Finbarr Allen

No significant retest effects in oral health-related quality of life assessment using the Oral Health Impact Profile

Objective. To investigate retest effects in assessment of the Oral Health Impact Profile (OHIP) in patients requiring prosthodontic treatment. Material and methods. The German 49-item OHIP was administered in 21 patients requiring prosthodontic treatment on three pretreatment occasions: twice (t1 and t2) on day 1, 1–2 h apart, and on day 2 (t3), 3–78 days later. Differences in reliability coefficients, OHIP summary scores, and item responses, and the influence of time on score differences were analyzed. Results. Some evidence of retest effects in oral health-related quality of life (OHRQoL) was found (the difference in reliability coefficients between t1–t2 and t2–t3 was 0.08; p=0.02). Conclusions. The findings support repeated OHRQoL assessment over short periods of time when perceived oral health is rapidly changing. This is important because many oral conditions have acute symptoms and treatments have immediate OHRQoL effects that need to be measured.

Cost-effectiveness of tooth replacement strategies for partially dentate elderly: a randomized controlled clinical trial

OBJECTIVE To conduct a cost-effectiveness analysis comparing two different tooth replacement strategies for partially dentate older patients, namely partial removable dental prostheses (RDP) and functionally orientated treatment based on the shortened dental arch concept (SDA). METHODS Ninety-two partially dentate older patients completed a randomized controlled clinical trial. Patients were randomly allocated to two treatment groups: the RDP group and the SDA group. Treatment effect was measured using impact on oral health-related quality of life (OHrQOL), and the costs involved in providing and maintaining care were recorded for all patients. Patients were followed for 12 months after treatment intervention. All treatment was provided by a single operator. RESULTS The total cost of achieving the minimally important clinical difference (MID) in OHrQOL for an average patient in the RDP group was €464.64. For the SDA group, the cost of achieving the MID for an average patient was €252.00. The cost-effectiveness ratio was therefore 1:1.84 in favour of SDA treatment. CONCLUSION With an increasingly ageing population, many patients will continue to benefit from removable prostheses to replace their missing natural teeth. From a purely economic standpoint, the results from this analysis suggest that the treatment of partially dentate older adults should be focused on functionally orientated treatment because it is simply more cost-effective.

Embedding a population oral health perspective in the dental curriculum

Over the past 40 years, oral healthcare has changed dramatically as a consequence of changing disease profiles and population demography. However, dental disease continues to be highly prevalent and costly to treat. Furthermore, it has been recognized that there are inequalities, with tooth loss being influenced by social, cultural and economic factors. Undergraduate education has been task oriented, with a heavy emphasis on training in technical aspects of treating disease. However, oral healthcare education needs to include a population health perspective, and each professional programme should describe appropriate learning outcomes for population oral health. This includes the need to understand health systems and health trends, and to have knowledge of the evidence base for community prevention strategies and health promotion. A key challenge in embedding population oral health into the curriculum is to break down traditional boundaries in the curriculum and to make teaching of this subject context specific and interdisciplinary. Embedding population oral health offers the potential to create synergies between educators and health service providers with the ultimate benefit of producing a reflective and holistic oral health practitioner. There are challenges, but it is important to produce graduates whose attitudes and clinical practices will be shaped by a sound knowledge of population oral health.

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A qualitative investigation into patients' perspectives on edentulousness.

OBJECTIVES This study explored the experiences of edentulous patients for their perceptions of tooth loss and patient attitudes to treatment options for rehabilitation of the edentate state. METHODS Purposive sampling was used to recruit edentate patients with varying denture-wearing experience from two dental hospitals in the Republic of Ireland. Sixteen edentate patients, aged 59 to 83 years, of whom 12 were women and four men were interviewed. Interviews were transcribed, and thematic analysis was undertaken. RESULTS Findings from this study reflect previous studies, whereby some patients indicated dissatisfaction with the functionality of their dentures. The majority of participants had no regret regarding the loss of their teeth, and despite dissatisfaction with dentures, they would not consider other forms of treatment. Finance was not considered an issue in determining whether to seek out treatment by these participants. These participants expressed a reluctance to get new dentures in case they were more problematic. CONCLUSION This study illustrates that some elder edentate patients were dissatisfied with the functionality of their dentures and raised concerns that about the quality of dentures which may be provided to them by dentists. These participants identified clinical dental technicians as a preferred point of contact for their care. Consideration should be given to new oral healthcare delivery models which are accessible and acceptable to future elders.