Oral Health Quality of Life in Children with Cerebral Palsy: Parental Perceptions.

OBJECTIVE: To assess the parents' perception of the oral health-related quality of life (OHRQOL) in children with Cerebral Palsy (CP) and compare it with normally developing children. STUDY DESIGN: 63 children with CP were recruited from 8 disability centers, and 99 healthy controls were recruited from 5 elementary schools. The ages of the children in both groups were from 6-12 years. The Franciscan Hospital for Children Oral Health-Related Quality of Life (FHC-OHRQOL) was used to measure the OHRQOL and an oral examination was conducted in the schools/centers of the children to assess the teeth, gingival health, and oral hygiene. RESULTS: The FHC-OHRQOL showed a significant difference in 3 out of 4 sections indicating lower OHRQOL in the CP group. The examination showed no significant difference in the dental and gingival health and in the level of oral hygiene. CONCLUSION: The OHRQOL of children with CP is significantly lower than that of normally developing children although the oral health status of children with CP is not significantly different from that of normally developing children.

Reliability and validity of the Chinese version of the short form of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15).

OBJECTIVES: The aim of this study was to validate the short form of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15) in Chinese patients with dentine hypersensitivity (DH). METHODS: In total, 200 patients with DH were recruited to complete the questionnaire. The reliability of the DHEQ-15 was evaluated using internal consistency and test-retest methods. The exploratory factor analysis (EFA) was conducted to identify domains of the DHEQ-15. Convergent validity was determined by analyzing the correlation between DHEQ-15 subscale scores and the global rating of oral health question. RESULTS: Cronbach's alpha value (internal reliability) for the total DHEQ-15 score was 0.934 (higher to the original DHEQ-15' 0.924), and the intraclass correlation coefficient value (test-retest reliability) was 0.894 (lower to the original DHEQ-15' 0.939). The EFA identified three components with eigenvalues >1, explaining 53.0, 17.1, and 12.3% of the variance, respectively, accounting for a total of 82.4% of the variance. The three components named 'restrictions' (three items), 'changes in eating habits' (six items), and 'emotions and identity' (six items). In terms of convergent validity, the DHEQ-15 subscale was significant highly negatively correlated to the global oral health rating. CONCLUSIONS: The results provide initial evidence that the DHEQ-15 can be properly used for assessment of patients with DH in China.

Dental fear and its possible relationship with periodontal status in Chinese adults: a preliminary study.

BACKGROUND: The aim of the present study was to describe the characteristics of dental fear of Chinese adult patients with periodontal disease and provide information for clinical assessment. METHODS: A total of 1203 dental patients completed questionnaires that included Corach's Dental Anxiety Scales (DAS), Dental Fear Survey (DFS) and the short-form Dental Anxiety Inventory (S-DAI). Among all the patients, 366 cases were self-reported periodontal disease. The general characteristics were described, such as socio-demographics, dental attendances and oral health behaviors. The statistical analysis was performed by t-test, Mann-Whitney U test and linear regression respectively to evaluate correlations between dental fear and general characteristics according to the three scales. RESULTS: The prevalence of dental fear was 74% among 1203 patients, 23.4% of total with high dental fear, while 27.3% in the patients with periodontal disease. The average score of DAS and DFS for patients with periodontal disease was significantly higher than those without periodontal disease. The regression analysis indicated that gender, age, periodontal status, dental attendances and oral health behaviors were correlated with dental fear. Among 366 patients with periodontal disease, gender, dental attendances and oral health behaviors had correlation with dental fear. The analysis of DFS scale exhibited that 'drilling with handpiece' and 'injecting the anesthetic' were the most important factors to contribute to dental fear. CONCLUSIONS: There was high prevalence of dental fear in Chinese adult patients, particularly in patients with periodontal disease, and high level of dental fear may lead to poor periodontal status.

The role of illness beliefs and coping in the adjustment to dentine hypersensitivity.

AIM: Dentine hypersensitivity is a common oral health problem, however, there has been little research on how people cope with this condition. This study aimed to quantify the effects of illness beliefs and coping strategies on the health outcomes of individuals with dentine hypersensitivity. MATERIALS AND METHODS: Participants were purposively sampled from students and staff in one large UK University and 101 self-diagnosed dentine hypersensitivity sufferers participated in the longitudinal study. Participants were required to complete questionnaires which assessed health anxiety, specific illness beliefs (control, consequences, illness coherence, timeline perspectives and emotional representations), coping strategies (passive and active coping) and oral health-related and health-related quality of life (OHRQoL and HRQoL) at baseline and 1 month follow-up. RESULTS: Over half of the participants (N = 56) experienced sensations in their teeth on a daily basis and the majority had experienced dentine hypersensitivity for at least 1 year (N = 87). Structural equation modelling indicated that predictors of OHRQoL and HRQoL impacts at follow-up were frequency of sensations, low levels of illness coherence, negative emotional representations, greater health anxiety and use of passive coping strategies at baseline. CONCLUSIONS: Illness beliefs and coping strategies predict oral and health-related quality of life outcomes in people with dentine hypersensitivity.

Derivation of a short form of the Dentine Hypersensitivity Experience Questionnaire.

AIM: To derive and evaluate a short form of the Dentine Hypersensitivity Experience Questionnaire. METHODS: Data from three previous studies of dentine hypersensitivity (n = 353) were pooled and randomly divided into half. Ten- and 15-item short forms were derived in the first half of the data using the item impact and regression methods. The four short forms were evaluated in the second half. RESULTS: The 10 and 15-item versions of the regression short form detected impacts in 37% and 61% of participants, respectively, compared to 68% and 93% using the item impact method. All short forms had internal consistency (Cronbach's α) >0.84 and test-retest reliability (ICC) >0.89. All correlated with the long form (all r > 0.93, p < 0.001) and with the effect of the mouth on everyday life (all r ≥ 0.73, p < 0.001). None of the short forms detected a treatment effect in two trials although all four showed a tendency to detect an effect in a trial where the long form had done so. CONCLUSIONS: The 15-item short form derived with the item impact method performed better than other short forms and appears to be sufficiently robust for use in individual patients.

The Dentine Hypersensitivity Experience Questionnaire: a longitudinal validation study.

AIM: To validate the Dentine Hypersensitivity Experience Questionnaire in terms of responsiveness to change and to determine the minimally important difference. MATERIALS AND METHODS: The study was a secondary analysis of data from three randomized controlled trials with 311 participants. Three aspects of responsiveness were examined: change within individuals, differences among people who improved, stayed the same or worsened using an external referent and change due to treatment. Responsiveness to treatments of differing efficacy was assessed in trials with negative and active controls. RESULTS: The measure showed excellent internal reliability, test-retest reliability and criterion validity. The measure was highly responsive to change within individuals (Cohen's effect sizes: 0.28, 0.56, 0.86) showing decreases in the total score (i.e. improvement in OHrQoL) across all trials. The effect sizes in participants whose self-reported QoL "improved" were large (0.73-1.31). Dentine Hypersensitivity Experience Questionnaire detected a treatment effect in one of two negative control trials (effect size: 0.47). Dentine Hypersensitivity Experience Questionnaire scores were similar in the test and control groups in the active control trial. The minimally important difference range was between 22 and 39 points. CONCLUSIONS: The measure is longitudinally reliable, valid and responsive and can discriminate between treatments of different efficacy.

Association between dental caries activity, quality of life and obesity in Brazilian adolescents.

OBJECTIVES: The impact of oral conditions on quality of life in overweight/obesity needs to be elucidated. The aim of this study was to evaluate the association between dental caries activity, quality of life and obesity in Brazilian adolescents. MATERIALS AND METHODS: This study was conducted at public schools in Brazil, on a sample of 202 adolescents, 12 years of age. For anthropometric evaluation, the body mass index (BMI)-for-age was used. In oral examinations, the Decayed, Missing, Filled teeth (DMFT), significant caries (SiC) and dental caries activity (DCA) indices were used (κ > 0.94). The Child-Oral Impacts on Daily Performance (Child-OIDP) index was applied. The sample was divided into two groups: O (overweight/obese; n = 101) and N (normal weight; n = 101). For data analysis, chi-square, odds ratio (OR), Wilcoxon and Pearson correlation tests were used (P < 0.05). RESULTS: The DMFT scores were 1.67 and 2.12 and the SiC scores were 3.85 and 4.26 for groups O and N, respectively. BMI-for-age was significantly related to DCA (OR = 0.579; P < 0.000) and to SiC (OR = 0.649; P = 0.024). There were differences between the groups in eating, cleaning mouth, emotional status, smiling, studying and the overall Child-OIDP (P < 0.05). Positive associations between the impacts on eating, cleaning mouth and smiling were found (P < 0.05). DMFT values showed significant correlation with the emotional status performance in group O and the DCA was positively correlated with performance at school in group O (P < 0.05). CONCLUSION: Obesity, dental caries and quality of life were not correlated. Adolescents with normal weight presented a low perception of the impact of oral conditions on quality of life; however, it seemed to affect psychological aspects in their daily performances. Providing adolescents with nutritional assistance may prevent obesity and dental caries, and improve their quality of life.

Knowledge of and management attitude regarding dentin hypersensitivity among dentists from a West African country.

AIM: The aim of the present study was to assess knowledge of, and management attitude of dentists regarding dentin hypersensitivity. MATERIALS AND METHODS: The study involved all the dentists from private and public sectors, exerting in Senegal. The following data were requested from the surveyed dentists using an anonymous questionnaire; sociodemographics (i.e. age, gender, area of activity, etc.) and knowledge on triggering factor, type of pain, diagnosis, preventive and curative procedures. RESULTS: Out of the 238 dentists who received the questionnaire, 68.9% returned properly filled forms. They were 116 males and 48 females with a mean age of 41.99 ± 8.50 years. Eighty three percent of the participants had a good understanding of the characteristics of pain related to DH and 92% recognized chemical and thermal stimuli as triggering factor while mechanical stimulus was not evoked. Many responders (90.9%) did not have any idea of the mechanism for pain transmission across the dentin. Regarding diagnosis technique, 68% use mechanical stimuli to elicit DH pain. Regarding management procedure, the use of desensitizing tooth paste is the mostly chosen option followed by professional topical application of fluoride. More than 1/3rd of the surveyed dentists confess resorting to root canal to manage DH. CONCLUSION: We recommend incorporation of basic science knowledge on orofacial pain and competencies to manage painful conditions like dentin hypersensitivity. Also, health regulatory institutions should make continuing dental education a requirement to preserve the dental licensure.

Dental bleaching: patient perception and satisfaction.

BACKGROUND: Teeth bleaching is a common practice performed by dental hygienists and dentists to correct aesthetic problems due to dental discoloration. Patients' opinions on this procedure may be different according to their personal experiences, expectations and individual sensitivities. The aim of this study is to assess the degree of satisfaction and related sensitivity of patients to professional and home bleaching treatment. METHODS: A questionnaire consisting of 12 multiple-choice questions was submitted to 625 subjects among general population. These were related to: 1) patient's age and whether the patient is a smoker; 2) personal satisfaction; and 3) post-treatment tooth sensitivity. Descriptive analyses of all variables in the questionnaire were performed, and statistical analyses between variables were carried out by Chi-square test and Fisher's Exact test. RESULTS: Of the people surveyed, 66% performed home bleaching, while the remaining performed the treatment in a dental office. Thirty-three percent of patients had previously undergone teeth bleaching and the 95.7% stated that they were satisfied with the treatment. Of these, only 36.4% reported experiencing postoperative hypersensitivity. Most patients (91.3%) received professional scaling before undergoing bleaching treatment. CONCLUSIONS: Patient satisfaction with tooth whitening treatment can vary from patient to patient and represents a strong indicator of treatment efficacy and suitability. A proper communication, careful management and individualized patient assessment are key to maximizing satisfaction and ensuring a positive and fulfilling patient experience.

Why don't patients with dentine hypersensitivity discuss the condition with their dentist?

OBJECTIVES: This qualitative study aimed to develop an understanding of patients' barriers and facilitators of conversations about dentine hypersensitivity (DH) with their dentist. METHODS: The Theoretical Domains Framework shaped the topic guide for 26 participants who were troubled (High H) or not particularly troubled (Low L) by DH. Inductive thematic analysis of anonymised, transcribed, online focus group conversations was undertaken to identify reasons for non-discussion of DH during dental consultations. RESULTS: Participants reported that dentists did not routinely discuss DH, nor did participants feel they could bring it up. There was a perception among participants that DH was not a 'proper' condition and DH pain was not worthy of dentists' attention. Participants reported dealing with DH through lifestyle changes, and had little faith that dentists could offer more than 'just toothpaste' and voiced a need for a 'miracle cure'. Dental anxiety was a reported barrier to conversations. A positive attitude to DH by a dental team that normalised the condition and acknowledged its impacts on patients was voiced as a potential facilitator to DH discussions. CONCLUSIONS: DH conversations do not routinely take place in dental practice because patients believe DH is not serious, DH pain is not legitimate and there is no credible solution dentists can offer. Patients and dental teams need to be supported through behavioural science tools to change these perceptions for DH conversations to take place more routinely. CLINICAL SIGNIFICANCE: As DH cannot be diagnosed by visual inspection of teeth, patients cannot be managed unless they raise the issue of their DH with their dentist. The paper helps clinicians manage patients who are reticent to discuss DH with them and suggests how dentists may intervene to help.

Patient perceptions of buccal gingival recessions and requests for treatment.

AIMS: The aims of this study were to verify patients' perception of buccal recessions and their requests for treatment. METHODS: The patients filled out a questionnaire dealing with demographic variables and perception of buccal gingival recessions. A calibrated examiner checked for recessions and recorded the clinical variables. Then, the patients were asked to explain what they believed to be the causes of the recessions and whether they were interested in obtaining treatment of their lesions. Descriptive statistics and multilevel logistic models were used. RESULTS: Of 120 enrolled patients, 96 presented 783 gingival recessions, of which 565 were unperceived. Of 218 perceived recessions, 160 were asymptomatic, 36 showed dental hypersensitivity, 13 aesthetics, 9 aesthetic + hypersensitivity issues. Only 11 patients requested treatment for their 57 recessions. Younger individuals (p = 0.0077), deeper recessions (p < 0.0001), incisors and canines (p < 0.0001) and non-carious cervical lesions (p = 0.0441) were significantly associated with patient perception of own recessions. Younger subjects (p = 0.0118), deeper recessions (p = 0.0387) and incisors (p = 0.0232) were significantly associated with patient request of treatment. Four hundred and sixty-eight recessions (60%) were not ascribed to exact causes by the patients. CONCLUSION: This study shows that perception of gingival recessions and the patients' requests for treatment should be evaluated carefully before proceeding with decision making.

What is known about the influence of dentine hypersensitivity on oral health-related quality of life?

OBJECTIVES: Oral health-related quality of life is a relatively new but rapidly growing concept in dentistry. It is an aspect of dental health addressing the patient's perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DHS), which is a common condition of transient tooth pain associated with a variety of exogenous stimuli, may disturb the patient during eating, drinking, toothbrushing and sometimes even breathing. The resulting restrictions on everyday activities can have an important effect on the patient's quality of life. The aims of this paper were to consider the concept of oral health-related quality of life and to review and discuss the literature on oral health-related quality of life and DHS. MATERIAL AND METHODS: A PubMed literature research was conducted using the terms ("dentin sensitivity" [MeSH Terms] OR ("dentin" [All Fields] AND "sensitivity" [All Fields]) OR "dentin sensitivity" [All Fields]) AND (("oral health" [MeSH Terms] OR ("oral" [All Fields] AND "health" [All Fields]) OR "oral health" [All Fields]) AND related [All Fields] AND ("quality of life" [MeSH Terms] OR ("quality" [All Fields] AND "life" [All Fields]) OR "quality of life" [All Fields])). Furthermore, a manual search was carried out. Any relevant work published presenting pertinent information about the described issue was considered for inclusion in the review. RESULTS: The combination of the search terms resulted in a list of only three titles. The few published studies convincingly demonstrated that oral health-related quality of life is negatively affected in patients suffering from DHS. CONCLUSIONS: Patients with sensitive teeth report substantial oral health-related quality of life (OHRQoL) impairment. Nevertheless, knowledge about the influence of DHS on oral health-related quality of life is incomplete and, therefore, needs further research. CLINICAL RELEVANCE: Oral diseases can lead to physical, psychological and social disability. This paper shows that DHS can have a negative impact on the patients' OHRQoL.

How to make a link between Oral Health-Related Quality of Life and dentin hypersensitivity in the dental office?

OBJECTIVES: Oral Health-Related Quality of Life (OHRQoL) can be considered as the scientific expression of that part of a person's well-being that is affected by his/her oral health. The aim of this paper was to evaluate how to use the data available in the field of research to make a link between OHRQoL and dentin hypersensitivity (DHS) in the dental office. MATERIALS AND METHODS: Research papers in the field of OHRQoL and DHS and reviews and research papers about OHRQoL were used for analysis in this short review, with a particular insight on the instruments used to evaluate OHRQoL. RESULTS: Various psychometric instruments have been used to measure OHRQoL that are more or less patient- or expert-centred. Some are generic, others are adapted to specific conditions/domains or populations. The impact of DHS or exposed cervical dentin (ECD) on OHRQoL has been assessed in very few studies. It is therefore of the upmost importance that the use of the OHRQoL as a quality control tool be established in robust clinical studies. CONCLUSIONS/CLINICAL RELEVANCE: Future studies evaluating the impact of the DHS/ECD on OHQoL or evaluating the efficacy of desensitising agents should respect some key points, including study design (randomization, placebo/control group, etc.), validated specific questionnaires and trained calibrated practitioners.

Knowledge of periodontitis and self-perceived oral health: a survey of periodontal specialist patients.

The aim of this study was to investigate changes in knowledge of periodontal disease among patients referred to periodontal specialist clinics. A further aim was to investigate the patients' self- perceived oral health before the treatment. Patients referred to five specialist clinics in periodontology for comprehensive periodontal treatment were consecutive sampled. The study was based on a questionnaire in a before and after design. The first questionnaire was sent to the patients before visiting the specialist clinic and the second was sent after six months. Four questions were analysed, two to measure knowledge about periodontitis and two to measure the patients self- perceived oral health. The first questionnaire was sent by post to 273 patients with a response rate of 31%. The second questionnaire was sent to 85 patients with a response rate of 73%. The results of the study showed a statistically significant improvement of correct answers on the knowledge questions after six months was found for scaling (p = 0.006), X-ray examination (p = 0.001) and increased space between the teeth (p = 0.001). The most frequent self-perceived trouble from the mouth was bleeding gum (70%) and sensitive teeth (51%). In conclusion knowledge of periodontitis improved after visiting the specialist clinic of periodontology. Many of the patients experienced some problems of the mouth.

Development of the Chinese version of the Dentine Hypersensitivity Experience Questionnaire.

The aim of this study was to evaluate the reliability and the validity of the Chinese version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ). After translation and cross-cultural adaptation following international guidelines, 110 patients with dentine hypersensitivity were recruited to complete the questionnaire. The reliability of the Chinese version of the DHEQ was evaluated using internal consistency and test-retest methods. Construct validity was determined based on factor analysis, discriminative validity (by comparing the subscale scores difference in the degree of sensitivity being investigated), and convergent validity (by analyzing the correlation between DHEQ subscale scores and the global rating of oral health question). Cronbach's alpha value (internal reliability) for the total DHEQ score was 0.95 and the intraclass correlation coefficient (ICC) value (test-retest reliability) was 0.85. Construct validity was determined by factor analysis, extracting eight factors, accounting for 74% of the variance. All items had factor loadings of >0.40. In addition, the Chinese version of the DHEQ was found to be valid for distinguishing patients with varying degrees of dentine hypersensitivity. In terms of convergent validity, the impact scale was significantly highly correlated to the global oral health rating. The results suggest that the Chinese version of the DHEQ has satisfactory psychometric properties and is applicable for patients with dentine hypersensitivity in China.

Association of clinical oral health status with self-rated oral health and GOHAI in Japanese adults.

OBJECTIVE: The objective of this study was to investigate clinical oral health status relationships that affect quality of life (using the 12-item General Oral Health Assessment Index (GOHAI)) and self-rated oral health in a community of Japanese residents. METHODS: 459 residents of Yokote City, Japan aged 40-55 years had oral health examinations and completed self-administered questionnaires collecting data on age, gender, GOHAI items and self-rated oral health. Linear regression analysis was performed with GOHAI or self-rated oral health as a dependent variable and gender, age and indicators of oral health status as independent variables. RESULTS: The GOHAI indicated 42.7% of subjects were concerned about the appearance of their teeth, 30.1% were worried about teeth problems and 27.5% concerned about sensitive teeth. Analyses showed that gender, decayed teeth, oral dryness and missing teeth were significantly associated with variation in GOHAI scores, and that gender, decayed teeth, oral dryness and oral hygiene were significantly associated with variation in self-rated oral health. CONCLUSION: This study revealed that in this sample of Japanese adults aged 40-55 years, decayed teeth and oral dryness affected both GOHAI and self-rated oral health, whereas missing teeth affected GOHAI and oral hygiene affected self-rated oral health. Subjects did not recognise periodontal disease as a quality of life impacting condition or as a health problem.

Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ).

AIM: To develop and validate a condition specific measure of oral health-related quality of life for dentine hypersensitivity (Dentine Hypersensitivity Experience Questionnaire, DHEQ). MATERIALS AND METHODS: Questionnaire construction used a multi-staged impact approach and an explicit theoretical model. Qualitative and quantitative development and validation included in-depth interviews, focus groups and cross-sectional questionnaire studies in a general population (n=160) and a clinical sample (n=108). RESULTS: An optimized DHEQ questionnaire containing 48 items has been developed to describe the pain, a scale to capture subjective impacts of dentine hypersensitivity, a global oral health rating and a scale to record effects on life overall. The impact scale had high values for internal reliability (nearly all item-total correlations >0.4 and Cronbach's α=0.86). Intra-class correlation coefficient for test-retest reliability was 0.92. The impact scale was strongly correlated to global oral health ratings and effects on life overall. These results were similar when DHEQ was validated in a clinical sample. CONCLUSIONS: DHEQ shows good psychometric properties in both a general population and clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.

Patients' experiences of the impact of periodontal disease.

AIM: To examine critically patients' experiences of the impact of periodontal disease on their daily lives. MATERIAL AND METHODS: Semi-structured interviews of a purposive sample of patients with periodontal conditions were conducted using a flexible evolving topic guide. Data collection and analysis were an inductive, iterative process that occurred concurrently. The data were organized in a framework and recurrent themes identified. Interviews occurred until it was felt that no new themes or ideas were being expressed by respondents (n=14). RESULTS: Effects of periodontal disease on patients' daily lives included impairment, functional limitation, discomfort and disability (including physical, psychosocial and social disability). A large number of the emergent themes from the analysis were relevant to the domains of Locker's conceptual model of oral health. The domain within Locker's model that had no data relevant to it in the context of periodontal disease was death. Two additional themes emerged that appeared unrelated to Locker's model, these were stigma and retrospective regret. CONCLUSION: Periodontal disease reportedly affects patients' lives in a negative manner in a variety of ways. This is of relevance in the management of patients with periodontitis.

Rasch analysis of the Geriatric Oral Health Assessment Index.

The aim of this study was to perform a psychometric analysis on the Geriatric Oral Health Assessment Index (GOHAI) using Rasch analysis, a modern statistical approach for examining rating scale data. Eighty-five subjects, long-term residents of a nursing home, were analysed using the GOHAI. The mean GOHAI score (range 0-48) was 11. Two of the five rating categories (1 = seldom; 3 = often) did not comply with the Rasch criteria for category functioning. After collapsing rating categories into a three-level rating scale (0 = never; 1 = sometimes; 2 = often/always), the new model met the set criteria. Item 12 'sensitivity to hot, cold or sweets' was misfitting. Rasch analysis showed both the unidimensionality of (at least) 11 of the 12 items of GOHAI, and the possibility of simplifying the structure of its rating scale.