Orofacial pain symptoms and associated disability and psychosocial impact in community-dwelling and institutionalized elderly in Hong Kong.

OBJECTIVE: The study investigated the experience of orofacial pain (OFP) symptoms and associated disability and psychosocial impact in community dwelling and institutionalized elderly people in Hong Kong. METHODS: A community-based cross-sectional survey involving elders aged 60 years and above. Participants were recruited at social centres for the elderly and homes for the aged throughout Hong Kong. Elders who reported OFP symptoms in the previous four weeks took part. Standard questions were asked about OFP conditions in the previous month and the Manchester Orofacial Pain Disability Scale (MOPDS), the Oral Health Impact Profile (OHIP-14) and the General Health Questionnaire (GHQ-12) were administered. The MOPDS was translated and validated for use in Chinese elders. RESULTS: 200 community dwelling and 200 institutionalized elders participated. Toothache was the most common symptom (62.0%) and burning sensation in the tongue was least common (0.5%). The distribution of pain symptoms, pain duration and severity and pain ratings were similar in both groups. The MOPDS (Chinese elders version) had good reliability and construct validity. The MOPDS and OHIP-14 summary scores was significantly higher in the institutionalized elderly (p < 0.001 and p < 0.013, respectively). Psychological distress (GHQ-12 score > or = 4) was more common among the institutionalized elderly (11%) than the community dwelling elderly (4.0%, p = 0.002). CONCLUSIONS: Orofacial pain symptoms were associated with significant disability and had a detrimental impact on psychological distress level and quality of life, particularly in the institutionalized elderly. There is a need to improve access to professional care and health-related outreach services generally for elderly people in Hong Kong.

Widespread pain symptoms and psychological distress in southern Chinese with orofacial pain.

The study investigated the experience of widespread pain (WP) symptoms and psychological distress in southern Chinese with orofacial pain (OFP). A community-based, cross-sectional case-control study involving people aged 35-70 registered with the Hospital Authority/University of Hong Kong Family Medicine Clinic served as the sampling frame. People with recent OFP symptoms and a group without OFP took part. Standard questions were asked about OFP conditions in the previous month. Psychological status was evaluated through depression, and non-specific physical symptoms (NPS) scores were measured with depression and somatization sub-scales of the Symptom Checklist-90. Widespread pain was determined using body outline drawings to identify painful sites prior to a standard clinical examination. Two hundred people with OFP and 200 without OFP participated. Compared with 5.0% in the comparison group (P = 0.005), 13.5% of participants with OFP had WP (OFP/WP). Multiple OFP symptoms were more common in the OFP/WP sub-group than the OFP sub-group without WP (OFP/No WP) (P < 0.002). Sixty-three percent of the OFP/WP sub-group had moderate/severe depression scores compared with 26.0% in the OFP/No WP sub-group (P < 0.001). When pain items were included and excluded, 92.6% and 88.9% of the OFP/WP sub-group had moderate/severe NPS scores, respectively compared with 68.5% and 65.0% in the OFP/No WP sub-group (P = 0.004). Co-morbid WP occurred relatively often in southern Chinese with OFP. Psychological distress was common in OFP sufferers, particularly those with WP. A multidisciplinary approach to treatment including cognitive/behavioural therapy should be considered in Chinese people with OFP as part of a WP pattern.

Depression and diffuse physical symptoms in southern Chinese with temporomandibular disorders.

The study investigated the experience of depressive symptoms and the relationship with diffuse physical symptoms reporting in southern Chinese seeking professional care for temporomandibular disorders (TMD) in Hong Kong. Eighty-seven new patients [77 females/10 males; mean age 39.3 years (SD 12.7)] referred to the specialist TMD clinic at the Prince Philip Dental Hospital, Hong Kong participated in this study. The Research Diagnostic Criteria (RDC)/TMD history questionnaire was used to derive Axis II psychological data. Psychological status was assessed through depression and non-specific physical symptoms (NPS) scores (pain items included and excluded) measured with RDC/TMD Axis II instruments; 42.5% of patients experienced moderate/severe depression symptoms; 59.8% and 57.5% had moderate/severe NPS scores when pain items were included and excluded, respectively. Strong, positive and statistically significant correlations were noted between depression scores and the NPS scores that included pain items (r = 0.80) and those that did not (r = 0.80). The correlations remained consistent and were of similar magnitude when male patients were excluded from the computation and also when the possible effect of patient age was controlled. While taking into account the modest patient sample which was related to a low rate of treatment seeking, depressive symptoms were common and similar to other western and Chinese patient groups. NPS reports were higher than in Singapore Chinese patients. There appeared to be a clear association between depression and diffuse physical symptoms. The findings should be considered in the holistic care of Chinese people with TMD.

Agreement between patient and proxy assessments of oral health-related quality of life after stroke: an observational longitudinal study.

This study aimed to assess agreement between patient and proxy assessment of patients' oral health-related quality of life (OHRQoL) during the acute stroke phase and 6 months after hospital discharge. As part of an observational longitudinal study, 161 consecutive patients hospitalized after stroke and their caregivers (CGs) were monitored during acute stroke and 6 months after hospital discharge. Patient-CG agreement of health-related quality of life as assessed by the General Oral Health Assessment Index (GOHAI) and Medical Outcomes Study 12-item Short Form (SF-12) which comprises physical (PCS-12) and mental component summaries (MCS-12) was determined by comparison and correlation analyses. Complete data were available for 65 patients and CGs. Compared with acute stroke, there were improvements in GOHAI and SF-12 scores from patient's and CG's perspective at 6-month follow-up. Caregivers overestimated the impact of stroke on MCS-12 over a period of time (P < 0.01) and underestimated the impact on GOHAI during acute stroke (P < 0.001) and on PCS-12 6 months later (P < 0.05). Patient-CG agreement was substantial to excellent during acute stroke [intra-class correlation coefficient (ICC 0.69-0.86)] and fair-to-moderate 6 months later (ICC 0.28-0.60). Agreement was adequate between patients' and CGs' assessment of patient OHRQoL during acute stroke but it was less reliable 6 months after hospital discharge. These findings suggest that proxy assessment of OHRQoL after stroke is effective in assessing stroke-related oral impairments that affect life quality without placing additional burden on stroke patients themselves to assess OHRQoL.

Diagnostic sub-types, psychological distress and psychosocial dysfunction in southern Chinese people with temporomandibular disorders.

The study aimed to assess the distribution of temporomandibular disorders (TMD) sub-types, psychological distress and psychosocial dysfunction in southern Chinese people seeking treatment for TMD using Research Diagnostic Criteria for TMD (RDC/TMD) and investigate potential cross-cultural differences in sub-type prevalence and psychosocial impact. Eighty-seven consecutive patients (77 females; 10 males) with a mean age of 39.3 years (s.d. 12.8) newly referred to the specialist TMD clinic at the Prince Philip Dental Hospital, Hong Kong over a 20-month period took part in the study. RDC/TMD history questionnaire and clinical assessment data were used to derive Axis I and II findings. Group I muscle disorders were the most common and found in 57.5% of patients. Group II (disc displacement) disorders were found in 42.5% and 47.1% of the right and left temporomandibular joints (TMJ) respectively. Group III disorders (arthralgia/arthrosis/arthritis) were revealed in 19.5% and 23.0% of right and left TMJ's respectively. In the Axis II assessment, 42.5% of patients had moderate/severe depression scores, 59.7% had moderate/severe somatization scores and based on graded chronic pain scores 15.0% had psychosocial dysfunction (grade III and IV). While acknowledging the small sample size, the distribution of RDC/TMD Axis I and II diagnoses was fairly similar in Chinese TMD patients compared with Western and other Asian patient groups. However, in Chinese patients, myofascial pain with limited jaw opening and TMJ disc displacement with reduction were more common and a significant number experienced psychological distress and psychosocial dysfunction. The findings have implications for the management of TMD in Chinese people.

Sjögren's syndrome sufferers have increased oral yeast levels despite regular dental care.

AIM: To investigate the prevalence and quantity of oral yeasts and their association with oral candidiasis in Sjögren's syndrome (SS) patients receiving regular dental care. MATERIALS AND METHODS: Yeasts in oral rinse and full-mouth supra-gingival plaque samples from 25 primary SS, 27 secondary SS and 29 control subjects were selectively cultured. All yeasts except single-species isolates were genotyped using pulsed field gel electrophoresis (PFGE). RESULTS: Ten (19%) SS sufferers had symptomless candidiasis. SS subjects had a higher prevalence (73%vs 7%) and quantity of yeasts than controls in both oral rinse and plaque samples (P < 0.05). The prevalence of yeasts in plaque was associated with candidiasis regardless of denture wearing (P < or = 0.04). Candida albicans was the predominant yeast isolated. PFGE showed 20 (66% of total) C. albicans isolate pairs, i.e. C. albicans species isolated from plaque and oral rinse samples of the same individual, were of closely related genetic clonal types (P < 0.01). CONCLUSIONS: Despite effective oral hygiene, more SS subjects than controls had detectable levels of oral yeasts and their presence in supra-gingival plaque was associated with candidiasis. Candida albicans colonized supra-gingival biofilm even in well-maintained SS individuals, posing a challenge to the control of oral candidiasis.

Oral carriage of yeasts and coliforms in stroke sufferers: a prospective longitudinal study.

AIM: To investigate prospectively the qualitative and quantitative changes in oral carriage of yeasts and coliforms in southern Chinese people suffering from stroke. MATERIALS AND METHODS: In 56 elderly people suffering from stroke in a rehabilitation unit of a general medical hospital in Hong Kong, oral microbiological sampling using a combined imprint culture, oral rinse approach and clinical assessment was made during the acute stroke phase, on hospital discharge and 6 months later. RESULTS: The oral carriage of yeasts increased significantly during acute stroke (P<0.05), whereas coliform carriage did not. A reduction in oral carriage of yeasts was found on hospital discharge and 6 months later and in coliforms at the 6-month assessment (P<0.05). Candida albicans and Klebsiella pneumoniae were the predominant yeast and coliform respectively. Stroke-related difficulty in tooth brushing and denture wearing were associated with higher oral yeast carriage (P<0.05). We also report here for the first time that the use of aspirin was associated with lower oral yeast carriage in people suffering from stroke. CONCLUSION: Oral yeast carriage was closely linked to the level of stroke-related functional disability that improved over time but had not totally resolved 6 months after hospital discharge. The oral reservoir of yeasts and coliforms in people suffering from stroke is noteworthy by care providers as K. pneumoniae may cause aspiration pneumonia.

Can caregivers be used in assessing oral health-related quality of life among patients hospitalized for acute medical conditions?

OBJECTIVES: To assess the agreement between patients' and caregivers' (CGs) assessment of patients' oral health-related quality of life (OHRQoL) during the acute stage of their hospitalization. METHODS: A sample of 161 consecutive patients admitted to hospital following stroke and their CGs. Patients and CGs were interviewed independently about the impact of oral health status on the life quality of the patient employing the General Oral Health Assessment Index (GOHAI). Agreement of impact was assessed by comparison (agreement at the group level) and correlation analyses (agreement of individual patient-CG pairs). RESULTS: The response rate was 76% with 121 pairs of patients and CGs participating. At the group level, variations in patient's own and CG GOHAI scores were found (P < 0.001). The CGs underestimated the impact of oral health on life quality, particularly with respect to aspects of psychosocial functioning compared with patients' own perceptions. However, the bias in reports was small (standardized difference = 0.43). The mean absolute difference in overall scores constituted 8% of the possible range of GOHAI scores. At the individual patient-CG pair level, the intraclass correlation coefficient for GOHAI scores was 0.73 (95% CI 0.61-0.82), indicating substantial agreement. CONCLUSION: At the group and individual level there was adequate agreement between patients' and CGs' assessment of patients' OHRQoL during the acute stage of their hospitalization. The findings have implications in the use of CGs as proxies in assessing oral health when patients' own assessment may be difficult to obtain.

The efficacy of cevimeline hydrochloride in the treatment of xerostomia in Sjögren's syndrome in southern Chinese patients: a randomised double-blind, placebo-controlled crossover study.

Cevimeline hydrochloride, a specific agonist of the M3 muscarinic receptor, is beneficial in the treatment of symptoms of xerostomia and xerophthalmia associated with Sjögren's syndrome (SS). Cevimeline has not been evaluated in southern Chinese patients. Furthermore, the effects of cevimeline on health-related quality of life and oral health status are not known. In this randomised, double-blind, placebo-controlled crossover study, patients received cevimeline 30 mg or matched placebo three times per day over 10 weeks followed by a 4-week washout period before treatment crossover. Participants self-completed the following questionnaires: Xerostomia Inventory (XI), the General Oral Health Assessment Index (GOHAI), the Ocular Surface Disease Index (OSDI) and the Medical Outcomes Short Form (SF-36). Clinical assessments included sialometry, examination of the oral cavity for the degree of xerostomia and dental complications of xerostomia. Fifty patients (22 primary SS and 28 secondary SS) were enrolled in the trial. Forty-four patients completed the study. There was a significant improvement in the XI and GOHAI scores as well as the objective rating of xerostomic signs of the oral cavity after treatment with cevimeline. However, there was no improvement in salivary flow rates and dry eye symptoms. SS patients had lower SF-36 scores, but these did not improve after treatment with cevimeline.

Supra-gingival microbiota in Sjögren's syndrome.

The aim of this study was to investigate the microbiota of noncaries associated supra-gingival plaque (SGP) microbiology in Sjögren's syndrome (SS). Stimulated whole saliva (SWS) and full-mouth SGP on intact tooth surfaces were collected from 26 primary (p) SS, 27 secondary (s) SS, and 29 control subjects for selective culture of lactobacilli, mutans streptococci, and aerobic and facultatively anaerobic gram-negative rods (AGNR). Predominant cultivable anaerobes from SGP of 11 randomly selected subjects from each group were investigated. Clinical and sialometric data were also collected. SS sufferers had significantly lower SWS flow rate and higher mean DMFT (decayed, missing, filled teeth), while pSS subjects also had lower SWS pH and fewer standing teeth. Lactobacillus acidophilus levels in SWS (P = 0.012) and SGP (P < 0.0001) were significantly elevated in pSS sufferers compared with sSS individuals and controls. AGNR isolation was uncommon. SS sufferers had significantly lower proportion of gram-negative species (P = 0.047). Non-oral species were isolated in greater proportions from pSS SGP (P = 0.007). Subjects with pSS harbored increased levels of L. acidophilus and non-oral species, while SS sufferers generally had lower proportions of gram-negative species. The microbial composition of noncaries associated SGP indicates a potential source of increased caries risk in SS.

Antifungal susceptibility of Candida albicans biofilms on titanium discs with different surface roughness.

Although it is well known that fungal biofilms have increased resistance to antimicrobial agents, limited information is available on the formation of candidal biofilms on implant surfaces with different surface roughness and their resistance to conventional antifungal therapy. In the current study, the effect of increasing the surface roughness of titanium discs on the susceptibility of Candida albicans biofilms to amphotericin B was determined. Grade I commercially pure titanium discs were sandblasted with 99.6% aluminium oxide of different grit sizes, producing surface roughness of 0.90, 1.88 and 3.82 microm (Groups A, B and C), respectively (P < 0.001). The antifungal susceptibility of C. albicans biofilm grown on different Ti discs was determined using XTT assay. The 50% reduction in metabolic activity (50% RMA) of planktonic C. albicans (0.5 microg/mL) was much lower than those from Groups A, B and C (2, 16, 2 microg/mL, respectively), while the 50% RMA from Group B was three-fold higher than those from Groups A and C. In conclusion, difference in titanium surface roughness was associated with variations in the antifungal resistance of the candidal biofilm. Group C appeared to have an optimum surface roughness for biofilm resistance.

Oral health-related quality of life and severe hypodontia.

The aims of the study were to assess oral health-related quality of life (ohqol) impact among patients with severe hypodontia and to determine the association between ohqol and the number of missing teeth. Twenty-five patients with severe hypodontia (four or more missing permanent teeth) self-completed the child perception questionnaire (CPQ) to assess oral symptoms (OS), functional limitation (FL), emotional well-being (EWB) and social well-being (SWB). Correlation between CPQ scores (overall and at domain level) and the number of missing teeth was assessed. All participants reported ohqol impact, 100% reported experiencing OS, 88% FL, 55% EWB and 100% SWB impacts. The correlation between the number of missing permanent teeth and the CPQ scores was moderate: overall CPQ score (r = 0.54), OS (r = 0.41), FL (0.52), EWB (0.52), SWB (0.49), P < 0.05. Having accounted for retained primary teeth (where a retained primary tooth was considered to have compensated for a missing permanent tooth), the correlation between the number of missing teeth and CPQ scores was strong: overall CPQ score (r = 0.94), OS (r = 0.78), FL (0.88), EWB (0.92), SWB (0.70), P < 0.001. Subjects with severe hypodontia report considerable ohqol impact. The number of missing permanent teeth was moderately correlated with ohqol. However, when retained primary teeth were taken into account, the number of missing teeth was highly correlated with ohqol. This study has implications in understanding the impact of hypodontia on quality of life and highlights the importance of retaining primary teeth in children and adolescents with severe hypodontia.

Influence of sensory deprivation and perturbation of trigeminal afferent fibers on corticomotor control of human tongue musculature.

Several recent studies with transcranial magnetic stimulation (TMS) have demonstrated changes in motor evoked potentials (MEPs) in human limb muscles following modulation of sensory afferent inputs, but little is known about the regulation of the human tongue motor control. To test the effect of local anesthesia (LA) of the lingual nerve and topical application of capsaicin stimulation on tongue MEPs. Fourteen volunteers participated (21-30 years) in two randomized sessions; before, during a nerve block of the lingual nerve or topical capsaicin application (30 microl 5%) on the tongue, and after anesthesia or pain had subsided. EMG electrodes were placed on the tongue and the first dorsal interosseous (FDI) muscle (control). EMG signals were amplified, filtered (20 Hz-1 kHz), and sampled at 4 kHz (Nicolet, USA). TMS were delivered with a figure-of-eight coil (Magstim 200, UK). Scalp sites at which EMG responses were evoked in the relaxed tongue or FDI at the lowest stimulus strength were determined, i.e., motor threshold (T). MEPs were assessed using stimulus-response curves in steps of 10% T. Eight stimuli were presented at each stimulus level. The proximal hypoglossal nerve was activated by TMS delivered over the parieto-occipital skull distal to the right ear. Eight stimuli were delivered at 50% of maximum stimulator output. ANOVAs were used to analyze latency and peak-to-peak amplitudes. Capsaicin evoked mild pain (2.8+/-0.5), and a strong burning sensation (6.2+/-0.4) on 0-10 visual analogue scales. MEP amplitudes in tongue and FDI were not influenced by capsaicin (P>0.44) but by stimulus strength (P<0.001). MEP latencies in tongue (8.9+/-0.2 ms) and FDI (22.4+/-0.4 ms) were not affected by capsaicin (P>0.19). Hypoglossal nerve stimulation evoked a short-latency (3.6+/-0.9 ms) response (mean amplitude 65+/-9 microV); but was unaffected by capsaicin (P>0.54). LA did not have any effect on FDI MEPs but was associated with a significant facilitation of tongue MEPs at T+50% and T+60% about 50 min after the nerve block in the recovery phase. Also in this condition, the direct motor responses evoked by hypoglossal nerve stimulation remained constant. No direct effect of a strong burning sensation could be shown on peripheral or central corticomotor pathways to the relaxed tongue musculature, however, LA of the lingual nerve (cranial nerve V) seems able to induce a delayed change in corticomotor control of tongue musculature (cranial nerve XII) possibly related to unmasking effects at the cortical level but not completely excluding excitability changes at the brain stem level.

Oral health of southern Chinese children and adolescents with severe hypodontia.

OBJECTIVE: The aim of this study was to assess the oral health condition of southern Chinese children and adolescents with severe hypodontia. METHODS: This was a cross-sectional clinical study in the dental teaching hospital in Hong Kong. Twenty-five children and adolescents with severe hypodontia, and a comparison group of 25 age- and gender-matched controls took part. Verified clinical examination techniques were used to assess the pattern of missing teeth, tooth spacing, dental caries, periodontal condition, enamel defects, and tooth wear. Statistical comparisons were made between groups using independent Student t-tests and chi-square tests. RESULTS: The mean number of congenitally missing permanent teeth in the severe hypodontia group was 9.1 (SD = 5.0), with the maxillary lateral incisor being the most common missing tooth (14.5%). There were significant space discrepancies in both jaws between groups (P < 0.001). Caries prevalence was low with no difference between groups. There was no difference in periodontal condition between groups, with about half of the participants having no gingival inflammation. The severe hypodontia group had more enamel defects (P = 0.043), enamel hypoplasia (P = 0.044) and tooth wear (P = 0.005) than the comparison group. Three of the severe hypodontia group had ectodermal dysplasia. CONCLUSIONS: The oral health condition of southern Chinese children and adolescents with severe hypodontia was good in terms of caries experience and periodontal health. However, the increased prevalence of developmental defects of enamel and tooth wear complicates already complex interim and definitive prosthodontic management, and may increase psychosocial impact.

Oral health-related quality of life of stroke survivors on discharge from hospital after rehabilitation.

The study aimed to investigate oral health-related quality of life (OHR-QoL) of stroke survivors on hospital discharge after rehabilitation. It was a cross-sectional study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. The Medical Outcomes Short Form 36 (SF-36) measure, the General Oral Health Assessment Index (GOHAI) and an oral health transition scale were administered prior to a dental examination. Median SF-36 subscale scores were significantly different between groups (P < 0.05). In physical function, role-physical, role-emotional and mental health domains, stroke survivors had significantly lower scores indicating poorer health. The median GOHAI score for the stroke group was 52 and 54 for the comparison group with no significant difference between groups although more stroke survivors had difficulty speaking compared with the comparison group. About 75% of stroke survivors considered their appearance to be worse, half of them felt that speech was worse and about a third had difficulty chewing hard food compared with the pre-stroke condition (P < 0.05). Most participants were partially dentate with no significant difference in DMFT scores or prosthetic status between groups (P > 0.05). Health-related quality of life in general was significantly poorer after stroke although patients were considered physically well enough to be discharged from hospital. There was some impairment of OHR-QoL. The nature of the stroke, the hospital environment including diet, coping strategies and elderly Chinese peoples' perception of health should be taken into account when interpreting measures of health status in stroke survivors.

Development and evaluation of a questionnaire to evaluate clinical dental teachers (ECDT).

OBJECTIVES: To develop and test the psychometric properties (validity and reliability) of a questionnaire to evaluate clinical dental teachers. METHODS: An item (question) pool was generated with the use of a literature review, feedback from faculty staff, and from focus group discussions with dental students. Following factor analysis the validity and reliability of a revised questionnaire was assessed. This involved 148 dental students and 453 assessments of 29 clinical dental teachers. RESULTS: Effective clinical dental teaching (ECDT) scores were associated with 'global ratings' of the effectiveness of clinical dental teaching (P<0.01), indicating strong criterion validity. In comparison analysis there was strong agreement between students regarding ratings of individual clinical dental teachers, indicating good construct validity. Reliability was assessed by examining internal consistency of sub-scales and overall ECDT scale, and found to be good (Cronbach alpha's > 0.80). CONCLUSION: A valid and reliable measure to evaluate clinical dental teachers has been developed for use in a clinical academia setting, and has potential use as a quality assurance measure.

Impact of Sjögren's syndrome on oral health-related quality of life in southern Chinese.

The effect of oral symptoms of Sjögren's syndrome (SS) on health-related quality of life is presently uncertain. This study aimed to investigate oral health-related quality of life (OHRQOL) among southern Chinese people with SS. Twenty-six primary SS cases, 25 secondary cases and 29 matched controls took part in this cross-sectional study. Each participant completed a SF-36 questionnaire, the Oral Health Impact Profile and a dry mouth measure, assisted by a trained interviewer. Data on socio-demographic variables were also collected. The dry mouth measure revealed that people with primary and secondary SS had significant problems associated with subjective symptoms of dry mouth generally, and dry mouth when eating and speaking (P < 0.01). Sticky saliva and coughing were also problems in some primary SS cases. OHIP summary and sub-scale scores did not reveal differences in negative impacts between groups. Mean SF-36 sub-scale scores were significantly different between groups (P < 0.05). In physical function, role-physical and general health domains, primary and secondary SS sufferers had lower scores indicating poorer health. Oral symptoms of SS, notably xerostomia, had a negative effect on OHRQOL. Health-related quality of life in general was also impaired in SS sufferers. The OHIP did not appear to discriminate oral problems of concern to SS sufferers.

Oral health-related quality of life in southern Chinese following radiotherapy for nasopharyngeal carcinoma.

Although the complications of head and neck radiotherapy in the treatment of nasopharyngeal carcinoma (NPC) have been described, there is limited information on the effect of oral complications on oral health related quality of life. The aim of this study was to describe the psychosocial and functional impact of oral conditions in southern Chinese following radiotherapy for NPC. A cross-sectional study design was used with a sample of 109 subjects including NPC survivors, newly diagnosed NPC cases and a control group. Oral health related quality of life was assessed through the SF-36 and the Oral Health Impact Profile measures and a dry mouth measure. Data on socio-demographic variables and treatment seeking were also collected. The psychosocial and functional impact of oral conditions as revealed by the health status measures was significantly greater in NPC survivors than newly diagnosed NPC cases and controls. The oral specific and condition specific measures appeared to discriminate more effectively between groups than the generic measure. NPC survivors sought significantly more dental treatment than the other groups. The oral complications of radiotherapy for NPC, notably sequelae of salivary gland damage, have a significant negative effect on oral health related quality of life and result in an increased burden of dental care in the long-term.

Oral health condition in southern Chinese after radiotherapy for nasopharyngeal carcinoma: extent and nature of the problem.

OBJECTIVE: To measure the oral health status of southern Chinese nasopharyngeal carcinoma (NPC) survivors 1-4 years after radiotherapy. SUBJECTS AND METHODS: A total of 109 subjects participated in this cross-sectional study. Thirty-eight subjects were NPC survivors, 40 subjects were patients newly diagnosed with NPC and 31 were healthy subjects. Verified clinical examination techniques were used to assess limitation of jaw opening, the presence of mucositis, candidiasis, dental caries, periodontal disease [community periodontal index (CPI)] including attachment loss (ALoss) and prosthetic status/need. Differences among three groups were tested by chi-squared and Kruskal-Wallis tests. Relationships between selected clinical variables and radiation parameters were analysed using Spearman's rank correlation coefficients. RESULTS: The NPC survivors attended for dental treatment more frequently than the other groups (P < 0.01). NPC survivors had significant xerostomia (92%, P < 0.01), trismus (29%, P < 0.01), a higher prevalence of clinical candidiasis (24%, P < 0.01), a greater DMFT (16.4 +/- 7.0, P < 0.01), more decay/filled roots (2.1 +/- 2.9, P = 0.01) compared with new NPC patients and controls. No difference was found in CPI, ALoss, prosthetic status and need between groups. Dry mouth and tooth hypersensitivity were the most common oral problems perceived by the NPC survivors. CONCLUSION: Despite having regular dental follow-ups, oral health was compromised in NPC survivors 1-4 years postradiotherapy.