Findings from the 2019 nationally representative oral health survey for adults in Singapore.

OBJECTIVES: The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). METHODS: A multi-stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face-to-face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC-AAP classifications. Weighted analysis was performed to adjust for oversampling, non-response and post-stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. RESULTS: Six hundred and sixty-three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1-2-room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC-AAP classification, the prevalence of moderate-severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. CONCLUSIONS: Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio-economic gradient in the distribution of tooth loss, untreated dental caries and moderate-to-severe periodontitis was observed.

Oral health knowledge, attitudes and behaviours of adults: Findings from a National Oral Health Survey in Singapore.

OBJECTIVES: Prevention complements the curative management of oral diseases. Effective preventive interventions involve the adoption of oral health promoting behaviours. Little is known about the awareness of oral disease and its prevention among Singaporean adults as well as their prevailing oral health attitudes and behaviours. The aim of the study was to describe the oral health knowledge, attitudes and behaviours of adults in Singapore. METHODS: A random sample of adults (≥21 years old) in Singapore was selected to complete an interviewer-administered questionnaire. The questionnaire gathered information about their knowledge of the aetiology, signs and symptoms as well as prevention of dental caries and periodontal disease; attitudes about the value of teeth, locus of control in maintaining oral health and oral health behaviours including toothbrushing, flossing and dental attendance. RESULTS: A total of 1196 adults of weighted mean age 48 years old with almost equal proportions of males and females responded to the questionnaire. Participants were more unaware about the causes of periodontal disease (25.7%) than dental caries (4%). While more than 90% of participants felt that healthy teeth were important and could affect their overall health, many (67.0%) felt it was natural to lose their teeth with old age. Among the participants, 83.5% brushed their teeth twice a day; 41.9% flossed their teeth and 53.9% visited the dentist at least once a year. CONCLUSIONS: The study findings showed good knowledge around dental caries but some gaps around periodontal disease. It also found that participants perceived having limited control over preventing tooth loss. Irregular dental attendance and poor denture wearing habits were also noted. The findings shed light on key areas to focus on through oral health promotion to improve overall oral health.

The oral and systemic health impact profile for periodontal disease (OSHIP-Perio)-Part 2: Responsiveness and minimal important difference.

OBJECTIVES: The Oral and Systemic Health Impact Profile for Periodontal Disease (OSHIP-Perio) was developed to measure health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL). This study aimed to determine the responsiveness and minimal importance difference (MID) of the OSHIP-Perio. METHODS: Subjects with periodontal disease completed the OSHIP-Perio at baseline and six to ten weeks after non-surgical periodontal therapy. Comparisons of the clinical variables and the OSHIP-Perio scores before and after treatment were analysed using the Wilcoxon signed-rank test, together with the Oral Health Impact Profile (OHIP-49, OHIP-14 and OHIP-5) scores. The MIDs for all the instruments were calculated using distribution-based methods. RESULTS: Fifty-one case subjects who completed periodontal treatment and the OSHIP-Perio instrument were included for analysis. Significant improvement in all clinical variables after treatment (p < 0.001) was observed. The OSHIP-Perio total score as well as its four-dimensional scores (periodontal, oral function, orofacial pain and psychosocial impact) were significantly reduced after treatment (p < 0.001), indicating better OHRQoL. Findings were consistent with the other OHIP instruments. In determining the MID, the percentage point change of the OSHIP-Perio was found to be lower than the shorter OHIP-5 instrument when using both effect sizes (ES) (10.71% vs. 15.0% at 0.5SD) and standard error of measurement (SEM) (5.36% vs. 10.0% at 1SEM; 8.93% vs. 20.0% at 2SEM) calculations. CONCLUSIONS: The OSHIP-Perio demonstrated good responsiveness which was comparable to the OHIP-49 and its short-form derivatives. Its required percentage point change in determining its MID is smaller than the OHIP-5.

The oral and systemic health impact profile for periodontal disease (OSHIP-Perio)-Part 1: development and validation.

OBJECTIVES: This study aimed to develop and validate the Oral and Systemic Health Impact Profile for Periodontal Disease (OSHIP-Perio), a disease-specific instrument for assessing the impact of periodontal disease on both general and oral health-related quality of life. METHODS: A pool of 58 items, developed from the Oral Health Impact Profile (OHIP-49) and data generated through semi-structured patient interviews, was tested on 80 case subjects with periodontal disease and 80 control subjects. The dimensionality of the preliminary measure was evaluated using exploratory factor analysis (EFA). Rasch analysis was then performed on the primary dimension using the Winsteps software (Version 5.1.4.0) to render the final items for the OSHIP-Perio. The reliability and validity of the final OSHIP-Perio were subsequently determined. RESULTS: Using an EFA factor loading >0.50, the primary dimension comprised 18 items. Using Rasch analysis, four items were subsequently excluded. The final OSHIP-Perio with 14 items showed excellent test-retest reliability (overall intraclass correlation coefficient index = 0.99) and internal consistency (overall Cronbach's alpha coefficient = 0.96). It also exhibited good discriminant validity when case and control groups were compared (p < 0.001). It showed very strong correlations (rho coefficients >0.90) with the OHIP-5, OHIP-14 and OHIP-49, exhibiting good concurrent validity. It demonstrated a moderate correlation (rho coefficient = 0.60) with the global health rating, exhibiting a moderate convergent validity. CONCLUSIONS: The 14-item OSHIP-Perio exhibited good psychometric properties comparable to the OHIP-5, OHIP-14 and OHIP-49 for evaluating the impact of periodontal disease on quality of life.

Providing Oral Healthcare to Older Patients-Do We Have What It Takes?

Over the past decades, there has been an increase in the number of natural teeth that are maintained into older age, and this has represented an increase in the need for more complex dental treatment for this population. A trained workforce is needed in order to provide dental care to the different groups of elderly. Currently, the undergraduate training in gerodontology offered by dental schools seems to be limited, with great variation among dental schools worldwide. Given the heterogeneity of elderly groups, it is unlikely that new graduates from dental schools can be deemed competent to deal with the different groups of elderly. In this article, barriers to oral healthcare's provision to older adults are discussed, including the lack of appropriately trained dental professionals. Training pathways are discussed, including the preparation of undergraduate education to provide a suitable foundation to be developed further in postgraduate education. It is also proposed that older adults are classified according to their dependency level and each level is managed by properly trained dental professionals. In order to upskill general dental practitioners to care for these patients, postgraduate certification programmes could be structured to provide additional training. Furthermore, the development of geriatric oral health educational programmes for non-dental healthcare workers is recommended.

Theory-derived intervention to improve oral health of older adults: study protocol for a randomised controlled trial.

INTRODUCTION: Changing health behaviours is an important and difficult task. Despite growing interest in behavioural theories and models, there is a paucity of research examining their validity in explaining oral health behaviours, and there is a need for interventional studies to assess their effectiveness in improving oral health. This study aims to test the explanatory power of the dominant psychological theories, develop theory-derived intervention and evaluate its effectiveness in improving oral health of older adults. METHODS AND ANALYSIS: 440 community dwelling older adults will be recruited. To be eligible for this trial, one needs to be 55-79 years old, having at least 8 natural teeth, and with no life-threatening disease, impaired cognitive function, or radiotherapy in the head and neck region. At the initial visit, each participant will be required to complete a detailed questionnaire which collects information on sociodemographic background, oral health behaviours and domains of three psychological theories and models: (1) health belief model, (2) theory of planned behaviour and (3) social cognitive theory. The theory or model that best explains the health behaviours will be selected for designing the oral health intervention. The effectiveness of the theory-derived intervention will be evaluated in a randomised controlled trial. Participants will be randomly assigned to two groups, receiving theory-derived intervention and conventional health education, respectively. At baseline and at 12 and 24 months post intervention, each participant will complete a short questionnaire and undergo an oral examination (dental check-up). The effectiveness of the interventions will be evaluated using behavioural outcomes (diet, toothbrushing, interdental cleaning) and clinical outcomes (oral hygiene, dental caries and periodontal conditions). ETHICS AND DISSEMINATION: This study has been approved by the Institutional Review Board of National University of Singapore (Ref: NUS-IRB-2020-417). Findings will be presented in international conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04946292.

Willingness to Pay for Preventive Dental Care Amongst Older Adults.

OBJECTIVE: The aims of this study were (1) to investigate willingness to pay (WTP) for preventive and curative dental care procedures and (2) to determine the factors that influence older adults' WTP for dental care. METHODOLOGY: Older, independently living adults from Singapore aged 60 years and older and eligible for government-subsidised dental care were nonrandomly recruited for this study. Data were collected using questionnaires and a clinical examination which recorded details of caries experience, number and distribution of posterior occluding contacts, prosthodontic status, and periodontal status. Using a contingent valuation method, participants were asked to rate WTP in Singapore dollars [SGD$] for 4 aspects of care: dental fillings, dental scaling, dental extraction, and disease prevention advice. Negative binomial regression was used to assess the relationship between the predictor variables associated with WTP for dental fillings, scaling, extraction, and preventive advice. RESULTS: The mean value of WTP for a dental filling was SGD$30.23 (SGD$31.05), for scaling was SGD$30.28 (SGD$29.46), for dental extraction was SGD$35.08 (SGD$58.54). In a multivariate model, factors associated with higher WTPfees were as follows: (1) dental filling: age (younger), level of education (higher), and frequency of dental visits (regular); (2) scaling: level of education (higher), agree that dental problems affect overall health, and frequency of dental visits (regular); (3) dental extractions: age (younger), level of education (higher), frequency of dental visits (regular), and prosthodontic status (not wearing); (4) preventive advice: age (younger), gender (male), ethnicity (Chinese), level of education (higher), marital status (married), self-perceived oral health (good), and dental visits (regular). CONCLUSIONS: The findings of our study suggest that older adults are willing to pay most for extraction and least for preventive advice.

Functional Dentition, Chronic Periodontal Disease and Frailty in Older Adults-A Narrative Review.

BACKGROUND: The likelihood of experiencing the impact of chronic disease rises with age, and cumulative functional deficits over time increase the risk of frailty in older adults. The exact causes of frailty are not clear, and research is needed to identify appropriate intervention measures to reduce risk of developing frailty in old age. OBJECTIVE: To review the evidence on the relationship between frailty, dental status and chronic periodontitis and to determine if improvements in oral health of older adults can contribute to reversal of frailty. RESULTS: The oral cavity is the entry point to the gastro-intestinal tract, and natural teeth facilitate efficient mastication of food prior to swallowing and subsequent digestion. The loss of natural teeth, which is gradual and cumulative over the life course, is associated with diminished nutritional intake, especially in older adults. Furthermore, chronic periodontitis has been postulated as a risk factor for frailty. The evidence supporting a strong relationship between oral health status and frailty is not clearcut. Cross sectional studies suggest an association with missing teeth and chronic periodontal inflammation. However, there are very few longitudinal studies and accordingly, it is not currently possible to claim a causal relationship. As yet, there is no evidence to suggest that improvements in oral health contribute to reversal of frailty. CONCLUSION: Longitudinal studies with robust designs are required to better inform the relationship across functional dentition, chronic periodontitis and frailty in older adults.

A qualitative study of dental professionals' and patients' knowledge and perceptions of the impact of periodontal disease on systemic health and quality of life.

OBJECTIVES: This qualitative study of dental professionals and patients with periodontal disease: (1) explored their knowledge and perceptions on the impact of periodontal disease on systemic health and quality of life (QoL); (2) assessed their familiarity with QoL instruments used to measure the impact of periodontal disease. METHODS: In-depth semi-structured face-to-face interviews were conducted with 10 dental professionals and 10 patients selected using purposive sampling. Audio recordings of the interviews were transcribed verbatim, coded and analysed using NVivo software (version 11, QSR International), followed by an inductive thematic analysis of the data. RESULTS: Three themes were identified for the dental professionals: (1) knowledge of periodontal disease, systemic health and QoL; (2) experience in managing patients with periodontal disease to improve their QoL; (3) perceived value of having a disease-specific QoL instrument for periodontal disease. Three themes were identified for patients with periodontal disease: (1) knowledge of periodontal disease, systemic health and QoL; (2) experience and perception of how periodontal treatment can improve QoL; (3) perceived value of having a disease-specific QoL instrument for periodontal disease. Both groups were knowledgeable about the relationship between periodontal disease, systemic health and QoL and had experienced how periodontal treatment could improve QoL. Both groups also agreed that a disease-specific QoL instrument for periodontal disease would be beneficial. CONCLUSIONS: Both the dental professionals and patients with periodontal disease were aware of the relationship between periodontal disease, systemic health and QoL, including the benefits of periodontal treatment in improving QoL. The value of developing a disease-specific QoL instrument for periodontal disease was recognized by both groups.

Correlation between microbial host factors and caries among older adults.

BACKGROUND: There is little knowledge about factors which may affect oral health among older adults. The objective of this study was to determine the relationship between Streptococcus mutans (MS) and Lactobacilli (LB) counts and caries among older adults. METHODS: In this community-based observation study, 141 participants aged 60 years and above were recruited from the west district of Singapore. Alongside the clinical examination, saliva samples were collected to determine Streptococcus mutans (MS) and Lactobacilli (LB) counts, as well as to record salivary flow rate and buffering capacity of saliva. RESULTS: Of the 141 participants, 63.8% were female and 94.3% were of Chinese ethnicity. The mean DMFT was 11.08 (s.d. 8.27). 9.9% of participants had at least one decayed tooth, 52.5% had minimum one missing tooth and 86.5% had at least one filled tooth. 67.4% had MS counts of ≥ 105 while LB counts were ≥ 105 for 48.2%. 83.7% had normal salivary flow or hypersalivation (> = 1 mL/min), the buffering capacity of the saliva was alkaline in 61% of the participants. Multivariate analysis showed that participants who had high MS counts were less likely to have a DMFT < 12 [OR (95% CI), 0.29 (0.11-0.77)] whereas participants who had high LB counts were less likely to have a DMFT ≤ 14 [OR (95% CI), 0.45 (0.20-1.002)]. CONCLUSION: Our study showed a positive correlation between MS and LB counts and caries experience in older adults. The mean DMFT was on the low side in our sample despite having a relatively high MS count. This suggests that there are many other factors which vary according to host environment, physiological and biological conditions that may affect MS and LB counts in the oral cavity. CLINICAL RELEVANCE: Our study supports the knowledge that the aetiology of dental caries among older adults is a complex process and it would be wrong to consider caries as a same problem with the same solution for all age groups.

Periodontal disease and quality of life: Umbrella review of systematic reviews.

This umbrella review appraised existing systematic reviews and meta-analysis to establish the impact of periodontal disease and therapy on general and oral health-related quality of life. A systematic electronic literature search was carried out in accordance with the PRISMA guideline up to January 2020 using PubMed, LIVIVO, EMBASE and OpenGrey (PROSPERO CRD 42020163831). Hand searching was performed through the reference lists of periodontal textbooks and related journals. All English language-based systematic reviews and meta-analysis that assessed the impact of periodontal disease and treatment interventions on general and oral health-related quality of life were included. Overall, eight articles met the inclusion criteria and their methodological quality was assessed using the AMSTAR2 criteria. Two systematic reviews showed a significant impact of oral conditions on general health-related quality of life, although the specific impact of periodontal disease remains inconclusive. Three systematic reviews established a negative impact of periodontal disease on oral health-related quality of life. Another three systematic reviews concluded that periodontal treatment can improve oral health-related quality of life. Oral conditions, like periodontal disease, can impact the general health-related quality of life. Periodontal disease is negatively correlated with oral health-related quality of life, although treatment interventions can improve self-reported quality of life. In view of the heterogeneity of generic instruments currently utilized to assess the self-reported quality of life of periodontal patients, the development of a general and oral health-related quality of life instrument specific for periodontal disease is strongly recommended.

CHI study: protocol for an observational cohort study on ageing and mental health in community-dwelling older adults.

INTRODUCTION: Ageing is associated with a multitude of healthcare issues including dementia, depression, frailty, morbidity associated with chronic disease and high healthcare utilisation. With Singapore's population projected to age significantly over the next two decades, it has become increasingly important to understand the disease burden and etiological process among older adults. The Community Health and Intergenerational study aims to holistically examine ageing in place by investigating the resilience and vulnerability factors of the ageing process in the biological, psychological and social domains within the environment. METHODS AND ANALYSIS: Using a cohort multiple randomised controlled trial design, comprehensive health profiles of community-dwelling older adults will be collected. The objective is to recruit 1000 participants (aged 60-99 years) living in the western region of Singapore within a period of 3 years (2018-2020). Assessments include basic sociodemographic, physical health and function (cardiac, oral and blood profiles and visual function), cognitive functioning, daily functioning, physical fitness, emotional state, free-flowing speech, sleep quality, social connectedness, caregiver burden, intergenerational communication, quality of life, life satisfaction, attitudes to ageing and gratitude and compassion. Results from the cohort will enable future studies to identify at-risk groups and develop interventions to improve the physical and mental health and quality of life of older adults. ETHICS AND DISSEMINATION: Approval of the cohort study by the National University of Singapore Institutional Review Board (NUS-IRB Reference code: H-17-047) was obtained on 12 October 2017. Written consent will be obtained from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local stakeholders.

Impact of Sleep Bruxism on Oral Health-Related Quality of Life.

PURPOSE: To determine the prevalence of possible tooth grinding (TG) and possible sleep bruxism (SB) and to examine their impacts on oral health-related quality of life (OHRQoL) among Asian adults. MATERIALS AND METHODS: A total of 3,072 subjects (18 to 65 years of age) from 12 dental centers were invited to complete a self-administered questionnaire on TG/SB and OHRQoL, and 2,417 were included in the study. Participants were subsequently categorized into three groups (no TG/SB, possible TG, and possible SB) based on the International Classification of Sleep Disorders. The 14-item Oral Health Impact Profile (OHIP-14) severity, extent, and prevalence scores were subsequently computed and compared. Data were examined using Kruskal-Wallis and Mann-Whitney U tests, Spearman correlation, and univariate regression analysis (P < .05). RESULTS: Of the 2,417 subjects (mean age 24.79 ± 7.49 years), 42.82% reported either possible TG (n = 921; 38.11%) or possible SB (n = 114; 4.72%). Significant differences in global and domain OHIP-14 scores were found between the groups, except for the extent scores in functional limitation and physical disability. Mean global severity scores of the possible SB group (9.36 ± 9.45) were 1.5- and 2.2-fold larger than the possible TG (6.39 ± 7.61) and no TG/SB (4.22 ± 6.15) groups, respectively. A significant but weak correlation (r = 0.14 to 0.19) was found between the number of positive responses for TG/SB and OHIP-14 severity scores. CONCLUSIONS: A high prevalence of possible TG and SB was found among the Asian cohort studied. Possible TG and SB were significantly associated with poorer OHRQoL. The physical pain, psychologic discomfort, and psychologic disability domains were most influenced by TG/SB. More epidemiologic studies on the functional, physical, and psychosocial influences of SB are required.

Factors affecting dental service utilisation among older Singaporeans eligible for subsidized dental care - a qualitative study.

BACKGROUND: The World Health Organization has highlighted the paucity of research into the oral health needs of older adults. In Singapore, until recently, publically funded/subsidized oral health care for adults has been limited to basic primary care at government-funded polyclinics. Access to a more comprehensive range of subsidized care in the private sector was widened through the government-funded Community Health Assistance Scheme (CHAS) in 2012 and Pioneer Generation (PG) scheme in 2015. Little is known about the attitude to dental service utilization among older adults in Singapore since then. METHODS: We conducted semi-structured individual interviews with 25 participants above 65 years of age who were eligible for subsidized dental care plans. Participants were recruited from a public teaching hospital and a public primary care clinic in Singapore. The duration of each interview was 15-30 min. Interviews were transcribed verbatim and the transcripts were analyzed thematically using a phenomenological approach. RESULTS: Pertinent themes emerged related to four major areas: (a) general awareness towards oral health, (b) life course perspective of oral health, (c) barriers to visit the dentist, (d) shaping dental service utilisation behaviours through provision of financial subsidies for dental care. Most participants perceived a strong relationship between oral health and systemic health. However, there were erroneous traditional beliefs such as oral health is not part of physical health and edentulous participants did not need to visit a dentist. Fear, anxiety, previous negative experience and lack of knowledge were barriers to visiting the dentist. Trust and convenience were considerations for patients when deciding whether to switch from public to private dental services where CHAS/PG were only available. CONCLUSION: Our study provided important insights regarding oral health perceptions and beliefs of older people residing in the community which may affect their dental service utilization. This further highlights the importance of understanding the concerns of this group when implementing healthcare policies for elderly in Singapore. The findings of our study will serve as a baseline for future studies in Singapore and inform studies in other countries that implement targeted schemes for older adults.

Minimal intervention dentistry for partially dentate older adults.

BACKGROUND: Chronic dental and oral diseases, such as dental caries and periodontal disease, continue to be a significant health problem among older adults. Given the rapidly changing profile of the ageing population, and their complex health needs, there is a need to develop new evidence-based approaches to oral health care. Recently, care philosophies have been developed that take a minimally invasive, functionally oriented, approach to oral health care with a focus on providing a reduced, but healthy, natural dentition which can be maintained with support of better oral hygiene. METHOD: A review of the literature concerning use of minimal intervention dentistry (MID) to manage caries and toothloss in partially dentate older adults was undertaken. RESULTS: A variety of chemotherapeutic agents are available to prevent development of root caries and/or arrest root caries lesions, with professionally applied solutions (ie 22 500 NaF, 38% SDF or 40% CHX) every 3 to 6 months demonstrating best outcomes. Application of 38% SDF annually in high-risk, institutionalised older adults is effective in arresting root caries. Atraumatic restorative treatment can be used successfully to manage active carious lesions and limit the removal of natural tooth tissue. Finally, functionally oriented treatment planning to manage partial toothloss is successful in terms of quality of life impact and cost-effectiveness. CONCLUSION: Available evidence is somewhat limited and more long-term studies are need. However, currently available evidence suggests that minimal intervention dentistry can be predictable and cost-effective in older adults.

Associations between symptoms of temporomandibular disorders, quality of life and psychological states in Asian Military Personnel.

BACKGROUND: Symptoms of Temporomandibular Disorders (TMD) could affect oral health-related quality of life (OHRQoL) and psychological distress. OBJECTIVE: This study aims to determine the prevalence of TMD symptoms, and impact of type and number of TMD symptoms on OHRQoL and psychological states among Asian military personnel. METHOD: The study was conducted across 12 military dental centres using self-administered questionnaire comprising demographical data, DC/TMD symptom questionnaire, OHIP-14 and DASS-21. A total of 3028 personnel, aged between 18-65 years old, were invited to participate with an acceptance rate of 90.5%. Data analysis was done using non-parametric tests, regression analysis and Spearman correlation (P < 0.05). RESULTS: Out of 2043 subjects (1998 males; 45 females, mean age 24.18 ± 7.18 years), 36.32% (n = 742) reported at least one TMD symptom. Significant differences in summary OHIP-14, depression, anxiety and stress scores were observed between subjects with and without TMD symptoms. Significant differences in OHIP-14 and DASS-21 scores were observed between dissimilar type and number of TMD symptoms in the TMD group. Those with headaches and 2-3 symptoms have substantially poorer OHRQoL and greater psychological distress. Associations between number of TMD symptoms, quality of life, depression, anxiety and stress were significant but weak (r = 0.19-0.40). CONCLUSIONS: Symptoms of Temporomandibular Disorders were prevalent among Asian military population. Significant differences in OHRQoL and psychological states were observed between subjects with and without TMD symptoms. Specific type and number of TMD symptoms impacted OHRQoL and psychological states differently. Associations between number of TMD symptoms and quality of life, depression, anxiety and stress were significant but weak.

Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up.

OBJECTIVE: This randomised clinical trial aimed to compare the impact of two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept, on Oral Health-related Quality of Life (OHrQOL). METHODS: 89 patients completed a randomised clinical trial. Patients were recruited in two centres: Cork University Dental Hospital (CUDH) and a Geriatric Day Hospital (SFDH). 44 patients were randomly allocated to the RPD group and 45 to the SDA group where adhesive bridgework was used to provide 10 pairs of occluding contacts. The impact of treatment on OHrQOL was used as the primary outcome measure. Each patient completed the Oral Health Impact Profile (OHIP-14) at baseline, 1, 6, 12 and 24 months after treatment. RESULTS: Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). For the SDA group OHIP-14 scores improved by 8.0 scale points at 12 months (p<0.001) and 5.9 scale points at 24 months (p<0.05). For the RPD group OHIP-14 scores improved by 5.7 scale points at 12 months (p<0.05) and 4.2 scale points at 24 months (p<0.05). Analysis using ANCOVA showed that there were significant between group differences recorded in both treatment centres. 24 months after intervention the SDA group recorded better OHIP-14 scores by an average of 2.9 points in CUDH (p<0.0001) and by an average of 7.9 points in SFDH (p<0.0001) compared to the RPD group. CONCLUSIONS: Patients in the SDA group maintained their improvements in OHrQOL scores throughout the 24 month study period. For the RPD group the initial improvement in OHrQOL score began to diminish after 6 months, particularly for those treated in SFDH. Thus, the benefits of functionally orientated treatment increased over time, particularly for the older, more systemically unwell cohort in SFDH.

Incidence, Prevalence and Global Distribution of Root Caries.

High quality epidemiological data are essential for both the development of national oral health policies and cost-effective targeting of resources. Unfortunately, a high level of clinical heterogeneity between studies in this area makes it difficult, and inappropriate, to try to produce any definitive figures on the global prevalence or incidence of root caries. Published studies have reported wide ranges for the prevalence of root caries (25-100%) and the mean Root Caries Index (9.7-38.7). The reported range for annual root caries incidence is also wide, from 10.1 to 40.6%. While more research is needed in this area, most studies conclude that the burden of root caries is high in the older age population.

Etiology, Risk Factors and Groups of Risk.

Population aging and the concomitant reduction in tooth loss will have a profound effect on dentistry. In particular, an increase in the prevalence of root caries can be expected. Root caries is not evenly distributed across the population and identification of high-risk groups or individuals would facilitate targeted prevention strategies. Unfortunately, the lack of consensus in the literature on the diagnosis and measurement of root caries makes comparison of studies extremely challenging. At present, we do not have an adequately validated risk assessment tool for root caries. Future research should focus resources on investigating risk indicators, which have been found to be significant in past studies and on externally validating previously described risk models.