P. F. Allen

Impacts of oral disorders in the United Kingdom and Australia.

Background Surveys of oral health have not previously compared national adult populations using measures of subjective oral health.Aims To compare subjective oral health of adults in the UK and Australian populations.Methods Cross sectional studies were conducted of people aged 18+ years in the 1998 UK Adult Dental Health Survey and the 1999 Australian National Dental Telephone Interview Survey. Subjective oral health was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14).Results Among dentate people, the percentage reporting impacts fairly often or very often was marginally greater in Australia (18.2%, 95% confidence interval (CI) = 16.2–20.2) than the UK (15.9%, 95%CI = 14.4–17.4). There were larger regional variations in prevalence within populations, ranging from 14.8% to 22.3% among Australian states/ territories, and from 13.6% to 19.8% among countries within the UK. However, the mean number of impacts and rated severity of impacts was significantly greater in Australia than the UK.Conclusions While the percentage of adults reporting adverse impacts of oral health was similar, Australians reported a larger number of impacts and more severe impacts than dentate people in the UK. Differences in the number and severity of impacts between the two populations may be an artifact of different data collection methods or may reflect relatively subtle socio-cultural differences in subjective oral health between these populations.

A Randomized Controlled Trial of Implant-retained Mandibular Overdentures

Evidence from randomized clinical trials of implant-retained overdentures is very limited at the present time. The aim of this study was to compare implant-retained mandibular overdentures and conventional complete dentures in a randomized controlled trial (RCT). Our a priori hypothesis was that implant-retained mandibular overdentures would be significantly better than conventional complete dentures. Edentulous patients (n = 118) were randomly allocated to either an Implant Group (n = 62) or a Denture Group (n = 56). Patients completed the Oral Health Impact Profile (OHIP) and a denture satisfaction scale pre-treatment and three months post-treatment. Upon completion of treatment, both groups reported improvement (p < 0.001, Wilcoxon Ranks Sum test) in oral-health-related quality of life and denture satisfaction. There were no significant post-treatment differences between the groups, but a treatment effect may be masked by application of “intention to treat” analysis. The OHIP change scores were significantly greater for patients receiving implants than for those who refused them.

Nutrition Counseling Increases Fruit and Vegetable Intake in the Edentulous

Edentulous denture-wearers eat fewer fruits and vegetables than do comparable dentate individuals. Improved chewing ability with new dentures has resulted in little dietary improvement, suggesting that dietary intervention is necessary. The objective of this randomized controlled trial was to have a positive impact upon dietary behavior of patients receiving replacement complete dentures through a tailored dietary intervention. Readiness to change diet (Stage of Change), intake of fruits, vegetables, and nutrients, and chewing ability were assessed pre-and 6 weeks post-intervention. The intervention group (n = 30) received two dietary counseling sessions; the control group (n = 28) received current standard care. Perceived chewing ability significantly increased in both groups. There was significantly more movement from pre-action into action Stages of Change in the intervention group, who had a greater increase in fruit/vegetable consumption (+209 g/d) than did the control group (+26 g/d) (P = 0.001). Tailored dietary intervention contemporaneous with replacement dentures can positively change dietary behavior.

The clinical relevance of orthognathic surgery on quality of life

The aim of orthognathic surgery is to produce a more aesthetic facial skeletal appearance, and improve jaw function. This prospective study, aimed to evaluate the impact of orthognathic surgery on quality of life for patients with dentofacial deformity, and whether it was clinically meaningful. 62 consecutive patients were recruited (27 male, 35 female) aged 18-38 years. Baseline data were collected using a validated health status measure (Orthognathic Quality of Life Questionnaire (OQLQ)) and a visual analogue scale (VAS). Postoperative questionnaires (OQLQ, VAS) and a Global Transition Scale (GTS) were completed at 6 months after completion of treatment and compared with pre-treatment scores. Following surgery, there was a significant (p<0.05, paired t test) improvement in OQLQ scores for each domain. The proportion of patients reporting a moderate or large improvement was: facial appearance (93%), chewing function (64%), comfort (60%) and speech (32%). Clinical relevance of change scores was reported in terms of effect sizes, and the largest effect was on facial aesthetics. The clinical impact was moderate on social aspects of deformity and oral function and a small effect on awareness of facial deformity. This research reaffirms that orthognathic surgery has positive effects on quality of life.

Attitudes, awareness and oral health‐related quality of life in patients with diabetes

The purpose of this study was to assess the knowledge diabetic patients have of their risk for periodontal disease, their attitude towards oral health and their oral health-related quality of life (OHRQL). One hundred and one consecutive patients (age range 31-79 years) recruited from a diabetic outpatient clinic participated in the study. Twenty-seven per cent of participants had type 1 diabetes, 66% type 2 and 7% did not know what type of diabetes they had. The length of time since participants were diagnosed as diabetic ranged from 1 to 48 years. Metabolic control of diabetes as determined by HbA1c levels ranged from 6.2% to 12.0% compared with the normal range of 4.5-6.0%. Thirty-three per cent of participants were aware of their increased risk for periodontal disease, 84% of their increased risk for heart disease, 98% for eye disease, 99% for circulatory problems and 94% for kidney disease. Half of the participants who were aware of their increased risk for periodontal disease had received this information from a dentist. Dental attendance was sporadic, with 43% reporting attendance within the last year. OHRQL was not significantly affected by the presence of diabetes in the group surveyed, in comparison with a previous survey of non-diabetic patients. A significant association was found between metabolic control and dentate status. Awareness of the potential associations between diabetes, oral health and general health needs to be increased in diabetic patients.

Determining "need" for a Removable Partial Denture: a qualitative study of factors that influence dentist provision and patient use.

Objective To identify factors that influence Removable Partial Denture (RPD) provision, and patient use of RPDs in the UK.Design Exploratory qualitative interview study.Subjects and methods Subjects There were two sample groups. A purposive sample of 16 male and female dentists was categorised in terms of level of RPD provision, experience, and practice characteristics. A purposive sample of 17 male and female partially dentate patients was categorised in terms of RPD use and demographic characteristics. Data collection Semi-structured in-depth interviews.Results For dentists, RPD provision was indicated by patient demand and physical function of the remaining teeth, but was mediated by NHS fee structures and professional satisfaction. For patients, RPD use was influenced by the trade-off between improved appearance and the unpalatable presence of an RPD in their mouth. The location of the gap(s) was important, but other issues were relevant such as ability to manage without the RPD.Conclusion When defining need for an RPD, dentists focused on physical function of the teeth whereas patients focused on social meanings of the mouth. These differing priorities may improve understandings of patient non-compliance in RPD use. Further research on the relationship between denture use and social identity could be beneficial.

Perceived Chewing Ability and Intake of Fruit and Vegetables

Edentulous individuals have reduced chewing ability and lower fruit and vegetable consumption compared with dentate individuals. It has been suggested that the two are causally related. However, psychosocial factors such as attitude, self-identity, and knowledge of recommendations are predictive of intake in non-edentulous persons. The aims of this study were to: determine if perceived chewing ability was predictive of fruit and vegetable intake; explore the predictive ability of knowledge, attitude, and self-identity; and compare intake between edentulous and dentate individuals. Full denture-wearing (N = 79) and dentate persons (N = 52) completed a three-day food diary. Perceived chewing ability, sociodemographic, and psychosocial factors were assessed via self-administered questionnaire. The dentate persons consumed significantly more fruit and vegetables, but differences were not significant when juices were excluded. Perceived chewing ability explained ~ 4% variance in intake. Attitude, self-identity, and knowledge explained a further ~ 20%. If the diet of denture-wearers is to be improved, psychosocial factors, as well as perceived chewing ability, must be addressed.

Complications and maintenance requirements of implant-supported prostheses provided in a UK dental hospital.

Aim: To assess the nature, timing and frequency of complications associated with implant therapy and to assess maintenance requirements of implant-supported prostheses.Design: Retrospective analysis.Setting: The Dental Hospital in Newcastle upon Tyne.Method: Dental records of 60 patients provided with implant-supported prostheses were examined. Data were compiled on the number of fixtures placed per patient, the type of prosthesis provided, complications during the surgical and prosthodontic phases, and peri-implant soft tissue complications.Results: 66 prostheses were placed on 236 fixtures over a 6-year period. Surgical complications included fixture loss (n = 6), dysaesthesia (n = 12), and the need for a guided tissue regeneration procedure (n = 10). Common maintenance requirements were tightening of components (n = 11), clip replacement (n = 7) and repair of conventional prostheses opposing implant supported prostheses (n = 7). Plaque control was unsatisfactory with almost half of the subjects requiring intensive oral hygiene instruction and scaling at the first post placement review.Conclusions: Prosthodontic maintenance requirements were high, particularly during the first year. Surgical complications were relatively infrequent. A case was made for a rigorous oral hygiene programme to reduce the potential for fixture loss through neglect. The financial cost associated with the maintenance of implant-supported prostheses should be incorporated in their overall funding

Quality of written prescriptions and master impressions for fixed and removable prosthodontics: a comparative study

Aim: Various ethical and legal guidelines require dental practitioners to adequately design, prescribe and fabricate good quality prostheses. The purpose of this investigation was to examine the quality of written instructions and choice of impression trays and materials for both fixed and removable prosthodontics in Ireland and the United Kingdom.Materials and methods: A pre-piloted questionnaire was distributed to a number of large commercial laboratories geographically distributed throughout the United Kingdom and Ireland. Information was sought relating to the quality of written instructions and use of impression trays and materials for three forms of dental precision casting — cobalt-chromium based removable partial dentures, full veneer porcelain-fused-to-metal crowns, and conventional fixed bridges.Results: Six hundred questionnaires were distributed, and information was received relating to 447 items of prosthodontic treatment (response rate= 75%). Ninety-five per cent of cases were privately funded. Using pre-determined grading criteria, poor or no written instructions were provided in one-half of cases examined. One-half of master impressions were made using a plastic stock tray. The technician felt that material had been appropriately disinfected prior to being sent to the laboratory in only 57% of cases.Conclusion: The written instructions and master impressions examined in this study failed to meet the relevant ethical and legal guidelines in approximately 50% of cases.

Why do dentists struggle with removable partial denture design? An assessment of financial and educational issues

Aim Published studies in the international dental literature illustrate that the quality of prescription and fabrication of cobalt-chromium removable partial dentures (CCRPDs) by general dental practitioners frequently fail to comply with ethical and legal requirements. The reasons cited for this in the past have broadly related to either financial or educational issues. The aim of this investigation is to determine the effect of financial and educational factors on the quality of CCRPD design and fabrication by general dental practitioners.Materials and methods This investigation was completed in two parts. (1) A pre-piloted pro-forma was distributed to a number of dental laboratories throughout the UK and Ireland. These sought information relating to the quality of written instructions for CCRPDs received by these laboratories, and details of the remunerative scheme under which they were being provided. Three categories of remunerative scheme were considered, private CCRPDs in Ireland, private CCRPDs in the UK, and CCRPDs being provided by salaried NHS practitioners. (2) A pre-piloted questionnaire was distributed to vocational dental practitioners in the UK and Ireland. This sought information relating to their attitudes, opinions, and educational and clinical experiences of CCRPD design and fabrication.Results (1) Three hundred completed pro-formas were returned from dental laboratories, 100 of which related to each of the three remunerative schemes. Poor or no written instructions were provided in 47% (n = 47) of CCRPD cases funded privately in the UK, 46% (n = 46) of CCRPD cases funded privately in Ireland, and 50% (n = 50) of CCRPDs being provided by salaried NHS practitioners. (2) One hundred and seven completed questionnaires were returned from vocational trainees. Vocational dental practitioners had completed fewer CCRPDs during VT than in dental school (dental school: median = 4, inter-quartile range = 3 to 5; VT: median = 2, inter-quartile range = 1 to 4). One-fifth of respondents (n = 22) had not completed any CCRPDs during VT. Nine per cent of VT practices (n = 10) had a surveyor on their premises. Only 15% (n = 16) of respondents felt the time they had spent in VT had increased their confidence in the design of CCRPDs.Conclusion Financial factors did not have as significant an effect on the quality of prescription and fabrication of CCRPDs as did educational factors. Serious deficiencies in the teaching of CCRPDs during vocational training were identified.