Farzana Sufi

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.

Clinical study investigating abrasive effects of three toothpastes and water in an in situ model

OBJECTIVES This in situ study compared the abrasive effect of repeated brushings (over 10 days) of a low relative abrasive dentine (RDA) toothpaste with moderate and high relative abrasive dentine (RDA) toothpastes, on human dentine in situ. MATERIALS AND METHODS The study design was single centre, single blind, randomized, split mouth, two period, four-treatment cross-over, in situ study in 20 healthy subjects. Subjects wore bi-lateral lower buccal appliances each fitted with four dentine sections with treatment applied with a power toothbrush, during each 10 day study period. Samples were measured at baseline, day 5 and day 10 by contact profilometry, and baseline and day 10 with non-contact profilometry. RESULTS Nineteen subjects were included in the efficacy analysis. Results as measured by contact and non-contact profilometry from brushing with the moderate RDA paste and high RDA paste showed significantly (p<0.0001) more abrasion to dentine than brushing with the low RDA paste or water after 10 days. Dentine loss following tooth brushing with the low RDA paste was not significantly different from brushing with water, after 10 days. CONCLUSIONS The methodology successfully showed clear differentiation between the amount of dentine lost following toothbrushing with the low RDA paste compared to the moderate or high RDA pastes. Dentine loss following brushing with the low RDA paste showed a comparable degree of abrasion to brushing with water.

Derivation of a short form of the Dentine Hypersensitivity Experience Questionnaire.

AIM To derive and evaluate a short form of the Dentine Hypersensitivity Experience Questionnaire. METHODS Data from three previous studies of dentine hypersensitivity (n = 353) were pooled and randomly divided into half. Ten- and 15-item short forms were derived in the first half of the data using the item impact and regression methods. The four short forms were evaluated in the second half. RESULTS The 10 and 15-item versions of the regression short form detected impacts in 37% and 61% of participants, respectively, compared to 68% and 93% using the item impact method. All short forms had internal consistency (Cronbachs α) >0.84 and test-retest reliability (ICC) >0.89. All correlated with the long form (all r > 0.93, p < 0.001) and with the effect of 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 where the long form had done so. CONCLUSIONS The 15-item short form derived with the item impact method performed better than other short forms and appears to be sufficiently robust for use in individual patients.

Evaluation of salivary fluoride retention from a new high fluoride mouthrinse

OBJECTIVES To evaluate salivary fluoride retention from a new high fluoride daily use mouthrinse over a 120 min period. METHODS Sixteen subjects completed a randomised single-blind, four-treatment cross-over trial. Sensodyne® Pronamel® mouthrinse (A) contained 450 ppm fluoride; reference products were Colgate® Fluorigard® (B), Listerine® Total Care (C) and Listerine Softmint Sensation (D) containing 225, 100 and 0 ppm fluoride respectively. Salivary fluoride retention was monitored ex vivo after a single supervised use of test product (10 mL, 60 s). Samples were collected at 0, 1, 3, 5, 15, 30, 60 and 120 min post-rinse, generating fluoride clearance curves from which the area under the curve (AUC) was calculated. Differences in salivary fluoride concentrations for each product were analysed using ANCOVA at each time point using a 5% significance level, as well as lnAUC for the periods 0-120, 0-1, 1-15, 15-60 and 60-120 min. Pairwise comparisons between all treatment groups were performed. RESULTS Salivary fluoride levels for A-C peaked immediately following use. Fluoride levels were statistically significantly higher for A versus B-D (p≤ 0.004), linear dose responses were apparent. AUC(0-120) was statistically significantly greater for A than for B (p = 0.035), C (p< 0.0001) and D (p< 0.0001). Post-hoc comparisons of lnAUC for the remaining time domains showed fluoride retention from A was statistically significantly greater versus B-D (p< 0.0001). CONCLUSIONS Single-use treatment with the new mouthrinse containing 450 ppm fluoride resulted in statistically significantly higher salivary fluoride levels throughout the 120 min test period. Total fluoride retention (AUC(0-120)) was also statistically significantly greater versus comparator rinse treatments.

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.

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.

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

Historically, the clinical assessment of dentine hypersensitivity (DH) has focused solely on intensity aspects of a pain response after stimulation of exposed dentine. More recent concepts of health shift the focus to the effect of the condition on the lives of those affected. Using well-characterized methods, this study attempted to incorporate these broader psychosocial impacts of DH on everyday life into an oral health-related quality of life (OHQoL) measure that was specific to DH: the Dentine Hypersensitivity Experience Questionnaire (DHEQ). The chapter outlines the stages in the production and initial evaluation of the measure. The results demonstrate that DHEQ can measure meaningful and relevant impacts on the everyday lives of people with DH. Aim: To develop and validate a condition-specific measure of OHQoL for dentine hypersensitivity (DHEQ). Materials and Methods: Questionnaire construction used a multistaged 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, with a scale to capture subjective impacts of DH, 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 Cronbach’s alpha=0.86). Intraclass correlation coefficient for test–retest reliability was 0.92. The impact scale was strongly correlated with 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 the general population and a clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.

14 – 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. One hundred one people with self-diagnosed dentine hypersensitivity completed questionnaires that 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 quality of life (OHRQoL) and health-related quality of life (HRQoL) at baseline and 1-month follow-up. Results: More than 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 modeling 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 OHRQoL and HRQoL outcomes in people with dentine hypersensitivity.