Oral Health-related Quality Of Life Dimensions Research Articles

Orthodontic pain is related to oral health-related quality of life in orthodontic patients.

Orthodontic pain (OP) is a subjective experience induced by prolonged force on the teeth in fixed orthodontic treatment. OP acts as a predictor of aspects related to oral health-related quality of life (OHRQOL). It is important to understand the extent of the impact of OP on a patient's daily life, especially on stomatognathic function and social impact. To assess the correlation between OP and OHRQOL in fixed orthodontic treatment patients. The comparative pain rating scale is used to assess pain intensity, while the oral health impact profile-14 (OHIP-14) assesses the impact of OP severity on OHRQOL of 57 patients undergoing fixed orthodontic treatment in the early stages of treatment (1-3 months of treatment) at the Dental Hospital, Universitas Airlangga. Gender, age, and malocclusion classifications were also analyzed for their influence. The data were analyzed using Spearman correlation and two-way analysis of variance (ANOVA). In the initial phase of treatment, most of the patients (53%) experienced mild OP and moderate OP (39%), and OP was reduced over a week. The overall OHRQOL score was 17.4 ± 8, which indicates a negative impact on OHRQOL. There were also positive correlation dimensions of OHRQOL, which include the dimensions of physical limitations, psychological discomfort, and psychological limitations (r > 0.50). There was a significant difference between age groups in OP perception and OHRQOL (P < 0.05). There was a positive correlation between OP intensity and OHRQOL experienced by fixed orthodontic patients at the Dental Hospital, Universitas Airlangga.

Commonalities among dental patient-reported outcomes (dPROs)-A Delphi consensus study.

Improvement of patients' oral health-related quality of life (OHRQoL) is the main goal of oral health care professionals. However, OHRQoL is not a homogenous construct and how to assess it is challenging because of the large number of currently available instruments. Investigating available instruments and what they have in common would be necessary for consolidation and standardization of these instruments into a smaller set of tools. If the OHRQoL dimensions including Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the fundamental building blocks of the dental patient's oral health experience, then these dimensions should be measured by generic multi-item dPROMs. In this study, a panel of 11 international dentists use the Delphi consensus process to determine how well 20 of these instruments measured the four OHRQoL dimensions. All 20 dPROMs questionnaires assessed at least one OHRQoL dimension while all four OHRQoL dimensions were measured by at least one dPROM instrument, i.e., the four OHRQoL dimensions were essential components of the patient's oral health experience. This shows that the currently available generic multi-item dPROMs have a lot in common, in that they share Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact as targeted dimensions. Based on these commonalities, it is plausible and desirable to move towards a single four-dimensional metric to assess oral health impact in all clinical, community-based, and research settings. This step is necessary to advance evidence-based dentistry and value-based oral health care.

PATIENT-REPORTED OUTCOME MEASURES FOR PEDIATRIC DENTAL PATIENTS: A METHODOLOGICAL REVIEW AND MAPPING EXERCISE.

The most important dental patient-reported outcome (dPRO) is oral health-related quality of life (OHRQoL) which was commonly based on the following four dimensions: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. However, until now, analyses linking dPROSs to the four dimensions have only been done in adults. We therefore examined if the existing dental patient-reported outcome measures (dPROMS) for pediatric patients could also be mapped to these four domains. We performed a literature search to identify generic dPROMs administered in children and adolescents. Two researchers independently assessed titles, abstracts and full texts and extracted pediatric dPROMs and items. dPROM items were then mapped to the four OHRQoL dimensions. We identified 701 articles. After abstract screening, 118 articles were reviewed in full text. Fifteen articles met the inclusion criteria. Twelve instruments were identified, including 6 modified versions of the questionnaires. All questionnaires and their included items could be mapped to the four dimensions. In some cases, items were linked to two dimensions. The four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for existing dPROMs in pediatric dental patients. These dimensions should therefore be considered when measuring OHRQoL in children and adolescents in future studies.

Is assessment of oral health-related quality of life burdensome? An item nonresponse analysis of the oral health impact profile

AimThis study aimed to investigate if in the 49-item Oral Health Impact Profile (OHIP): (i) more missing data occurred when participants answered more questions, (ii) more missing data occurred in a particular item or set of related items, and (iii) item missingness was associated with the demographic characteristics and oral health-related quality of life (OHRQoL) impairment level.MethodsWe used OHIP data from the Dimensions of OHRQoL (DOQ) project, which consolidated data from 35 individual studies. Among these studies, we analyzed OHIP data from 19 studies (4,847 surveyed individuals, of which 3,481 were completed under supervision and 1,366 were completed unsupervised) that contained some missing information. We computed descriptive statistics to investigate the OHIP missingness. We also used logistic regression analyses, with missing information as the dependent variable, and number of questions filled in (OHIP item rank) as the independent variable for samples with and without supervision. To investigate whether missing data occurs more in a particular item or set of related items we fitted regression models with individual OHIP items and the OHRQoL dimensions as indicator variables. We also investigated age, gender, and OHRQoL level as predictor variables for missing OHIP items.ResultsWe found very low levels of missingness across individual OHIP items and set of related items, and there was no particular item or set of related items that was associated with more missing data. Also, more missing data did not depend on whether the participants answered more questions. In studies without supervision, older persons and females were 5.47 and 2.66 times more likely to have missing items than younger persons and females. However, in studies with supervision, older persons, and participants with more OHRQoL impairment were 1.70 and 2.65 times more likely to have missing items.ConclusionThe study participants from general and dental patient populations did not find OHIP-49 burdensome. OHIP item missingness did not depend on a particular OHIP item or set of related items, or if the study participants responded to a greater number of OHIP items. We did not find a consistent pattern of the influence of sociodemographic and OHRQoL magnitude information on OHIP missingness. The amount of missing OHIP information was low making any potential influence likely small in magnitude.

Frequency of Four-dimensional Oral Health Problems across Dental Fields - a Comparative Survey of Slovenian and International Dentists.

ObjectivesTo compare the frequency of patients’ oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions.MethodsAn anonymous electronic survey in the English language was designed using Qualtrics software. A probability sampling for Slovenia and a convenience sampling strategy for dentist recruitment was applied for 31 countries. Dentists engaged in six dental fields were asked to categorize their patients’ oral health problems and prevention needs into the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). Proportions of patients’ problems and prevention needs were calculated together with the significance of Slovenian and international dentists’ differences based on dental fields and WHO regions.ResultsDentists (n=1,580) from 32 countries completed the survey. There were 223 Slovenian dentists (females: 68%) with a mean age (SD) of 41 (10.6) years and 1,358 international dentists (females: 51%) with a mean age (SD) of 38 (10.4). Pain-related problems and prevention needs were the most prevalent among all six dental fields reported by dentists; Slovenian (37%) and 31 countries (45%). According to Cohen, differences between Slovenia, the broader European Region, and 31 countries were considered non-significant (<0.1).ConclusionAccording to the dentists’ responses, the frequency of patients’ oral health problems and prevention needs are proportionate between Slovenia and 31 countries, regionally and globally. The four OHRQoL dimensions can be considered universal across all dental fields.

Temporomandibular dysfunction experience is associated with oral health-related quality of life: an Australian national study

BackgroundThere are very few studies of the association between temporomandibular dysfunction (TMD) and oral health-related quality of life (OHRQoL) in a representative sample from the Asia–Pacific region. Accordingly, we aimed to quantify the association of TMD with OHRQoL dimensions and overall measurement scores in a representative sample of Australian adults while accounting for a range of confounders, and statistically estimating whether TMD experience is meaningfully associated with OHRQoL.MethodAustralia’s National Survey of Adult Oral Health 2004–2006 data were used. The outcome variables were the Oral Health Impact Profile (OHIP-14) domains and overall scores while the main exposure was self-reported Diagnostic Criteria Question for TMD. The analysis accounted for confounders including oral health status obtained from the oral examination, demographics, socioeconomics, health behaviours and health including perceived stress subscales of the PSS-14. We conducted complex samples analysis while using Cohen’s f2 effect size to estimate whether the association is meaningful.ResultsTMD prevalence was 9.9% (95% CI: 8.4–11.6%) among 4133 Australian adults. TMD experience was associated with impairments to the seven OHIP-14 OHRQoL domains (P < .05) with higher impairments observed in physical pain (B = 0.82, 95% CI: .45–1.20, P < .001), psychological discomfort (B = 0.68, 95% CI: .29–1.06, P = .001) and psychological disability (B = 0.52, 95% CI: .20–.84, P = .001) in adjusted multivariate analyses. The difference in the mean OHIP-14 scores for those reporting TMD (Mean = 13.1, 95% CI: 12.0–14.0) and those who did not (Mean = 6.6, 95% CI: 6.0–6.8) was significant (t = 7.51, P < .001). In an adjusted multivariable model for OHIP-14 scores, TMD experience was associated with higher OHIP-14 scores (B = 3.34, 95% CI: 1.94–4.75, P < .001) where the Cohen’s f2 was .022. Further, perceived stress subscales: perceived distress and perceived control were associated with TMD experience and OHIP-14 scores (P < .05).ConclusionLower OHRQoL was observed in Australian adults who reported TMD experience but with small clinical importance which might support considering TMD in regular dental care. The higher impairments observed in physical pain, psychological discomfort and psychological disability domains of OHRQL can help clinicians and researchers focus their attention on these domains. The confounding effect exhibited by the perceived stress subscale might support their inclusion in future TMD and OHRQoL research.

IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE

BackgroundA shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars. ObjectivePurpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement. MethodsPatients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed. ResultsAfter an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions. ConclusionsIn patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients’ preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

Including the patient's oral health perspective in evidence-based decision-making.

How to approach the assessment of patient-perceived oral health is of fundamental importance for the evaluation of clinical and public health interventions because the patient's assessment should be used as an adjunct to objective dental findings in order to decide which interventions work. This review article aims to provide an overview of the principles, current status, and future outlook for how a patient's oral health perception can and should be assessed. The hierarchical position of dental patient-reported outcomes, oral health-related quality of life (OHRQoL), and dental patient-reported outcome measures within the hierarchical concepts of quality of life and its component, health-related quality of life, is presented. The Mapping Oral Disease Impact with aCommon Metric project is outlined as an international effort to describe current approaches to standardize the measurement of oral impact using the four OHRQoL dimensions of oral function, orofacial pain, orofacial appearance, and psychosocial impact. Ultimately, these four dimensions of OHRQoL provide apractical and psychometrically solid way to collect and analyze OHRQoL data for all oral diseases in all settings, and eventually for all treatments through the use of astandardized, universal measurement tool. This universal impact metric capturing the patient's oral health perspective is the key to moving evidence-based dentistry and value-based oral health care forward.

Pediatric patients\u2019 reasons for visiting dentists in all WHO regions

BackgroundOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct.MethodsDentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients’ oral health problems and prevention needs were computed.FindingsData from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories.ConclusionsThe study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

Temporomandibular Disorder and Oral Health-Related Quality of Life in Brazilian Adults: A Population-Based Survey

OBJECTIVE: Evaluate the association between TMD symptoms and physical and psychosocial oral health impact among adults of a small Brazilian municipality. &#x0D; &#x0D; METHODS: A population-based epidemiological study with a probabilistic sample of adults (30-49 years) was carried out. Data was collected in the participant&amp;rsquo;s residence using a structured questionnaire, and a clinical examination was conducted by calibrated examiners (Kappa &amp;gt;0.7). The presence of TMD symptoms was evaluated using the Fonseca&amp;rsquo;s Anamnesis Questionnaire (1994). Physical and psychosocial impact was considered if at least one oral functions item was reported as being experienced fairly often or very often, assessed by the Oral Health Impact Profile (OHIP-14), an instrument of Oral Health Related Quality of Life (OHRQoL). The association between TMD symptoms and presence of impact was adjusted for oral health condition, sociodemographic and socioeconomic profiles, and health behaviors. Associations were investigated using the crude and multivariate Poisson regression. &#x0D; &#x0D; RESULTS: Of the 197 participants, 114 (59.30%) had physical and psychosocial impact of oral health and 135 (68.19%) had at least one TMD symptom. After adjusting for covariates, individuals who reported TMD symptoms had a 1.75 times higher prevalence of impact (95%CI 1.18 - 2.57) than those who did not report symptoms, with psychological discomfort (60.46%), physical pain (40.19%), and psychological disability (35.71%) being the most affected dimensions (p &amp;lt;0.01). &#x0D; &#x0D; CONCLUSION: TMD is a common condition and the presence of symptoms is associated with impact in different dimensions of OHRQoL. These results demonstrate the importance of early identification of TMD symptoms to reduce the impact on OHRQoL.

Impact of tooth loss position on oral health-related quality of life in adults treated in the community

Background:Tooth loss is known to have negative effects on both functional and psychological oral health-related quality of life (OHRQoL), but the impact of the position of the tooth loss (i.e. anterior or posterior) on the different psychosocial dimensions of OHRQoL has yet to be examined. Here, we examined how the position of lost teeth impacts the different dimensions of OHRQoL.Methods:This was a cross-sectional epidemiological study of adults aged 18 years and older attending routine examinations at primary care dental centers in Jeddah, Kingdom of Saudi Arabia. Demographic information was collected, and OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14) (Arabic form). Differences in total and subdomain OHIP-14 scores between individuals without tooth loss and those with ≥1 anterior or posterior missing teeth were assessed using Student's t-test, and analysis of covariance was used to assess the association between the presence and absence of missing teeth in each compartment and total and subdomain OHIP-14 scores after controlling for age, gender, and income.Results:The overall prevalence of tooth loss was 76%. In multivariate analysis controlling for age, gender, and income as covariates, anterior missing teeth were significantly associated with higher OHIP-14 total, physical pain, physical disability, psychological disability, and social disability scores, accounting for 6%–12% of the score variance. However, posterior missing teeth were only associated with total OHIP-14 and functional limitations domain scores, accounting for 6% and 7% of the variance, respectively.Conclusions:Here, we show for the first time the impact of the location of missing teeth on different OHRQoL dimensions. Anterior tooth loss has a wide-ranging impact on both physical and psychosocial functioning compared to posterior tooth loss, suggesting that anterior tooth restoration should be prioritized when treatment planning. The position of lost teeth must be considered in addition to the number of losses when examining the impact of tooth loss and its treatment on OHRQoL.

Body mass index and self-care behaviors related to oral health–related quality of life in patients with oral squamous cell carcinoma within three months posttreatment

Oral dysfunction is a common adverse event of treatment and may affect oral health-related quality of life (OHRQoL). This study aimed to identify factors associated with OHRQoL in patients with oral squamous cell carcinoma (OSCC) within the first three months posttreatment. This cross-sectional study examined OSCC patients who received treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed using the Self-Care Behaviors Scale (SCB), Oral Health Impact Profile (OHIP), and Karnofsky Performance Status (KPS) questionnaires. Among 148 OSCC patients, 11.5% reported being underweight and 70.3% reported normal weight. The most common self-care factors associated with adverse effects were decreased appetite and fatigue. Psychological disability, functional limitation, and physical pain were the most negative OHRQoL factors. Poor OHRQoL was associated with more severe adverse effects after self-care behaviors, using feeding tubes during treatment, and having BMI less than 25, which together explained 33.5% of the variance in OHRQoL. The severity of adverse effects after self-care behaviors and using feeding tubes during treatment strongly influenced overall OHRQoL and seven specific dimensions of OHRQoL.

Dental patients' functional, pain-related, aesthetic, and psychosocial impact of oral conditions on quality of life-Project overview, data collection, quality assessment, and publication bias.

Knowledge about the magnitude of Oral Health-Related Quality of Life (OHRQoL) impairment across dental patient populations is essential for clinical practice, public health and research. Within the project Mapping Oral Disease Impact with a Common Metric, this systematic review aimed to describe functional, pain-related, aesthetic and broader psychosocial impact of oral conditions with a single metric using OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact. A search using PubMed, EMBASE, Cochrane, CINAHL and PsycINFO was performed on 8 June 2017, and updated on 14 January 2019. Only publications in the English language were considered. To characterise the extent of available standardised and clinically relevant OHRQoL information, we determined the number of publications, dental patient populations, which are clinically similar, and patient samples within each population with four-dimensional OHRQoL information using the Oral Health Impact Profile (OHIP) questionnaire. A quality assessment and a publication bias assessment were performed. We identified 171 publications that characterised 199 dental populations and 329 patient samples with four-dimensional OHRQoL information. The vast majority of populations were only characterised by one patient sample. Study quality was not related to OHRQoL magnitude, and substantial publication bias could be excluded. Standardised and clinically relevant information using the four OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact was available for a significant number of dental patient populations. Findings can provide a framework to interpret OHRQoL impairment of individual patients, or groups of patients, for clinical practice, public health and research.

Foundations of oral health-related quality of life.

Oral health-related quality of life (OHRQOL) is the component of health-related quality of life that relates to the effects of oral diseases and dental interventions on patients. This article describes why OHRQOL is important and how it is measured. The conceptual basis for OHRQOL is discussed. A four-dimensional structure consisting of Oral Function, Orofacial Pain, Orofacial Appearance and Psychosocial Impact as the OHRQOL dimensions has emerged as psychometrically sound and clinically intuitive. Consequently, when the impact of oral diseases or the effects of dental interventions are measured, four dimension scores capturing these attributes need to be used.

Why Patients Visit Dentists – A Study in all World Health Organization Regions

ObjectiveThe dimensions of oral health–related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions. MethodsDentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated. ResultsFor every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering. ConclusionOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.

The Schizophrenia Coping Oral Health Profile. Development and Feasibility.

BackgroundThe aim of this work was to present the creation of appropriate tools to evaluate the coping strategies in Oral-Health-related Quality of Life (OHrQOL) implemented by persons with schizophrenia (PWS), the Schizophrenia Coping Oral Health Profile (SCOOHP), and the results of a feasibility study.MethodsA qualitative investigation was conducted between June 2016 and May 2017.The first step included 26 semi-structured individual interviews, 20 with PWS and 6 with health professionals (HPs), and 2 focus groups (PWS and HPs) to explore the experiences of the participants and how they felt about coping strategies in OHrQOL. The second step was a feasibility study involving a statistical analysis to test the acceptability and internal consistency (Cronbach’s α) of the SCOOHP.ResultsThe analysis of these interviews allowed for us to obtain 277 items from 3545 verbatim transcriptions related to various dimensions of OHrQOL. We presented the items selected in coping concepts in this study. After selecting items in several stages, we drew up the SCOOHP scale with 23 items (15 items for positive coping and 8 items for negative coping). The feasibility study showed good acceptability, good understanding of the items and good consistency reliability (α = 0.59).ConclusionsThis is the first study that has enabled us to draw up a specific tool to assess coping strategies in OHrQOL of PWS. A multicentre study involving a larger sample of PWS is underway in order to perform the psychometric validation of the SCOOHP.Trial registrationClinical Trials Gov NCT02730832. Date registered: 21 March 2016.

Tooth Color as a Predictor of Oral Health-Related Quality of Life in Young Adults.

Smiling plays an important role in social interaction. The purpose of this research was to explore the extent to which objective parameters of color of one's own teeth affected the social and emotional dimensions of young adults' lives. The sample included 134 subjects-students of the University of Rijeka, Croatia (65% female) aged 19 to 28 years (median 21). All subjects had six intact maxillary anterior teeth without restorations or severe malocclusions and healthy gingiva with no signs of inflammation. Tooth color was assessed intraorally using a spectrophotometer. Lightness, chroma, and translucency of the right maxillary central incisors (the reference teeth) were calculated and used for analysis. Subjects reported dimensions of their oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP), Orofacial Esthetic Scale (OES), and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Linear relationships between elements of tooth color and OHRQoL were explored using Pearson correlations. Multiple linear regression, while controlling for the influence of age and gender, was also calculated. ANOVA with a Tukey post hoc test was employed to test whether nonlinear relationships existed between OHRQoL and categories of color elements. Dental self-confidence, esthetic concerns, orofacial appearance, social impact and psychological impact were not related to lightness, chroma, or translucency of the subjects' teeth. Neither linear nor nonlinear relationships were detected between those aspects. Satisfaction with smile esthetics was only related to translucency where subjects with moderate translucency were least likely to be satisfied (p = 0.033). Women tended to report greater psychosocial impacts than men (p < 0.05), regardless of their tooth color. According to the results of this study objective, measurable, quantitative parameters of tooth color did not accurately predict psychosocial dimensions of OHRQoL in dentate young adults.

Does orthodontic treatment before the age of 18years improve oral health-related quality of life? A systematic review and meta-analysis.

Orthodontics aims to improve oral health-related quality of life (OHRQoL). In this systematic review, we examined the evidence for changes in OHRQoL after orthodontic treatment for patients treated before they were 18years old. The participants were patients aged less than 18years. The interventions were nonorthognathic and cleft orthodontic treatment. The comparisons were before and after orthodontic treatment, or nonorthodontic control. The outcomes were validated measures of OHRQoL. The study designs wererandomized controlled trials, controlled clinical trials, prospective cohort studies, and cross-sectional or case-control studies. Multiple electronic databases were searched, with no language restrictions; authors were contacted, and reference lists screened. The Newcastle-Ottawa scale was used for quality assessments. Screening, data extraction, and quality assessments were performed by 2 investigators independently. We found 1590 articles and included 13 studies (9 cohort, 3 cross sectional, and 1 case control), with 6 in the meta-analyses. All were judged of low or moderate quality. A moderate improvement in OHRQoL was observed before and after orthodontic treatment (n=243 participants; standardized mean difference, -0.75; 95% CI, -1.15 to -0.36) particularly in the dimensions of emotional well-being (n=213 participants; standardized mean difference, -0.61; 95% CI, -0.80 to -0.41) and social well-being (n=213 participants; standardized mean difference, -0.62; 95% CI, -0.82 to -0.43). Orthodontic treatment during childhood or adolescence leads to moderate improvements in the emotional and social well-being dimensions of OHRQoL, although the evidence is of low and moderate quality. More high quality, longitudinal, prospective studies are needed.

Integration of oral health-related quality of life instruments

ObjectivesTo integrate items from two widely used oral health-related quality of life (OHRQoL) questionnaires, the General Oral Health Assessment Index (GOHAI) and the Oral Impacts on Daily Performances (OIDP), as well as culturally-specific items of the Oral Health Impact Profile (OHIP) into a four-dimensional OHRQoL model consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. MethodsSubjects came from an ancillary study of the Dimensions of Oral Health-Related Quality of Life Project (N=267 patients, mean age±SD: 54.0±17.2years, 58% women.) Patients filled in the original 49 items of OHIP and 22 additional OHRQoL items in a cross-sectional study. These additional items consisted of 7 culturally specific OHIP items and 15 GOHAI or OIDP items with unique content not covered in OHIP-49. Before data collection, three experts hypothesized to which of the four OHRQoL dimensions these items belong. Hypotheses were tested in correlation analyses between the 22 items and the four dimension scores that were derived from OHIP-49. ResultsFive of the 22 items did not provide sufficient information to which dimension they belong. In 16 of the remaining 17 items, the pattern of correlation coefficients fitted experts’ a priori hypotheses. Acceptance of 16 of the 17 hypotheses was interpreted as evidence that additional (not in OHIP-49 contained) OHRQoL items can be assigned to Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. ConclusionItems of three OHRQoL instruments can be integrated into a dimensional OHRQoL model consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. Clinical significanceOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact can serve as a simple and clinically appealing set of oral health-related quality of life (OHRQoL) dimensions and therefore provide an opportunity for simpler, but psychometrically improved OHRQoL measurement in the future.

Patterns of impaired oral health-related quality of life dimensions.

How dental patients are affected by oral conditions can be described with the concept of oral health-related quality of life (OHRQoL). This concept intends to make the patient experience measurable. OHRQoL is multidimensional, and Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact were suggested as its four dimensions and consequently four scores are needed for comprehensive OHRQoL assessment. When only the presence of dimensional impact is measured, a pattern of affected OHRQoL dimensions would describe in a simple way how oral conditions influence the individual. By determining which patterns of impact on OHRQoL dimensions exist in prosthodontic patients and general population subjects, we aimed to identify in which combinations oral conditions' functional, painful, aesthetical and psychosocial impact occurs. Data came from the Dimensions of OHRQoL Project with Oral Health Impact Profile (OHIP)-49 data from 6349 general population subjects and 2999 prosthodontic patients in the Learning Sample (N=5173) and the Validation Sample (N=5022). We hypothesised that all 16 patterns of OHRQoL dimensions should occur in these individuals who suffered mainly from tooth loss, its causes and consequences. A dimension was considered impaired when at least one item in the dimension was affected frequently. The 16 possible patterns of impaired OHRQoL dimensions were found in patients and general population subjects in both Learning and Validation Samples. In a four-dimensional OHRQoL model consisting Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact, oral conditions' impact can occur in any combination of the OHRQoL dimensions.