Oliver Schierz

Association between perceived oral and general health

OBJECTIVES The aim of this study was to determine the magnitude of the association between perceived oral and general health-related quality of life (O/HRQoL) in the German general population and to compare it with the correlation of both constructs in dental patients. METHODS OHRQoL was assessed using the OHIP-49 and HRQoL using the SF-36 in a sample (N=811) representative of the adult general population of Germany (age: 18-99 years), and in a sample (N=313) of consecutive adult dental patients at least 18 years of age seeking prosthodontic care or attending their annual checkup. Correlation between OHRQoL and HRQoL was computed using structural equation modelling-based confirmatory factor analysis and path analysis. Based on the correlation coefficients, the coefficients of determination (r(2)) were calculated. RESULTS Correlation between OHRQoL and HRQoL after partialling out effects of age, gender and level of depression in general population subjects was rho=0.28 resulting in an explanation of the variance of HRQoL by OHRQoL of 7.8%. In dental patients the correlation coefficient was somewhat lower (rho=0.24) corresponding to an explanation of the variance of HRQoL by OHRQoL of 5.6%. Difference between correlation coefficients was not significant (p=0.514). CONCLUSION Our findings provide evidence for the inseparable, intertwined relationship between perceived oral and general health.

Influence of administration method on oral health-related quality of life assessment using the Oral Health Impact Profile

The influence of the administration method used to collect oral health-related quality of life (OHRQoL) data is largely unknown. Therefore, the aim of this study was to determine whether OHRQoL information obtained using the Oral Health Impact Profile (OHIP) differed with different methods of collection (personal interview, via telephone or as a self-administered questionnaire). The OHRQoL was measured using the German version of the OHIP. The instrument was administered to each of 42 patients using three different methods, in a randomized order, about 1 wk apart. The test-retest reliability coefficient for the repeated OHIP assessment across the three methods of administration, and the magnitude of the variance component for administration method, were determined, characterizing the degree of OHIP score variation that is caused by this factor. Whereas OHIP mean score differences of 3.9 points were present between administration methods, the reliability coefficient of 0.90 (95% CI, 0.85-0.95) indicated that 90% of the OHIP score variation was caused by differences between subjects (and not by the administration method or measurement error). The variance component for administration method explained 0.5% of the OHIP score variation. In conclusion, the method of administration (personal interview, telephone interview or self-administered questionnaire) did not influence substantially OHIP scores in prosthodontic patients.

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.

Temporomandibular disorder pain is related to the general disposition to be anxious.

AIMS To assess whether trait anxiety as a persons general disposition to be anxious is a risk factor for temporomandibular disorder (TMD) pain. METHODS A total of 320 adult TMD patients with at least one pain-related TMD diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were included in the study. Subjects from the general population without pain-related TMD were used as controls (n = 888). All study participants completed the State-Trait Anxiety Inventory (STAI). The association between the level of trait anxiety (STAI-Trait scores) and case-control status (patients diagnosed with pain-related TMD and controls) was analyzed using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were computed. RESULTS The level of trait anxiety was associated with the subject status (case vs control). A one-point increase in STAI-Trait sum scores (range: 20 to 80) was related to an increase of the odds for pain-related TMD by the factor 1.04 (CI: 1.02-1.05; P < .001). Severe trait anxiety (above the 90th percentile of general-population subjects) doubled the odds (OR: 2.05; CI: 1.42-2.98; P < .001). Analyses adjusted for age, gender, and level of education did not change the results. CONCLUSION Trait anxiety is significantly associated with diagnoses of TMD pain.

[An abbreviated version of RDC/TMD].

BACKGROUND The aim of this study was to develop a short diagnostic test for pain-related craniomandibular disorders (CMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). MATERIAL AND METHOD Participants included 1,177 CMD patients and 896 general population subjects who were examined according to the RDC/TMD. This new diagnostic short test consisted of a combination of the least amount of RDC/TMD items that distinguished between patients and subjects with a sensitivity of > or =70% and a specificity of > or =90%. The diagnostic test items were selected from all available RDC/TMD items using best subset logistic regression. RESULTS The question about the presence of facial pain achieved a sensitivity of 96% and a specificity of 95%. The lower limits of the confidence interval for test accuracy measures exceeded the postulated thresholds specified for test development. Assuming a CMD pain prevalence of 10% in the general population this short test resulted in a positive predictive value of 80% and a negative predictive value of >99%. CONCLUSION A single question about facial pain is a strong predictor for a pain-related CMD disorder and could provide an effective CMD short test.

Eine Kurzversion der RDC/TMD

BACKGROUND The aim of this study was to develop a short diagnostic test for pain-related craniomandibular disorders (CMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). MATERIAL AND METHOD Participants included 1,177 CMD patients and 896 general population subjects who were examined according to the RDC/TMD. This new diagnostic short test consisted of a combination of the least amount of RDC/TMD items that distinguished between patients and subjects with a sensitivity of > or =70% and a specificity of > or =90%. The diagnostic test items were selected from all available RDC/TMD items using best subset logistic regression. RESULTS The question about the presence of facial pain achieved a sensitivity of 96% and a specificity of 95%. The lower limits of the confidence interval for test accuracy measures exceeded the postulated thresholds specified for test development. Assuming a CMD pain prevalence of 10% in the general population this short test resulted in a positive predictive value of 80% and a negative predictive value of >99%. CONCLUSION A single question about facial pain is a strong predictor for a pain-related CMD disorder and could provide an effective CMD short test.

Self-reported severity of taste disturbances correlates with dysfunctional grade of TMD pain

Altered central neural processing of sensory information may be associated with temporomandibular disorders (TMD) pain. The objectives of this study were to compare the prevalence of self-reported taste disturbances in TMD pain patients and in a control population, and to determine whether frequency of taste disturbances was correlated with dysfunctional grade of TMD pain. Subjects were 2026 people within a German population sample and 301 consecutive TMD patients diagnosed using the Research Diagnostic Criteria. Taste disturbances were measured using two questions from the Oral Health Impact Profile. Dysfunctional grade of TMD pain was measured with the Graded Chronic Pain Scale. A two-sample test of proportions revealed that TMD patients reported a greater frequency of taste disturbances, 6%, than did the general population subjects, 2% (P < 0.001). Moreover, the frequency of taste disturbances correlated with the dysfunctional grade of TMD pain. For each 1 unit increase in taste disturbance, the odds of observing a higher grade of TMD pain increased by 29% (95% CI: 3-63%, P = 0.03). Analysis by individual taste question and adjustment for age and gender did not substantially affect the results. These findings are consistent with a central neural dysfunction in TMD pain and suggest that a common neural substrate may underlie sensory disturbances of multiple modalities in chronic pain patients. Further research regarding taste disturbances and trigeminally mediated pains such as in TMD is warranted.

Impact of shortened dental arch on oral health-related quality of life over a period of 10 years – a randomized controlled trial

OBJECTIVES To compare oral health-related quality of life (OHRQoL) in patients with either molar replacement by partial removable dental prostheses (PRDP) or with restored shortened dental arches (SDA) over a period of 10 years. METHODS In this multi-center RCT, a consecutive sample of 215 patients with bilateral molar loss in at least one jaw was initially recruited in 14 prosthodontic departments. Of those patients, 150 could be randomly allocated to the treatment groups (SDA: n = 71; PRDP: n = 79), received the allocated treatment, and were available for follow-up assessments. OHRQoL was assessed using the 49-item version of the Oral Health Impact Profile (OHIP) before treatment (baseline) and at follow-ups after treatment (4-8 weeks and 6, 12, 24, 36, 48, 60, 96, and 120 months). To investigate the course of OHRQoL over time, we longitudinally modelled treatment and time effects using mixed-effects models. RESULTS OHRQoL substantially improved from baseline to first follow-up in both groups indicated by a mean decrease in OHIP scores of 20.0 points (95%-CI: 12.5-27.5). When compared to the SDA group, OHRQoL in the PRDP group was not significantly different (-0.6 OHIP points; 95%-CI: -7.1 to 5.9) during the study period when assuming a constant time effect. OHRQoL remained stable over the 10 years with a statistically insignificant time effect (p = 0.848). CONCLUSIONS For patients requesting prosthodontic treatment for their lost molars, treatments with SDA or PRDP improve clinically relevantly OHRQoL and maintain it over a period of 10 years with no option being superior to the other. CLINICAL SIGNIFICANCE Since there was no significant difference between the two treatment options over the observation period of 10 years, and since results have stayed stable over time, patients can be informed that both treatment concepts are equivalent concerning OHRQoL.

Reliability of mandibular movement assessments depending on TMD

Abstract Objective: This study determines the effect of temporomandibular disorders (TMD) on the reliability of mandibular movement assessments. Methods: The vertical and horizontal jaw movements, as well as overjet and overbite, were measured twice in 56 consecutively recruited adult subjects with TMD according to the RDC/TMD and 29 controls without TMD diagnosis by experienced dentists utilizing a millimeter ruler. The reliability was determined by intraclass correlation coefficient (ICC). Results: Neither statistically nor clinically relevant differences in the repeatability between both subgroups could be detected (all p ≥ 0.077). The mouth opening and overjet proved an excellent reliability (ICC 0.85–0.92). Overbite and laterotrusion showed good to excellent reliable results (ICC 0.74–0.82). The second measurement of the vertical jaw movement resulted in systematically higher values (p < 0.003). Discussion: The assessment of the mandibular movement with a millimeter ruler is a reliable procedure irrespective of TMD. To decrease the variances in the mouth opening measurements, the patient should be asked beforehand to practice this movement.

Impact of mounting methods in computerized axiography on assessment of condylar inclination

Abstract Objective: Valid and reliable recording is a key requirement for accurately simulating individual jaw movements. Methods: Horizontal condylar inclination (HCI) and Bennett’s angle were measured using a digital jaw tracker (Cadiax® Compact 2) in 27 young adults. Three mounting methods (paraocclusal tray adapter, periocclusal tray adapter, and tray adapter with mandibular clamp) were tested. Results: The mean values of the HCI differed by up to 10° between the mounting methods; however, the values for Bennett’s angle did not differ substantially. While the intersession reliability of the Bennett’s angle assessment did not depend on the mounting method, the reliability of the HCI assessment was only fair to good for the paraocclusal mounting method but poor for both periocclusal mounting methods. Discussion: For attaching the tracing bow of jaw trackers to the mandible, a paraocclusal tray adapter should be applied, to achieve the most reliable results.