The Rural Dental Health Program: Long-term Impact of Two Dental Delivery Systems on Children''s Oral Health

This paper addresses the long-term effect of two dental delivery systems established during the Rural Dental Health Program (RDHP) in 1975. At that time 725 children in grades K-2 were assigned randomly to an enriched dental health education program or regular health education program and to a SCHOOL- or COMMUNITY-based dental delivery system. Seven years after funding for RDHP ended, children originally assigned to the COMMUNITY group utilized more professional services and showed a higher level of dental knowledge than children assigned to the SCHOOL group. In addition, COMMUNITY-based children had, on average, twice as many sealed teeth. While the follow-up study did not reveal any statistically significant difference in the clinical oral health indices (DMFS, gingival index, calculus index, plaque index, periodontal probing depth, and orthodontic treatment priority index) the COMMUNITY-based children's higher level of professional dental service utilization, greater number of sealed teeth, and increased dental knowledge should lead to a higher level of oral health in the long run.     

Comparing the Impact of Oral Disease in Two Populations of Older Adults: Application of the Geriatric Oral Health Assessment Index

Objectives : This study compares the distributional and psychometric properties of the Geriatric Oral Health Assessment Index (GOHAI) in two samples of older adults, and examines how the self-perceived impact of oral disease, as measured by the GOHAI, varies in accordance with sample sociodemographic and health characteristics. Methods : Results are based on survey data from two samples of older men: a Medicare sample of patients using community physicians (n=799; mean age=74) and users of VA ambulatory health care (n=542; mean age=72). Results : The findings indicated significant differences between samples in mean GOHAI scores, with the VA sample exhibiting worse scores. A number of similarities in psychometric properties of the instrument across the two samples were found: high internal consistency reliability and similar inter-item and item-scale correlations. Factor analyses revealed somewhat different structures between the two samples, but explained similar amounts of variance; regression analyses indicated that income and self-rated oral health were significant predictors of GOHAI scores in both samples. Conclusions : The GOHAI exhibits satisfactory psychometric properties in both samples and is sensitive to sociodemographic differences among and between two samples of older men. Results suggest continued use of the GOHAI as an indicator of the impact of oral conditions on functioning and well-being in a variety of samples.     

Impact of oral rehabilitation on patients with head and neck cancer: A study using the Liverpool Oral Rehabilitation Questionnaire and the Oral Health Impact Profile-14

Statement of problem

The treatment of oral cancers affects oral functions and quality of life (QOL). Dental rehabilitation is a major step toward enhancing quality of life after controlling the disease. The effects of the disease, treatment, and rehabilitation need to be evaluated to assess oral health-related QOL. The Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3) and Oral Health Impact Profile-14 (OHIP-14) are specific assessment questionnaires of oral rehabilitation.

Impact of Type and Duration of Application of Commercially Available Oral Moisturizers on Their Antifungal Effects

Purpose

To examine the impact of oral moisturizer type and application time on antifungal effects.

Materials and Methods

Seventeen oral moisturizers (7 liquids, 10 gels) and amphotericin B (AMPH‐B) were tested. Antifungal effects were evaluated with newly opened moisturizer samples (0 hour) and with samples incubated for 8 hours to simulate contact during sleep. Candida albicans samples (10⁸ cells/ml) were placed into cylindrical holes in 50% trypticase soy agar plates. Antifungal effects were evaluated based on growth‐inhibitory zones after 24 hours. Equal quantities of moisturizers showing growth‐inhibitory zones were mixed as additional samples. The effects of moisturizer type and application time on growth‐inhibitory zones were evaluated with ANOVA. Growth‐inhibitory zone sizes were compared with multiple comparisons.

Results

Growth‐inhibitory zones were found with two liquids, one gel, moisturizer mixtures, and AMPH‐B. Significant differences in antifungal effects were found among different moisturizer types and between the 0‐ and 8‐hour groups. The growth‐inhibitory zones of the 8‐hour group were significantly smaller than those of the 0‐hour group. In both the 0‐ and 8‐hour groups, the growth‐inhibitory zones of the liquid‐gel mixtures were significantly larger than those of other moisturizer types, and were the same size as those of AMPH‐B at two concentrations (1.25 and 2.5 μg/ml). Growth‐inhibitory zones of individual moisturizers and liquid‐liquid mixtures were the same size as those of lower AMPH‐B concentrations (0.16, 0.31, and 0.63 μg/ml).

Conclusion

Our findings suggest that mixing liquid and gel moisturizers improves their antifungal efficiency.     

Effect of Intensive Oral Hygiene Regimen During Pregnancy on Periodontal Health,Cytokine Levels,and Pregnancy Outcomes: A Pilot Study

Background: Data are limited on the potential effect of intensive oral hygiene regimens and periodontal therapy during pregnancy on periodontal health, gingival crevicular fluid (GCF) and serum cytokines, and pregnancy outcomes. Methods: A clinical trial was conducted on 120 community‐dwelling, 16‐ to 35‐year‐old pregnant women at 16 to 24 weeks of gestation. Each participant presented with clinical evidence of generalized, moderate‐to‐severe gingivitis. Oral hygiene products were provided, together with instructions for an intensive daily regimen of hygiene practices. Non‐surgical therapy was provided at baseline. Oral examinations were completed at baseline and again at 4 and 8 weeks. In addition, samples of blood and GCF were collected at baseline and week 8. Mean changes in clinical variables and GCF and serum cytokine levels (interleukin [IL]‐1β, IL‐6, tumor necrosis factor [TNF]‐α) between baseline and week 8 were calculated using paired t test. Pregnancy outcomes were recorded at parturition. Results: Results indicated a statistically significant reduction in all clinical variables (P <0.0001) and decreased levels of TNF‐α (P = 0.0076) and IL‐1β (P = 0.0098) in GCF during the study period. The rate of preterm births (<37 weeks of gestation) was 6.7% (P = 0.113) and low birth weight (<2,500 g) was 10.2% (P = 1.00). Conclusions: Among the population studied, intensive instructions and non‐surgical periodontal therapy provided during 8 weeks at early pregnancy resulted in decreased gingival inflammation and a generalized improvement in periodontal health. Large‐scale, randomized, controlled studies are needed to substantiate these findings.     

Effect of reducing the number of items of the Oral Health Impact Profile on responsiveness, validity and reliability in edentulous populations

Abstract – Background: The 49‐item Oral Health Impact Profile (OHIP) has shown strong responsiveness, reliability and validity. However, the large number of items included may limit its use in clinical trials, clinical practice and surveys. Objective: The main objective of this study is to assess the effect of reducing the number of items in each domain, one at a time, on responsiveness, reliability and validity of the OHIP in edentulous populations. Materials and methods: Data used in this study were obtained from two randomized clinical trials comparing mandibular implant overdentures and conventional dentures among 102 subjects between 35 and 65 years of age, and 60 subjects over the age of 65 years. Participants were edentulous individuals who wished to replace their current prostheses. Subjects in both trials were asked to complete the 49‐item OHIP prior to treatment and at 2 months post‐treatment. Within the study, effect sizes were computed at each stage of item reduction using the impact method. Intraclass correlation coefficients and Pearson's correlation coefficients were also assessed at each stage of item reduction. In addition, receiver‐operating characteristic (ROC) curves were used to indicate the accuracy with which measurement changes corresponded to judgements of important changes in Oral Health Related Quality of Life (OHRQL). Results: The results indicated that, in general, domain responsiveness was not affected by the reduction of the number of items used per domain. However, there was a decrease in reliability, especially within the ‘psychological’ and ‘social’ disabilities and ‘handicap’ domains (35‐ to 65‐year group). In addition, there was a decrease in construct validity of the ‘physical pain’, ‘psychological’ and ‘social disabilities’ domains (35‐ to 65‐year group), as well as on ‘physical pain’, ‘psychological discomfort’, ‘physical’ and ‘psychological’ disabilities in the 65‐year and older group. This occurred primarily, when reducing from two to one item per domain. Among the 35‐ to 65‐year group, there were consistencies in patients’ ratings of the importance of similarly measured changes in oral health. Conclusion: The results indicate that although the 49‐item OHIP responsiveness could be maintained with item reduction, this will lead to compromises in reliability and validity.     

The use of the Oral Health Impact Profile to measure the impact of mild,moderate and severe hypodontia on oral health‐related quality of life in young adults

There is limited understanding of the subjective impact of congenital absence of teeth in patients with hypodontia. This study aimed to investigate the impact of mild, moderate and severe hypodontia on oral health‐related quality of life (OHRQoL) and its relationship to age, gender and extent of hypodontia prior to treatment. 82 patients (43 females and 39 males, age range from 16 to 34 years) with a confirmed diagnosis of non‐syndromic hypodontia were recruited for this study prior to treatment. Demographic details were recorded and a clinical examination documented the number and location of missing teeth. Participants were also asked to complete an oral health‐related quality of life measure, the OHIP‐49. The impact was of hypodontia was significant, with appearance concerns being the most prevalent impacts on oral health‐related quality of life. Gender was a significant predictor of the overall OHIP‐49 score, with females having higher level of impacts. The number and location of missing permanent teeth was not a good predictor of quality of life. However, location of missing teeth was a predictor of the psychological discomfort subscale score. There was a positive correlation between age and the functional limitation and physical disability subscale scores. This study shows that the impact of hypodontia on oral health‐related quality of life is substantial.     

Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children: A report from the American Dental Association Science and Research Institute,the University of Pittsburgh School of Dental Medicine,and the Center for Integrative Global Oral Health at the University of Pennsylvania

BackgroundA guideline panel convened by the American Dental Association Council on Scientific Affairs, American Dental Association Science and Research Institute, University of Pittsburgh School of Dental Medicine, and Center for Integrative Global Oral Health at the University of Pennsylvania conducted a systematic review and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after 1 or more simple and surgical tooth extractions and the temporary management of toothache (that is, when definitive dental treatment not immediately available) associated with pulp and furcation or periapical diseases in children (< 12 years).Types of Studies ReviewedThe authors conducted a systematic review to determine the effect of analgesics and corticosteroids in managing acute dental pain. They used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework to formulate recommendations.ResultsThe panel formulated 7 recommendations and 5 good practice statements across conditions. There is a small beneficial net balance favoring the use of nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen compared with not providing analgesic therapy. There is no available evidence regarding the effect of corticosteroids on acute pain after surgical tooth extractions in children.Conclusions and Practical ImplicationsNonopioid medications, specifically nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen alone or in combination with acetaminophen, are recommended for managing acute dental pain after 1 or more tooth extractions (that is, simple and surgical) and the temporary management of toothache in children (conditional recommendation, very low certainty). According to the US Food and Drug Administration, the use of codeine and tramadol in children for managing acute pain is contraindicated.