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S Fernandez M, Pauli LA, Araújo ABG, Demarco GT, Azevedo MS, da Costa VPP, Goettems ML. Dental pain in Brazilian preschool children: association with the severity of dental caries and impact on oral health-related quality of life. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00906-6. [PMID: 38761358 DOI: 10.1007/s40368-024-00906-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This study aimed to verify the association between dental pain and severity of dental caries (caries morbidity stages) and the impact on oral health-related quality of life (OHRQoL) in preschool children. METHODS A cross-sectional study with 199 children (2-5 years old) enrolled at preschools in Capão do Leão-RS, Brazil. The self-report of mothers of children with a history of dental pain in the last 6 months and perception of their child's OHRQoL (ECOHIS) were obtained through a structured questionnaire. This questionnaire also collected independent variables. Children's oral examination was performed using the CAST instrument to determine caries morbidity stage. Crude and adjusted Poisson regression analysis was performed. RESULTS The prevalence of dental pain was 14.57%. The chance of the occurrence of dental pain was higher among children diagnosed in morbidity [Prevalence ratio-PR: 5.29 (95% confidence interval-95% CI 1.91-14.61); p = 0.001] and severe morbidity [RP = 6.12 (95 CI% 2.25-16.64); p < 0.001] stages. Children with dental pain presented higher scores in the total ECOHIS [rate ratio = 7.11 (95% CI 4.55-11.09); p < 0.001] and in all of the domains of this instrument. Furthermore, children with a history of dental trauma [PR = 2.41 (95% CI 1.15-5.04); p < 0.001] and those whose reason for last visit to the dental office was for restorative/endodontic/extraction treatment [PR = 1.29 (95% CI 1.01-6.19); p = 0.049] had a higher prevalence of dental pain. CONCLUSION A substantial prevalence of dental pain in the last 6 months and negative impact on children's OHRQoL was identified in this sample. Children diagnosed with carious dentin lesions and abscess and fistula were more likely to have dental pain.
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Affiliation(s)
- M S Fernandez
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - L A Pauli
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - A B G Araújo
- School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - G T Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - M S Azevedo
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - V P P da Costa
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - M L Goettems
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
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de Souza VGL, Herkrath FJ, Garnelo L, Gomes AC, Lemos UM, Parente RCP, Herkrath APCDQ. Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey. PLoS One 2022; 17:e0277845. [PMID: 36413557 PMCID: PMC9681076 DOI: 10.1371/journal.pone.0277845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tooth loss is an oral health condition with high prevalence and negative impact on quality of life. It is the result of the history of oral diseases and their treatment as well as provision of dental care and access to dental services. Socioeconomic characteristics are determinants of tooth loss and living in rural areas is also a risk factor for its incidence. OBJECTIVE To identify contextual and individual factors associated with self-reported tooth loss among adults and elderly people living in rural riverside areas. METHODS A cross-sectional household-based survey was conducted in 2019 with rural riverside communities on the left bank of the Rio Negro River, Manaus, Amazonas. These communities are covered by a fluvial health team and two riverside health teams. Interviews were conducted in a representative random sample of dwellers aged ≥ 18 years, using electronic forms to obtain information on oral health conditions, demographic and socioeconomic characteristics, and use of and access to health services. The outcome was self-reported tooth loss. After the descriptive analysis of the data, a multilevel Poisson regression analysis was performed to estimate the prevalence ratio for the outcome. Variables with p-value ≤0.20 in the bivariate analyses were included in the multiple analysis considering the hierarchy between individual and contextual variables in the multilevel model. Variables with p-value ≤0.10 were kept in the final model and the significance level adopted was 0.05. RESULTS 603 individuals from 357 households were assessed (mean age 44.1 years). The average number of missing teeth was 11.2 (±11.6); 27.4% of individuals had lost more than 20 teeth (non-functional dentition) and 12.1% were completely edentulous. Contextual characteristic of primary healthcare offered was associated with the outcome. The tooth loss was lower in territories covered by riverside health teams. At individual level, tooth loss was greater in older individuals who had experienced dental pain over the past six months and whose sugar consumption was high. Black or brown individuals, individuals whose household income was higher, those who were on the Bolsa Família cash transfer program, those who consulted a dentist over the past year, and those who reported satisfaction with their teeth/oral health reported less tooth loss. CONCLUSION Tooth loss was associated with contextual territorial factors related to the healthcare service and individual demographic, behavioral, socioeconomic, and service-related characteristics as well as self-perceived oral health conditions. The findings suggest that actions focused on the oral health of these populations involve not only changes in the healthcare service organization, but also intersectoral policies that contribute to reducing social inequalities.
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Affiliation(s)
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- Superior School of Health Siences, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Luiza Garnelo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
| | - Andréia Coelho Gomes
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
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Rauber ED, Menegazzo GR, Knorst JK, Bolsson GB, Ardenghi TM. Pathways between toothache and children's oral health-related quality of life. Int J Paediatr Dent 2021; 31:558-564. [PMID: 32767803 DOI: 10.1111/ipd.12692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Toothache is considered a multifactorial health problem that is associated with oral diseases and comorbidities. AIM Evaluate the direct and indirect pathways between toothache and children's oral health-related quality of life (COHRQoL). DESIGN This is a cross-sectional study conducted with a random sample of children from southern Brazil. The variables included demographic, socioeconomic, behavioral, and oral health characteristics. Toothache was collected through the question 'Have you had toothache in the last 12 months?'. COHRQoL was collected by the Child Perceptions Questionnaire 8-10 in his Brazilian version. The pathways between the associated variables, toothache, and COHRQoL were analyzed through structural equation modeling. RESULTS A total of 449 schoolchildren were evaluated. The prevalence of toothache was 50.1% (95% confidence interval: 45.4%-54.8%). The poorer COHRQoL was directly affected by the presence of toothache. Considering the indirect pathways, the low household income, high household crowding, low age, the use of public health service, and the untreated dental caries influenced indirectly in the worst COHRQoL via toothache. CONCLUSION This study determined that COHRQoL was directly influenced by toothache. Meanwhile, indirect pathways were observed. These findings justify initiatives that highlight the importance of the reduction of oral diseases that can lead to pain experiences.
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Affiliation(s)
| | | | - Jessica Klöckner Knorst
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Gabriela Bohrer Bolsson
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Thiago Machado Ardenghi
- School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil.,Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
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Tenani CF, De Checchi MHR, da Cunha IP, Mendes KLC, Soares GH, Michel-Crosato E, Jamieson L, Ju X, Mialhe FL. Factors associated with poor oral health-related quality of life among non-institutionalized Brazilian older adults: Oral health and quality of life in older adults. SPECIAL CARE IN DENTISTRY 2021; 41:391-398. [PMID: 33705587 DOI: 10.1111/scd.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 12/17/2022]
Abstract
AIMS To investigate the factors associated with poor oral health-related quality of life (OHRQoL) in a sample of Brazilian older adults. METHODS AND RESULTS A cross-sectional study was conducted with 535 non-institutionalized elders aged 60 years or older from Piracicaba, São Paulo, Brazil. OHRQoL was measured using the Geriatric Oral Health Assessment Index (GOHAI). Data on sociodemographic characteristics, self-perceived general health status, and health-related behaviors were obtained through a structured questionnaire. Data on chronic diseases were obtained from health records. Associations between exploratory factors and low OHRQoL (% GOHAI score <30) were evaluated using multivariate Poisson regression models to estimate adjusted prevalence ratios (PRs) and confidence intervals. The mean OHRQoL score was 30 (± 4.4). In bivariate analysis, being not married, smoking, and self-rated "fair/poor" general health status were associated with lower OHRQoL. In the adjusted model, self-rated "fair/poor" general health (PR: 1.25; 95% CI: 1.05-1.48), presence of chronic diseases (PR: 1.88; 95% CI: 1.37-2.58), smoking (PR: 1.25; 95% CI: 1.02-1.53), and reason for last dental appointment (PR: 1.34; 95% CI: 1.13-1.59) were associated with poor OHRQoL. CONCLUSION Non-institutionalized older adults with a history of chronic diseases, who smoke, have a negative perception of their general health, and had the last dental appointment motivated by pain present significantly higher prevalence rates of poor OHRQoL.
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Affiliation(s)
- Carla Fabiana Tenani
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Area of Health Education and Health Promotion, University of Campinas, Piracicaba, São Paulo, Brazil
| | | | - Inara Pereira da Cunha
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Area of Health Education and Health Promotion, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Karine Laura Cortellazzi Mendes
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Area of Health Education and Health Promotion, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Gustavo Hermes Soares
- Department of Forensic Dentistry and Community Health, University of São Paulo, São Paulo, Brazil
| | - Edgard Michel-Crosato
- Department of Forensic Dentistry and Community Health, University of São Paulo, São Paulo, Brazil
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Fábio Luiz Mialhe
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Area of Health Education and Health Promotion, University of Campinas, Piracicaba, São Paulo, Brazil
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Scalzo MTA, Matta-Machado ATG, Abreu MHNG, Martins RC. Structural characteristics of oral health services in Brazilian Primary Health Care. Braz Oral Res 2021; 35:e023. [PMID: 33605354 DOI: 10.1590/1807-3107bor-2021.vol35.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023] Open
Abstract
This study aimed to describe the structure of oral health services in primary health care in Brazil with centers participating in the second cycle of the 'National Program for Improving Access and Quality of Primary Care' (PMAQ-AB), the largest health service evaluation program ever instituted in the country. This cross-sectional study evaluated 16,202 oral health services, regarding 22 pieces of dental equipment and 25 dental supplies. The presence of each piece of equipment/dental supply generated a score for services. The sum of these scores was compared among different regions in Brazil. Quantitative data were described by quartiles and categorical data by frequencies, using the SPSS, version 25. Most of the evaluated centers presented adequate equipment in good using conditions and sufficient dental supplies for primary oral health care. Data also showed a lack of some equipment, such as X-rays, bicarbonate jet, and ultrasound devices, while for dental supplies, a lack of amalgam (capsule and manual preparation), anesthesia without vasoconstrictors, and intracanal medication was found. The services presented a median of 14 pieces of equipment and 22 dental supplies. Of the Brazilian regions, the South presented the highest median, while the North and Northeast regions presented the lowest one. The oral health services presented dental offices with good availability of equipment and dental supplies to perform clinical activities. However, differences in the structure of services among the Brazilian regions was still observed.
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Affiliation(s)
- Maria Tereza Abreu Scalzo
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry , Postgraduate Program in Dentistry , Belo Horizonte , MG , Brazil
| | | | | | - Renata Castro Martins
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry , Department of Community and Preventive Dentistry , Belo Horizonte , MG , Brazil
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Ilhan B, Bayrakdar İS, Orhan K. Dental radiographic procedures during COVID-19 outbreak and normalization period: recommendations on infection control. Oral Radiol 2020; 36:395-399. [PMID: 32601787 PMCID: PMC7323880 DOI: 10.1007/s11282-020-00460-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022]
Abstract
Dental professionals have always been meticulous about infection control due to high risk of cross-contamination during dental procedures. Nevertheless, there is an urgent need to review and revise our current practice of infection control and develop more strict protocols that will prevent nosocomial spread of infection during COVID-19 outbreak and future pandemics. The risk of contamination is high during dental radiography if proper disinfection techniques are not applied. This document provides advice and guidance for infection control when practicing dental radiography during COVID-19 pandemic.
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Affiliation(s)
- Betul Ilhan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ege University, Izmir, Turkey.
| | - İbrahim Sevki Bayrakdar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Kaan Orhan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Franciscatto GJ, Brennan DS, Gomes MS, Rossi‐Fedele G. Association between pulp and periapical conditions and dental emergency visits involving pain relief: epidemiological profile and risk indicators in private practice in Australia. Int Endod J 2020; 53:887-894. [DOI: 10.1111/iej.13293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Affiliation(s)
- G. J. Franciscatto
- Graduate Program in Dentistry School of Health and Life Sciences Pontifical Catholic University of Rio Grande do Sul Porto AlegreBrazil
- Medical and Dental Centre of the Military Police of Rio Grande do Sul Porto Alegre Brazil
| | - D. S. Brennan
- The Australian Research Centre for Population Oral Health (ARCPOH)Adelaide Dental SchoolUniversity of Adelaide AdelaideSAAustralia
| | - M. S. Gomes
- Graduate Program in Dentistry School of Health and Life Sciences Pontifical Catholic University of Rio Grande do Sul Porto AlegreBrazil
- Medical and Dental Centre of the Military Police of Rio Grande do Sul Porto Alegre Brazil
| | - G. Rossi‐Fedele
- Adelaide Dental School University of Adelaide Adelaide SA Australia
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Maulina T, Rachmi CN. The Association between Reported Dental Pain Symptoms and Increased BMI in Indonesia: Evidence From The Indonesian Family Life Survey. Open Dent J 2020. [DOI: 10.2174/18742106020140103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Overweight/obesity remains one of the most important health issues. Not only due to the current health consequences but also because of its long-term effect. One of the most common health problems experienced by an individual with overweight/obesity is dental problem, which can be reflected from dental pain being complained.
Objective:
The objective of the current study was to evaluate the association of overweight/obesity to be the predictor of the occurrence of dental pain.
Methods:
Data from the Indonesian Family Life Survey (IFLS) from five consecutive survey waves (1993, 1997, 2000, 2007 and 2014) that involved more than 30.000 participants and their offsprings that were grouped into three different age categories (0-4.9 years old; 5-19.9 years old; and 20-49.9 years old) were gathered and analyzed for Odds Ratio (OR) and Confidence Interval (CI). Trends of childhood overweight/obesity, the occurrence of dental pain, as well as the likelihood of individuals with childhood overweight/obesity to develop dental pain were analyzed by using STATA Data Analysis and Statistical Software version 13.
Results:
The results of the current study revealed that all age groups exhibited an increase in numbers when it comes to the prevalence of overweight/obesity from the first wave (in 1993) up to the latest wave (in 2014). It was also revealed that those who were in the 0-4.9 years old age group, were those who were more likely to develop dental pain (OR:1.12; 95% CI: 0.84-1.5; p:0.44).
Conclusion:
Despite the wave to wave variation, overweight/obesity has the potential to be associated with future dental problems, with dental pain in particular.
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ARANHA RLDB, PINTO RS, ABREU MHNGD, MARTINS RDC. Factors associated with toothache among Brazilian adults: a multilevel analysis. Braz Oral Res 2020; 34:e036. [DOI: 10.1590/1807-3107bor-2020.vol34.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 02/28/2020] [Indexed: 11/22/2022] Open
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Cavalcanti YW, Almeida LDFD, Lucena EHG, Probst LF, Cavalcante DDFB, Frias AC, Bulgareli JV, Pereira AC. Factors that influence the oral impact on daily performance of older people in Brazil: A cross‐sectional population‐based study. Gerodontology 2019; 37:78-86. [DOI: 10.1111/ger.12452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/07/2019] [Accepted: 11/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Yuri Wanderley Cavalcanti
- Department of Clinical and Social Dentistry School of Dentistry Federal University of Paraíba (UFPB) Joao Pessoa Brazil
| | | | - Edson Hilan Gomes Lucena
- Department of Clinical and Social Dentistry School of Dentistry Federal University of Paraíba (UFPB) Joao Pessoa Brazil
| | - Livia Fernandes Probst
- Department of Social Dentistry Piracicaba Dental School State University of Campinas (FOP/UNICAMP) Piracicaba Brazil
| | | | - Antônio Carlos Frias
- Department of Social Dentistry School of Dentistry University of São Paulo (FO/USP) São Paulo Brazil
| | - Jaqueline Vilela Bulgareli
- Department of Social Dentistry Piracicaba Dental School State University of Campinas (FOP/UNICAMP) Piracicaba Brazil
| | - Antônio Carlos Pereira
- Department of Social Dentistry Piracicaba Dental School State University of Campinas (FOP/UNICAMP) Piracicaba Brazil
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Gaewkhiew P, Bernabé E, Gallagher JE, Klass C, Delgado-Angulo EK. Oral impacts on quality of life and problem-oriented attendance among South East London adults. Health Qual Life Outcomes 2017; 15:82. [PMID: 28446237 PMCID: PMC5405499 DOI: 10.1186/s12955-017-0663-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore the association between OHRQoL and problem-oriented dental attendance among adults. METHODS We analysed cross-sectional data for 705 adults, aged 16 years and above, living in three boroughs of Inner South East London. Data were collected during structured interviews at home. The short form of the Oral Health Impact Profile (OHIP-14) was used to assess the frequency of oral impacts on daily life in the last year. Problem-oriented attendance was defined based on time elapsed since last visit (last 6 months) and reason for that visit (trouble with teeth). The association between OHIP-14 (total and domain) scores and problem-oriented attendance was tested in logistic regression models adjusting for participants' sociodemographic characteristics. RESULTS Problem-oriented attenders had a higher OHIP-14 total score than regular attenders (6.73 and 3.73, respectively). In regression models, there was a positive association between OHIP-14 total score and problem-oriented attendance. The odds of visiting the dentist for trouble with teeth were 1.07 greater (95% Confidence Interval: 1.04-1.10) per unit increase in the OHIP-14 total score, after adjustment for participants' sociodemographic characteristics. In subsequent analysis by OHIP-14 domains, greater scores in all domains but handicap were significantly associated with problem-oriented attendance. CONCLUSION This study shows that oral impacts on quality of life are associated with recent problem-oriented dental attendance among London adults. Six of the seven domains in the OHIP-14 questionnaire were also associated with dental visits for trouble with teeth.
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Affiliation(s)
- Piyada Gaewkhiew
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Eduardo Bernabé
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK.
| | - Jennifer E Gallagher
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
| | - Charlotte Klass
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
- Public Health England - London Region, London, UK
| | - Elsa K Delgado-Angulo
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
- Departamento Académico de Odontología Social, Universidad Peruana Cayetano Heredia, Lima, Peru
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