Comparisons between dentist ratings and self-ratings of dental appearance in an elderly population

Satisfaction with dental appearance in two cohorts of 75-year-olds examined in 2007 and 2017: A repeated cross-sectional study

BACKGROUND

Satisfaction with dental appearance plays an important role in the self-esteem and psychological well-being of the elderly, the significance of which the attending dentist may not always be fully cognisant of.

OBJECTIVES

To assess the level of satisfaction with dental appearance, its associated factors and temporal changes in two cohorts of 75-year-old Swedes born 10 years apart.

METHODS

In 2007, a questionnaire was mailed to all those living in Örebro and Östergötland counties, Sweden, who were born in 1932 (n = 5195), and in 2017 to all born in 1942 (n = 7204). The evaluation was carried out with a global question 'Are you satisfied with the appearance of your teeth?', and four attitude-related statements about dental appearance.

RESULTS

About 80% in both cohorts were 'very satisfied' or 'to large extent satisfied' with their dental appearance. The 1932 cohort was significantly more concerned about their dental appearance than the 1942 cohort, and women were generally also significantly more concerned than men. In the regression analysis, 'very satisfied' with dental appearance was predicted by good chewing efficiency, having complete dentures, no impact from Oral Impacts on Daily Performance, disagreement that 'minor esthetic imperfections of the teeth have no importance, only they should function well', better perceived general health than same-aged peers and belonging to the 1932 cohort.

CONCLUSION

Satisfaction with dental appearance among 75-year-olds was generally high, with attitudes varying by gender and temporally. Women and the earlier-born generation (1932) were more concerned about dental appearance than men and the later-born generation (1942), respectively.

Extra-oral assessment of conventional and CAD-CAM complete denture appearance by dental professionals and CRDP wearers: A randomized survey

INTRODUCTION

Complete removable dental prostheses' (CRDPs) appearance may vary between conventional and contemporary CAD-CAM manufacturing techniques.

OBJECTIVES

The aim of this randomized survey was to analyze appreciation of CRDPs, manufactured with different techniques, by dental professionals and elder CRDP wearers.

METHODS

Four participant groups, comprised of undergraduate students (n=10), postgraduate residents (n=10), dental technicians (n=10) and elder CRDP wearers (n=10), evaluated the appearance of maxillary CRDPs manufactured by six different techniques: three conventional methods 1. flask-pack-press (FP), 2. Injection-molded (IM), 3. intrinsically colored natural gingiva finish before injection-molded (NG) and three CAD-CAM methods 4. milled base with bonded prefabricated teeth (M), 5. fully milled including milled teeth (FM) and 6. rapid-prototyped including printed teeth (P). A randomized, blinded survey included 18 pairwise comparative assessments and 12 individual judgements of the CRDPs on general appearance as well as pink and white aspects. Statistical analyses included parametric- and nonparametric tests as well as linear regression models; the level of statistical significance was set at p<.05.

RESULTS

NG was preferred by the professional groups but not by the elder CRDP wearers (p<.05). P was scored lowest by all four participant groups (p<.05). CRDP wearers' ratings were less severe and within a narrower range. The ratings of the two CAD-CAM milled CRDPs (M and FM) were ranked closer to FP and IM); the order of preference was different depending on the participant groups.

CONCLUSIONS

The findings of this study revealed marked differences in the assessment of CRDP appearances between dental professionals and older CRDP wearers.

CLINICAL SIGNIFICANCE

A shared and informed approach to decision making concerning the CRDP appearance might foster denture acceptance and treatment success.

Perception of orofacial appearance among laypersons with diverse social and demographic status

BACKGROUND

The perception of dentofacial esthetics differs considerably between patients and dentists. Patient's expectations regarding his/her esthetics are important and should be assessed ahead of any planning of esthetic treatment. The aim of this study was to explore the differences in perception of orofacial appearance by laypersons with different social and demographic status.

MATERIALS AND METHODS

Self-administered questionnaires were distributed to 400 subjects. The questionnaire comprised three parts; the first part addressed the demographic variables. The second part queried about dental prosthesis, orthognathic or plastic surgery, and/or ongoing or previous orthodontic treatment. The third part included the Arabic version of the-8-item Orofacial Esthetic Scale (OES-Ar) whose responses were scored in the 5-point Likert scale. These scores were compared by different grouping factors (age, gender, marital status, and education) using non-parametric Mann-Whitney U and Kruskal Willis tests with 95% confidence interval (α > 0.05).

RESULTS

A total of 268 questionnaires were eligible for analysis, representing 67% response rate. The satisfaction with facial profile appearance was the highest (4.0±1.1) followed by facial appearance (3.9±1.1), while the color of teeth was the least satisfying item (3.1±1.3). No significant differences were found between age groups for the mean summary score as well as for each item independently. No significant difference was found between both sexes except for the last item "overall impression". Married subjects rated one item (alignment of teeth) better than their counterparts. Positive perception of orofacial appearance increased significantly with the increase of education level, the perception of the oral health status, and the perception of the general health status.

CONCLUSION

Good oral health and/or high education level are significant determinants of more positive perception of orofacial esthetic appearance. Patients with these characteristics might be more concerned about their orofacial appearance, and this should be taken into consideration before planning any esthetic restorative dental treatment.

Association of Self-Perceived Oral Health and Function with Clinically Determined Oral Health Status among Adults Aged 35⁻54 Years: A Cross-Sectional Study

This study aimed to analyse the association of self-perceived oral health status (OHS) and functions with clinical OHS in Korean adults aged 35–54 years. The study was designed as a cross-sectional study using data from the Fourth Korea National Health and Nutrition Examination Survey (2007–2009). A total of 6605 subjects aged 35–54 years who completed the oral examination and questionnaires were included. An association of self-perceived OHS and functions with clinically determined OHS was confirmed by a complex-samples general linear model. Data on socioeconomic variables, i.e., household income and education level, self-perceived OHS and functions, such as chewing and speaking, were collected by trained interviewers. The clinical OHS was determined by trained dentists and included the number of untreated decayed teeth (DT); decayed, missing, and filled teeth (DMFT); prosthetic and periodontal status. The combined score was estimated as the sum of self-perceived OHS and functions. Based on the estimation coefficient, the clinical variables that were most strongly associated with self-perceived OHS and functions were, in order, periodontal status, prosthetic status, DT, and DMFT. In addition, the combined score for self-perceived OHS and functions was associated with household income, education, and clinically determined OHS.

Orofacial esthetics and dental anxiety: associations with oral and psychological health

OBJECTIVE

Severe dental anxiety (DA) is associated with both oral health and psychosocial consequences in what has been described as a vicious circle of DA. The aim of this study was to investigate self-rated orofacial esthetics in patients with DA and its relationship to psychological and oral health.

MATERIALS AND METHODS

A consecutive sample of 152 adult patients who were referred or self-referred to a specialized dental anxiety clinic filled out the Orofacial Esthetic Scale (OES) as well as measurements on DA, self-rated oral health and general anxiety and depression. Clinical measures of dental status were also obtained.

RESULTS

Compared with the general population, patients with DA had lower ratings of satisfaction on all aspects of their orofacial esthetics, which included the teeth, gingiva, mouth and face, as well as a global orofacial assessment. Furthermore, the perception of the orofacial appearance was related both to dental status and self-rated oral health, as well as to general anxiety and depression. The level of dissatisfaction with the orofacial appearance was similar for both genders, but women reported more regular dental care and better dental status.

CONCLUSIONS

The results of this study clearly show less satisfaction with dental and facial appearance in patients with DA, and that the self-rating of orofacial esthetics is related to both oral and psychological health. The OES can be used to assess orofacial esthetics in patients with DA.

Oral Health-Related Quality of Life in institutionalized elderly in Barcelona (Spain)

Objective: The objective of this study is to describe the oral health status and the factors associated with oral health-related quality of life (OHRQoL) in people aged 65 and older institutionalized in Barcelona in 2009. Study Design: Cross sectional study in 194 elderly. The dependent variable was poor OHRQoL, according to the Geriatric Oral Health Assessment Index (GOHAI). The independent variables were socio-demographic data, last dental visit, subjective and objective oral health status. Robust Poisson regression analysis was used to determine the factors associated with OHRQoL as well as the strengths of association (Prevalence Ratios with respective confidence intervals at 95%). Results: According to GOHAI, 94 women (68.1%) and 36 men (64.3%) had poor OHRQoL. The average DMFT index (number of decayed, missing and filled teeth) was 22.8, with mean 10.2 remaining teeth. According to the Community Periodontal Index only 1.9% were healthy. 33.8% of the sample (35.5% of women and 30.4% of men) presented edentulism, 54.2% needed upper dental prostheses (51.1% of women and 60.7% of men) and 64.7% needed lower ones (61.6% of women and 71.4% of men). Only 7.2% had visited a dentist in the past year (8.8% of women and 3.6% of men). After fitting several multivariate adjusted robust Poisson regression models, poor OHRQoL was found to be associated to self-reporting problems with teeth or gums, self-reporting poor opinion about teeth/gums/denture and also associated to functional edentulism, needing upper denture, but not to socio-demographic factors or time since last dental visit. Conclusions: The study population has poor objective oral health. A high percentage has poor OHRQoL associated to subjective and objective oral health conditions. Dental care is required and these services should be included in the Spanish National Health System.

Key words:Oral health, homes for the aged, elderly, self-assessment, quality of life, geriatric oral health assessment index (GOHAI).

Oral health-related quality of life among parents and teachers of disabled schoolchildren in Kuwait

OBJECTIVE

The objective of this study was to assess the oral health-related quality of life between the parents and the teachers of disabled schoolchildren in Kuwait.

SUBJECTS AND METHODS

The three category response version of the General Oral Health Assessment Index (GOHAI) (12 questions, always, sometimes, never) was used in the questionnaires in Kuwait. Three hundred and eight (308) parents and 112 teachers were enrolled in this study.

RESULTS

The mean age of the parents was 45 ± 9.9 years and of the teachers 38 ± 8.4 years. The mean GOHAI was 27.2 ± 3.5 among the parents and 27.8 ± 3.3 among the teachers (p = 0.091). GOHAI was higher in the older age groups (p = 0.002) and among the parents with a university education (p < 0.001). GOHAI was also higher with increasing toothbrushing frequency among the parents (p = 0.047) and the teachers (p = 0.003). Altogether, 203 (66%) of the parents and 85 (76%) of the teachers were always able to swallow comfortably; 123 (40%) of the parents and 41 (37%) of the teachers were able to eat without discomfort. Overall, 132 (43%) of the parents and 41 (37%) of the teachers were always pleased and happy with the looks of their teeth and gums, or dentures. The Cronbach's alpha (0.83) indicated a high degree of internal consistency between different GOHAI items.

CONCLUSION

There seemed to be no difference in the impact of oral health on the quality of life between the parents and the teachers of disabled schoolchildren. Oral health had a relatively weak impact on the quality of life of these adults.

Postextraction implant placement with immediate provisionalisation and finalisation, using a simplified technique: technical notes and a case report

Trauma of maxillary teeth is a common accident. In most cases, the result is a root or crown fracture requiring tooth extraction and implant placement. Immediate postextraction implants are considered an effective option for restoring missing teeth in order to achieve successful aesthetic and functional outcomes. The aim of this article is to describe a clinical case in which a fractured maxillary canine was replaced by an osseointegrated implant using a simplified technique in a patient who was a smoker and presented poor oral hygiene. The technique adopted permits a reduction of the number of implant components and consequently a lower cost of treatment, while at the same time maintaining acceptable aesthetic and functional outcomes.

A survey of dentulous and edentulous patient preference among different denture esthetic concepts

STATEMENT OF PROBLEM

Most esthetic preference research and anatomical average analysis come from dentulous populations. If edentulous patients have a different preference, application of this data during denture construction is problematic.

PURPOSE

The aim of this survey was to compare dentulous and edentulous respondent preference among three different denture esthetic concepts.

MATERIAL AND METHODS

A questionnaire and test booklet of standardized full-face digital photographs were used. It included three arrangements during maximum smile for six subjects. Dentulous and edentulous respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 167 dentulous and 269 edentulous questionnaires were analyzed descriptively and with Chi-squared tests to compare the esthetic preference of the respondents.

RESULTS

There was no statistically significant difference overall between dentulous and edentulous preference. Respondent preference varied significantly depending upon subject set and gender. Preference data compared closely to previous research.

CONCLUSION

Within the limitations of this survey, dentulous and edentulous respondent preference among the three esthetic concepts was not significantly different. Questionnaire respondents continued to frequently prefer appearances that are far from the anatomical average.

Comparison of GOHAI and OHIP-14 measures in relation to objective values of oral function in elderly Japanese

OBJECTIVES

The aims of this study were to assess the correlations between the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile-14 (OHIP-14) and to examine which survey is more sensitive to objectively measured oral function in the Japanese elderly.

METHODS

The subjects were 290 community-dwelling, cognitively healthy, and independently living people over the age of 60 years (mean: 66.3 years). Measures included the GOHAI and OHIP-14 questionnaires, as well as self-rating of general and oral health, dry mouth, number of residual teeth, and objective values of occlusal force, masticatory performance, and salivary flow rate. Bivariate and linear regression analyses were used to identify which of these variables predicted GOHAI and OHIP-14 scores.

RESULTS

Spearman's correlation coefficient between the GOHAI and OHIP-14 scores was 0.728 (P < 0.001), although the OHIP-14 showed a greater number of 0 scores, suggesting a greater floor effect. At the bivariate level, self-rating of general and oral health, dry mouth, number of residual teeth, occlusal force, and masticatory performance were associated with GOHAI and OHIP-14 scores. Multiple linear regression analyses showed that after controlling for the other significant variables, both the occlusal force (standardized regression coefficient [β] = -0.164, P = 0.004) and masticatory performance (β = -0.125, P = 0.019) had significant associations with the GOHAI score, whereas this association was not found with the OHIP score.

CONCLUSIONS

Although the GOHAI and OHIP-14 had a strong correlation, the GOHAI was more sensitive to the objective values of oral functions among independently living elderly persons in Japan.

Self-perceived oral health status in institutionalized elderly in Brazil

This study aims to identify self-perceived oral health status in institutionalized elderly in Brazil, using the Geriatric Oral Health Assessment Index (GOHAI) and to seek associations with objective and subjective conditions and behavior related to oral health, individual traits, and environmental factors. A cross-sectional study using census with institutionalized elderly in Brazil. A total of 1192 individuals were evaluated, and 587 (49.2%) responded to the GOHAI. A questionnaire and an epidemiological survey were applied. The Mann-Whitney, Kruskal-Wallis, Fisher's exact, chi-square, and multiple logistic regression tests were performed. Mean age was 74.98 ± 9.5 years, 51.4% (302) were male. The mean DMFT-index (DMFT=decayed, missing, filled teeth) was 28.8 ± 5.5 and 54.5% (320) of the elderly were toothless. Categorized GOHAI showed that 75% (440) of the individuals had positive self-perception of oral health status. Multiple logistic regression demonstrated that the last visit to the dentist (adjusted prevalence ratio=PR=4.058; confidence interval=CI=1.526-10.789), presence of gingival problems (adjusted PR=5.703; CI=1.754-18.544), and self-rating of teeth, gums, or prosthesis (adjusted PR=19.514; CI=5.075-75.041) remained significant in the model. Predominance of positive self-perception of oral health status was observed despite poor oral conditions. Thus, for the institutionalized population, the present study recommends epidemiological and self-perception surveys to ensure adequate planning of oral health strategies.

Social Perceptions of Individuals Missing Upper Front Teeth

Although it is assumed that there are negative social consequences for individuals missing visible front teeth, no study of the way in which edentulous individuals were perceived in a social context and the potential social repercussions could be located. This initial study concerned college students' perceptions of individuals missing visible upper front teeth. 200 volunteers, 19 to 50 years of age ( M = 20.6, SD = 4.4), rated five photographs depicting tooth presence or absence, from a full dentition to missing as many as four upper front teeth, on social traits including attractiveness, health status, educational attainment, satisfaction with life, active social life, aggressiveness, intelligence, trustworthiness, amount of caring, friendship, dating, and likelihood to live as a neighbor. Analysis suggested a person missing visible teeth was more negatively perceived on all social traits than a person with full dentition. Results were strongest when students were proposed to be linked to the edentulous individual in a personal way, i.e., dating or living as neighbor. Men and women agreed on perceptions of social traits and dentition condition. These results suggest the presence of strong Western cultural values, whereby those who are missing teeth may experience significant barriers to personal and social success.

Health benefits and reductions in bacteria from enhanced oral care

This investigation assessed the oral cavity and microbiological status of 36 non-verbal persons with developmental disabilities. The authors examined oral hygiene interventions aimed at reducing risk factors linked to bacterial colonization and aspiration pneumonia. The findings indicated a statistically significant decrease of potentially pathogenic bacteria and a reduction in total bacteria counts for people receiving oral care via intermittent suction.

Oral health-related quality of life: a critical appraisalof assessment tools used in elderly people

OBJECTIVE

The purpose of this study was to undertake a critical appraisal of oral health-related quality of life (OHRQoL) measurements used for research in the elderly.

BACKGROUND

A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person's quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly.

MATERIALS AND METHODS

Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative-qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions).

RESULTS

In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative-qualitative criteria.

CONCLUSION

Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile-49, Dental Impact on Daily Living, Oral Health Impact Profile-14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.

Satisfaction With Dental Appearance Among Diverse Groups of Dentate Adults

Objectives: To quantify (a) the prevalence of dissatisfaction with dental appearance in a diverse sample of dentate adults and (b) the associations between dissatisfaction with dental appearance, sociodemographic factors, and other measures of oral health. Methods: Data were taken from the Florida Dental Care Study , a population-based longitudinal cohort study of oral health and related behaviors. The sample included 873 participants at baseline. Descriptive analysis and logistic regression were conducted to analyze the baseline data in the current report. Results: Females, problem-oriented dental attenders, and participants who had not completed high school were significantly more dissatisfied with their dental appearance than their respective counterparts. Dissatisfaction with dental appearance was also independently associated with six specific clinical and self-reported measures of oral health. Discussion: Dissatisfaction with dental appearance was common in this population-based sample of middle-aged and older adults, and was significantly associated with key sociodemographic and oral health factors.

A Survey of Edentulous Patient Preference among Different Denture Esthetic Concepts

STATEMENT OF PROBLEM

Despite the fact that solutions to functional problems are available, successfully restoring the appearance of an edentulous patient remains a challenge.

PURPOSE

The aim of this survey was to determine if edentulous respondents could differentiate among three denture esthetic concepts and if there was an overall preference among the three.

MATERIALS AND METHODS

Six edentulous test subjects were selected based on age and smile criteria. One wax tooth arrangement was completed according to each of the three esthetic concepts for a total of three wax tooth arrangements per test subject. The three esthetic concepts followed were natural, supernormal, and denture look. Standardized full-face digital photographs were made of each arrangement (three) during maximum smile for each subject (six). These 18 photographs were included in a questionnaire. Respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 147 completed questionnaires were analyzed.

RESULTS

Ninety-six percent of respondents were able to differentiate among the three esthetic denture concepts. Natural tooth arrangements were preferred by 55% of the respondents, supernormal tooth arrangements were preferred by 19%, and the denture look arrangements were preferred by 26%.

CONCLUSION

Within the limitations of this survey, the questionnaire respondents differentiated between the three esthetic denture concepts. The tooth arrangement most closely resembling the anatomical average was selected by 55% of the respondents. Preference for a particular concept changed when responses to each test subject set were considered individually. Demographic factors do not significantly affect patient preference.

CLINICAL SIGNIFICANCE

Three esthetic concepts for complete denture construction have been differentiated. Questionnaire respondents preferred appearances that are far from the anatomical average 45% of the time.

Validation of the Geriatric Oral Health Assessment Index (GOHAI) in the Malay Language

OBJECTIVE

To translate and validate the Geriatric Oral Health Assessment Index (GOHAI into the Malay language for use in Malaysia.

METHODOLOGY

The 6-Likert scale GOHAI was translated into the Malay language and self-administered on 189 subjects aged 60+. All subjects underwent oral status assessment. The measure was assessed for construct and discriminant validity, for test-retest reliability and principal component factor.

FINDINGS

Mean GOHAI score was 46.2 (SD 9.7, range 17-60). The Cronbach's alpha was 0.79. Mean GOHAI scores increased with more positive self-rated oral health and general health. The elderly with no perceived dental treatment need had higher mean GOHAI scores than those with perceived needs. There were slightly stronger inverse correlations between GOHAI scores and caries experience, number of teeth present, and number of pathologically mobile teeth. The measure demonstrated strong test-retest reliability. Eight of the 12 items had Spearman's r3 0.7. Only one principal factor was found at eigenvalue > 1. Using ANCOVA, self-rated perception of oral health and perceived need for dental treatment had the most significant impact on the GOHAI score.

CONCLUSION AND RECOMMENDATIONS

The Malay language version of the GOHAI demonstrated acceptable validity and reliability and will be an important instrument to measure oral health-related quality of life among Malay-speaking Malaysians. Use of the Malay language version GOHAI should also be pursued among diverse adult age groups.

Restoring dentate appearance: A literature review for modern complete denture esthetics

Despite the fact that solutions to functional and comfort problems are often available, successfully restoring the appearance of an edentulous patient remains a challenge. This review of the literature demonstrates the limited amount of useful evidence-based information available for restoration of dentate appearance in edentulous individuals. The English language peer-reviewed literature from 1880 to the present was reviewed. Articles were identified through previous literature reviews, an extensive hand search, and a search of MEDLINE using the key words esthetics and denture esthetics. Three main areas of information were found: published guidelines for achieving natural appearance, patient preference studies, and studies that have collected and analyzed anatomic norms.

Impact of new prostheses on the oral health related quality of life of edentulous patients

OBJECTIVE

A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI).

BACKGROUND

Oral health quality of life indicators can be used to evaluate the effects of dental treatments.

MATERIAL AND METHODS

The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients' satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group.

RESULTS

At baseline, the impact of oral health problems was apparent; the mean GOHAI-Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI-Add scores was negatively correlated with the initial GOHAI-Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants' satisfaction with the new dentures and change in GOHAI scores (p < 0.05).

CONCLUSION

The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures.

Effectiveness of dental services in facilitating recovery from oral disadvantage

OBJECTIVE

To determine the effectiveness of dental health care services in facilitating recovery from quality of life decrements in symptom-specific subgroups with the most prevalent chronic infectious diseases (periodontal disease and dental caries), and a 'stained teeth' subgroup.

METHODS

Data were taken from the prospective longitudinal Florida Dental Care Study of 873 individuals 45+ years old. Logistic regression modeling quantified associations between recovery from oral health-related quality of life decrements ('recovery') and dental services.

RESULTS

Adjusting for age, race, gender, income, approach to dental care, and signs/symptoms, any dental visit (odds ratio, OR: 4.0; 95% confidence interval, CI: 2.3, 6.9), corrective treatment (OR: 3.8; 95% CI: 1.6, 8.7), denture visit (OR:4.8; 95% CI: 1.1, 21.9), or extraction (OR: 6.2; 95% CI: 2.2, 17.4) were positively associated with recovery. Upon conditioning the analyses on specific symptoms, point estimates increased substantially for most service types, and dental cleaning was associated with recovery for the stained teeth subgroup (OR: 10.9; 95% CI: 1.2, 99.4).

CONCLUSION

Dental care was highly effective in treating quality of life decrements. Treatment effectiveness increased substantially when analyses were restricted to symptom-specific subgroups similar to selection criteria of randomized clinical trials (RCTs). Restricted cohort analyses can be applied to many other health outcomes for which RCTs are not feasible or ethical.

Self-rated oral health as an independent predictor of self-rated general health, self-esteem and life satisfaction

Self-rated health (SRH) is a useful summary measure of people's general health and was found to predict future health outcomes. Self-rated oral health (SROH) is a similarly useful summary measure of people's oral health. Both are related to quality of life, especially at old age. The objectives of the study were: (1) to assess the independent contribution of SROH to concurrent and future SRH of elderly people, controlling for sociodemographics and health measures, and, (2) to assess whether SROH adds unique information not captured by SRH by testing their independent associations with self-esteem and life satisfaction. Participants were 850 residents of a retirement community (mean age 73) interviewed in their homes at baseline and 5 years later. The interview included single-item self-ratings of general and oral health, self-reports of medical history, recent chronic diseases, medication usage, functional disability, self-esteem and life satisfaction. Multiple regression analyses showed that SROH had an independent effect on concurrent and future SRH, controlling for age and other measures of health status. Both SRH and SROH independently explained a significant amount of variance in concurrent ratings of self-esteem and life satisfaction. SROH has a unique role in people's perceptions of their overall health yet is not fully captured by SRH. Therefore, it should be considered by general health care providers in their assessments of the health status of older adults.

Application of short-form oral health impact profile on elderly Japanese

OBJECTIVES

The purpose of this study was to use the oral health impact profile (OHIP-14) to evaluate the impact of oral disease on the quality of life of a group of independently-living elderly persons in an urban area of Japan.

SUBJECTS

A total of 1244 participants of the Senior Citizen's College, who attended the lectures once a week. They were community-dwelling, independently-living people over 60 years of age.

MEASUREMENTS

Japanese version of the short-form OHIP-14.

RESULTS

Internal reliability for the 14 items overall was very high (Cronbach's alpha = 0.95). Report of 'painful aching' and 'uncomfortable to eat' were the two most highly scored items using the mean sum OHIP-14 score. A multiple logistic regression analysis indicated that the sum OHIP-14 score had significant associations with self-assessment of general health, dental status, and a perceived need for dental treatment. However, age, gender, dissatisfaction with financial status or education level was not significantly associated with the sum OHIP-14. Compared with that of other countries, the items were ranked similarly, whereas the perceived magnitudes of the problems were quite different from other population.

CONCLUSIONS

The OHIP-14 in Japanese had a high internal reliability, was significantly associated with dental status and comparable ranking for items when compared with studies from other countries.

A review of satisfaction with dental service at a Jerusalem community clinic serving elderly patients

AIM

The audit of dental satisfaction and its association with the reported outcome of a dental health care programme for elderly patients.

DESIGN

A telephone survey of 162 patients in a Jerusalem municipal dental clinic for geriatric patients, who had completed a treatment course in oral rehabilitation.

RESULTS

The average age of the respondents was 73.2 +/- 8.45 years, over 80% of who were very satisfied or satisfied with the treatment given by the dental clinic staff. Only 1.8% were not satisfied (the remaining 17.9% were unable to answer the question). Among those who responded, 91.6% were currently using their full dentures, 80.4% reported an improvement in chewing ability, and 82.3% an improvement in appearance. Respondents who reported daily use of dentures and improved chewing and appearance, also reported higher levels of satisfaction with the clinic.

CONCLUSIONS

These results indicate a potentially important role of satisfaction with dental staff in optimal compliance and success of a geriatric oral health care programme.

Two-year incidence of oral disadvantage, a measure of oral health-related quality of life

Dental research has progressed from describing the burden of oral disease using traditional epidemiologic measures of incidence and prevalence, to measuring how oral disease, oral signs, and oral symptoms affect the daily activities and the overall quality of life of the individual. However, longitudinal evaluation of these associations remains rare.

OBJECTIVES

To (i). describe the 2-year incidence and patterns of oral disadvantage; (ii). identify dimensions of oral health measures that are significant antecedents of oral disadvantage; and (iii). determine which oral health dimensions are the most strongly predictive of oral disadvantage.

METHODS

The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth and were 45 years or older. Incidence rates, odds ratios, and 95% confidence intervals were used to describe oral disadvantage and its relation to other measures of oral health.

RESULTS

Nearly one-half of the participants experienced oral disadvantage at least once during 24 months of follow-up. The strongest antecedents associated with oral disadvantage were toothache pain and chewing difficulty.

CONCLUSIONS

The incidence of oral disadvantage is substantial and consistent with the notion that oral health has a substantial impact on quality of life. Measures of oral pain and oral functional limitation were more strongly predictive of oral disadvantage than disease and tissue damage antecedents.

Understanding health behavior and perceptions

Oral health and general health status depend on a dynamic interplay of many factors, including the individual's personal characteristics, behaviors, and perceptions. There are differences and disparities among different racial and ethnic groups in terms of oral health status, and in the physical, socioeconomic, cultural, and political environment. Furthermore, response to the environment may vary among individuals and populations. Access to care and patient-provider interactions are key issues to consider. This article presents a conceptual model of the variable influences on behaviors and perceptions that determine oral health status in minority and other populations.

Translation and validation of the Chinese version of GOHAI

OBJECTIVE

To translate and validate the Chinese version of General Oral Health Assessment Index (GOHAI) for elderly in Hong Kong and to investigate factors that possibly may influence the GOHAI scores.

METHODS

The English version of GOHAI was translated into Chinese. Persons aged 60-80 years were interviewed by two trained interviewers and clinically examined by a dentist. Information on subjects' demographic background and oral health conditions was collected.

RESULTS

Altogether 1,023 elderly were interviewed and clinically examined. The mean GOHAI score was 48.9 (SD = 7.2). Cronbach's alpha of the translated GOHAI was 0.81; item-scale correlation ranged from 0.28-0.61. It was found that the mean GOHAI scores were lower for subjects with poorer perceived oral health (rs = 0.57, P < .001). Elderly who had perceived dental treatment need had a lower mean GOHAI score than those who did not (P < .001). It was also found that elderly who lived in elderly homes, those who received social welfare assistance, those who had recent dental visits, and those with higher DMFT scores had higher mean GOHAI scores.

CONCLUSION

The translated Chinese version of GOHAI demonstrated acceptable reliability and validity. It is available for use by researchers in oral health-related quality of life studies on Chinese elderly population.

Level and predictors of agreement between patients and their dentists concerning need for replacement of teeth at the time of extraction

The aims were to determine the level of agreement between patient and dentist about the need for a replacement of teeth at the time of extraction, and to identify and assess the effect of predictor variables on the level of agreement. Data were obtained from questionnaires. A systematic random sample of 1,500 Norwegian general dental practitioners were contacted, 67% of them responded and 75% of their patients. The final sample consisted of 427 patients (16-92 years old) and 224 dentists. Overall agreement was 62% of the cases and agreement about replacement 26%. Multiple logistic regression analysis with overall agreement as dependent variable identified tooth type (OR = 2.7 for anterior teeth versus molars, 95% CI: 1.3; 5.6 and OR = 1.9 for molars versus premolars, 95% CI: 1.2; 3.2), service sector, dentist's age and patient gender as significant predictors. Tooth type (OR = 36.0 for anterior teeth versus molars, 95% CI: 12.5; 104.0 and OR = 5.8 for premolars versus molars, 95% CI: 2.7; 12.3), service sector (OR = 7.0, 95% CI: 2.3; 21.1), the number of teeth extracted and the number of remaining natural teeth affected the likelihood of agreement about the need for replacement of extracted teeth. Predictors of no need for replacement were tooth type (OR = 6.7 for molars versus premolars, 95% CI: 3.3; 13.7) and the dentist's age (OR = 2.1, 95% CI: 1.2; 3.6). Clinical factors were the most important predictors of patients' and dentists' likelihood to agree about replacement, but service sector, dentist's age and patient's gender had also a significant impact on the level of agreement.

Oral health status of adults from a California regional center for developmental disabilities

The oral health status and treatment needs of developmentally disabled adults (18 years and older) from a Los Angeles Regional Center who live in a variety of settings were measured as part of a comprehensive study to determine their overall health status. A dental assessment was performed on a sample of 325 persons which was similar in demographic composition to the entire population at the center. Approximately 80% of clients reported a personal dentist of record, and 73% brushed their own teeth. Edentulism was 9%. The mean number of retained teeth per person was 22. Subjectively, 15.7% of the sample was rated as having "good" overall dental health, 77.7% "fair," and 6.6% "poor." The major reasons rendering fair or poor assessments were oral hygiene, clinical periodontal disease, and dental caries. More females than males were assessed as having "good" overall dental health. The overall appearance of the teeth for a majority of the sample (76.5%) was rated as "same as most." Persons who brushed their own teeth had fewer missing teeth than those who did not. Persons with a dentist of record had fewer decayed and more filled teeth. Persons living at home with family or friends had a significantly lower DMFT index than those living independently or in facilities. In general, these findings are encouraging; however, caution must be exercised, since efforts to improve the oral health status of this population require continued attention.

Factors affecting self-ratings of oral health

OBJECTIVES

The purpose of this study is to determine the relationship of self-rated oral health to a comprehensive battery of clinical, sociodemographic, physical health, and mental health measures in a well-elderly urban population.

METHODS

Results are based on telephone interviews and clinical assessments of 550 subjects over 65 years of age participating in a Los Angeles-based Medicare project during 1990. Subjects were mostly female, white (89%), with above-average income.

RESULTS

Findings show that: (1) the DMF measure is not as strongly related to self-rated oral health as was a single measure of missing teeth; (2) the major predictors of self-rated oral health were "worry about teeth" and "appearance of teeth" followed by total missing teeth, race, education, and depression scores; and (3) self-rated general health is related to self-rated oral health.

CONCLUSION

Self-rated oral health may be, for older adults, a better measure of "health" than of "morbidity".