Development of an oral health-related quality of life questionnaire on neurosensory disturbances after orthognathic surgery - a pilot study.

OBJECTIVE: Development of a new questionnaire, Oral Health-Related Quality of Life - Neurosensory Disturbances after Orthognathic Surgery (OHRQL-NDO), designed to measure the effects of neurosensory disturbance (NSD) on patients' oral health-related quality of life (OHRQL) and to evaluate reliability and validity of this questionnaire. MATERIALS AND METHODS: A questionnaire including 11 items was constructed. Thirty patients with NSD affecting the lower lip and/or chin following orthognathic surgery were included. Convergent validity was assessed by comparing OHRQL-NDO with OHIP-14 and two global questions. Test-retest reliability was assessed by asking the patients to complete OHRQL-NDO at two different occasions with an interval of two to three weeks. RESULTS: The internal consistency, measured with Cronbach's alpha, was 0.84. The test-retest reliability, measured with ICC, was 0.89 (95% CI 0.77-0.95). The correlation between the mean sum score for the OHRQL-NDO and the mean sum score for the OHIP-14 was r = 0.75, using Pearson correlation coefficient. The correlations between the mean total score for the OHRQL-NDO and the global questions 1 and 2 were r = 0.74 and r = 0.72, respectively. CONCLUSIONS: The current instrument OHRQL-NDO is a promising test, but needs further development to better capture the different aspects of OHRQL. Further tests of the questionnaire must follow in other samples to finalize the instrument.

Dietary intake and meal patterns among young adults with high caries activity: a cross-sectional study.

BACKGROUND: Dental caries is a multifactorial disease that is highly dependent on diet, where a lower consumption and intake frequency of sugar would be favorable. The aims were (i) to examine dietary intake and meal patterns, more specifically sugar intake and foods high in sugar, among young adults with high caries activity, and (ii) to investigate the association between dietary and meal patterns consumption, and level of caries activity. METHODS: This study presents baseline data from an ongoing randomized controlled trial. A total of 50 young adults (aged 23.0 ± 3.0 years) with ≥ 2 decayed tooth surfaces were included. Dietary intake was captured with a 59-item food frequency questionnaire (FFQ) and a three-day food diary. Adherence to dietary guidelines was analyzed by comparing the dietary intake to the Nordic Nutritional Recommendations (NNR) 2012 and by using the Healthy Dietary Adherence score (HDAS). Participants were categorized into two groups: (i) the Caries group with 2-4 decayed surfaces, and (ii) the High caries group with ≥ 5 decayed surfaces. RESULTS: The High caries group reported a statistically significantly higher snack and total meal intake compared to the Caries group, as well as a sugar intake exceeding the Nordic nutritional recommendations. The majority of the participants reported a high intake frequency (> 2.5/day) of sweet foods and drinks and less than one intake of fruit and vegetables, respectively, per day. Similar results were found when analyzing adherence by using the HDAS, where the lowest adherence according to dietary guidelines was shown for the food groups of sugar, whole meal products, and fruit and vegetables. CONCLUSION: The results indicated a high intake of sugar and low intake of fruit, vegetables, and fiber in high caries-active individuals.

Evaluating the validity of the Index of Dental Anxiety and Fear (IDAF-4C+) in adults with severe dental anxiety.

Dental anxiety is a common condition with severe consequences for oral health and health-related quality of life. The aim of this study was to evaluate the recently developed self-report scale Index of Dental Anxiety and Fear (IDAF-4C+) in adults with severe dental anxiety. A sample of 147 adults (age 20-71 yr) with severe dental anxiety completed a questionnaire including the IDAF-4C+ and three other dental anxiety scales. In a clinically assessed subgroup (n = 93), 95% had an International classification of diseases and related health problems 10th version (ICD-10) diagnosis of specific phobia for dentistry. Agreement between the scales was analysed using Spearman's correlation, the Kappa measure of agreement and the intraclass correlation coefficient. The agreement of dental phobia according to the IDAF-4C+ phobia module and the ICD-10 was very low (ĸ = 0.02). The anxiety and fear module of the IDAF-4C+ showed acceptable agreement with the other scales (rs 0.69-0.75; ICC 0.90, 95% CI 0.87-0.93). We conclude that the IDAF-4C+ offers more information to clinicians and researchers than the older dental anxiety scales, but the phobia module needs further development.

Orofacial pain and its relationship with oral health-related quality of life and psychological distress in middle-aged women.

Objective: To investigate the relationship between subjective symptoms of orofacial pain and oral health-related quality of life (OHRQoL), as well as psychological distress in population-based middle-aged women.Material and methods: The two study samples comprised 1059 women, 38 and 50 years old, in representative cross-sectional studies. Women with long-lasting, frequent pain or headaches, related to temporomandibular disorders (TMD), with moderate-to-high estimates were analysed in relation to the non-case group. OHRQoL was measured using the Oral Health Impact Profile (OHIP-5). Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS) and Sense of Coherence (SOC-13).Results: Women with orofacial pain (n = 82, 7.7%) had a significantly higher mean score on the OHIP-5, HADS-A and HADS-D and a lower mean score for SOC-13. In a multivariable logistic regression, orofacial pain was statistically significantly associated with poorer OHRQoL (OR = 1.2) and signs of depression (HADS-D) (OR = 2.0). A higher score for SOC-13 protected from the experience of orofacial pain (OR = 0.95).Conclusion: Orofacial pain was associated with poorer OHRQoL and signs of psychological distress. In interpreting the value of SOC, women with orofacial pain also appear to have a poorer adaptive capacity.

A behavioural intervention for young adults with dental caries, using acceptance and commitment therapy (ACT): treatment manual and case illustration.

BACKGROUND: There is a need for effective behavioural interventions in dentistry. This paper presents an innovative behavioural intervention for young adults with dental caries, in an interdisciplinary collaboration between dental personnel and licensed psychologist in general dental care. The intervention has been evaluated in an RCT, with positive effects on oral health behaviour. METHOD: The intervention, Acceptance and Commitment Therapy (ACT), a recent form of cognitive behaviour therapy (CBT), was adapted to young adult patients (18-25 years of age) with high dental caries activity. RESULTS: The intervention included two individual sessions, provided by a clinical psychologist at general dental clinics. The rationale for selecting ACT as the theory base is presented, together with the treatment manual and a case illustration. CONCLUSIONS: ACT may be a promising alternative for behavioural interventions in dentistry for patients with oral diseases, specifically dental caries. Interprofessional collaboration between psychologists and dental personnel opens up for new possibilities to help and treat patients with various health issues in public dental care. TRIAL REGISTRATION: TRN ISRCTN15009620 www.isrctn.com , retrospectively registered 14/03/2018.

Oral health-related quality of life, measured using the five-item version of the Oral Health Impact Profile, in relation to socio-economic status: a population survey in Sweden.

Oral health-related quality of life (OHRQoL) is an important patient-reported outcome measure in dental research. This study was conducted to analyse the association between OHRQoL, as measured using the five-item version of the Oral Health Impact Profile (OHIP-5), and different socio-economic indices. A national survey of randomly selected adult individuals in Sweden (n = 3,500) was performed using telephone interviews. The questions asked for the purpose of this study were defined by the items of the OHIP-5, just as questions were asked regarding socio-economic variables, including education, income, and economic resources. Poor OHRQoL, as identified by an OHIP-5 score of 3 or higher on at least two of the five items, was statistically significantly associated in multivariate analysis with low income (OR = 1.84) and having no economic resources (OR = 2.19). The statistical models were adjusted for age, gender, ethnicity, marital status, dental-care utilization, dental anxiety, and smoking. The OHIP-5 may be used in larger epidemiological surveys because it demonstrates the ability to discriminate for a range of important areas of measurement in dental public health, including social determinants.

Dental pain and oral health-related quality of life in individuals with severe dental anxiety.

OBJECTIVES: To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL). METHODS: The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status. RESULTS: The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0-61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual's daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p < .001). Dental pain and number of decayed teeth were associated with the probability of poor OHRQoL (OR = 8.2, p < .001, OR = 3.8, p = .008). CONCLUSION: This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.

Periodontal disease among older people and its impact on oral health-related quality of life.

OBJECTIVE: The aim of the study was to evaluate the associations between degree of periodontal disease and number of teeth on oral health-related quality of life among older individuals. MATERIAL AND METHODS: Randomly selected 804 participants aged ≥70 derived from two cohorts were included in the analysis. Dental examinations and evaluation of OHRQL using the OHIP-14 (Oral Health Impact Profile-14) were performed. After categorisation of the participants according to the extent of periodontitis in three groups (none, localised with <30% of teeth affected, generalised with ≥30% of teeth affected) and the number of teeth, associations between periodontal status and the number of teeth and the OHIP-14 scores were analysed. Multivariable regression analyses were used taking into account level of periodontitis, number of teeth, age and sex. RESULTS: Among 70-year-old men and women, generalised periodontitis showed an association with poor OHRQL. However, a multivariable analysis failed to demonstrate this association (OR = 1.02, 95% CI: 0.72-1.44). In participants with 1-10 remaining teeth, the OHIP-14 score was significantly increased indicating poor OHRQL, compared with participants with ≥21 remaining teeth (OR = 1.57, 95% CI: 1.13-2.19). Similar findings were observed among women aged 70-92 years. CONCLUSIONS: Periodontitis did not show an association with poor OHRQL, however, a significant association between the number of teeth and poor OHRQL was found.

A psychological intervention for caries active young adults, a randomized controlled trial.

OBJECTIVE: The aim of the present study was to evaluate the effect of a brief version of the behavioral intervention Acceptance and Commitment Therapy (ACT) on reducing gingivitis and plaque levels after 18 weeks. MATERIALS AND METHODS: One hundred thirty-five caries-active young adults (18-25 years of age), recruited from two public dental clinics, participated in this parallel group randomized control trial (RCT). Participants in the intervention (n = 67) received two ACT sessions in combination with standard information on oral health, and participants allocated to the control group (n = 68) received standard information only. Gingivitis and plaque levels were recorded at baseline and at the 9- and 18-week follow-ups. The effect of the intervention versus standard information alone was analyzed by intention-to-treat and per protocol, applying the General Linear Model (GLM). Exploratory analyses for the intervention and control groups were conducted to evaluate the effect of gender and smoking habits on the gingivitis and plaque outcome. The CONSORT guidelines for RCT were followed. RESULTS: A significant decrease in gingivitis and plaque levels was observed over time, irrespective of treatment allocation. However, the ACT intervention was not significantly more effective at reducing gingivitis and plaque scores than standard information alone, even though the intervention participants had maintained their improvement to a greater extent. The exploratory analysis revealed that females improved their gingivitis and plaque levels significantly more than the males in the intervention group (p = 0.025 for gingivitis and p = 0.013 for plaque). CONCLUSION: A brief ACT intervention was not proven to be more effective than standard information alone at improving oral health in a sample of young adults with poor oral health. However, ACT seems to have a positive effect on oral health among females. (TRN ISRCTN15009620).

Treatment of Dental Anxiety and Phobia-Diagnostic Criteria and Conceptual Model of Behavioural Treatment.

Dental anxiety and dental phobia are still prevalent among adult individuals and should be considered a dental public health issue. Dental anxiety/phobia is often described as a vicious cycle where avoidance of dental care, poor oral health, and psychosocial effects are common features, often escalating over time. Treatment should include therapy for dental anxiety/phobia and oral diseases. This paper discusses aetiology, prevalence, and diagnosis of dental anxiety/phobia and, in detail, presents a conceptual treatment model at the Dental Fears Research and Treatment Center in Gothenburg, Sweden. In addition, based on systematic reviews, evidence-based treatment for dental anxiety is revealed including the interdisciplinary approach between psychology and dentistry.

Oral health and oral health behavior in young adults with caries disease.

OBJECTIVE: The aim of this study was to describe and analyze oral health, oral health behaviors, and oral health-related quality of life (OHRQoL) in relation to the level of caries disease among caries-active young adults. MATERIAL AND METHODS: This study presents data from a sample of young adults (n = 135) with active caries disease who were enrolled in a clinical, randomized controlled trial. The independent variables of sociodemographics, oral health (gingivitis, plaque), oral health behaviors (such as toothbrushing, dental attendance, sugar-containing sweets and drinks), dental anxiety, self-rated oral health, and OHRQoL were collected. Multinomial logistic regression was used to simultaneously evaluate the associations between the independent variables and caries severity. RESULTS: Multinominal logistic regression showed that poor OHRQoL and gingivitis were associated with caries severity in a gradient fashion in accordance with caries disease activity. Also, irregular dental care and frequent consumption of sugary soda were significantly associated with very high caries severity. CONCLUSIONS: The risk factors related to caries severity among young adults were poor OHRQoL, gingivitis, consumption of sugary soda and irregular dental care attendance, indicating the need for a combination of different interventions specifically health behavior change. Furthermore, these findings may contribute to identifying high caries-risk individuals.

General and oral health problems among adults with focus on dentally anxious individuals.

OBJECTIVES: The objective of this epidemiological survey was to analyse the association between dental anxiety and health-related quality of life (HRQL) among adults. METHODS: Individuals were randomly selected (n = 3500), and they were interviewed by telephone and asked to complete a questionnaire concerning dental anxiety, HRQL [Oral Health Impact Profile-5 (OHIP-5) and EuroQol-5D (EQ-5D)] and several socioeconomic variables. RESULTS: Dental anxiety was revealed as a significant factor relative to the OHIP-5 and EQ-5D. Dental anxiety had a stronger association with the OHIP-5 [odds ratio (OR): 3.50] than with the EQ-5D (OR: 1.75). In addition, socioeconomic status demonstrated a gradient, with higher ORs the lower the income and the likelihood of reporting poor HRQL. CONCLUSION: High dental anxiety was associated with lower HRQL.