DTIN0210

trends &applications DeNtaltribuNe|april-June, 20104 Dr Katrin Bekes Germany Dentine hypersensitivity is an oral complaint frequently repor- ted in clinical dental practice. While many individuals do not seek treatment to desensitise their teeth because they do not perceive dentine hypersensitiv- ity to be a severe oral health problem,asubstantialnumberof patients experience discomfort to the extent that it interferes with their eating, drinking, oral hygiene habits and sometimes even breathing. These symptom often have a considerably adve- rse impact on their daily quality of life (QoL). This article reviews the impairments of oral health related quality of life in patients seeking care for dentine hyper- sensitivity. Traditionally, dentists have been trained to recognise & treat oral diseases & to describe them by using dental indices. Dental indices provide a quantitative method for measuring, scoring, and analysing dental conditions in individuals and groups. They describe the status of individu- als or groups with respect to the condition being measured. How ever, important as these objective measures are, they only reflect the end-point of the disease processes. They give no indication of the impact of the disease process, especially oral disorder, on function or psycho- social well being, and only pro- vide little insight into the impact on daily living and QoL. Therefore, QoL research in medicine & dentistry has attrac- ted increasing attention over the past years. QoL is defined as an individual’s perception of his or her position in life, in the context of the culture and value systems in which he or she lives and in relation to his or her expectations, goals and con- cerns. QoL has multiple dimen- sions (such as cultural factors, social integration, socioecono- mic status, quality of environ- ment and personal autonomy). One dimension of QoL is health. The real impact of health and disease on QoL is known as health related quality of life (HRQoL). Oral health related quality of life (OHRQoL) is that part of HRQoL that focuses on oral health and orofacial concerns (Fig. 1). The concept of OHRQoL facilitates studying the impact of a disease on a person’s total oral health be- cause it can be used across conditions. It describes the way in which oral health affects a person’sabilityto function,hisor her psychological status, social factors and pain or discomfort. How to measure OHRQoL OHRQoL is a multidimensional construct that cannot be obser- ved directly. It needs to be visua- lised by means of suitable indi- cators. In order to comprehend a construct like this, target per- sons, that is patients, have to be asked pertinent questions. For example, some questions focus on function, some are concerned with pain and discomfort, and others evaluate self-image and social interaction. The Oral Health Impact Profile (OHIP) is amongst the most widely used instrument in studies evaluating OHRQoL. It attempts to measure both the frequency and severity of oral problems on functional & psychosocial well being. This tool was developed by Slade and Spencer in Australia in 1994. The OHIP is a 49-item meas- ure, with statements grouped into seven theoretical domains, namely functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. Examples of some OHIP questions are: • Have you had trouble pron- ouncing words because of problems with your teeth, mouth or dentures? • Have you found it uncomfort- able to eat any foods because of problems with your teeth, mouth or dentures? • Have you felt that your sense of taste has worsened beca- use of problems with your teeth, mouth or dentures? For each of the 49 OHIP ques- tions, subjects are asked how frequently they have experien- ced the oral problem. Responses are according to a Likert-type scale: 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, and 4 = very often. A summary score of between 0 & 196 results from the 49 ques- tions, with 5 scoring steps each, which provides a good impres- sion of the extent to which OHR QoL is affected. A score of 0 indicates the absence of any oral health related problem. Higher scores represent an OHRQoL that is more impaired. The most extensive impairment of the OHRQoL is expressed by a score of 196. This is termed the problem index and demonstra- tes that all oral problems are frequently encountered. A table of standard values representa- tive of different populations is provided, according to which the patient’s score can be compared and evaluated. To be able to assess levels of OHRQoL in non-English speak- ing populations, cross-culturally adapted translations of the origi- nal English-language version of the OHIP into Chinese, Dutch, Hungarian, Italian, Japanese, Portuguese, Spanish & Swedish has been achieved in several countries. The demand for an internationally comparable Ger- man tool led to the development of a German version of the OHIP (OHIP-G), which determines the OHRQoL of German speaking persons. OHIP-G includes the 49 items of the English original, as well as four additional items that were regarded as important for the German population specifi- cally. OHIP-G can be applied to patients of 16 years and older. OHRQoL in patients seeking care for dentine hypersensitivity Dentine hypersensitivity is a common oral complaint that is frequently reported in dental practice. It is characterised by a short and sharp pain arising from exposed dentine and occu- rring in the presence of ther- mal, chemical, tactile or osmotic stimuli (Fig. 2). From the rela- tively few studies that investi- gate the prevalence of dentine hypersensitivity, it can be con- cluded that it is a frequent con- dition. Studies have reported a prevalence of dentine hypersen- sitivity in the adult dentate popu- lation ranging from 4 to 57 per- cent. However, figures as high as 60 to 98 per cent have been reported in patients with peri- odontitis. While many indivi- duals do not seek treatment to desensitise their teeth because they do not perceive dentine hypersensitivity to be a severe oral health problem, 10 to 25 per cent of patients experience discomfort to the extent that it interferes with their eating, drinking (hot & cold beverages), oral hygiene habits and some- times even breathing. The deg- ree of discomfort depends on individual pain perception, pain tolerance, and emotional and physical factors. These symp- toms are highly relevant from the patient’s point of view and often have a considerably adve- rse effect on daily QoL. A study was conducted at the Martin Luther University, Halle-Wittenberg, Germany to describe and evaluate OHR QoL in patients with dentine hyper- sensitivity. Data was collected through a questionnaire as part ofalargerstudytargetingseveral areas of oral health beyond hypersensitiveteeth,suchasoral hygiene, prevention efforts, and oral behaviours and habits. There were 724 patients (mean age: 42.8 ± 13.0 years) who participated in the study, presenting at 161 German dental offices because of hypersensi- tive teeth and reacting positively to an air stimulus applied by the dentist. Patients with removable partial dentures & patients with missing answers in the OHIP questionnaire were excluded. After these exclusions, 656 patients remained in the study for analysis. These patients were compared with 1,541 subjects without removable partial den- tures from a national, general German population sample (mean age: 37.7 ± 13.4 years). OHRQoL was assessed using OHIP-G. The patients comple- ted the OHIP-G questionnaire in the dental office. Fig. 2. Hypersensitive cervical dentine surfaces.Fig. 1. OHRQoL is one dimension of quality of life. Fig.4.OHRQoLinpatientswithdentinehypersensitivityandinageneralpopulation grouped by gender. Fig. 3. Differences in OHRQoL measured with the OHIP questionnaire in patients with dentine hypersensitivity and in a general population sample. Does dentine hypersensitivity affect oral health-related qualty of life?