- Email: [email protected]
Oral health-related quality of life
through spirituality, higher family social support, and low levels of plaque were significantly related to lower levels of periodontitis. Religiosity led to higher family social support and support of internal life through spirituality, and that was in turn related to plaque level and periodontitis. Discussion.—Religiosity led to higher social support from the family, which is already well-established as a determinant of periodontitis. Religiosity was also related to perception of support of internal life through spirituality, which was related to plaque level and to periodontitis. Thus religiosity was plausibly considered a protective factor against periodontitis. However, the findings of this study may not be applicable to other populations.
Clinical Significance.—Dental care providers should consider not just the risk factors for
developing periodontitis but also the factors that protect against developing this disease. Sociopsychological factors can positively influence the etiology, prognosis, and interventions in periodontal disease. Religiosity offers specific protection and should help in preventive and treatment efforts against periodontitis.
Zini A, Sgan-Cohen HD, Marcenes W: Is religiosity related to periodontal health among the adult Jewish population in Jerusalem? J Periodont Res 47:418-425, 2012 Reprints available from A Zini, Dept of Community Dentistry, The Hebrew Univ Hadassah School of Dental Medicine, POB 12272, Jerusalem 91120, Israel; fax: þ972 2 6415574; e-mail: [email protected]
Quality of Life Oral health-related quality of life Background.—The implications of oral health-related quality of life (OHRQoL) for the clinical practice of dentistry and dental research are significant, with this parameter integral to individuals’ health and well-being. OHRQoL was defined, its importance to dental practice and research was described, its uses in research and research trends were outlined, and the implications of OHRQoL research for health policy were identified.
one to determine the importance of children’s oral health to their overall health and well-being as well as the impact of oral health on children’s QoL. Such assessment also allows the shift from traditional medical/dental criteria to evaluation and care focusing on a person’s social and emotional experience and physical functioning to define appropriate treatment goals and outcomes. Medical and dental research on health-related QoL has been useful because of the increased role patients play as members of the treatment team, the need for evidence-based approaches to health decisions, and the fact that many chronic disease treatments do not actually cure the condition but may influence QoL, making this a valuable health outcome variable. OHRQoL also has implications for analyzing oral health disparities and access-to-care issues. The impact of such issues on overall health and QoL can be determined.
Definition.—OHRQoL is defined as the result of an interaction between and among oral health conditions, social and contextual factors, and the rest of the body. A framework has been developed that links health status or clinical variables, functional status, orofacial appearance, psychological status, OHRQoL, and overall quality of life (QoL), recognizing the effects of environmental or contextual factors and access to care on oral health perceptions and related QoL. Thus, OHRQoL is a function of various symptoms and experiences and represents the patients’ personal perspective. Instruments to measure OHRQoL try to identify the impact of treatment along with the positive influences of oral health and appearance on overall health and well-being. Both these positive and any relevant negative dimensions are assessed at all ages.
Uses in Research.—Several things must be considered when OHRQoL is used in research. The specific purpose of the OHRQoL assessment must be established. The tool used to assess OHRQoL should be able to discriminate between and among the possible applications for the research, measuring extent of the condition and identifying the various diagnostic or treatment-seeking groups.
Significance in Practice and Research.—OHRQoL offers important information in both the theoretical and the practical realms. For example, assessing OHRQoL allows
Another consideration is the use of generic or disease condition-specific instruments. Disease-specific instruments may have advantages over generic instruments,
Volume 58
Issue 5
2013
265
such as measuring specific conditions, which increases their sensitivity compared with the generic approaches. Generic instruments often have higher incidences of ‘‘no impact’’ because many of the symptoms considered are either not prevalent or not relevant among the groups seeking dental care. OHRQoL measures are specific to oral health but general because they measure a range of oral symptoms and impacts. OHRQoL are appropriate across a multitude of oral health conditions but not sensitive to people seeking care for a specific health condition that has no oral health manifestation. However, in developing a condition-specific measure, the measure must have effective evaluative properties. Generic measures are usually less responsive to change than the measures focused on a single disease or condition. Age-specificity and oral health should also be included in OHRQoL instruments. Measuring children’s OHRQoL is a unique challenge because their dental, facial, and cognitive development changes dramatically throughout childhood and adolescence. Proxy ratings are a valuable resource for verifying or contradicting children’s selfreported OHRQoL and are important for both providers and researchers. The ratings of children and their caregivers on OHRQoL can be discordant, so obtaining both will give a more accurate depiction of children’s COHRQoL. OHRQoL is used in health services research to evaluate trends in oral health and population-based needs assessment. Epidemiologic survey research examines trends in OHRQoL, identifies individual and environmental characteristics that influence OHRQoL, and helps to perform needs assessments and health planning for population-based policy initiatives. Individual characteristics and environmental aspects can theoretically predict outcomes, but sociodemographic factors may also have an impact. Certain medical, dental, and emotional conditions are also consistently associated with low OHRQoL. For example, the greater the untreated dental decay, the lower the QoL; the greater the malocclusion, the lower the QoL; and the presence of craniofacial condition is associated with a lower QoL. These baseline assessments inform health practitioners about specific areas requiring attention on the patient’s perspectives. OHRQoL is also associated with the perceived need for dental treatment, poor self-related health, reduced mental health, fewer teeth, and relatively poor cognitive status in elderly people with disabilities. OHRQoL is also related to dental esthetics and facial appearance. Mediating factors in these interactions include personal characteristics, positive attributes like resilience, and the influence these have on the access, use, and health perceptions of individuals. Including OHRQoL in survey research adds a powerful dimension to planning and developing health promotion programs.
266
Dental Abstracts
The use of OHRQoL assessments to measure the efficacious nature of treatment may help to improve care. Longitudinal studies of OHRQoL are designed to measure changes in scores from baseline to after treatment. This helps to apply individual growth models, for example, to children with cleft conditions and estimate change trajectories over time. Elective interventions tend to improve QoL, but subjective evaluations are needed to determine whether the interventions have the desired effect and whether that effect continues with time. Considering evidence-based care, it is important to understand the effectiveness of an intervention from the patient’s perspective and to comprehend more clearly the interrelationships of specific oral and facial issues and general QoL, psychological factors, and family variables. Use of OHRQoL to assess outcome is congruent with patient-centered care. By using this as one of the several evaluative tools, practitioners are better equipped to accurately weigh benefits and risks of treatment approaches. Costs related to value can be better evaluated from the patient’s perspective, and patients and their families can be helped to make better treatment decisions. For example, patients’ strengths and weaknesses with respect to their QoL can be analyzed and helped to develop adjunct multidisciplinary service programs. Finally, OHRQoL as an outcome measure helps to address and evaluate clinically meaningful change. Determining the clinical significance of OHRQoL data requires that attention be given to overall group differences as well as individual assessments. Two issues must be addressed in doing this: (1) determining whether a statistically significant difference between experimental and comparison groups has clinical meaningfulness and (2) determining whether a statistically significant difference for a group has relevance for clinically meaningful change for individuals. The assessment of clinically meaningful change in oral health requires further research. Implications for Health Policy.—Access to care is a major health policy issue. Using the relationship between oral health conditions and QoL can communicate to policymakers the importance of oral health and equal access to care. As treatment options increase and patient samples become more diverse, sociocultural and psychological factors must be considered when evaluating needs, outcomes, and clinical practices. Disparities in access to care and treatment rationing related to costs may be better handled by comparing QoL in various treatment groups, helping patients, health care providers, and policymakers to make more informed decisions. Measuring the impact of dental services before and after treatment may also improve evidence-based decisions related to treatment needs, effectiveness, and policy perspectives. Dental practice-based research networks have been created to enhance care and improve community health. An integral part of dental practice-based research networks is subjective patient evaluations about their oral health and treatment experiences.
By measuring OHRQoL in patients, oral health care professionals can enhance evidence-based care. Objective and subjective assessments are being compared in longitudinal protocols that are being developed to indicate treatment outcomes.
Clinical Significance.—Using applied science and individual-centered approaches to measuring treatment needs and efficacy of care will require that we measure OHRQoL for our patients. Patient-oriented outcomes such as OHRQoL will help us better understand how oral health and general health are related. It will also direct clinical researchers and practitioners to the many factors that contribute to
the patient’s well-being besides having dental problems treated. Both public policy and oral health disparities can be addressed using information from OHRQoL research. Thus, OHRQoL has an important contribution to make in dentistry, in health care in general, and in dental research efforts.
Sischo L, Broder HL: Oral health-related quality of life: What, why, how, and future implications. J Dent Res 90:1264-1270, 2011 Reprints available from HL Broder, NYU College of Dentistry – Cariology & Comprehensive Care, 380 Second Ave, Suite 301, New York, NY 10010; e-mail: [email protected]
Regenerative Medicine Role of dentistry Background.—Regenerative medicine is an emerging multidisciplinary field that combines principles from biology, medicine, and engineering to restore, maintain, or enhance tissue and organ function. Dentistry has long embraced the concept of restoring function to damaged teeth and fits well within the aims of regenerative medicine. Currently, regenerative medicine is being driven by the use of stem cells or existing cells in the body, but also uses synthetic materials, harvests biologic extracellular matrix, uses growth factors and cytokines, and combines these in ways to reconstitute tissue and organ function throughout the body. For dentists, the main areas are teeth and oral and facial soft tissues such as mucosa and facial muscles. Few medical specialties focus as much on restoration of organ and tissue function as dental medicine, which uses concepts from biomaterials, biomedical engineering, tissue engineering, and regenerative medicine to treat patients. Examples of dental regenerative medicine were offered. Implants.—The success of dental implants relies on their ability to integrate in bone and soft tissue. Integrating epithelium and fibrous connective tissue helps to form a seal against the oral environment. Local tissue responses to surgical implants occur mainly because of the cellular response to the implant surface during healing. When a cell contacts the implant surface, that surface becomes extracellular matrix to that cell, being coated with proteins from blood and tissue. As a result, the cell responds to the local proteins and the microstructure and nanostructure of the surface. Ideally, an implant surface would control the behavior of attached cells, including cellular proliferation,
cell shape, and differentiation. As a result, the soft and hard tissue response would produce tissue integration and function much like an intact organ, which is what regenerative medicine aims to do. Some regenerative engineered implant surfaces contain repeat-pattern microchannels that control the shape and proliferation of cells and inhibit colonization and growth of fibroblasts. These laser microchannel surfaces have been applied to the collars of experimental dental implants and prevented epithelial downgrowth and crestal bone loss in animal models. This technology is now used in humans as the Laser-Lok surface, which attaches bone, fibrous connective tissue, and epithelium and halts epithelial downgrowth. Scaffolds.—All bone grafting materials and bone graft substitutes are scaffolds designed to act not only as a structural component but also as a template for tissue formation. The response of cells and tissues depends on the composition of the scaffold, its surface microstructure, and its three-dimensional (3-D) architecture. The ideal scaffold for a tissue depends on the tissue’s structure and properties. The material must be nontoxic and biocompatible, needs appropriate 3-D architecture and physical and chemical stability so it will last long enough, and requires the right porosity and pore structure to accept and organize the types of cells and tissues to be regenerated. The scaffold must also have mechanical properties appropriate for the cells and their macroenvironments and microenvironments. It should promote healing and be readily fabricated so it is
Volume 58
Issue 5
2013
267
Clinical Significance.—Dental care providers should consider not just the risk factors for
developing periodontitis but also the factors that protect against developing this disease. Sociopsychological factors can positively influence the etiology, prognosis, and interventions in periodontal disease. Religiosity offers specific protection and should help in preventive and treatment efforts against periodontitis.
Zini A, Sgan-Cohen HD, Marcenes W: Is religiosity related to periodontal health among the adult Jewish population in Jerusalem? J Periodont Res 47:418-425, 2012 Reprints available from A Zini, Dept of Community Dentistry, The Hebrew Univ Hadassah School of Dental Medicine, POB 12272, Jerusalem 91120, Israel; fax: þ972 2 6415574; e-mail: [email protected]
Quality of Life Oral health-related quality of life Background.—The implications of oral health-related quality of life (OHRQoL) for the clinical practice of dentistry and dental research are significant, with this parameter integral to individuals’ health and well-being. OHRQoL was defined, its importance to dental practice and research was described, its uses in research and research trends were outlined, and the implications of OHRQoL research for health policy were identified.
one to determine the importance of children’s oral health to their overall health and well-being as well as the impact of oral health on children’s QoL. Such assessment also allows the shift from traditional medical/dental criteria to evaluation and care focusing on a person’s social and emotional experience and physical functioning to define appropriate treatment goals and outcomes. Medical and dental research on health-related QoL has been useful because of the increased role patients play as members of the treatment team, the need for evidence-based approaches to health decisions, and the fact that many chronic disease treatments do not actually cure the condition but may influence QoL, making this a valuable health outcome variable. OHRQoL also has implications for analyzing oral health disparities and access-to-care issues. The impact of such issues on overall health and QoL can be determined.
Definition.—OHRQoL is defined as the result of an interaction between and among oral health conditions, social and contextual factors, and the rest of the body. A framework has been developed that links health status or clinical variables, functional status, orofacial appearance, psychological status, OHRQoL, and overall quality of life (QoL), recognizing the effects of environmental or contextual factors and access to care on oral health perceptions and related QoL. Thus, OHRQoL is a function of various symptoms and experiences and represents the patients’ personal perspective. Instruments to measure OHRQoL try to identify the impact of treatment along with the positive influences of oral health and appearance on overall health and well-being. Both these positive and any relevant negative dimensions are assessed at all ages.
Uses in Research.—Several things must be considered when OHRQoL is used in research. The specific purpose of the OHRQoL assessment must be established. The tool used to assess OHRQoL should be able to discriminate between and among the possible applications for the research, measuring extent of the condition and identifying the various diagnostic or treatment-seeking groups.
Significance in Practice and Research.—OHRQoL offers important information in both the theoretical and the practical realms. For example, assessing OHRQoL allows
Another consideration is the use of generic or disease condition-specific instruments. Disease-specific instruments may have advantages over generic instruments,
Volume 58
Issue 5
2013
265
such as measuring specific conditions, which increases their sensitivity compared with the generic approaches. Generic instruments often have higher incidences of ‘‘no impact’’ because many of the symptoms considered are either not prevalent or not relevant among the groups seeking dental care. OHRQoL measures are specific to oral health but general because they measure a range of oral symptoms and impacts. OHRQoL are appropriate across a multitude of oral health conditions but not sensitive to people seeking care for a specific health condition that has no oral health manifestation. However, in developing a condition-specific measure, the measure must have effective evaluative properties. Generic measures are usually less responsive to change than the measures focused on a single disease or condition. Age-specificity and oral health should also be included in OHRQoL instruments. Measuring children’s OHRQoL is a unique challenge because their dental, facial, and cognitive development changes dramatically throughout childhood and adolescence. Proxy ratings are a valuable resource for verifying or contradicting children’s selfreported OHRQoL and are important for both providers and researchers. The ratings of children and their caregivers on OHRQoL can be discordant, so obtaining both will give a more accurate depiction of children’s COHRQoL. OHRQoL is used in health services research to evaluate trends in oral health and population-based needs assessment. Epidemiologic survey research examines trends in OHRQoL, identifies individual and environmental characteristics that influence OHRQoL, and helps to perform needs assessments and health planning for population-based policy initiatives. Individual characteristics and environmental aspects can theoretically predict outcomes, but sociodemographic factors may also have an impact. Certain medical, dental, and emotional conditions are also consistently associated with low OHRQoL. For example, the greater the untreated dental decay, the lower the QoL; the greater the malocclusion, the lower the QoL; and the presence of craniofacial condition is associated with a lower QoL. These baseline assessments inform health practitioners about specific areas requiring attention on the patient’s perspectives. OHRQoL is also associated with the perceived need for dental treatment, poor self-related health, reduced mental health, fewer teeth, and relatively poor cognitive status in elderly people with disabilities. OHRQoL is also related to dental esthetics and facial appearance. Mediating factors in these interactions include personal characteristics, positive attributes like resilience, and the influence these have on the access, use, and health perceptions of individuals. Including OHRQoL in survey research adds a powerful dimension to planning and developing health promotion programs.
266
Dental Abstracts
The use of OHRQoL assessments to measure the efficacious nature of treatment may help to improve care. Longitudinal studies of OHRQoL are designed to measure changes in scores from baseline to after treatment. This helps to apply individual growth models, for example, to children with cleft conditions and estimate change trajectories over time. Elective interventions tend to improve QoL, but subjective evaluations are needed to determine whether the interventions have the desired effect and whether that effect continues with time. Considering evidence-based care, it is important to understand the effectiveness of an intervention from the patient’s perspective and to comprehend more clearly the interrelationships of specific oral and facial issues and general QoL, psychological factors, and family variables. Use of OHRQoL to assess outcome is congruent with patient-centered care. By using this as one of the several evaluative tools, practitioners are better equipped to accurately weigh benefits and risks of treatment approaches. Costs related to value can be better evaluated from the patient’s perspective, and patients and their families can be helped to make better treatment decisions. For example, patients’ strengths and weaknesses with respect to their QoL can be analyzed and helped to develop adjunct multidisciplinary service programs. Finally, OHRQoL as an outcome measure helps to address and evaluate clinically meaningful change. Determining the clinical significance of OHRQoL data requires that attention be given to overall group differences as well as individual assessments. Two issues must be addressed in doing this: (1) determining whether a statistically significant difference between experimental and comparison groups has clinical meaningfulness and (2) determining whether a statistically significant difference for a group has relevance for clinically meaningful change for individuals. The assessment of clinically meaningful change in oral health requires further research. Implications for Health Policy.—Access to care is a major health policy issue. Using the relationship between oral health conditions and QoL can communicate to policymakers the importance of oral health and equal access to care. As treatment options increase and patient samples become more diverse, sociocultural and psychological factors must be considered when evaluating needs, outcomes, and clinical practices. Disparities in access to care and treatment rationing related to costs may be better handled by comparing QoL in various treatment groups, helping patients, health care providers, and policymakers to make more informed decisions. Measuring the impact of dental services before and after treatment may also improve evidence-based decisions related to treatment needs, effectiveness, and policy perspectives. Dental practice-based research networks have been created to enhance care and improve community health. An integral part of dental practice-based research networks is subjective patient evaluations about their oral health and treatment experiences.
By measuring OHRQoL in patients, oral health care professionals can enhance evidence-based care. Objective and subjective assessments are being compared in longitudinal protocols that are being developed to indicate treatment outcomes.
Clinical Significance.—Using applied science and individual-centered approaches to measuring treatment needs and efficacy of care will require that we measure OHRQoL for our patients. Patient-oriented outcomes such as OHRQoL will help us better understand how oral health and general health are related. It will also direct clinical researchers and practitioners to the many factors that contribute to
the patient’s well-being besides having dental problems treated. Both public policy and oral health disparities can be addressed using information from OHRQoL research. Thus, OHRQoL has an important contribution to make in dentistry, in health care in general, and in dental research efforts.
Sischo L, Broder HL: Oral health-related quality of life: What, why, how, and future implications. J Dent Res 90:1264-1270, 2011 Reprints available from HL Broder, NYU College of Dentistry – Cariology & Comprehensive Care, 380 Second Ave, Suite 301, New York, NY 10010; e-mail: [email protected]
Regenerative Medicine Role of dentistry Background.—Regenerative medicine is an emerging multidisciplinary field that combines principles from biology, medicine, and engineering to restore, maintain, or enhance tissue and organ function. Dentistry has long embraced the concept of restoring function to damaged teeth and fits well within the aims of regenerative medicine. Currently, regenerative medicine is being driven by the use of stem cells or existing cells in the body, but also uses synthetic materials, harvests biologic extracellular matrix, uses growth factors and cytokines, and combines these in ways to reconstitute tissue and organ function throughout the body. For dentists, the main areas are teeth and oral and facial soft tissues such as mucosa and facial muscles. Few medical specialties focus as much on restoration of organ and tissue function as dental medicine, which uses concepts from biomaterials, biomedical engineering, tissue engineering, and regenerative medicine to treat patients. Examples of dental regenerative medicine were offered. Implants.—The success of dental implants relies on their ability to integrate in bone and soft tissue. Integrating epithelium and fibrous connective tissue helps to form a seal against the oral environment. Local tissue responses to surgical implants occur mainly because of the cellular response to the implant surface during healing. When a cell contacts the implant surface, that surface becomes extracellular matrix to that cell, being coated with proteins from blood and tissue. As a result, the cell responds to the local proteins and the microstructure and nanostructure of the surface. Ideally, an implant surface would control the behavior of attached cells, including cellular proliferation,
cell shape, and differentiation. As a result, the soft and hard tissue response would produce tissue integration and function much like an intact organ, which is what regenerative medicine aims to do. Some regenerative engineered implant surfaces contain repeat-pattern microchannels that control the shape and proliferation of cells and inhibit colonization and growth of fibroblasts. These laser microchannel surfaces have been applied to the collars of experimental dental implants and prevented epithelial downgrowth and crestal bone loss in animal models. This technology is now used in humans as the Laser-Lok surface, which attaches bone, fibrous connective tissue, and epithelium and halts epithelial downgrowth. Scaffolds.—All bone grafting materials and bone graft substitutes are scaffolds designed to act not only as a structural component but also as a template for tissue formation. The response of cells and tissues depends on the composition of the scaffold, its surface microstructure, and its three-dimensional (3-D) architecture. The ideal scaffold for a tissue depends on the tissue’s structure and properties. The material must be nontoxic and biocompatible, needs appropriate 3-D architecture and physical and chemical stability so it will last long enough, and requires the right porosity and pore structure to accept and organize the types of cells and tissues to be regenerated. The scaffold must also have mechanical properties appropriate for the cells and their macroenvironments and microenvironments. It should promote healing and be readily fabricated so it is
Volume 58
Issue 5
2013
267