A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health‐related quality of life

Chankanka O, Levy SM, Warren JJ, Chalmers JM. A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health‐related quality of life. Community Dent Oral Epidemiol 2010. © 2009 John Wiley & Sons A/S Abstract – Aesthetic perceptions and oral health‐related quality of life concerning dental fluorosis have been assessed in several studies during the past two decades. However, no comprehensive review article summarizing the studies investigating this issue has been published. Objective: To assess the relationships between perceptions of dental appearance/oral health‐related quality of life (OHRQoL) and dental fluorosis. Methods: The PubMed database was searched using the Medical Subject Headings (MeSH) for English‐language studies from 1985 to March 2009. Thirty‐five articles qualified for inclusion and then were classified into three categories based on the type of study approach: (i) respondent review of photographs and assessment concerning satisfaction/acceptance, (ii) respondent assessment of study subject’s teeth concerning satisfaction/acceptance, and (iii) respondent assessments of the psychosocial/OHRQoL impact. Results: There were varied results from earlier studies focused on satisfaction/acceptance of very mild to mild fluorosis. More recent studies with methodological improvements to assess impact on quality of life clearly showed that mild fluorosis was not a concern. Furthermore, mild fluorosis was sometimes associated with improved OHRQoL. Severe fluorosis was consistently reported to have negative effects on OHRQoL. Conclusion: Because dental fluorosis in the United States and other nations without high levels of naturally‐occurring fluoride is mild or very mild, with little impact on OHRQoL, dental professionals should emphasize the appropriate use of fluorides for caries prevention and preventing moderate/severe fluorosis.     

Impact of shortened dental arches on oral health‐related quality of life

This study described the prevalence of adults with shortened dental arches (SDA) in Brazil, specifically assessing the differences of oral health‐related quality of life [the prevalence and severity of oral impacts on daily performance (OIDP)] by dentition status. We analysed data from the 2010 National Survey of Oral Health in Brazil, including home interviews and oral examinations. The assessment of SDA used two alternative definitions: having 3–5 natural occlusal units (OUs) in posterior teeth or having 4 OUs in posterior teeth. Both definitions included having intact anterior region and no dental prosthesis. The analysis was weighted, and a complex sampling design was used. Negative binomial regression models assessed associations as adjusted for socio‐demographic conditions and dental outcomes. A total of 9779 adults (35–44 years old) participated in the study. A non‐negligible proportion had SDA: 9·9% and 3·8% for the first and second definition, respectively. Individuals with SDA (first definition) ranked higher in OIDP prevalence [count ratio (CR) 1·22; 1·09–1·36, 95% confidence interval (CI)] and severity (CR = 1·43; 1·19–1·72, 95% CI) than those with more natural teeth. This difference was not statistically significant when adjusted for socio‐demographic and dental covariates: OIDP prevalence (CR = 1·04; 0·92–1·17, 95% CI) and severity (CR = 1·09; 0·91–1·30, 95% CI). Analogous results were obtained when the second definition of SDA was adopted. These findings suggest that a considerable contingent of adults may function well without dental prostheses, despite having several missing teeth. This conclusion challenges the traditional approach of replacing any missing tooth and instructs the allocation of more dental resources to preventive, diagnostic and restorative services.     

Association between oral health‐related and general health‐related quality of life in subjects attending dental offices in Germany

Objectives: To evaluate the GHRQoL and OHRQoL of patients attending dental offices in Germany and to determine correlation coefficients between SF (Short Form)‐12 and OHIP (Oral Health Impact Profile)‐14 scores. Methods: A total of 10,342 dental offices were randomly selected. Each of the 1,113 that consented to participate received 20 questionnaires to be filled in by a convenience sample of the patients. The questionnaire included the OHIP‐14‐form for OHRQoL as well as the SF‐12‐form for GHRQoL. Results: A total of 12,392 completed questionnaires were analyzed. The mean age of the participants (64.9 percent female, 35.1 percent male) was 44.25 years. The mean summary score of OHIP‐14 was 6.30 (SD 7.46). The mean physical component summary scale (PCS) of the SF‐12 was 51.15 (SD 7.23) and the mental component summary scale (MCS) was 50.17 (SD 8.55). The variance of PCS and MCS could be explained to 10 percent each by oral health‐related quality of life (r² = 0.095 and 0.101, P < 0.001). Conclusion: OHRQoL is considerably related to GHRQoL.     

Longitudinal evaluation of the impact of dental caries treatment on oral health‐related quality of life among schoolchildren

This study aimed to evaluate the impact of dental caries treatment on oral health‐related quality of life (OHRQoL) among schoolchildren and the responsiveness of the Child Perceptions Questionnaire (CPQ_8‐10) instrument. Brazilian schoolchildren, 8–10 yr of age, were randomly selected and assigned to two groups – dental caries treatment (DCT) and caries‐free (CF) – according to their caries experience [decayed, missing, or filled primary teeth (dmft) and decayed, missing or filled secondary teeth (DMFT) values of ≥0]. The CPQ_8‐10 instrument was administered at baseline and at 4 wk of follow‐up (i.e. 4 wk after completion of dental treatment). In the DCT group, increases in CPQ_8‐10 scores were observed between the baseline and follow‐up results. However, longitudinal evaluation of the CF group demonstrated no statistically significant difference in CPQ_8‐10 scores. Responsiveness of the CPQ_8‐10 instrument (magnitude of change in CPQ_8‐10 scores) in the DCT group was greater (effect size >0.7) than in the CF group. The findings of this study show that dental caries treatment has an important impact on OHRQoL of children. The CPQ_8‐10 was considered an acceptable instrument for longitudinal measurement of changes in OHRQoL.     

Comparison of perceptions of oral health‐related quality of life in adolescents affected with ectodermal dysplasias relative to caregivers

The objective of this study was to assess the perceived oral health‐related quality of life (OHQoL) of adolescents affected with one of the ectodermal dysplasias (EDs). Data were collected from 2003 to 2007 in a cross‐sectional study of a convenience sample of individuals affected by ED (n = 35) using the Child Perceptions Questionnaire (CPQ11–14) for children and the Parent‐Caregiver Perceptions Questionnaire for their caregivers. The main findings of this study were that individuals who were affected with ED in the older age group (15‐ to 19‐year‐olds) perceived more functional problems than younger individuals (11‐ to 14‐year‐olds) (p= .04). Females with ED (n = 13) perceived more emotional problems than males (n = 22; p= .01). Although caregivers tended to report slightly higher OHQoL scores (indicating worse OHQoL), no significant differences were observed between children’s and parents’ total OHQoL and individual domains’ median scores (p > .05). Thus, the perceptions of oral health and well‐being may vary by age and gender for children who have ED. Caution is warranted concerning using parents as proxies for their children when assessing the child’s OHQoL.