Chronic Oral Mucosal Condition Research Articles

Quality of Life in Patients with Chronic Oral Mucosal Conditions: A Qualitative Research

Objective: To use qualitative research methods to evaluate the experiences of patients with chronic oral diseases. Material and Methods: Purposive sampling was used to recruit patients from the Oral Medicine Unit of Kerman University Dental School. An experienced independent facilitator convened the focus groups and conducted individual interviews in a non-clinical setting. Focus groups were mixed regarding their gender, age, chronic oral mucosal condition, time since diagnosis, and severity. A total of 39 patients participated in the study, including patients with oral lichen planus, pemphigus, recurrent aphthous stomatitis and leukoplakia. Results: Analysis of the interviews revealed that patient views could be divided into the following themes: biopsychosocial issues, treatment limitations and side effects, unpredictability of the conditions and the potential for malignant transformation. Chronic oral mucosal conditions affected patients' daily lives in various areas, from physical health and functioning to concerns about their future. Conclusion: The oral medicine practitioner's role in treating patients with chronic oral mucosal diseases extended beyond active management and symptomatic relief to the management of all aspects of these conditions that affected their daily lives.

Development and validation of a short version of Chronic Oral Mucosal Disease Questionnaire (COMDQ‐15)

The adoption of the Chronic Oral Mucosal Disease Questionnaire (COMDQ) into clinical practice has been low, despite its rigorous development process. A potential limitation of the COMDQ is the high response burden to patients. Therefore, the aim of the present study was to develop and validate a short version of the 26-item COMDQ. The COMDQ data of 520 patients with chronic oral mucosal diseases were randomly divided into two subsamples. Descriptive item analysis and exploratory factor analysis (EFA) were performed using data from the first subsample for item reduction and development of the shortened COMDQ. The resulting short version was then validated using confirmatory factor analysis (CFA) on the other subsample. Internal consistency reliability of the short-form COMDQ was assessed using Cronbach's alpha. Criterion validity of this new scale was examined against its original version. Based upon item analysis, 11 items were dropped. EFA results on the remaining 15 items extracted four factors consistent with the original COMDQ, and CFA results displayed acceptable goodness-of-fit indices of this factor structure on different sample. The COMDQ-15 was then created. Cronbach's alpha of four subscale scores ranged from 0.7 to 0.91, indicating good internal consistency reliability of the COMDQ-15. Correlations between total and subscale scores of the COMDQ-15 and its parent scale were high, supporting good criterion validity of this shortened scale. The COMDQ-15 is a brief, valid and reliable instrument that can give an overview of the patient's quality of life related to their chronic oral mucosal conditions.

Validity and reliability of the persian version of the chronic oral mucosal diseases questionnaire.

Background:Chronic oral mucosal disease questionnaire (COMDQ) is used to evaluate the quality of life in patients with chronic conditions of the oral mucosa. The aim of the present study was to evaluate the validity and reliability of the Persian version of this questionnaire.Methods:A total of 135 subjects were selected in two groups; group 1 consisted of 95 patients with chronic oral mucosal conditions, including recurrent aphthous stomatitis, oral lichen planus and pemphigus and mucous membrane pemphigoid and group 2 consisted of 40 patients with other oral diseases. The subjects completed the demographic data sheets and COMDQ and then underwent examinations to determine disease severity. After 14 days, the questionnaire was completed again by the group 1subjects only.Results:Cronbach’s α coefficient for COMDQ was estimated at 0.969 and the interclass correlation coefficient was estimated at 0.997. There was a significant relationship between the mean COMDQ scores and disease and pain severity. There was a clear correlation between the patients’ self-report about their general health and mean COMDQ scores and also between their opinions about their oral health and the mean COMDQ scores.Conclusions:The Persian version of COMDQ exhibited proper levels of reliability and validity. It is suggested that this questionnaire be used for the evaluation of the effect of treatment on the oral health-related quality of life (OHQoL).

‘Surviving the sting’: the use of solicited diaries in children and young people with oral mucosal disease

Chronic oral mucosal conditions, including oral ulcers, commonly affect children and young people and are capable of significant pain and morbidity. Little is known about patient perception of paediatric oral medicine services offered in relation to these conditions. The concept of a diary is increasingly recognised as a valuable way to capture patient events and perspective in healthcare research. This article provides the background to the use of solicited diaries as a method of accessing the perspective of children and young people and describes a service evaluation that aimed to explore the experiences of young people with chronic oral ulcers attending the paediatric oral medicine clinic in a UK Dental Hospital. Chronic oral ulcers were found to significantly impact on a variety of physical and psychosocial aspects of young people's lives. Overall, feedback regarding the specialist service was positive but suggestions were made for improvements. This article reviews the use of the solicited diary within healthcare research. It also illustrates the value of the diary in exploration of children and young people's perspective on their chronic oral mucosal disease. In addition, a need for further research in this area has been highlighted.

Further reliability and responsiveness of the Chronic Oral Mucosal Diseases Questionnaire

To test the reliability and responsiveness of the Chronic Oral Mucosal Diseases Questionnaire (COMDQ), in measuring the quality of life (QofL) in patients with chronic oral mucosal conditions. A random sample of 160 patients with the following chronic oral mucosal conditions, recurrent aphthous stomatitis, oral lichen planus, the more common vesiculobullous conditions (mucous membrane pemphigoid and pemphigus vulgaris) and orofacial granulomatosis received a copy of the COMDQ. A subset of 100 patients received the questionnaire on two further occasions, 2 weeks and 3 months later. Statistical tests were carried out to evaluate the test-retest reliability and responsiveness of this instrument. This study has demonstrated that the COMDQ has good test-retest reliability with an intraclass correlation coefficient of 0.81 and is responsive to changes in the patients' overall conditions. In conclusion, this study has further demonstrated the reliability and responsiveness of the COMDQ in assessing QofL in patients with chronic oral mucosal diseases.

Validity and reliability of a newly developed quality of life questionnaire for patients with chronic oral mucosal diseases

The aims of this study were to test the validity and reliability of a newly developed discipline-specific questionnaire, the Chronic Oral Mucosal Diseases Questionnaire (COMDQ), to measure quality of life in patients with chronic oral mucosal conditions. Two patient samples were recruited for the purposes of this study. First, a random sample of 160 patients attending the Oral Medicine Unit of Cork University Dental School and Hospital with the following chronic oral mucosal conditions, recurrent aphthous stomatitis, oral lichen planus, the more common vesiculobullous conditions (mucous membrane pemphigoid and pemphigus vulgaris) and orofacial granulomatosis. Second, the COMDQ was randomly distributed to a sample of 100 patients without a chronic oral mucosal condition. Convergent and discriminative validity and internal consistency of the newly developed questionnaire were assessed. This study has demonstrated that the newly developed questionnaire has good convergent validity with Pearson correlation coefficient of 0.819 with Oral Health Impact Profile-14 and 0.883 with Visual Analogue Scale for pain scores. The discriminative validity was also good with statistically significant differences between patients with chronic oral mucosal conditions and without chronic oral mucosal conditions. The new instrument has also demonstrated excellent reliability with Cronbach's alpha of 0.929. In conclusion, this study has demonstrated that the COMDQ is a valid and reliable measure to assess quality of life in patients with chronic oral mucosal diseases and therefore will be a valuable instrument in the management of these conditions.

Psychiatric morbidity among patients with oral sub-mucous fibrosis: a preliminary study

Oral submucous fibrosis (OSF) is a chronic oral mucosal condition with pre-malignant potential. The association between psychiatric morbidity and OSF has been sparsely studied. This cross-sectional study included 33 consecutive subjects clinically diagnosed with OSF who attended an academic tertiary care dental centre. General Health Questionnaire-28 was administered to assess the psychological morbidity. Dependence to areca products was assessed using the ICD-10 criteria. Patient group was compared with an age and gender matched control group (n=33) from the same hospital that comprised patients who had dental diseases other than OSF and had no areca/tobacco habit. Total mean scores (SD) of GHQ-28 for study group and control group respectively were 48.2 (18.1) vs. 24.2 (6.5) (P<0.001). Among the patient group, the mean total GHQ scores were significantly higher in those with functional stage C (those with worst functional staging) of OSF 63.4 (15.2) when compared with those with stage B 54 (14.2) and stage A 38.7 (17) (d.f.=2; P=0.005). 22 (66.7%) of patients met ICD-10 criteria for dependence to areca products. OSF may be associated with considerable psychological morbidity. This morbidity may be significantly more in patients with worst functional staging. It is difficult to determine whether this is the cause or effect of the disease. Further systematic studies are urgently needed to address this issue.

Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study

To explore the experience of daily life of persons with chronic oral mucosal conditions. Purposive sampling was used to recruit patients from the Oral Medicine Unit of Cork University Dental School and Hospital. An experienced independent facilitator convened the focus groups and conducted individual interviews in a non clinical setting. Focus groups were mixed with regard to gender, age, chronic oral mucosal condition, time since diagnosis and severity. A total of 24 patients took part, including patients with oral lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, recurrent aphthous stomatitis and orofacial granulomatosis. Analysis of the interviews revealed that patient views could be divided into the following themes - biopsychosocial issues, treatment limitations and side effects, unpredictability of the conditions and the potential for malignant transformation and issues for the healthcare professionals. Chronic oral mucosal conditions impact upon the experience of daily life of patients in a variety of areas from physical health and functioning, to concerns about their future. The role of the oral medicine practitioner in treating patients with chronic oral mucosal diseases extends beyond active management and symptomatic relief to the management of all aspects of these conditions that impact upon their daily lives.

Deficiency in collagen and fibronectin phagocytosis by human buccal mucosa fibroblasts in vitro as a possible mechanism for oral submucous fibrosis.

Oral submucous fibrosis (OSF), a chronic oral mucosal condition commonly found in south Asians, is a disorder characterized by a quantitative as well as a qualitative alteration of collagen deposition within the subepithelial layer of the oral mucosa. Since degradation of collagen by fibroblast phagocytosis is an important pathway for physiological remodelling of soft connective tissues, we have investigated phagocytosis of collagen- and fibronectin-coated latex beads by fibroblast cultures with an in vitro model system. Coated fluorescent latex beads were incubated with human oral mucosa fibroblasts and the fluorescence associated with internalized beads was measured by flow cytometry. Cells from normal tissues that had been incubated with beads for 16 h contained a mean of 75% collagen phagocytic cells and 70% fibronectin phagocytic cells; however, about 15% and 10% of phagocytic cells individually contained more than twice the mean number of beads per cell. In contrast, cells from OSF tissues exhibited a 40% reduction of the proportions of collagen phagocytic cells (mean=35%) and a 48% decrease of the proportions of fibronectin phagocytic cells (mean=22%), none of the cells having a high number of beads as compared to normal fibroblasts. OSF lesions appear to contain fibroblasts with marked deficiencies in collagen and fibronectin phagocytosis. To investigate if inhibition of phagocytosis could be demonstrated in vitro, normal fibroblast cultures were incubated with areca nut alkaloids (arecoline, arecaidine). The cultures had a dose-dependent reduction in the proportions of phagocytic cells. On the other hand, corticosteroid used in the treatment of OSF exhibited a dose-dependent enhancement in the proportion of phagocytic cells. Therefore, our hypothesis for OSF, although oversimplified, is that betel nut alkaloids (arecoline, arecaidine) inhibit fibroblast phagocytosis and this provides a mechanism for the development of OSF. The benefit of a local intralesional injection of corticosteroid is also possibly, at least in part, through an enhancement of fibroblast collagen phagocytosis.