Sarah R. Baker

What Psychosocial Factors Influence Adolescents’ Oral Health?

Few studies have examined, comprehensively and prospectively, determinants of oral-health-related quality of life. The aim of this study was to examine the relationships between psychosocial factors and oral health status, health perceptions, and quality of life. Measures of symptom and functional status, health perceptions, quality of life, oral health beliefs, and psychological (sense of coherence, self-esteem, health locus of control) and social factors (parents’ income and education) were collected from 439 12- and 13-year-olds at baseline and six-month follow-up, together with a clinical examination at baseline. Structural equation modeling indicated that increased levels of caries and more symptoms predicted more functional limitations, and, cross-sectionally, greater functional impact was associated with worse health perceptions, which were linked to lower quality of life. Sense of coherence was the most important psychosocial predictor. These factors are important in understanding how oral health affects young people’s daily lives.

‘I Felt as though I’d been in Jail’: Women’s Experiences of Maternity Care during Labour, Delivery and the Immediate Postpartum:

It has been widely recognized, both in the UK and internationally, that there is a need for a multidimensional or holistic approach to maternity care, which incorporates psychological as well as physical aspects, in order to optimize women’s experiences both in the intra- and postpartum period. Central to such an approach is the relationship between women and maternity care staff. The aim of this study was to explore the impact of maternity care staff on women’s experiences, and feelings associated with the childbirth process. Semi-structured interviews were conducted with 24 primiparous and multiparous women, and transcripts analysed using open and axial coding with triangulation. Three main themes emerged from women’s accounts: perceptions of control, staff attitudes and behaviours, and resource issues. Each of these themes was evident throughout the various stages of the childbirth process, in the delivery suite, on the maternity ward, and specifically in relation to breastfeeding. In the women’s accounts, feelings of little control were related to inadequate information provision, poor communication, and no opportunity to influence decision making. These, together with the negative attitudes and behaviours of maternity staff, and issues of under-resourcing, were often linked to negative feelings such as fear, anger, disappointment, distress, guilt, and inadequacy. These findings illustrate the importance of maternity care staff recognizing women’s psychological and emotional needs during the childbirth process, and the impact that they themselves may have on women’s experiences. These issues are discussed with reference to the wider debate on authority and power within the medical relationship, from a feminist viewpoint.

Coping Strategies and Social Support in the Family Impact of Cleft Lip and Palate and Parents' Adjustment and Psychological Distress

Objective: To examine the role of parents’ coping strategies and social support in the family impact of cleft lip and palate (CLP) and levels of adjustment and psychological distress and to investigate whether a childs age, type of cleft, or other reported medical problems influenced such outcomes. Design: A cross-sectional study. Participants: One hundred three parents of children or young adults with CLP recruited from families attending a multidisciplinary cleft lip and palate clinic. Outcome measures: Family impact, psychological distress, and positive adjustment were assessed using validated psychological questionnaires. Results: Findings indicated that while there were many impacts of a childs CLP, negative outcomes (family impact, psychological distress) were not high. In contrast, parents reported high levels of positive adjustment or stress-related growth as a result of their childs condition. Participants also reported high levels of social support and relied more on the use of approach rather than avoidance-oriented coping strategies. Having more support from friends and family was associated with less negative family impact, lower psychological distress, and better adjustment. Greater use of approach coping was associated with more positive adjustment; whereas, avoidant coping was associated with a greater family impact and more psychological distress. Having a younger child and/or a child with medical problems in addition to CLP was associated with a greater impact on the family. Conclusions: How parents cope with their childs condition and the levels of support received may have implications for caregivers, the family unit, and the delivery of more family-oriented CLP services.

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.

Testing relationships between clinical and non-clinical variables in xerostomia: A structural equation model of oral health-related quality of life

ObjectivesThe aim of the study was to systematically test Wilson and Cleary’s [Wilson IB, Cleary PD. JAMA 1995; 273: 59–65] conceptual model of the direct and mediated pathways between clinical and non-clinical variables in relation to the oral health-related quality of life (OHRQoL) of patients with xerostomia.MethodsWe collected measures of clinical variables, self-reported symptoms, OHRQoL, global oral health perceptions and subjective well-being from 85 patients attending outpatient clinics.ResultsStructural equation modelling indicated support for the dominant direct pathways between the main levels of the model; more severe clinical signs predicted worse patient reported symptoms; worse symptom perception was associated with a lower functional status as measured by OHRQoL; and lower OHRQoL predicted worse global oral health perceptions. There was no relationship between the final two levels of the model; global oral health perceptions and subjective well-being. Subjective well-being was associated instead with earlier non-adjacent levels; biological variables, symptoms and functional status. These pathways were both direct (salivary flow–well-being, functioning–well-being) and indirect (clinical signs–well being, symptom status–well-being). There were also indirect pathways; most notably, the impact of clinical variables on OHRQoL was mediated by patient reported symptom status.ConclusionsThe results support Wilson and Cleary’s conceptual model of patient outcomes as applied to a chronic oral health condition and highlight the complexity of (inter)relationships between key clinical and non-clinical variables. Further conceptual development of the model is discussed, particularly the role of individual difference factors, and theoretical and methodological issues in OHRQoL research are highlighted.

Testing a Conceptual Model of Oral Health: a Structural Equation Modeling Approach

Locker’s (1988) multidimensional model of oral health provides a scientific model for the understanding of oral disease and its consequences. To date, there have been no studies that have explicitly tested the model with empirical evidence. This study aimed to: first, test the model in a general population sample using data from the UK adult dental health survey (N = 5268); and, second, to cross-validate these results in two different and diverse samples—edentulous elders (N = 133) and a clinical sample of xerostomia patients (N = 85). Structural equation modeling indicated support for the model as applied to each of the samples. All of the direct pathways hypothesized by the model were significant, in addition to several indirect or mediated pathways between key variables. Further conceptual development of the model is discussed, particularly the role of individual difference factors, and theoretical and methodological issues in oral-health-related quality-of-life research are highlighted. Abbreviations: oral health quality of life (OHQoL); structural equation modeling (SEM); Adult Dental Health Survey (ADH survey); Oral health Impact Profile-short form (OHIP14).

Applying Andersen's behavioural model to oral health: what are the contextual factors shaping perceived oral health outcomes?

OBJECTIVES Andersens revised behavioural model provides a framework for understanding the factors which influence utilization of health services and key health outcomes. To date, there have been few studies that have explicitly tested the model in relation to oral health. The aim of this study was to test the model and to examine the direct and mediated pathways between social, attitudinal and behavioural factors and perceived oral health outcomes. METHODS The model was tested in a general population sample with data from the UK adult dental health survey (N = 3815) using the two-stage process of structural equation modelling. RESULTS Structural equation modelling indicated support in line with the hypotheses within the model; enabling resources (oral health education advice, type of dental service, finding NHS treatment expensive, dental anxiety) predicted need (number of decayed or unsound teeth and perceived treatment need); enabling resources and need predicted personal health practices and use of services (frequency of toothbrushing, recent dental attendance, attendance orientation) which, in turn, predicted perceived oral health outcomes (oral health quality of life). Both enabling resources and need also predicted perceived oral health outcomes. The impact of predisposing factors (social class, qualifications, income) on need, personal health practices and use of services, and oral health outcomes was indirect; that is, mediated by intervening factors. In the final model, 26%, 37%, 49% and 21% of the variance was accounted for in enabling resources, treatment need, personal health practices and use of services and perceived oral health outcomes respectively. CONCLUSION The results provide support for Andersens behavioural model as applied to perceived oral health. Further conceptual development of the model is discussed.

Enhancing Oral Health via Sense of Coherence A Cluster-randomized Trial

Sense of coherence (SOC) has been related to oral health behaviors and oral-health-related quality of life (OHRQoL) in observational studies. This cluster-randomized trial aimed to test the effect of an intervention to enhance SOC on OHRQoL in children. Twelve primary schools were randomly allocated to intervention and control groups. The intervention was comprised of 7 sessions over 2 mos, focusing on child participation and empowerment. The first 4 sessions were classroom activities, and the last 3 involved working on healthy school projects. Trained teachers who received a one-day course delivered the intervention. Socio-demographic and clinical data, together with self-reported measures of OHRQoL, SOC, and oral health beliefs, were obtained from 261 total 10- to 12-year-olds (133 in the intervention and 128 in the control groups). Data were collected at baseline, 2 wks after the intervention, and at three-month follow-up. Mixed-effects models indicated that the intervention increased SOC and improved OHRQoL, together with oral health beliefs and gingival health. The findings offer experimental evidence that OHRQoL can be influenced by SOC. SOC may also provide an avenue for oral health promotion (Australian New Zealand Clinical Trials Registry ACTRN12612000547842).

The everyday impact of dentine sensitivity: Personal and functional aspects

Research of oral health status and research of the impact of oral conditions on everyday life have been developed over the past 30 years. To date, the degree to which these measures can be applied to the problems and impacts associated with dentine sensitivity is not clear. Regarding research of dentine sensitivity, it appears that there has been very little research of its everyday impact. Objective: The aim of this study was to explore the impact of dentine sensitivity on everyday life. Method: Participants were purposively recruited from a general population with the specific aim of securing a range of experiences and views about the everyday impact of dentine sensitivity. Participants were currently experiencing sensitivity in their teeth and were adults (older than age 18 years) and were initially recruited using the research team’s contacts and through snowball sampling. Data were analyzed through the use of a framework generated from the data and informed by the literature on chronic illness, coping, and illness beliefs, along with the general literature on the biopsychosocial impact of oral health. Data analysis also focused on detailing the range of impacts associated with the condition. Results: A total of 23 interviews were conducted. Fifteen participants were female and eight were male. The principal impacts on everyday life were described as pain, impact on functional status, and impact on everyday activities such as eating, drinking, talking, toothbrushing, and social interaction in general. Impacts appeared to be related to a range of individual and environmental influences. Conclusions: The data indicate the depth and complexity of the pain experiences associated with dentine sensitivity. Accordingly, it is suggested that there is a relationship between factors such as the length of one’s illness and the degree of control one has over the condition. These findings confirm similar findings in the psychological literature on pain. The findings of this study confirm that further research into the everyday nature of dentine-sensitive pain would be beneficial.

Oral cancer screening: what have we learnt and what is there still to achieve?

Oral cancer is an important global healthcare problem. In the UK, the incidence is increasing and late-stage presentation is common. Determining the feasibility of a national screening program for oral cancer is therefore an important step in the prevention of the disease. Evidence exists to suggest that an oral examination of high-risk individuals may be a cost-effective screening strategy. However, questions remain over which primary care environment would be the most suitable and the criteria for a positive screen and referral. Further research is needed in the form of clinical trials or demonstration studies in primary care. The impact on secondary care, the role of auxiliaries and training needs also need to be determined. In addition, the assessment of adjunctive aids and evaluation of potential biomarkers are considered important.