) in elderly Chileans

Background

The OHIP-49 is widely used to assess oral health-related quality of life, but its length makes it time-consuming and difficult to use. An abbreviated version of the OHIP-49 with fourteen items has been validated for older adults, but not in Chile. The aim was to develop and validate the Spanish version of the OHIP-14 in an elderly Chilean population.

Methods

Two studies were conducted; a cross sectional to develop and a retrospective study to validate the OHIP-14Sp. The OHIP-49Sp was applied to 490 older adults and the fourteen questions with the higher impact on oral health-related quality of life were selected through linear regression. These items were applied on a retrospective dataset of 85 older adults to test internal consistency (Cronbach’s alpha). A discriminative validity analysis was performed along with the assessment of sociodemographic (age and gender, educational level) and clinical variables (number of teeth, caries lesions, CPITN, prosthetic needs and prosthetic functionality). Data were analyzed using Mann–Whitney U, Student’s t and one-way ANOVA tests with a 95% confidence level and finally were analyzed by a Multivariate Logistic Regression Model.

Results

High internal consistency values were obtained for the OHIP-14Sp instrument (0.91). There was an association between the OHIP-14Sp scores and the presence of caries (p = 0.003), need for complex periodontal treatment (p = 0.002), prosthetic needs (p < 0.0001) and age younger than 70 years-old (p < 0.0001). Subjects with periodontal treatment need were more likely to report reduced oral health-related quality of life (PR = 2.10).

Conclusions

The OHIP-14Sp proved to be a consistent and valid tool to assess oral health-related quality of life when tested in Chilean older adults.

Self-reported and clinically diagnosed dental needs among institutionalized adults in Vijayawada: A cross-sectional study

BACKGROUND

Frail and functionally dependent elderly people, living in institutions, have difficulties in accessing dental care. Hence, the present study aims to determine the relationship between subjective need and the equivalent clinical findings in an attempt to understand the factors that contribute to individual's perception of the need for dental care among institutionalized adults in Vijayawada.

MATERIALS AND METHODS

A cross-sectional study is conducted in all old age homes in Vijayawada. A total of 182 subjects were interviewed with a questionnaire consisting of demographic details, dental behavior (last visit, reason for the last visit), and self-rating of oral health and impact of oral problems, followed by the clinical examination for oral mucosal condition, dentition status and treatment needs, prosthetic status and treatment needs, and periodontal status by using World Health Organization proforma.

RESULTS

Results showed that normative needs of subjects are significantly more than the self-perceived needs. Response of subjects regarding their present condition of mouth and teeth is 65.4% of subjects reported good and 0.5% reported poor, with respective to perceived oral symptoms 61.9% of subjects' complaints of hypersensitivity and 23.1% of subjects were having toothache and 80.5% subjects are having difficulty in eating. The overall prevalence of complete Edentulous and require complete denture was 12.1%, and 60.4% required partial denture.

CONCLUSION

About half of the participants confirmed need for problem-oriented dental care. The main reason for the problems faced by the institutionalized people is due to lack of teeth which could be prevented by appropriate care.

Self-rated dental health and dental insurance: modification by household income

Background

Previous studies have reported that socioeconomically disadvantaged Australians have poorer self-rated dental health (SRDH), are less likely to be insured for dental services and are less likely to have regular dental visits than their more advantaged counterparts. However, less is known about the associations between dental insurance and SRDH. The aim of this study was to examine the associations between SRDH and dental insurance status and to test if the relationship was modified by household income.

Methods

A random sample of 3,000 adults aged 30–61 years was drawn from the Australian Electoral Roll and mailed a self-complete questionnaire. Analysis included dentate participants. Bivariate associations were assessed between SRDH and insurance stratified by household income group. A multiple variable model adjusting for covariates estimated prevalence ratios (PR) of having good to excellent SRDH and included an interaction term for insurance and household income group.

Results

The response rate was 39.1% (n = 1,093). More than half (53.9%) of the participants were insured and 72.5% had good to excellent SRDH. SRDH was associated with age group, brushing frequency, insurance status and income group. Amongst participants in the $40,000– < $80,000 income group, the insured had a higher proportion reporting good to excellent SRDH (80.8%) than the uninsured (66.5%); however, there was little difference in SRDH by insurance status for those in the $120,000+ income group. After adjusting for covariates, there was a significant interaction (p < 0.05) between having insurance and income; there was an association between insurance and SRDH for adults in the $40,000– < $80,000 income group, but not for adults in higher income groups.

Conclusions

For lower socio-economic groups being insured was associated with better SRDH, but there was no association for those in the highest income group. Insurance coverage may have the potential to improve dental health for low income groups.

Thirty years of portraying oral health through models: what have we accomplished in oral health-related quality of life research?

OBJECTIVES

This paper critically examines the different models of oral health aimed at representing oral health-related quality of life (OHRQoL) and explores the extent to which such models changed conceptually to accommodate current theories and empirical knowledge of oral function, impairment and disability.

METHODS

A critical synthesis of the existing literature based on a comprehensive yet non-systematic review using Ovid-MEDLINE was performed. Full text of manuscripts available on models of oral health and OHRQoL published in English between 1 January 1950 and 30 June 2013 were identified.

RESULTS

Nineteen manuscripts were identified presenting and discussing various models of oral health and OHRQoL that are predominantly negative and linear. These models are mostly based on sick role-related theories and do not readily accommodate the biopsychosocial theories of oral health. Alternative portrayals have emerged to include positive behaviours and adaptive strategies dynamically, but have yet to influence patient care and the development of subjective OHRQoL indicators.

CONCLUSION

Despite the multitude of graphical representations of concepts, dental research has remained somewhat 'linear' in portraying the consequences of oral diseases as a one-way street. Although the conceptualization of oral health has evolved in the past 30 years, dental research still refers to it as the absence of disease in more than half a dozen models of OHRQoL focused mostly on dysfunction and disability.

Satisfação com saúde bucal de idosos brasileiros: um estudo de gênero com modelo hierárquico

Os objetivos do presente estudo foram identificar as diferenças de gênero em relação aos fatores associados à satisfação com saúde bucal de idosos e estimar a prevalência de edentulismo por gênero e faixa etária. Foram incluídos 2.052 idosos com 60 anos e mais de idade, residentes em Sete Lagoas, Minas Gerais, Brasil. A regressão de Poisson foi utilizada para estimar a prevalência de edentulismo. A associação entre satisfação bucal e as variáveis independentes foi realizada por meio da regressão ordinal com modelo hierárquico multidimensional. A prevalência de edentulismo nos gêneros masculino e feminino foi de 63% e 68,8%, respectivamente. A maioria dos idosos do gênero masculino (63%) e feminino (57%) estava satisfeita com a saúde bucal. O modelo final ajustado, para ambos os gêneros, foi formado por variáveis referentes ao ambiente externo, comportamentos de saúde e condições de saúde bucal. Conclui-se que a satisfação com a saúde bucal é influenciada fortemente pelas condições de saúde bucal e por comportamentos de saúde, e que os fatores associados são diferentes para cada gênero.

Oral health associated with quality of life of people living with HIV/AIDS in Brazil

Background

The epidemic of HIV/AIDS enters into its fourth decade and is still considered an important public health problem in developed and developing countries. The purpose is verify the oral health and other factors that influence the quality of life of people living with HIV/AIDS attending a public service reference in Brazil.

Methods

The participants answered the questionnaire on socio-demographic conditions, issues related to HIV and daily habits. The quality of life was analyzed by the HIV/AIDS Targeted Quality of Life (HAT-QoL) instrument with 42 items divided into nine domains: General Activity, Sexual Activity, Confidentiality concerns, Health Concerns, Financial Concern, HIV Awareness, Satisfaction with Life Issues related to medication and Trust in the physician. The oral health data were collected by means of the DMFT index, use and need of dentures and the Community Periodontal Index, according to the criteria proposed by the World Health Organization, by a calibrated researcher. Bivariate and multiple linear regressions were performed.

Results

Of the participants, 53.1% were women and had a mean age of 42 years, 53.1% had eight years or less of schooling and 20.3% were not employed. In analyzing the quality of life domain of the HAT-QoL, with a lower average there was: Financial concern (39.4), followed by Confidentiality concern (43.2), Sexual activities (55.2) and Health concerns (62. 88). There was an association between the variables: do not have link to employment (p <0.001), is brown or black (p = 0.045), alcohol consumption (p = 0.041), did not make use of antiretroviral therapy (p = 0.006), high levels of viral load (p = 0.035) and need for dentures (p = 0.025), with the worse quality of life scores.

Conclusion

Socioeconomic and inadequate health conditions had a negative impact on the quality of life of people with HIV/AIDS.

Increasing dependency of older people in nursing homes is associated with need for dental treatments

To determine relationships between the need for dental treatments of institutionalized elderly people and cognitive impairment and the general level of care needed. Two hundred and sixty-eight residents of long-term care facilities in Germany were included in this study. Age, sex, diseases, number of frequently taken drugs, and location of the long-term care facility of the participants were recorded. For each participant, the need for care was assessed by use of the Barthel index (BI). Cognitive impairment was evaluated by use of the mini-mental state examination (MMSE). To assess dental treatment needs, the revised oral assessment guide (ROAG) was applied for different oral health conditions, which were rated "healthy" or "treatment needed". Spearman correlations were performed to evaluate associations between BI and MMSE and dental treatment needs. Statistical analysis revealed significant associations of BI (P<0.001) and MMSE (P=0.015) with the ROAG score. Increasing dependency and decreasing cognitive ability worsen oral health and increase the need for dental treatment.

The impact of frailty on oral care behavior of older people: a qualitative study

BACKGROUND

Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people.

METHODS

We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers.

RESULTS

Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports.

CONCLUSION

The level and type of frailty influences people's perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and support, are discussed.

[Self-rated oral health: results of the World Health Survey-Primary Care in four municipalities in Rio de Janeiro State, Brazil, 2005]

Self-rated health is a subjective indicator that combines physical and emotional components and individual well-being. It has gained an important role in Public Health, with increasing use in the evaluation of the general population's health status. This study focuses on dental care and oral health status, including self-rated oral health, using data from 1,871 individuals 18 years or older, interviewed in World Health Survey-Primary Care, conducted in four municipalities in the State of Rio de Janeiro, Brazil. Bivariate logistic regression models were used to identify the determinants of 'excellent' or 'good' self-rated oral health. For both men and women, variables significantly associated with self-rated oral health were: per capita family income, frequency of dental visits, tooth loss, and use of dental prostheses. The results showed a socioeconomic gradient in self-rated oral health, precarious oral health among the elderly, and the importance of regular dental visits for maintaining oral health.

Satisfaction with the dentition related to dental functional status and tooth replacement in an adult Bulgarian population: a cross-sectional study

OBJECTIVES

The purpose of this study is to assess satisfaction with the dentition in general, dental esthetics, and chewing function related to dental functional status and tooth replacement in subjects, dentate in both jaws.

MATERIALS AND METHODS

Dentitions of subjects (n = 2,437) aged ≥20 years were categorized in a hierarchical functional classification system, with and without tooth replacements, according to four dental conditions: '≥10 teeth in each jaw', 'complete anterior regions', 'sufficient premolar regions' (≥3 occluding pairs), and 'sufficient molar regions' (bilaterally ≥1 occluding pair). Likelihood ratios (LR) were used to express the ability of these conditions to discriminate between satisfied and not satisfied subjects. Odds ratios (OR) were calculated to evaluate associations between satisfaction, the four dental conditions separately, and tooth replacement.

RESULTS

In the hierarchical system, subjects having '<10 teeth' were more likely of being not satisfied with their dentitions (LR 4.09), esthetics (LR 3.51), and chewing (LR 5.49). As a separate condition, '≥10 teeth' was significantly associated only with satisfaction with chewing. The conditions 'complete anterior regions' and 'sufficient' premolar and molar regions' were associated with all satisfaction variables (ORs 1.47-2.96, p values ≤0.012). When dental conditions were determined on the basis of natural teeth only, having teeth replaced was positively correlated with satisfaction; when determined on the basis of natural plus replaced teeth, subjects having teeth replaced tended to be less satisfied than their counterparts with natural teeth only.

CONCLUSIONS

Satisfaction was strongly associated with dental functional status.

CLINICAL RELEVANCE

Dental configurations comprising both natural and artificial teeth were less likely to provide the same level of satisfaction as equivalent dental configurations comprising natural teeth only.

[Self-perceived oral health among elderly individuals in a medium-sized city in Northeast Brazil]

This study focused on self-perceived oral health of the elderly and associated variables. The sample consisted of 321 functionally independent individuals 60 years or older living in Parnaíba, Piauí State, Brazil. Oral examinations were performed and questionnaires were applied during home visits. The elderly presented poor oral health, with mean DMFT 29.41 (SD = 4.10). However, their self-perceived oral health was positive, with 52% showing high scores according to the Geriatric Oral Health Assessment Index (GOHAI). Multivariate analysis showed that predictors of self-perceived oral health included the need for upper prostheses, oral mucosal lesions, and self-rated oral health. The most important predictor was self-rated oral health, with a weight of 20% variation in self-perceived oral health. In conclusion, subjective measurement of oral health in the elderly is less associated with their actual clinical status and more with other subjective factors.