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Impact of dental services on quality of life
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 of 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.
The project was an observational prospective cohort study of a sample of randomly selected dentate adult Tasmanians surveyed in 2006 and followed over a oneyear 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 12-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.
From 1745 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 12-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 effect was not homogeneous. The global general health transition statement showed an unfavourable effect of dental visits, although it was not statistically significant. Follow-up OHIP-14 dental attendance was associated with worsening QoL, although the effect 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, whilst 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 were those related to socio-economic status, particularly education and occupation.
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.
Department/SchoolSchool of Health Sciences
PublisherWiley-Blackwell Publishing Ltd.
Place of publicationUK