Effect of implant therapy on oral health-related quality of life (OHIP-49), health status (SF-36), and satisfaction of patients with several agenetic teeth: Prospective cohort study.

BACKGROUND: Effect of fixed prosthodontics on patients with several agenetic teeth is not well understood. PURPOSE: To assess the effect of implant-based fixed prosthodontics on oral health-related quality of life (OHRQoL), general health status, and satisfaction regarding dental appearance, ability to chew and speech in patients with several agenetic teeth. MATERIALS AND METHODS: For this prospective cohort study, all patients (≥18 years) with several agenetic teeth who were scheduled for treatment with fixed dental implants between September 2013 and July 2015 at our department were approached. Participants received a set of questionnaires before and 1 year after implant placement to assess OHRQoL (OHIP-NL49), general health status (SF-36), and satisfaction regarding dental appearance, ability to chew and speech. RESULTS: About 25 out of 31 eligible patients (10 male, 15 female; median age: 20 [19;23] years; agenetic teeth: 7 [5;10]) were willing to participate. Pre- and post-treatment OHIP-NL49 sum-scores were 38 [28;56] and 17 [7;29], respectively (P < .001). Scores of all OHIP-NL49 subdomains decreased tool, representing an improved OHRQoL (P < .05) as well as that satisfaction regarding dental appearance, ability to chew and speech increased (P < .001). General health status did not change with implant treatment (P > .05). CONCLUSIONS: Treatment with implant-based fixed prosthodontics improves OHRQoL and satisfaction with dental appearance, ability to chew and speech, while not affecting general health status.

Long-term implant performance and patients' satisfaction in oligodontia.

OBJECTIVES: To assess long-term (≥10 years) implant survival, peri-implant health, patients' satisfaction and oral health related quality of life (OHQoL) in oligodontia patients rehabilitated with implant-based fixed prosthodontics. METHODS: All oligodontia patients treated ≥10 years previously with implant-based fixed prosthodontics at the University Medical Center Groningen, The Netherlands, were approached to participate. Clinical (plaque index, bleeding index, pocket probing depth) and radiographic (marginal bone level) data were collected between February and May 2016. Surgical implant details (e.g., bone augmentation) and implant loss were recalled from the medical records. Patients completed a satisfaction questionnaire (maximum score 10, high score favourable satisfaction) and the Oral Health Impact Profile (OHIP-NL49, maximum score 196, low score favourable satisfaction) to rate OHQoL. Implant survival was expressed according to Kaplan Meier. The Mann-Whitney U Test was used for the other analyses. RESULTS: Forty-one patients had been treated with implant-based fixed prosthodontics (n = 258) ≥10 years previously. Cumulative 10-year implant survival of these 41 patients was 89.1% (95%CI 85.2-93.0%). Twenty-eight of them (n = 163 implants) were willing to visit us for additional clinical and radiographic assessments. In these 28 patients, highest peri-implant bone loss was observed for implants placed in augmented bone (p < 0.001). Peri-implant mucositis (65.4%) and peri-implantitis (16.1%) were rather common. Patients' satisfaction (8.3 ±â€¯1.5) and OHIP-NL49 scores (32.6 ±â€¯30.1) were favourable and not associated with number of agenetic teeth (≤10 versus >10). CONCLUSIONS: Long-term survival, satisfaction and OHQoL results reveal that implant treatment is a predictable and satisfactory treatment modality for oligodontia, although peri-implant mucositis and peri-implantitis are common. CLINICAL SIGNIFICANCE: This study showed unique long-term (≥10 years) results about implant survival, peri-implant health, patients' satisfaction and OHQoL in oligodontia patients rehabilitated with implant-based fixed prosthodontics.

Location of implant-retained fixed dentures affects oral health-related quality of life.

BACKGROUND: The effects of the locations of dental implants on treatment outcomes, as evaluated by oral health-related quality of life (OHRQoL) assessment, remain controversial. PURPOSE: To investigate the association between the locations of dental implants and changes in OHRQoL. MATERIALS AND METHODS: Sixty-eight subjects received implant treatment in the anterior or posterior region and completed the Oral Health Impact Profile (OHIP) questionnaire before and after treatment. Change in OHIP summary scores and the 4 dimension scores were calculated to evaluate the effects of implant treatment on OHRQoL. RESULTS: The mean Oro-facial Appearance score for the anterior group was significantly higher than that for the posterior group (10.4 ± 5.1 and 7.2 ± 3.8, respectively; P ＝ .005; Effect size = 0.63) at baseline. All questionnaire scores were significantly improved following implant treatment in both groups, and no significant group differences were observed at follow-up. Regression analysis revealed a significant association between the locations of most anterior implants and changes in the Oro-facial Appearance score (adjusted R2 = 0.073; P = .015). CONCLUSION: Our results suggest that the locations of dental implants influence OHRQoL impairments and improvements after treatment. This information might be useful in clinical decision-making.

Comparison of Rehabilitating Missing Mandibular First Molars with Implant- or Tooth-Supported Prostheses Using Masticatory Efficiency and Patient Satisfaction Outcomes.

PURPOSE: To determine whether a fixed partial denture (FPD) or an implant replacement of a single missing tooth leads to better masticatory efficiency and patient satisfaction. MATERIALS AND METHODS: One-hundred and twenty participants with missing mandibular right first molars were selected on the basis of predefined inclusion and exclusion criteria. After obtaining informed consent, 60 participants were randomized to the teeth-supported (FPD) group and 60 to the implant placement group (IMP). The study was divided into the following parts: (i) Completion of a Likert scale satisfaction questionnaire (postrehabilitation) by the participants. (ii) Evaluation of masticatory efficiency and performance 3 months after rehabilitation. Data were evaluated by applying t-test and z-test using statistical analysis (α ˂ 0.05). RESULTS: Masticatory efficiency of participants in the IMP and FPD groups was 74.95 ± 0.90% and 74.41 ± 3.35%, respectively (p = 0.607). Total satisfaction questionnaire scores for the two groups were also not significantly different; however, the mean scores of overall satisfaction and function categories in this questionnaire were significantly higher for the IMP group, while the mean score for the duration of treatment question was higher for the FPD group (p < 0.05). CONCLUSION: The results of this study suggested that although masticatory performance and efficiency were not statistically different for single teeth replaced with implants or FPDs, patients perceived higher satisfaction with implant restorations; they also preferred the shorter treatment times for rehabilitation in the FPD group.

Functional and Esthetic Comparison of Metal-Ceramic and All-Ceramic Posterior Three-Unit Fixed Dental Prostheses.

PURPOSE: The aim of this study was to assess functional and esthetic satisfaction plus evaluate changes in oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP-14) after insertion of a metal-ceramic (MC-FDP) or a veneered zirconia all-ceramic (AC-FDP) posterior three-unit fixed dental prosthesis (FDP). Additionally, patients' and professionals' esthetic evaluations were compared. MATERIALS AND METHODS: A convenience sample of 34 patients was randomized to receive a MC-FDP (n = 17) or an AC-FDP (n = 17). Patients were assessed using the OHIP-14 and also answered a questionnaire regarding satisfaction with function and esthetics using visual analog scales (VAS) before treatment and after 2 weeks, after 3 months, and after 1, 2, and 3 years. A fully dentate control group (n = 20) was also assessed using the OHIP-14. The operator and another observer evaluated the esthetics of the FDPs using VAS. RESULTS: The patients assessed the two FDP types similarly for all parameters. In contrast, there was a statistically significant difference in OHIP-14 results between the treated patients and the control group before treatment. After treatment, a statistically significant improvement in OHIP-14 was observed at all examinations. Patients were highly satisfied with the function and esthetics of the FDPs. The overall satisfaction with esthetics was statistically significantly higher among the patients than among the professionals at three out of five examinations. CONCLUSION: The patients experienced improved OHRQoL and increased satisfaction with function and esthetics after receiving a posterior three-unit FDP. No important differences were observed between the two types of FDPs when evaluated by the patient or the professionals.

Single-Tooth Implant Versus Three-Unit Fixed Partial Denture: A Study of Oral Health-Related Quality of Life.

PURPOSE: Many studies have investigated the impact of prosthetic treatment on oral health-related quality of life (OHRQoL). However, most of these have been performed among fully or partially edentulous patients. Studies involving patients with a single missing tooth are limited. The purpose of this study was to compare the OHRQoL between patients treated by single-tooth implants and three-unit fixed partial dentures (FPDs) for single missing tooth restoration. MATERIALS AND METHODS: A cross-sectional survey was conducted in Korea with patients drawn by stratified purposive sampling based on age. OHRQoL was measured using the Korean version of the 14-item Oral Health Impact Profile (OHIP-14K) questionnaire. Pre- and posttreatment OHIP-14K scores were compared by paired t test. Single-tooth implants and three-unit FPDs were compared by two-sample t test. In addition, multiple regression analysis was used to evaluate the impact of treatment mode on OHIP-14K total score after adjusting the effect of demographics and clinical factors. RESULTS: Thirty-five patients with single-tooth implants and 36 patients with three-unit FPDs were included. All participants had a significant improvement in OHRQoL compared with before the treatment (P < .0001). However, there was no statistically significant difference in the change of OHIP-14K score between the two treatment modes. In addition, the treatment mode had no significant impact on the change of OHIP-14K total score after adjusting the influence of covariates (P = .170). CONCLUSION: Both single-tooth implants and three-unit FPDs for single missing tooth replacement resulted in significant and similar improvement of OHRQoL.

Relationship between impact of maxillary anterior fixed prosthodontic rehabilitation on daily living, satisfaction, and personality profiles.

STATEMENT OF PROBLEM: Personality profiles may affect the impact of dental treatment on daily living and patient satisfaction. PURPOSE: The purpose of this clinical trial was to evaluate the impact of maxillary anterior fixed prosthodontic rehabilitation on daily living and the satisfaction of patients and to investigate its relationship with personality profiles. MATERIAL AND METHODS: Fifty-nine participants (25 men and 34 women; mean age 32.4 ± 6.9 years) received maxillary anterior partial fixed dental prostheses. The clinical success of the prostheses was evaluated following specific criteria. The Dental Impact on Daily Living (DIDL) questionnaire was used to measure satisfaction with the prostheses and their impact on daily living. The Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) was used to measure patients' personality profiles. The paired sample t test was used to compare satisfaction and personality scores before and after treatment (α=.05). RESULTS: Participants' total satisfaction and their satisfaction with appearance, pain tolerance, oral comfort, general performance, and eating improved after treatment (P<.05). Before treatment, women were less satisfied with general performance (P=.047) and scored higher on the Neuroticism score (P=.039); however, after treatment, women were more satisfied with appearance (P=.004). Age and sex had no significant correlation with personality profiles after treatment. Before treatment, Neuroticism, Openness, and Conscientiousness scores were associated with dental satisfaction and impact on daily life (P<.05). After treatment, Neuroticism, Openness, and Extraversion scores were associated with dental satisfaction and impact on daily life (P<.05). CONCLUSIONS: Patient satisfaction with their oral condition improved after partial fixed dental prosthetic rehabilitation in the maxillary anterior esthetic zone. Psychological profiles (Neuroticism, Extraversion, Openness, and Conscientiousness) may be involved in and explain the impact on daily living and the degree of patient satisfaction with their prostheses.

The effect of implant placement in patients with either Kennedy class II and III on oral health-related quality of life: a prospective clinical trial.

There is little evidence of the effect of implants restored with fixed partial dentures on oral health-related quality of life (OHRQoL) in partially edentulous Kennedy class II and III patients. The aim of this study was to determine the change in OHRQoL in Kennedy classification II and III patients treated with a two-implant-supported fixed dental prosthesis (FDP). Kennedy class II and III patients received dental implants and an FDP. Oral health-related quality of life was measured by administration of the Oral Health Impact Profile-14 (OHIP-14NL) questionnaire at intake (T1), 2 weeks after surgery (T2) and after 1 year of loading (T3). The mean OHIP score at T1 was 6·5 ± 1·2, 2·4 ± 1·0 at T2, and 0·9 ± 0·3 at T3. There was a statistically significant difference between T1 and T2 (P = 0·002) and T1 and T3 (P < 0·001) but not between T2 and T3 (P = 0·407). The OHIP score in Kennedy II patients decreased from 4·8 ± 3·2 at T1 to 1·5 ± 2·0 at T2 and 1·1 ± 1·8 at T3, and that in Kennedy III patients decreased from 8·9 ± 9·6 at T1 to 3·6 ± 8·9 at T2 and 0·8 ± 2·2 at T3. There were no statistically significant differences in the reductions in Kennedy II and III patients. Oral health-related quality of life changed positively in patients treated with implants and an FDP in both groups. There was no change in OHRQoL between the times of implant placement and FDP placement.

Oral health-related quality of life and complications after treatment with partial removable dental prosthesis.

The aims of this study were to measure and describe the oral health-related quality of life (OHRQoL) and to identify the complications caused by partial removable dental prosthesis (RDPs) in patients 1-5 years after treatment. Complications were identified in 65 patients who were treated with 83 RDPs (48 upper, 35 lower). OHRQoL was measured using the OHIP-49 before treatment and at the baseline (1-2 months after treatment) and follow-up (1-5 years after treatment) examinations. The types and numbers of oral problems that were experienced were described based on OHIP items with a score of 3 and 4. A significant improvement (P < 0·05) in the total OHIP-49 was registered from pre-treatment (mean 42, SD ± 37) to baseline (mean 29, SD ± 27) and from pre-treatment to 1-5 years after treatment (mean 32, SD ± 30). There was no significant difference between the baseline and 1- to 5-year follow-up examinations. Problems with eating and appearance registered at pre-treatment were improved at baseline and after 1-5 years. Problems with dentures that had been registered pre-treatment were improved at baseline but reoccurred after 1-5 years. The two most frequent complications were ill-fitting RDPs and inflammation of the oral mucosa, followed less frequently by fractures of the clasps. Treatment with RDPs improved OHRQoL, but denture-related problems partly remained, and new problems related to RDPs occurred 1-5 years after treatment. The two most frequent complications were ill-fitting RDPs and inflammation of the oral mucosa.

The effects of the number of natural teeth and posterior occluding pairs on the oral health-related quality of life in elderly dental patients.

OBJECTIVES: To compare between the oral health-related quality of life (OHRQoL) of Thai elderly dental patients at the Faculty of Dentistry, Chulalongkorn University with at least 20 natural teeth (NT) and those with less than 20 NT, and between those with at least 4 posterior occluding pairs (POP) and those with less than 4 POP. BACKGROUND: Thai government recommended that elderly people should have at least 20 NT and 4 POP. MATERIALS AND METHODS: The participants comprised 240 Thai elderly dental patients who were interviewed and had their OHRQoL determined using the Oral Impacts on Daily Performances Index (OIDP). Higher OIDP score indicates poorer OHRQoL. We counted the functional NT and POP in each participant. RESULTS: Participants with less than 20 NT or less than 4 POP had significantly higher OIDP scores than those with at least 20 NT or at least 4 POP. Moreover, when we evaluated one by one tooth loss, we found the first and the last significant differences between the OIDP scores in the participants with at least 23 teeth and with less than 23 teeth, and those in the participants with at least 5 teeth and with less than 5 teeth, in consequently. CONCLUSION: Thai elderly participants with at least 20 NT or at least 4 POP had greater OHRQoL than those with less than 20 NT or less than 4 POP, and in our study sample, we observed that 5 teeth may be an important clinical threshold for Thai elderly dental patients' quality of life.

Psychometric properties of the Albanian version of the Orofacial Esthetic Scale: OES-ALB.

UNLABELLED: The aim was to adapt the Orofacial Esthetic Scale (OES) and to test psychometric properties of the Albanian language version in the cultural environment of the Republic of Kosovo. METHODS: The OES questionnaire was translated from the original English version according to the accepted techniques. The reliability (internal consistency), and validity (construct, convergent and discriminative) were tested in 169 subjects, test-retest in 61 dental students (DS), and responsiveness in 51 prosthodontic patients with treatment needs (PPTN). RESULTS: The corrected item correlation coefficients of OES-ALB ranged from 0.686 to 0.909. The inter-item correlation coefficient ranged between 0.572 and 0.919. The Cronbach's alpha was 0.961 and IIC 0.758. Test- retest was confirmed by good ICCs and by no significant differences of the OES scores through the period of 14 days without any orofacial changes (p > 0.05). Construct validity was proved by the presence of one-factor composition that assumed 79.079% of the variance. Convergent validity showed significant correlation between one general question about satisfaction with orofacial esthetics and the OES summary score, as well as between the sum of the 3 OHIP-ALB49 questions related to orofacial aesthetics and the OES summary score. Discriminative validity was confirmed with statistically significant differences between DS, prosthodontic patients without treatment need and PPTN (p < 0.01). Responsiveness was confirmed by a significant increase of OES scores after PPTN patients received new fixed partial or removable dentures (P < 0.001). CONCLUSION: The results proved excellent psychometric properties of the OES-ALB questionnaire in the Republic of Kosovo.

Perception of dental esthetics: influence of restoration type, symmetry, and color in four different countries.

In this study, the influence of restoration type, symmetry, and color on the perception of dental appearance was evaluated. An esthetic questionnaire was completed by 29 patients before and after esthetic rehabilitation. In addition, 94 dentists from four countries (Germany, the United Kingdom [UK], China, and Switzerland) evaluated the influence of the above factors using before-and-after rehabilitation pictures. The most invasive treatment was recommended by Chinese dentists, while German, Swiss, and UK dentists recommended comparable treatment options. As for restorative symmetry, restoration type, and color, significant differences could be found among and within the dentists of the four countries (P ± .05).

Perception of dental esthetics in different cultures.

PURPOSE: The purpose of this study was to compare patients' and dentists' perception of dental appearance. MATERIALS AND METHODS: Based on internationally accepted guidelines about dental esthetics, a questionnaire was developed to measure "dental appearance" (QDA). Eleven items defined a QDA score (0 = "absolutely dissatisfied" to 100 = "absolutely satisfied"). The QDA was completed by 29 patients (21 women, 8 men) before and after a complete oral rehabilitation that included restoration of the maxillary anterior teeth. Overall, 94 dentists from four countries (Germany, the United Kingdom, China, and Switzerland) evaluated the esthetics before and after rehabilitation on a visual analog scale (VAS: 0 = "absolutely unesthetic" to 100 = "absolutely esthetic"). RESULTS: Patients and dentists of all countries found a significant esthetic improvement after treatment (P ≤ .0001). Significant differences could be found when comparing the evaluation of the dentists from the various countries among one another and with the patients' self-evaluation (P ≤ .05). With the exception of the professional rating of the initial situation, no gender-related differences could be found in any of the test groups. CONCLUSIONS: In daily practice, it seems of utmost importance for dentists to incorporate the patients' feedback in order to avoid esthetic treatment failures.

Oral health-related quality of life in partially edentulous patients treated with removable, fixed, fixed-removable, and implant-supported prostheses.

PURPOSE: This study investigated changes in oral health-related quality of life (OHRQoL) in partially edentulous patients treated with removable dental prostheses (RDPs), fixed dental prostheses (FDPs), fixed-removable (combined) restorations (COMBs), and implant-supported fixed prostheses (ISFPs). MATERIALS AND METHODS: A total of 200 patients (30 to 50 years old) were enrolled: 45 received RDPs, 32 received FDPs, 66 received COMBs, and 57 received ISFPs. OHRQoL was measured using the shortened version of the Oral Health Impact Profile (OHIP-14) before treatment and 6 weeks and 6 months after treatment. Treatment groups were sex-neutral; however, significant differences were found relative to age and Kennedy classification. A general linear model was used to explore the interaction of age and Kennedy classification with treatment modality. RESULTS: Pretreatment analysis revealed that the psychologic discomfort domain showed the greatest negative impact on OHRQoL, while functional limitation had the smallest effect. Within-group comparison revealed a significant decrease in OHIP scores throughout the study in all groups except the younger age group treated with RDPs after 6 weeks. Between-group comparison revealed significant differences among the treatment groups. The least amount of OHRQoL improvement was recorded for RDPs for both age groups at 6 weeks and for the younger age group at 6 months. There were no significant differences between FDPs and ISFPs. CONCLUSIONS: All treatments produced significant improvement in OHRQoL. The least amount of improvement was observed in patients with RDPs. OHRQoL changes in patients treated with FDPs and ISFPs were comparable. The same treatment can have different impacts on the OHRQoL of partially edentulous individuals depending on their age and Kennedy classification.

Clinical decision making for a tooth with apical periodontitis: the patients' preferred level of participation.

INTRODUCTION: To effectively engage patients in clinical decisions regarding the management of teeth with apical periodontitis (AP), there is a need to explore patients' perspectives on the decision-making process. This study surveyed patients for their preferred level of participation in making treatment decisions for a tooth with AP. METHODS: Data were collected through a mail-out survey of 800 University of Toronto Faculty of Dentistry patients, complemented by a convenience sample of 200 patients from 10 community practices. The Control Preferences Scale was used to evaluate the patients' preferences for active, collaborative, or passive participation in treatment decisions for a tooth with AP. Using bivariate and logistic regression analyses, the Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to the Control Preferences Scale questions to understand the influential factors (P ≤ .05). RESULTS: Among 434 of 1,000 respondents, 44%, 40%, and 16% preferred an active, collaborative, and passive participation, respectively. Logistic regression showed a significant association (P ≤ .025) between participants' higher education and preference for active participation compared with a collaborative role. Also, immigrant status was significantly associated with preference for passive participation (P = .025). CONCLUSIONS: The majority of patients valued an active or collaborative participation in deciding treatment for a tooth with AP. This pattern implied a preference for a patient-centered practice mode that emphasizes patient autonomy in decision making.

Initial effects of a treatment by fixed partial dentures supported by mini dental implants from a patient's point of view.

Mini dental implants (MDIs) in dentistry are recommended for cases with adequate bone quality and height, but a lack of alveolar bone width. Some studies well documented successful usage of MDIs for a removable denture support, but studies of MDIs supporting fixed prosthodontic restorations are scarce. We aimed to study the effect of fixed partial dentures (FPD) therapy supported by MDIs or by MDIs and natural teeth, on patients self perceived oral health related quality of life (OHRQoL), self perceived oral aesthetics and self perceived chewing function. A total of 23 patients (10 female and 13 men, age range from 54 to 78 years) were included and 61 MDIs were inserted, 10 in the maxilla and 51 in the mandible. In 14 patients FPDs were constructed only on MDIs and in 9 patients FPDs were constructed on both, MDIs and natural teeth. FPDs on MDIs were replacing mostly mandibular incisors, the second maxillary incisors and the first maxillary premolars. Those FPDs supported by both, MDIs and natural teeth had some MDIs inserted in frontal regions to allow a FPD construction. The three questionnaires: the OHIP-CRO14 for the assessment of OHRQoL, the OES-CRO for assessment of oral aesthetics and the Chewing function questionnaire (CFQ) for assessment of chewing function have been administrated twice:prior to the MDIs insertion and three months after the FPD treatment supported by MDIs had been finished. The CFQ and the OHIP summary scores significantly decreased revealing better OHRQoL and better chewing ability after treatment, and the OES scores significantly increased indicating increased self perceived oral aesthetics (p < 0.01). Clinical examination revealed no periimplant inflammation. Patients' data supplement the initially promising clinical findings. However, further follow ups will be necessary to finally confirm the long term clinical benefit of MDIs.

Making sense of complication reporting associated with fixed dental prostheses.

The current reporting of complications associated with FDPs is inadequate and misleading. Complications,which incur significant monetary costs, will particularly impact the perceived value (worth or importance)that patients derive from their prostheses.Effective documentation of complications should include type (biologic and technical), incidence, and severity. The fiscal burden of treatment should be quantified. Comparisons of different restorative materials,techniques, and procedures should be meaningful.Data collated prospectively or retrospectively and pooled over time should allow for comparisons within and between different practice settings. The proposed classification, based on the fiscal consequences of complications, achieves these objectives.Effective documentation of complications in conjunction with actual or projected survival data and personal clinical experience will enable clinicians to provide realistic information of the expected clinical service of dental prostheses.

Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: a pilot study.

OBJECTIVES: The aims of this pilot study were to investigate the prevalence of xerostomia and hyposalivation and their impact on quality of life in a cohort of elderly patients including dental status and the character of potential prosthetic restorations as independent variables. METHODS: Patients aged 60 years or older without any objective or subjective need for prosthodontic treatment taking part in a regular recall programme were included in the trial. Quality of life was assessed using the German version of the GOHAI; prevalence and severity of xerostomia was investigated using the shortened version of the Xerostomia Inventory (XI). Stimulated salivary flow rate was determined using a sialometric approach. Dental status and the character of prosthetic restorations (no/fixed restorations and removable but tooth-supported dentures vs. gum-supported dentures) were assessed in a clinical examination by experienced dentists specialized in prosthodontic treatment. RESULTS: A total of 68 patients were included in the trial; a prevalence of xerostomia of 16% and a prevalence of hyposalivation of 31% were identified. The quality of life in the study cohort decreased significantly as a function of xerostomia severity but not salivary flow; moreover, a significant impact of the number of teeth/implants in the upper jaw and the presence of gum-supported dentures in both jaws on GOHAI scores could be identified. CONCLUSIONS: Within the limitations of a pilot study, the results support the assumption that the quality of life in elderly patients is particularly related to their subjective perception of xerostomia. A decline in salivary flow, the dental status and the character of prosthetic restorations appear to play a subordinate role for the quality of life in elderly patients. CLINICAL SIGNIFICANCE: The quality of life in elderly patients may be severely diminished due to an increased subjective perception of dry mouth. Dental treatment should focus on alleviating xerostomia, whereas the impact of dental status and prosthetic restoration appear to be subordinate.

Sensitivity to change of oral and general health-related quality of life during prosthodontic treatment.

The literature presents conflicting findings on whether health-related quality of life (HRQoL) measures have sufficient evaluative properties to assess changes caused by dental interventions. The aim of our study was to compare sensitivity to change in HRQoL and OHRQoL in prosthodontic patients. In this prospective intervention study, a total of 165 consecutively recruited patients completed the Short Form-36 (SF-36) and the 49-item Oral Health Impact Profile (OHIP), as self-administered questionnaires, before prosthodontic treatment and 1 month after treatment was finished. Differences in SF-36 and OHIP scores between baseline and follow up were tested for statistical significance using paired t-tests. Effect sizes (Cohen's d) were calculated. Health-related quality of life improved during prosthodontic treatment, indicated by a slight, but statistically significant, increase in the SF-36 physical component (difference: 1.0 points), whereas perceived mental health did not change substantially (difference: −0.5 points). Improvement in OHRQoL (difference in OHIP sum score: −6.7 points) was statistically significant. Although the OHIP effect size (of 0.2) was considered as small, according to guidelines, it was greater than for the SF-36 component scores (physical: 0.1; mental: 0.1). Sensitivity to change in quality of life measures was greater for OHRQoL than for HRQoL, limiting the usefulness of HRQoL as an outcome measure in dentistry.

Clinical factors and self-perceived oral health.

Self-perceived oral health is affected not only by awareness of the clinical status but also by comparisons with people of a similar age. This study explored the relative contributions of clinical variables assessing caries, periodontal status, and prosthetic status to self-perceived oral health within two age groups. Data of 891 adults (35-44 yr of age) and 760 older people (65-74 yr of age) from the Fourth German Oral Health Study (DMS IV, 2005) were evaluated. Self-perceived oral health was obtained from questionnaires. Numbers of decayed, filled, and unreplaced teeth, mean attachment loss, bleeding on probing (BOP), the presence of a fixed denture, and the presence of a removable denture were assessed. Multinomial logistic regression models were developed for both age groups, separately, using stepwise methods. For adults, unreplaced teeth, filled teeth, decayed teeth, the presence of a removable denture, and mean attachment loss were added to the final model. For older people, the presence of a removable denture, unreplaced teeth, decayed teeth, mean attachment loss, filled teeth, and BOP were included in the final model. Awareness of the relative contributions of clinical variables to self-perceived oral health is important for obtaining a clearer understanding of patients' subjective and objective self-perceptions of oral health.