Patient-generated aspects in oral rehabilitation decision making I. Comparison of traditional history taking and an individual systematic interview method

Summary  Decision making in oral rehabilitation is often based on diagnoses related to impairment of different oral functions. In making the decision when to treat, the dentist must work in cooperation with the patient. By incorporating patient-generated aspects into the decision making process, the dentist finds it easier to decide if and why treatment should be undertaken and what treatment modality to use. The purpose of this study was to describe the potential of an interview method, the 'Schedule for the Evaluation of Individual Quality of Life-Direct Weighting' (SEIQoL-DW), and compare it with a traditional history taking, in generating information to be used in decision making in oral rehabilitation. Fifty-seven participants in need of oral rehabilitation were enrolled in the study. The participants underwent a traditional history taking and were interviewed using the SEIQoL-DW method. The SEIQoL-DW generated a high number of cues for all participants. Significantly more cues and additional information were generated by the SEIQoL-DW than by the traditional history taking. The additional information concerned consultation and dentist issues, psychological aspects and treatment preferences. A high percentage of the participants were positive towards the use of the SEIQoL-DW method in their treatment planning. The SEIQoL-DW was considered to be a viable tool for decision making in oral rehabilitation.     

The impact of the National Denture Service on oral health-related quality of life among poor elders

The objective of this study was to assess the effects of the Korean National Denture Service (NDS) for poor elderly people requiring dentures on oral health-related quality of life (OHRQOL). Data from follow-up studies were collected from 439 subjects at eight public health centres who answered every question of a questionnaire, and the OHRQOL was measured at the baseline and at 3-month follow-up after receiving the NDS according to the type of denture provision. The multivariate linear mixed model with a public health centre as a random effect for the score change of Oral Health Impact Profile (OHIP)-14K was carried out to confirm the factors related to the improvement in OHRQOL. The mean OHIP-14K was 28.60 at the baseline time points, and there was a decrease in the OHIP-14 scores to 21.14 ± 12.52 at the 3-month follow-up of the removable partial denture beneficiaries. The changes in OHIP-14K among complete denture beneficiaries were 21.53 ± 12.01 for previously dentate subjects and 22.54 ± 11.12 for edentate subjects. The multivariate linear mixed model of dentate subjects demonstrated that the improvement in the OHRQOL was associated with the number of remaining teeth, satisfaction with denture and self-reported oral health status after 3 months. In the case of the edentate model, satisfaction with denture was the only factor related to the improvement in OHRQOL. This study revealed considerable improvement in OHRQOL among poor elderly people after NDS. Satisfaction with provision of dentures was associated with improvement in the OHRQOL.     

The impact of periodontitis on oral health‐related quality of life: a review of the evidence from observational studies

Modern population based oral health management requires a complete understanding of the impact of disease in order to provide efficient and effective oral health care and guidance. Periodontitis is an important cause of tooth loss and has been shown to be associated with a number of systemic conditions. The impact of oral conditions and disorders on quality of life has been extensively studied. However, the impact of periodontitis on quality of life has received less attention. This review summarizes the literature on the impact of periodontitis on oral health‐related quality of life (OHRQoL). Relevant publications were identified after searching the MEDLINE and EMBASE electronic databases. Screening of titles and abstracts and data extraction was conducted. Only observational studies were included in this review. Most of the reviewed studies reported a negative impact of periodontitis on OHRQoL. However, the reporting standards varied across studies. Moreover, most of the studies were conducted in developed countries.     

Cross‐cultural equivalence in translations of the oral health impact profile

The Oral Health Impact Profile (OHIP) has been translated for comparisons across cultural boundaries. This report on a systematic search of literature published between 1994 and 2014 aims to identify an acceptable method of translating psychometric instruments for cross‐cultural equivalence, and how they were used to translate the OHIP. An electronic search used the keywords ‘cultural adaptation’, ‘validation’, ‘Oral Health Impact Profile’ and ‘OHIP’ in MEDLINE and EMBASE databases supplemented by reference links and grey literature. It included papers on methods of cross‐cultural translation and translations of the OHIP for dentulous adults and adolescents, and excluded papers without translational details or limited to specific disorders. The search identified eight steps to cross‐cultural equivalence, and 36 (plus three supplemental) translations of the OHIP. The steps involve assessment of (i) forward/backward translation by committee, (ii) constructs, (iii) item interpretations, (iv) interval scales, (v) convergent validity, (vi) discriminant validity, (vii) responsiveness to clinical change and (viii) pilot tests. Most (>60%) of the translations involved forward/backward translation by committee, item interpretations, interval scales, convergence, discrimination and pilot tests, but fewer assessed the underlying theory (47%) or responsiveness to clinical change (28%). An acceptable method for translating quality of life‐related psychometric instruments for cross‐cultural equivalence has eight procedural steps, and most of the 36 OHIP translations involved at least five of the steps. Only translations to Saudi Arabian Arabic, Chinese Mandarin, German and Japanese used all eight steps to claim cultural equivalence with the original OHIP.     

Influence of administration method on oral health-related quality of life assessment using the Oral Health Impact Profile

The influence of the administration method used to collect oral health-related quality of life (OHRQoL) data is largely unknown. Therefore, the aim of this study was to determine whether OHRQoL information obtained using the Oral Health Impact Profile (OHIP) differed with different methods of collection (personal interview, via telephone or as a self-administered questionnaire). The OHRQoL was measured using the German version of the OHIP. The instrument was administered to each of 42 patients using three different methods, in a randomized order, about 1 wk apart. The test-retest reliability coefficient for the repeated OHIP assessment across the three methods of administration, and the magnitude of the variance component for administration method, were determined, characterizing the degree of OHIP score variation that is caused by this factor. Whereas OHIP mean score differences of 3.9 points were present between administration methods, the reliability coefficient of 0.90 (95% CI, 0.85-0.95) indicated that 90% of the OHIP score variation was caused by differences between subjects (and not by the administration method or measurement error). The variance component for administration method explained 0.5% of the OHIP score variation. In conclusion, the method of administration (personal interview, telephone interview or self-administered questionnaire) did not influence substantially OHIP scores in prosthodontic patients.     

Impact of dental treatment under general anesthesia on the oral health‐related quality of life of adolescents and adults with special needs

This study aimed to assess the perception of the family's primary caregiver on the oral health‐related quality of life (OHRQoL), and the impact on family dynamics, of dental treatment under general anesthesia (GA) in adolescent and adult patients with intellectual and developmental disabilities (IDD) and neurocognitive disorders. Self‐administered questionnaires were completed, before dental treatment, by 116 primary family caregivers of patients who received dental treatment under GA, and 102 (88%) of these caregivers completed the same questionnaires within 4 wk after treatment. The Child Oral Health Impact Profile (COHIP) and the Family Impact Scale (FIS) were shortened to a 14‐item COHIP (COHIP‐14) and a 12‐item FIS (FIS‐12) based on the limitations of patients’ communication. The COHIP‐14 and FIS‐12 scores and each subscale improved after treatment. The baseline scores varied based on certain characteristics of the patients, such as age, disabilities, medications, caregivers, meal types, cooperation levels, and treatment needs. The postoperative improvement in OHRQoL was significant in the patients who were older than 30 yr of age, originally eating soft meals, displaying no or very low levels of cooperation, or receiving endodontic treatment. Based on the primary caregiver perceptions, the OHRQoL of adolescents and adults with IDD and neurocognitive disorders was improved by dental treatment under GA.     

A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea

The purpose of this study was to compare the oral health related quality of life (OHRQoL) between older Korean adults with complete and partial removable dentures using oral health impact profile (OHIP). A pool of 4250 Korean older adults was identified by random stratification by area from the sample cohort of Korean National Survey of Oral Health in the year of 2000. Out of the potential pool, 445 subjects with removable partial dentures (RPDs) or complete dentures (CDs) agreed to be interviewed by telephone. Each question in the survey was about how frequently each event was experienced during the past 12 months. To analyse the association between OHIP scores and removable denture status, bivariable analysis and multiple linear regression analysis were used. RPD users showed higher scores on eight items than CD users. They were 'breath stale', 'food catching', 'sensitive teeth', 'toothache', 'tense', 'unable to brush teeth', 'less tolerant to family members' and 'irritable with others'. RPD users might be associated with higher scores of functional limitation, physical pain and psychological discomfort than CD users. RPD users had slight tendency to be associated with higher OHIP-49 score than CD users, but it was not statistically significant. The findings of the present study confirm that there is no general OHRQoL difference between RPD and CD users. But in the items and subscales of OHIP, RPD users might experience more impaired OHRQoL than CD users.     

Sensitivity to change of oral and general health‐related quality of life during prosthodontic treatment

The literature presents conflicting findings on whether health‐related quality of life (HRQoL) measures have sufficient evaluative properties to assess changes caused by dental interventions. The aim of our study was to compare sensitivity to change in HRQoL and OHRQoL in prosthodontic patients. In this prospective intervention study, a total of 165 consecutively recruited patients completed the Short Form‐36 (SF‐36) and the 49‐item Oral Health Impact Profile (OHIP), as self‐administered questionnaires, before prosthodontic treatment and 1 month after treatment was finished. Differences in SF‐36 and OHIP scores between baseline and follow up were tested for statistical significance using paired t‐tests. Effect sizes (Cohen's d) were calculated. Health‐related quality of life improved during prosthodontic treatment, indicated by a slight, but statistically significant, increase in the SF‐36 physical component (difference: 1.0 points), whereas perceived mental health did not change substantially (difference: ?0.5 points). Improvement in OHRQoL (difference in OHIP sum score: ?6.7 points) was statistically significant. Although the OHIP effect size (of 0.2) was considered as small, according to guidelines, it was greater than for the SF‐36 component scores (physical: 0.1; mental: 0.1). Sensitivity to change in quality of life measures was greater for OHRQoL than for HRQoL, limiting the usefulness of HRQoL as an outcome measure in dentistry.     

Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population

Objectives: To evaluate the psychometric properties of the Geriatric/General Oral Health Assessment Index, Spanish version (GOHAI‐Sp) and their relationship with the dentition status of an elderly Mexican population as a discriminatory validation. Methods: A cross‐sectional study was conducted among persons over 60 years of age. A Spanish version the GOHAI‐Sp validated in Spain in institutionalized geriatric patients was used. Clinical evaluation was done in order to determine experience with coronal and root caries. Results: Measurement of internal consistency of the GOHAI gave a Cronbach alpha coefficient of 0.77 for the 12 items. In factorial analysis, one factor alone was capable of explaining 30.6 percent of the total variance. The factor that was most apparent in the factorial analysis of the GOHAI had coefficients >0.30 for the 12 items. The Kaiser‐Meyer‐Olkin measure of simple adequacy was 0.81 and the Bartlett's sphericity test was 1,748.55 with 66 degrees of freedom (P < 0.001). There was a statistically significant difference in the GOHAI scores between the responses to self‐perception of oral and general health (P < 0.001). Also, there was a statistically significant low correlation coefficient between the missing and filled components of the DMFT index and the number of healthy and functional teeth (P < 0.05). Conclusions: The GOHAI has acceptable psychometric properties, discriminates between self‐perception of oral health and self‐perception of general health, and correlates with past caries experience measured by the DMFT index.     

Shortened dental arch and prosthetic effect on oral health‐related quality of life: a systematic review and meta‐analysis

This systematic review aimed to compare oral health‐related quality of life (OHRQoL) between two tooth replacement strategies – the shortened dental arch (SDA) concept and conventional treatment with removable partial dental prosthesis (RPDP) or implant‐supported fixed partial dental prosthesis (IFPDP) – for distal extension of edentulous space in the posterior area. We retrieved eligible randomised controlled trials (RCTs) and non‐RCTs published between 1980 and November 2016 retrieved from MEDLINE and the Cochrane Central Register of Controlled Trials. The primary outcome was OHRQoL evaluated using validated questionnaires. Two reviewers independently screened and selected the articles, evaluated the risk of bias and determined the standardised weighted mean difference (SWMD) in OHRQoL scores between the two strategies using a random effects model. Two RCTs and one non‐RCT involving 516 participants were included in this review. All studies employed the oral health impact profile (OHIP) for evaluation of OHRQoL. There was no statistically significant difference in OHIP summary scores between SDA and RPDP at 6 (SWMD = 0·24) or 12 (SWMD = 0·40) months post‐treatment. Only one non‐RCT had reported higher OHRQoL with IFPDP than with SDA; however, because of the small sample size, there was no significant difference in OHIP summary scores between the two strategies at 6 (SWMD = ?0·59) or 12 (SWMD = ?0·67) months post‐treatment. In terms of OHRQoL in partially dentate patients, the SDA concept appears to be as feasible as RPDP restoration. Further clinical trials are required to clarify the effect of IFPDP restoration on OHRQoL.     

Efficacy of stabilisation splint treatment on the oral health‐related quality of life–A randomised controlled one‐year follow‐up trial

The aim of this randomised controlled trial was to assess the efficacy of stabilisation splint treatment on the oral health‐related quality of life OHRQoL during a 1‐year follow‐up. Originally, the sample consisted of 80 patients (18 men, 62 women) with temporomandibular disorders (TMD) who had been referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, for treatment. Patients were randomly designated into splint (n = 39) and control group (n = 41). Patients in the splint group were treated with a stabilisation splint. Additionally, patients in both groups received counselling and instructions on masticatory muscle exercises. The patients filled in the Oral Health Impact Profile‐14 (OHIP‐14) questionnaire before treatment and at 3 months, 6 months and 1 year. At total, 67 patients (35 in the splint group vs. 32 in the control group) completed the questionnaire at baseline. The outcome variables were OHIP prevalence, OHIP severity and OHIP extent. Linear mixed‐effect regression model was used to analyse factors associated with change in OHIP severity during the 1‐year follow‐up, taking into account treatment time, age, gender and group status. OHIP prevalence, severity and extent decreased in both groups during the follow‐up. According to linear mixed‐effect regression, decrease in OHIP severity did not associate significantly with group status. Compared to masticatory muscle exercises and counselling alone, stabilisation splint treatment was not more beneficial on self‐perceived OHRQoL among TMD patients over a 1‐year follow‐up