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PubMed1986

Judging severity of dental problems in relation to other individual problems.

The methods of paired comparisons and direct ranking were applied to the study of the relative severity of three dental problems and nine problems concerning general health, material affairs, and psychologic well-being. Subjects (n = 51) were men and women, psychology freshmen. Direct ranking and paired comparison resulted in highly comparable overall orderings of the 12 problems. It appeared that all subjects were consistent in their comparative pairwise choices. Agreement between judges was statistically significant also, but the results indicated large individual differences. Subjects judge the severity of the three dental problems to be less than the severity of the other problems. There were no significant differences between the judged severity of the three dental problems among themselves. In the discussion several possibilities for future research are mentioned.

Anxiety↗
PubMed1987

Spontaneous recall as an indicator of the impact of dental complaints.

A hypothesis was developed that the impact or importance of oral health problems may be reflected in a person's ability to remember these problems occurring in a given period spontaneously. That means that the recollection should occur on a nonspecific stimulant, i.e. a general question regarding recall of health problems. This hypothesis was first tested on existing data. A representative sample (n = 1622) of the Dutch population was asked to list all the health problems they had experienced the preceding year. Only 13 persons mentioned an oral health problem. From more specific questions on dental matters it appeared that about 15% of the sample had experienced oral health problems in this period. One hundred and forty-six respondents indeed had received dental care because of acute pain. These data indicate that the impact of oral health problems on a person's daily life is small. Otherwise the oral health problem would have been mentioned spontaneously more often. Three possible explanations for this phenomenon are discussed.

Adolescent↗
PubMed1990

Dental treatment demands among patients in Tanzania.

The dental treatment demands of 824 patients attending regional dental clinics were recorded. Overall 86% of the patients sought treatment for pain, ranging from 77% to 97% in the different clinics. Caries was the main cause of pain. The proportion of patients with demands for aesthetics was 5%, prosthetics 2%, and check up 3%. The data indicated a need for emergency care. The type of curative treatment needed, mainly extractions, could well be performed by dental auxiliaries. Since the data was collected from patients among whom many visited the clinics in the late stages of painful oral diseases, it is assumed that it reflects only the tip of an iceberg that represents a much larger dormant demand (want) for emergency care among the population. Any strategy aiming to be effective in improving oral health should at least meet the emergency dental needs of the population. Consequently there is a definite need of data on dental treatment demands and wants for adequate planning of dental health care systems in their infancy in countries with limited financial resources.

Adolescent↗
PubMed1990

Patients' retrospective preference for extraction of asymptomatic third molars.

The purpose of this study was to determine the personal utility of asymptomatic third molar removal in military patients. From 1 to 30 days (mean = 7.4) after the extraction of one or more third molars, 100 returning patients (all male, mean age = 20.1) were asked to respond to hypothetical questions concerning the extraction of asymptomatic third molars. If the likelihood of third molars ever having to be removed was given as 10%, 50%, and 100%, then 45%, 61%, and 88% of responses, respectively, showed preference for immediate extraction. When respondents chose to delay treatment until there was a problem, no likelihood group would tolerate more than 2.77 additional days of post-extraction pain before changing their preference to immediate extraction. 87% of respondents preferred extractions prior to a deployment which would make treatment delivery difficult, and 89% prior to becoming a civilian at which time treatment might no longer be free. The results indicate general acceptance of the strategy of prophylactic third molar removal among a sample of military patients who have undergone pre-treatment counseling and the surgical procedure. A question remains as to the personal utility that might be measured prior to surgery.

Adult↗
PubMed1993

Attitudes and perceptions of adults towards orthodontic treatment in an Asian community.

A retrospective survey of 358 local Chinese adult orthodontic patients was undertaken to determine the motivating factors behind orthodontic treatment and the discomfort caused by fixed orthodontic appliances. From the completed questionnaires of 203 patients, the principal conclusions were that the improvement in dento-facial aesthetics following orthodontic treatment enhanced their self-confidence and self-esteem in a majority of patients; discomfort in oral soft tissues and teeth were transient and did not exceed 7 days; transient pain from teeth was experienced by 91% of patients and in 39% of these patients the discomfort to teeth was experienced with each new archwire or elastic force application. These results may be useful in relating discomfort levels to prospective orthodontic patients. It was also evident in the study that several cross-cultural differences existed in the attitudes of our patients compared to those reported in Caucasians.

Adolescent↗
PubMed1993

Perceived need and use of oral health services among adolescents and adults in Tanzania.

The perceived need and use of oral health services among adolescents and adults in Tanzania were studied. One region from each of the country's five zones was chosen at random. Final sample selection (n = 1061) was done in the main towns of the selected regions. Participants were interviewed using a structured questionnaire which dealt with perceived need for dental treatment and use of oral health services and several demographic variables. Frequency tables were computed and analyzed. Odds ratios were calculated based on 2 x 2 tables and logistic regression models. The majority, 82% (95% CI: 79-85%) had sought treatment due to pain or for tooth extraction. Perceived need, dissatisfaction with own oral health status and use of oral health services were slightly more frequent among women. Bleeding gums had no explanatory value on the dependent variables. The strongest explanatory variable in a logistic regression model for perceived need and dissatisfaction with own oral health status was previous dental treatment with an estimated odds ratio of 6.4 (95% CI: 4.7-8.7) and 7.2 (95% CI: 5.3-9.9), respectively. People living nearest a treatment facility tended to use the services more [odds ratio 1.3 (95% CI: 0.8-2.1)]. A very strong relation between previous dental problems and use of oral health services was found, namely an odds ratio of 68.8 (95% CI: 39.0-121.4). The findings in the study may be useful in the attempts to implement Tanzania's National Plan for Oral Health.

Adolescent↗
PubMed1995

Perception of dental and other individual problems: adolescents versus young adults.

The importance of dental problems in comparison with general health problems and psychological problems was judged by 642 adolescents. The methods used were paired comparison and direct ranking of nine stimuli. Adolescents were quite consistent in their choices. The agreement within the group was statistically significant. Adolescents judged dental problems as less important than general health problems and as more important than psychological problems. The correlation between the methods of paired comparison and direct ranking was high. The results were compared retrospectively with findings from a study of 51 older subjects. Adolescents and adults did not differ much from each other except for the ordering of the nine problems. Adults ranked dental problems as the least important.

Adolescent↗
PubMed1996

Trends and fluctuations in the impact of oral conditions among older adults during a one year period.

While longitudinal epidemiological studies document the rate of disease progression in populations, it is not known how people's lives are affected by oral conditions over a period of time. This study aimed to describe patterns of change in the reported impact of oral conditions among community-dwelling persons aged 61+ years in South Australia. A self-complete questionnaire, the Oral Health Impact Profile, obtained data about 49 impacts of oral conditions on everyday activities. Questionnaires were issued to 90 people once a month for 12 months and 67 people provided usable responses for at least nine months. The number of reported impacts per month formed the dependent variable for analyzing patterns of change. An increase or decrease of at least two impacts from one month to the next was categorized as a fluctuation. Year-long trends of increase or decrease in at least two impacts were identified using linear regression. Most people (86.5 per cent) experienced no trend, although nearly one half of them reported fluctuations in at least one month. Trends were more likely among denture wearers and people with 16+ missing teeth (P < 0.05), although the associations were confounded by initial impact scores which were higher for both groups. Impacts concerning eating and oral pain were subject to the greatest amount of change. The findings demonstrate that many older adults experience short-term impacts of oral conditions during longer periods of temporal stability in perceived impact of oral health.

Aged↗
PubMed1996

Survey of reasons for extraction of permanent teeth in Italy.

The purpose of the study is to collect information on the reasons given by dentists, randomly selected from the Italian Dental and Maxillo-Facial Association's, for extracting permanent teeth in Italy. From the 164 dentists responding, 1056 teeth in 839 patients were extracted during two weeks of working activity. More than two-thirds of the teeth were extracted for dental caries (34.4%) and periodontal disease (33.1%). The mean number of teeth extracted per patient showed a significant increasing trend with increasing age, being 1.09 in those from 16 to 39 yr, 1.25 in the 40-59-yr-old group, to 1.54 in those over 59 yr of age (F = 21.44; P < 0.0001). The third molar was the most frequently extracted tooth and 41.3% were removed due to impaction reasons, in particular from the mandible. The first and second molars and the premolars were extracted most often because of caries; more than half of the incisors and the canines were extracted for periodontal reasons; the majority of the teeth removed for prosthetic reasons, 57.1%, were incisors and canines, especially in the mandible; of the teeth extracted for orthodontic reasons, 47.4% were first and second premolars. The prevalence of subjects with at least one tooth extracted for dental caries and for orthodontic reasons were respectively significantly higher in the irregular than the regular attenders (chi-square = 46.55; P < 0.0001), and in the regular than the irregular dental attenders (chi-square = 63.12; P < 0.0001). Dental practitioners should promote targeted initiatives for prevention and treatment of diseases in order to reduce in particular the incidence of tooth extraction because of caries and periodontal disease.

Adolescent↗
PubMed1997

Oral disadvantage among dentate adults.

Oral disadvantage can be defined as the avoidance of certain daily activities because of decrements in oral health. These decrements include oral disease and tissue damage, pain, and functional limitation. The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least 1 tooth, were 45 years old or older, and who participated for an interview and clinical examination. Three objectives of the FDCS are: (1) to describe selected psychometric properties of the measurement of oral disadvantage; (2) to describe oral disadvantage in a diverse sample of dentate adults; and (3) to describe the relationship between disadvantage and other aspects of oral health, such as disease/tissue damage, pain, and functional limitation. The prevalence of oral disadvantage within the previous 6 months, using eight self-reported measures, ranged from 5% to 25%, depending upon the measure. Factor analysis suggested that oral disadvantage is best described as three factors: disadvantage due to (1) oral disease/tissue damage, (2) oral pain, and (3) oral functional limitation. Irregular dental attenders, poor persons, and blacks had the highest prevalence of oral disadvantage. Clinical measures of oral disease/tissue damage, self-reported measures of oral disease/tissue damage, oral pain, and oral functional limitation were strongly associated with the presence of oral disadvantage. In multivariate analyses that accounted for differences in clinical measures of disease/tissue damage, self-reported disease/tissue damage, oral pain, and oral functional limitation, females were more likely to report disadvantage due to disease/tissue damage, and middle-aged persons and irregular dental attenders were more likely to report oral disadvantage due to pain. In these same regressions, differences in disadvantage due to race, poverty status, socioeconomic status, and rural/urban area of residence were not evident. These results have implications regarding the use of oral disadvantage to assess the long-term effectiveness of dental care.

Activities of Daily Living↗
PubMed1998

Issues in measuring change in self-perceived oral health status.

An important goal of a health care intervention or system is to improve the health of an individual or a population. The challenge for health services research is to measure and explain this change. However, the issue of how changes in health status should be defined and measured has been given relatively little attention. This paper draws on the rather sparse literature to examine some issues involved in measuring changes in oral health status and illustrates these using data from a longitudinal study of the oral health of older adults. The paper draws a distinction between quantitative and qualitative change and the challenges involved with each. Four different ways of assessing change are reviewed and their strengths and weaknesses highlighted. Global transition judgements, although relatively simple measures of change, incorporate patients' values and avoid the statistical problems associated with measures such as change scores. Nevertheless, the measurement of change in oral health status is complex and controversial and no approach is universally accepted. Consequently, the decision as to which strategy to adopt is far from simple.

Aged↗
PubMed2004

Reliability and validity of the Dental Satisfaction Questionnaire in a population of 23-year-olds in Norway.

OBJECTIVE: The aim of this study was to explore the internal structure, reliability, and construct validity of the Dental Satisfaction Questionnaire (DSQ) in a population of young adults in Norway. METHODS: The DSQ scale was mailed to a representative sample of 968 subjects aged 23 years in two Norwegian counties. The reliability assessment of the instrument was based on internal consistency analysis (Cronbach's alpha). A factor analysis (principal component) was used to confirm the internal structure of the scale. The construct validity of the DSQ was indicated by: (i) its correlation with the patients' beliefs regarding the way dentists deliver care, indexed by the Dental Beliefs Survey (DBS); and (ii) differences in DSQ scores between subjects who had dropped out from dental care at the age of 23 years and regular attenders. RESULTS: The response rate was 69%. The alpha (Cronbach's) coefficient for the overall construct of DSQ was 0.81 (n = 655), and 0.65 or more for the subscales pain management, quality, and access. The correlation coefficient between the sum-scores of DSQ and DBS for the entire sample was r = -0.69. Subjects in the dropout group had significantly lower satisfaction with dental care than the rest of the group (P < 0.001). CONCLUSIONS: This study generally confirms the structure of the DSQ instrument and indicates that it is a reliable and valid instrument in cultures other than the one for which it was previously tested.

Adult↗
PubMed2004

An assessment of the validity and reliability of dental self-report items used in a National Child Nutrition Survey.

OBJECTIVES: To examine the clinical validity and reliability of dental self-report items used in a National Child Nutrition Survey. METHODS: The study involved completion of dental self-report questionnaires by 6-9-year-old children who attended one of the three schools with ethnic distributions, similar to schools in the national survey, and their care-givers. Children were then dentally examined. RESULTS: Two hundred and four children (response rate 74.2%) returned questionnaires and were dentally examined. The highest degree of child and care-giver concordance for the self-reported dental items was for the "has had an extraction due to dental caries" item (kappa = 0.92), while the lowest was for the "brushes twice or more per day" item (kappa = 0.61). The prevalence of dental caries in the deciduous dentition was 67.6%. The mean dfs, mean DFS and mean number of missing primary teeth because of caries were 6.15 (SD 6.51), 0.83 (SD 1.28) and 0.30 (SD 0.82), respectively. Caries severity was higher in children who reported brushing infrequently, having received a filling, having had an extraction because of caries, having been kept awake at night because of dental pain or having had a general anaesthetic for dental treatment. Values for self-report and clinical reliability were above 0.80 in all instances. CONCLUSIONS: The dental self-report items showed a high level of concordance between child and care-giver, and appeared to be clinically valid. The findings suggest that using dental self-report measures for children may be valuable in dental epidemiological investigations.

Analysis of Variance↗
PubMed2006

Assessing oral health-related quality of life in general dental practice in Scotland: validation of the OHIP-14.

OBJECTIVES: To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice. METHODS: Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals. RESULTS: A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients. CONCLUSIONS: The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.

Adolescent↗
PubMed2006

Oral health-related quality of life and periodontal status.

BACKGROUND: As patient-centered approaches become more popular, increasing attention is being given to assess the effects of various human health situations on an individual's overall quality of life (QoL). Measures have been used in dentistry to study the effects of orthodontic treatment and oral surgery, but so far little has been reported about the effects of periodontal disease. OBJECTIVE: This study assessed the impact of periodontal health status on QoL. METHODS: A subsample of 767 subjects were selected from a community study (n=1000) which investigated the association between psychological factors and clinical periodontal attachment level (CAL). The sample included subjects with full-mouth mean CAL 3 mm (high/severe periodontal attachment loss group). The subjects were requested to complete the Chinese short-form version of Oral Health Impact Profile (OHIP-14S) and a checklist of self-reported periodontal symptoms during the previous 12 months. RESULTS: A total of 727 subjects (95%) completed the questionnaire. The OHIP-14S and subscale scores were significantly associated with six of seven of the self-reported periodontal symptoms. A comparison of the mean OHIP-14S scores of the healthy/low and the high/severe periodontal attachment loss groups revealed significant differences in respect of the subscales of functional limitation, physical pain, psychological discomfort, physical and psychological disabilities. CONCLUSION: This study demonstrates a significant association between oral health-related QoL and periodontal disease.

Adult↗
PubMed2005

Vascular status in human primary and permanent teeth in health and disease.

The present study sought to compare the vascular status of human primary teeth with that of human permanent teeth, and to determine whether caries or painful pulpitis was associated with changes in vascularity. Coronal pulps were removed from 62 primary and 62 permanent mandibular molars with a known pain history. Teeth were categorized as intact, moderately carious or grossly carious. Pulp sections were labelled with Ulex europaeus I lectin (UEIL), which is a marker of human vascular endothelium. Image analysis was then used to quantify the percentage area of UEIL-labelled tissue (vascularity) and the number of blood vessels present within three regions: the pulp horn, the subodontoblastic region, and the mid-coronal pulp. Only the mid-coronal region of the primary tooth pulp was found to be significantly more vascular than the corresponding area of the permanent tooth pulp. Both dentitions showed a significant increase in vascularity within the pulp horn region with caries progression, but this was not accompanied by an increase in vessel number. There was no correlation between vascularity and pain symptoms. These findings suggest that the primary tooth pulp is more vascular than its successor within the mid-coronal region. However, the functional and clinical significance of this finding remains speculative.

Adolescent↗