Journal of Evidence-Based Dental Practice最新文献

Objective

To identify and summarize the presence and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within comparative observational studies published in 5 leading orthodontic journals.

Methods

Electronic searching was performed to identify intervention (therapeutic or preventive) related comparative observational studies published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included study independently and in duplicate and summarized the dPROs and dPROMs used in these studies. All dPROs were classified into 2 general types (oral health-related quality of life [OHRQoL] and others), while dPROMs were divided into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). In addition, dPROMs were examined, if they evaluated the 4 dimensions of OHRQoL (oral function, orofacial pain, orofacial appearance, and psychosocial impact).

Results

A total of 683 observational studies were eligible and included of which 117 (17.1%) used dPROs and dPROMs. Seven different dPROs (OHRQoL, patients’ satisfaction with treatment, preferences, concerns, compliance, duration, and unwanted events) and 33 different dPROMs (including 8 single-item questionnaires, 11 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these studies. OHRQoL was the most commonly used dPRO (92/117, 78.6%), while Oral Health Impact Profile 14 (OHIP-14) was the most frequently used dPROM (20/92, 21.7%). In terms of study design, cross-sectional studies had the highest proportion of dPRO usage (62/148, 41.9%), followed by cohort studies (63/505, 12.5%) and case-control studies (1/30, 3.3%).

Conclusions

Only one-sixth of comparative observational studies published in leading orthodontic journals could reflect patients’ perspectives. Observational studies in orthodontics need to provide more patient-important information through the use of dPROs and dPROMs.

Dental patient-centered outcomes can improve the relevance of clinical study results to dental patients and generate evidence to optimize health outcomes for dental patients. Dental patient-reported outcomes (dPROs) are of great importance to patient-centered dental care. They can be used to evaluate the health outcomes of an individual patient about the impact of oral diseases and treatment, and to assess the quality of oral health care delivery for a health care entity. dPROs are measured with dental patient-reported outcome measures (dPROMs). dPROMs should be validated and tested before wider dissemination and application to ensure that they can accurately capture the intended dPROs. Evidence suggests inadequate dPRO usage among dental trials, as well as potential flaws in some existing dPROMs. This Glossary presents a collection of main terms in dental patient-centered outcomes to help clinicians and researchers read and understand patient-centered clinical studies in dentistry.

Objectives

Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals.

Methods

The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review.

Results

After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60.

Conclusions

This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.

The emergence and rapid development of disruptive innovations are quickly turning our profession into personalized dentistry, built upon evidence-based, data-oriented, and patient-centered research. In order to help improve the quality and quantity of patient-centered evidence in dentistry, further promote the wide and standard use of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs), the Journal of Evidence-Based Dental Practice has put together this special issue, the third of a series entitled Dental Patient-Reported Outcomes Update.

A total of 7 solicited articles are collected in this issue. To put them into a broader perspective, this review provides a concise summary of key, selected PRO and dPRO articles published during 2023. A brief introduction to those articles included in this Special Issue follows. Four main domains are covered in this Special Issue: (1) dPROs and digital dentistry, (2) standardization of dPRO-related methodology, (3) current usage of dPROs and dPROMs in published research, and (iv) the significance and relevance of dPRO usage.

Oral health impact or oral health related quality of life is an increasingly important and well-known metric in dental care and research. There have been recent calls for greater integration of the behavioral and social sciences into oral health research and practice, including the need for frameworks and theories to guide this work. One such framework for understanding the role of predisposing, precipitating, and perpetuating biopsychosocial mechanisms in health and disease is the “3P” model. Here, the 3P model is described and applied to case examples to help understand the development and maintenance of oral health impact. Additionally, this paper outlines how this conceptualization using the 3P model and oral health impact makes way for greater integration of behavioral interventions to prevent, mitigate, or treat the negative impact that oral, craniofacial, or dental disease may have on individuals. Doing this allows for a broadening of what evidence-based dentistry means for the future and provides a roadmap going forward.

Over the past 50 years, digitization has gradually taken root in dentistry, starting with computer tomography in the 1970s. The most disruptive events in digital dentistry were the introduction of digital workflow and computer-aided manufacturing, which made new procedures and materials available for dental use. While the conventional lab-based workflow requires light or chemical curing under inconsistent and suboptimal conditions, computer-aided manufacturing allows for industrial-grade material, ensuring consistently high material quality. In addition, many other innovative, less disruptive, but relevant approaches have been developed in digital dentistry. These will have or already impact prevention, diagnosis, and therapy, thus impacting patients’ oral health and, consequently, their oral health-related quality of life. Both software and hardware approaches attempt to maintain, restore, or optimize a patient's perceived oral health. This article outlines innovations in dentistry and their potential impact on patients’ oral health-related quality of life in prevention and therapy. Furthermore, possible future developments and their potential implications are characterized.

Background

Different dental patient-reported outcome measures (dPROMs) exist for children and adults, leading to an incompatibility in outcome assessment in these 2 age groups. However, the dental patient-reported outcomes (dPROs) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the same in the 2 groups, providing an opportunity for compatible dPRO assessment if dPROMs were identical. Therefore, we adapted the 5-item Oral Health Impact Profile (OHIP-5), a recommended dPROM for adults, to school-aged children to allow a standardized dPRO assessment in individuals aged 7 years and above.

Aim

It was the aim of this study to develop a 5-item OHIP for school-aged children (OHIP-5_School) and to investigate the instrument's score reliability and validity.

Methods

German-speaking children (N = 95, mean age: 8.6 years +/- 1.3 years, 55% girls) from the Department of Pediatric Dentistry at the Medical University of Vienna, Austria and a private dental practice in Bergisch Gladbach, Germany participated. The original OHIP-5 was modified and adapted for school going children aged 7-13 years and this modified version was termed OHIP-5_School. It's score reliability was studied by determining scores’ internal consistency and temporal stability by calculating Cronbach's alpha and intraclass correlation coefficients, respectively. Construct validity was assessed comparing OHIP-5_School scores with OHIP-5 as well as Child Perceptions Questionnaire (CPQ-G_8-10) scores.

Results

Score reliability for the OHIP-5_School was “good” (Cronbach's alpha: 0.81) or “excellent” (Intraclass correlation coefficient: 0.92). High correlations between OHIP-5_School, OHIP-5, and CPQ-G_8-10 scores were observed and hypotheses about a pattern of these correlations were confirmed, providing evidence for score validity.

Conclusion

The OHIP-5_School and the original OHIP-5 are short and psychometrically sound instruments to measure the oral health related quality of life in school-aged children, providing an opportunity for a standardized oral health impact assessment with the same metric in school-aged children, adolescents, and adults.