Syftet med studien var att undersöka om det förekommer skillnader i upplevelsen av oral hälsorelaterad livskvalitet hos personer som överlevt akut hjärtinfarkt jämfört med personer som inte har haft hjärtinfarkt.Studien genomfördes under åren 2001-2002 och alla personer som sökte vård vid ett mellanstort sjukhus i södra Sverige med diagnosen akut hjärtinfarkt och som överlevt infarkten inkluderades i studien. Kontrollgruppen bestod av vänner (n=69) till personerna som hade överlevt akut hjärtinfarkt samt personer (n=90) från en tidigare undersökning från samma sjukhus och som överensstämde i kön, ålder, socioekonomisk bakgrund och rökstatus. Totalt deltog 154 personer som överlevt akut hjärtinfarkt och 159 personer i kontrollgruppen.Mätinstrumentet som användes i studien var Oral Health Impact Profile (OHIP), vilket är ett frågeformulär för att mäta självupplevd munhälsorelaterad livskvalitet. Formuläret ger mått på dysfunktion, obehag och funktionshinder relaterade till munhålan. OHIP består av 49 frågor, fördelade över sju dimensioner: funktionsbegränsningar, fysisk smärta, psykiska problem, fysisk oförmåga, psykisk oförmåga, social oförmåga och handikapp.Resultatet visar att inga statistiskt säkerställda skillnader fanns mellan de personer som överlevt akut hjärtinfarkt och kontrollgruppen i de sju dimensionerna i OHIP. Det var få personer som upplevde besvär från munhålan som påverkade deras livskvalitet i båda grupperna. I denna studie framkom endast en statistisk säkerställd skillnad mellan de undersökta grupperna i påståendet att de upplevde att mat fastnat mellan tänderna (p-värde 0.024), vilket kan tyda på att användbarheten för OHIP är litet på denna patientgruppen. Fler studier krävs för att undersöka skillnader i upplevelsen av oral hälsorelaterad livskvalitet hos personer som överlevt akut hjärtinfarkt jämfört med personer som inte har haft hjärtinfarkt.

The aim: The overall aim of this licentiate thesis was to describe and analyze oral health-related quality of life measured with OHIP-14. The thesis comprises two studies, each with a specific aim.   Study I: To describe oral health-related quality of life measured with OHIP-14 in an Swedish adult population Study II: To study the relationship between oral health-related quality of life, measured with OHIP-14, and subjective as well as objective dry mouth conditions in fragile old people. Furthermore, the aim was to study the reliability and validity of a new instrument (VAS) to measure dry mouth   Material and methods: Study I comprised a stratified random sample of 519 individuals 20-80 years of age. In Study II, 41 randomly selected fragile old people, residents at three different community care centers, participated. In both studies, the questionnaire OHIP-14 was used for measurement of oral health-related quality of life. The participants in Study II answered a questionnaire for subjectively experienced dry mouth (VAS). For objective dry mouth measurements, saliva was absorbed into a preweighted cotton roll. Results: In Study I, 21% of the respondents stated that they had no oral problems that had a negative impact on their well-being. In Study II, the corresponding figure was 71%. In study I the mean value for OHIP-14 was 6.4 (SD=7.1) for the entire population; 5.9 (SD=7.1) for men and 6.8 (SD=7.2) for women in. Subjects, who frequently experienced problems related to oral health, with scores ranging from 16 to 41 points, accounted for 10% of the study group. In Study II, significant associations were identified between both objectively measured respective subjectively experienced dry mouth and oral health-related quality of life. The validity of the VAS instrument was good for subjective mouth dryness, but poor for objectively measured dry mouth in fragile old people. Conclusion: From Study I it can be concluded that, in this Swedish population, a number of individuals, both young and old, experience oral problems that have a negative impact on their well-being. From Study II, the conclusion is that dry mouth (both objective and subjective) is significantly associated with poorer oral health-related quality of life, underlining the value of monitoring dry mouth conditions in the care of fraigile old people.

<p><em>The aim:</em> The overall aim of this licentiate thesis was to describe and analyze oral health-related quality of life measured with OHIP-14. The thesis comprises two studies, each with a specific aim.</p><p> </p><p><em>Study I: </em>To describe oral health-related quality of life measured with OHIP-14 in an Swedish adult population</p><p><em>Study II: </em>To study the relationship between oral health-related quality of life, measured with OHIP-14, and subjective as well as objective dry mouth conditions in fragile old people. Furthermore, the aim was to study the reliability and validity of a new instrument (VAS) to measure dry mouth</p><p> </p><p><em>Material and methods: </em>Study I comprised a stratified random sample of 519 individuals 20-80 years of age. In Study II, 41 randomly selected fragile old people, residents at three different community care centers, participated. In both studies, the questionnaire OHIP-14 was used for measurement of oral health-related quality of life. The participants in Study II answered a questionnaire for subjectively experienced dry mouth (VAS). For objective dry mouth measurements, saliva was absorbed into a preweighted cotton roll.</p><p><em> </em></p><p><em>Results:</em> In Study I, 21% of the respondents stated that they had no oral problems that had a negative impact on their well-being. In Study II, the corresponding figure was 71%. In study I the mean value for OHIP-14 was 6.4 (SD=7.1) for the entire population; 5.9 (SD=7.1) for men and 6.8 (SD=7.2) for women in. Subjects, who frequently experienced problems related to oral health, with scores ranging from 16 to 41 points, accounted for 10% of the study group. In Study II, significant associations were identified between both objectively measured respective subjectively experienced dry mouth and oral health-related quality of life. The validity of the VAS instrument was good for subjective mouth dryness, but poor for objectively measured dry mouth in fragile old people.</p><p><em>Conclusion:</em> From Study I it can be concluded that, in this Swedish population, a number of individuals, both young and old, experience oral problems that have a negative impact on their well-being. From Study II, the conclusion is that dry mouth (both objective and subjective) is significantly associated with poorer oral health-related quality of life, underlining the value of monitoring dry mouth conditions in the care of fraigile old people.</p>

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A literatura científica ainda não é consistente em relação aos benefícios psicossociais proporcionados pelo tratamento ortodôntico. Os objetivos deste estudo foram conhecer as alterações na qualidade de vida relacionada com a saúde bucal (OHRQoL) e com a autopercepção estética de adolescentes brasileiros de 12 a 15 anos de idade tratados ortodonticamente, durante dois anos de avaliação prospectiva longitudinal. A amostra foi constituída de 318 jovens: 92 que iniciaram tratamento ortodôntico em uma instituição de ensino (grupo orto), e 226 indivíduos não tratados: 124 que procuraram avaliação ortodôntica na mesma instituição e não receberam tratamento durante os dois anos em que foram acompanhados na pesquisa, pois estavam aguardando uma vaga na lista de espera para iniciar o tratamento (grupo de espera), e 102 que nunca buscaram tratamento ortodôntico e que estudam em uma escola vizinha à instituição (grupo escola). A qualidade de vida foi mensurada utilizando o OHIP-14. A necessidade normativa e estética de tratamento ortodôntico foi avaliada com o índice IOTN, o nível social com o Critério de Classificação Econômica Brasil e a saúde dental com o índice CPO-D. As avaliações foram repetidas em três momentos: no exame inicial (T1); um ano depois do início do tratamento ortodôntico, para o grupo orto, e um ano após o exame inicial, para os grupos de espera e escola (T2); e dois anos depois do início do tratamento para o grupo orto, e dois anos depois do exame inicial para os grupos de espera e escola (T3). O tratamento ortodôntico reduziu significativamente os escores de OHRQoL: as médias do escores tiveram uma redução de 10,4 para 9,2 e para 1,6 entre a primeira, segunda e terceira avaliações (p<0,001). A autopercepção estética se comportou de maneira similar, com uma redução progressiva e significativa (p<0,001) nos pacientes tratados, que também tiveram melhora significativa na gravidade da má oclusão (p<0,001). Porém, os indivíduos que removeram o aparelho tiveram OHRQoL e autopercepção estética significativamente melhores em relação aos pacientes que não finalizaram o tratamento no período de dois anos. Os adolescentes do grupo de espera tiveram significativa piora na OHRQoL, que sofreu um aumento de 10,8 para 12,0 da primeira para a terceira avaliações (p<0,001), o que também ocorreu na autoavaliação estética, que sofreu um aumento significativo (p<0,001). Por outro lado, os adolescentes do grupo escola não tiveram nenhuma alteração desses índices nos períodos de avaliação, apresentando uma tendência estacionária para OHRQoL (p=0,34) e para a autopercepção estética (p=0,09). A gravidade da má oclusão não foi alterada nos grupos não tratados durante os dois anos de avaliação e o CPO-D não teve alteração significativa para nenhum dos três grupos. Foi possível concluir que o tratamento ortodôntico melhorou significativamente a qualidade de vida relacionada com a saúde bucal e a autopercepção estética dos adolescentes brasileiros submetidos a tratamento. / Literature is not yet conclusive about orthodontic treatments psychosocial benefits. The aim of this study was to assess oral health-related quality of life (OHQoL) and self-perceived aesthetics in brazilian adolescents who was under orthodontic treatment during two years of prospective evaluation. The sample consisted of 318 subjects, 12 to 15 years of age; 92 of these had sought and started orthodontic treatment in an university (ortho group) and the other 226 were not treated adolescents: 124 had sought orthodontic treatment at the same university but did not started, once they were waiting a vacant in the wait list to initiate the treatment (waiting group), and 102 were from a public school right next door to the university clinic and had never undergone or sought orthodontic treatment (school group). OHQoL was assessed with the Brazilian version of the short form of the Oral Health Impact Profile (OHIP-14), malocclusion severity and aesthetic impairment with the IOTN index, socioechonomic status with the Brazilian Economic Classification Criteria, and oral health with the DMTF Index. All subjects completed three distinct intervals of interviews: first interview before treatment (T1), one year after the placement of the fixed appliance for ortho group and one year after the first interview for school and waiting groups (T2) and two years after the placement of the fixed appliance for ortho group and two years after the first interview for school and waiting groups. Orthodontic treatment reduced OHRQoL scores from 10.4, to 9.2 and 1.6, among first, second and third interviews (p<0.001), and also produced a significant reduction in self-perceived aesthetics (p<0.001), and in malocclusion severity (p<0.001). Patients who have finished the treatment had significant better results in all scores than the ones who received treatment for two years but still were wearing braces. Adolescents from waiting group reported worse scores in OHRQoL, wich rised from 10.8 to 12.0 between first and third interviews (p<0.001). Self-perceived aesthetics scores also worsened (p<0.001) during the evaluation period in this group. On the other hand, adolescents from school group did not had alterations in any of the evaluated indexes, including OHRQoL (p=0.34) and self-perceived aesthetics (p=0.09). In patients from not treated groups (waiting and school groups), malocclusion severity did not change during the two years, as well as DMTF did not worsened in any of the three groups. Orthodontic treatment in brazilian adolescents resulted in significant better OHRQoL and self-perceived aesthetics.

In der vorliegenden Untersuchung sollte ein möglicher Zusammenhang zwischen mundgesundheitsbezogener Lebensqualität (MLQ) und Depression untersucht und bei prothetischen Patienten und Personen der Allgemeinbevölkerung vergleichend betrachtet werden. Es handelt sich um eine Querschnittsstudie, in welche 311 zahnärztlich-prothetische Patienten und 811 erwachsene Probanden der Bundesrepublik Deutschland einbezogen wurden. Zur Erfassung von MLQ und Depression wurden als standardisierte Instrumente zum einen die deutsche Version des Oral Health Impact Profile (OHIP) und zum anderen das Vereinfachte-Beck-Depressions-Inventar (BDI-V) eingesetzt. Die statistischen Zusammenhänge der Konstrukte wurden mit Hilfe von Korrelationsanalysen sowie Strukturgleichungsmodellen ermittelt. Die konfundierenden Variablen Alter und Geschlecht wurden dabei kontrolliert. In beiden Populationen wurde ein signifikanter Zusammenhang zwischen Depression und MLQ festgestellt. Diese gegenseitige Beeinflussung zwischen MLQ sowie deren Dimensionen und der Depression war jedoch zwischen den beiden Probandengruppen signifikant unterschiedlich stark ausgeprägt. Bei den prothetischen Patienten war der Zusammenhang nur halb so stark ausgeprägt wie bei den Personen der Allgemeinbevölkerung. Die OHIP-Dimension „Psychosozialer Einfluss“ der MLQ korrelierte in beiden Probandengruppen signifikant stärker mit Depression als die anderen Dimensionen. Folglich könnte sie auf eine mögliche Depression hinweisen und als zahnärztliches Diagnostikum eingesetzt werden. Zudem legt diese Studie nahe, dass eine eingeschränkte MLQ möglicherweise erst zeitversetzt zu depressiven Symptomen führen kann.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A literatura científica ainda não é consistente em relação aos benefícios psicossociais proporcionados pelo tratamento ortodôntico. Os objetivos deste estudo foram conhecer as alterações na qualidade de vida relacionada com a saúde bucal (OHRQoL) e com a autopercepção estética de adolescentes brasileiros de 12 a 15 anos de idade tratados ortodonticamente, durante dois anos de avaliação prospectiva longitudinal. A amostra foi constituída de 318 jovens: 92 que iniciaram tratamento ortodôntico em uma instituição de ensino (grupo orto), e 226 indivíduos não tratados: 124 que procuraram avaliação ortodôntica na mesma instituição e não receberam tratamento durante os dois anos em que foram acompanhados na pesquisa, pois estavam aguardando uma vaga na lista de espera para iniciar o tratamento (grupo de espera), e 102 que nunca buscaram tratamento ortodôntico e que estudam em uma escola vizinha à instituição (grupo escola). A qualidade de vida foi mensurada utilizando o OHIP-14. A necessidade normativa e estética de tratamento ortodôntico foi avaliada com o índice IOTN, o nível social com o Critério de Classificação Econômica Brasil e a saúde dental com o índice CPO-D. As avaliações foram repetidas em três momentos: no exame inicial (T1); um ano depois do início do tratamento ortodôntico, para o grupo orto, e um ano após o exame inicial, para os grupos de espera e escola (T2); e dois anos depois do início do tratamento para o grupo orto, e dois anos depois do exame inicial para os grupos de espera e escola (T3). O tratamento ortodôntico reduziu significativamente os escores de OHRQoL: as médias do escores tiveram uma redução de 10,4 para 9,2 e para 1,6 entre a primeira, segunda e terceira avaliações (p<0,001). A autopercepção estética se comportou de maneira similar, com uma redução progressiva e significativa (p<0,001) nos pacientes tratados, que também tiveram melhora significativa na gravidade da má oclusão (p<0,001). Porém, os indivíduos que removeram o aparelho tiveram OHRQoL e autopercepção estética significativamente melhores em relação aos pacientes que não finalizaram o tratamento no período de dois anos. Os adolescentes do grupo de espera tiveram significativa piora na OHRQoL, que sofreu um aumento de 10,8 para 12,0 da primeira para a terceira avaliações (p<0,001), o que também ocorreu na autoavaliação estética, que sofreu um aumento significativo (p<0,001). Por outro lado, os adolescentes do grupo escola não tiveram nenhuma alteração desses índices nos períodos de avaliação, apresentando uma tendência estacionária para OHRQoL (p=0,34) e para a autopercepção estética (p=0,09). A gravidade da má oclusão não foi alterada nos grupos não tratados durante os dois anos de avaliação e o CPO-D não teve alteração significativa para nenhum dos três grupos. Foi possível concluir que o tratamento ortodôntico melhorou significativamente a qualidade de vida relacionada com a saúde bucal e a autopercepção estética dos adolescentes brasileiros submetidos a tratamento. / Literature is not yet conclusive about orthodontic treatments psychosocial benefits. The aim of this study was to assess oral health-related quality of life (OHQoL) and self-perceived aesthetics in brazilian adolescents who was under orthodontic treatment during two years of prospective evaluation. The sample consisted of 318 subjects, 12 to 15 years of age; 92 of these had sought and started orthodontic treatment in an university (ortho group) and the other 226 were not treated adolescents: 124 had sought orthodontic treatment at the same university but did not started, once they were waiting a vacant in the wait list to initiate the treatment (waiting group), and 102 were from a public school right next door to the university clinic and had never undergone or sought orthodontic treatment (school group). OHQoL was assessed with the Brazilian version of the short form of the Oral Health Impact Profile (OHIP-14), malocclusion severity and aesthetic impairment with the IOTN index, socioechonomic status with the Brazilian Economic Classification Criteria, and oral health with the DMTF Index. All subjects completed three distinct intervals of interviews: first interview before treatment (T1), one year after the placement of the fixed appliance for ortho group and one year after the first interview for school and waiting groups (T2) and two years after the placement of the fixed appliance for ortho group and two years after the first interview for school and waiting groups. Orthodontic treatment reduced OHRQoL scores from 10.4, to 9.2 and 1.6, among first, second and third interviews (p<0.001), and also produced a significant reduction in self-perceived aesthetics (p<0.001), and in malocclusion severity (p<0.001). Patients who have finished the treatment had significant better results in all scores than the ones who received treatment for two years but still were wearing braces. Adolescents from waiting group reported worse scores in OHRQoL, wich rised from 10.8 to 12.0 between first and third interviews (p<0.001). Self-perceived aesthetics scores also worsened (p<0.001) during the evaluation period in this group. On the other hand, adolescents from school group did not had alterations in any of the evaluated indexes, including OHRQoL (p=0.34) and self-perceived aesthetics (p=0.09). In patients from not treated groups (waiting and school groups), malocclusion severity did not change during the two years, as well as DMTF did not worsened in any of the three groups. Orthodontic treatment in brazilian adolescents resulted in significant better OHRQoL and self-perceived aesthetics.

Syfte Syftet med denna studie var att undersöka hur tandförlust påverkar den orala hälsorelaterade livskvalitén genom ett OHIP-14 fråge-formulär samt ytterligare konstruerade frågor, bland patienter som besöker Kantipur Dental College and Hospital (KDCH) i Katmandu, Nepal. Material och metod Data erhölls från ett frågeformulär baserat på OHIP-14, kompletterande frågor och klinisk undersökning. Studien var av beskrivande karaktär och undersökte konsekutiva patienter (n=249) som besökte KDCH. Data från ifyllda formulär analyserades genom SPSS för att undersöka sambandet mellan tandförlust och påverkan på livskvalitén. Resultat Medelåldern var 47.6 år med en könsfördelning på 48 % (n=119) män och 52 % (n=130) kvinnor. Det genomsnittliga antalet saknade tänder var 5, och den genomsnittliga totala OHIP-poängen var 21.57 (SD 12.55). De mest påverkade dimensionerna för OHIP-14 var "Fysisk smärta" (77 %) och "Psykologiskt obehag" (82.5 %). 96.8 % av den undersökta befolkningen upplevde någon form av påverkan på deras orala hälsorelaterad livskvalitet. Slutsats Resultaten i denna studie visar att en stor majoritet av patienterna som besöker KDCH upplever någon form av påverkan på sin oral-hälsorelaterade livskvalitet relaterad till tandförlust. De saknade tändernas position hade ingen signifikant effekt på den orala hälsorelaterade livskvaliteten medan en större inverkan på livskvalitén kunde observeras vid ökande antal saknade tänder. De OHIP-poäng, utifrån de kriterier som använts i denna studie, visade sig vara högre i jämförelse med andra internationella fynd. / Aim The aim of this study was to investigate how tooth loss affects the oral health related quality of life through an OHIP-14 questionnaire and additional questions among patients visiting the Kantipur Dental College and Hospital (KDCH) in Kathmandu, Nepal. Materials and method Data was obtained from a questionnaire based on the OHIP-14 form, additional questions and a clinical examination. The study was of a descriptive nature and investigated consecutive patients (n=249) visiting the KDCH. Data from completed forms were analysed with SPSS to investigate how tooth loss affects the oral health related quality of life (OHRQoL) Results Mean age was 47.6 years with a gender ratio of 48 % (n=119) male and 52 % (n=130) female. The mean number of missing teeth was 5, and the mean total OHIP-score was 21.57 (SD 12.55). The most frequently impacted dimensions for the OHIP-14 were “Physical pain” (77 %) and “Psychological discomfort” (82.5 %). 96.8 % of the investigated population experiencing some form of impact on their OHRQoL. Conclusion A large majority of the patients visiting the KDCH experienced an impact on their OHRQoL related to missing teeth. The number of missing teeth had an impact on OHRQoL, but the position of missing teeth had not. The OHIP score with the criteria used in this study was found to be higher in comparison to other international findings.

In der vorliegenden Untersuchung sollte ein möglicher Zusammenhang zwischen mundgesundheitsbezogener Lebensqualität (MLQ) und Depression untersucht und bei prothetischen Patienten und Personen der Allgemeinbevölkerung vergleichend betrachtet werden. Es handelt sich um eine Querschnittsstudie, in welche 311 zahnärztlich-prothetische Patienten und 811 erwachsene Probanden der Bundesrepublik Deutschland einbezogen wurden. Zur Erfassung von MLQ und Depression wurden als standardisierte Instrumente zum einen die deutsche Version des Oral Health Impact Profile (OHIP) und zum anderen das Vereinfachte-Beck-Depressions-Inventar (BDI-V) eingesetzt. Die statistischen Zusammenhänge der Konstrukte wurden mit Hilfe von Korrelationsanalysen sowie Strukturgleichungsmodellen ermittelt. Die konfundierenden Variablen Alter und Geschlecht wurden dabei kontrolliert. In beiden Populationen wurde ein signifikanter Zusammenhang zwischen Depression und MLQ festgestellt. Diese gegenseitige Beeinflussung zwischen MLQ sowie deren Dimensionen und der Depression war jedoch zwischen den beiden Probandengruppen signifikant unterschiedlich stark ausgeprägt. Bei den prothetischen Patienten war der Zusammenhang nur halb so stark ausgeprägt wie bei den Personen der Allgemeinbevölkerung. Die OHIP-Dimension „Psychosozialer Einfluss“ der MLQ korrelierte in beiden Probandengruppen signifikant stärker mit Depression als die anderen Dimensionen. Folglich könnte sie auf eine mögliche Depression hinweisen und als zahnärztliches Diagnostikum eingesetzt werden. Zudem legt diese Studie nahe, dass eine eingeschränkte MLQ möglicherweise erst zeitversetzt zu depressiven Symptomen führen kann.

Das Ziel dieser Arbeit war die Bestimmung der kleinsten relevanten Veränderung des wahrgenommenen Mundgesundheitszustandes, der Minimal Important Difference (MID), des Oral Health Impact Profile (OHIP). Die MID sollte für die deutsche Version des OHIP mit 49 Fragen (OHIP-G49), die deutsche Kurzversion mit 14 Fragen (OHIP-G14) sowie für die einzelnen Dimensionen der deutschen und englischen Version des OHIP bestimmt werden. Es handelt sich um eine klinische Fallserie mit 224 konsekutiv rekrutierten, prothe-tischen Patienten. Die mundgesundheitsbezogene Lebensqualität wurde mittels des OHIP- G49 an zwei Terminen vor der Behandlung (Basisuntersuchungen) sowie vier und sechs Wochen nach Behandlungsende (Nachkontrolluntersuchun-gen) bestimmt. Zu den Nachkontrolluntersuchungen schätzten die Patienten zu-sätzlich die Veränderung ihres Mundgesundheitszustandes gegenüber dem Zeit-punkt vor der Therapie anhand einer globalen Frage ein. Anhand der Ergebnisse der Basis- und Nachkontrolluntersuchungen wurde der Median der Differenzen der OHIP-Summenwerte errechnet. Dieser Wert entspricht der MID. Für die deutsche Version des OHIP mit 49 Fragen wurde ein Wert von 6,0 OHIP-Punkten ermittelt. Der Wert für den kurzen Fragebogen OHIP-G14 betrug 2,0 OHIP-Punkte. Für die Dimensionen der deutschen und englischen Sprachversion des OHIP konnten nur teilweise Ergebnisse gefunden werden. Das Studienergebnis lässt den Schluss zu, dass für beide untersuchten Versionen des OHIP ein klar definierter, minimal relevanter Unterschied (MID) der Summen-werte existiert. Die MID unterstützt die Interpretation der klinischen Bedeutung von Veränderungen des vom Patienten wahrgenommenen Mundgesundheitszustan-des. Sie stellt eine wichtige Größe zur Bewertung prothetischer Therapieeffekte dar.

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