The influences of dental treatment on the change in oral health-related quality of life among elderly people

Objectives: To investigate the influences of dental treatment on change in oral health-related quality of life (OHQoL) among older adults, an instrument to measure oral health impacts on daily living (OHIDL) and the change in the impact after dental treatment was developed and validated. Methods: A qualitative study was conducted among older adults aged 55+ years. Information on their perceived oral health impacts was collected through semi-structured interview. The dimensions of OHIDL and the relevant items were identified through thematic framework approach. The OHIDL measured oral health impacts with intensity and bother measurements and the change in oral health impacts was assessed through transition scale. OHIDL was administrated through face-to-face interviews to older adults who attended dental clinics for general dental treatments at baseline and 1-3 months after the treatment. Construct validity was assessed through convergent, divergent and factorial validity. Criterion and longitudinal validity were investigated through assessing the correlation between the measurements and the global questions. Reliability was assessed through Cronbach’s α and test-retest correlation respectively. The relationships between oral health problems, perceived oral health impacts, dental treatment received, and change in the impacts were explored. Linear regression model was used to investigate the treatment effect in changing OHQoL. Results: In the qualitative study, 22 women and 17 men were interviewed (mean age: 72 years). Twenty items were generated and classified into seven domains: Cleansing, Eating, Speaking, Appearance, Social, Psychological, and Health & Finance. In the quantitative study, 306 subjects (mean age: 70 years) completed the interviews at baseline. Three items with over 90% of the subjects reported no impact and two items with poor discriminant validity (100% scaling error) were eliminated. Both intensity and bother measurements demonstrated good construct and criterion validity with the intensity measurement showing better performance and was selected in the OHIDL to reduce the respondents’ burden. At the follow-up evaluation, 56 subjects without receiving any treatment were excluded and 176 subjects were re-interviewed after the dental treatment. The transition scale showed good longitudinal validity. The Cronbach’s α coefficient of the intensity and transition measurements were 0.88 and 0.87, respectively. The test-retest correlation for each item as measured by intensity and transition measurement ranged from 0.35 to 1.00 and 0.28 to 0.998, respectively. Compared to baseline, the mean number of oral health problems was significantly decreased from 4.80 to 2.73 (p < 0.05). Most of the subjects rated the overall perceived oral health impacts as improved (58%), the total transition score ranged from -11 to 39 with a mean value of 4.79 (SD = 8.02), which was over the threshold of MCID (3.3). Patients who perceived more oral health impacts at baseline and had received endodontic treatment had more improvement in the perceived oral health impacts. Conclusion: OHIDL is valid and reliable in measuring the oral health impacts on daily life and the change of the impacts after dental treatment. In this study, after receiving dental treatment, older adults perceived fewer oral health problems and positive change in the oral health impacts on daily living.published_or_final_versionDentistryDoctoralDoctor of Philosoph