Alexander J. Hassel

A German version of the GOHAI

OBJECTIVES Translation, reliability analysis and validation of a German version of the Geriatric/General Oral Health Assessment Index (GOHAI) was the aim of this study. METHODS Translation was performed by a forward-backward process. Validity was assessed as convergent validity in comparison with another self-perceived assessment of oral health (OHIP-14) and as group validity (n = 218; mean age 73 years). Reliability was proved in terms of internal consistency, inter-item and item-scale correlations, and stability (test-retest procedure; n = 36; mean age 77 years). The responsiveness to change in oral health status was assessed by pre- and post-treatment comparison (n = 21; mean age 63 years). RESULTS A German version of the GOHAI is presented. Convergent validity was sufficient (r = -0.76 compared with OHIP-14); group validity could be demonstrated for self-perceived need for treatment, chewing problems, number of own teeth, caries lesions present and dental status. The internal consistency was high (Cronbachs alpha = 0.92) as were inter-item and item-scale correlations, for which good homogeneity of the index was apparent. The test-retest correlation for the summary score was r = 0.84, single item correlations ranged from r = 0.36 to r = 0.89. The GOHAI sum score increased significantly after patients received new dentures, indicating responsiveness of the GOHAI to clinical change in the expected direction. CONCLUSIONS The German version of the GOHAI had sufficient reliability, validity and responsiveness to be used as measure of oral health-related quality of life in cross-sectional and longitudinal studies of the elderly.

Survival and Chipping of Zirconia-Based and Metal–Ceramic Implant-Supported Single Crowns

PURPOSE The objective of this retrospective study was to compare the incidence of chipping of implant-supported, all-ceramic, and metal-ceramic single crowns. MATERIAL AND METHODS One hundred fifty-three patients (51.7% male, mean age 55.0 years) received 232 cemented implant-supported single crowns. One hundred and seventy-nine crowns had a metal framework (gold alloy) and 53 crowns were all-ceramic (zirconia framework and glass-ceramic veneer material). Age, gender, kind of cementation, and location of the restorations were assessed as possible factors affecting chipping. RESULTS During the observation period of up to 5.8 years (mean 2.1 years; standard deviation 1.4), a total of 13 (24.5%) all-ceramic and 17 (9.5%) metal-ceramic crowns suffered from chipping, a difference that was statistically significant. A total of ten single crowns had to be remade resulting in survival of 86.8% (all-ceramic) and 98.3% (metal-ceramic). The other possible factors did not have a significant effect on the chipping. CONCLUSION Chipping was found to be more frequent for all-ceramic implant-supported single crowns. If the reasons for the vulnerability of all-ceramic crowns remain unknown, implants with all-ceramic single crowns should generally be recommended with care.

Factors associated with oral health-related quality of life in institutionalized elderly

Objective. The aim of this study was to investigate factors associated with the oral health-related quality of life (OHRQoL) of institutionalized elderly in Germany. Material and Methods. One-hundred-and-fifty-eight subjects from old peoples homes were selected (mean 82.8 years). OHRQoL was measured using the Oral Health Impact Profile (OHIP). Denture characteristics (kind and age of denture, retention of removable denture, number of teeth in static occlusion) and general issues (age, gender, education level, and general pain status) were assessed. All factors were subjected to bivariate testing for their effects on the OHIP summary score (OHIP-SC) and to multivariate testing in subjects with removable dentures (n=128); a linear regression model with backward elimination was used, with OHIP-SC as the dependent variable. Results. In the context of other studies, a median OHIP-SC of 29 indicated highly impaired OHRQoL. According to the bivariate analysis, retention, age of denture, number of teeth in static occlusion, general pain status, and education all exhibited significant influence on OHIP-SC. In the final linear regression model, general pain status, education level, and retention of denture remained at a statistically significant level. The model explained 34% (R2=0.34) of the variance of the OHIP-SC. The kind of denture had no significant impact on OHIP-SC. Conclusions. In contrast to other groups, the kind of denture exhibited little impact on OHIP-SC for this highly specific collective. However, there were functional aspects of dentures which seemed to be important. Non-dental factors had a striking effect on OHRQoL.

Oral health-related quality of life is linked with subjective well-being and depression in early old age

Although a body of research has targeted predictors of well-being and depression in old age, the consideration of oral health-related quality of life (OHRQoL) as a predictor of these major psychosocial endpoints has been rare in the previous literature. The objective of this study was to test whether OHRQoL is associated with well-being and depression, after controlling for relevant confounders; also, the mediating role of subjective health, a major predictor of both well-being and depression, has been explored. OHRQoL was measured by two commonly used assessment instruments, the geriatric oral health assessment index (GOHAI) and oral health impact profile (OHIP); well-being was assessed by the Philadelphia Geriatric Center Morale Scale (PGCMS) and depression by the self-rating depression scale (SDS). We used a subsample of 197 participants from the older cohort (1930–1932) of the Interdisciplinary Longitudinal Study of Adult Development. Regression models and structural equations modeling (SEM) were used for the test for study variable relationships. Both GOHAI and OHIP revealed significant associations to both PGCMS and SDS at the bivariate level. In regression analyses considering gender, household situation, subjective health, and both OHRQoL indicators, only OHIP remained a significant predictor of well-being and depression. In addition, supportive evidence for a mediating role of subjective health regarding the linkage between OHRQoL and an overall latent construct of well-being was found in the SEM analysis. In conclusion, OHRQoL is significantly linked with well-being and depression in old age, while subjective health is able to mediate the relationship. The generally underrated role of OHRQoL with respect to well-being and depression in late adulthood deserves more attention.

The prevalence of myofascial pain and its association with occlusal factors in a threshold country non-patient population

The objective of the study is to assess the prevalence of myofascial pain in a threshold country and to isolate occlusal risk factors. One hundred and seventy-one randomized selected women were examined by a trained examiner in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) examination procedure. Subscales of the SCL 90-R, graded chronic pain status, and anamnestic questionnaires were also used. Logistic regression was performed to compute the odds ratios for six common occlusal features with regard to the presence of myofascial pain, in accordance with the RDC/TMD criteria. Fifteen subjects (15 / 151 = 9.93%) suffered from myofascial pain. Results from logistic regression analysis showed that non-occlusion (posterior teeth, at least one side) and open bite increased the risk of myofascial pain. The prevalence of myofascial pain in this study is comparable with that in another study, in a highly industrialized environment, in which the RDC/TMD was used. The role of occlusion in a non-patient population seems to be restricted to serious alterations of normality. This article presents the prevalence of myofascial pain and its association with occlusal factors. This issue will help the clinicians to assess the influence of occlusion in myofascial pain patients and to send the patient to the appropriate specialist.

Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5‐year clinical results from a prospective study

AIM The purpose of this study was to evaluate the survival and success of early-loaded implants placed in the intraforaminal area of the edentulous mandible, and the survival of the implant-supported fixed dental prostheses (FDP). MATERIAL AND METHODS Thirty-seven patients (18.9% male, mean age 64.5 years) with edentulous lower jaws were treated with implant-supported FDPs in the mandible. One hundred and eighty-five screw-type implants were placed in the intraforaminal area of the symphysis (five implants per patient). Immediately after implant placement, a framework was fabricated and the FDP was manufactured on the framework. Within 2 weeks, the implants were rigidly connected and loaded with the implant-retained FDP. RESULTS During the 1-8-year observation period (mean 4.5 years), a total of 32 implant-retained complications occurred. Nineteen implants were lost in 10 patients, resulting in a cumulative survival of 89.7%. Nine implants in five patients did not osseointegrate. Although these implants were not removed, because stability within the connective tissue was acceptable and inflammation was absent, they were recorded as unsuccessful. Consequently, the cumulative success declined to 84.9%. Four implants in three patients had clinical signs of periimplantitis (2.2% of all implants). Denture-related complications included one complete failure, when one FDP had to be removed after the last of five implants had been replaced. Furthermore, 10 fractures of the framework occurred in six patients, three FDPs had to be adapted or modified, and the facing of the FDP had to be repaired 16 times in 11 patients. CONCLUSION Although one-stage early-loaded implants functioned well for most patients with edentulous mandibles, immediate loading is associated with a larger number of implant-related complications than in other studies investigating delayed loading. Because of the substantial prosthetic complications and aftercare, this procedure cannot be generally recommended.

Phenol chemical matricectomy is less painful, with shorter recovery times but higher recurrence rates, than surgical matricectomy: a patient's view.

BACKGROUND Ingrown toenails have a tendency for recurrence. Operative interventions can be successful, and several procedures are in use. OBJECTIVE Retrospective evaluation, to reveal differences in postoperative pain, time to recovery, and satisfaction with the cosmetic outcome in patients treated with a phenol (PCM) or surgical matricectomy (SM). MATERIALS & METHODS All matricectomy patients at the Dermatology Department of the Ludwigshafen City Hospital between 2004 and 2008 were interviewed over the telephone. Of 72 evaluable patients with a total of 112 ingrown nail sides, 33 were treated with PCM and 39 with SM. The patient group consisted of 40.3% women, the median age was 31. RESULTS Patients after PCM indicated two points less postoperative pain on an analogue scale from 0 to 10 (p<.001). In the PCM group, more patients recovered from the operation in less than 1 week (p=.007). Patient evaluation of cosmetic outcome was not different between the groups (p=.76), but recurrence rates were significantly higher in the PCM group (31.5%, vs 6.9% in the SM group, p=.006) CONCLUSION Both matricectomies have advantages and disadvantages. We should discuss these issues with our patients to help them decide on the kind of matricectomy. The authors have indicated no significant interest with commercial supporters.

Oral health-related quality of life and depression/anxiety in long-term recurrence-free patients after treatment for advanced oral squamous cell cancer

This report focuses on the association between oral health-related quality of life (OHRQoL) and depression/anxiety of a homogeneous group of cancer patients who were recurrence-free for 8 years after treatment for advanced oral squamous cell. Participants were 24 patients (mean age 55 years, 75% men) treated with neoadjuvant concurrent radiochemotherapy followed by surgery with a mean recurrence-free period of 95 months (from 39 to 164 months). The OHRQoL (OHIP) and the anxiety/depression (HADS) were assessed twice (1 year between t1 and t2). OHRQoL was impaired in this group (mean OHIP score 65 units). In cross-lagged correlation analysis, the correlation between OHRQoL to t1 and depression to t2 was significant and greater than the non-significant correlation for depression to t1 and OHRQoL to t2 indicating that OHRQoL predicts depression better than vice versa. However, the difference in the correlation coefficients was not significant (ZPF-test). The same was true for OHRQoL and anxiety. The OHRQoL measured with the OHIP was impaired in comparison to the normal population. In the limitations of the study design and bearing the small sample size in mind, the results give evidence that OHRQoL predicts psychological outcomes, namely depression and anxiety, better than vice versa.

Comparison of the Easyshade Compact and Advance in vitro and in vivo

ObjectiveThe objective of this study was to evaluate the repeatability, inter-examiner and inter-device reliability, and accuracy of the new VITA Easyshade Advance (ES-A) spectrophotometer in comparison with the Easyshade Compact (ES-C).MethodsFor the in vitro study, six porcelain disks of random shade mixtures were fabricated from VITA ceramic powders. To analyze the repeatability of the ES-C and ES-A, readings were obtained by one examiner for one porcelain disk and one shade tab (VITA 3D-Master). Measurements were repeated by two examiners to evaluate inter-examiner reliability. To assess accuracy, porcelain disks and shade tabs were measured with the ES-C and ES-A and by means of a spectroradiometer (SR). ∆E values between the shade tabs and disks were calculated. Differences between devices were evaluated by use of univariate analysis. Reliability and accuracy of both devices were also tested in a clinical setting. The intra-class correlation coefficient (ICC) was calculated for all assessments of reliability.ResultsGood agreement was observed for replicate measurements (ICC > 0.9), for inter-examiner reliability of the ES-A and ES-C (ICC > 0.9), and for inter-device agreement (ICC > 0.9). Univariate analysis revealed that ∆E values for the spectrophotometers were consistent (p = 0.783); spectroradiometrically measured ∆E was comparable, but the mean value was smaller than that for the spectrophotometers (p = 0.004). Clinical inter-device agreement was acceptable to high (ICC > 0.777). The accuracy of the ES-A was higher than that of the ES-C (p = 0.001).ConclusionWithin the limitations of the experiment, the spectrophotometers tested enabled reliable and accurate measurement. In the clinical setting, however, the ES-A seems more accurate.Clinical relevanceES-C and ES-A can be valuable tools for the determination of tooth colors. Because of their good reliability, they should especially be used for the assessment of tooth color changes over time.

Psychosomatic or allergic symptoms? High levels for somatization in patients with drug intolerance

Patients with dermatological diseases often have associated psychological problems. For patients with allergic diseases, only a few publications have focused on psychological aspects. The objective of this study was to assess the psychometric profile, including somatization, depression, anxiety and health‐related quality of life (HRQoL), of patients suffering from drug intolerance or hymenoptera venom allergies. In a prospective cohort study design, patients who were admitted to hospital for a challenge test for an alternative drug (n = 49, 24.5% men) or for induction of desensitization therapy with hymenoptera venom (n = 58, 37.9% men) were included. Psychometric screening questionnaires focusing on somatization (Symptom Check List), depression and anxiety (Hospital Anxiety Depression Scale), and also on HRQoL (Short Form questionnaire) were assessed. The scores were compared with population scores and between the two groups. Both groups had significantly higher somatization scores (P ≤ 0.003) than the normal population, and the challenge‐test group had lower HRQoL than the normal population. Between‐group analysis revealed significantly higher somatization scores in the challenge‐test group (P = 0.011) and more impaired HRQoL (physical health domain P < 0.001). Anxiety/depression scores were not significantly different from those of the normal population, or between groups, although abnormally high scores for anxiety were frequent (18% and 12% for the challenge‐test and allergy groups, respectively). Somatization, reduced HRQoL and anxiety seem to be part of the symptoms of patients with allergic diseases, especially for patients with drug intolerance. Standardized questionnaires could help to discover patients who may need psychological support. This may help to improve the patients’ symptoms and quality of life.