Oral health-related quality of life of older adults living in long-term care facilities and its association with dental prosthesis use and condition / Qualidade de vida relacionada à saúde bucal de idosos residentes em instituições de longa permanência: associação com o uso e condição da prótese

OBJECTIVE: This cross-sectional study aimed to evaluate the association of oral health-related quality of life with prosthetic rehabilitation status and dental prosthesis condition in residents of Brazilian long-term care facilities. METHODS: The oral health-related quality of life of older adults (n = 194; mean [standard deviation] age = 78.93 [9.10]) was assessed by the Geriatric Oral Health Assessment Index and the Oral Health Impact Profile questionnaires. Prosthetic rehabilitation status was recorded according to the absence of teeth and use of dental prostheses. Dental prosthesis condition was considered good or poor based on stability, retention, occlusion, vertical dimension, and defects. Poisson regression models were plotted to analyze the data (α = 0.05). RESULTS: Lower Geriatric Oral Health Assessment Index scores were associated with edentulism with denture use only on one jaw (B = -0.05) and poor dental prosthesis stability (B = -0.04). Similarly, edentulous participants with denture only on one jaw (B = 0.59) and those wearing dental prostheses with poor stability (B = 0.36) are more likely to achieve higher Oral Health Impact Profile scores. Also, lower Oral Health Impact Profile scores were associated with denture defects (B = -0.34). CONCLUSION: In summary, the oral health-related quality of life of older adults living in long-term care facilities is negatively impacted by edentulism with denture only on one jaw and use of dental prostheses with poor stability. Therefore, long-term care facilities should provide oral health training to caregivers, include dental professionals in the staff, and articulate demands with oral health teams in the primary care system. (AU)

OBJETIVO: Este estudo transversal objetivou avaliar a associação da qualidade de vida relacionada à saúde bucal com o status de reabilitação protética e a condição da prótese em residentes de instituições de longa permanência no Brasil. METODOLOGIA: A qualidade de vida relacionada à saúde bucal dos idosos (n = 194; média [desvio padrão] idade = 78,93 [9,10]) foi avaliada pelos questionários Geriatric Oral Health Assessment Index e Oral Health Impact Profile. O status de reabilitação protética foi registrado de acordo com a ausência de dentes e uso de próteses dentárias. A condição da prótese foi considerada boa ou ruim com base na estabilidade, retenção, oclusão, dimensão vertical e defeitos. Modelos de regressão de Poisson foram plotados para analisar os dados (α = 0,05). RESULTADOS: Como resultado, menores escores no Geriatric Oral Health Assessment Index foram associados ao edentulismo com o uso de dentadura em apenas uma arcada (B = -0,05) e ao uso de próteses com estabilidade ruim (B = -0,04). De forma similar, participantes edêntulos que usavam dentadura em apenas uma arcada (B = 0,59) e aqueles que portavam prótese com estabilidade ruim (B = 0,36) são mais propensos a ter maiores escores no Oral Health Impact Profile. Além disso, menores escores no Oral Health Impact Profile foram associados a defeitos na prótese (B = -0,34). CONCLUSÃO: Sumarizando, a qualidade de vida relacionada à saúde bucal de idosos residentes em instituições de longa permanência é negativamente impactada pelo edentulismo com o uso de dentadura em apenas uma arcada e uso de prótese com estabilidade ruim. Assim, instituições de longa permanência devem promover capacitação em saúde bucal aos cuidadores, incluir dentistas no quadro de funcionários e articular com as equipes de saúde bucal da Atenção Primária à Saúde. (AU)

Prosthetic rehabilitation with removable dentures positively influences quality of life in older patients: a systematic review / A reabilitação protética com próteses removíveis influencia positivamente a qualidade de vida de pacientes idosos: uma revisão sistemática

OBJECTIVE: This systematic review assessed the effects of prosthetic rehabilitation with removable dentures on oral health-related quality of life (OHRQoL) in older adults. METHODS: A comprehensive electronic search was conducted in the PubMed/MEDLINE, Web of Science, and Cochrane databases to identify randomized clinical trials and prospective clinical studies. The included studies evaluated the effects of prosthetic rehabilitation on OHRQoL in patients whose mean age was > 60 years. The interventions included complete dentures, implant-retained overdentures, and removable partial prostheses, with a minimum follow-up period of 1 month after prosthetic rehabilitation. Patient-reported outcome measures, specifically OHRQoL, were the primary outcome. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized clinical trials and the ROBINS-I tool for prospective clinical studies. RESULTS: Eleven articles were considered eligible for the systematic review. The findings indicated that removable dentures improved various OHRQoL domains, mainly functional limitations and physical and psychological disabilities. Retention, stability, comfort, speech, and masticatory efficiency were significantly better with implant overdentures than complete dentures, leading to higher patient satisfaction and OHRQoL. CONCLUSIONS: This systematic review suggests that prosthetic rehabilitation with removable dentures has a positive influence on OHRQoL in older patients. The findings highlight the beneficial impact of implant overdentures and fixed adhesive prostheses for enhancing functional outcomes and patient satisfaction.

OBJETIVO: Esta revisão sistemática avaliou os efeitos da reabilitação protética com próteses removíveis na qualidade de vida relacionada à saúde bucal (QVRSB) em pacientes idosos. METODOLOGIA: Foi realizada uma pesquisa eletrônica abrangente nas bases de dados United States National Library of Medicine/ Medical Literature Analysis and Retrieval System Online ­ PubMed/MEDLINE, Web of Science e Cochrane para identificar ensaios clínicos randomizados (ECR) e estudos clínicos prospectivos. Os artigos selecionados tiveram como foco avaliar o efeito da reabilitação protética na QVRSB em indivíduos com média de idade superior a 60 anos. As intervenções descritas incluíram próteses totais, overdentures suportadas por implantes e próteses parciais removíveis, com acompanhamento mínimo de um mês após a reabilitação protética. As medidas de resultados relatadas pelos pacientes, especificamente QVRSB, foram o desfecho primário. O risco de viés foi avaliado com a ferramenta Cochrane RoB 2 pare ensaios clínicos randomizados e a ferramenta ROBINS-I para estudos clínicos prospectivos. RESULTADOS: Os resultados mostraram que as próteses dentárias removíveis melhoraram vários domínios da QVRSB, principalmente limitações funcionais e físicas e deficiências psicológicas. A retenção, estabilidade, conforto, fala e eficiência mastigatória foram significativamente melhores com overdentures sobre implantes do que com próteses totais, levando a maior satisfação do paciente e QVRSB. CONCLUSÕES: Esta revisão sistemática sugere uma influência positiva da reabilitação protética com próteses removíveis na QVRSB em pacientes idosos. As descobertas destacam o impacto benéfico das overdentures sobre implantes e das próteses adesivas fixas para melhorar os resultados funcionais e a satisfação do paciente

Using Item Response Theory to evaluate the psychometric characteristics of questions in a Brazilian programme and the performance of dental teams in primary care.

OBJECTIVES: First, to assess the psychometric properties of key questions included in a public sector evaluation of primary dental care in Brazil; and second, to evaluate the performance of dental teams in relation to these items. METHODS: Secondary analysis of a national primary care dataset monitoring quality and access to dental care. Data were collected through face-to-face interviews with representatives of dental teams participating in the 'National Programme for Improving Access and Quality of Primary Care'. Twenty-three mandatory questions about the dentists' reported delivery of dental procedures were included in the analysis. Item Response Theory (IRT) modelling was applied to measure the psychometric properties of the instrument-level of difficulty and discrimination parameter of each item-and then to estimate dental team performance scores based on these parameters. Based on IRT, possible scores ranged from -4 to +4. RESULTS: Three of the 23 mandatory items were removed due to poor internal consistency, resulting in a scale of 20 items for assessing dental team performance. The results showed variation in procedures delivered by the dental teams; whilst more than a half of the procedures were executed by at least 80% of the dental teams, those relating to dentures (partial/total) and frenectomy (lingual/labial) were performed by less than 30%. Amongst the 20 items included in the model, those related to partial/total dentures and oral cancer follow-up presented higher levels of difficulty and were less frequently provided. The items relating to the treatment of deciduous teeth and access to the dental pulp of permanent teeth had the highest discrimination parameters and, consequently, greater weight in the performance's score estimation; therefore, dental teams that did not perform these items had the lowest performance scores. In the present study, dental team performance scores ranged from -3.66 to +1.87 with a mean/median of -0.06/+0.01. CONCLUSION: The findings suggest that whilst the items within the instrument demonstrated some potential to discriminate between poor and very poor teams, they were ineffective in discriminating between poor and good teams. Whilst Brazilian dental teams perform many mandatory procedures, variation in the nature of their delivery of care requires further investigation to enhance service provision to the population.

Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency.

The aim of this non-randomized controlled clinical trial was to evaluate the oral health-related quality of life and masticatory efficiency of patients rehabilitated with mandibular two-implant overdentures with immediate loading or conventional dentures. Fifty completely edentulous patients wearing bimaxillary conventional dentures, for at least one year, were recruited. The patients were then assigned to either two treatment groups: mandibular overdentures supported by two implants with bar-clip system and a maxillary conventional denture (n = 25), and new maxillary and mandibular conventional complete dentures (n = 25). Masticatory efficiency and oral health-related quality of life were assessed before and 3 months after denture insertion. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral health-related quality of life. Masticatory efficiency was evaluated with chewing capsules through a colorimetric method. The results revealed fewer oral health-related quality of life problems in patients wearing mandibular two-implant overdentures compared to the conventional dentures group. In addition, the implant overdenture group presented statistically significant improvement in masticatory efficiency (p = 0.001). There was no correlation between masticatory efficiency and OHIP in the implant group (p > 0.05), however a correlation was found in the conventional denture group (p < 0.05). Therefore, these short-term results suggest that mandibular overdenture retained by 2 implants with immediate loading combined with maxillary conventional dentures provide better masticatory efficiency and oral health-related quality of life than mandibular conventional dentures.

Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency

Abstract The aim of this non-randomized controlled clinical trial was to evaluate the oral health-related quality of life and masticatory efficiency of patients rehabilitated with mandibular two-implant overdentures with immediate loading or conventional dentures. Fifty completely edentulous patients wearing bimaxillary conventional dentures, for at least one year, were recruited. The patients were then assigned to either two treatment groups: mandibular overdentures supported by two implants with bar-clip system and a maxillary conventional denture (n = 25), and new maxillary and mandibular conventional complete dentures (n = 25). Masticatory efficiency and oral health-related quality of life were assessed before and 3 months after denture insertion. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral health-related quality of life. Masticatory efficiency was evaluated with chewing capsules through a colorimetric method. The results revealed fewer oral health-related quality of life problems in patients wearing mandibular two-implant overdentures compared to the conventional dentures group. In addition, the implant overdenture group presented statistically significant improvement in masticatory efficiency (p = 0.001). There was no correlation between masticatory efficiency and OHIP in the implant group (p > 0.05), however a correlation was found in the conventional denture group (p < 0.05). Therefore, these short-term results suggest that mandibular overdenture retained by 2 implants with immediate loading combined with maxillary conventional dentures provide better masticatory efficiency and oral health-related quality of life than mandibular conventional dentures.

Validation of the Spanish version of the Oral Health Impact Profile (OHIP-14Sp) in elderly Chileans.

BACKGROUND: The OHIP-49 is widely used to assess oral health-related quality of life, but its length makes it time-consuming and difficult to use. An abbreviated version of the OHIP-49 with fourteen items has been validated for older adults, but not in Chile. The aim was to develop and validate the Spanish version of the OHIP-14 in an elderly Chilean population. METHODS: Two studies were conducted; a cross sectional to develop and a retrospective study to validate the OHIP-14Sp. The OHIP-49Sp was applied to 490 older adults and the fourteen questions with the higher impact on oral health-related quality of life were selected through linear regression. These items were applied on a retrospective dataset of 85 older adults to test internal consistency (Cronbach's alpha). A discriminative validity analysis was performed along with the assessment of sociodemographic (age and gender, educational level) and clinical variables (number of teeth, caries lesions, CPITN, prosthetic needs and prosthetic functionality). Data were analyzed using Mann-Whitney U, Student's t and one-way ANOVA tests with a 95% confidence level and finally were analyzed by a Multivariate Logistic Regression Model. RESULTS: High internal consistency values were obtained for the OHIP-14Sp instrument (0.91). There was an association between the OHIP-14Sp scores and the presence of caries (p = 0.003), need for complex periodontal treatment (p = 0.002), prosthetic needs (p < 0.0001) and age younger than 70 years-old (p < 0.0001). Subjects with periodontal treatment need were more likely to report reduced oral health-related quality of life (PR = 2.10). CONCLUSIONS: The OHIP-14Sp proved to be a consistent and valid tool to assess oral health-related quality of life when tested in Chilean older adults.

Oral health-related quality of life of older people from three South American cities.

OBJECTIVE: To describe subjective oral health status and its association with overall health conditions and socioeconomic factors in the elderly (60 years and older) living in the capital cities with the oldest average populations in South America. BACKGROUND: Oral diseases are a public health problem, frequently neglected in older adults. In recent years, the subjective assessment of psychological and social consequences of the problems related to oral health has been valued. One of the instruments used to estimate the Oral Health-Quality of Life is the Geriatric Oral Health Assessment (GOHAI). MATERIAL AND METHODS: Representative samples from SABE study (1999-2000) of Santiago (n = 1301), Buenos Aires (n = 1043), and Montevideo (n = 1450) aged 60 and over community-dwelling people. We assessed OH-QoL (GOHAI), self-reported missing teeth, denture use, and self-rated-health, among other indicators. Logistic regression models(GOHAI < 58) for each city, adjusted by sex and age, were applied. RESULTS: GOHAI average scores were higher in Montevideo (54.8 ± 6.1) than in Buenos Aires (53.1 ± 7.4) and Santiago (49.9 ± 8.6). A pronounced gradient of the oral condition and GOHAI scores were observed within the three-cities. Denture use -less prevalent in Santiago and more common among women- is a protective factor against a poor OH-QoL. CONCLUSION: Socioeconomic inequalities in oral health status and OH-QoL are observed in the three cities. The increasing life expectancy emphasizes the need to integrate prevention and treatment efforts, as a way to improve OH-QoL over the course of a lifetime.

The association between clinical oral health and general quality of life: a population-based study of individuals aged 50-74 in Southern Brazil.

OBJECTIVES: Few studies have assessed the impact that oral health status and prosthetic rehabilitation have on the general quality of life (QoL) of individuals and there is a lack of information about the association between prosthetic status and QoL. Therefore, the objective of this study was to investigate the association between clinical oral health variables and general QoL in individuals aged 50-74 years in Porto Alegre. METHODOLOGY: This cross-sectional study consisted of 720 participants aged between 50 and 74 years residing in three health districts of Porto Alegre, Southern Brazil. They were selected through multistage proportional random sampling. Data were collected through (i) interview using structured questionnaire on demographic data and the World Health Organization Abbreviated Instrument for Quality of Life Assessment (WHOQOL-BREF) to assess QoL, (ii) oral clinical examination using criteria recommended by the World Health Organization (WHO) and the Epidemiological Survey SB/Brazil in 2000. The interviews and clinical examinations were performed at their homes by four pairs of trained and calibrated researchers. The scores of QoL were categorized by their median into low (≤median) and high (>median). The association between outcomes and the factors studied was analysed by Poisson Regression using multiple backward methods, with adjustment for robust variance, and Svyset function scheduled following the stages of the research. RESULTS: The physical domain of WHOQOL-BREF was associated with use of upper prosthesis and educational level. The psychological domain score was related to level of education. The decayed, missing and filled teeth (DMFT), gender and educational level were associated to the social relations domain. In the environment domain, an association with use and need of lower prosthesis, age and educational level was observed. CONCLUSIONS: Clinical oral health variables such as DMFT and use and need of prosthesis were associated with general QoL in this population.

Derivation of the short form of the Oral Health Impact Profile in Spanish (OHIP-EE-14).

BACKGROUND AND OBJECTIVE: The Oral Health Impact Profile is the most frequently used and validated of the Oral Health Quality of Life instruments. Several short versions have been developed; and a validation of the OHIP-49 in Spanish has been published. The objective was to develop the short version of the Oral Health Impact Profile in Spanish (OHIP-EE-14). METHODS: Cross-sectional study. One hundred and thirty-one persons aged ≥60 years attending a social centre for the elderly, residents of a nursing home and persons seeking dental care at a dental school in Mexico City were interviewed and examined. The validity of each of the 49 questions was evaluated, and, to construct the short version, 14 items were selected. The perceived need for dental treatment, number of teeth, presence of coronal caries, root caries, presence of dental plaque and utilisation of removable prosthesis were measured. Internal consistency, repeatability and discriminant validity were calculated. RESULTS: The OHIP-EE-14 was reliable (Cronbach's-α = 0.918, ICC = 0.825). Significant associations were found between OHIP-EE-14 and the number of teeth and perceived need for dental treatment. CONCLUSIONS: The OHIP-EE-14 is a reliable and valid instrument and can be used in subjects aged 60 years and over from Mexico City.

Oral health of institutionalised elderly: a qualitative study of health caregivers' perceptions in Brazil.

OBJECTIVE: The aim of this study was to qualitatively explore caregivers' perceptions of oral health care and factors influencing their work in a public long-term care institution for the elderly in Goiania, Brazil. METHOD: Data were collected from a sample of 10 caregivers using personal in-depth interviews and observation. RESULTS: Caregivers were mainly nurses' aides without training in oral health care. Oral health was associated with access to dental treatment, oral hygiene and use of dentures. Edentulousness, use of inappropriate dentures and appetite loss were perceived as negative images. Procedures used for oral hygiene were toothbrushing, mouth cleaning with a gauze and using a mouthwash. Conflicting priorities in routine care, lack of caregivers' knowledge and the co-operation of the elderly were the main obstacles to satisfactory oral care. CONCLUSION: Oral health care of the elderly was perceived as a burden by caregivers, and did not follow a standard protocol. Caregivers' knowledge and perceptions reinforce the need for education and training in oral health issues.

The prosthetic need WHO index: a comparison between self-perception and professional assessment in an elderly population.

The purpose of this study was to consider the criteria for establishing the need for prosthesis, by comparing the need perceived subjectively by a patient (self-perception) with that assessed by an examiner according to the WHO diagnosis criteria. The proposed domiciliary sample comprised 270 elderly (aged 60 years or older) residents in a municipality in southern Brazil. The interviews and oral examinations were conducted by two dentists following a period of training and calibration. The criteria used conformed to the WHO and FDI standards. Statistical treatment of data included bivariate and multivariate analysis using SPSS 10.0. Only five patients identified the need for a prosthesis when not identified by the examiner. In the case of 172 elderly subjects, there was agreement in the self-perceived and observed treatment needs. The need for prosthesis was found in 93 elderly subjects who did not perceive any need for prosthetic treatment. The multivariate analysis showed that the variables age, gender, residential area and form of service most sought after during their lives were significantly associated with a better self-perception of oral health. The professional criteria based on WHO guidelines differed from the self-perceived need. Elderly male subjects who lived in a rural area and were 70 years of age or more, who did not participate in third age groups, and who had not sought dental services for most of their lives were the least likely to perceive the need for prosthetic treatment, thereby underestimating their oral health needs.

Impacto da prótese dentária total removível na qualidade de vida de idosos em Grupos de convivência de Belo Horizonte- MG / The impact of removable complete dental prostheses on the quality of life among individuals in elderly support Groups in the city of Belo Horizonte- MG, Brasil

Resultados de um recente estudo epidemiológico nacional de saúde bucal revelaram um alto percentual de idosos edêntulos, muitos destes, necessitando de reabilitação protética. O objetivo deste estudo foi avaliar o impacto da reabilitação com próteses totais removíveis na qualidade de vida de idosos, independentes, que participavam de atividades sociais. O universo de estudo foi constituído por idosos que participavam dos Grupos de Convivência conveniados com a Prefeitura de Belo Horizonte (Brasil) em 2004. O cálculo amostral foi feito pelo método de proporção (intervalo de confiança de 95%, erro a de 0,05 e um percentual de impacto de 80%). Depois de ajustado para uma população finita, o tamanho da amostra foi determinado em 245 indivíduos (n=245), proporcionalmente dividido pelas 9 regionais administrativas da cidade...

Results from a recent national epidemiological survey regarding oral health reveal high percentages of elderly with missing teeth, many of whom require prosthetic rehabilitation. The aim of the present study was to assess the impact of removable complete prosthesis rehabilitation on the quality of life of independent elderly individuals who participate in social activities. The present study’s sample was made up of elderly individuals who participated in support Groups sponsored by the City of Belo Horizonte (Brazil) in 2004. The sample calculation was determined by the proportion method (a 95% confidence interval, a α error of 0.05, and an 80% impact proportion). After adjusting to a finite population, the sample size was determined at n = 245, proportionately distributed among the nine administrative districts of the city. Individuals were interviewed at the location of the support Group meetings by a single researcher using the Geriatric Oral Health Assessment Index (GOHAI)...

Assessing perceived potential outcomes of prosthodontic treatment in partial and fully edentulous patients.

The aim was to develop an instrument to measure and to explore the perception of potential outcomes of prosthodontic treatment in partial and fully edentulous patients, including benefits, risks and consequences of non replacement of missing teeth. It was also aimed to assess the influence of clinical and socio-demographic variables on the perception of potential outcomes. Using a two-phase data collection (open-ended and closed-form), a scale was developed containing 41 statements to measure subject's perception scores in a 5-point Likert-type scale (1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree). In the second phase 126 partially or fully edentulous subjects were interviewed. Influence of age, gender and clinical variables on perceived outcomes were tested using one-way anova, independent t-test and two-way anova (general linear model). Respondents' mean age was 51.8 years (s.d.=12.3), and 74% were female. Cronbach's alpha coefficient of the scale and subscales ranged from 0.70 to 0.90. Patients' mean scores ranged from 2.37 to 4.88 (mean=4.25; s.d.=0.65), indicating that subjects tended to agree with the proposed affirmatives (scores 4 and 5). Perception scores were influenced by age, gender, edentulous spaces and use of prosthodontics. Older subjects, female, those with higher number of missing teeth and who have been previously treated had greater perception of benefits and risks of prosthodontic treatment. It was concluded that the proposed instrument was suitable for measuring subjects' perception of potential outcomes of prosthodontic treatment.

An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students.

OBJECTIVE: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students. DESIGN: Cross-cultural survey of dental students. SETTING: 18 cultural areas. PARTICIPANTS AND METHODS: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions. RESULTS: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001). CONCLUSIONS: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.