Assessment of the impact of toothache, untreated caries and its consequences on the quality of life among poor Brazilian children / Avaliação do impacto da dor de dente, da cárie não tratada e suas consequências na qualidade de vida de crianças brasileiras

Purpose: to evaluate the impact of dental pain and the consequences of untreated dental caries on the quality of life in children of low social-economic status aged from 8 to 10 years old. Materials and Methods: in this cross-sectional study, 230 children were submitted to a clinical examination in which the caries-pufa ratio was measured, afterward, they answered to two questionnaires: one about their quality of life (CPQ8-10) and the other about dental pain. Data were statistically analyzed through Chi-square, Mann-Whitney or Kruskal-Wallis tests to evaluate the association between the variables with impact on children's OHRQoL. To establish the existence of risk factors among variables and impact on OHRQoL a Poisson Regression model was applied. Results: dental caries (p = 0.003; PR 2.39; 95% CI 1.04­1.56), severity of untreated caries (p = 0.008; PR 2.86; 95% CI 1.13­2.00), toothache (p < 0.001; PR 2.31; 95% CI 1.64­3.27) and PUFA + pufa index (p < 0.023; PR 2.68; 95% CI 1.10­1.87) were associated with and were a predictor factor for impact on overall OHRQoL. All of these variables also had an effect over the social welfare subscale (p ≤ 0.001), whereas caries presence was also statistically linked with the emotional wellbeing subscale (p = 0.008) and dental pain with all four subscales (p ≤ 0.001). Conclusion: untreated dental caries' clinical consequences and dental pain exerted a negative influence on the quality of life of schoolchildren analyzed.(AU)

Objetivo: avaliar o impacto da dor de dente e das consequências da cárie não tratada na qualidade de vida de crianças entre 8 e 10 anos com baixos indicadores socioeconômicos. Métodos: neste estudo transversal, 230 crianças escolares foram submetidas a um exame clínico, no qual foram avaliados seus CPO/ceo (Dentes cariados, perdidos e obturados) e PUFA/pufa (Envolvimento pulpar, ulceração, fístula e abscesso). Em um segundo momento, elas responderam a dois questionários: um sobre a qualidade de vida (CPQ8-10) e outro sobre odontalgia. Os dados foram analisados estatisticamente por meio dos testes de Chi-quadrado, Mann-Whitney ou Kruskal-Wallis, para avaliar a associação entre as variáveis e o impacto na qualidade de vida relacionada à saúde oral (QdVRSO) da criança. Para estabelecer a existência de fatores de risco para impacto na QdVRSO entre as variáveis, um modelo de regressão de Poisson foi aplicado. Resultados: a presença de cárie (p = 0,003; RP 2,39; 95% IC 1,04-1,56), a severidade da cárie não tratada (p = 0,008; RP 2,86; 95% IC 1,13-2,00), dor de dente (p < 0,001; RP 2,31; 95% IC 1,64-3,27) e PUFA/pufa (p < 0,023; RP 2,68; 95% IC 1,10- 1,87) foram associados com impacto na QdVRSO, assim como também foram fatores preditores para o impacto na qualidade de vida relacionada à saúde oral. Todas as então citadas variáveis também exerceram efeito sobre a subescala do bem-estar social (p ≤ 0,001), enquanto a presença de cárie esteve estatisticamente conectada com a subescala do bem-estar emocional (p = 0,008) e a dor dentária com todas as subescalas da QdVRSO (p ≤ 0,001). Conclusão: as consequências clínicas da cárie não tratada e a dor dentária exercem uma influência negativa na qualidade de vida das crianças analisadas.(AU)

Oral pain and eating problems in Spanish adults and elderly in the Spanish National Survey performed in 2005.

AIMS: To analyze and quantify the sociodemographic, behavioral, and clinical factors influencing the oral pain and eating difficulties reported by Spanish 35- to 44-year-old adults and more elderly people in the most recent Spanish National Oral Health Survey. METHODS: Pain and chewing difficulties were gathered in a Likert-scale format from a representative sample of the Spanish general population between the ages of 35 and 44 years (n = 540) and 65 to 74 years (n = 540). Risk factors were identified using bivariate analysis, after which the crude association between risk factors (sociodemographic, behavioral, and clinical) and outcome variables (pain and eating problems) was assessed by adjusted odds ratios, calculated by means of multivariate logistic regression. RESULTS: In the 35- to 44-year-old adults, eating problems were mainly associated with caries and prosthetic treatment needs and oral pain by the number of decayed teeth. In the more elderly individuals, eating problems and oral pain were influenced by prosthetic needs and the number of missing teeth. Female sex was seen to be a risk factor for suffering pain and eating restrictions. Additionally, several independent variables such as social class, place of residence, brushing habits, or periodontal needs became nonsignificant after logistic regression modelling. CONCLUSION: According to this high-specificity regression model, caries and prosthetic treatment needs should be considered key factors in determining the oral well-being of the Spanish population. Missing teeth represent the most relevant influencing factor for the elderly and decayed teeth for younger adults.

Chronic intraoral pain--assessment of diagnostic methods and prognosis.

The overall goal of this thesis was to broaden our knowledge of chronic intraoral pain. The research questions were: What methods can be used to differentiate inflammatory, odontogenic tooth pain from pain that presents as toothache but is non-odontogenic in origin? What is the prognosis of chronic tooth pain of non-odontogenic origin, and which factors affect the prognosis? Atypical odontalgia (AO) is a relatively rare but severe and chronic pain condition affecting the dentoalveolar region. Recent research indicates that the origin is peripheral nerve damage: neuropathic pain. The condition presents as tooth pain and is challenging to dentists because it is difficult to distinguish from ordinary toothache due to inflammation or infection. AO is of interest to the pain community because it shares many characteristics with other chronic pain conditions, and pain perpetuation mechanisms are likely to be similar. An AO diagnosis is made after a comprehensive examination and assessment of patients' self-reported characteristics: the pain history. Traditional dental diagnostic methods do not appear to suffice, since many patients report repeated care-seeking and numerous treatment efforts with little or no pain relief. Developing methods that are useful in the clinical setting is a prerequisite for a correct diagnosis and adequate treatment decisions. Quantitative sensory testing (QST) is used to assess sensory function on skin when nerve damage or disease is suspected. A variety of stimuli has been used to examine the perception of, for example, touch, temperature (painful and non-painful), vibration, pinprick pain, and pressure pain. To detect sensory abnormalities and nerve damage in the oral cavity, the same methods may be possible to use. Study I examined properties of thermal thresholds in and around the mouth in 30 pain-free subjects: the influence of measurement location and stimulation area size on threshold levels, and time variability of thresholds. Thresholds for cold, warmth and painful heat were measured in four intraoral and two extraoral sites. Measurements were repeated 3 times over 6 weeks, using four sizes of stimulation area (0.125-0.81 cm2). The threshold levels were highly dependent on location but less dependent on measuring probe size and time variability was small, and this knowledge is important for the interpretation of QST results. Study II applied a recently developed standardized QST examination protocol (intended for use on skin) inside the oral cavity. Two trained examiners evaluated 21 pain-free subjects on three occasions over 1-3 weeks, at four sites-three intraoral and one extraoral. Most tests had acceptable reliability and the original test instruments and techniques could be applied intraorally with only minor adjustments. Study III examined the value of cone-beam computed tomography (CBCT) in pain investigations. Twenty patients with AO and 5 with symptomatic apical periodontitis (inflammatory tooth pain) participated. The results indicate that when AO is suspected, addition of CBCT can improve the diagnostic certainty compared to sole use of periapical and panoramic radiographs, especially because of the superior ability of CBCT to exclude inflammation as the pain cause. Study IV assessed the long-term prognosis of AO, and analyzed potential outcome predictors. A comprehensive questionnaire including validated and reliable instruments was used to gather data on patient and pain characteristics and pain consequences from 37 patients in 2002 and 2009. Thirty-five percent of the patients reported substantial overall improvement at follow-up, but almost all still had pain of some degree after many years. The initial high level of emotional distress was unchanged. Low baseline pain intensity predicted improvement over time.

Predictors of change in satisfaction with chewing ability: a 24-month study of dentate adults.

People's satisfaction with chewing ability is not determined entirely by their mechanical chewing function. Instead, it is a complex measure that embraces broad physical, social and psychological components. Using data from the Florida Dental Care Study, a prospective longitudinal study of oral health and dental care, this current study aimed to identify the longitudinal relationships between changes in satisfaction with chewing ability and changes in other dimensions of oral health and oral health-related quality of life (OHRQoL). A multidimensional conceptual model of oral health and OHRQoL was applied to guide the analysis. Most dentate people were satisfied with their chewing ability. However, changes in satisfaction with chewing ability were common: nearly 11-22% of subjects experienced improved satisfaction, depending on the interval; while about 12-18% of subjects experienced deteriorated satisfaction by the end of the interval. Changes in satisfaction with chewing ability were significantly associated with changes in other aspects of oral health and OHRQoL. Onset of certain oral health problems/conditions or constantly having such problems was associated with a lower probability of reporting improvement in satisfaction and a higher probability of experiencing deterioration. In contrast, recovery from certain oral health problems/conditions or not having such problems was associated with a higher probability of improvement and a lower probability of deterioration.

Racial and socioeconomic disparities in oral disadvantage, a measure of oral health-related quality of life: 24-month incidence.

OBJECTIVES: This paper estimates the incidence of oral disadvantage based on the subject's approach to dental care, sex, race, and financial status; identifies demographic and socioeconomic characteristics that were associated with oral disadvantage; and determines if these characteristics were differentially associated with the three domains of oral disadvantage. METHODS: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth, were 45 years or older, and were either African American or non-Hispanic white. Incidence rates, odds ratios, and 95 percent confidence intervals were used to describe oral disadvantage and its relation to race, income, and other key sociodemographic characteristics. RESULTS: The strongest independent predictors of oral disadvantage were approach to dental care (problem-oriented attenders or regular), and situation if faced with an unexpected $500 dental bill. Demographic and socioeconomic characteristics were differentially associated with each disadvantage domain. CONCLUSIONS: African Americans, females, rural residents, individuals who did not graduate from high school, individuals with limited financial resources, and problem-oriented dental attenders had significantly higher occurrences of oral disadvantage. Racial and sex disparities in oral disadvantage were largely explained by differences in approach to dental care and financial resources between these groups.