Faculty Bibliography

INTRODUCTION: The frequency of persistent pain 3-5 years after primary root canal therapy and its impact on the patient's perceived oral health-related quality of life was determined in a practice-based research network. METHODS: All patients presenting to participating network practices who received primary root canal therapy and restoration for a permanent tooth 3-5 years previously were invited to enroll. Persistent pain was defined as pain occurring spontaneously or elicited by percussion, palpation, or biting. The patient also completed an oral health-related quality of life questionnaire (Oral Health Impact Profile-14). RESULTS: Sixty-four network practices enrolled 1323 patients; 13 were ineligible, 12 did not receive a final restoration, and 41 were extracted, leaving 1257 for analysis. The average time to follow-up was 3.9 +/- 0.6 years. Five percent (63/1257) of the patients reported persistent pain, whereas 24 of 63 (38%) exhibited periapical pathosis and/or root fracture (odontogenic pain). No obvious odontogenic cause for persistent pain was found for 39 of 63 (62%). Teeth treated by specialists had a greater frequency of persistent pain than teeth treated by generalists (9.3% vs 3.0%, respectively; P < .0001). Sex, age, tooth type, type of dentist, and arch were not found to be associated with nonodontogenic persistent pain; however, ethnicity and a preoperative diagnosis of pulpitis without periapical pathosis were. Patients reporting pain with percussion tended to experience pain with other stimuli that negatively impacted quality of life including oral function and psychological discomfort and disability. CONCLUSIONS: These results suggest that a small percentage (3.1%) of patients experience persistent pain not attributable to odontogenic causes 3-5 years after primary root canal therapy that may adversely impact their quality of life.

Objective : This paper describes the process and outcomes of the 2013 American Cleft Palate-Craniofacial Association task force on Holistic Outcomes. The goals and membership of the task force are presented. Methods : Using internet communication, the group introduced themselves, shared ideas and information related to holistic assessment and implementation of using a validated holistic measure, the Child Oral Health Impact Profile (COHIP) at participating international sites. Results : Data from the sites were analyzed using descriptive statistics. Administration of the COHIP was successful. It varied from self-completion as well as verbal presentation due to language differences and a function of the short time period to complete collection. Additionally qualitative comments were reported by the task force site directors. Conclusions : Future directions for holistic assessment and communication among task force members and sites were discussed at the Congress and are presented in this report.

OBJECTIVE: This study sought to examine oral health beliefs and attitudes, and utilisation of oral health care services among individuals with diabetes and health professionals who serve them in Ghana. BASIC RESEARCH DESIGN: A qualitative study using grounded theory was conducted. CLINICAL SETTING: University of Ghana Dental School at Korle Bu, University of Ghana School of Public Health, National Diabetes Research and Management Centre at Korle Bu, and New York University College of Dentistry. PARTICIPANTS: A convenience sample of 59 patients comprised 7 focus groups conducted in either Twi or English. Seven key informant interviews with healthcare professionals and one spiritual leader were completed. RESULTS: Data from the focus groups and interviews reveal: 1, half of the participants with diabetes have oral manifestations (e.g., bleeding gums) and participants are generally unaware of interrelationship between diabetes and oral health; 2, dental treatment utilisation is minimal and associated almost exclusively with reparative and emergency care; and 3, medical health providers do not acknowledge the interrelationship between oral health and diabetes nor do they incorporate oral health issues into diabetes screening/treatment. CONCLUSION: Oral health knowledge and practices are limited among patients with diabetes in Accra, Ghana. Collaborative efforts for in-service education and training for oral health and medical professionals may be beneficial in serving the oral and general health care needs as well as improving the oral health-related quality of life of Ghanaians with diabetes.

BACKGROUND: Patient-reported quality-of-life outcomes in cleft lip-cleft palate treatment are critical for evidence-based care. Scant data exist analyzing treatment from the patient's perspective. The authors examined the interrelationship among variables associated with oral health-related quality of life among youth with cleft. METHODS: As part of an ongoing longitudinal study, clinical evaluations and research questionnaire packets were completed before surgical recommendations were made (baseline). Participants completed the Child Oral Health Impact Profile, a validated oral health-related quality-of-life measure for children with cleft. During the baseline clinical evaluations, plastic surgeons determined whether surgical interventions were recommended within the year (expert determination represents a greater degree of current clinical need). General linear models incorporating surgical recommendation, gender, and age were fit for each subscale of and for the total Child Oral Health Impact Profile. Significant interaction terms were evaluated for their effect on the subscale. RESULTS: Baseline assessments were obtained from 1200 participants (mean, 11.8 years; 57 percent male). Participants with a surgical recommendation had lower quality of life on all but the self-esteem subscale compared with those without a surgical recommendation (p < 0.002). Two subscales had statistically significant age-sex interactions (p < 0.003), whereas another subscale had a statistically significant surgery by sex interaction term (p = 0.027). CONCLUSIONS: Overall, youth for whom surgery is currently recommended had lower oral health-related quality-of-life scores on the Child Oral Health Impact Profile Total scale than those with no surgical recommendation; older female subjects had lower quality-of-life scores than male subjects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Objectives. We evaluated relationships among physical and psychological indicators and oral health-related quality of life (OHRQOL) in youths with cleft. Methods. We recruited youths aged 7 to 18 years with cleft palate (n = 282) or cleft lip and palate (n = 918) and their caregivers into a 5-year observational investigation at 6 US treatment centers from 2009 to 2011. At baseline, youths completed surveys to assess psychological status. After clinical evaluation, 433 youths received a recommendation for surgery. We developed structural models from the baseline data incorporating age, gender, race, and cleft diagnosis to examine direct relationships between depressive symptoms and, in separate models, self-concept and sense of mastery and OHRQOL. Subsequent models examined the possible mediating effect of surgical recommendation. Results. Depressive symptoms were negatively and self-concept and self-efficacy were positively associated with OHRQOL. Surgical recommendation appeared to mediate the effect of psychological well-being, but not depression, on OHRQOL, even after adjustment for cleft diagnosis. In some models, individual-level characteristics were significant. Conclusions. Path analyses support the theoretical model and underscore the importance of examining positive psychosocial characteristics such as resiliency and self-concept in this patient population. (Am J Public Health. Published online ahead of print March 13, 2014: e1-e7. doi:10.2105/AJPH.2013.301686).

Background/Purpose: Clinically, differences have been observed in psychosocial functioning over the course of adolescence among youth with cleft. This may reflect age-typical variations in social and emotional functioning based on models of adolescent development, such as those described by Erikson. This study explored the influence of stages of psychosocial development, as indicated by age, on depression, anxiety, self-concept, resilience, and health related quality of life (QOL) among youth with cleft. Methods/Description: Six U.S. cleft centers participated in a longitudinal observational study of QOL among youth with cleft. Cross-sectional data were collected using Beck's Youth Inventories (Beck et. al., 2005), the Pediatric Quality of Life Inventory (Varni, Seid & Rode, 1999), and the Resiliency Scale for Children and Adolescents (Prince-Embury, 2008). 1,200 youth (mean age =11.6 years old (SD= 3.1)) were grouped by age: middle childhood (ages 8-11), n=690; early adolescence (ages 12-15), n=347; middle adolescence (ages 16-18), n= 124; and late adolescence (ages 19-21), n = 39. GLM was used to explore the association between age group and self-concept, anxiety, depression, resilience and QOL. Secondarily, we explored differences relative to cleft type and surgical status. Results: The two younger groups reported significantly lower anxiety (F (3, 1159) = 4.69, p = 0.0029) and depression (F (3, 1159) = 11.16, p < .0001) than the older groups. Age groups did not differ on self-concept, resilience, or quality of life. Cleft type was not associated with differences in outcomes by age group, but participants recommended for surgery within a year endorsed lower self-concept and resilience and higher anxiety and depression (all p's < .04). Conclusions: Middle and older adolescence are associated with higher anxiety and depression among youth with cleft, as would be predicted by Erikson's stage of "Identity vs. Role Confusion," during which teens focus on social relationships and developing a sens!

Background/Purpose: The rationale for treatment interventions for individuals with clefts is to improve and enhance their quality of life (QoL). While QoL research has been incorporated into medical care across many conditions, QoL has been largely unexplored in individuals with clefts. Patient-reported QoL outcomes in cleft lip and palate treatment are critical as we advance evidence-based care. The overall purposes of this panel are to present: the importance of QoL research; why we do it; how we do it; and what we know from it. The panel objectives are to identify methods used to assess patientreported outcomes in plastic surgery, speech, and psychological outcomes, namely oral health-related quality of life (OHRQoL). Methods/Description: Panel members will consist of investigators from the NIH-research team, including clinical and health services research specialists from academia and from the Centers for Disease Control and Prevention. Data from the ongoing NIH-supported sixcenter observational, longitudinal project entitled "Quality of Life in Children with Cleft" will be presented, with assessments from clinicians, patients and caregivers. Certain family characteristics (e.g., expressiveness, cohesion, and conflict) have been examined as risk and protective factors for adjustment within the broader pediatric illness and child development literatures. Findings on QoL and evaluation of standardized judgment scales from speech and plastic surgeon's facial appearance ratings and patient and caregiver reported perceptions will be presented for 1200 participants (7-20 years old), who are evaluated and followed per standards of care. Findings regarding the association among teams' surgical recommendations and patient-reported factors like depression, resilience, self-concept and OHRQoL will be presented, using descriptive statistics and modeling methodology. Suggestions for modifying current techniques will be expanded. Methodological issues from varying perspectives and different data sources !

Background/Purpose: Oral health-related quality of life (QoL) is an essential factor for determining treatment needs in youth with clefts and is also linked to surgical recommendations. This study sought to investigate demographic factors (i.e., race/ethnicity) associated with surgical recommendation and QoL in youth with clefts Methods/Description: Data come from a five-year longitudinal study examining outcomes in youth (ages 7 to 18) with cleft and their caregivers Participants were 1200 youth (43.28% female) recruited from six U.S. cleft centers. They averaged 11.6 years old (sd=3.1), and 16.5% were recommended for surgery within one year. The majority of the sample was white (67.7%), 16% were Hispanic, 10.7% Asian, 9.7% Black/African American, and 11.8% other/mixed. At baseline, participants completed self-report questionnaires to assess demographic factors and QoL. QoL was assessed with the Child Oral Health Impact Profile (COHIP), a 34-item, self-report measure with five discrete subscales: Oral Health; Functional Well-being; Socio- Emotional Well-being; School; and Self-esteem. Surgeons also provided recommendations for surgery within a year time span. Results: Chi-square analyses revealed that more Hispanic youth (46%) were recommended for surgery within the year compared to non-Hispanic youth (34%). P <.004. Comparisons of racial differences showed that only 33% of white youth were recommended for surgery, compared to 48.7% of African-American and 41% of mixed/other race, P <.004. GLM models separately examined race and ethnicity differences in COHIP, controlling for age, gender, diagnosis (CP or CLP), and clinical rating of the severity of defect. Results showed significant racial differences across all subscales, except for self-esteem, such that African-American and other/mixed race participants reported lower QoL compared to other groups. Significant ethnicity differences were also observed across COHIP subscales, except for functional well-being, showing that Hispanic youth repor!

PURPOSE: To examine (a) the pattern of responses to a generic health-related quality of life (HRQL) measure (Pediatric Quality of Life Inventory-PedsQL) and an oral health-related quality of life (OHRQoL) measure (Child Oral Health Impact Profile-COHIP), and (b) the associations of these scores with surgical recommendation status among youth with cleft. METHODS: Cross-sectional data (baseline) regarding clinicians' surgical recommendations and quality of life (QoL) measures were examined from an ongoing observational study on treatment outcomes. Approximately one-third of the racially and geographically diverse sample (N = 1,200; [Formula: see text] = 11.6 years) received surgical recommendations to correct either visible (aesthetic) or invisible (functional) defects. Effect sizes were used to quantify differences in QoL based on surgical recommendation and to compare the sensitivity of the PedsQL and COHIP subscales. Using Pearson coefficients, the scores of those recommended for surgery were compared with those without a surgical recommendation. RESULTS: A moderate correlation (0.52) was found between the total scores on the PedsQL and COHIP (p < 0.0001). Subscale correlations between the QoL measures ranged from 0.19 to 0.48 with the strongest correlation between the PedsQL Emotional (r = 0.47) and COHIP Socioemotional Well-being subscale. The effect size for the COHIP Socioemotional Well-being (0.39) was larger than the PedsQL Social/Emotional (0.07/0.11) subscale (Z = 5.30/Z = 4.64, p < 0.0001, respectively), and the total COHIP (0.31) was significantly greater than the total PedsQL scale (0.15, z = 2.65, p = 0.008). CONCLUSIONS: A significant relationship was found between generic HRQL, OHRQoL, and surgical needs among youth with cleft with the COHIP having larger effect sizes than the PedsQL among surgical groups.