Demographic factors, denture status and oral health-related quality of life

OBJECTIVES: This study investigated the association between denture status, demographic factors, and oral health-related quality of life (OHRQoL). METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G, 53 items), which was administered in a personal interview to 2050 subjects (60% of eligible subjects responded) 16-79 years of age in a national survey. Median regression was used to analyze the influence of denture status (no, removable, complete dentures), age, gender, education (less than 10 years of schooling, 10-12 years, more than 12 years), and residential area (rural, urban) on the OHIP-G summary score. RESULTS: In bivariable analyses, compared to the base category, the OHIP-G median increased 8.0 U for subjects with removable dentures, 20.0 U for subjects with complete dentures, 1.7 U for each 10-year age period, 2.0 U for men, 3.0 U for less than 10 years of schooling (compared to > or =10 years.), and 1.0 U for urban areas (P < 0.05 for all effects except for residential area). In the multivariable analysis, compared to subjects without dentures, subjects with removable dentures had a 7.5 (95% CI: 5.2-9.8) higher OHIP-G median and subjects with complete dentures had a 18.5 (95% CI: 14.7-22.4) higher median when demographic variables were controlled. No demographic variables were statistically significant except for residential area (P = 0.04). CONCLUSIONS: Denture status was a stronger predictor for impaired OHRQoL than demographic variables and rendered age and education almost negligible in their influence on OHRQoL.     

Masticatory performance and oral health-related quality of life before and after complete denture treatment

Purpose

To clarify the relationship between masticatory performance and oral health-related quality of life (OHRQoL) before and after complete denture treatment.

Tooth loss, denture wearing and oral health-related quality of life in elderly Chinese people

OBJECTIVES: To investigate the relationship between tooth loss, denture wearing and oral health-related quality of life (OHQoL) among community-dwelling elderly people in Hong Kong. METHODS: A questionnaire study of elderly people aged 60-80 years who were recruited at neighborhood social centres for the elderly. The Chinese version of the General Oral Health Assessment Index (GOHAI) was used and information about natural tooth number and denture wearing were obtained. RESULTS: 233 elderly subjects were recruited and interviewed. Around 20% of the partially dentate subjects had their last tooth loss within the previous year and a quarter within the last five years. Significantly fewer edentulous subjects had their last tooth loss within the previous year (3%) and within the last five years (12%, p < 0.001). Twenty two percent of the subjects had difficulty in accepting tooth loss. More edentulous subjects (69%) were satisfied with their dentures than partially dentate denture wearers (37%, p < 0.001). Edentulous elderly subjects had a higher mean GOHAI score (53.0) than partially dentate denture wearers (49.1, p < 0.001). Results from a multiple factor ANOVA revealed that elderly subjects who had loose teeth, difficulty in accepting tooth loss and were not satisfied with their removable dentures had a lower mean GOHAI score. CONCLUSIONS: In general, tooth loss and denture wearing did not have a major impact on OHQoL in elderly Chinese people. However, partially dentate denture wearers experienced a greater adverse impact on OHQoL than edentulous subjects most probably due to less satisfaction with their dentures and discomfort associated with loose teeth.     

大学生错畸形与口腔健康相关生存质量的相关性

目的调查错畸形与大学生口腔健康相关生存质量(OHRQoL)的相关性。方法从秦皇岛地区4所高校随机抽取610名无正畸史、缺失牙和颌面部畸形的大学生为研究对象。选用正畸治疗需要指数(IOTN)行牙颌检查,以口腔健康相关生存质量影响程度量表(OHRQoL-UK)对样本进行评估。结果 8.7%受试者自诉在过去1个月中,16个条目中至少有一项受到错畸形的负面影响。在生理、心理和社会三分项中,心理方面的分值最低。OHRQoL-UK表在总分值及三分项上与牙齿健康分值(IOTN-DHC)和牙齿美学分值(IOTN-AC)均呈负相关。结论错畸形客观检查的IOTN牙齿健康部分(IOTN-DHC)和主观自评的IOTN牙齿美学部分(IOTN-AC)均与OHRQoL呈负相关关系。IOTN-DHC与生理方面相关性最大,而IOTN-AC与心理方面相关性最大且无性别差异。     

A structural equation model relating oral condition,denture quality,chewing ability,satisfaction, and oral health-related quality of life in complete denture wearers

ObjectivesTo investigate the relationship between mandibular ridge form, stability and retention of mandibular complete denture, accuracy of jaw relation recording, patients’ perception of chewing ability, satisfaction with dentures and oral health-related quality of life (OHRQoL) in complete denture wearers.MethodsA total of 183 edentulous patients, who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures, were recruited. Oral examination was performed. Cawood and Howell's method was used to grade the mandibular ridge form. The stability and retention of the mandibular complete denture were assessed using Kapur method. Accuracy of jaw relation recording was evaluated using a newly developed jaw relation index. Patients’ perception of chewing ability was rated using a food intake questionnaire. Patients’ satisfaction with complete dentures was assessed on a 100-mm visual analogue scale. OHRQoL was measured using the Japanese version of the Oral Health Impact Profile for edentulous subjects. A structural equation model was constructed based on the hypothesis that oral condition and denture quality would be related to chewing ability, satisfaction and OHRQoL.ResultsSignificant relationships were found between mandibular ridge form, stability of mandibular complete denture, accuracy of jaw relation recording, perceived chewing ability, satisfaction and OHRQoL. Various fit indices were within acceptable limits.ConclusionsOral condition and denture quality were related to patients’ perception of chewing ability, satisfaction with dentures and OHRQoL in complete denture wearers.Clinical significanceA favourable oral condition and denture quality are important for successful complete denture therapy.     

Structural equation modeling of the impact of mandibular ridge form and denture quality on oral health-related quality of life in complete denture wearers

PurposeTo examine the effect of mandibular ridge form and denture quality on oral health-related quality of life (OHRQoL) in complete denture wearers by using structural equation modeling (SEM) analysis of data before and after new complete denture insertion.MethodsFour hundred thirty-two edentulous patients who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. An intervention study design was conducted, including complete denture fabrication with SEM analysis. Mandibular ridge form, mandibular denture stability, accuracy of jaw relation record, and the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-J) total score before and after new complete denture insertion were used in the hypothesized model.ResultsTwo hundred and thirty-seven participants completed the research. SEM analysis demonstrated adequate model fit. Path coefficients of mandibular ridge form to OHIP-EDENT-J before and after insertion, and mandibular denture stability to OHIP-EDENT-J before insertion, were significant.ConclusionsThis study demonstrated that mandibular denture stability and mandibular ridge form are important to ensure successful complete denture therapy.     

Interpreting oral health-related quality of life data

The most common way of presenting data from studies using quality of life or patient-based outcome (PBO) measures is in terms of mean scores along with testing the statistical significance of differences in means. We argue that this is insufficient in and of itself and call for a more comprehensive and thoughtful approach to the reporting and interpretation of data. PBO scores (and their means for that matter) are intrinsically meaningless, and differences in means between groups mask important and potentially different patterns in response within groups. More importantly, they are difficult to interpret because of the absence of a meaningful benchmark. The minimally important difference (MID) provides that benchmark to assist interpretability. This commentary discusses different approaches (distribution-based and anchor-based) and specific methods for assessing the MID in both longitudinal and cross-sectional studies, and suggests minimum standards for reporting and interpreting PBO measures in an oral health context.     

The association between dental anxiety and oral health-related quality of life in Britain

OBJECTIVE: The aim of this study was to identify associations between level of dental anxiety and the impact of oral health on quality of life (OHQOL) in Britain, controlling for sociodemographic and oral health status (self-reported) factors. METHODS: The basic research design included a cross-sectional study involving a random probability sample of 3000 UK residents. The outcome measures were: levels of dental anxiety, which were measured on the Corah Dental Anxiety Scale (DAS), and the impact of OHQOL, which was assessed using UK oral health-related quality of life instrument (OHQoL-UK (W)). Results: DAS was correlated with OHQoL-UK (W) scores (P < 0.01). Having controlled for sociodemographic factors (age, gender and social class) and oral health status factors (self-reported number of teeth possessed and denture status), known confounding factors associated with OHQOL, those with high levels of dental anxiety (DAS > or = 15) were approximately two times as likely to be among those experiencing the poorest OHQOL (below the population median OHQoL-UK (W) score) in Britain (P < 0.001; OR = 1.93; 95% CI 1.41, 2.65). CONCLUSION: Dental anxiety is associated with the impact oral health has on life quality. Those experiencing high levels of dental anxiety are among those with the poorest oral health-related quality of life in Britain.     

The relationship between oral conditions,masticatory performance and oral health-related quality of life in children

Objective

To evaluate the association between oral conditions, masticatory performance (MP) and oral health-related quality of life (OHRQoL) in 8–12 year-old children.

Design

150 Brazilian scholars were examined for caries and malocclusions. MP was evaluated based on the ability to comminute an artificial test food followed by the determination of the median particle size (X₅₀) and particle distribution in different-sized sieves (“b”). OHRQoL was measured using the Brazilian versions 8–10 and 11–14 of the child perceptions questionnaire (CPQ), considering the following domains: oral symptoms (OS), functional limitations (FL), emotional well-being (EW) and social well-being (SW). Higher scores indicated worse OHRQoL. Data were submitted to Spearman's correlation test and multiple linear regression analysis.

Results

There were significant positive correlations between the psychosocial and OS domains scores of the CPQ_8–10 and the number of decayed and missing teeth, respectively. The number of decayed teeth positively correlated with the number of missing teeth and the CPQ_11–14 scores. The number of decayed and missing teeth was significantly associated with higher CPQ_8–10 scores. Higher CPQ_11–14 overall scores were associated with female gender, higher FL domain scores were associated with the number of missing teeth, and higher X₅₀ values and EW domain scores were associated with female gender and the number of decayed teeth.

Conclusions

A higher number of missing teeth correlated with an inferior MP in older children. Children with a higher number of caries rated their oral health less favourably. Older females and those who broke the test material into smaller sizes were also more likely to report a worse OHRQoL, suggesting that the time allowed to reduce food appears to be a more influential factor on children’ perception of oral health than their ability to break down the test material into smaller sizes. Moreover, the subjectivity of functional domain and artificial nature of chewable test material could have influenced the test sensitivity.     

Associations between oral health-related quality of life and emotional statuses in children and preadolescents

Oral Diseases (2012) 18 , 639–647 Objectives: To evaluate the associations between oral health‐related quality of life (OHRQoL) and emotional statuses in children and preadolescents. Methods: One hundred and forty‐five Brazilian students (8–14 years) were clinically examined for caries, gingivitis, fluorosis, malocclusions, and temporomandibular disorders (TMD). OHRQoL was measured using two global ratings of oral health (OH) and overall well‐being (OWB). The Revised Children’s Manifest Anxiety Scale (R‐CMAS) and Children’s Depression Inventory (CDI) were used to assess anxiety and depression, respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). The results were analyzed using non‐paired t test/one‐way ANOVA, Pearson’s correlation test, and multiple linear regression analyses. Results: 11–14‐year‐old participants had higher CDI scores (P < 0.01) and DDSC concentrations (P < 0.001). Participants with fewer caries and without gingivitis had higher DDSC concentrations (P < 0.05). TMD patients had higher DDSC concentrations and OWB ratings (P < 0.001). Girls had higher Revised Children’s Manifest Anxiety Scale (RCMAS) scores (P < 0.01). There was positive correlation between RCMAS and CDI scores and OWB ratings (P < 0.05). The OH model retained age (β =0.312; P < 0.001) and the OWB model retained TMD (β = 0.271; P < 0.001) and CDI scores (β=0.175; P < 0.05). Conclusions: Children and preadolescents with poor emotional well‐being are more sensitive to the impacts of OH and its effects on OWB.     

可摘局部义齿佩戴与口腔健康相关生活质量的关系

目的研究可摘局部义齿治疗前后老年修复患者的口腔健康相关生活质量,为可摘局部义齿治疗计划的制定提供参考。方法收集可摘局部义齿修复的老年牙列缺损患者154例,平均年龄为64.35岁,采用老年口腔健康评价指数(geriatric oral health assessment index,GOHAI)量表中文版进行问卷调查,对可摘局部义齿修复治疗前后的GOHAI得分进行统计学分析。结果可摘局部义齿修复后,患者GOHAI量表中生理功能(Z=-7.989)、心理功能维度(Z=-8.128)和总体得分(Z=-7.932)较治疗前明显升高,差异具有统计学意义(P<0.01)。结论可摘局部义齿修复通过改善患者的口腔生理功能和心理社会功能,可显著提高老年牙列缺损患者的口腔健康相关生活质量。     

Model specification in oral health-related quality of life research

The aim of this study was to analyze conventional wisdom regarding the construction and analysis of oral health-related quality of life (OHRQoL) questionnaires and to outline statistical complications. Most methods used for developing and analyzing questionnaires, such as factor analysis and Cronbach's alpha, presume psychological constructs to be latent, inferring a reflective measurement model with the underlying assumption of local independence. Local independence implies that the latent variable explains why the variables observed are related. Many OHRQoL questionnaires are analyzed as if they were based on a reflective measurement model; local independence is thus assumed. This assumption requires these questionnaires to consist solely of items that reflect, instead of determine, OHRQoL. The tenability of this assumption is the main topic of the present study. It is argued that OHRQoL questionnaires are a mix of both a formative measurement model and a reflective measurement model, thus violating the assumption of local independence. The implications are discussed.     

The relationship between normative orthodontic treatment need and oral health-related quality of life

OBJECTIVES: The first objective was to assess whether having had orthodontic treatment affected the levels of oral health-related quality of life impacts in Brazilian adolescents. A second objective was to assess the relationship between a normative clinical measure of orthodontic treatment need and two measures of oral health-related quality of life. METHODS: A cross-sectional study was conducted in Bauru, SP, Brazil, on 1675 randomly selected adolescents aged between 15 and 16 years. Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess the adolescents' oral health-related impacts. Multiple logistic regression was used in the data analysis. RESULTS: Adolescents who had completed orthodontic treatment reported less oral health impacts on their daily life activities than those currently under treatment or those who never had any treatment. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study provided more information about the adolescents' perceived satisfaction with their appearance than the IOTN on its own. CONCLUSION: Current methods of assessing orthodontic need should be complemented by oral health-related quality of life measures with valid psychometric properties, and measures of perceived need.     

Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders

Abstract – Objective The aim of this study was to assess the association of chewing ability to oral health‐related quality of life (OHRQoL) measured by the Oral Health Impact Profile‐14 (OHIP‐14) controlling for clinical oral health status, self‐reported health status, demographic factors, and socioeconomic conditions among community‐dwelling and institutionalized Korean elders. Methods This cross‐sectional study comprised a sample of 307 community‐dwelling and 102 institutionalized people over the age of 60, using a cluster sampling procedure. A questionnaire was implemented and a clinical oral examination was completed for each subject. The outcome variable of interest was the OHIP‐14 score, and its associations with chewing ability, objective oral health status, self‐reported health status, demographic factors, and socioeconomic conditions were assessed. Because of highly‐skewed distribution of the OHIP‐14 scores, nonparametric analytic methods were used. The final model was developed using a multivariable two‐level logistic regression model for a dichotomized OHIP‐14 score to account for the cluster sampling method applied to this study. Results The mean age of the participants was 75.4 years, with 67.7% being women. The median OHIP‐14 score was 7. Negative oral health impacts were experienced fairly often or very often by a total of 36.4% of elderly. In the final model, elders who could chew none to three and four to six foods among seven indicator foods were 3.4 (P = 0.010) and 2.0 (P = 0.040) times more likely, respectively, to have worse OHRQoL compared with elders who could chew all seven food types. Also significant associations with worse OHRQoL were shown for being concerned about oral health [Odds Ratio (OR) = 4.9, P = 0.002], fair or better self‐reported oral health (OR = 0.12, P = 0.002), very good/good self‐reported general health (OR = 0.38, P = 0.008), being married (OR = 2.0, P = 0.054), and having a favourable economic status (OR = 0.43, P = 0.042). Conclusions This study showed highly significant association between chewing ability and OHRQoL measured by the OHIP‐14 score after controlling for related factors. Amelioration of chewing ability might independently contribute to improving the OHRQoL of elders.