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.     

Denture quality has a minimal effect on health-related quality of life in patients with removable dentures

The present study examined the association of denture quality and health-related quality of life (HRQoL) in patients with removable dentures. In a study of 171 consecutive patients with removable partial dentures or complete dentures (mean age: 68·0 ± 9·3 years) at a university-based prosthodontic clinic, dentists rated two aspects of denture quality (stability and aesthetics) using a 100-mm visual analog scale (VAS). HRQoL was evaluated using the mental and physical component summary (MCS and PCS) scores of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36). Oral health-related quality of life (OHRQoL) was evaluated using the Oral Health Impact Profile-Japanese version (OHIP-J). The associations among denture quality, OHRQoL, and HRQoL were examined by linear regression models. Bivariable linear regression analyses revealed that denture stability was significantly associated with the SF-36 MCS [regression coefficient = 0·52 for a 10-unit increase in denture stability on a 0-100 VAS, 95% confidence interval (CI): 0·03-1·00, P = 0·04], but not with the PCS (0·11, 95% CI: -0·49 to 0·70). Denture aesthetics was not related to the PCS or the MCS (0·22, 95% CI: -0·44 to 0·88 or 0·07, 95%CI: -0·47 to 0·62). When OHIP-J was added to the regression model, this variable was substantially and significantly associated with the MCS and PCS summary scores; in addition, the regression coefficient for denture quality decreased in magnitude and was statistically nonsignificant in all analyses. The quality of removable dentures had a minimal effect on HRQoL in patients with removable dentures, and this association was mediated by OHRQoL.     

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.     

Assessing oral health-related quality of life in general dental practice in Scotland: validation of the OHIP-14

OBJECTIVES: To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice. METHODS: Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals. RESULTS: A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients. CONCLUSIONS: The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.     

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.     

Response shift in oral health-related quality of life measurement in patients with partial edentulism

The purposes of this study were to determine whether a response shift was observable after partial denture treatment and to identify the predictors that influenced the response shift magnitude and direction. A total of 173 consecutive patients with no more than eight missing teeth who received implant-supported, fixed or removable partial dentures at Okayama University Dental Hospital were asked to complete a full-version Oral Health-Related Quality of Life (OHRQoL) questionnaire before (pre-test) and after treatment (post-test). Additionally, a short form (then-test) consisting of seven questions selected from the full version had its reliability verified and was utilised to retrospectively assess the pre-treatment OHRQoL status. The difference between the summary scores of the then-test and the pre-test determined the response shift magnitude and direction. The then-test mean score (22·9 ± 6·6) was significantly lower (worse OHRQoL) than that of the pre-test (26·4 ± 5·2). The response shift effect size was of moderate magnitude and negative direction (d = -0·78). A multiple regression analysis showed that age (younger patients) (P < 0·01), number of replaced teeth (fewer) (P < 0·01) and pre-test scores (lower) (P < 0·01) were the significant predictors for response shift. In conclusion, a response shift phenomenon with negative and moderate effect size was observed after partial denture treatment. The significant predictor variables were young age, fewer numbers of replaced teeth and lower pre-test scores.     

Work stress and oral health-related quality of life among Indian information technology workers: an exploratory study

Objectives: To assess the relationships among work stress, oral health and oral health‐related quality of life (OHRQoL) in information technology (IT) professionals in south India. Methods: The study population consisted of 134 IT industry workers in four mid‐size IT companies in south India. A self‐administered questionnaire consisting of the eight‐item Oral Impact on Daily Performance (OIDP) scale and a 25‐item modified version of the original 167‐item Work Stress Questionnaire was given, following which an oral examination was carried out. Results: Mean ± standard deviation scores on the Work Stress Questionnaire, the decayed, missing and filled teeth (DMFT) index and the Community Periodontal Index of Treatment Needs (CPITN) for the sample population were 53.82 ± 15.07, 4.23 ± 3.47 and 1.81 ± 0.58, respectively. A comparison of clinical oral health status data against respondents’ work stress and OIDP scores showed that mean DMFT and CPITN scores were significantly greater among those who reported oral impact on their daily performance. However, although participants who reported oral problems had consistently higher work stress scores, the differences were statistically significant only for gingival bleeding and sensitive teeth. Multivariate analysis after controlling for age and sex showed that higher levels of work stress and periodontal disease were significant predictors for poor OHRQoL in the sample population. Conclusions: Work stress may be an important predictor for poor OHRQoL and hence requires to be studied in greater detail.     

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.     

Validity of two oral health-related quality of life measures

OBJECTIVES: To assess the validity of the Oral Impacts on Daily Performance (OIDP) and the short form of the Oral Health Impact Profile (OHIP 14) in the UK. SETTING: Primary care department at a UK dental hospital. SAMPLE: Consecutive patients. METHOD: Cross-sectional comparison of impacts using OIDP and OHIP 14 against clinical findings, Global Oral Health Ratings and pain. RESULTS: A total of 179 patients participated (83.2% response rate). OIDP had weak face validity because it contained contingency questions. Both instruments were developed from the same theoretical model and appeared to have reasonable content validity. In regression analyses, the number of impacts detected by each measure and the total score using OHIP 14 were related to the presence of oral disease and inversely related to age. No suitable transformation could be found to allow regression analysis of OIDP total scores. OHIP 14 correlated more closely with Global Oral Health Ratings but both measures correlated similarly to the experience of pain (0.43 < r < 0.47). The correlation between OHIP and OIDP scores was +0.78. The use of a simple additive method for calculating the total OHIP 14 score did not compromise its validity. CONCLUSION: Both instruments have some validity as measures of Oral Health-Related Quality of Life (OHRQoL) among dental hospital patients. The superior face, criterion and convergent validity and greater amenability to analysis of OHIP 14 render it more suitable for questionnaire-based research and for comparing groups. The additive method may be used to calculate the total score for OHIP 14.     

口腔扁平苔藓患者口腔健康相关生活质量的初步研究

目的通过口腔健康影响程度量表（OHIP）-14中文版了解口腔扁平苔藓患者口腔健康相关生活质量情况,探讨其应用于口腔扁平苔藓临床诊疗的可靠性和准确性。方法采用OHIP-14中文版对51例口腔扁平苔藓患者进行问卷调查,同时采用视觉类比标尺（VAS）对疼痛程度进行评分,REU评分系统对病损情况进行评分。通过SPSS 16.0软件对量表的信度和效度进行统计分析。结果OHIP-14的得分为21.67±9.45,量表的内部一致性Cronbach’s α系数为0.901,因子分析提取的5个公因子与量表各领域有密切的逻辑关系,量表得分与REU分值和VAS分值间呈正相关关系（r=0.608,0.807;P<0.000）。结论OHIP-14中文版评测口腔扁平苔藓患者的口腔健康相关生活质量具有较好的信度和效度,可为病情评估提供参考。     

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.     

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.     

Impact of oral diseases and disorders on oral health-related quality of life of preschool children

Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP. Impact of oral diseases and disorders on oral health‐related quality of life of preschool children. Community Dent Oral Epidemiol 2011; 39: 105–114. © 2010 John Wiley & Sons A/S Abstract – Background: The presence of oral diseases and disorders can produce an impact on the quality of life of preschool children and their parents, affecting their oral health and well‐being. However, socioeconomic factors could confound this association, but it has not been yet tested at this age. Objective: To assess the impact of early childhood caries (ECC), traumatic dental injuries (TDI) and malocclusions on the oral health‐related quality of life (OHRQoL) of children between 2 and 5 years of age adjusted by socioeconomic factors. Methods: Parents of 260 children answered the Early Childhood Oral Health Impact Scale (ECOHIS) (six domains) on their perception of the children’s OHRQoL and socioeconomic conditions. Two calibrated dentists (κ > 0.8) examined the severity of ECC according to dmft index, and children were categorized into: 0 = caries free; 1–5 = low severity; ≥6 = high severity. TDI and malocclusions were examined according to Andreasen & Andreasen (1994) classification and for the presence or absence of three anterior malocclusion traits (AMT), respectively. OHRQoL was measured through ECOHIS domain and total scores, and poisson regression was used to associate the different factors with the outcome. Results: In each domain and overall ECOHIS scores, the severity of ECC showed a negative impact on OHRQoL (P < 0.001). TDI and AMT did not show a negative impact on OHRQoL nor in each domain (P > 0.05). The increase in the child’s age, higher household crowding, lower family income and mother working out of home were significantly associated with OHRQoL (P < 0.05). The multivariate adjusted model showed that the high severity of ECC (RR = 3.81; 95% CI = 2.66, 5.46; P < 0.001) was associated with greater negative impact on OHRQoL, while high family income was a protective factor for OHRQoL (RR = 0.93; 95% CI = 0.87, 0.99; P < 0.001). Conclusions: The severity of ECC and a lower family income had a negative impact on the OHRQoL of preschool children and their parents.