Oral health-related quality of life in a birth cohort of 32-year olds

Abstract – Objectives: To describe oral health‐related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well‐established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services. Methods: A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14‐item Oral Health Impact Profile questionnaire (OHIP‐14). The questionnaire also collected data on each study member’s occupation, self‐rated oral health and reasons for seeing a dental care provider. SES was determined from each individual’s occupation at age 32 years. Results: The mean total OHIP‐14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems ‘fairly often’ or ‘very often’. When the prevalence of impacts ‘fairly/very often’ was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and ‘episodic’ dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts. Conclusions: OHIP‐14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age‐ and sex‐standardized estimates from Australia (18.2%) and the UK (15.9%).     

Dental fear and subjective oral impacts among adults in Finland

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: ‘How afraid are you of visiting a dentist?’ and subjective oral impacts were measured using the 14‐item Oral Health Impact Profile (OHIP‐14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP‐14 items fairly often or very often, and the ‘extent’ and ‘severity’. Those with high dental fear reported higher levels of prevalence, ‘extent’, and ‘severity’ of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP‐14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.     

To what extent do oral disorders compromise the quality of life?

Locker D, Quiñonez C. To what extent do oral disorders compromise the quality of life? Community Dent Oral Epidemiol 2011; 39: 3–11. © 2010 John Wiley & Sons A/S Abstract – Objective: Most measures of ‘oral health‐related quality of life’ assess the presence and frequency of functional and psychosocial impacts rather than explicitly documenting their impact on the quality of life. The aim of this study was to evaluate Prutkin and Feinstein’s suggestion for addressing the issue of quality of life in health outcome research by the use of global ratings. Methods: Data were collected from a national sample of Canadian adults by means of a telephone interview survey based on random digit dialing. Participants completed the OHIP‐14. Those reporting one or more impacts in the previous year were asked three questions concerning the extent to which these impacts bothered them, affected their life as a whole, and affected their quality of life. These items were scored on a scale ranging from ‘Not at all’ to ‘A great deal’. All participants were asked to rate the quality of their life using a six‐point scale ranging from ‘Very poor’ to ‘Excellent’. Results: Interviews were completed with 2027 participants, and 2019 were included in the analysis. Overall, 19.5% reported one or more impacts ‘fairly often’ or ‘very often’. Of these, 48.3% reported being bothered by these impacts, 40.3% that their life overall was affected, and 36.0% that their quality of life was affected. These individuals represent 9.4%, 7.8%, and 6.9% of the sample as a whole. Among those reporting impacts, there was a significant association between OHIP‐14 extent and severity scores and the three ratings. Those with impacts that bothered them, that affected their life overall or affected their quality of life, rated their overall quality of life less favorably than those with impacts that did not. Analysis by household income indicated that low‐income participants were more likely to be OHIP‐14 ‘cases’. Moreover, among the ‘cases’, low‐income participants were more likely to report an impact on the quality of life. Conclusions: The addition of global ratings of oral health‐related quality of life and quality of life provides information of use in understanding the negative consequences of oral disorders.     

Oral health disparities and food insecurity in working poor Canadians

Objectives: This study explored oral health disparities associated with food insecurity in working poor Canadians. Methods: We used a cross‐sectional stratified study design and telephone survey methodology to obtain data from 1049 working poor persons aged between 18 and 64 years. The survey instrument contained sociodemographic items, self‐reported oral health measures, access to dental care indicators (dental visiting behaviour and insurance coverage) and questions about competing financial demands. Food‐insecure persons gave ‘often’ or ‘sometimes’ responses to any of the three food insecurity indicators used in the Canadian Community Health Survey (2003) assessing ‘worry’ about not having enough food, not eating enough food and not having the desired quality of food because of insufficient finances in the previous 12 months. Results: Food‐insecure working poor persons had poor oral health compared with food‐secure working poor persons indicated by a higher percentage of denture wearers (P < 0.001) and a higher prevalence of toothache, pain and functional impacts related to chewing, speaking, sleeping and work difficulties (P < 0.001). Fewer food‐insecure persons rated their oral health as good or very good (P < 0.001). Logistic regression analyses showed that oral health disparities between food‐insecure and food‐secure persons related to denture wearing, having a toothache, reporting poor/very poor self‐rated oral health or experiencing an oral health impact persisted after adjusting for sociodemographic factors and access to dental care factors (P < 0.05). Food‐insecure working poor persons reported relinquishing goods or services in order to pay for necessary dental care. Conclusions: This study identified oral health disparities within an already marginalized group not alleviated by access to professional dental care. Working poor persons regarded professional dental care as a competing financial demand.     

The burden of disease of dental anxiety: generic and disease‐specific quality of life in patients with and without extreme levels of dental anxiety

The aim of this study was to compare disease‐specific (oral health‐related) quality of life (OHRQoL), assessed using the Oral Health Impact Profile‐14 (OHIP‐14), and generic (health‐related) quality of life (HRQoL), assessed using the EuroQol5D (EQ‐5D‐5L), in patients with severe dental anxiety (who were visiting a centre for special care dentistry) with a control group from the general population. Seventy‐six patients with severe dental anxiety [Dental Anxiety Scale (DAS) score ≥ 13] were matched, according to age, gender, and socio‐economic status, to a control group of 76 participants in a larger epidemiological study on oral health in the Netherlands (n = 1,125). The Wilcoxon signed‐rank test was used to compare levels of HRQoL and OHRQoL in both groups. The total OHIP score (indicating lower OHRQoL) was higher for the patient group (10th percentile = 30.5; 90th percentile = 46.0) than for the control group (10th percentile = 1.0; 90th percentile = 14.5). The patient group showed higher scores on all seven OHIP domains. Lower utility scores were found in patients with severe dental anxiety (HRQOL: 10th percentile = 0.7; 90th percentile = 0.9) relative to the control group (HRQOL: 10th percentile = 0.9; 90th percentile = 1.0). A disease burden of 74,000 disability‐adjusted life years (DALYs) was calculated for the Netherlands. The findings of this study show differences between patients visiting a dental fear clinic and matched controls from the general population for both OHRQoL and HRQoL, indicating that having severe dental anxiety generates a significant burden of disease.     

Will improving access to dental care improve oral health‐related quality of life?

Background

The aim of this study was to determine if Australian Defence Force (ADF) members had better oral health‐related quality of life (OHRQoL) than the general Australian population and whether the difference was due to better access to dental care.

Methods

The OHRQoL, as measured by OHIP‐14 summary indicators, of participants from the Defence Deployed Solomon Islands (SI) Health Study and the National Survey of Adult Oral Health 2004–06 (NSAOH) were compared. The SI sample was age/gender status‐adjusted to match that of the NSAOH sample which was age/gender/regional location weighted to that of the Australian population.

Results

NSAOH respondents with good access to dental care had lower OHIP‐14 summary measures [frequency of impacts 8.5% (95% CI = 5.4, 11.6), extent mean = 0.16 (0.11, 0.22), severity mean = 5.0 (4.4, 5.6)] than the total NSAOH sample [frequency 18.6 (16.6, 20.7); extent 0.52 (0.44, 0.59); severity 7.6 (7.1, 8.1)]. The NSAOH respondents with both good access to dental care and self‐reported good general health did not have as low OHIP‐14 summary scores as in the SI sample [frequency 2.6 (1.2, 5.4), extent 0.05 (0.01, 0.10); severity 2.6 (1.9, 3.4)].

Conclusions

ADF members had better OHRQoL than the general Australian population, even those with good access to dental care and self‐reported good general health.     

Oral health‐related quality of life,measured using the five‐item version of the Oral Health Impact Profile,in relation to socio‐economic status: a population survey in Sweden

Oral health‐related quality of life (OHRQoL) is an important patient‐reported outcome measure in dental research. This study was conducted to analyse the association between OHRQoL, as measured using the five‐item version of the Oral Health Impact Profile (OHIP‐5), and different socio‐economic indices. A national survey of randomly selected adult individuals in Sweden (n = 3,500) was performed using telephone interviews. The questions asked for the purpose of this study were defined by the items of the OHIP‐5, just as questions were asked regarding socio‐economic variables, including education, income, and economic resources. Poor OHRQoL, as identified by an OHIP‐5 score of 3 or higher on at least two of the five items, was statistically significantly associated in multivariate analysis with low income (OR = 1.84) and having no economic resources (OR = 2.19). The statistical models were adjusted for age, gender, ethnicity, marital status, dental‐care utilization, dental anxiety, and smoking. The OHIP‐5 may be used in larger epidemiological surveys because it demonstrates the ability to discriminate for a range of important areas of measurement in dental public health, including social determinants.     

The influence of dental attendance on change in oral health-related quality of life

Crocombe LA, Brennan DS, Slade GD. The influence of dental attendance on change in oral health–related quality of life. Community Dent Oral Epidemiol 2012; 40: 53–63. © 2011 John Wiley & Sons A/S Abstract – Background: Few longitudinal studies have investigated the association between dental attendance and oral health–related quality of life (OHRQoL). These studies were limited to older adults, or to study participants with an oral disadvantage and did not assess if dental attendance had a different effect on OHRQoL for different people. Objective: This project was designed to test whether routine dental attendance improved the OHRQoL of survey participants and whether any patient factors influenced the effect of dental attendance on change in OHRQoL. Methods: Collection instruments of a service use log book and a 12 month follow‐up mail self‐complete questionnaire were added to the Tasmanian component of the National Survey of Adult Oral Health 2004/06. The dependent variable was change in OHIP‐14 severity and the independent variable was dental attendance. Many putative confounders/effect modifiers were analysed in bivariate, stratified and three‐model multivariate analyses. These included indicators of treatment need, sociodemographic characteristics, socioeconomic status, pattern of dental attendance and access to dental care. Results: None of the putative confounders were associated with both dental attendance and the change in mean OHIP‐14 severity. The only statistically significant interaction for change in OHIP‐14 severity was observed for dental attendance by residential location (P < 0.01). In multivariate analysis, there was a statistically significant association of dental attendance with change in mean OHIP‐14 severity. It also showed that the difference in association of attendance between Hobart, the capital city of Tasmania, and other places was statistically significant based on the interaction between residential location and attendance (P < 0.05). Conclusion: The effect of dental attendance on OHRQoL was influenced by a patient's residential location.     

Oral health care needs and oral health‐related quality of life (OHIP‐14) in homeless people

Daly B, Newton T, Batchelor P, Jones K. Oral health care needs and oral health‐related quality of life (OHIP‐14) in homeless people. Community Dent Oral Epidemiol 2010. © 2009 John Wiley & Sons A/S Abstract – Objectives: The aim of this study was (i) to determine the oral health status and oral health care needs of this population, (ii) to assess oral health‐related quality of life using OHIP‐14 and (iii) to explore whether there is a relationship between oral health status and oral health‐related quality of life. Methods: A convenience sample was drawn from eight facilities catering for homeless people in south east London. Participants were invited to attend an outreach dental clinic and receive a clinical oral health and treatment needs assessment. The impact of oral disease was assessed using OHIP‐14. Results: There were 102 people from a range of vulnerable housing situations invited to participate in the study. The mean age was 39.5 (SD ± 12.3) and 92% (n = 92) were men. The mean DMFT of dentate participants (n = 94) was 15.5 (SD ± 7.6), mean DT was 4.2 (SD ± 5.2), mean MT was 6.8 (SD ± 6.0) and mean FT was 4.6 (SD ± 4.8). Normative needs were extensive with 76% having a restorative need, 80% having a need for oral hygiene measures and periodontal treatment and 38% having a prosthetic treatment need. Ninety one per cent of homeless people experienced at least one impact and the mean number of impacts (n = 90) was 5.9 (SD ± 4.8).The most commonly experienced oral health‐related quality of life impacts were in the dimension of pain, with aching in the mouth having a prevalence of 65% and discomfort while eating foods having a prevalence of 62%. Forty‐four per cent felt handicapped by their oral condition. The experience of oral impact had only a slight relationship with clinical status and there were no differences in clinical status or oral impact by vulnerability of housing situation. Conclusions: Oral health care needs were extensive and greater than that of the general population in the UK, although disease levels were similar. While homeless people experienced many more oral impacts (as measured with OHIP‐14) compared with adults of the same age in the general population in the UK, there was only a slight relationship with clinical status and oral health‐related quality of life.     

Quality of life and psychological well‐being among endodontic patients: a case‐control study

Background: Much is already known about the consequences of endodontic disease from clinicians’ perspectives; a significant omission is an understanding from patients’ perspectives. This study aimed to determine oral health‐related quality of life (OHQoL) and psychological distress among subjects referred for endodontic care compared to patients in periodontal maintenance. Methods: This was a case‐control study involving 200 patients; 100 patients requiring endodontic treatment and 100 control subjects (periodontal maintenance patients). OHQoL was assessed using the short form Oral Health Impact Profile measure (OHIP‐14) and psychological well‐being using the short form of the General Health Questionnaire (GHQ‐12). Variations in OHIP‐14 and GHQ‐12 scores between the ‘case’ and ‘control’ group were determined, and the magnitude of such differences through effect size (ES) calculations. Results: There were significant differences in OHIP‐14 summary scores between the case and control groups (p < 0.001) and significant differences across all seven domain scores (p < 0.05). The ES was moderate (0.63) with respect to summary OHIP‐14 scores. There were also significant differences in GHQ‐12 scores between the case and control groups (p < 0.05), but the ES was small (0.36). Conclusions: OHQoL and psychological well‐being is compromised among patients seeking endodontic treatment, and to a greater magnitude than patients in periodontal maintenance.     

Factors affecting oral health-related quality of life among pregnant women

Abstract: Objectives: To assess oral health status and to describe the possible factors that could affect the oral health‐related quality of life (OHRQoL) among a group of pregnant rural women in South India. Materials and methods: A total of 259 pregnant women (mean age 26 ± 5.5 years) who participated in the cross‐sectional study were administered the Oral Health Impact Profile (OHIP‐14) questionnaire and were clinically examined for caries and periodontal status. Results: The highest oral impact on quality of life was reported for ‘painful mouth’ (mean: 1.7) and ‘difficulty in eating’ (mean: 1.1). On comparing the mean OHIP‐14 scores against the various self‐reported oral problems, it was seen that the mean OHIP‐14 scores were significantly higher among those who reported various oral problems than those who did not. Those with previous history of pregnancies had more severe levels of gingivitis than those who were pregnant for the first time. Also gingival index scores, community periodontal index of treatment needs scores and previous pregnancies was associated with poorer OHRQoL scores. Conclusion: Increased health promotion interventions and simple educational preventive programmes on oral self‐care and disease prevention during pregnancy can go a long way in improving oral health and lessening its impact on the quality of life in this important population.     

Oral health‐related quality of life and its relationship with health locus of control among Indian dental university students

Objectives: The objectives of this study were to assess the relationship between Oral Health‐Related Quality of Life (OHRQoL) and Health Locus of Control (HLC) among students in an Indian dental school. Materials and methods: A cross sectional study design was used. Three hundred and twenty‐five dental students returned completed forms containing the 14 item Oral Health Impact Profile (OHIP‐14) and the 18 item Multidimensional Health Locus of Control Scale (MHLC). Results: The results showed that the perceived OHRQoL differed among students studying in different stages of the dental course. The OHRQoL dimensions of ‘Social Handicap’ and ‘Handicap’ were significantly (P < 0.01) lower among the later years of the course than the freshman year students. There was a sharp increase in Self‐reported dental problems, in particular, Malocclusion, Tooth decay, Calculus among the third year and final year students respectively. The OHIP‐14 scores were significantly higher among those with self‐reported oral problems. Correlation analysis between the OHIP‐14 and the MHLC scores also showed a statistically significant (P < 0.01) correlation between the ‘Chance’ dimension of the MHLC and OHIP‐14 scores. Conclusions: The results of this study underscored the relationship between the OHRQoL and HLC and of importance of assessing health attitudes and their impact on OHRQoL among the dental student community.     

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     

Oral health‐related quality of life of removable partial denture wearers and related factors

This study aims to investigate the oral health‐related quality of life (OHRQoL) in a group of removable partial denture (RPD) wearers in Shiraz (Iran), using the Persian version of the Oral Health Impact Profile (OHIP‐14). Two hundred removable partial denture wearers had completed a questionnaire regarding patients' demographic characteristics and denture‐related factors. In addition, the OHIP‐14 questionnaire was filled out by interviewing the patients. Two measures of interpreting the OHIP‐14 scales were utilised: OHIP‐14 sum and OHIP‐14 prevalence. The relationship of the patients' demographic characteristics and denture‐related factors, with their OHRQoL was investigated. The mean OHIP‐14 sum and OHIP‐14 prevalence of RPD wearers were 13·80 (±10·08) and 44·5%, respectively. The most problematic aspects of OHIP‐14 were physical disability and physical pain. Twenty‐seven percentage and 24% of participants had reported meal interruption and eating discomfort, respectively. OHIP‐14 prevalence and OHIP‐14 sum were found to be significantly associated with factors representing RPD wearer's oral health such as self‐reported oral health and frequency of denture cleaning. Furthermore, OHIP‐14 prevalence and OHIP‐14 sum were significantly associated with factors related to frequency of denture use such as hours of wearing the denture during the day and wearing the denture while eating and sleeping. Therefore, it can be concluded that the OHRQoL of the patients of the study was generally not optimal and found to be strongly associated with oral health.     

Halitosis and oral health-related quality of life: a case report

To cite this article:
Int J Dent Hygiene 10 , 2012; 3–8
DOI: 10.1111/j.1601‐5037.2011.00512.x
Buunk‐Werkhoven YAB, Dijkstra‐le Clercq M, Verheggen‐Udding EL, de Jong N, Spreen M. Halitosis and oral health‐related quality of life: a case report. Abstract: Objectives: This is a clinical case of a 36‐year‐old Dutch male, patient in the Dr. S. van Mesdag Forensic Psychiatric Centre in Groningen. It demonstrates a short‐time effect of a tailored oral hygiene self‐care intervention in three sessions over a period of 3 months on halitosis and a patient’s oral health‐related quality of life (OH‐QoL). Methods: In addition to a dental screening and professional oral hygiene care, a semi‐structured interview was conducted by the dental hygienist, and questionnaires were administered. The questionnaires included were; the Dutch version of the Oral Health Impact Profile‐14 (OHIP‐14‐NL; used as a measurement of OH‐QoL), scales for expected social outcomes for having healthy teeth, attitudes towards oral hygiene behaviour (OHB) and dental anxiety. Results: Clinical observations showed an improvement in patient’s OHB, while the extreme foetor‐ex‐ore was reduced to an acceptable level. A retrospective assessment showed that patient’s attitude towards the recommended OHB together with his self‐perceived OH‐QoL had positively increased. Conclusions: This case highlights the value of professional individual oral hygiene instructions performed by a dental hygienist. It also illustrates that a patient’s effective OHB may play an important role in the reduction in halitosis and self‐perceived OH‐QoL. Finally, the retrospective version of the OHIP‐14‐NL may be an adequate method to assess self‐perceived OH‐QoL within a relative short period of time.     

A multi‐country comparison of reasons for dental non‐attendance

The purpose of this study was to describe differences across countries with respect to the reasons for dental non‐attendance by Europeans currently 50 yr of age and older. The analyses were based on retrospective life‐history data from the Survey of Health, Ageing, and Retirement in Europe and included information on various reasons why respondents from 13 European countries had never had regular dental visits in their lifetime. A series of logistic regression models was estimated to identify reasons for dental non‐attendance across different welfare‐state regimes. The highest proportion of respondents without any regular dental attendance throughout their lifetime was found for the Southern welfare‐state regime, followed by the Eastern, the Bismarckian, and the Scandinavian welfare‐state regimes. Factors such as patients’ perception that regular dental treatment is ‘not necessary’ or ‘not usual’ appear to be the predominant reason for non‐attendance in all welfare‐state regimes. The health system‐level factor ‘no place to receive this type of care close to home’ and the perception of regular dental treatment as ‘not necessary’ were more often referred to within the Southern, Eastern, and Bismarckian welfare‐state regimes than in Scandinavia. This could be relevant information for health‐care decision makers in order to prioritize interventions towards increasing rates of regular dental attendance.     

Oral health-related quality of life among low-income adults living with HIV

Objectives: To explore oral health‐related quality of life and its correlates among low‐income human immunodeficiency virus (HIV)‐positive patients receiving primary HIV care. Methods: Data were from a randomized experimental trial evaluating an intervention to increase use of oral health services by low‐income HIV‐positive adults. Interviews were conducted in English or Spanish among 594 adults receiving HIV medical care but not dental care. Oral health‐related quality of life was measured with the 49‐item Oral Health Impact Profile (OHIP‐49). Primary predictor variables included measures of HIV disease: duration of HIV infection, CD4 cell count, and HIV viral load. Other predictors included sociodemographic and behavioral factors. Results: Overall, 62.6 percent of participants had experienced at least one oral health impact very often or fairly often in the 4 weeks preceding the survey, with a mean of 5.8 impacts. The mean number of impacts was significantly higher for women, the unemployed, those living in temporary housing, and current smokers. Neither the prevalence nor the mean number of impacts differed significantly by duration of HIV infection, CD4(+) T lymphocyte cell count, or HIV viral load. In bivariate analysis, women had higher mean OHIP‐49 scores than men overall (62.6 versus 50.5, P < 0.05) and for most subscales, indicating that women experienced more oral health impacts. In the final multivariate model, significant correlates of OHIP‐49 were sex, race/ethnicity, living situation, and smoking status. Conclusions: Oral health impacts are prevalent among adults in South Florida living with HIV, particularly among women, cigarette smokers, those in prison or other institutional settings, and certain racial and ethnic groups.     

Socio‐economic status,social support,social network,dental status,and oral health reported outcomes in adolescents

This study explored the relationships between sex, socio‐economic status, social support, social network, dental clinical status, dental pain, oral health‐related quality of life (OHRQoL), and self‐rated oral health (SROH) in adolescents. A cross‐sectional study involving 542 adolescents, aged 12–14 yr, was conducted in Dourados, Brazil, to collect dental clinical measures (dental caries, missing teeth, and dental trauma), as well as measures of social support, social network, dental pain, OHRQoL, and SROH. Information on family income and parental education were collected from participant's parents. Structural equation modeling showed that higher income predicted better dental status and better SROH. Greater social support was linked to better dental status and better OHRQoL. Having more social networks was directly linked to better dental status. Poor dental status was linked to dental pain and poor OHRQoL. Dental pain predicted poor OHRQoL and worse SROH. Poor OHRQoL predicted worse SROH. Family income, social support, and social networks indirectly predicted dental pain via dental status. The latter was indirectly linked to OHRQoL and SROH via dental pain. Social support and social networks indirectly predicted OHRQoL and SROH via dental status and dental pain. Socio‐economic factors and social relationships should be considered when planning health promotion and dental care provision to improve an adolescent's oral health.     

Multivariate analyses of patient financial systems and oral health‐related quality of life

Johansson V, Axtelius B, Söderfeldt B, Sampogna F, Paulander J, Sondell K. Multivariate analyses of patient financial systems and oral health‐related quality of life. Community Dent Oral Epidemiol 2010; 38: 436–444. © 2010 John Wiley & Sons A/S Abstract – Objectives: Since 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, has two co‐existing patient financial systems, i.e. ways for the patient to pay for dental care services. Alongside the traditional system of fee‐for‐service payment, i.e. paying afterwards for provided services, a new system of contract care is offered. In this system, dental care is covered by a contractual agreement, for which the patient pays an annual fee and receives care covered by the contract without additional costs. The aim of this article was to study whether patient financial system was associated with oral health‐related quality of life (OHRQoL). Methods: A questionnaire was answered by 1324 randomly selected patients, 52% from contract care and 48% from fee‐for‐service. The questionnaire contained questions about how much one was prepared to pay for dental care, how much one paid for dental care the previous year, OHIP‐14 (measured OHRQoL), dental anxiety, humanism of caregiver, SF‐36 (measured general health), multidimensional health locus of control, sense of coherence (SOC), self‐esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The material was analysed with a hierarchical block method of multiple regression analysis. Results: When controlling for all other variables, patient financial system was one of the strongest associations with OHRQoL: patients in fee‐for‐service had worse OHRQoL than those in contract care. OHRQoL was also associated with general health, SOC and to some extent also with psychological and economic factors. Of the social variables, only being foreign born was significant: it was associated with worse OHRQoL. Conclusions: Patient financial system was associated with OHRQoL when controlling for confounding factors: patients in contract care had better OHRQoL than those in fee‐for‐service care.