The impact of rehabilitation using removable partial dentures and functionally orientated treatment on oral health-related quality of life: A randomised controlled clinical trial
Introduction
Increasingly it is recognised that purely clinically based indictors of disease are insufficient when assessing health status and treatment outcomes. In the case of chronic disease without cure, amelioration of symptoms is a key therapeutic goal and this cannot be defined by objective criteria alone. The so-called “disability paradox”, manifested in studies reports that patients with serious illness often rate their quality of life as better than healthy individuals.1, 2 Adaptive capacity and personal characteristics appear to have a significant influence patient's response to chronic disease. This can result in reports which seem counterintuitive, for example, the finding in a large German survey that having fewer than nine teeth had more impact on health-related quality of life than having cancer, hypertension, or allergy.3 It is, therefore, important to incorporate subjective assessment methods when evaluating the impact of chronic disease, and the treatment interventions for managing the symptoms of those diseases.
In 2001, the Institute of Medicine proposed a number of specific aims to improve the quality of care for all patients. One of these aims was to ensure that care was “patient-centred”. It was suggested that to promote patient-centred care, clinicians should measure the health status of their patients using standardised questionnaires and use this information to inform clinical decision making.4 As a result, a variety of health status measures have subsequently been developed largely through work carried out in the social sciences.5 These include general surveys and condition specific questionnaires. The oral health impact profile (OHIP) is a widely reported and validated tool used to capture oral health-related quality of life (OHRQoL) particularly amongst older adults.6, 7, 8 The measure contains statements divided into seven theoretical domains, namely functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and, handicap.9 Originally a 49 item questionnaire, further work has developed a shortened version of the OHIP made up of a subset of 14 items taken from the original. Regression analysis of an epidemiological study conducted in Southern Australia yielded an optimal set of 14 questions. The study indicated that the short form of the OHIP (OHIP-14) had good reliability, validity and precision.6
The aim of this study was to compare two different tooth replacement strategies for partially dentate older patients; namely functionally orientated treatment according to the principles of the shortened dental arch (SDA) and conventional treatment using removable partial dentures (RPDs). The primary outcome measure for this study was impact of the treatments on OHRQoL measuring using OHIP-14. The null hypothesis for the study stated that patients treated according to the principles of the SDA would be no worse off than those treated using RPDs in terms of impact on OHRQoL.
Section snippets
Study design
A randomised controlled clinical trial (RCT) of partially dentate older patients (>65 years) was conducted (Fig. 1). Patients were included in the study if they were seeking replacement of missing natural teeth, had a minimum of six remaining natural teeth in both arches of good prognosis, could accept routine dental care in a dental chair, could communicate in English and had no medical conditions which precluded routine dental treatment. Full ethical approval was granted for the study from
Results
In total, 132 patients were recruited to the study and were randomly allocated to the two treatment groups. After 12 months 89 patients completed the RCT (69.7%): 44 from the RPD group and 45 from the SDA group. The study outline is shown in Fig. 1.
The results recorded for change in mean summary OHIP-14 scores are summarised in Table 1, Table 2. The ANCOVA analysis illustrated that there was an interaction observed between treatment group, time-point and recruitment centre (p < 0.0001). This
Discussion
The results of this study illustrate that treatment according to the SDA concept resulted in significantly better mean OHIP-14 scores compared with RPD treatment. This result was seen in both treatment centres where the SDA group recorded better mean OHIP-14 scores in SFDH at 1 month (p = 0.0082), 6 months (p = <0.0001) and 12 months (p < 0.0001) compared to the RPD group. Similarly in CUDH, whilst the two groups recorded similar scores at 1 month (p = 0.1961) and 6 months (p = 0.2130), 12 months after
Conclusions
This study illustrated that in terms of impact on OHRQoL, treatment based on the SDA concept achieved significantly better results than that based on RPDs 1 month, 6 months and 12 months after treatment intervention. Further research will be required to determine if these findings are maintained over a longer follow-up period particularly if maintenance of the restorations is required. Given that this study was conducted in a hospital setting it would also be worthwhile to investigate if
Acknowledgement
This study was funded by a research grant from the Health Research Board (HRB/2008/220).
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