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Purpose: Removable partial dentures (RPDs) represent standard treatment for partial edentulism despite major shortcomings. To alleviate these shortcomings, endosseous implants provide support and stability as well as contribute to maintenance of alveolar bone. This prospective, within subject, time series study evaluated patient-based outcomes of RPDs compared to implant-supported removable partial dentures (ISRPDs). The study hypothesis was that the ISRPD would substantially improve oral health quality of life for patients., Materials and Methods: Seventeen patients requesting new mandibular Kennedy I or II RPDs received one 6-mm dental implant in one or both of the posterior edentulous areas. After healing, conventional RPDs were fabricated and delivered. Twelve weeks later, second-stage surgery was performed, and ball abutments with Clix attachments were inserted, thereby converting the prostheses to ISRPDs. Oral health quality of life was evaluated using the 49-item Oral Health Impact Profile (OHIP-49) questionnaire. The OHIP-49 was administered prior to treatment (baseline), at 6 and 12 weeks following RPD delivery and at 6 and 12 weeks following ISRPD conversion. Radiographic evaluation was performed at 6 and 12 weeks following ISRPD conversion. In statistical analysis, a fixed-slope random intercept variance components model took account of the multiple observations per person over time., Results: In 17 subjects, 29 of 30 implants survived. The failed implant was replaced without complications. Abutment complications were limited to one abutment loosening and one attachment replacement. Minor prosthodontic complications were recorded. The OHIP-49 score reduced by 11.8 points, on average, at 12 weeks following ISRPD conversion (P = 0.011)., Conclusions: Patients reported improved oral health following conversion to an ISRPD from RPD. The ISRPD involving short implants is one treatment option that should be considered when treatment planning Kennedy Class I and II patients., (© 2012 John Wiley & Sons A/S.)

Explanations for the social gradient in health status are informed by the rare exceptions. This cross-sectional observational study examined one such exception, the "Latino paradox" by investigating the presence of a Latino advantage in oral health-related quality of life and the effect of nativity status on this relationship. A nationally representative sample of adults (n=4208) completed the National Health and Nutrition Examination Survey (NHANES) 2003-2004. The impact of oral disorders on oral health-related quality of life was evaluated using the NHANES Oral Health Impact Profile. Exposures of interest were race, ethnicity and nativity status. Covariates included sociodemographic characteristics, smoking status, self-rated health, access to dental care and number of teeth. Unconditional logistic regression models estimated odds of impaired oral health-related quality of life for racial/ethnic and nativity groups compared to the Non-Latino white population. Overall, prevalence of impaired oral health-related quality of life was 15.1%. A protective effect of Latino ethnicity was modified by nativity status, such that Latino immigrants experienced substantially better outcomes than non-Latino whites. However, the effect was limited to first-generation Latinos. U.S. born Latinos did not share the oral health-related quality of life advantage of their foreign-born counterparts. This advantage was not attributable to the healthy migrant phenomenon since immigrants of non-Latino origin did not differ from Non-Latino whites. The excess risk among Non-Hispanic Blacks was rendered non-significant after adjustment for socioeconomic position. A protective effect conferred by Latino nativity is unexpected given relatively disadvantaged socioeconomic position of this group, their language barrier and restrictions to needed dental care. As the Latino advantage in oral health-related quality of life is not explained by healthy immigrant selection, cultural explanations seem more likely than explanations based on characteristics of individuals., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

The length of the reference period used in surveys of subjective oral health may have a marked influence on the responses obtained. We aimed to evaluate the effect of a 1-month (RP-1) vs. a 12-month (RP-12) reference period in the Oral Health Impact Profile (OHIP-14) questionnaire. Using a randomized cross-over design, RP-1 and RP-12 OHIP-14 questionnaires were administered, 1 month apart, to two samples of Finnish adults, namely people awaiting orthognathic surgery (n = 104) and non-patient workers (n = 111). The effect of the reference period was computed by subtracting RP-1 OHIP-14 severity scores from RP-12 OHIP-14 severity scores (DeltaRP). Potential order effects were assessed by comparing DeltaRP between groups completing the RP-1 vs. the RP-12 questionnaire first. Mean OHIP-14 severity scores were slightly higher when the RP-12 questionnaire was administered first, but mean DeltaRP values were below the value of 2.5 considered clinically meaningful, and all 95% confidence intervals for DeltaRP included zero. No order effects in the OHIP-14 severity scores were observed. Therefore, although a standardized reference period of 12 months is recommended, in population surveys the use of a shorter reference period does not appear to influence responses.

Objectives: To examine the association between neighborhood disadvantage and individual-level socioeconomic position (SEP) and self-reported oral health., Methods: A population-based cross-sectional study conducted in 2003 among males and females aged 43-57 years. The sample comprised 2915 individuals and 60 neighborhoods and was selected using a stratified two-stage cluster design. Data were collected using a mail survey (69.4% response rate). Neighborhood disadvantage was measured using a census-based composite index, and individual-level SEP was measured using education and household income. Oral health was indicated by self-reports of the impact of oral conditions on quality of life (0 = none or minor, 1 = severe), self-rated oral health (0 = excellent-good, 1 = fair/poor) and missing teeth (measured as a quantitative outcome). Data were analyzed using multilevel modeling., Results: After adjusting for age, sex, education, and household income, residents of socioeconomically disadvantaged neighborhoods were significantly more likely than those in more advantaged neighborhoods to indicate negative impacts of oral conditions on quality of life, to assess their oral health as fair or poor, and to report greater tooth loss. In addition, respondents with low levels of education and those from a low income household reported poorer oral health for each outcome independent of neighborhood disadvantage., Conclusions: The socioeconomic characteristics of neighborhoods are important for oral health over and above the socioeconomic characteristics of the people living in those neighborhoods. Policies and interventions to improve population oral health should be directed at the social, physical and infrastructural characteristics of places as well as individuals (i.e. the traditional target of intervention efforts).

Objective: To compare perceptions of general health versus oral health within two populations., Methods: Secondary analysis of cross-sectional survey data obtained from representative samples of dentate adults in Australia and the United States. Australian data were collected in the 2002 National Dental Telephone Interview Survey and United States data were from the NHANES, 1988-1994. A stratified analysis compared self-ratings of general and oral health among groups classified by age, socioeconomic status and access to dental care., Results: In Australia, 43.6% rated their dental health 'very good' or 'excellent' whereas 58.6% rated their general health 'very good' or 'excellent'--a deficit of 15.0%. In the US, there was a comparable deficit of 24.2%. The deficit could be explained as a 'generation gap' where oral health ratings of the youngest cohort resembled the general health ratings of middle-aged adults in Australia and retirees in the US. An 'affluence gap' was evident where the oral health ratings of wealthier adults resembled the general health ratings of disadvantaged adults. Among Australians with private dental insurance who had visited a dentist in the past year the oral health deficit was negligible. Similar stratification in the US sample considerably attenuated the deficit., Conclusion: There is a deficit in perceived oral health compared with general health at all stages of adulthood and spanning the socioeconomic spectrum. The deficit was diminished among insured adults who had made a dental visit within the preceding year, suggesting that improved access to dental services may help redress the discrepancy.

Objectives: The nature of the relationship between status and health has theoretical and applied significance. To compare the shape of the socioeconomic -oral health relationship using a measure of relative social status (MacArthur Scale of Subjective Social Status) and a measure of absolute material resource (equivalised household income); to investigate the contribution of behaviour in attenuating the socioeconomic gradient in oral health status; and to comment on three hypothesised explanatory mechanisms for this relationship (material, psychosocial, behavioural)., Methods: In 2003, cross-sectional self-report data were collected from 2,915 adults aged 43-57 years in Adelaide, Australia using a stratified cluster design. Oral conditions were (1) < 24 teeth, (2) 1+ impact/s reported fairly often or very often on the 14-item Oral Health Impact Profile; (3) fair or poor self-rated oral health, and (4) low satisfaction with chewing ability. Prevalence ratios and 95% confidence intervals (PR, 95%CI) were calculated from a logistic regression model. Covariates were age, sex, country of birth, smoking, alcohol use, body mass index, frequencies of toothbrushing and interdental cleaning., Results: There was an approximately linear relationship of decreasing prevalence for each oral condition across quintiles of increasing relative social status. In the fully adjusted model the gradient was steepest for low satisfaction with chewing (PR = 4.1, 95%CI = 3.0-5.4). Using equivalised household income, the shape more closely resembled a threshold effect, with an approximate halving of the prevalence ratio between the first and second social status quintiles for the adverse impact of oral conditions and fair or poor self-rated oral health. Adjustment for covariates did not attenuate the magnitude of PRs., Conclusions: The nature of the relationship between social status and oral conditions differed according to the measure used to index social status. Perception of relative social standing followed an approximately straight-line relationship. In contrast, there was a discrete threshold of income below which oral health deteriorated, suggesting that the benefit to oral health of material resources occurs mostly at the lower end of the across the full socioeconomic distribution.

Objective: The aim of this study was to describe differences in dental attendance and dental self-care behaviour between socioeconomic groups and to investigate the extent to which the socioeconomic gradient in oral health was explained by these behaviours., Methods: We used data from a representative sample of adults in Australia, surveyed by telephone interview and by self-complete questionnaire. The dependent variables were self-reported missing teeth and the social impact of oral conditions evaluated with the 14-item Oral Health Impact Profile (OHIP-14). Socioeconomic position was measured at the small-area level. We conducted bivariate analysis using one-way analysis of variance and 95% confidence intervals (95% CI) and adjusted for the effect of age. After adjusting for age, dental behavioural variables were entered individually into multivariate linear regression models., Results: Data were obtained for 3678 dentate adults aged 18-91 years. Missing teeth and OHIP-14 scores followed a social gradient with poorer adults experiencing poorer outcomes. Routine dental attendance and diligent dental self-care were associated with inverse monotonic gradients in missing teeth (P < 0.05) and OHIP-14 scores (P < 0.05). Although adults living in areas with the least disadvantage had a preventive dental attendance orientation, no socioeconomic pattern was found for dental self-care. In multivariate analysis, the slope of the socioeconomic gradient [beta estimate for Index of Relative Socioeconomic Disadvantage (IRSD)] in missing teeth was not significantly attenuated by either dental attendance or dental self-care. For OHIP-14 scores, the slope of the socioeconomic gradient was significantly attenuated by dental visiting, but not by dental self-care and not by the combined effect of both behaviours., Conclusion: The commonly held view that the poor oral health of poor people is explained by personal neglect was not supported in this study.

Objectives: The aim of this study was to determine whether childhood familial conditions are associated with the social impact of adult oral health and to investigate the role of psychosocial attributes as potential mechanisms by which risk might be conveyed from childhood to adulthood., Methods: Using a cross-sectional design, self-report data were obtained from a representative sample of adults in Australia with a telephonic interview and a self-completed questionnaire. The dependent variable was the sum of impacts on the short-form Oral Health Impact Profile (OHIP-14). Childhood familial conditions included socioeconomic position assessed by paternal occupation group, family structure and quality of rearing. Current adult sense of control, perceived stress and satisfaction with life were assessed with standard scales and social support was evaluated with four items., Results: Data were obtained for 3678 dentate adults aged 18-91 years. In bivariate analysis controlling for sex, age and household income in adulthood, parenting style was significantly associated with OHIP-14 scores (anova, P < 0.001). Adults who were reared supportively had more favourable scores on all four current psychosocial attributes (anova, P < 0.001). All four psychosocial attributes were associated with summed OHIP scores in the expected directions (anova, P < 0.001). In the multiple regression, parental rearing style was significantly associated with social impact after adjusting for sex, age and household income in adulthood, but was no longer significant in the presence of the psychosocial factors., Conclusion: The importance of parental rearing to adult oral health may be mediated through the quality and nature of psychosocial attributes.

Unlabelled: The way in which work is structured and organised is associated with the health and well-being of workers., Objectives: To examine the associations between hours worked, job security, skill maintenance and work and home interference and subjective oral health; and to compare findings for different occupational groups., Methods: Data were collected in 1999 from a random stratified sample of households in all Australian States and Territories using a telephone interview and a questionnaire survey. Subjective oral health was evaluated with the short form Oral Health Impact Profile (OHIP-14), which assesses the adverse impact of oral conditions on quality of life., Results: Data were obtained for 2,347 dentate adults in the workforce. In the 12 months preceding the survey, 51.9% had experienced oral pain and 31.0% reported psychological discomfort from dental problems. Males, young adults, Australian-born workers, and those in upper-white collar occupations reported lower mean OHIP-14 scores (ANOVA p < 0.001). Having controlled for the effects sex, age, country of birth and socioeconomic factors in a linear multiple regression analysis, hours worked, skill maintenance and work and home interference were significantly associated with OHIP-14 scores for all workers. While part-time work was associated with higher OHIP-14 among upper white-collar workers, working >40 hours a week was associated with higher OHIP-14 scores for other workers., Conclusions: Aspects of the work environment are associated with the subjective oral health of workers. Because these contexts are subject to only limited control by individual workers, their influence is a public health issue.

Objective: To establish population estimates of self-assessed tooth loss and subjective oral health and describe the social distribution of these measures among dentate adults in Australia., Methods: Self-report data were obtained from a nationally representative sample of 3,678 adults aged 18-91 years who participated in the 1999 National Dental Telephone Interview Survey and completed a subsequent mail survey. Oral health was evaluated using (1) self-assessed tooth loss, (2) the 14-item Oral Health Impact Profile, and (3) a global six-point rating of oral health., Results: While the absolute difference in tooth loss across household income levels increased at each successive age group (18-44 years, 45-64 years, 65+ years) from 0.7 teeth to 6.1 teeth, the magnitude of the difference was approximately twofold at each age group. For subjective oral health measures, the magnitude of difference across income groups was most pronounced in the 18-44 years age group. In multivariate analysis, low household income, blue-collar occupation, and high residential area disadvantage were positively associated with social impact from oral conditions and pathological tooth loss. Speaking other than English at home (relative to English), low household income (relative to high income), and vocational relative to tertiary education were each associated with more than twice the odds of poor self-rated oral health., Conclusions: Significant social differentials in perceived oral health exist among dentate adults. Inequalities span the socio-economic hierarchy., Implications: In addition to improving overall levels of oral health in the adult community, goals and targets should aim to reduce social inequalities in the distribution of outcomes.

Age and loss of teeth can be expected to have a complex relationship with oral health-related quality of life. This study aimed to explain how age and tooth loss affect the impact of oral health on daily living using the short form, 14-item Oral Health Impact Profile (OHIP-14) on national population samples of dentate adults from the UK (1998 UK Adult Dental Health Survey) and Australia (1999 National Dental Telephone Interview Survey). After correcting for key covariables, increasing age was associated with better mean impact scores in both populations. Those aged 30-49 years in Australia showed the worst (highest) scores. In the UK, those aged under 30 showed the highest scores. In both countries, adults aged 70+ showed much better scores than the rest (P < 0.001). When corrected for age, the independent effect of tooth loss was that the worst scores were found where there were fewer than 17 natural teeth in the UK and fewer than 21 teeth in Australia. People with 25 or more teeth averaged much better scores than all other groups (P < 0.001), although there were differences in pattern between countries. When Australians were analysed by region of birth, the pattern of scores by tooth loss for British/Irish immigrants was strikingly similar to that for the UK sample. First-generation immigrants from elsewhere showed much worse overall scores and a profoundly different pattern to the Australian- and British-born groups. Age, number of teeth and cultural background are important variables influencing oral health-related quality of life.

Aim This nested case-control study sought to determine whether an accelerated rate of leukocyte telomere length ( LTL) shortening over 6 years was associated with chronic periodontitis. Materials and Methods We sampled cases ( n = 178) with severe chronic periodontitis and controls ( n = 178) with no/mild chronic periodontitis from the Atherosclerosis Risk in Communities study. Controls were frequency-matched to cases by study site, age, sex and race. Age ranged from 53 to 73 years. Severe chronic periodontitis was defined using the CDC- AAP case classification. LTL was measured from DNA collected at two time points, 6 years apart, with quantitative polymerase chain reaction relative to a single-copy control gene. Multiple linear regression evaluated associations between LTL measured at baseline, follow-up and change scores with severe chronic periodontitis, adjusting for potential confounders. Results Cases had shorter LTL than controls at baseline ( p = 0.03) and follow-up ( p = 0.04) after adjusting for confounding. Overall there was a net reduction in LTL over time ( p = 0.02). The rate of LTL did not differ between cases and controls ( p = 0.80). Conclusions Leukocyte telomere length shortening occurred at the same rate among adults with and without severe chronic periodontitis. This suggests that LTL shortening may have occurred earlier in the life course. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusion Palateless overdentures (PLODs) provide advantages of improved taste perception and retention over conventional dentures. We aimed to evaluate 5‐year outcomes of four implant maxillary PLODs.In this prospective observational study, edentulous participants were enrolled. A new conventional maxillary denture was prepared followed by implant placement and insertion of four implant retained maxillary PLOD. Oral health quality of life was assessed using the 49‐item Oral Health Impact Profile (OHIP‐49) at multiple intervals over 5 years along with biological and mechanical outcomes.Nine patients were evaluated at year 5. The mean age was 68 years, and six of the nine patients were males. The cumulative survival rate of implants was 100% while the implant success rate was 86%. Nylon retentive replacement was the most common encountered complication noted approximately four times per patient over 5 years. From a mean OHIP‐49 severity score of 71.2 at baseline, severity scores decreased to 23.9 (p < 0.001) at year 1, denoting a clinically meaningful and statistically significant improvement in oral health quality of life. The lowered OHIP‐49 severity scores remained stable throughout 5 years of follow‐up.Four implant supported maxillary overdenture appears to have good patient perceived, biological and mechanical outcomes over 5 years. Fully powered studies are needed to replicate these findings. [ABSTRACT FROM AUTHOR]