Cm de Oliveira

Oral health-related quality of life and the IOTN index as predictors of children's perceived needs and acceptance for orthodontic treatment

Objective To evaluate whether the index of orthodontic treatment need (IOTN) could be improved by adding an oral health-related quality of life measure to predict both the outcome of orthodontic consultation and the childs perceived need for orthodontic treatment.Methods The sample consisted of 187 children aged 11-16 years referred to orthodontic clinics in the Bedfordshire Personal Dental Service (PDS) in the United Kingdom. The children completed a questionnaire containing the Child Perception Questionnaire (CPQ11-14), were clinically examined and completed the Child-OIDP index in face-to-face interviews. Demographic information and perceived need for orthodontic treatment were also collected. Clinical data on orthodontic treatment need was collected using the IOTN.Results 49.3% of children reported one or more oral impacts. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study did not predict outcome of consultation, however it explained childrens perceived need for braces. There were some discrepancies between need according to the orthodontist and childrens perceptions.Conclusions Adding an oral health-related quality of life measure to IOTN did not influence prediction of outcome of consultation but it explained the prediction of perceived need for braces. Importantly, children with an impact were denied orthodontic treatment.

Impacts on daily performances attributed to malocclusions using the condition-specific feature of the Oral Impacts on Daily Performances Index.

OBJECTIVE To assess the prevalence, intensity, and extent of sociodental impacts attributed to malocclusions by sex, socioeconomic status, and normative orthodontic treatment need level. MATERIALS AND METHODS One thousand sixty 15- to 16-year-old adolescents without history of previous or current orthodontic treatment were randomly selected from all secondary schools in Bauru, Brazil. Interviews were done to collect information about sociodemographic variables and sociodental impacts on quality of life attributed to malocclusions using the Oral Impacts on Daily Performances Index. Adolescents were also clinically examined using the Index of Orthodontic Treatment Need. Statistical comparison by covariables was performed using chi(2) and Kruskal-Wallis tests. RESULTS The prevalence of condition-specific impacts (CSIs) was 24.6%. Among adolescents with CSIs, 52.1% reported severe or very severe intensity and 77.4% reported impacts on only one daily performance, commonly, smiling. The prevalence, intensity, and extent of CSIs differed by level of normative orthodontic treatment need but not by sex or socioeconomic status. However, among adolescents with definite normative orthodontic treatment need, 24.5% reported CSIs of severe or very severe intensity, whereas among those with moderate or slight/no need, 13.0% and 7.9%, respectively, experienced CSIs of severe or very severe intensity. CONCLUSIONS Untreated malocclusions have physical, psychological, and social consequences on quality of life of Brazilian adolescents. However, because adolescents with a definite normative orthodontic need are considered by orthodontists as in need of care, these results raise the issue of whether all these adolescents should be considered for orthodontic attention since most had no perceived impacts on performing their daily life activities.

Condition-Specific Impacts on Quality of Life Attributed to Malocclusion by Adolescents with Normal Occlusion and Class I, II and III Malocclusion

OBJECTIVE To compare the prevalence, intensity, and extent of condition-specific oral impacts on quality of life attributed to malocclusion by Brazilian adolescents with normal occlusion and those with Angle Class I, II, and III malocclusion. MATERIALS AND METHODS Four groups of 55 adolescents were configured such that each group represented normal occlusion, as well as Angle Class I, II, and III malocclusion. No radiographs were taken. Adolescents aged 15 to 16 years were selected from those attending all secondary schools in Bauru (Sao Paulo, Brazil). The Oral Impacts on Daily Performances index was used to collect data on condition-specific impacts (CSIs) attributed to malocclusion. The prevalence, as well as the intensity and extent, of CSIs was compared among the four groups with the use of Chi-square and Kruskal-Wallis tests, respectively. RESULTS Groups were comparable according to sex, age, and socioeconomic status. The prevalence of CSI was significantly different between groups (P = .039). Class II and III malocclusion groups reported a higher prevalence of CSI than those with normal occlusion and Class I malocclusion. However, the intensity and extent of CSI were not significantly different between groups. CONCLUSIONS The prevalence, but not the intensity and extent, of CSIs attributed to malocclusion differed among groups with different malocclusions. The present findings support the concept that malocclusion has physical, psychological, and social effects on quality of life.

Impacts on daily performances attributed to malocclusions by British adolescents

The aim of this study was to assess the prevalence of condition-specific impacts on daily performances attributed to malocclusion in British adolescents. Two hundred 16- to 17-year-old adolescents were randomly selected from 957 children attending a public college in London, UK. During interviews, participants provided information about demographic variables and socio-dental impacts on quality of life attributed to malocclusions, using the Condition-Specific form of the Oral Impacts on Daily Performances (CS-OIDP) index. Adolescents were also clinically examined using the Index of Orthodontic Treatment Need. Statistical comparison by covariates was performed using chi-squared test and chi-squared test for trends. The prevalence of oral impacts on daily performances attributed to any oral condition was 26.5% whereas the prevalence of CS-OIDP attributed to malocclusion was 21.5%. There was no statistically significant difference by sex, age, ethnicity or orthodontic treatment status of schoolchildren in the prevalence of CS-OIDP attributed to malocclusion (P >/= 0.243 for all cases). However, there was a linear trend for the prevalence of CS-OIDP attributed to malocclusion, by level of normative orthodontic treatment need (P = 0.042). The prevalence of such impacts increased from 16.8% for adolescents with no/slight need for orthodontic treatment, to 31.7% for those with definite need for orthodontic treatment. Although findings support the idea that malocclusion has physical, psychological and social effects on quality of life of these adolescents, the inconsistencies in findings between the self-reports of impacts of malocclusion and the assessment of normative needs highlight the shortcomings of using only clinical indexes to estimate orthodontic treatment needs.

The planning, contracting and monitoring of orthodontic services, and the use of the IOTN index: a survey of consultants in dental public health in the United Kingdom

Key PointsThis paper highlights the need: To improve the assessment of orthodontic treatment needTo improve the IOTN index by reporting its shortcomingsTo stress the need for incorporation of a measure of oral health-related quality of life in the assessment of orthodontic treatment needTo reduce inequalities in the provision of orthodontic treatmentAbstractObjectives To establish which factors are used in planning, contracting and monitoring orthodontic services in the United Kingdom. In addition, the study investigated the value of the Index of Orthodontic Treatment Need (IOTN) as an instrument for planning orthodontic provision.Methods A structured questionnaire was sent to all consultants in dental public health in the United Kingdom.Results Over 80% of the respondents used the Index of Orthodontic Treatment Need (IOTN) as an instrument for planning, contracting and monitoring orthodontic services. Seventy per cent of these consultants regarded the IOTN index as a useful or very useful instrument. The main strength reported was that the IOTN index allows prioritisation (25.0%). The main weakness reported was that the index does not assess complexity (70.5%).Conclusions Consultants in dental public health perceived the IOTN as a useful tool for planning orthodontic provision despite some shortcomings.Objectives To establish which factors are used in planning, contracting and monitoring orthodontic services in the United Kingdom. In addition, the study investigated the value of the Index of Orthodontic Treatment Need (IOTN) as an instrument for planning orthodontic provision.Methods A structured questionnaire was sent to all consultants in dental public health in the United Kingdom.Results Over 80% of the respondents used the Index of Orthodontic Treatment Need (IOTN) as an instrument for planning, contracting and monitoring orthodontic services. Seventy per cent of these consultants regarded the IOTN index as a useful or very useful instrument. The main strength reported was that the IOTN index allows prioritisation (25.0%). The main weakness reported was that the index does not assess complexity (70.5%).Conclusions Consultants in dental public health perceived the IOTN as a useful tool for planning orthodontic provision despite some shortcomings.

Impacts on daily performances related to wearing orthodontic appliances.

OBJECTIVE To assess the prevalence, intensity, and extent of the impacts on daily performances related to wearing different types of orthodontic appliances. MATERIALS AND METHODS A total of 1657 students, 15 to 16 years old, were randomly selected from those attending all secondary schools in Bauru, São Paulo, Brazil. Only those wearing orthodontic appliances at the time of the survey were included. Face-to-face structured interviews were done to collect information about impacts on quality of life related to wearing orthodontic appliances, using the Oral Impact on Daily Performances (OIDP). Adolescents were also clinically examined to assess the type of orthodontic appliance they were wearing. Comparisons, by type of orthodontic appliance and covariables, were performed using nonparametric statistical tests. RESULTS Three hundred fifty-seven adolescents (36.1% boys and 63.9% girls) undergoing orthodontic treatment participated in the study. The prevalence of condition-specific impacts related to wearing orthodontic appliances was 22.7%. Among adolescents with impacts related to wearing orthodontic appliances, 35.8% reported impacts of severe or very severe intensity and 90.1% reported impacts on only one daily performance, commonly eating or speaking. The prevalence, but not the intensity or the extent, of condition-specific impacts differed by type of orthodontic appliance (P = .001). CONCLUSIONS One in four Brazilian adolescents undergoing orthodontic treatment reported side effects, specific impacts on daily living, related to wearing orthodontic appliances. Such impacts were higher among adolescents wearing fixed rather than removable or a combination of fixed and removable orthodontic appliances. This information could help to inform patients about the frequency and intensity of sociodental impacts during the course of their treatment.

Comparison of the generic and condition-specific forms of the Oral Impacts on Daily Performances (OIDP index).

OBJECTIVE This study aimed to compare generic and condition-specific forms of the Oral Impacts on Daily Performances (OIDP) in terms of their ability to discriminate between adolescents with and without normative need for orthodontic treatment. METHODS A total of 1,060 15- to 16-year-old adolescents without history of previous or current orthodontic treatment were randomly selected from all secondary schools in Bauru, Brazil. Adolescents were clinically examined by using the Dental Aesthetic Index (DAI). Normative need for orthodontic treatment was defined by using three different suggested cutoff values on DAI score; 28, 31, and 36 points. Two different estimates (overall score and prevalence of oral impacts) were calculated by using the generic and the condition-specific OIDP (CS-OIDP) attributed to malocclusion. Discriminative ability was assessed, comparing both estimates between groups. Effect size and adjusted odds ratios were used to interpret the magnitude and meaning of differences. RESULTS The overall score and prevalence of oral impacts on quality of life in the last 6 months were significantly lower for the CS-OIDP attributed to malocclusion than for the generic OIDP (P < 0.001 in both cases). However, effect sizes and adjusted odds ratios were always larger for the CS-OIDP attributed to malocclusion than for the generic OIDP. CONCLUSIONS Although generic and condition-specific OIDP forms were able to discriminate adolescents with normative need for orthodontic treatment from those without such a need, CS-OIDP attributed to malocclusion had better ability to distinguish between groups. Further studies are needed to compare discriminative ability of both OIDP forms between groups with different levels of other oral conditions.

Assessing levels of agreement between two commonly used oral health-related quality of life measures.

OBJECTIVE This study aimed to assess the level of agreement between two commonly used oral health-related quality of life (OHRQoL) measures, the short form of the Oral Health Impact Profile (OHIP14) and the Oral Impacts on Daily Performances (OIDP). METHODS A sample of 1,675 15- to 16-year-old students attending all schools in Bauru (Sao Paulo, Brazil) was selected. The impact of oral conditions on quality of life in the last 6 months was reported using both OHIP14 and OIDP. To allow for comparison with the 100 percent OIDP score, OHIP14 scores were converted to percentages. Then, agreement between the two OHRQoL measures was analyzed using the Bland and Altman method. RESULTS The mean difference between OHIP14 and OIDP was 6.48 percent [confidence interval 95% (6.08; 6.89)], with higher scores reported for OHIP14 than for OIDP. Besides, 95 percent of the differences between the two OHRQoL measures were between -10.59 and 23.56 percent. Finally, differences between OHIP14 and OIDP increased significantly as the magnitude of their average increased (P < 0.001). CONCLUSION There was a moderate level of agreement between OHIP14 and OIDP, which may be partly due to the fact that both OHRQoL measures assess different levels of oral impacts on quality of life in addition to having different scoring systems.

OP67 Hearing impairment and incident frailty in older English community-dwelling men and women: a 4-year follow-up study

Background Hearing impairment is common in later life and associated with morbidity. However few population-based studies have investigated the impact of hearing impairment on frailty in older adults. We examined the association between hearing impairment and the risk of incident frailty over 4 years. Methods 2836 community-dwelling adults aged ≥60 years from the English Longitudinal Study of Ageing were followed up from 2004 (baseline) to 2008. Hearing impairment was defined as reporting poor self-experienced hearing. Frailty was defined using the Fried Phenotype based on self-reported questionnaires and nurse assessments. A score of 0 out of 5 frailty components (slow walking gait speed, grip strength, self-reported exhaustion, weight loss and low physical activity) was defined as having no prevalent frailty, 1–2 pre-frailty and ≥3 was defined as being frail. Participants without prevalent frailty at baseline were followed up for pre-frailty and frailty, and participants who were pre-frail at baseline were followed up for subsequent frailty. Results At follow-up, there were 367 new cases of pre-frailty and frailty among those without prevalent frailty at baseline (n = 1396), and 133 new cases of frailty among those who were pre-frail at baseline (n = 1178). Compared to participants with no prevalent frailty at baseline who reported good hearing, participants with no prevalent frailty who reported poor hearing had an increased risk of becoming pre-frail at follow-up (age- and sex-adjusted OR 1.43, 95% CI 1.05–1.95). However the association was attenuated after further adjustment for wealth and education. Compared to pre-frail participants with good hearing, pre-frail participants with poor hearing were associated with an increased risk of becoming frail at follow-up (age- and sex-adjusted OR 1.64, 95% CI 1.07–2.51) and the association remained after further adjustment for wealth, education, CVD, cognitive function and depression. Conclusion Older adults with pre-frailty who experience poor hearing have an increased risk of becoming frail over 4 years. In contrast, those with no prevalent frailty who experienced poor hearing did not have an increased risk of becoming pre-frail or frail. This suggests that hearing impairment in older adults may be a particular problem in those who are starting to experience other health and functional concerns. Identifying and actively managing hearing impairment in pre-frail older adults may have potential to delay the development of frailty. Further research is warranted on the possible mechanisms of frailty in hearing impaired older adults.

P59 Changes in the body mass index and waist circumference distribution of adults aged 25–64 years in England, Scotland, and the United States, 1998–2012

Background Body Mass Index (BMI) and waist circumference (WC) are anthropometric indicators strongly associated with diabetes, cardiovascular disease, cancer and mortality. Focusing on secular changes in the mean values of BMI and WC can mask differences at the lower- and upper-tails of the distribution. Our network of health examination survey researchers from the Americas and the UK quantified secular changes in the BMI and WC distributions in England, Scotland, and the United States (US). Methods Nationally-representative surveys of adults aged 25–64 y from similar time periods: Health Survey for England (1999–2012; n = 75,813); Scottish Health Survey (1998–2011; n = 33,010) and US National Health and Nutrition Examination Survey (1999–2012; n = 22,340). Comparisons across time for mean values of measured height, weight, BMI, and WC and prevalence of obesity (BMI ≥ 30 kg/m2) and abdominal obesity (WC ≥ 88 cm) were performed by age-standardising descriptive estimates by the direct-method to the 2000 US population. Quantile regression was used to evaluate whether BMI and WC values increased across survey years at pre-specified centiles of the distribution (5th, 50th, 95th). Models were adjusted for age, age-squared and survey year. Results Mean BMI values for men (women) at baseline were 27.1 kg/m2 (26.6 kg/m2) in England; 27.1 kg/m2 (26.8 kg/m2) in Scotland; and 27.8 kg/m2 (28.6 kg/m2) in the US. Obesity and abdominal obesity increased for both sexes in England and in Scotland. In the US, obesity increased only for men; abdominal obesity increased only for women. Mean BMI increased by 0.4 kg/m2 (0.7 kg/m2) for men (women) in England; 0.8 kg/m2 for both sexes in Scotland; and 1.0 kg/m2 for men in the US. BMI at the 5th centile was unchanged in England, but increased in Scotland and the US. Increases at the median and upper-tail occurred in each country: the increase at the 95th BMI percentile was 2.1 kg/m2 (1.3 kg/m2) for men (women) in England; 1.9 kg/m2 for both sexes in Scotland; and 2.0 kg/m2 (1.9 kg/m2) in the US (each P < 0.001). Mean WC increased by 2.1 cm (4.7 cm) for men (women) in England; 3.4 cm (6.5 cm) in Scotland; and 2.4 cm (3.8 cm) in the US. The increase at the 95th WC percentile was 6.3 cm (5.4 cm) for men (women) in England; 3.6 cm (8.4 cm) in Scotland; and 4.5 cm (18.3 cm) in the US (each P < 0.001). Ongoing analyses will incorporate data from Chile, Colombia, Mexico, and Brazil. Conclusion Secular increases in BMI and WC were fairly consistent by country for both sexes, with clear evidence of increases across the whole distribution in Scotland and the US.