Prpposal Presentation Oct 2011 Rev

8/2/2019 Prpposal Presentation Oct 2011 Rev

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Impact of severe chronic periodontitis on oralhealth-related quality of lifesupervised by Dr Rathna and Assoc. Pof Roslan

Dr Leilawati Sulaiman

Department of Oral Pathology ,

Oral Medicine and Periodontology

University of Malaya


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INTRODUCTION

RESEARCH QUESTIONS

Does severe periodontal disease have an impact on OHRQoL ?

Do clinical indicators of periodontal disease have an influence onOHRQoL

Is there an association between perceived sign and symptom and

OHRQoL?


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LITERATURE REVIEW

Chronic periodontitis is an infectious disease resulting in inflammationwithin the supporting tissues of the teeth, progressive attachment

loss, bone resorption and characterized by pocket formation and/orgingival recession (1)

1. Armitage GC. Development of a classification system for periodontal diseases andconditions. Ann Periodontol. 1999 Dec;4(1):1-6


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LITERATURE REVIEW

The more destructive form of periodontal disease, which breaks downthe supporting tissues of the teeth, progressively leading to loosening

of teeth and tooth loss, affects 10 to 15 percent of most adultpopulations (2)

2. Papapanou PN. Epidemiology of periodontal diseases: an update. J Int AcadPeriodontol. 1999 Oct;1(4):110-6


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LITERATURE REVIEW

Periodontal disease through inflammation and destruction of theperiodontium, produces a wide range of clinical signs and symptoms,

some of which may have a considerable impact on daily life qualitybut little is known about this aspect (3).

3. Locker D. Measuring oral health: a conceptual framework. Community Dent Health.1988 Mar;5(1):3-18


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LITERATURE REVIEW

The various tools and methods for measuring OHRQoL include

Sickness Impact Profile (SIP) (4),

Geriatric Oral Health Assessment Index (GOHAI) (5) Dental Impact Profile (6).

Oral Health Impact Profile (OHIP)- new index which was conceptuallydistinct and methodologically rigorous was developed in 1994

4. Gilson BS, Gilson JS, Bergner M, Bobbit RA, Kressel S, Pollard WE, et al. Thesickness impact profile. Development of an outcome measure of health care. Am J PublicHealth. 1975 Dec;65(12):1304-10.

5. Atchison KA, Dolan TA. Development of the Geriatric Oral Health Assessment Index.J Dent Educ. 1990 Nov;54(11):680-7.

6. Strauss RP, Hunt RJ. Understanding the value of teeth to older adults: influences onthe quality of life. J Am Dent Assoc. 1993 Jan;124(1):105-10


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LITERATURE REVIEW

OHIP

In 2005, Saub and Locker adapted the original OHIP (7), forMalaysian population, followed by development of a short version ofthe Malaysian Oral Health Impact Profile the OHIP-14 (M). Reliabilityand validity was also tested and was found appropriate for use incross-sectional studies in Malaysian adult population (8).

7. Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact

Profile. Community Dent Health. 1994 Mar;11(1):3-11.

8. Saub R, Locker D, Allison P. Derivation and validation of the short version of theMalaysian Oral Health Impact Profile. Community Dent Oral Epidemiol. 2005Oct;33(5):378-83


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LITERATURE REVIEW

OHIP

The theorical basis of the OHIP was the 1980 WHO International

Classification of Impairments, Disabilities and Handicapssubsequently adapted for oral health (3).

OHIP comprises of 49 items which has later been simplified to ashorter version containing 14 items (9) .

These 14 items (OHIP-14) represent seven domains (subscales):functional limitation, physical discomfort, psychological discomfort,physical disability, psychological disability, social disability andhandicap

9. Slade GD. Derivation and validation of a short-form oral health impact profile.

Community Dent Oral Epidemiol. 1997 Aug;25(4):284-90.


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LITERATURE REVIEW

The following are those research concerning impact of periodontaldisease on quality of life, all of which had described the adverse

impact on quality of life.


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LITERATURE REVIEW

Araujo et al. (2010)

used OHIP-14 validated for the Portuguese language

cross-sectional study involving a convenience sample of 401 patientsof both sexes ages 19 to 71 years, diagnosed with periodontalcondition

their conclusion was that functional limitation was the most affecteddimension, and impact was significantly associated with age, income,and a diagnosis of periodontal disease

Araujo AC, Gusmao ES, Batista JE, Cimoes R. Impact of periodontal disease on quality oflife. Quintessence Int. 2010 Jun;41(6):e111-8


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LITERATURE REVIEW

Cunha-cruz et al. (2007)

study population consisted of members of the Washington Dental

Service presenting to a periodontal specialist

A total of3617 individuals were invited to participate in the study and1497 patients consented to participate and mailed back thequestionnaire.

Cunha-Cruz J, Hujoel PP, Kressin NR. Oral health-related quality of life of periodontalpatients. J Periodontal Res. 2007 Apr;42(2):169-76.


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LITERATURE REVIEW

....continued Cunha-cruz et al. (2007)

The questionnaire included perceived oral health (one question) andsix item questionnaire on oral health-related quality of life.

Number of teeth with PPD deeper than 5 mm and 8 mm and numberof missing teeth were abstracted from dental charts.

Cunha-Cruz J, Hujoel PP, Kressin NR. Oral health-related quality of life of periodontalpatients. J Periodontal Res. 2007 Apr;42(2):169-76.


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LITERATURE REVIEW

....continued Cunha-cruz et al. (2007)

They found that oral health-related problems in patients presentingto a periodontal specialist office negatively affect their quality of life.If some of the findings of this study can be confirmed in otherstudies, it could change the perception of chronic periodontitis as asilent disease

Cunha-Cruz J, Hujoel PP, Kressin NR. Oral health-related quality of life of periodontalpatients. J Periodontal Res. 2007 Apr;42(2):169-7


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LITERATURE REVIEW

Lopez and Baelum (2007)

conducted a cross-sectional study among Chilean high schoolstudents (adolescents)

9163 persons participated where clinical attachment levels andpresence of necrotizing ulcerative gingivitis were recorded

the Spanish version of the OHIP were answered by the students inaddition to information on several socio-economic indicators.

Lopez R, Baelum V. Oral health impact of periodontal diseases in adolescents. J Dent Res.

2007 Nov;86(11):1105-9.


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LITERATURE REVIEW

..continued Lopez and Baelum (2007)

Results

showed that both attachment loss and necrotizing ulcerativegingivitis were significantly associated with higher impact on theOHRQoL of adolescents.

Individuals in lower socioeconomic positions systematicallyreported a higher impact on their oral-health-related quality oflife

Lopez R, Baelum V. Oral health impact of periodontal diseases in adolescents. J Dent Res.

2007 Nov;86(11):1105-9.


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LITERATURE REVIEW

Ng and Leung (2006)

subjects from a community study conducted at the University of HongKong which investigated the associations of stress with periodontaldisease

cross-sectional sample of767 subjects aged 25-64 years

The Chinese short-form version of OHIP and a checklist of self-reported periodontal signs and symptoms were sent by mail to thesubjects and 727 completed it.

This study has demonstrated a significant association between

OHRQoL and periodontal disease

Ng SK, Leung WK. Oral health-related quality of life and periodontal status. CommunityDent Oral Epidemiol. 2006 Apr;34(2):114-22


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LITERATURE REVIEW

Needleman et al. (2004)

205 patients attending a private specialists periodontal practise.

A questionnaire incorporating 16-item UK oral health related quality

of life measure (OHQoL-UK) was used. They came to the conclusion that periodontal status impacts on life

quality bringing the implications in understanding the consequencesof periodontal health and in the use of patient-centered outcomes inperiodontal research

Needleman I, McGrath C, Floyd P, Biddle A. Impact of oral health on the life quality ofperiodontal patients. J Clin Periodontol. 2004 Jun;31(6):454-7


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AIM AND OBJECTIVES

The aim of this study is to investigate the impact of severe

periodontal disease on the OHRQoL using the OHIP-14(M) for aselected Malaysian population.


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AIM AND OBJECTIVES

Objectives

As to answer the research questions, the objectives of the study are:

To assess the OHRQoL in advanced periodontal disease subjects andhealthy subjects .

To compare the OHRQoL between periodontal disease subject andhealthy subjects.

To assess the relationship between periodontal clinical indicators(bleeding on probing and probing pocket depth) and the OHRQoL.

To assess the association between perceived sign and symptom ofperiodontal disease with OHRQoL.


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AIM AND OBJECTIVES

Null Hypothesis

There will be no significant difference in the prevalence and severityof OHRQoL of patients with advanced periodontal disease compare tohealthy patients.

There will be no significant relationship between the clinicalindicators of periodontal disease and the OHRQoL.

There will be no significant association between perceived sign and

symptom and the OHRQoL.


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METHODS

Study design

This will be a case-control study involving chronic periodontitispatients who have severe destruction of periodontal condition and

patients without periodontal disease as controls.

Target Population

All patients who are seeking treatment at the Faculty of Dentistry,

University of Malaya who fulfil the inclusion/exclusion criteria will bethe target population in this research


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METHODS

Study design

This will be a case-control study involving chronic periodontitispatients who have severe destruction of periodontal condition and

patients without periodontal disease as controls.

Target Population

All patients who are seeking treatment at the Faculty of Dentistry,

University of Malaya who fulfil the inclusion/exclusion criteria will bethe target population in this research


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METHODS

Sampling frame

All patients whom identified to be having severe chronic

periodontitis will form the sampling frame. The classification on theAmerican Academy of Periodontology workshop in 1999 will be used(1).

Controlled group of patients who do not have periodontal diseasebut matched on sex, age of within five years and ethnicity will also

be included in the sampling frame.

Armitage GC. Development of a classification system for periodontal diseases and conditions.Ann Periodontol. 1999 Dec;4(1):1-6.


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METHODS

Sampling design

Inclusion criteria :

Aged of3O to 70 years with at least 12 teeth present.

Those diagnosed clinically with severe chronic periodontitis andhaving minimum of 4 sites with probing pocket depth (PPD)greater or equal to 6mm (which bleeds on probing) in any two ormore different quadrants, and exhibit not less than 5mm

attachment loss.

A controlled group of patients exhibiting generally soundperiodontal condition with less than 15% alveolar bone loss andPPD not more than 3mm.


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METHODS

Sampling design

Exclusion criteria :

Non Malaysian subjects

Patients with systemic disease

Patients who have been on antibiotics within the past four months

Patients who have received periodontal treatment within the pastfour months

Patients who are pregnant

Patients who unable to meet the inclusion criteria


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METHODS

The sample size

To determine the impact of periodontal disease on the quality oflife, the sample size was calculated considering a 50% prevalence

of impact on quality of life, a figure adopted to maximize thesample.

The level of significance was set at 5%, the confidence interval at95%, and the strength of the test at 80%, using the Epi infoversion 6.04 statistical software (free access, World HealthOrganization), thus requiring a minimum of 400 patients (10).

Araujo AC, Gusmao ES, Batista JE, Cimoes R. Impact of periodontal disease on quality of life.Quintessence Int. 2010 Jun;41(6):e111-8


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METHODS

MEASUREMENT (QUESTIONNAIRE)

a)DEMOGRAPHIC DATA AND LIFESTYLEPRACTICES/HABITS

b)PERCEIVED SIGN AND SYMPTOMS OF

CHRONIC PERIODONTAL DISEASE

c)ORAL HEALTH IMPACT PROFILE

OHIP-14

PretestAll the above will be put in one questionnaire, pretest will

be done to see whether patients are able to answer the questions well


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METHODS

MEASUREMENT

1. Gingival and Plaque Index (15)

2. Probing Pocket Depth (PPD)3. Recession

4. Clinical attachment loss (CAL)

5. Missing teeth

Florida Probe will be used in order to exclude

measurement errors related to the effect of variationsin probing force

15. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J.

1975 Dec;25(4):229-35


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METHODS

CALLIBRATION

Intra-operator standardization for periodontalexamination will be conducted prior to the study.

Inter-operator reproducibility will also be conductedwith other investigators involved in the study.


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METHODS

An interview will be conducted for the questionnaire .

Data management and analysis

Data will be analysed to determine the frequency distribution,means, and medians using the Statistical Package of SocialSciences 12.0 (SPSS) software. The chi-square will beemployed.

For the value of impact in points, the analysis will beperformed using the median values as a benchmark(significance level 5%)


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METHODS

Ethical Consideration

Ethical clearance has been obtained from the Medical EthicsCommittee, Faculty Of Dentistry University of Malaya (DFPE1103/0037(L))

The nature of the project will be explained to the subjects with awritten information sheet given to them. Participation is voluntary

and subjects will sign terms of informed consent.


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Workflow

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Calibration & Pretest

Patient screening

-BPE

Data collection

-Questionnaire & Periodontal examination

Data analysis


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WORK PROGRESSIONGantt chart and milestones

Research activities Year 1 (2011) Year 2 (2012) Year 3 (2013)

Sept Oct Nov Nov Dec Mar Apr

Title: Impact of severe chronic periodontitis on oral health-related quality of life

1. Proposal Development

2. Intra and inter-examiner calibration

3. Data collection

4. Data analysis

5. Research writing

6. Submission of report


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ANY QUESTIONS.

Thank you for your kind attention.

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Documents

Prpposal Presentation Oct 2011 Rev