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Oral health-related quality of life (OHRQOL) refers to the impact of oral disorders on aspects of everyday life that are important to patients and persons, with those impacts being of sufficient magnitude, whether in terms of severity, frequency or duration, to affect an individual's perception of their life overall. OHRQOL has become an important focus for assessing the impact of oral conditions on every day life, sometimes as an outcome of clinical care (e.g. Allen et al 2001; Locker 2004; Marshman and Robinson 2007). To date, several studies have explored children's OHRQOL using such child-centred measures. These studies show that oral health can impact on children's functioning and well-being. However, none of these studies have incorporated a broad range of clinical and other non-clinical variables factors that may influence children's OHRQOL or attempted to explicitly test the relationships between them within a theoretical model. Such research hopefully would highlight important issues to further our understanding of the antecedents and consequents of children OHRQOL in order to facilitate effective intervention strategies. Thus, this research alms to assess relationships between clinical and non-clinical variables in relation to children's OHRQOL. The theoretical model chosen to guide the research is that by Wilson and Cleary (1995), which classifies the variables at five main levels; clinical status, symptom status, functioning, general health perceptions and overall quality of life. The model has been used in adults in relation to several health chronic conditions, including oral health (Baker et al 2007; Baker et al 2008) but is relatively untested in children's oral health and oral health related quality of life. 12 This thesis is structured as follows: Chapter One captures the overview of the research. Chapter Two is a narrative reVIew of the literature. It considers health as conceptualized within different approaches; the biomedical, psychosocial model and bio-psychosocial models, to develop an understanding on OHRQOL. The review also introduces two models feasible for use in the study; Locker (1988) and Wilson and Cleary (1995). The Wilson and Cleary model is then used to structure a brief discussion on individual factors, sense of coherence, self esteem, oral health beliefs and health locus of control that may play a role in OHRQOL. Included also are environmental factors such as parental income, education level and work status. Chapter Three summarises the rationale, aim and objectives of the study. It argues that clinical and non clinical variables impact on children's QOL. Individual factors and environment issues may be important factors that need to be considered in understanding children's oral health. Furthermore, no study so far has systematically considered these factors guided by a theoretical framework. The study therefore aimed to identify the determinants and consequences of oral health related quality of life in children. The objectives are as follows; • To test the relationships between clinical variables, symptom status, functioning, general health perceptions and overall well-being as hypothesised within Wilson and Cleary's model of patient outcomes. • To examine whether socio-demographic and individual difference factors influence children's OHRQOL and the key relationships identified within the Wilson and Cleary model. • To explore different configurations of SOC, COHRQOL and the model Chapter Four describes the translation procedures conducted to achieve high quality translated measures that are suitable for children. Chapter Five details the material and methods including a brief description on the data analysis strategy, missing data management and data analysis management. 13 Chapter Six presents the research findings. The sample had good clinical status. Broadly speaking in lagged analyses the linear relationships of the model were not strongly supported, whereas individual factors, notably sense of coherence, were consistently linked to symptoms, functional limitation and overall quality of life. Chapter Seven brings together the discussion highlighted from the findings. Chapter Eight highlights the major conclusions and summarises the recommendations arising from the research. Chapter Nine lists the references. Appendices section contains copies of key research documents.

Background: There is a considerable variation in dental patients’ post-operative pain experience and analgesic requirements following identical surgical procedures. This has been related to a variety of psychological factors. Pain is one of the most commonly cited factors that is strongly associated with dental fear. Surgical removal of a third molar, the most common procedure in oral surgery and generally associated with dread, has received limited research attention. It is, therefore, essential to understand factors likely to influence the pain experience of patients in such a stressful setting. Such an understanding will not only help patients cope with fear and pain, but also will assist clinicians create a less stressful environment. This study investigated psychological factors predicting heightened pain perception in tooth extraction: dental anxiety; dental control; pain catastrophizing; expectation of pain; social desirability (defensiveness); trait anxiety and monitor-blunter style coping. Methods: The sample consisted of 306 participants (144 male and 162 female aged between 18 and 62 years with the mean age of 31.82) who were referred by their local dental practitioners for the surgical removal of tooth/teeth under local anaesthetic at the unit of Oral and Maxillofacial surgery at UCL Eastman Dental Institute. The tooth/teeth which needed extraction were not limited to the third molars. The variables were measured at four different time points: on recruitment (baseline: T0), before (T1), after (T2) and the following day (T3) of the dental surgery. The variables assessed were: dental anxiety; dental control; pain catastrophizing; social desirability; trait anxiety; monitor-blunter style coping; sensory intensity of pain, affective quality of pain, state anxiety and mood states. After the surgery, the dental surgeons rated the complexity of the surgical procedure and the perception of their patients’ distress levels. Results: It was found that pain 24 hours post-tooth extraction was best predicted by the levels of expected sensory pain together with post-surgery state anxiety, trait anxiety and expected affective pain. Expected sensory pain, in turn, was predicted by dental anxiety, monitoring and felt (perceived) control (i.e., the dental pain predictors). Moreover, dental anxiety was found to be a precursor to all the dental pain predictors. Furthermore, pain catastrophizing did not make to the primary dental pain predictors. Nevertheless, it contributed to heightened levels of trait anxiety and expected affective pain which sequentially helped to intensify perception of dental pain. In addition, it was revealed that dental surgeons underevaluated their patients’ treatment pain.

Introduction Peri-implantitis is a bacterially induced inflammatory reaction surrounding dental implants leading to loss of supporting bone. Microbial biofilm development seems to play an important role in altering the biocompatibility of the implant surface leading to loss of the implant. Aims The aim of this study was to develop an in vitro model of peri-implantitis. Material and Methods Microcosm biofilms were grown on titanium discs in a constant depth film fermentor (CDFF). Artificial saliva and peri-implant sulcular fluid (PISF) were delivered to simulate three communities associated with dental implants (health, peri-implant mucositis and peri-implantitis). The intact biofilms were visualised by confocal laser scanning microscope (CLSM) at different time points. Biofilms were cultured on non-selective and selective media. PCR-cloning and comparative sequencing of the 16S rRNA gene was carried out to determine bacterial richness. To quantify bacterial species, multiplex qPCR was used for a range of important oral species; qPCR probes were designed, tested and used to quantify Capnocytophaga in the communities. Evaluation of current and novel treatment modalities, to eliminate the microcosm biofilm, on commercial titanium surfaces (polished, SLA and SLActive surfaces) was carried out. Furthermore, novel antimicrobial surfaces were prepared and initial biofilm formation assessed by cultural analysis and CLSM. Results The biofilms shifted from coccid dense communities, to those dominated by rods and long filaments. The clones shifted from healthy to mixed pathogens. The qPCR revealed significant differences between a healthy and disease conditions. The combined treatment (mechanical and chemical) revealed the greatest reduction of biofilm on all surfaces tested. The antibacterial surfaces showed promotion towards a healthy community on old mature biofilm. Discussion/Conclusion The CDFF allowed successful growth of microbial communities and the ability to monitor the bacterial shifts between three communities associated with dental implants. In addition, it has allowed the testing of a range of titanium surfaces and treatment modalities. This model will allow further understanding of the microbiology of peri-implantitis and provide appropriate biofilm communities for testing surfaces infection and treatments.

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Dentinogenesis Imperfecta (DI) and Dentine Dysplasia (DD) are rare inherited condition affecting the dentine. Previous studies have reported the histological presentation of teeth with dentine defects but the differences between clinical appearances and physical properties, and how do they link to the underlying gene defects, is limited. In addition, the differences between primary and permanent teeth are poorly understood. Aim and Objective: The aim of this study was to investigate if there is an association between the underlying gene defect (genotype) and the physical properties and appearance (phenotype) of teeth with dentine defects. The objectives were to assess the colour, radiographic feature and dentine hardness of the teeth with dentine defects, to discover any other unidentified genes that might involve in causing inherited dentine diseases, and to relate them to the phenotype recorded clinically. Materials and Method: The discolouration and radiographic features of teeth from 16 patients (6 DI type I, 5DI type II, 4 OI and 1 DD type I respectively) were recorded. 20 control primary teeth and five DI teeth (four DI type I, one DI type II) were sectioned transversely using a diamond wheel saw. The dentine hardness measurement was done using Wallace Hardness Machine and recorded as Vickers Hardness Number (VHN). Dentine microstructure was examined using scanning electron microscope (SEM). Saliva samples were obtained from 14 patients for genomic analysis. Results: All DI type II and DI type I patients had marked discolouration of their teeth. DD and OI patients had normal teeth colour. The mean value of dentine hardness of control teeth was VHN=57.11±62. The VHN for DI teeth were significantly low compared to control teeth. The mean value for DI teeth was 30.61±8.24 VHN. Histologically, both DI type I and DI type II teeth showed reduced number of dentine tubules. DI type II had irregular dentine surface, while DI type I dentine showed a tear-like appearance on an empty dentine surface. Genetic analysis did not show any known mutations on COL1A1 and no novel genetic mutations has been observed. Conclusion: Collagen plays a role in maintenance of healthy dentine. Therefore, defects on COL1A1 and COL1A2 lead to abnormality of collagen thus the occurrence of OI and DI type I. Mutation in DSPP caused disruption in dentine mineralisation which also present as dentine defects in DI type II. Both DSPP and COL1A1/COL1A2 caused dentine abnormalities which present as teeth discolouration, abnormal appearance and reduced dentine hardness.

The first responsibility of the dental surgeon is for the patients teeth, and observations made at the Cleft Palate Clinic revealed many features relating to the teeth that required further investigation. This study was undertaken as an investigation into the abnormalities of number, form, and structure of the teeth in a group of children with cleft palate. As a result of this study it was hoped that a more complete picture would emerge of the abnormalities of the teeth in children with cleft palate, including the relationship of such abnormalities with the development defects and environmental upsets found in these patients. The study is not concerned with the skeletal and occlusal deformities which may frequently be associated with cleft palate.

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Aim of the present study: To devise a method for the measurement of changes in surface form of the denture bearing area following the extraction of maxillary teeth and to describe the changes observed in a selected sample of human adults.

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