Oral health-related quality of life and complications after treatment with partial removable dental prosthesis.

The aims of this study were to measure and describe the oral health-related quality of life (OHRQoL) and to identify the complications caused by partial removable dental prosthesis (RDPs) in patients 1-5 years after treatment. Complications were identified in 65 patients who were treated with 83 RDPs (48 upper, 35 lower). OHRQoL was measured using the OHIP-49 before treatment and at the baseline (1-2 months after treatment) and follow-up (1-5 years after treatment) examinations. The types and numbers of oral problems that were experienced were described based on OHIP items with a score of 3 and 4. A significant improvement (P < 0·05) in the total OHIP-49 was registered from pre-treatment (mean 42, SD ± 37) to baseline (mean 29, SD ± 27) and from pre-treatment to 1-5 years after treatment (mean 32, SD ± 30). There was no significant difference between the baseline and 1- to 5-year follow-up examinations. Problems with eating and appearance registered at pre-treatment were improved at baseline and after 1-5 years. Problems with dentures that had been registered pre-treatment were improved at baseline but reoccurred after 1-5 years. The two most frequent complications were ill-fitting RDPs and inflammation of the oral mucosa, followed less frequently by fractures of the clasps. Treatment with RDPs improved OHRQoL, but denture-related problems partly remained, and new problems related to RDPs occurred 1-5 years after treatment. The two most frequent complications were ill-fitting RDPs and inflammation of the oral mucosa.

Patients' experience of partial tooth loss and expectations to treatment: a qualitative study in Danish and Swedish patients.

Knowledge of impairments, wishes and expectations is essential to make correct decisions regarding oral rehabilitation. The purpose of this study was to investigate discomforts, wishes and expectations in patients' with partial edentulism before entering oral rehabilitation. In Copenhagen, Denmark, and Malmö, Sweden, respectively, 20 patients with partial edentulism seeking rehabilitation were interviewed in a semistructured qualitative manner. The interviews were transcribed and analysed yielding overall domains. Six themes appeared as overall domains: (i) experienced impairments, (ii) experienced social awareness, (iii) expectation to treatment, (iv) expectation to durability/survival, (v) coping strategies dealing with the tooth loss including explanations of the tooth loss and (vi) modifications to experienced impairment. The impairments were mostly experienced as problems in social settings. Most participants expressed a simple wish to function normally; a fixed solution was preferred. Many Danish participants accepted a removable solution whereas only few Swedish participants did so. The domains 'coping strategies' and 'modifications' were not part of the chosen topics of interest, indicating a high wish of the participants to explain their tooth loss and how they coped with it. In conclusion, a large degree of social impairment was found in the patient group along with several coping strategies. The impairments were modified by a number of factors indicating that highly individualised care and treatment is needed. A state of normality was described as the primary treatment wish with a higher acceptance of removable solutions in Denmark than in Sweden. For final decision-making, surrounding factors seemed to influence the patients' choices.

Recognition of patient-reported impairment in oral aesthetics.

The objectives of this study were to investigate the degree of effective recognition by professionals of patient-estimated oral aesthetic impairment and the most reliable aspects in such recognition. Participants consisted of 95 patients with partial dentition in need of prosthodontic replacements. The oral aesthetics was professionally evaluated using the Prosthetic Esthetic Index (PEI), compiling 13 aesthetic aspects and an overall evaluation. The patient-reported impairment was evaluated using the Oral Health Impact Profile Aesthetic (OHIP-Aes) and the Oral Esthetic Scale (OES). Background variables were as follows: gender, age, work situation, education level, marital status, number and location of teeth, wearing a removable dental prosthesis (RDP) and smile line. A significant correlation was found between the overall professional evaluation and the OHIP-Aes score (R = 0·43, P < 0·05), the OES score (R = 0·46, P < 0·05) and the overall patient evaluation (0·35, P < 0·05). Correlations of the 13 specific aspects of the PEI with the patient-reported evaluations were generally small to moderate: the aspect 'discoloration of the teeth' showed the highest correlation. The multivariate analyses showed that up to 57% of the patient-reported impairment could be explained by the professionally evaluated oral aesthetic in combination with background variables. Discoloration of the teeth was the greatest explanatory variable, but also dental arch symmetry, and position and colour of the teeth were significant aspects. A high percentage of the patient-reported aesthetic impairment can be recognised by the professionals. The most reliable aspect is discoloration of the teeth, but also dental arch symmetry, and the position and colour of the teeth are important for recognising the aesthetic impairment.

Effect of treatment with fixed and removable dental prostheses. An oral health-related quality of life study.

The aim of the study was to evaluate patient-reported effects of treatment with fixed dental prostheses (FDP) and removable dental prostheses (RDP) and relate the change in Oral Health Related Quality of Life (OHRQoL) to the type of treatment and objective dental variables of aesthetics and mastication. Additionally, the purpose of the study was to identify aspects of impairment and improvement that the treatments caused. Fixed dental prostheses treatment was performed in 200 patients and RDP treatment in 107 patients. Gender, age, region of replacement, and number of teeth present and replaced were obtained. The participants completed the Oral Health Impact Profile 49 (OHIP-49) before and after treatment. A control group with no need for dental treatment also completed the OHIP-49. All participants had a significant improvement in OHRQoL. The improvement was higher for the RDP group than the FDP group. Removable dental prostheses that replaced only masticatory teeth did not improve the OHRQoL significantly. The improvement in OHRQoL for both the FDP and RDP groups was not at the level of the control group. Higher age was associated with lower improvement in OHRQoL. Higher age, being a woman and having teeth replaced in the aesthetic zone were associated with deterioration in OHRQoL. Both RDP treatment and FDP treatment were associated with a reduction in the problems most frequently reported before treatment. Treatment with RDP was associated with new problems caused by the RDP. Fixed dental prostheses and RDP treatments improved OHRQoL and reduced the number of problems. The RDP participants improved more than the FDP participants.

Comparison of an individual systematic interview method and the oral health impact profile. Responsiveness and ability of describing treatment effect of oral rehabilitation.

The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) has shown potential for generating information and measuring Oral Health-Related Quality of Life (OHRQoL) in oral rehabilitation. The Oral Health Impact Profile-49 (OHIP-49) has been widely used in population studies. The purpose of this study was to compare the responsiveness and ability of the SEIQoL-DW and the OHIP-49 to qualitatively describe the change following oral rehabilitation. Twenty-two participants treated with fixed or removable prosthesis were interviewed before and after treatment using the SEIQoL-DW and the OHIP-49 questionnaire. The participants rated the subjective perception of change and answered two global oral rating questions. A clinical examination was performed to identify dental status variables. No significant difference was found between pre- and post-treatment SEIQoL-DW scores. A significant difference between pre- and post-treatment OHIP-49 scores was found. The SEIQoL-DW and OHIP-49 change scores was significantly correlated. The dental status variables such as number of teeth, number of teeth replaced, number of occluding units, type of treatment, extractions and removable dental prosthesis (RDP) before treatment did not influence the change scores. The effect size was low for the SEIQoL-DW (0.15) and moderate for the OHIP-49 (0.60). Improvement in subjective perception of change was related to both improvement and deterioration in change scores. More aspects were mentioned in the SEIQoL-DW compared to the OHIP-49. Based on the change in overall score and effect size, the SEIQoL-DW showed a weaker responsiveness than the OHIP-49. The SEIQoL-DW, however, described the change more detailed than the OHIP-49.

Patient-generated aspects in oral rehabilitation decision making I. Comparison of traditional history taking and an individual systematic interview method.

Decision making in oral rehabilitation is often based on diagnoses related to impairment of different oral functions. In making the decision when to treat, the dentist must work in cooperation with the patient. By incorporating patient-generated aspects into the decision making process, the dentist finds it easier to decide if and why treatment should be undertaken and what treatment modality to use. The purpose of this study was to describe the potential of an interview method, the 'Schedule for the Evaluation of Individual Quality of Life-Direct Weighting' (SEIQoL-DW), and compare it with a traditional history taking, in generating information to be used in decision making in oral rehabilitation. Fifty-seven participants in need of oral rehabilitation were enrolled in the study. The participants underwent a traditional history taking and were interviewed using the SEIQoL-DW method. The SEIQoL-DW generated a high number of cues for all participants. Significantly more cues and additional information were generated by the SEIQoL-DW than by the traditional history taking. The additional information concerned consultation and dentist issues, psychological aspects and treatment preferences. A high percentage of the participants were positive towards the use of the SEIQoL-DW method in their treatment planning. The SEIQoL-DW was considered to be a viable tool for decision making in oral rehabilitation.

A method for assessment of quality of life in relation to prosthodontics. Partial edentulism and removable partial dentures.

The aim of this study was to evaluate the possible use in prosthodontics of a method for an interview technique allowing maximal individuality within the cultural boundaries. The impact of partial edentulism and removable partial denture (RPD) wearing on quality of life was chosen as the target question. The interview included patient generated selection of five quality of life cues. The current status/intensity of each cue was measured by use of a Visual Analogue Scale (VAS), the relative weight/importance between the cues by a direct-weighting (DW) instrument, and a summarized quality of life score was calculated. One hundred and one participants with partial edentulism with or without RPDs were included in the study. No correlation was found between the VAS- and DW-scores, indicating that different aspects are measured with these two instruments. Sixty to seventy per cent of the participants answered positively to questions about the test method, including self-knowledge, consciousness and identification of needs and wishes. The 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting' turned out to be a useful instrument for assessing patients' priorities, and fulfils in many ways the demands for individualized problem identification, decision-making and treatment planning. The results of the comparison of RPD wearers and non-RPD wearers showed that aesthetics is a major factor and that the overall quality of life between the experienced RPD wearers and non-RPD wearers in this study did not differ significantly.