Three-year changes in self-perceived oral health status in an older Canadian population

The minimally important difference for the Xerostomia Inventory among Sjögren's disease patients

OBJECTIVE

Until now, the clinically relevant improvement for the Xerostomia Inventory (XI) has not been defined. Therefore, our aim was to determine the Minimally Important Difference (MID) of the XI for improvement in dry-mouth symptoms in SjD patients.

METHOD

The study recruited 34 SjD patients who underwent sialendoscopy of major salivary glands and 15 SjD patients in a nonintervention control group. XI scores were assessed at several time points. The MID was determined from the mean difference in XI scores between the groups with and without improvement.

RESULTS

In the control group, no significant XI score changes were seen. In the sialendoscopy group, a clinically relevant XI score change of four scale points was identified after 1 week. For a prolonged duration (≥16 weeks), a minimum reduction of seven scale points in the XI score was required to indicate clinically relevant improvement.

CONCLUSION

In SjD patients, a minimum change of four points in the XI score indicates a clinically relevant improvement for evaluating short-term effects. For prolonged effects, a clinically relevant improvement requires a MID of seven points. The determination of the MID in XI could assist in future studies that evaluate changes in xerostomia.

Ten-year cross-sectional and longitudinal assessment and factors associated with unfavourable self-rated oral health in older adults in the United States

OBJECTIVE

To investigate the association of demographic and socio-economic characteristics with self-reported oral health (SROH) among older adults who participated in the Health and Retirement Study (HRS) in 2008, 2018, or both, and to describe temporal changes.

METHODS

Data were from the University of Michigan's Health and Retirement Study (HRS), a nationally representative longitudinal survey of Americans aged 51 and older. Responses from participants who completed the Core HRS survey and Dental Module (DM) in 2008 (n = 1310), 2018 (n = 1330), and the "common group" at both timepoints (n = 559) were analysed. Using the common group, the outcome measure was 2018 self-rated oral health (Favourable vs Unfavourable). Potential explanatory variables included 2008 self-rated oral health (SROH), sociodemographic, and dental utilisation-related factors. Survey logistic regression analysis was used to identify factors that were associated with unfavourable 2018 SROH in 2018.

RESULTS

Unfavourable SROH prevalence was 28.5% and 31.6% in 2008 and 2018, respectively. Among the common, longitudinal group, the unfavourable prevalence remained the same, 26.1% at both timepoints. A positive association was seen between 2018 unfavourable SROH and baseline variables of 2008 unfavourable SROH, male gender, less education, and lower levels of wealth.

CONCLUSIONS

Over a quarter of participants reported unfavourable SROH. There was little change in SROH during this period. Sociodemographic factors influence the SROH of the older population. Policies and programs to promote and protect the oral health of older adults should be designed and implemented to reduce social inequalities and improve the SROH of disadvantaged older adults.

Is social origin, destination or mobility what matters to adult self-rated oral health?

OBJECTIVES

To evaluate the independent contributions of parental socioeconomic position (SEP), own SEP and social mobility to explain adult self-rated oral health.

METHODS

Data from 6633 participants in the 1970 British Cohort Study were analysed. Parental SEP at the age of 10 years (social origin) and own SEP at the age of 46 years (social destination) were indicated by the 7-class National Statistics Socioeconomic Classification (NS-SEC). The study outcome was self-rated oral health (SROH) at the age of 46 years. Diagonal reference models (DRMs) were used to parse out the effects of parental SEP, own SEP and intergenerational mobility from childhood to middle adulthood, after adjusting for demographic characteristics (sex, ethnicity, country and area of residence).

RESULTS

Overall, 23.1% of participants reported poor SROH. A baseline DRM, with no indicators of social mobility, showed that the contribution of own SEP to explain variations in SROH was higher than that of parental SEP. However, they became almost equal after indicators of social mobility were introduced. Downward mobility was associated with poor SROH (odds ratio: 1.24, 95% CI: 1.01-1.51), but upward mobility was not (1.01, 95% CI: 0.83-1.23). Also, short-range downward mobility and long-range downward mobility (moving 1 and 2+ social classes down in NS-SEC, respectively) were associated with poor SROH (1.26, 95% CI: 1.01-1.58 and 1.39, 95% CI: 1.06-1.83, respectively) whilst short-range upward mobility (1.04, 95% CI: 0.84-1.28) and long-range upward mobility (0.88, 95% CI: 0.67-1.14) were not.

CONCLUSIONS

The contributions of parental and own SEP were similar once social mobility was accounted for. Only downward mobility was associated with poor SROH, with new evidence that long-range mobility was more strongly associated with poor SROH than short-range mobility.

The impact of socioeconomic status, general health and oral health on Health-Related Quality of Life, Oral Health-Related Quality of Life and mental health among Polish older adults

BACKGROUND

The study aims to evaluate the impact of socioeconomic status, general health and oral health parameters on Health-Related Quality of Life (HRQoL), Oral Health-Related Quality of Life (OHRQoL) and mental health in elderly urban residents of South-Western Poland.

METHODS

The 500 residents of Wroclaw, aged 65 and older provided demographic and personal information as well as their medical history. A patient's oral condition were determined based on the clinical oral examination.Quality of Life was assessed using Euro-Quality of Life (EQ-5D), Oral Health Impact Profile-14 (OHIP-14) and Patient Health Questionnaire (PHQ-9).The association between exposure (socioeconomic status, general health and oral health) and outcome (HRQoL, OHRQoL and mental health variables) were analyzed with the use of four models: P - Poisson model, NB-Negative Binomial model, ZIP - Zero Inflated Poisson model, ZINB - Zero Inflated Negative Binomial model.

RESULTS

The best model turned out to be the ZINB model, in which a negative binomial distribution in the count equation is assumed. In this model, only 13 independent variables had a significant effect on HRQoL, OHRQoL, and mental health. HRQoL assessed with the EQ-5D is significantly influenced by: living conditions 0.133 (95% CI: 0.001, 0.267, p = 0.049), income -0.348 (95%CI: -0.466, -0.230, p < 0.001), diabetes mellitus 0.437 (95%CI: 0.250, 0.624, p < 0.001), myocardial infarction 0.454 (95% CI: 0.151, 0.757, p = 0.003), stroke 0.543 (95%CI: 0.094, 0.992, p = 0.018) and renal disease 0.466 (95% CI: 0.206, 0.726, p < 0.001). Factors negatively affecting OHRQOL are: the need for oral treatment 0.278 (95%CI: 0.104, 0.452, p = 0.002), the number of missing teeth 0.053 (95%CI: 0.039, 0.067, p < 0.001) and gender 0.271 (95%CI: 0.015, 0.527, p = 0.038) and age -0.025 (95%CI: -0.042, -0.008, p = 0.003). An important factor influencing the level of depression assessed by the PHQ-9 questionnaire may be the material condition -0.225 (95%CI: -0.349, -0.101, p < 0.001). It should be emphasized that living with other people may be a factor that significantly increases the probability of avoiding the occurrence of depression symptoms.

CONCLUSION

The study concerning elderly residents of the macroregion in Poland found the impact of socioeconomic, general health and oral health parameters on Health-Related Quality of Life, Oral Health-Related Quality of Life and mental health. Research on the quality of life of the elderly at the local level allowed to assess the factors linked to quality of life of older adults.

Health-related quality of life in burning mouth syndrome - a case-control study

Objectives The cardinal symptom of burning mouth syndrome (BMS) is long-lasting pain and comprehensive health-related quality of life (HRQL) assessments may estimate how well patients with BMS live in relation to their health issues. The aims of the study were to explore general and BMS-specific HRQL based on an HRQL model and to compare HRQL in patients with BMS and age-matched controls. Methods For this case-control study 56 female patients with BMS and 56 female controls completed the following: A general questionnaire with Global items for life satisfaction, general health and oral health; General Population-Clinical Outcomes in Routine Evaluation (GP-CORE); Hospital Anxiety and Depression Scale (HADS); and Oral Health Impact Profile-14 (OHIP-14). Patients with BMS completed additional questionnaires which included BMS-problem severity, a global item for ratings of overall severity perceptions measured by visual analog scale (VAS); and BMS-modified Multidimensional Pain Inventory-Swedish version (MPI-S). BMS-modified MPI-S includes the three subscales Pain severity, Interference and Social support. Results Patients with BMS scored worse on all global items, GP-CORE, HADS and OHIP-14 compared to controls and the differences were large. Patients with severe BMS problems, as defined by a median split on BMS-problem severity, scored worse on the BMS-modified MPI-S subscale Pain severity and the difference was large. Conclusions We found clearly impaired general HRQL in patients with BMS compared to controls. For specific HRQL, the severity of pain was worse among patients with higher overall BMS-problem severity. The HRQL model with global ratings together with physical, psychological and social concepts has capacity to increase comparability and validity of studies, however further evaluations of the measures are needed. The HRQL model may be used over time to increase the understanding of different HRQL aspects and their internal relationships. In clinical settings, with an increased knowledge of one´s own distinctive quality of life abilities and restrictions, the patients with BMS can be guided and supported to manage their long-lasting pain. The HRQL model may be an aid toward bridging distinctions between general and oral health to further encourage collaboration between medicine and odontology.

Access to dental services and oral health-related quality of life in the context of primary health care

The aim of the present study was to evaluate the association between access to oral health care in the Primary Health Care (PHC) and Oral Health-Related Quality of Life (OHRQoL). The present study was a cross-sectional study, and the sample was composed of 412 users living in the areas covered by the public PHC services who visited a health unit for an oral exam or treatment in the last 24 months. Participants in the study responded to a home-based interview with questions that addressed socioeconomic status, behavioral, general health, dental prostheses, access to dental services in the PHC and their OHRQoL as measured by the Oral Health Impact Profile (OHIP-14) instrument. After the interview, a dental examination was performed to count the number of teeth. Chi-square tests, Student's t tests and multivariate analyses were performed using a hierarchical model and a Poisson regression with robust variance to evaluate the association between independent variables and OHRQoL. Access to oral health services in the PHC was statistically associated with OHRQoL, and the estimated prevalence rate was PR = 1.17 (CI 95% 1.00-1.37). In this study, the definition of access was based on the availability of dental consultations on demand. The study identified that lack of access to oral health services offered by the PHC was associated with a higher prevalence of impact on the quality of life of individuals.

Changes in oral health-related quality of life (OHRQoL) related to long-term utilization of dental care among older people

OBJECTIVE

To examine whether long-term utilization of dental care, treatment with fillings and crowns and persistent tooth loss between age 50 and 65 years associate with subsequent changes in OHRQoL from age 65 to 70 years.

METHOD

In 1992, a census of 50-year-olds received invitation to participate in a questionnaire survey. Of 6346 respondents, 3585 completed follow-ups in 1997, 2002, 2007 and 2012. OHRQoL was measured using the Oral Impacts on Daily Performances (OIDP) inventory.

RESULTS

Around 70.4%, 11.2% and 18.4% confirmed respectively, no change, worsening, and improvement in OIDP scores between age 65 and 70 years. Compared to those being permanent non-routine dental attenders, ORs of improving and worsening of OIDP were respectively, 0.4 and 0.6 if being a permanent routine dental attender. ORs for improving OIDP was 1.6 if reporting persistent specialist attendance and 2.5 if having received crowns and fillings. Participants with permanent tooth loss were most likely to both worsen and improve OIDP.

CONCLUSION

Long-term routine dental attendance and permanent tooth loss occurred as predictors simultaneously for improvement and worsening of OIDP. Accumulation of advantages and disadvantages throughout the life-course increases and decreases the probability of improvement and worsening in OIDP among older people in Sweden.

Assessment of oral health-related quality of life as a function of non-invasive treatment with high-fluoride toothpastes for root caries lesions in community-dwelling elderly

PURPOSE

Non-invasive treatment of root caries lesions (RCLs) may impact oral health-related quality of life (OHRQoL), but no evidence is available. The purpose of the study was to assess changes in OHRQoL among patients exposed to non-invasive treatment of RCLs with conventional or high-fluoride dentifrices.

METHODS

To be eligible, subjects had to be ≥60 years of age, independently living, with at least five teeth and one RCL. The 14-item Oral Health Impact Profile for adults in Spanish (OHIP-14Sp), oral examination and sociodemographic data were documented at the beginning of the study (T0). The presence and activity of RCLs were detected and diagnosed. Subjects were randomly assigned to either the control (1,450 ppm fluoride) or the experimental (5,000 ppm fluoride) treatment group. A new set of measurements was obtained at 12 months (T1). Mean comparisons were carried out using the Student's t-test for total OHIP-14Sp scores. To determine whether T1 OHRQoL scores were different regarding sex, age, educational level and socio-economic status, mean OHIP-14Sp scores were obtained and compared with those variables at 12 months.

RESULTS

An overall improvement in OHRQoL after the non-invasive treatment of RCLs was verified when T1 was compared with T0 (P < 0.0001). Regarding treatment type, no significant differences were detected between groups (P = 0.114). Subjects with higher income and more years of formal education had better OHRQoL than those with a lower salary (P < 0.0001) and with fewer years of education (P = 0.0006).

CONCLUSIONS

Non-invasive treatment for RCLs in community-dwelling elders appears to cause a positive impact on OHRQoL. Better OHRQoL was associated with higher socio-economic status and educational level. No significant differences were detected regarding the fluoride concentration in the dentifrices.

Global self-rating of oral health as summary tool for oral health evaluation in low-resource settings

Objectives:

Global Self-Rating of Oral Health (GSROH) has numerous benefits, especially in resource-constrained environments with a paucity of dentists thereby potentially limiting administration of oral health surveys and monitoring of dental treatment. The aim of the study was to identify factors that could influence or predict poor self-ratings of oral health.

Materials and Methods:

The study was descriptive in design. Data were collected using structured interviewer-administered questionnaire, which had items on socio-demographic characteristics of the respondents and their GSROH. Oral examination was conducted to identify untreated dental caries, missing teeth, and mobile teeth. Data were analyzed using SPSS, and the P value was set at 0.05.

Results:

There were 600 participants; 400 were teachers constituting the non-patient population and 200 were dental patients with age ranging from 18 to 83 years. A total of 169 (28.1%) participants rated their oral health as poor, including 104 patients (52.0%) and 65 (16.2%) non-patients (P < 0.001). Having had toothache in the preceding 6 months (62.4% vs. 16.0%, P < 0.001), mobile teeth (46.7% vs. 24.2%, P < 0.001), decayed teeth (49.0% vs. 21.3%, P < 0.001), missing teeth (35.0% vs. 26.1%, P = 0.042), or DMFT score greater than zero (41.1% vs. 20.7%, P < 0.001) was associated with poor GSROH. Presence of mobile teeth [odds ratio (OR) = 2.68; 95% confidence interval (CI): 1.29, 4.23; P < 0.001] and carious teeth (OR = 2.25; 95% CI: 1.09, 4.65; P = 0.029) were independent predictors of GSROH.

Conclusion:

The GSROH was able to identify individuals with or without oral conditions in the studied population, and thus may be used in oral health surveys to assess the oral health status and in monitoring of treatment outcome.

Oral health related quality of life

Diseases and disorders that damage the mouth and face can disturb well-being and his self-esteem. Oral health-related quality of life (OHRQOL) is a relatively new but rapidly growing notion. The concept of OHRQOL can become a tool to understand and shape not only the state of clinical practice, dental research and dental education but also that of community at large. There are different approaches to measure OHRQOL; the most popular one is multiple item questionnaires. OHRQOL should be the basis for any oral health programme development. Moreover, research at the conceptual level is needed in countries where OHRQOL has not been previously assessed, including India.

Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden

BACKGROUND

Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.

METHODS

In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.

RESULTS

Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p < 0.05). Stratified analysis revealed that the mean OIDP frequency score worsened in participants who became dissatisfied- and improved in participants who became satisfied with oral health. Compared to participants who maintained all teeth, those who lost teeth were more likely to experience improvement and worsening of OIDP across both countries. The two-way interaction between country and tooth loss was not statistically significant.

CONCLUSIONS

Changes in OIDP at the individual level were more pronounced than the percentage distribution of OIDP at each point in time would suggest. The OIDP frequency score showed promising evaluative properties in terms of acceptable longitudinal validity, responsiveness and reproducibility among older people in Norway and Sweden. This suggests that the OIDP instrument is able to detect change in the oral health status that occurred over the 5 year period investigated. Norwegian elderly were more likely to report worsening in OIDP than their Swedish counterparts. Disease prevention should be at focus when formulating the health policy for older people.

[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.

Self-reported oral health and oral health behaviors in older adults in the last year of life

BACKGROUND

The complex physiological, psychological, and functional changes at the end of life may dramatically affect oral health. However, evidence regarding oral health changes at the end of life is scarce. This study's objective was to examine self-rated oral health and oral health behaviors among community-dwelling elders in the last year of life.

METHODS

This study was a retrospective longitudinal study including 810 dentate community-dwelling older adults aged 65 and older. Based on death certificate data, the participants were retrospectively classified into two groups: died within 1 year after the last interview (end-of-life group) and survived more than 1 year after the last interview (comparison group). Participants were interviewed at baseline, 18, 36, 60, and 84 months regarding their sociodemographics, self-reported oral health, oral conditions, use of oral health services, and preventive behaviors. Generalized estimating equations were used to compare self-reported oral health and oral health behaviors between two groups.

RESULTS

After adjusting for sociodemographics, the end-of-life group was more likely to rate their oral health (odds ratio [OR] = 2.94, 95% confidence interval [CI]: 1.32, 6.54) and overall health (OR = 2.35, 95% CI: 1.12, 4.91) as bad than the comparison group. End-of-life participants were also more likely to dislike their mouth appearance (OR = 2.27, 95% CI: 1.07, 4.83) and rate their ability to taste (OR = 7.24, 95% CI: 2.64, 19.77) and smell (OR = 2.98, 95% CI: 1.09, 8.15) as bad. There was no difference in self-reported oral conditions, use of oral health services, and preventive behaviors.

CONCLUSIONS

Self-rated oral health significantly declines in the last year of life.

[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.

Construct validity of Locker's global oral health item

With clinical oral examinations not always possible in health surveys, researchers may instead be invited to add questions to a wider health survey. In such situations, an item is needed which adequately represents both clinical and self-reported oral health. This study investigated the clinical validity of Locker's global self-reported oral health item among young middle-aged adults in populations in New Zealand and Australia. Clinical examination and self-report data (including the OHIP-14) were obtained from recent national dental surveys in NZ and Australia, and from age-38 assessments in the Dunedin Multidisciplinary Health and Development Study. National dataset analyses involved 35- to 44-year-olds. Caries and tooth-loss experience showed mostly consistent, statistically significant gradients across the Locker item responses; those responding 'Excellent' had the lowest scores, and those responding 'Poor' the highest. Periodontitis experience gradients in the NZ national sample were mainly as hypothesized; those rating their oral health as 'Poor' had the highest disease experience. OHIP-14 gradients across the Locker item responses were consistent and as hypothesized. The proportion of disease in the population borne by those 'Fair' or 'Poor' ranged from 26% to 72%. These findings provide preliminary support for the measure's validity as a global self-reported oral health measure in young middle-aged adults.

Do the indonesians receive the dental care treatment they need? A secondary analysis on self-perceived dental care need

Increasing access for citizens to health services, including dental care, is one of the primary targets of the Indonesian Ministry of Health. To assess progress toward this goal, we sought to describe the magnitude of unmet needs for dental care among Indonesians. Secondary data of nationally representative surveys conducted from 2003 to 2007 were analysed to describe the associations between unmet needs for dental care in different demographic groups. In average, 2.28% of the Indonesian population reported perceiving need for dental care and 0.74% reported utilizing dental care. The average of unmet need was 72.04%. Logistic regression analysis indicated that respondents who lived in rural areas, who were uninsured, had higher odds ratios in reporting unmet dental care needs. Perceived need for and utilization of dental care among Indonesians was found to be low. Moreover, the unmet need for dental care is relatively high.

The influence of the volume of dental treatment on change in self-reported oral health

OBJECTIVES

To find an association between self-reported change in oral health and dental treatment volume.

METHODS

Baseline data were obtained from the Tasmanian component of the National Survey of Adult Oral Health 2004-06 and 12-month follow-up data from service use logbooks and mail self-complete questionnaires. The global oral health transition statement indicated change in oral health. Many putative confounders were analyzed and Poisson regression with robust variance estimation was used to calculate the prevalence ratios and 95 percent confidence intervals for bivariate- and multivariate-adjusted relationships.

RESULTS

One-eighth (12.4 percent) of the participants reported that their oral health had improved. Over half visited a dentist (n=176, 52.6 percent), of whom 105 received less than six dental services and 71 received six or more dental services. Baseline oral disease (P=0.01), having a treatment need (P<0.01), usually visiting a dentist for a problem (P<0.05), and having a lot of difficulty paying a $100 dental bill (P=0.01) were significantly associated with the same or worsening oral health. The regression model indicated that having six or more dental services (P<0.01) was significantly associated with improvement in oral health, indicating a threshold effect. Usually visiting a dentist for a check-up was significantly associated with improvement in oral health (P<0.01).

CONCLUSION

Having six or more dental services was significantly associated with a greater self-reported improvement in oral health than having less than six dental services. The greater prevalence ratios with increasing dental service volume suggested a threshold effect.

Correlates of change in self-perceived oral health among older adults in Brazil: findings from the Health, Well-Being and Aging Study

BACKGROUND

Identifying changes in the oral health status of older populations, and their predictors and explanations, is necessary for public health planning. The authors assessed patterns of change in oral health-related quality of life in a large cohort of older adults in Brazil during a five-year period and evaluated associations between baseline characteristics and those changes.

METHODS

The sample consisted of 747 older people enrolled in a Brazilian cohort study called the Health, Well-Being and Aging (Saúde, Bem-estar e Envelhecimento [SABE]) Study. Trained examiners measured participants' self-perceived oral health by using the General Oral Health Assessment Index (GOHAI). The authors calculated changes in the overall GOHAI score and in the scores for each of the GOHAI's three dimensions individually by subtracting the baseline score from the score at follow-up. A positive difference indicated improvement in oral health, a negative difference indicated a decline and a difference of zero indicated no change.

RESULTS

The authors found that 48.56 percent of the participants experienced a decline in oral health and 33.48 percent experienced an improvement. Participants with 16 or more missing teeth and eight or more years of education were more likely to have an improvement in total GOHAI score. Deterioration was more likely to occur among those with two or more diseases. Improvement and decline in GOHAI functional scores were related to the number of missing teeth. The authors found no significant model for the change in the psychosocial score, and self-rated general health was the only variable related to both improvement and decline in pain or discomfort scores.

CONCLUSIONS

The authors observed a bidirectional change in self-perceived oral health, with deterioration predominating. The strongest predictor of improvement in the total GOHAI score was the number of missing teeth, whereas the number of diseases was the strongest predictor of deterioration.

CLINICAL IMPLICATIONS

Dental professionals and policymakers need to know the directions of change in older adults' oral health to establish treatment priorities and evaluate the impact of services directed at this population.

[Psychosocial aspects of teenager in Aracaju, Sergipe State, related to oral health perception]

The objective of this article is to investigate the autoperception of teenagers, age range of 12 to 19 years old in Aracaju, Sergipe State, about their health and relate it with psychosocial aspects. The present work is a quali-quantitative study of transversal cut, carried through with 247 adolescents registered institutions of education, private or public, of the urban zone of the city of Aracaju. Most of the adolescents (85%) consider themselves healthful, while 9% have shame of the oral conditions. Seventy-one percent of the students referred to pain, however it wasn't the main cause to search dentistry services. The subjective pointers of this research may be used to guide programs directed toward education in health.

Validity of single-item parental ratings of child oral health

OBJECTIVE

The aim of this study was to assess the validity of single-item parental ratings of child oral heath.

METHODS

Data were collected during a study to assess the impacts of dental injury. Clinical examinations of children aged 11-14 years were undertaken that included measures of trauma, decay, treatment needs, and fluorosis. Children with trauma and a group of trauma-free children were followed-up. Parents were mailed a questionnaire along with a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire 11-14 (CPQ11-14). Bivariate analyses examined associations between parents' ratings of their child's oral health, measures of dental disease, clinically defined treatment needs, and scores on the CPQ11-14. Logistic regression was used to see if the associations observed remained after controlling for access to dental care variables.

RESULTS

Complete data were collected from 370 children and their parents. Parental ratings showed significant associations with most of the clinical indicators used and CPQ11-14 scores. Similar results were obtained when the data were analysed for subgroups defined by household income and mother's education. These associations remained after controlling for access to dental services.

CONCLUSION

The data suggest that single-item parental ratings of child oral health have adequate construct validity.

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.

Measuring change in dry-mouth symptoms over time using the Xerostomia Inventory

OBJECTIVE

To examine the responsiveness to change of the Xerostomia Inventory (XI).

BACKGROUND

The XI is an 11-item summated rating scale which results in a single continuous scale score representing the severity of chronic xerostomia. While the XI has been used as an outcome measure in clinical research, the magnitude of a clinically meaningful change score has yet to be determined.

METHODS

This study comprises a secondary analysis of data from a longitudinal study of changes in xerostomia symptoms in two groups whose symptom trajectories were likely to differ substantially: the normal group was a convenience sample of asymptomatic middle-aged and older individuals with otherwise stable perceptions of mouth dryness; and the onset group comprised patients who were about to undergo radiotherapy for head/neck cancer (and would therefore be expected to develop more severe xerostomia after the baseline measurements). Statistical analyses examined cross-sectional construct validity and internal consistency, test-retest reliability and the measure's responsiveness and longitudinal construct validity. The mean change scores of those for whom 'a little' improvement was reported were used to determine the minimally important difference for the XI.

RESULTS

Over two-thirds of the onset group members reported dry mouth 'frequently' or 'always' at follow-up (2 months) and there was a concomitant increase in their mean XI score. Test-retest reliability was acceptable. Examination of within-individual change among those who changed and those for whom stability was observed, showed that only those who worsened had significantly greater XI scores at follow-up. The minimally important difference to reflect deterioration in xerostomia symptoms was determined to be 6 scale points. Between baseline and 2 months, the XI scores of 32 participants (33.7%) deteriorated by the minimally important difference (7.1% and 54.7% respectively among the normal and onset groups; p < 0.0001).

CONCLUSION

The validity and responsiveness of the XI appear to be acceptable, and a change in XI score of 6 or more points is clinically meaningful.

Predictors of oral health quality of life in older adults

There is limited information regarding oral health status and other predictors of oral health-related quality of life. An association between oral health status and perceived oral health-related quality of life (OHQOL) might help clinicians motivate patients to prevent oral diseases and improve the outcome of some dental public health programs. This study evaluated the relationship between older persons' OHQOL and their functional dentition, caries, periodontal status, chronic diseases, and some demographic characteristics. A group of 733 low-income elders (mean age 72.7 [SD = 4.71, 55.6% women, 55.1% members of ethnic minority groups in the U.S. and Canada) enrolled in the TEETH clinical trial were interviewed and examined as part of their fifth annual visit for the trial. OHQOL was measured by the Geriatric Oral Health Assessment Index (GOHAI); oral health and occlusal status by clinical exams and the Eichner Index; and demographics via interviews. Elders who completed the four-year assessment had an average of 21.5 teeth (SD = 6.9), with 8.5 occluding pairs (SD = 4.6), and 32% with occlusal contacts in all four occluding zones. Stepwise multiple regressions were conducted to predict total GOHAI and its subscores (Physical, Social, and Worry). Functional dentition was a less significant predictor than ethnicity and being foreign-born. These variables, together with gender, years since immigrating, number of carious roots, and periodontal status, could predict 32% of the variance in total GOHAI, 24% in Physical, 27% in Social, and 21% in the Worry subscales. These findings suggest that functional dentition and caries influence older adults' OHQOL, but that ethnicity and immigrant status play a larger role.

Oral conditions and quality of life

Oral conditions can have serious, disabling effects. The purposes of this study are 2-fold: first to estimate the prevalence and severity of self-reported oral problems in male veterans who use Department of Veterans Affairs (VA) outpatient medical (but not dental) care and, second, we examine to what extent the impact of oral conditions is associated with measures of general health and well-being. Male veteran users of outpatient VA medical care from the Veterans Health Study (N = 2425) were surveyed using questionnaires, which included sociodemographic information, the SF-36, the Geriatric Oral Health Assessment Index (GOHAI), and the Oral Health and Quality of Life (OHQOL) measure. Only 28% of these users of VA outpatient care rated their oral health as excellent or very good, 32% as good, and nearly 40% as fair or poor. Furthermore, only one half of respondents could always eat without discomfort, were pleased with the looks of their teeth, and had no worries about their teeth. Factor analysis of the SF-36, GOHAI, and OHQOL items confirmed that both the GOHAI and the OHQOL are separate and independent of the 8 scales of the SF-36. Regression analyses showed that the GOHAI but not the OHQOL is significantly associated with the mental and physical component summary scales of the SF-36 when both sociodemographics and disease burden are controlled for in the models. Oral problems, as measured by the GOHAI and the OHQOL, are significant burdens on the health and function of veterans who use VA outpatient care. Oral health, as measured by the GOHAI, contributes in an important way to the functional well-being of users of VA healthcare.

Oral Impacts on Daily Performance in Norwegian adults: validity, reliability and prevalence estimates

The Oral Impacts on Daily Performance (OIDP) instrument was translated into Norwegian and reviewed for cultural and conceptual equivalence by a group of bilingual academics. A sample of employees from the University of Bergen completed the Norwegian OIDP frequency questionnaire twice. A total of 173 and 108 subjects participated in the first and the second administration, respectively, of this questionnaire. A two-stage proportionate random sample, comprising 2,000 residents (age-range 16-79 yr), was drawn from the national population register by the Central Bureau of Statistics. Information became available for 1,309 persons who completed telephone interviews. The Norwegian OIDP preserved the overall concept of the English version. Test-retest reliability, in terms of Cohen's kappa, was 0.65, and Cronbach's alpha was high (> or = 0.80). In both samples, variations in the OIDP scores were apparent in relation to self-reported oral health and number of remaining teeth, supporting construct and criterion validity of the inventory. Only three of the OIDP interviews were discarded, which supports face validity. A total of 18.3% confirmed that they had at least one oral impact. Age-specific rates were 17.5%, 19.0%, 17.9% and 18.4% among 16-24, 24-44, 45-66 and 67-79-yr-old participants. The satisfactory psychometric properties provide evidence for the cross-cultural use of the OIDP. The presence of a distinct floor effect indicates poor sensitivity of the OIDP to detect improvements of oral health-related quality of life at a population level. Prevalence estimates were low, suggesting that the current oral health status has little impact on the daily performance of the Norwegian adult population.

The sensitivity and responsiveness of an oral health related quality of life measure to tooth whitening

OBJECTIVES

To assess the sensitivity and responsiveness of an oral health related quality of life measure to tooth whitening.

METHODS

Following screening at a clinic, 87 subjects were given an array of tooth whitening products to use at home and reviewed 8 weeks later. Subjects self-completed the 49-item Oral Health Impact Profile (OHIP) at baseline and follow-up, and rated their satisfaction with the whiteness of their teeth compared to baseline on a global transition scale.

RESULTS

In terms of sensitivity, observed changes were apparent in overall OHIP scores (P<0.05) and across several domains, notably functional limitation (P<0.01). However, the magnitude of change (effect size) was generally small except for the functional domain. There was an observed gradient in observed change in OHIP scores and in the magnitude of such changes (effect sizes) in relation to global rating of satisfaction with the outcome, supporting the responsiveness of the measure.

CONCLUSION

The OHIP scale is sensitive and responsive to the effects of tooth whitening. Greatest sensitivity and responsiveness was in relation to functional limitations. These findings have implications for the use of oral health related quality of life measures as an outcome measure of interventions aimed at improving dental aesthetics through tooth whitening.

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

OBJECTIVES

General health perceptions, usually measured by means of single-item indicators, are commonly included in health and oral health surveys. The aim of the study reported here was to assess the relationship between self-rated oral health and satisfaction with oral health in two studies of older adult populations.

METHODS

Participants in Study 1 were aged 50 years and over, the majority of whom had multiple chronic medical conditions and disabilities and lived within a multi-level geriatric care setting. They were recruited when attending a clinic in that setting for their annual dental screening. Participants in Study 2 were somewhat healthier community dwelling individuals, also aged 50 years and older, who took part. They were originally recruited by means of a telephone survey based on random-digit dialing. For Study 1, data were collected by means of personal interviews and a review of dental clinic charts, while for Study 2 personal interviews, clinical examination and self-completed questionnaires were used. Measures included self-rated oral health, satisfaction with oral health, oral health-related quality of life (OHRQoL) and tooth loss.

RESULTS

Data were obtained from 225 persons in Study 1 and 541 in Study 2. In both studies there was a significant association between self-ratings of oral health and satisfaction with oral health. However, also in both studies there was a discrepancy between the measures: approximately 10% of those with favourable oral health ratings were dissatisfied while approximately half of those with unfavourable ratings were satisfied. Those with apparently discordant responses had significantly higher scores on OHRQoL measures such as the GOHAI and the OHIP-14 than those with concordant responses. In Study 2, a similar discrepancy between self-rated general health and satisfaction with general health was also observed.

CONCLUSIONS

There is degree of discordance between self-ratings of and satisfaction with both oral and general health status in the older adult populations studied here. This may be because of the expectations concerning health in later life. More needs to be known about the frames of reference people use in constructing their responses to questions designed to assess health perceptions.

Autopercepção e condições de saúde bucal em uma população de idosos

Este estudo avaliou as condições de saúde bucal clinicamente e através da autopercepção. A amostra foi de 112 indivíduos com mais de 60 anos, residentes em Rio Claro, São Paulo, Brasil, dividida em G1 - sem acesso a tratamento odontológico conveniado (n = 55) e G2 - com acesso a tratamento odontológico conveniado (n = 57). Os exames clínicos seguiram critérios da Organização Mundial da Saúde. A autopercepção foi avaliada usando o índice GOHAI (Geriatric Oral Health Assessment Index). O CPO-D foi de 29,13, maior no G1 (p = 0,0091). A média de dentes presentes foi de 7,63, maior no G2 (p = 0,0131). As condições periodontais avaliadas apresentaram uma grande porcentagem de sextantes nulos (70,3%), sendo que o CPI apontou o cálculo como a maior prevalência, e o PIP, as bolsas até 3mm. A porcentagem de indivíduos edêntulos foi de 45,5%, maior no G1 (p = 0,0142). Dentre os edêntulos, 69,6% usavam próteses totais superiores, e 42,9%, inferiores. A média do GOHAI foi de 33,61, qualificando como positiva a percepção da saúde bucal e houve diferença apenas na dimensão física, com o maior valor no G2 (p = 0,0154). A autopercepção da saúde bucal foi satisfatória, o que não pôde ser confirmado com os dados clínicos obtidos nos grupos.

Applicability of an abbreviated version of the oral impacts on daily performances (OIDP) scale for use among Tanzanian students

OBJECTIVES

The objective was to examine the applicability of an abbreviated version of the oral impact of daily performances (OIDP) inventory to Tanzanian adults attending the University of Dar es Salaam.

METHOD

A total of 1123 students (mean age 26.4 years, response rate 58%) completed a survey instrument designed to measure subjective oral health indicators including the eight-item OIDP frequency scores. After a period of 4 weeks, 228 students (mean age 24.6 years, response rate 65%) were examined clinically for the presence or absence of oral disorders.

RESULTS

A total of 51% of the participants reported that an oral problem had affected them on at least one daily performance in the 6 months preceding the survey. Cronbach's alpha for the OIDP frequency items was 0.83 and 0.87 on the first and second administration of the questionnaire. A reliability coefficient (Spearman's rho) of 0.87 was obtained for the OIDP frequency scores. For five of the eight OIDP frequency items, the kappa values ranged from 0.60 to 1.0, whereas one scale item had the less satisfactory value of 0.22. Construct validity was demonstrated in that the OIDP frequency scores were statistically significantly associated in the expected direction with clinically observed oral problems and a global self-report indicator of oral health status, respectively.

CONCLUSION

The OIDP frequency scale seems to have acceptable psychometric properties in the context of a descriptive questionnaire survey among Tanzanian university students.

Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population

Numerous studies have demonstrated that many older adults have problems chewing, pain, difficulties in eating, and problems in social relationships because of oral disorders. However, it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction. Consequently, this paper begins to address the question, 'Does poor oral health compromise the quality of life?'. Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults. As at baseline and three-year follow-up, oral health was measured by self-ratings of oral health and five oral health indices. Psychological well-being and life satisfaction were assessed according to the Morale Index, the Perceived Life Stress Questionnaire, The Life Satisfaction Scale, and the General Health Questionnaire. All oral health variables were significantly associated with scores from the first three of these measures in the expected direction. These associations remained after we controlled for other potential influences on the quality of life. In addition, prospective analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years. These results suggest that poor self-perceived oral health and relatively poor quality of life co-exist in the same subgroup of older adults.

Patterns of change in self-reported oral health among dentate adults

BACKGROUND

Although self-assessments of oral health have become useful tools in dental research, the use of self-reports to study changes in oral health over time has been limited. The aim of this investigation was to describe how oral disease and tissue damage, pain, functional limitation, disadvantage, and self-rated oral health change over time.

METHODS

The Florida Dental Care Study (FDCS) (n = 873) is a longitudinal study of oral health among dentate adults (age, > or = 45 years). Incidence rates and transition probabilities were used to describe changes in oral health over a 24-month period.

RESULTS

The probability of reporting a specific problem during the 24-month study ranged from 0.52 for perceived need for dental care to 0.07 for avoided eating with others. Only dental sensitivity and perceived need for dental care had transition probabilities >0.20. Decomposition of transition probabilities revealed moderate probabilities of onset coupled with relatively high probabilities of recovery.

CONCLUSION

Although oral health status is clearly dynamic, no individual measure exhibited profound fluctuation. Most oral health problems were episodic rather than chronic. Patterns of change in oral health varied across dimensional lines.

Geographic variations in dental services provided to older adults in Ontario, Canada

In an initial study, Leake et al. (J Public Health Dent 1996; 52: 182-90) found that older Ontarians living in metropolitan communities received almost twice the amount of dental care than older Ontarians living in non-metropolitan communities. Since data were collected for the 2 years prior to the enrollment of subjects in a longitudinal study, factors responsible for this variation could not be explored. This paper extends these findings by examining the volume of dental services received by these subjects in the 3 years between the baseline and follow-up phases of the longitudinal study. During this 3-year period, geographic variations in the volume of services provided were also observed. In a regression analysis, geographic location remained a significant predictor of the number of services received after controlling for six other explanatory variables: insurance coverage, number of teeth, restorative treatment need, self-rated oral health, regular dental visits and use of specialist services. Together, these explained only 24% of the variance in service provision. Since patient-reported outcomes were better in the communities with higher volumes of provision, further research concerning the patient and dentist factors influencing treatment provision is warranted.

Perceptions of the natural dentition in the context of multiple variables

Perceived oral health status has been shown to be associated with a variety of single clinical and self-reported indicators of oral health and oral health-related behaviors. A behavioral model is utilized which hypothesizes that perceived condition of natural teeth is predicted by multiple factors, including individual demographic and enabling characteristics, other health perceptions and orientations, actual levels of diseases and conditions, and self-defined need for treatment. The data are from the clinical examination and adult questionnaire of Phase 1 (1988-1991) of the Third National Health and Nutrition Examination Survey, which is based on a stratified multistage probability sample to produce nationally representative data for the civilian, non-institutionalized US population. Multivariate hierarchical regressions were used to assess perceived condition of natural teeth in two groups of dentate adults (those with a dental visit during the past 12 months, and those with a less recent dental visit). Self-defined treatment need made a significant, non-trivial contribution after other variables had been controlled. In both subpopulation models, the perception of general health and epidemiological indicators of oral health status were also significant factors. Socio-economic indicators did not contribute significantly in either regression. Understanding components of overall perceptions of oral health moves us closer to understanding oral health behaviors and oral-health-related quality of life.