Ashley P.S. Barlow

Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ)

AIM To develop and validate a condition specific measure of oral health-related quality of life for dentine hypersensitivity (Dentine Hypersensitivity Experience Questionnaire, DHEQ). MATERIALS AND METHODS Questionnaire construction used a multi-staged impact approach and an explicit theoretical model. Qualitative and quantitative development and validation included in-depth interviews, focus groups and cross-sectional questionnaire studies in a general population (n=160) and a clinical sample (n=108). RESULTS An optimized DHEQ questionnaire containing 48 items has been developed to describe the pain, a scale to capture subjective impacts of dentine hypersensitivity, a global oral health rating and a scale to record effects on life overall. The impact scale had high values for internal reliability (nearly all item-total correlations >0.4 and Cronbachs α=0.86). Intra-class correlation coefficient for test-retest reliability was 0.92. The impact scale was strongly correlated to global oral health ratings and effects on life overall. These results were similar when DHEQ was validated in a clinical sample. CONCLUSIONS DHEQ shows good psychometric properties in both a general population and clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.

Influence of Fluoride Availability of Dentifrices on Eroded Enamel Remineralization in situ

Remineralization of eroded enamel by dentifrices containing similar sources/concentrations of fluoride was investigated in situ. Fifty-three subjects completed a double-blind crossover study with 3 randomly assigned dentifrice treatments: placebo (0 ppm F, PD); reference (1,450 ppm NaF, RD) and test (1,450 ppm NaF + 5% KNO3, TD). Fluoride availability for each dentifrice was analyzed in vitro by standard tests (1-min fluoride release rate and enamel fluoride uptake). The subjects wore palatal appliances holding bovine enamel specimens previously eroded in vitro. Surface microhardness was determined before and after the in vitro erosive challenge, after in situ remineralization and after a second in vitro erosive challenge. ANOVA and pairwise comparisons were performed (α = 0.05). TD was superior to RD in the fluoride release tests, but similar to RD in the enamel fluoride uptake test. The mean percent surface microhardness recovery was 21.9 (standard deviation 8.0) for PD, 28.6 (8.0) for RD and 36.0 (8.0) for TD. The mean percent relative erosion resistance change was –58.8 (12.7) for PD, –31.3 (12.7) for RD and –27.3 (12.6) for TD. Both fluoride-containing dentifrices provided superior remineralization (p < 0.001) and erosion resistance (p < 0.001) compared to PD. The percent surface microhardness recovery demonstrated by the TD was significantly greater than for the RD (p < 0.001). There was no significant difference (p = 0.073) between TD and RD in relative resistance to further erosive challenge. The results suggest that fluoride availability may be different in dentifrices with similar sources/concentrations of fluoride, providing different levels of remineralization of eroded enamel.

The everyday impact of dentine sensitivity: Personal and functional aspects

Research of oral health status and research of the impact of oral conditions on everyday life have been developed over the past 30 years. To date, the degree to which these measures can be applied to the problems and impacts associated with dentine sensitivity is not clear. Regarding research of dentine sensitivity, it appears that there has been very little research of its everyday impact. Objective: The aim of this study was to explore the impact of dentine sensitivity on everyday life. Method: Participants were purposively recruited from a general population with the specific aim of securing a range of experiences and views about the everyday impact of dentine sensitivity. Participants were currently experiencing sensitivity in their teeth and were adults (older than age 18 years) and were initially recruited using the research team’s contacts and through snowball sampling. Data were analyzed through the use of a framework generated from the data and informed by the literature on chronic illness, coping, and illness beliefs, along with the general literature on the biopsychosocial impact of oral health. Data analysis also focused on detailing the range of impacts associated with the condition. Results: A total of 23 interviews were conducted. Fifteen participants were female and eight were male. The principal impacts on everyday life were described as pain, impact on functional status, and impact on everyday activities such as eating, drinking, talking, toothbrushing, and social interaction in general. Impacts appeared to be related to a range of individual and environmental influences. Conclusions: The data indicate the depth and complexity of the pain experiences associated with dentine sensitivity. Accordingly, it is suggested that there is a relationship between factors such as the length of one’s illness and the degree of control one has over the condition. These findings confirm similar findings in the psychological literature on pain. The findings of this study confirm that further research into the everyday nature of dentine-sensitive pain would be beneficial.

Development of labeled magnitude scales for the assessment of pain of dentin hypersensitivity.

AIMS To develop and test labeled magnitude (LM) scales that are sensitive to variations in pain associated with dentin hypersensitivity (DH). METHODS Qualitative methods were used first to obtain words that describe the pain of DH. Magnitude estimation was then used to determine the position of these descriptive terms by relative magnitude along four vertical LM scales. To assess their DH, patients used the four LM scales following dentin stimulation with 4°C and 25°C water. The LM scales were then compared to visual analog scale (VAS) ratings by using eight pain scenarios of varying severity. Finally, participants with DH completed the four horizontal LM scales and VAS after dentin stimulation with 4°C and 25°C water. Within-subject t tests were used for comparisons between scales and water temperatures, and between-subject t tests were used for comparisons between participants with and without DH. RESULTS Participants showed comparable differentiation between 4°C and 25°C water on VAS and three of the LM scale measures. Responses on the fourth LM scale showed better differentiation than VAS between the two water temperatures. Participants used a greater portion of the LM scales than VAS when rating low-level pain scenarios. CONCLUSION LM scales were shown to provide some advantages compared to standard VAS when used to evaluate DH-associated pain. These advantages may be generalized to other low-level pain conditions.

Novel in-situ longitudinal model for the study of dentifrices on dental erosion-abrasion.

A novel longitudinal erosion-abrasion in-situ model was proposed. In an exploratory test (phase 1) toothbrushing effect was investigated using a parallel design, whereas in the main study (phases 1 + 2), a crossover design tested the effect of fluoride dentifrice. In phase 1, 16 subjects (n = 5-6 subjects per group) wore partial dentures with enamel specimens for 28 d and adhered to one of the following treatment regimens: regimen A, erosion only; regimen B, erosion + toothbrushing with fluoride-containing dentifrice [1,100 ppm of fluoride as sodium fluoride (NaF)]; and regimen C, erosion + toothbrushing with placebo dentifrice (0 ppm fluoride). Erosion consisted of the exposure of specimens to grapefruit juice. In regimens B and C, toothbrushing was performed with the test dentifrices 5 min after erosion. For the main study a second phase was carried out in which subjects initially treated with regimen B were treated with regimen C, and vice versa (crossover, n = 11), repeating the same experimental protocol. Enamel wear was measured by optical profilometry at baseline and every 7 d thereafter. In the exploratory test (phase 1), no significant differences were observed among regimens at any of the study time-points. In the main study (phases 1 + 2), higher enamel wear was observed for regimen C than for regimen B. A significant trend was observed for the increase of enamel wear over time. Fluoridated dentifrice reduced the development of erosive-abrasive lesions. The proposed longitudinal model provided adequate responses for erosion-abrasion frequency and fluoride effects.

The role of illness beliefs and coping in the adjustment to dentine hypersensitivity

AIM Dentine hypersensitivity is a common oral health problem, however, there has been little research on how people cope with this condition. This study aimed to quantify the effects of illness beliefs and coping strategies on the health outcomes of individuals with dentine hypersensitivity. MATERIALS AND METHODS Participants were purposively sampled from students and staff in one large UK University and 101 self-diagnosed dentine hypersensitivity sufferers participated in the longitudinal study. Participants were required to complete questionnaires which assessed health anxiety, specific illness beliefs (control, consequences, illness coherence, timeline perspectives and emotional representations), coping strategies (passive and active coping) and oral health-related and health-related quality of life (OHRQoL and HRQoL) at baseline and 1 month follow-up. RESULTS Over half of the participants (N = 56) experienced sensations in their teeth on a daily basis and the majority had experienced dentine hypersensitivity for at least 1 year (N = 87). Structural equation modelling indicated that predictors of OHRQoL and HRQoL impacts at follow-up were frequency of sensations, low levels of illness coherence, negative emotional representations, greater health anxiety and use of passive coping strategies at baseline. CONCLUSIONS Illness beliefs and coping strategies predict oral and health-related quality of life outcomes in people with dentine hypersensitivity.

The dentine hypersensitivity experience questionnaire (DHEQ): A longitudinal validation study

Aim: To validate the Dentine Hypersensitivity Experience Questionnaire (DHEQ) in terms of responsiveness to change and to determine the minimally important difference (MID). Materials and methods: The study was a secondary analysis of data from three randomized controlled trials with 311 participants. Three aspects of responsiveness were examined: change within individuals; differences between people who improved, stayed the same, or worsened using an external referent; and change attributable to treatment. Responsiveness to treatments of differing efficacy was assessed in trials with negative and active controls. Results: The measure showed excellent internal reliability, test–retest reliability, and criterion validity. The measure was highly responsive to change within individuals (Cohen’s effect sizes (ES): 0.28, 0.56, 0.86), showing decreases in the total score (i.e., improvement in oral health-related quality of life) across all trials. The ES for participants whose self-reported quality of life was “improved” were large (0.73–1.31). DHEQ detected a treatment effect in one of two negative control trials (ES: 0.47). DHEQ scores were similar in the test and control groups in the active control trial. The MID range was between 22 and 39 points. Conclusions: The measure is longitudinally stable, valid, and responsive, and it can discriminate between treatments of different efficacy.

Derivation of a short form of the dentine hypersensitivity questionnaire

The original Dentine Hypersensitivity Experience Questionnaire (DHEQ) has 48 items, 34 of which comprise the scale that measures the subjective impacts of dentine hypersensitivity (DH). If a questionnaire is extensive, it is helpful to develop a short form to minimize participant burden by reducing the time to complete it. Doing so will also limit the cost of data collection. A short form of a questionnaire will facilitate its use in broader segments of the population and in special groups such as the elderly. It may also have applicability in clinical settings and in larger population samples. Further, a shorter version may reduce missing data. Naturally, such a short form should preserve the properties of the original when possible. This chapter reports the work to derive and evaluate short forms of the DHEQ. Two methods were used: the item-impact and the stepwise regression methods. The short forms were then evaluated cross-sectionally and in two randomized controlled trials, in part by assessing their performance compared with the original DHEQ. The two techniques produced quite similar short forms, so the choice between them required careful consideration. Aim: To derive and evaluate a short form of the DHEQ. Methods: Data from three previous studies of DH (n=353) were pooled and randomly divided in half. Ten-item and 15-item short forms were derived using the first half of the data using the item-impact and regression methods. The four short forms were evaluated using the second half of the data. Results: The 10-item and 15-item versions of the regression short form detected impacts in 37% and 61% of participants, respectively, compared with 68% and 93% using the item-impact method. All short forms had internal consistency (Cronbach’s α>0.84) and test–retest reliability (intraclass correlation coefficient, ICC >0.89). All correlated with the long form (all r>0.93, P<0.001) and with the impact of the effect on the mouth on everyday life (all r≥0.73, P<0.001). None of the short forms detected a treatment effect in two trials, although all four showed a tendency to detect an effect in a trial when the long form had also done so. Conclusions: The 15-item short form derived from the item-impact method performed better than other short forms and appeared to be sufficiently robust for use by individual patients.

Development of condition-specific scales for reporting the pain of dentine hypersensitivity

This chapter describes the development of labeled magnitude (LM) scales specifically designed for assessing the pain of dentine hypersensitivity (DH). Qualitative methods were first used to identify words that describe the pain of DH. Next, magnitude estimation was used to determine the position of these words by relative magnitude along four vertical LM scales. The LM scales were then compared to a standard 100-mm visual analog scale (VAS) by asking participants to use the scales to rate different pain scenarios or water applied to sensitive teeth. As expected, participants used a wider range along the LM scales compared with the VAS for rating scenarios involving low-level pain. Use of one of the four LM scales resulted in greater differences in pain reports compared with VAS when two different temperatures of water were applied to sensitive teeth. LM scales specifically designed to assess DH were thus shown to provide some advantages compared with standard VAS scales when used to evaluate DH-associated pain as well as scenarios involving other low-level pain conditions.

10 – Derivation of a short form of the dentine hypersensitivity questionnaire*

The original Dentine Hypersensitivity Experience Questionnaire (DHEQ) has 48 items, 34 of which comprise the scale that measures the subjective impacts of dentine hypersensitivity (DH). If a questionnaire is extensive, it is helpful to develop a short form to minimize participant burden by reducing the time to complete it. Doing so will also limit the cost of data collection. A short form of a questionnaire will facilitate its use in broader segments of the population and in special groups such as the elderly. It may also have applicability in clinical settings and in larger population samples. Further, a shorter version may reduce missing data. Naturally, such a short form should preserve the properties of the original when possible. This chapter reports the work to derive and evaluate short forms of the DHEQ. Two methods were used: the item-impact and the stepwise regression methods. The short forms were then evaluated cross-sectionally and in two randomized controlled trials, in part by assessing their performance compared with the original DHEQ. The two techniques produced quite similar short forms, so the choice between them required careful consideration. Aim: To derive and evaluate a short form of the DHEQ. Methods: Data from three previous studies of DH (n=353) were pooled and randomly divided in half. Ten-item and 15-item short forms were derived using the first half of the data using the item-impact and regression methods. The four short forms were evaluated using the second half of the data. Results: The 10-item and 15-item versions of the regression short form detected impacts in 37% and 61% of participants, respectively, compared with 68% and 93% using the item-impact method. All short forms had internal consistency (Cronbach’s α>0.84) and test–retest reliability (intraclass correlation coefficient, ICC >0.89). All correlated with the long form (all r>0.93, P<0.001) and with the impact of the effect on the mouth on everyday life (all r≥0.73, P<0.001). None of the short forms detected a treatment effect in two trials, although all four showed a tendency to detect an effect in a trial when the long form had also done so. Conclusions: The 15-item short form derived from the item-impact method performed better than other short forms and appeared to be sufficiently robust for use by individual patients.