Validity of patient self-reports and clinical signs in the assessment of sleep bruxism based on home-recorded electromyographic/electrocardiographic data.

BACKGROUND: Reliable and suitable bruxism assessment would be desirable, but available studies presented heterogeneous results. OBJECTIVE: To determine the agreement of patient self-reports and clinical signs of sleep bruxism (SB) with electromyographic/electrocardiographic data. METHODS: Two hundred individuals from a German dental clinic population (120 women and 80 men) participated in the study. Participants completed different SB questionnaires, had a clinical examination to evaluate bruxism signs and used the Bruxoff® device to record electromyographic/electrocardiographic data for five nights. To investigate interrater reliability for clinical diagnosis of bruxism, 126 of the 200 participants were assessed for clinical signs of bruxism by two independent uncalibrated examiners. Statistical evaluation included calculation of sensitivity, specificity and accuracy and of Cohen's kappa. RESULTS: Based on the Bruxoff® data, 106 participants were identified as bruxers and 94 as non-bruxers. The 106 bruxers were further classified into 47 moderate and 59 intense bruxers. The highest accuracy and sensitivity values were recorded for the overall score for clinical bruxism signs (accuracy: 72.0% and sensitivity: 70.8%). The best specificity (96.8%) was seen for the question regarding tooth grinding in the last two weeks reported by others, but concurrent sensitivity was very low (3.8%). Analysis of interrater reliability revealed a substantial agreement (Cohen's kappa of 0.6). CONCLUSION: The study results indicate that self-report questionnaires and clinical signs have moderate sensitivity, specificity and accuracy for diagnosing bruxism comparing with an ambulatory device for current SB (Bruxoff®). Regarding interrater reliability for clinical signs of SB, substantial agreement was found between the two examiners. CLINICAL TRIAL NO: NCT03039985.

How Do Changes in Oral Health and Chewing Efficiency Affect the Changes of Oral-Health-Related Quality of Life of Nursing-Home Residents in the Short Term?

OBJECTIVE: To evaluate how changes in oral health and chewing efficiency affect the changes in oral-health-related quality of life (OHRQoL) of nursing-home residents over six months. METHODS: The study was conducted in nine nursing homes. Sociodemographic and general data were collected for all eligible individuals (n = 150). Of these, 114 participants (mean age 82.0 [± 9.5] years, 77.2% women) were available for the following tests at baseline and six months later: a comprehensive examination of dental and general health, a two-colour mixing-ability test (to assess chewing efficiency), the Geriatric Oral Health Assessment Index (GOHAI; to evaluate the OHRQoL), and the Mini Mental State Examination (MMSE; to diagnose the presence and severity of dementia). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting OHRQoL. RESULTS: For the final analysis, 108 participants were available. For the study cohort as a whole, a decrease in the number of functional occluding pairs (C: 0.195; p = 0.034) and an increase in dental-treatment needs (C: -1.968; p = 0.056) had the greatest negative effects on OHRQoL as expressed by the GOHAI score. For denture wearers, a deterioration of denture condition (C: -2.946; p = 0.003) was the most important predictor for a decline in OHRQoL. CONCLUSION: A short-term decline in oral health and function affects the OHRQoL of nursing-home residents. The most important dental variables in this regard are the number of functional occluding pairs and dental and denture-related treatment needs.

Development of a German version of the Oral Health Assessment Tool.

BACKGROUND: Limited assessment tools for estimating the oral health of nursing home residents are available in the German language. AIMS: To develop a German version of the Oral Health Assessment Tool (OHAT) and to evaluate test-retest and inter-examiner reliability in use for the assessment of nursing home residents' oral health by caregivers before and after dental training. METHODS: The original English version of the OHAT was translated into German by a forward-backward translation process. Reliability assessments were conducted in a nursing home (n = 18) by independent application of the OHAT by two trained dentists and four professional caregivers. After receiving dental training, the caregivers repeated the OHAT with the same participants. Reliability analyses of single items were performed using Cohen's kappa statistics. Intra-class correlations were compiled to assess reliability of the total scores. T tests were used to compare percentage agreement, and under- and overestimation of findings between a reference dentist and the caregivers before and after the training unit. RESULTS: Specificity and sensitivity of the German OHAT were 87% and 86%. Test-retest reliability of the total OHAT score as estimated by the dentists was excellent (ICC 0.910; 95% CI 0.776-0.965). Before training, mean κ values between the reference dentist and caregivers ranged between 0.155 and 0.912, whereas the inter-examiner reliability of most items was only fair. After training, overall agreement between the dentist and the caregivers improved significantly from 62.1 to 83.1% (p < 0.001), as well as satisfying inter-examiner agreement for the single items. CONCLUSIONS: The German version of the OHAT is a reliable and valid tool for the assessment of oral health conditions of nursing home residents. When used by caregivers, instruction on the tool and practical training are mandatory to ensure reliable estimations. However, further studies with a larger sample size are encouraged to verify the outcomes of this study.

Association between patient satisfaction with complete dentures and oral health-related quality of life: two-year longitudinal assessment.

The objective was to evaluate the development of oral health-related quality of life (OHRQoL) in patients with complete dentures and the association between OHRQoL and patient satisfaction. Fifty-two patients (mean age, 66.3, 48.1% male) received dentures in at least one jaw. The analysis was conducted on participants with dentures in both jaws (CD-Both; n = 22) or in the upper jaw only (CD-Max; n = 28). Data were collected 4 weeks, 6 months, and 1 and 2 years after insertion. OHRQoL was measured by use of the OHIP-EDENT. Self-rated patient satisfaction was assessed on a scale of 0-10. To prove the hypothesis that patient satisfaction would be a meaningful predictor of OHRQoL, and not vice versa, multilevel analysis and cross-lagged correlation analysis were performed for both groups separately. OHRQoL improved from 22.9 (SD, 20.7) to 12.1 (SD, 14.5) for CD-Both and from 20.3 (SD, 17.2) to 14.7 (SD, 15.1) for CD-Max. Multilevel analysis revealed that patient satisfaction and OHRQoL were significantly associated (p < 0.0001) for both groups. Differences between the groups were found with regard to the effect of time after insertion and the interaction between time and satisfaction with OHRQoL which were significant only for the group CD-Both; however, no evidence was found for the causality of this association in the cross-lagged analysis for both groups (ZPF test, p > 0.016). Patient satisfaction and OHRQoL were associated for wearers of complete dentures. Within the limitations of the study, however, the causality that patient satisfaction predicts OHRQoL, and not vice versa, could not be proven.

Estimating costs for shade matching and shade corrections of fixed partial dentures for dental technicians in Germany: a pilot investigation.

AIMS: To evaluate the additional operating expenses caused by shade matching by dental technicians in the dental practice and by color changes of fixed partial dentures. METHODS: A questionnaire was handed out to visitors of the 2010 ADT dental technician congress in Germany. Thirty-one completed questionnaires were evaluated. RESULTS: Mean costs caused by shade matching and shade correction per month were 1269$ (SD = 1278$; n = 25) and per unit of FPD 9.32$ (SD = 8.89$). CONCLUSIONS: An improvement of shade matching, shade communication and reproduction should be made in order to minimize the considerable economic damage for dental laboratories.

Validity of temporomandibular disorder examination procedures for assessment of temporomandibular joint status.

INTRODUCTION: This hypothesis-generating study was performed to determine which items in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and additional diagnostic tests have the best predictive accuracy for joint-related diagnoses. METHODS: One hundred forty-nine TMD patients and 43 symptom-free subjects were examined in clinical examinations and with magnetic resonance imaging (MRI). The importance of each variable of the clinical examination for correct joint-related diagnosis was assessed by using MRI diagnoses. For this purpose, "random forest" statistical software (based on classification trees) was used. RESULTS: Maximum unassisted jaw opening, maximum assisted jaw opening, history of locked jaw, joint sound with and without compression, joint pain, facial pain, pain on palpation of the lateral pterygoid area, and overjet proved suitable for distinguishing between subtypes of joint-related TMD. Measurement of excursion, protrusion, and midline deviation were less important. CONCLUSIONS: The validity of clinical TMD examination procedures can be enhanced by using the 16 variables of greatest importance identified in this study. In addition to other variables, maximum unassisted and assisted opening and a history of locked jaw were important when assessing the status of the TMJ.

[Clinical assessment of oral health between physician and dentist--a pilot study on inter-examiner reliability]. / Wie verlässlich ist die klinische Erhebung von Mundgesundheitsparametern durch Arzte bei geriatrischen Patienten? : Eine Pilotstudie zur Ubereinstimmung zwischen den Untersuchungsergebnissen eines Arztes und eines Zahnarztes.

OBJECTIVE: Very little is known about the ability of physicians to assess oral health of geriatric patients. The aim of this pilot study was to assess the in ter-examiner reliability in assessment of oral health for a dentist and a physician, and to evaluate the influence of training in dental findings for the physician on inter- examiner reliability. METHODS: Inter-examiner reliability between a physician and a dentist was tested in a primary geriatric hospital with 126 participants 60 years old or more (mean 77 years; 32% men) using the Revised Oral Assessment Guide (ROAG) and additional items relating to caries and dentures (14 items). Calculated were kappa-coefficients, and percentage agreement between the examiners before (n = 50) and after (n = 51) training for the physician in dentistry (n = 25 for the common training session). RESULTS: Before the training both kappa-values and percentage agreement were not acceptable in the different categories. After the training, with the exception of the categories swallow and tongue, the reliability of all items was moderate or good. The number of occasions on which the physician underestimated the clinical finding compared to the dentist - indicating a clinical finding was overlooked - decreased for every item; for retention of denture and decayed teeth this decrease was significant. CONCLUSION: Screening for oral health performed by a physician was insufficient regarding the different clinical aspects. Training in the use of an oral health assessment tool improved the reliability of the screening. Because of the low number of examiners the results should be interpreted as a pilot investigation on this new topic.

Assessment of the reliability and validity of panoramic imaging for assessment of mandibular condyle morphology using both MRI and clinical examination as the gold standard.

OBJECTIVES: The purpose of this study was to evaluate both reliability and validity of the assessment of the shape of the mandibular condyle in panoramic images of the TMJ. STUDY DESIGN: Forty subjects were included and were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders. Panoramic radiographs (PRs) and magnetic resonance images (MRIs) were completed for all subjects. Both MRIs and PRs were rated by raters blinded to the clinical diagnosis. Kappa statistics were used to compare the results of the raters of the PRs. Additionally, the specificity and the sensitivity of the PRs were calculated for 2 scenarios: one with MRI and the other with clinical findings as the gold standard. RESULTS: The sensitivity was 0.94 (specificity = 0.45) for the assumption that MRI is the gold standard and 0.86 (specificity = 0.49) for the assumption that the clinical examination is the gold standard. For reliability, the results for kappa ranged from 0.06 to 0.327. CONCLUSION: It can be concluded that PRs are not a reliable method of accurately judging the shape of the mandibular condyle.