Impact of dental services on quality of life.
Date
2009
Authors
Crocombe, Leonard A.
Editors
Advisors
Slade, Gary Douglas
Brennan, David Simon
Brennan, David Simon
Journal Title
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Volume Title
Type:
Thesis
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Statement of Responsibility
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Abstract
Background
Health-related quality of life (HRQoL) measures have become important when
determining health priorities, but only five longitudinal studies limited to older adults
and/or to subjects with an oral disadvantage have investigated the association between
routine dental care and HRQoL. The aims in this study were to determine if dentist
visiting or the volume, complexity and cost of general dental care, and baseline oral
HRQoL and treatment need were associated with changes in HRQoL, and/or modify
the impact of dental care on changes in HRQoL.
Methods
The project was an observational prospective cohort study of a sample of randomly
selected dentate adult Tasmanians surveyed in 2006 and followed over a one-year
period. The collection procedures comprised a computer-assisted telephone interview,
an oral epidemiological examination, a baseline mail self-complete questionnaire, a
service use log book, and a twelve-month mail self-complete questionnaire. Change in
HRQoL was measured by change in the summary measure of the Oral Health Impact
Profile (OHIP-14 severity) and change in the EuroQol index (EQ-5D), global oral and
general transition statements, and follow-up OHIP-14 severity.
Results
From 1,745 eligible household numbers, 59.7% were interviewed, of whom 43.7%
received epidemiological examinations. Of those, over three-quarters (77.4%)
completed the baseline mail questionnaire. Nearly three-quarters of those who
completed the baseline self-complete questionnaires completed the twelve-month
follow-up questionnaire (73.5%).
More than half of the respondents (53.8%) visited a dental practitioner, the vast
majority of whom (94.9%) saw a private sector dentist. The most common types of
dental care received were diagnostic, preventive and restorative services When the dependent variable was change in mean OHIP-14 severity, visiting a dentist
was associated with a statistically significant worsening of oral HRQoL after
adjusting for confounders. In contrast, visiting a dentist was associated with a
significant improvement in quality of life when the dependent variable was the global
oral health transition statement, although that association was not homogeneous. The
global general health transition statement showed an unfavourable association of
dental visits, although it was not statistically significant. Follow-up OHIP-14 dental
attendance was associated with worsening QoL, although the association was not
statistically significant.
When change in HRQoL was measured by the global general health transition
statement, high compared to low volume of dental care had a statistically significant
favourable influence on HRQoL, although there was effect modification. With the
global oral health transition statement, high complexity dental care was associated
with a statistically significant worsening of HRQoL, while high cost dental care was
associated with a statistically significant improvement of HRQoL. Across all
measures of HRQoL, the survey participant factors most often subject to effect
modification where those related to socio-economic status, particularly education and
occupation.
Conclusions
The results varied according to which dependent measure of change in HRQoL was
used. Dental care had a differing effect on general health compared to oral health,
although the effects on general health varied considerably among some population
groups. Researchers need to devise consistent definitions of health, HRQoL, oral
health and oral HRQoL.
School/Discipline
School of Dentistry
Dissertation Note
Thesis (Ph.D.) - University of Adelaide, School of Dentistry, 2009
Provenance
Copyright material removed from digital thesis. See print copy in University of Adelaide Library for full text.