Long-term quality of life outcomes of maxillomandibular advancement osteotomy in patients with obstructive sleep apnoea syndrome

This study was performed to evaluate the long-term impact of maxillomandibular advancement (MMA) surgery on the apnoea–hypopnoea index (AHI) and quality of life (QoL) in patients with obstructive sleep apnoea syndrome (OSAS). The medical files of 12 OSAS patients who underwent MMA by one surgeon between 1995 and 1999 were reviewed retrospectively. Patients received a clinical assessment, polysomnography, and QoL questionnaires as part of routine care preoperatively (n = 12), within 2 years postoperative (n = 12), and again in 2016 (n = 9). A successful surgical outcome was defined as an AHI decrease of >50% with <20 events/h. Of the 66.7% (8/12) of patients who were initially cured, 66.7% (4/6) remained stable at a median follow-up of 19 years. Only the two patients with the highest AHI showed abnormal Epworth Sleepiness Scale scores. After convalescence, most patients reported stable symptomatic improvement. Aesthetic changes were found acceptable and all but one patient stated that they would undergo the surgery again. It is concluded that MMA is a safe and effective procedure. Ageing and weight gain might counterbalance the positive effects of surgery in the long term. It is therefore suggested that re-evaluation every 5 years should be scheduled, since a spontaneous AHI increase over time does not seem to be reflected by symptomatic changes.     

Association between diet, social resources and oral health related quality of life in edentulous patients

To assess whether there was an association between diet, oral health related quality of life and social resources in a population of older edentulous adults, and, to assess the impact of provision of new complete replacement dentures. This study was carried out at Cork University Dental Hospital in Ireland. In this prospective clinical study, 35 edentulous adults who requested new complete dentures completed pre-treatment questionnaires which included validated oral health status, social resources and nutritional assessment questionnaires. New dentures were provided and the impact of treatment on oral health related quality of life, diet and ability to chew food was assessed. Satisfaction with dentures and oral health related quality of life improved following provision of new dentures. However, food choice remained similar to pre-treatment choice, and subjects were rated as medium risk for poor nutritional status on the Mini Nutritional Assessment (MNA) score. Oral health related quality of life and diet were not correlated. Three quarters of the sample felt they had no nutritional problems. However, approximately 70% reported that they had changed their food choices because of dental problems and that financial cost was a barrier to dental treatment. Food selection among the group studied was not ideal, and not improved by the provision of new dentures. There was no association between diet and oral health related quality of life. Further research is needed to improve our understanding of the relationship between oral health and diet.     

Traumatic dental injuries in Brazilian children and oral health‐related quality of life

Background/Aims

Population‐based studies that investigate the impact of TDI on oral health‐related quality of life (OHRQoL) among school children and its association with socioeconomic factors are scarce and offer conflicting results. The aim of this study was to evaluate the impact of TDI on OHRQoL among school children and its association with socioeconomic status.

Materials and Methods

A cross‐sectional study was conducted with 588 12‐year‐old children enrolled in public and private schools in the urban areas in the city of Diamantina (southeastern Brazil). Clinical examinations were performed for the diagnosis of traumatic dental injury based on Andreasen's classification. The Child Perceptions Questionnaire (CPQ_11–14), which has been validated for the population in Brazil, was employed to evaluate oral health‐related quality of life. Socioeconomic status and overjet were also analyzed. Statistical analysis involved the chi‐square test and logistic regression.

Results

A total of 29.4% of the students exhibited some type of trauma to at least one tooth. A negative impact on oral health‐related quality of life was found in 53.1% of the sample. Traumatic dental injury was associated with a high impact on oral health‐related quality of life [OR = 1.61 (95% CI: 1.08‐2.39)] and overjet >3 mm [OR = 5.42 (95% CI: 3.66‐8.02)]. However, no statistically significant associations were found between TDI and socioeconomic status.

Conclusions

Prevalence of traumatic dental injury was high among the children who participated in the study, and it was associated with a high impact on oral health‐related quality of life as well as overjet >3 mm.     

External fixation greatly improves outcomes in the surgical treatment of osteoradionecrosis of the jaws without affecting quality of life: a five-year retrospective study

Osteoradionecrosis of the jaw can be treated using both conservative treatment and surgery. External fixation may be used to bridge large resection defects after sequestrectomy for stabilisation and before secondary mandibular reconstruction. We designed a retrospective analysis of 70 patients with osteoradionecrosis treated between the years 2014 and 2018, and found that the use of external fixation greatly improves their outcomes. Patients were grouped according to Notani’s classification: those who had Notani I disease were treated surgically but without external fixation; and those with Notani II and Notani III disease were eligible for external fixation. In those with Notani II disease, there was a significant reduction in the number of pathological fractures that occurred with external fixation. In those with Notani III disease, the success rate of primary sequestrectomy was only 1:14; however, those treated with external fixation all successfully healed after their first operation. It was hypothesised that although external fixation would improve outcome, it would come at a detriment to their quality of life (QoL). However, in a subset of these patients, we showed that in addition to increasing successful healing, patients’ QoL with the external fixator was no worse than when they had an active osteonecrotic lesion. The treatment of osteoradionecrosis is cumbersome and advanced stages are associated with more complications. The use of an external fixator significantly reduces the probability of pathological fractures and increases the rate of successful healing in patients after mandibular resection. It does this without greatly interfering with patients’ lives, while improving their condition sufficiently to allow for subsequent mandibular reconstruction.     

Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders

Abstract – Objective The aim of this study was to assess the association of chewing ability to oral health‐related quality of life (OHRQoL) measured by the Oral Health Impact Profile‐14 (OHIP‐14) controlling for clinical oral health status, self‐reported health status, demographic factors, and socioeconomic conditions among community‐dwelling and institutionalized Korean elders. Methods This cross‐sectional study comprised a sample of 307 community‐dwelling and 102 institutionalized people over the age of 60, using a cluster sampling procedure. A questionnaire was implemented and a clinical oral examination was completed for each subject. The outcome variable of interest was the OHIP‐14 score, and its associations with chewing ability, objective oral health status, self‐reported health status, demographic factors, and socioeconomic conditions were assessed. Because of highly‐skewed distribution of the OHIP‐14 scores, nonparametric analytic methods were used. The final model was developed using a multivariable two‐level logistic regression model for a dichotomized OHIP‐14 score to account for the cluster sampling method applied to this study. Results The mean age of the participants was 75.4 years, with 67.7% being women. The median OHIP‐14 score was 7. Negative oral health impacts were experienced fairly often or very often by a total of 36.4% of elderly. In the final model, elders who could chew none to three and four to six foods among seven indicator foods were 3.4 (P = 0.010) and 2.0 (P = 0.040) times more likely, respectively, to have worse OHRQoL compared with elders who could chew all seven food types. Also significant associations with worse OHRQoL were shown for being concerned about oral health [Odds Ratio (OR) = 4.9, P = 0.002], fair or better self‐reported oral health (OR = 0.12, P = 0.002), very good/good self‐reported general health (OR = 0.38, P = 0.008), being married (OR = 2.0, P = 0.054), and having a favourable economic status (OR = 0.43, P = 0.042). Conclusions This study showed highly significant association between chewing ability and OHRQoL measured by the OHIP‐14 score after controlling for related factors. Amelioration of chewing ability might independently contribute to improving the OHRQoL of elders.     

Dental status, xerostomia and the oral health-related quality of life of an elderly institutionalized population

The author examined the relative effects of tooth loss and xerostomia on the oral health-related quality of life of an elderly, medically compromised population, living in a long-term care setting. Data were collected from 225 subjects (mean age: 83 years) via a questionnaire and review of dental charts. Oral health-related quality of life was assessed using self-ratings, satisfaction ratings, an index of chewing capacity, the GOHAI, and OH1P-14. Almost all participants had one or more chronic medical conditions and were taking prescribed medications. Two-thirds of the study group was dentulous with a mean number of 16 remaining teeth. One-third of the participants had scores on a xerostomia index indicating marked oral dryness. In bivariate and multivariate analyses, xerostomia index scores were significantly associated with all oral health-related quality of life outcomes. Dental status was associated with chewing capacity only. The results suggest that xerostomia has an important influence on the well-being and quality of life of this population.     

28例晚期口腔鳞癌患者新辅助化疗围化疗期营养状况及生活质量评估

目的: 探讨晚期口腔鳞癌患者新辅助化疗围化疗期的营养状况、生活质量变化和两者的相关性,以及化疗对营养状况和生活质量的影响。方法: 选择2019年6月—2019年12月于上海交通大学附属第九人民医院口腔颌面-头颈肿瘤科行新辅助化疗的晚期口腔鳞癌患者28例,采用队列研究方法。所有患者均以TPF方案(多西他赛+顺铂+5-氟尿嘧啶)进行化疗,化疗期间采用个体化方案进行营养支持。分析患者化疗前、后PG-SGA、QLQ-H&N35评分变化以及两者的相关性,并根据肿瘤消退情况,将患者分为有反应组(CR+PR)和无反应组(PD+SD)进行分层分析。采用 SPSS 23.0软件包对数据进行统计学分析。结果: 化疗后患者的PG-SGA评分和QLQ-H&N35评分较化疗前显著降低(P=0.0301,P=0.0015),两者之间具有显著的相关性(r=0.5953,P<0.0001)。分层分析显示,有反应组和无反应组患者的PG-SGA评分与QLQ-H&N35评分变化无统计学差异(P>0.05)。2组患者的体重、肌肉量和脂肪量变化均无统计学差异。排除女性患者后发现,2组患者体重及脂肪量变化无显著差异(P>0.05),但有反应组患者的肌肉量显著增多而无反应组患者的肌肉量显著下降(P=0.0358)。结论: 新辅助化疗能够改善晚期口腔鳞癌患者的营养状况,提高患者生活质量。     

口腔种植修复对牙列缺失患者生活质量及龈沟液AST、OPN水平的影响

目的: 探讨口腔种植修复与常规修复对牙列缺失患者生活质量及龈沟液天冬氨酸转氨酶（aspartate amino transferase,AST）、骨桥蛋白（osteopontin ,OPN）水平的影响。方法: 前瞻性选择2016年10月—2018年10月解放军中部战区总医院汉口院区口腔科收治的牙列缺失患者106例,采用随机数字表法将患者分为2组,实验组（53例）采用口腔种植修复治疗,对照组（53例）采用常规修复治疗。观察2组疗效以及患者生活质量、龈沟液AST、OPN水平的差异。采用SPSS 25.0 软件包对数据进行统计学分析。结果: 实验组总治疗有效率90.57%,显著高于对照组（P<0.05）。实验组治疗后龈沟液AST、OPN水平显著低于对照组（P<0.05）。实验组治疗后OHIP-14评分中,功能受限、生理性疼痛、心理不适、生理障碍、心理障碍、社会障碍、残疾评分均显著低于对照组（P<0.05）。结论: 口腔种植修复可明显改善牙列缺失患者的生活质量,对龈沟液AST和OPN水平影响较小。     

心理干预对头颈部恶性肿瘤患者负性情绪及生活质量影响的meta分析

目的: 系统分析和评价心理干预对头颈部恶性肿瘤(HNC)患者负性情绪及生活质量的影响,为开展HNC心理干预提供依据。方法: 计算机检索PubMed、Central、Embase、clinicaltrials.gov、ICTRP、Web of Science、CBM、CNKI、VIP、万方等网站有关HNC患者心理干预的随机对照临床试验(RCT)。检索时间从数据库建立到2021年5月15日,经过筛选、质量评价和数据提取,采用RevMan 5.4软件进行meta分析。结果: 最终纳入RCT 18项,包括2 097例受试者。与对照组常规护理相比,试验组加入心理干预降低了HNC患者的焦虑评分[SMD=-2.33,95%CI（-2.96,-1.70）,P<0.000 01]、抑郁评分[SMD=-2.26,95%CI（-2.78,-1.74）,P<0.000 01],生活质量评分提高[SMD=6.04,95%CI（1.53,10.56）,P=0.009]及症状自评量表评分[MD=29.99,95%CI（-36.22,-23.76）,P<0.000 01]提高。结论: 心理干预能有效缓解HNC患者的焦虑、抑郁情绪,促进HNC患者的心理健康和生活质量。但受纳入RCT质量的限制,需要更多设计严谨、方法学质量较高的研究进行验证。     

种植覆盖义齿修复牙列缺失的生活质量研究

目的研究下颌牙列缺失患者采用全口义齿（CD）和种植覆盖义齿（IOD）修复后的患者满意度以及口腔健康相关生活质量（OHRQoL）,探讨种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为是否存在积极的影响。 方法收集2016至2018年在中山大学附属口腔医院门诊就诊,50 ~ 80岁下颌牙列缺失,曾采用传统全口义齿修复且因义齿稳定性差而自愿行种植覆盖全口义齿修复的受试者19例,其中男8例,平均69.25岁;女11例,平均72.45岁。通过自身对照研究,每位受试者均先后佩戴在相同标准下制作的新传统全口义齿（CD）以及种植覆盖义齿（IOD）,并于戴用义齿3个月后完成口腔健康影响程度量表（OHIP-20）、老年口腔健康评价指数量表（GOHAI）和日常生活牙科影响量表（DIDL）调查,分析传统全口义齿和种植覆盖全口义齿修复对患者心理状态和生活质量的影响。数据采用Wilcoxon符号秩检验进行统计分析,P<0.05为差异有统计学意义,并计算CD组和IOD组OHRQoL得分的效应量（ES值）以评价其影响程度。 结果OHIP-20、GOHAI、DIDL量表均显示,IOD组在量表的功能限制、疼痛、心理不适、生理能力受限、心理能力受限、社交能力丧失、身心缺陷、美观、口腔舒适的各领域得分及总体得分上均明显优于CD组,差异具有统计学意义（P<0.05）。此外,根据DIDL量表评价标准得知,IOD修复可有效提提升患者满意度,并减少不满意人数的比例。3个量表在各领域及总得分的ES值均大于0.8,代表每个领域均受到高度影响,并以咀嚼能力（ES = 3.74）、生理能力受限（ES = 3.12）和功能限制（ES = 2.94）等生理功能改善最为显著。说明,IOD组比CD组对患者的生活质量改善较好,且对各方面的改善程度较高。 结论OHIP-20、GOHAI、DIDL量表调查结果反映种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为有积极的影响。     

The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention

Objective: The aim of this study was to compare the impact of customised dietary advice on patients' satisfaction with their dentures and oral health‐related quality of life (OHRQoL) in patients wearing implant‐supported mandibular overdentures (IOD) or conventional dentures (CD). Materials and methods: In this prospective cohort study, 28 IOD (two implant‐retained mandibular overdenture) and 26 CD patients completed a denture satisfaction scale and the 20‐item oral health impact profile (OHIP‐20) before and 6 months following provision of customised dietary advice. Results: At 6 months following provision of individualised dietary advice, the IOD group showed significantly greater satisfaction than the conventional group for denture comfort (80.6, ± 15.6, vs. 68.7 ± 15.6 P=0.001), stability (75.8 ± 15.9 vs. 59.5 ± 30.4, P=0.002), and perceived chewing ability (79 ± 30.4 vs. 59.5 ± 30.4, P=0.027) ± when adjusted for baseline scores. Before delivery of the dietary advice there were no significant differences between groups for Satisfaction or OHIP scores. No difference in OHRQoL was seen between groups. Conclusions: The delivery of customised dietary advice to edentulous patients impacts differently on their satisfaction with denture comfort, stability and chewing ability depending on the nature of their prosthesis. This re‐evaluation of satisfaction occurs when edentulous patients challenge themselves to consume more fruits, vegetables and fibre‐rich foods. The IOD group reported an increased level of satisfaction and perceived chewing ability whereas it appeared that CD wearers may have had their awareness of the shortcomings of this sort of prosthesis reawakened. To cite this article:
Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M. The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention.
Clin. Oral Impl. Res. 21 , 2010; 386–391.
doi: 10.1111/j.1600‐0501.2009.01859.x     

A structural equation model relating oral condition,denture quality,chewing ability,satisfaction, and oral health-related quality of life in complete denture wearers

ObjectivesTo investigate the relationship between mandibular ridge form, stability and retention of mandibular complete denture, accuracy of jaw relation recording, patients’ perception of chewing ability, satisfaction with dentures and oral health-related quality of life (OHRQoL) in complete denture wearers.MethodsA total of 183 edentulous patients, who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures, were recruited. Oral examination was performed. Cawood and Howell's method was used to grade the mandibular ridge form. The stability and retention of the mandibular complete denture were assessed using Kapur method. Accuracy of jaw relation recording was evaluated using a newly developed jaw relation index. Patients’ perception of chewing ability was rated using a food intake questionnaire. Patients’ satisfaction with complete dentures was assessed on a 100-mm visual analogue scale. OHRQoL was measured using the Japanese version of the Oral Health Impact Profile for edentulous subjects. A structural equation model was constructed based on the hypothesis that oral condition and denture quality would be related to chewing ability, satisfaction and OHRQoL.ResultsSignificant relationships were found between mandibular ridge form, stability of mandibular complete denture, accuracy of jaw relation recording, perceived chewing ability, satisfaction and OHRQoL. Various fit indices were within acceptable limits.ConclusionsOral condition and denture quality were related to patients’ perception of chewing ability, satisfaction with dentures and OHRQoL in complete denture wearers.Clinical significanceA favourable oral condition and denture quality are important for successful complete denture therapy.     

Orthognathic treatment of dentofacial disharmonies: its impact on temporomandibular disorders,quality of life,and psychosocial wellness

Aim: The objective of this literature review was to assess the effect of orthognathic surgical treatment on temporomandibular disorders (TMD), quality of life (QoL), and psychosocial wellness.

Methods: Journal articles and systematic reviews published in English between 1982 and 2015 were searched using PubMed, MEDLINE, and Cochrane database using the search terms “orthognathic,” “temporomandibular disorders,” “quality of life,” and “psychosocial.” The articles were then reviewed and discussed.

Results: Both objective and subjective parameters play a role in orthognathic treatment outcome satisfaction and QoL. Psychological factors and TMD exerted a stronger influence on patients’ QoL more than objective treatment outcome measures.

Conclusion: A paradigm shift in clinical mindset from solely objective measures to a more holistic, patient-centric approach of addressing patients’ expectations and improving QoL is warranted when treating patients with dentofacial disharmonies.