Prevalence of oral and facial pain and discomfort: preliminary results of a mail survey

Abstract A mail survey was undertaken to estimate the prevalence of oral and facial pain and discomfort in the City of Toronto. Self-complete questionnaires were sent to a random sample of 1014 persons drawn from the voter's list. Replies were received from 72% of those eligible. Overall, 53% of respondents had experienced some pain or discomfort in the 4 wk prior to the completion of the questionnaire. The most common kinds of pain and discomfort reported were pain in the teeth with hot or cold fluids (28.8%), sore and bleeding gums (26.3%) and toothache (14.1 %). Pain in jaws, face and oral mucosa was reported by less than 10% of the subjects. While much of the pain experienced by the respondents was classified as mild, half (50.1%) said that it was moderately severe or severe. Only 40% of those reporting pain had sought the advice of a dentist or doctor. Sex differences in the reporting of pain were small and statistically non-significant, although age differences were marked and significant. The younger age groups were more likely to report both pain and discomfort than the older age groups. The survey has revealed a substantial amount of oral and facial pain in the community, much of which is not subject to professional attention.     

Elderly nonrespondents to a mail survey: A telephone follow-up

The most frequently used method to request and collect health-related information has been the mail questionnaire. While self-administered surveys offer a relatively low-cost and convenient method for collecting health data, they have been unpopular among researchers because of concerns about low response rates and nonresponse bias. This study examines differences in demographic and health characteristics between mail survey respondents and nonrespondents who were subsequently interviewed by telephone. Subjects for this study had at least one health care encounter in 1990 from a Medicare-waiver program. The telephone survey was conducted approximately two months after the last wave of a three-wave mailing survey of this urban elderly population. No significant differences were found between telephone and mail respondents for demographic, socioeconomic, quality of life, or perceived oral health characteristics. However, mail respondents were more likely to be dentate and report better perceived general health than were the telephone respondents.     

Response and nonresponse bias in oral health surveys

Oral health surveys are undertaken to provide estimates of the dental health and behaviors of populations or population subgroups. However, the integrity of the data from sample surveys may be compromised by one or more sources of sampling and nonsampling error. An important source of nonsampling error is the failure to collect data from some of the individuals comprising the sample. Consequently, the response to a sample survey, and the direction and magnitude of bias induced by nonresponse, need to be taken into account when using estimates derived from sample surveys. Although the response rate to a survey is usually used as an indicator of the quality of the data it provides, nonresponse error is a function of nonresponse and the extent of differences in the characteristics of responders and nonresponders. Nonresponse may be managed in two ways. The first is to reduce nonresponse to a minimum using response-enhancement strategies. The second is the post-survey adjustment of data using weighting or imputation techniques to produce estimates that correct for nonresponse. This paper discusses issues concerning response and nonresponse bias in oral health surveys and provides guidelines on the management and reporting of nonresponse. It describes response-enhancement strategies to reduce noncontacts and refusals, sources of data to facilitate the comparison of responders and nonresponders, methods of assessing the degree of bias induced by nonresponse, techniques for producing adjusted survey estimates, and the assumptions on which these procedures and processes are based.     

Comparing different methods to detect and correct nonresponse bias in postal questionnaire studies

OBJECTIVES: This study compares methods for detecting and correcting the bias associated with nonresponse to postal questionnaires. METHODS: Questionnaires were sent out in three sequential stages to parents of all 5-year-old children examined in a clinical survey. Each stage progressively targeted nonresponders. Data on dmft and area measures of socioeconomic status were available for all children. Estimates for whole population dmft were produced by different methodologies comparing the relationship between dmft and stage of response and three area measures of socioeconomic status. RESULTS: A total of 1,776 children were examined and 1,437 questionnaires were obtained, a response rate of 80.9 percent. The mean dmft of the total population (1.49) was 17.3 percent more than responders (1.27). The dmft of the nonresponders was 2.41, 89.7 percent more than responders. There were significant linear trends in dmft and socioeconomic status across the mailing stages. The methodology using mailing stage regressed against dmft produced the most accurate adjusted dmft value (1.42). The methods using area measures of socioeconomic status produced nearly identical adjusted dmft values ranging from 1.31 to 1.32. CONCLUSIONS: Even with an "acceptable" response rate, nonresponse bias can still be present. Researchers should report the outcomes of analyses to detect nonresponse bias when publishing questionnaire studies.     

Nonresponse Bias in a Survey of Ontario Dentists' Infection Control and Attitudes Concerning HIV

Objective : This study investigated late response and nonresponse bias in an HIV-related survey of dentists. Methods : Questionnaires with ID numbers were mailed to all dentists in Ontario ( N =5,997) with additional mailings four and seven weeks later. Results : Proportionately more respondents who returned questionnaires less than four weeks after the first mailing reported that they knowingly treated ( P <.05) or were willing to treat HIV-infected patients ( P <.05); that they had an accurate perception of risk of HIV infection after a needlestick injury ( P <.01), and preferred not to refer HIV-infected patients ( P <.01). Linear extrapolation of cumulative percent responses indicated nonresponse bias in terms of attitude and knowledge items; however, the magnitude was low. Conclusion : The effects of late response and nonresponse bias on the results of this study were small. However, these results cannot be generalized beyond the study population, and obtaining high response rates and testing for nonresponse bias in surveys of attitudes related to HIV are recommended.     

Prevalence of tinnitus according to temporomandibular joint disorders and dental pain: The Korean National Population‐based Study

Some studies have reported that temporomandibular joint disorder (TMD) is related to tinnitus. However, there is no study of the relationship and prevalence of dental pain and tinnitus. We evaluated the associations between the prevalence of tinnitus and TMD and dental pain by analysing the Korean national health survey. We analysed totally 11 745 participants. The presence of tinnitus, TMD symptoms and dental pain was surveyed by self‐assessment questionnaires from all the participants. Multivariable regression analysis was applied to acquire odds ratios (OR) and 95% confidence intervals (CI). The prevalence of tinnitus was higher in the subjects with dental pain (21.1%), TMD (22.5%) and both symptoms (31.2%) than subjects without those symptoms (19.6%). After adjusting for all covariates, subjects with TMD had tinnitus 1.6 times more than subjects without TMD. In the subanalysis, age group more than 65 years, women, and obese subjects had tinnitus more than men, age group <65, and non‐obese subjects, respectively. TMD alone and both dental pain and TMD were associated with tinnitus (OR = 1.389 and 95% CI 1.054‐1.832 and 2.206 and 1.637‐2.974, respectively). Subjects with TMD had more tinnitus than subjects without TMD. Moreover, subjects with dental pain in addition to TMD had increased prevalence of tinnitus than TMD alone.     

Nonresponse bias in a national study of dentists' infection control practices and attitudes related to HIV

Abstract The aim was to investigate late response and nonresponse bias in a survey related to HIV and infection control. Questionnaires with ID numbers were mailed to a stratified random sample of dentists in Canada with additional mailings 4 and 7 weeks later (n=6444). We compared responses received after <4 weeks, 4–7 weeks, >7 weeks. Extrapolation was used to estimate nonresponse bias. Univariate analyses showed significant differences between responses received <4 weeks after initial mailing and those received later for items on sociodemographics, knowledge, infection control practices and attitudes: late responders were more likely to report that they would refuse to treat any patients with HIV (P<0.01). Multiple logistic regression indicated that the best predictors of responses received ≥4 weeks were disagreement that HBV is more infectious than HIV (OR=1.7); unwillingness to attend a dentist who treats HIV/AIDS patients (OR=1.3); incorrect perception of the risk of HIV infection after an HIV-contaminated needlestick injury (OR =1.2): and sometimes or never heat-sterilizing handpieces after each patient (OR=1.2). Extrapolation indicated that the percentage of all respondents who reported refusal to treat (15.2%) would have been 17.1% if a 100% response rate had been obtained. We found significant evidence of late response and nonresponse bias primarily in knowledge and fears related to HIV infectivity; however, the impact on the final results was small and we concluded that additional follow-up to improve response rates would not be worthwhile.     

Response rate and nonresponse bias in a questionnaire survey of dentists

OBJECTIVES: (a) To report on response rate and nonresponse bias of a questionnaire survey of dentists. (b) To make recommendations for future questionnaire survey research in dentistry. METHODS: A questionnaire was mailed to a stratified systematic sample of 908 Australian dentists. The strategy included three mailings, a final telephonic contact, university stationery, paid reply envelopes and personalized correspondence. Nonresponse bias was assessed by comparing responses to a simple 'yes/no' question from each contact (late responders), and by comparing demographic information (nonresponders). RESULTS: The response rate achieved was 87% and there was no evidence of nonresponse bias based on practice location or year of graduation. The cumulative proportions of 'yes/no' responses essentially remained constant after each contact, but significantly more late responders answered in the negative to the test question than did early responders. The telephonic contact aided in the identification of nonparticipants and ineligible units. CONCLUSIONS: The current survey indicates that differences in data between early and nonresponders can occur despite there being no demographic differences. Therefore, assessment of nonresponse bias based on demographic data alone would seem to be insufficient. Questionnaire survey research must first be based on sound sampling techniques, and then on achieving as high a response rate as possible using the many incentives available.     

Psychological factors and perceptions of pain associated with dental treatment

Although pain during dental treatment has been identified as playing a major role in the onset of dental anxiety and is a major concern of patients when seeking dental care, there have been very few studies of the prevalence of pain during dental treatment and the factors associated with patients' perceptions of pain. This study used data from a longitudinal population-based study to assess the proportion of dental attenders who experienced pain while having dental treatment and the psychological characteristics which predisposed them to experience pain. Of 1422 subjects who completed questionnaires at baseline and five-year follow-up, 96.4% had visited a dentist over the observation period. Two fifths, 42.5%, reported having pain during treatment and one-fifth, 19.1%, had pain that was moderate to severe in intensity. Reports of pain were associated with the types of treatment received, and a number of baseline sociodemographic and psychological factors. In a logistic regression analysis predicting the probability of pain, a variable documenting the number of types of invasive treatment received (restorations, extractions, crowns/bridges, root canal therapy and periodontal treatment/surgery) had the strongest independent effect. Pain was also more likely to be reported by those with previous painful experiences and those who were anxious about dental treatment, expected treatment to be painful and felt that they had little control over the treatment process. Pain was less likely to be reported by those who said they were unwilling to accept or tolerate pain. Younger subjects and those with higher levels of education were more likely to report pain than older subjects and those with a lower educational level. These results indicate that pain is as much a cognitive and emotional construct as a physiological experience. They also have implications for dentists' behaviour when providing dental care.     

Determinants of perceived need for dental pain medication

Abstract – Objectives: To describe the perceived inability to cope (PIC) and impact on quality of life (QOL) in dental pain patients, and investigate their effect on perceived need for pain medication. Methods: Fully structured self‐complete questionnaire survey of a sample of patients with current experience of dental pain/discomfort and sensitivity. Subjects were recruited from a dental teaching hospital’s emergency and restorative clinics. Questions were asked on pain intensity, PIC, impact on QOL and perceived need for pain medication. Results: Of 318 subjects approached, 199 (63%) completed usable questionnaires. In expressing PIC, 48.2% of the sample reported that they felt dependent on somebody else doing something about the pain, whereas 69.3% reported feeling helpless in their effort to try and do something about the pain. The prevalence of impact on QOL ranged from 55.8% reporting feeling like isolating oneself from other people to 77.9% for feeling grumpy, irritable, bad‐tempered or miserable. Logistic regression analysis identified impact on QOL (OR = 1.17, 95% CI = 1.06–1.30), PIC (OR = 1.10, 95% CI = 1.01–1.21) and pain intensity (OR = 1.26, 95% CI = 1.05–1.50) as independent significant predictors of perceived need for pain medication. Conclusions: Pain intensity and PIC can enhance the ability of QOL measures in differentiating population groups into those who perceive the need for pain medication and those who do not.     

Dental pain and care-seeking in 11-14-yr-old adolescents in a low-income country

The purpose of this article was to document the 1-month dental pain prevalence in 11-14-yr-old subjects attending Grade Six of middle schools in Peshawar, Pakistan, and to explore the effect of dental pain and the impact on daily living on dental care-seeking. A self-completed questionnaire survey of all 13 middle schools in University Town, Peshawar, Pakistan, was carried out in April 2007. Questionnaire items on dental pain were adapted from the dental pain screening questionnaire (DePaQ) and items on the impact on daily living were adapted from the child-oral impact on daily performance (OIDP-Child) questionnaire. Regression analysis was carried out to determine the relative usefulness of predictors for care-seeking. The prevalence of dental pain was estimated to be 30.4%, and care-seeking in those reporting pain was estimated to be 64%. Care-seeking was associated with 'pain felt in one tooth', 'painful tooth felt loose', 'difficulties sleeping', and 'difficulties playing', which accounted for 35% of the explained variance. The findings substantiate dental pain as an important dental public health concern in Pakistan and support the hypothesis that assessment of dental pain characteristics can add to the accuracy of dental need estimation.     

Disparities in self reported oral health problems among a young Syrian adult population

OBJECTIVE: To describe the prevalence of dental pain and other oral health problems among a young Syrian adult population and to identify socio-demographic factors associated with these experiences. Subjects: An industrial sample of 400 men and women aged 18-34 years from Damascus, Syria. METHODS: Study participants were interviewed about their experience of oral health problems in the previous year (1998). Socio-demographic information was collected. RESULTS: 93% (369) of the interviews were completed. The prevalence of oral health problems was high, with 96% (353) of respondents claiming that they experienced one or more problems in the previous year. Two thirds of participants (65%, 239) claimed they had dental pain in the previous year. Analysis revealed that dental pain experience was significantly associated with age and gender. Analysis considering all factors revealed that the odds of experiencing dental pain were higher amongst the younger age group (18-24 compared to 25-34 year-olds). CONCLUSION: The prevalence of oral health problems was high among the population studied. Socio-demographic variations in experience of dental pain were apparent, with young men of lower education having the greatest odds of dental pain experience in the previous year.     

Dental hygienists-independent practice and pain control services

Abstract – In 1990, 78 dental hygienists who were members of the Dutch Dental Hygiene Association and working in an independent practice received a questionnaire (response rate: 79%) about the administration of local anesthesia. The main aim of this study was to dertermine the need for this service prior to deep scaling. The results of the survey showed that the need to administer local anesthesia for this purpose is limited in spite of the large number of patients with periodontal problems treated in independent dental hygiene practices. In most circumstances the cooperation with the dentist is satisfactory. However, 83% of the respondents indicate a limitation in the pain control services.     

Use of dental services among Danish youths: role of the social environment, the individual, and the delivery system

The purpose of the present study was to analyze the separate effect and the total effect of the social environment, the individual and the delivery system on frequency of use of dental services among youths. The variables of use were divided into the three main groups according to Coleman (12). Information concerning use of dental services, individual and structural variables was obtained by a self-administered questionnaire to 756 Danes 20-21 yr old in 1984-85. Information concerning social environmental variables was obtained by a postal questionnaire to the mothers of the individuals in 1974 (16). Information from 552 mothers was available. Firstly, the variables concerning the social environment were inserted into a multiple dummy regression analysis as independent variables, and it was found that the following characteristics of the mothers were significant predictors: regularity of dental visits and perceived economic barriers. Secondly, the variables concerning the individual resources were set into a multiple dummy regression model as independent variables. The results showed that the following variables had a significant effect: sex, social conditions, pain tolerance, dental anxiety, and perceived economic barriers. Thirdly, multiple dummy regression analysis showed that among the structural variables general assessment of Child Dental Care compared to Youth Dental Care, and a personality assessment of the general dental practitioner were significant predictors. Finally the predictors from the three main groups all together were inserted as independent dummy variables into a regression model. The results showed that sex, social conditions, pain tolerance, dental anxiety, perceived economic barriers of the youth themselves, general assessment of Child Dental Care compared to Youth Dental Care were significant predictors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Does computerized anaesthesia reduce pain during local anaesthesia in paediatric patients for dental treatment? A systematic review and meta‐analysis

This systematic review and meta‐analysis analysed whether pain and disruptive behaviour can be decreased by the use of computerized local dental anaesthesia (CDLA) in children. The literature was screened to select randomized clinical trials that compared computerized and conventional anaesthesia. The primary outcome was pain perception during anaesthesia; the secondary, disruptive behaviour. The risk of bias of individual papers and the quality of the evidence were evaluated. After search, 8389 records were found and 20 studies remained for the qualitative and quantitative syntheses. High heterogeneity was detected for both outcomes. For the pain perception, the overall analysis showed a standard mean difference of ?0.78 (?1.31, ?0.25) favouring CDLA; however, when only studies at low risk of bias were analysed (subgroup analysis), there was no difference between the two techniques [?0.12(?0.46, 0.22)]. For disruptive behaviour, no differences were detected for continuous [?0.26 (?0.68, 0.16)] or dichotomous data [0.81 (0.62, 1.06)]. The quality of evidence was judged as low for pain perception and very low for disruptive behaviour. It is concluded that there is no difference in the pain perception and disruptive behaviour in children subjected to computerized or conventional dental local anaesthesia. Notwithstanding, the quality of the available evidence is low.     

Graduate orthodontic education in Turkey: the residents' perspective

The aim of the present study was to explore residents' perceptions of their educational and clinical treatment experiences including the number of clinical cases undertaken, patient completion rates, techniques utilised and the scientific component of Turkish graduate orthodontic programmes. Residents recorded in the list of Turkish Orthodontic Society were sent an e‐mail to participate in a survey containing 46 multiple‐choice questions and ten one‐line answers. An e‐mail with a personalised online link was sent to a total of 227 residents throughout the Turkey. Data were categorised, and basic statistics including chi‐square comparative analyses were performed. A total of 136 (response rate of 59.91%) residents completed the survey. The majority of residents (58.08%) were either ‘very satisfied’ or ‘satisfied’ with their programme. Respondents said they have just the right amount of formal didactic teaching sessions or dedicated and protected academic time. Most residents (69.11%) indicated their programme offers training in numerous philosophies; whilst 97.79% said they have sufficient clinically based training and 42.64% said they have sufficient research‐based training. Overall, residents in the Turkey are satisfied with their orthodontic programme. They receive comprehensive training with the opportunity to start and complete a significant number of their patients. The survey findings suggest that orthodontic programmes in Turkey are deficient in providing care to underserviced populations and disabled patients. Programmes could improve the opportunity for residents to treat patients requiring interdisciplinary treatment.     

Effect of gender on acute pain prediction and memory in periodontal surgery

Pain is a complex experience that is affected by factors such as gender, stress, anxiety and cognitions. The purpose of this study was to investigate the inter-relationship between gender and acute pain prediction and memory under periodontal surgery treatment. The study was conducted on 15 male and 22 female dental patients (mean age 34 yr, mean education level 14.7 yr), who were scheduled for periodontal surgery. Patients were evaluated during four consecutive appointments: at initial check-up, immediately pre-operatively, 1 wk post-operatively, and at 4 wk post-operative follow-up. Patients were requested to complete questionnaires concerning their anxiety at each appointment and to indicate their subjective evaluations concerning pain (on a visual analogue scale). Evaluations concerning expectation to experience pain during the planned surgery (pain prediction) were made at the first two appointments and evaluations of the experienced pain as remembered from the surgery (pain memory) were made at the last two appointments. Gender had a significant effect on pain prediction and pain memory. Men expected to experience more pain pre-operatively than women but remembered less pain post-operatively. It was concluded that cognitive pain perception in clinical situations differs between genders.     

The prevalence of myofascial pain and its association with occlusal factors in a threshold country non-patient population

The objective of the study is to assess the prevalence of myofascial pain in a threshold country and to isolate occlusal risk factors. One hundred and seventy-one randomized selected women were examined by a trained examiner in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) examination procedure. Subscales of the SCL 90-R, graded chronic pain status, and anamnestic questionnaires were also used. Logistic regression was performed to compute the odds ratios for six common occlusal features with regard to the presence of myofascial pain, in accordance with the RDC/TMD criteria. Fifteen subjects (15 / 151 = 9.93%) suffered from myofascial pain. Results from logistic regression analysis showed that non-occlusion (posterior teeth, at least one side) and open bite increased the risk of myofascial pain. The prevalence of myofascial pain in this study is comparable with that in another study, in a highly industrialized environment, in which the RDC/TMD was used. The role of occlusion in a non-patient population seems to be restricted to serious alterations of normality. This article presents the prevalence of myofascial pain and its association with occlusal factors. This issue will help the clinicians to assess the influence of occlusion in myofascial pain patients and to send the patient to the appropriate specialist.     

Dental pain and oral health-related quality of life in individuals with severe dental anxiety

Objectives: To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL).

Methods: The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status.

Results: The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0–61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual’s daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p?p?p?=?.008).

Conclusion: This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.