Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial.

BACKGROUND: As the world population ages, the requirement for cost-effective methods of treating chronic disease conditions increases. In terms of oral health, there is a rapidly increasing number of dentate elderly with a high burden of maintenance. Population surveys indicate that older individuals are keeping their teeth for longer and are a higher caries risk group. Atraumatic Restorative Treatment (ART) could be suitable for patients in nursing homes or house-bound elderly, but very little research has been done on its use in adults. OBJECTIVES: To compare the cost-effectiveness of ART and a conventional technique (CT) for restoring carious lesions as part of a preventive and restorative programme for older adults. METHODS: In this randomized clinical trial, 82 patients with carious lesions were randomly allocated to receive either ART or conventional restorations. Treatment costs were measured based on treatment time, materials and labour. For the ART group, the cost of care provided by a dentist was also compared to the cost of having a hygienist to provide treatment. Effectiveness was measured using percentage of restorations that survived after a year. RESULTS: Eighty-two patients received 260 restorations, that is, 128 ART and 132 conventional restorations. 91.1% of the restorations were on one surface only. After a year, 252 restorations were assessed in 80 patients. The average cost for ART and conventional restorations was €16.86 and €28.71 respectively; the restoration survival percentages were 91.1% and 97.7%, respectively. This resulted in a cost-effectiveness ratio of 0.18 (ART) and 0.29 (CT). When the cost of a hygienist to provide ART was inserted in the analysis, the resulting ratio was 0.14. CONCLUSIONS: Atraumatic restorative treatment was found to be a more cost-effective alternative to treat older adults after 1 year, compared to conventional restorations, especially in out of surgery facilities and using alternative workforce such as hygienists. Atraumatic restorative treatment can be a useful tool to provide dental care for frail and fearful individuals who might not access dental treatment routinely.

Chewing ability and associated factors in a Sudanese population.

This study aimed to assess self-reported chewing ability among a sample of Sudanese adults and to identify factors associated with impaired oral function. A total of 1,888 adults (≥16 years old) attending outpatient clinics in Khartoum State were included. Subjective chewing ability was assessed by interviewing participants on chewing complaints and perceived difficulty of chewing 15 common Sudanese foods. Pearson and multivariate analyses were used to examine relationships between chewing ability and characteristics obtained from interviews and clinical examination. Chewing complaints were reported by 33.5% of subjects; 15.2-33.4% had perceived difficulty of chewing hard foods, whereas only 1.5-6.9% had difficulty eating soft foods. The likelihood of chewing complaints was higher in people with dry mouth, <20 teeth, tooth decay, poor self-rated oral health, perceived difficulty of chewing, and higher oral health-related quality of life (OHRQoL) scores. Individuals with <20 teeth, poor self-rated general health, and higher OHRQoL scores were all more likely to have perceived difficulty of chewing certain foods. Impaired chewing ability was rather highly prevalent among Sudanese adults. Addressing factors such as dry mouth and tooth loss/decay, which have been identified to be associated with impaired oral function, might help to decrease the risk of omission of essential foods from the diet and improve OHRQoL.

Psychometric properties and performance of the Oral Health Impact Profile (OHIP-14s-ar) among Sudanese adults.

The aims of this study were to develop a Sudanese-Arabic version of the English-language Oral Health Impact Profile-14 (OHIP-14), assess the psychometric properties and performance of this new instrument, and then use it to investigate the impacts of selected oral disorders on oral health-related quality of life (OHRQoL). Sudanese adolescents and adults (age, ≥ 16 years; 781 males and 1107 females) attending outpatient clinics in Khartoum State were enrolled. The OHIP-14 was adapted, and the validity and reliability of the Sudanese-Arabic version of the questionnaire (OHIP-14s-ar) were assessed. The OHIP-14s-ar was then used to measure OHRQoL. Pearson correlation coefficients and multivariate analysis were used to examine relationships between OHRQoL and characteristics ascertained by interviews and clinical examinations. The OHIP-14s-ar had suitable construct validity, reliability, and internal consistency (i.e., Cronbach α). More than half of the participants reported that oral disorders affected quality of life; psychological discomfort and physical pain were the most frequently reported oral health impacts. Our results suggest that being female, tooth decay, systemic illness, and dry mouth worsen OHRQoL. The oral disorder with the greatest impact was dental caries, and tooth condition seemed to be more important than absence of teeth. The OHIP-14s-ar yielded convincing psychometric data, and its performance makes it a suitable measure for future cross-sectional and longitudinal studies in Sudan.

Factors associated with tooth loss and prosthodontic status among Sudanese adults.

A study was conducted to determine the degree of tooth loss, factors influencing tooth loss, and the extent of prosthodontic rehabilitation in Sudanese adults (≥ 16 years old) attending outpatient clinics in Khartoum State. Pearson and multivariate analyses were used to examine the relationships between tooth loss and specific characteristics determined through interviews and clinical examinations. The mean number of missing teeth was 3.6 (SD, 4.9) and the prevalence of edentulism was 0.1%. The prevalence of tooth loss (missing at least one tooth) was 78%; 66.9% of tooth loss was due to caries, and 11.2% was attributable to other reasons. Prosthetic replacement of missing teeth was evident in 3%, whereas a need for prosthetic replacement was evident in 57%. Having < 20 teeth was associated with age, gender, and socioeconomic status; tooth loss due to caries was associated with age, tribe, frequency of tooth-brushing, and a low rate of dental consultation. Tooth loss due to other reasons was associated with age, tribe, education, periodontal pocketing, tobacco use, tooth wear, and prosthetic status. The results of the present study indicated that the major cause of tooth loss was dental caries, thus emphasizing the importance of a public prevention-based healthcare program. Replacement of missing teeth was uncommon in the study subjects, which may reflect lack of access to this type of oral healthcare.

A survey of oral health in a Sudanese population.

BACKGROUND: We aimed to assess the oral health status and risk factors for dental caries and periodontal disease among Sudanese adults resident in Khartoum State. To date, this information was not available to health policy planners in Sudan. METHODS: A descriptive population-based survey of Sudanese adults aged ≥ 16 years was conducted. After stratified sampling, 1,888 adult patients from public dental hospitals and dental health centres scattered across Khartoum State, including different ethnic groups present in Sudan, were examined in 2009-10. Data were collected using patient interviews and clinical examinations. Dental status was recorded using the DMFT index, community periodontal index (CPI), and a validated tooth wear index. RESULTS: Caries prevalence was high, with 87.7% of teeth examined having untreated decay. Periodontal disease increased in extent and severity with age. For 25.8% of adults, tooth wear was mild; 8.7% had moderate and 1% severe toothwear. Multivariate analysis revealed that decay was less prevalent in older age groups but more prevalent in southern tribes and frequent problem based attenders; western tribes and people with dry mouths who presented with less than18 sound, untreated natural teeth (SUNT). Older age groups were more likely to present with tooth wear; increasing age and gender were associated with having periodontal pocketing ≥ 4 mm. CONCLUSIONS: The prevalence of untreated caries and periodontal disease was high in this population. There appear to be some barriers to restorative dental care, with frequent use of dental extractions to treat caries and limited use of restorative dentistry. Implementation of population-based strategies tailored to the circumstances of Sudanese population is important to improve oral health status in Sudan.

The Oral Health Impact Profile: ranking of items for temporomandibular disorders.

The study aimed to rank the Oral Health Impact Profile (OHIP-49) items by relevance to temporomandibular disorders (TMD). A modified version of the OHIP-49 was completed by 110 patients with TMD and by age- and gender-matched TMD-free individuals. Patients were diagnosed using the Research Diagnostic Criteria (RDC) for TMD. The modified OHIP included a reference to the 'jaw' and a 1-month reference period. The difference in item prevalence for problems reported fairly/very often (FOVO) between the two groups was calculated for each OHIP item. The FOVO prevalence differences were ranked to reveal the most relevant problems for TMD. Patients' total OHIP scores were higher (60.6, SD = 31.6) than those of controls (17.1, SD = 18.1). Patients scored higher on all items, with 41 items showing a statistically significant difference between the patient score and the control score. The patient-control difference in FOVO item prevalence varied considerably between different items, ranging from 1 to 67%. Substantial differences were noted between patients and controls for a number of specific items, including those relating to pain and physical impact. Smaller differences across most items were also noted, even those not expected to have an impact. The OHIP provides a starting point for a measure of TMD treatment outcome, once items less attributable to TMD are excluded.

Prospective evaluation of the referral pattern to restorative dentistry consultation clinics in Ireland.

The objective of this study was to analyse pattern of referral to Restorative Dentistry Consultation Clinics in a Dental Teaching Hospital. Patient demographic details and referral information were collected on new patient clinics. The majority of patients were female (62.1%). The greatest proportion of patients, 41.6%, was referred from the adjacent urban area. The highest percentage of referrals was from general practitioners, (37.6%). The main referral reasons were periodontal (24.7%), fixed prosthodontics (18.6%), endodontics (10.7%) and removable prosthodontics (8.3%). The study clearly showed that the majority of patients referred were female and from close proximity to the Hospital. Patients were referred for a broad range of restorative reasons.