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David Locker

Publications and source records attributed to David Locker.

36 records · Page 2Linked to original sources
PubMed2003

Oral and general health-related quality of life with conventional and implant dentures.

UNLABELLED: Implant overdentures and conventional prostheses have been compared in several trials using a variety of functional and oral health-related quality of life (OHQOL) outcomes. In this paper, we describe the impact of implant overdentures on general and OHQOL in seniors. OBJECTIVES: To compare the oral health-related and general quality of life of seniors (aged 65-75 years) who received either mandibular implant overdentures or conventional dentures. METHODS: Sixty edentulous patients were recruited. Thirty received mandibular overdentures retained by two implants (IOD) and a conventional maxillary denture, the other 30 subjects received new maxillary and mandibular conventional complete dentures (CD). All completed the 20-item version of the Oral Health Impact Profile (OHIP-20) before treatment, then at two and 6 months after delivery of the dentures. The SF-36 general health questionnaire was completed at baseline and 6 months only. RESULTS: Pretreatment and 6-month data from 55 subjects were analyzed. Those who received the IODs had significantly better OHIP-20 total scores at 6 months. Results for IOD subjects were also superior in the functional limitation, physical pain, physical disability and psychological disability subscales. While no significant between group difference was found on the SF-36 health survey, significant pre-post-treatment differences within the IOD group were detected for the role emotional, vitality and the social function scales. CONCLUSIONS: Mandibular overdentures retained by two implants provide elderly patients with better OHQOL. General health-related quality of life improved in the implant group.

Aged↗
PubMed2003

Barriers to wellness activities for Canadian women with physical disabilities.

Although there is a great deal of interest in women's health, research on the health and well being of women with disabilities has not increased. In this article we present internal and structural barriers to wellness activities experienced by women with disabilities. We also discuss women's actual and recommended strategies to address these barriers. Data were collected in six focus groups in urban and rural Ontario, Canada. The participants represented a diversity of disability, age, and ethnoracial backgrounds. Our findings suggest that individual and structural barriers exist for the women, with structural barriers (physical, informational, and systemic access) being predominant. Barriers prevented women from engaging in desired wellness activities. Women discussed actual strategies to address these barriers, such as collective efforts to buy nutritious foods and recommendations to create greater access (e.g., increase health professionals' training in disability issues).

Activities of Daily Living↗
PubMed2003

Measuring parental perceptions of child oral health-related quality of life.

OBJECTIVES: The aim of this study was to develop and evaluate the P-CPQ, a measure of parental/caregiver perceptions of the oral health-related quality of life of children. This forms one component of the Child Oral Health Quality of Life Questionnaire (COHQOL). METHODS: An item pool was developed through a review of existing child health questionnaires and interviews with parents/caregivers of children with pedodontic, orthodontic, and orofacial conditions. The resulting 47 items were used in a study in which 208 parents/caregivers provided data on their frequency and importance. The 31 items rated the most frequent and important were selected for the final questionnaire (P-CPQ). The P-CPQ validity and reliability were assessed by a new sample of 231 parents, 79 of whom completed two copies for the assessment of test-retest reliability. RESULTS: The P-CPQ discriminated among the three clinical groups included in the expected direction. Within-group analyses using clinical data provided some evidence that scores were associated with the severity of the condition. The P-CPQ also showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.94 and demonstrated perfect test-retest reliability (ICC=0.85). CONCLUSION: The study provides data to indicate that the P-CPQ is valid and reliable.

Adolescent↗
PubMed2003

Dental status, xerostomia and the oral health-related quality of life of an elderly institutionalized population.

The author examined the relative effects of tooth loss and xerostomia on the oral health-related quality of life of an elderly, medically compromised population, living in a long-term care setting. Data were collected from 225 subjects (mean age: 83 years) via a questionnaire and review of dental charts. Oral health-related quality of life was assessed using self-ratings, satisfaction ratings, an index of chewing capacity, the GOHAI, and OHIP-14. Almost all participants had one or more chronic medical conditions and were taking prescribed medications. Two-thirds of the study group was dentulous with a mean number of 16 remaining teeth. One-third of the participants had scores on a xerostomia index indicating marked oral dryness. In bivariate and multivariate analyses, xerostomia index scores were significantly associated with all oral health-related quality of life outcomes. Dental status was associated with chewing capacity only. The results suggest that xerostomia has an important influence on the well-being and quality of life of this population.

Aged↗
PubMed2002

Family impact of child oral and oro-facial conditions.

OBJECTIVES: The aim of this study was to develop and evaluate the Family Impact Scale, a measure of the family impact of child oral and oro-facial disorders. This formed one component of the Child Oral Health Quality of Life Instrument. METHODS: The scale was developed using a process described by Guyatt et al. (1987) and Juniper et al. (1996). An item pool was developed using a review of existing child health status and family impact questionnaires, interviews with 41 parents-caregivers of children with paedodontic, orthodontic and oro-facial conditions and discussions with dental specialists. The resulting pool of 21 items was used in an item impact study in which 93 parents-caregivers provided data on the frequency and importance of these items. The 14 items identified most frequently or rated the most important were selected for the final questionnaire. The discriminant and construct validity and internal consistency reliability of this 14-item scale were assessed in a study of 266 parents-caregivers from the three clinical groups. Seventy-nine of these participants completed a second copy of the questionnaire to facilitate assessment of test-retest reliability. RESULTS: Family Impact Scale scores ranged from 0 to 33, indicating that the measure was sensitive to variations in family impact. Floor effects were minimal with only 10.2% of subjects having a score of zero and there were no ceiling effects, that is, subjects with maximum scores. Almost three-quarters of parents-caregivers reported some family impact 'sometimes' or 'often/everyday' over the previous 3 months. Impact on parental or family activities of this frequency was reported by 53.0%, impact on parental emotions by 44.0%, conflict in the family by 31.6% and financial difficulties by 31.2%. The measure and its component items were reasonably good at discriminating between the three clinical groups included in the study and showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.83 and was reproducible for parent-caregivers who reported that their child's condition was stable (ICC = 0.80). CONCLUSIONS: The study provides some data to suggest that child oral and oro-facial conditions have a pervasive impact on the family. The Family Impact Scale had good technical properties. Its evaluative properties need to be tested in longitudinal studies.

Adolescent↗
PubMed2002

Developing short-form measures of oral health-related quality of life.

OBJECTIVES: Using the item-impact method, we developed an alternative short-form Oral Health Impact Profile (OHIP) that has good psychometric properties and minimal floor effects. METHODS: OHIP data were collected from a sample of older Canadians at two points in time. Data from the first administration were used to develop a 14-item short-form measure; data from the second compare the latter's psychometric properties with those of the original short form developed by Slade (1997), who used a controlled regression procedure. RESULTS: The short form based on the item-impact method had only two items in common with the short form derived from the regression approach and contained more high-prevalence items. The regression short form was subject to marked floor effects, while the impact short form had floor effects comparable to those of the full 49-item OHIP. The former discriminated between dentate and edentulous subjects, while the latter did not. Both discriminated between dentate subjects who did and did not wear dentures, those with and without dry mouth, and those with and without chewing problems. Both were also significantly associated with self-ratings of oral health, satisfaction with oral health, and self-perceived need for dental treatment. The strength of the associations was somewhat stronger with the regression short form, indicating that it performed better as a discriminatory instrument. However, because of its floor effects, it was markedly less sensitive to change than the impact short form. There was an indication that item-impact methods of shortening oral health-related quality of life measures produced more stable results across samples than the statistical approach. CONCLUSIONS: Because the content validity of short-form measures is always compromised, different short forms are required for different purposes and different patient populations. The regression short form developed by Slade (1997) is likely to be better when the aim is to discriminate, while the impact short form developed here may be preferable when the aim is to describe the oral health-related quality of life of populations or to detect change.

Attitude to Health↗
PubMed2002

Risk indicators for periodontal disease in a remote Canadian community--a dental practice-based study.

OBJECTIVES: The purpose of this cross-sectional study was to identify risk markers and risk indicators for periodontal attachment loss in a remote Canadian community. Of special interest was the association between smoking and periodontal disease experience. METHODS: Data were collected from a convenience sample of 187 adult patients attending a dental office in a rural community located in Northern Ontario. Information was obtained via a questionnaire and a periodontal examination. The questionnaire included the use of dental services, self-care behaviors, general health status, smoking, and personal characteristics. Periodontal health was assessed using the mean periodontal attachment loss (MPAL), measured at two sites on all remaining teeth and the proportions of sites examined with loss of 2 mm or more and 5 mm or more. Plaque scores and measures of the number of missing teeth also were obtained. The relationships between mean periodontal attachment loss, the proportion of sites with 5 mm or more of loss and independent variables such as age, sex, current smoking status, mean tooth plaque scores, flossing frequency, and regularity of preventive dental visits were examined in bivariate and multivariate analyses. RESULTS: The data revealed a mean periodontal attachment loss of 3.9 mm (SD=1.5). The mean proportion of sites examined with loss of 2 mm or more was 0.89 and the mean proportion with loss of 5 mm or more was 0.35. In linear regression analysis, plaque scores, the number of missing teeth, age, current smoking status, regularity of dental visits, and flossing frequency had statistically significant independent effects and explained 60.0 percent of the variance in mean periodontal attachment loss. Just over 30 percent of subjects had severe periodontal disease, defined as 50 percent or more of sites examined with loss of 5 mm or more. In logistic regression analysis, missing teeth, dental visiting, smoking status, age, and flossing frequency had significant independent effects. The strongest association observed was with smoking, which had an odds ratio of 6.3. The logistic regression model correctly predicted 64.3 percent of cases with severe disease. CONCLUSIONS: The data indicate that the periodontal health of these patients is poor. Risk indicators or markers of poor periodontal health in the population studied included missing teeth, plaque scores, age, current smoking status, regularity of dental visits, and flossing frequency. This supports previous findings that behavioral factors play an important role in periodontal disease.

Adult↗
PubMed2002

General health status and changes in chewing ability in older Canadians over seven years.

OBJECTIVES: The purpose of this study was to describe the onset of and recovery from chewing problems in an older adult population over a seven-year period and to describe factors associated with these changes. Of particular interest was the relationship between general health and changes in oral functioning. METHODS: The data came from a longitudinal study of community-dwelling individuals who were aged 50 years and older when first recruited. Data were collected at baseline (n = 907) and at three (n = 611) and seven-year (n = 425) follow-ups. Oral function was assessed by means of a six-item index of chewing ability. Data were weighted to account for loss to follow-up using weights derived from the seven-year response proportions for dentate and edentulous subjects. Logistic regression analysis using backward stepwise selection was used to identify predictors of onset and recovery. RESULTS: At baseline, 25 percent of subjects reported a problem chewing. This rose to 26 percent at three years and 34 percent at seven years. The seven-year incidence of chewing dysfunction was 19 percent. Of those with a chewing problem at baseline, 21 percent did not have a problem at seven years. A logistic regression model predicting the seven-year incidence of chewing problems indicated that subjects aged 65 years or older, the edentulous, those rating their oral health as poor, those without dental insurance and those without a regular source of dental care were more likely to be an incident case. In addition, a variable denoting the number of chronic medical conditions at baseline also entered the model. A logistic regression model predicting recovery indicated that older subjects, the edentulous, those from low-income households, and those with limitations in activities of daily living were less likely to recover over the observation period. CONCLUSION: The results of this study indicate a marked increase in the prevalence of chewing problems in this older adult population over the seven-year observation period. Poorer general health at baseline increased the probability of the onset of a chewing problem and decreased the probability of recovery.

Aged↗
PubMed2002

Oral health-related quality of life of a population of medically compromised elderly people.

OBJECTIVES: The purpose of this study was to assess the oral health-related quality of life of a population of medically compromised individuals most of whom lived within a long-term care centre. DESIGN: A cross-sectional survey with data collected by means of a personal interview and a review of dental records. Subjects 225 subjects with a mean age of 83 years, most of whom were medically compromised and lived within a multi-level geriatric care setting. MEASURES: The questionnaire included two single-item indicators of oral health and two oral health indexes; namely, the Geriatric Oral Health Assessment Index (GOHAI) and the short form Oral Health Impact Profile (OHIP-14). It also included three measures intended to tap the broader construct of quality of life; namely morale, perceived life stress and life satisfaction. RESULTS: The main oral problems of this population were missing teeth, dry mouth and limitations in chewing ability. One third rated their oral health as only fair or poor and 20% were dissatisfied with their oral health status. Using the GOHAI, 53% reported experiencing one or more functional or psychosocial problems 'very often' or 'all the time'. Since the OHIP-14 taps more severe impacts, functional and psychosocial problems were reported by 17%. All four oral health indicators were significantly associated with the quality of life measures, indicating that those with poor self-perceived oral health had lower morale, more life stress and lower levels of life satisfaction. These associations remained after controlling for other potential influences on quality of life such as general health, income and marital status. CONCLUSION: These data suggests that oral disorders have a significant effect on the well-being and life satisfaction of the individuals in the study even though they are characterised by high rates of chronic physical and mental conditions and physical disabilities. Consequently, access to appropriate oral health care is likely to improve overall quality of life. The data also suggest that instruments such as the GOHAI and OHIP-14 are measuring aspects of life that these individuals regard as being important.

Activities of Daily Living↗
PubMed2002

Five-year incidence of dental anxiety in an adult population.

OBJECTIVES: The purpose of the study was to assess the incidence of dental anxiety and factors associated with onset in adults aged 18 years and over. DESIGN: A longitudinal mail survey of a random sample of the general population consisting of a baseline phase and a follow-up after five years. SUBJECTS: 1,422 individuals completed baseline and follow-up questionnaires concerning dental anxiety; 1,226 subjects who were not anxious at baseline were included in the analysis. A sub-sample of 747 of these subjects had also completed a psychological questionnaire at baseline. MEASURES: Dental anxiety was assessed using the Dental Anxiety Scale (DAS). Other measures included the Dental Belief Survey, The Iowa Dental Control Index, a scale to measure attitudes towards pain, and measures of trait anxiety and general fearfulness. Questions were also asked about dental visiting patterns and dental treatment experiences prior to baseline and between baseline and follow-up. RESULTS: The five-year incidence of dental anxiety in this population was 5.8%. This varied from 12.2% in those aged 18 to 24 years at baseline to 1.7% among those aged 65 years and over at baseline. Those reporting an episodic visiting pattern between baseline and follow-up and those who avoided dental care altogether were also more likely to become anxious about dental treatment. Seven variables entered a logistic regression model predicting onset: age at baseline, DAS score at baseline, fear of pain, dental visiting pattern and three variables indicating aversive dental experiences between baseline and follow-up. These were: experiencing pain during dental treatment; being treated by a dentist in a cold or uncaring manner and being frightened or worried about things the dentist did. Data from the 747 subjects completing the baseline psychological questionnaire indicated that scores on a trait anxiety index were also predictive of onset. CONCLUSION: Dental anxiety may arise during adulthood, younger adults being particularly vulnerable to onset. Both aversive conditioning experiences and pre-existing psychological states appear to be associated with the development of anxiety about dental treatment in this adult population.

Adolescent↗
PubMedDate not supplied

Non-clinical information obtained by dentists during initial examinations of older adult patients.

The authors sent a questionnaire to a random sample of general dentists in Ontario, Canada, to assess the types of non-clinical information (NCI) dentists usually obtain during initial examinations of older patients. From a list of 11 NCI questions, dentists indicated which questions they usually asked during new patient examinations. The adjusted response rate was 34% (n = 672). Respondents most often asked about pain and satisfaction with the appearance of teeth and/or dentures. About half the respondents asked about oral dryness and whether problems with chewing had limited food choices. Respondents were least likely to ask about problems with speaking and avoidance of eating with others because of chewing problems. Traits of those who asked the least common NCI questions typically including continuing education courses in geriatric dentistry, self-perceived competence in treating elderly adults living in institutional settings, exposure to geriatric outreach settings during dental school and greater dentist involvement in patient history taking.

Aged↗
PubMedDate not supplied

Salivary sIgA and cortisol: markers for functional dependence in older adults.

Elderly persons with health problems and physical limitations have reduced independence. Since poor functional ability is a known risk factor for disease among older populations, including oral disease, this study was undertaken to assess whether salivary defense factors and the stress hormone cortisol are significant markers for functional dependence. Oral examinations; salivary and microbial analyses; and interviews using the Activities of Daily Living (ADD index, the Mini Nutritional Assessment (MNA) and the Perceived Life Stress Questionnaire (PLSQ) were conducted for 123 dentate subjects. Of the subjects, 80 lived independently in the community or in apartments at the Baycrest Centre for Geriatric Care in Toronto, Canada, and 43 resided in the Baycrest nursing home or the Baycrest Hospital. Whole saliva samples were assayed for total secretory immunoglobulin A (sIgA), sIgA1, sIgA2, total protein and cortisol using ELISA. Dependent residents in the nursing home/hospital scored significantly lower in the nutritional assessment, had higher mean PLSQ scores, increased total protein and cortisol concentrations, and reduced salivary flow rates in comparison to ambulatory residents in the community/apartments. In multivariable logistic regression, factors associated with functional dependence were: being male, perceiving income as inadequate, having low salivary flow rate and drinking less than 5 cups of water per day. These results indicate that salivary flow and cortisol may be useful markers of functional dependence; however, the ability of these markers to predict functional decline cannot be confirmed until longitudinal studies are conducted.

Activities of Daily Living↗
PubMedDate not supplied

A modified short version of the oral health impact profile for assessing health-related quality of life in edentulous adults.

PURPOSE: The aim of this study was to develop a shortened version of the Oral Health Impact Profile (OHIP) appropriate for use in edentulous patients and to evaluate its measurement properties. MATERIALS AND METHODS: Data were collected from the Ontario Study of Older Adults and a longitudinal clinical trial of implant-retained prostheses undertaken in Newcastle Dental Hospital, UK. All subjects completed an OHIP at baseline, and UK subjects also completed an OHIP posttreatment. Using an item impact reduction method, a shortened version of the OHIP (called OHIP-EDENT) was derived from both datasets. Discriminant validity and responsiveness properties of this modified version were compared with OHIP-14 and OHIP-49. RESULTS: Using an item impact method of reducing the 49 OHIP items produced very similar subsets in both Canadian and British populations; the modified version had little overlap with the current short version (OHIP-14). Discriminant validity properties of OHIP-EDENT were similar to OHIP-14 and OHIP-49. Using effect sizes to assess sensitivity to change, OHIP-EDENT exhibited less susceptibility to floor effects than OHIP-14 and appeared to measure change as effectively as OHIP-49. CONCLUSION: The modified shortened version of the OHIP derived in this study has measurement properties comparable with the full 49-item version. This modified shortened version may be more appropriate for use in edentulous patients than the current short version.

Aged↗
PubMedDate not supplied

Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures: a randomized clinical trial in a senior population.

PURPOSE: The purpose of this study was to compare elderly patients' satisfaction and oral health-related quality of life with mandibular two-implant overdentures and conventional dentures. MATERIALS AND METHODS: Sixty edentulous subjects aged 65 to 75 years were randomly assigned to two groups treated with maxillary conventional dentures and either a mandibular conventional denture (n = 30) or an overdenture supported by two implants with ball retainers (n = 30). Subjects rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, speech, esthetics, and cleaning ability), prior to treatment and 2 months postdelivery. Changes in ratings on the original Oral Health Impact Profile (OHIP) and its short form (OHIP-EDENT) were also used as indicators of oral health-related quality of life. RESULTS: The primary outcome of this study, ratings of general satisfaction 2 months postdelivery, was significantly better in the group treated with mandibular two-implant overdentures (P = .001). In addition, the implant group gave significantly higher ratings on comfort, stability, and ability to chew. Furthermore, using OHIP-EDENT, subjects who received mandibular two-implant overdentures had significantly fewer oral health-related quality of life problems than did the conventional group. CONCLUSION: These short-term results suggest that mandibular two-implant overdentures combined with maxillary conventional dentures provide better function and oral health-related quality of life than conventional dentures.

Aged↗
PubMedDate not supplied

Prevalence of traumatic dental injury in grade 8 children in six Ontario communities.

OBJECTIVES: To determine the prevalence of traumatic injury to the anterior dentition in Grade 8 children in six Ontario communities. METHODS: Clinical examination of 3,010 children attending a stratified random sample of 66 schools in the communities served by 6 Ontario Public Health departments. Trauma to the hard tissues was classified according to the Trauma Index. RESULTS: Damage to the anterior dentition was observed in 18.5% of those examined. Unrestored fractures of the enamel were present in 13.0%, with more severe damage or damage sufficiently severe to have been treated being present in 5.9%. Of those with the more severe injuries, 20% had not received treatment. The prevalence of injury was higher in males than in females (21.3% vs. 13.4%: p < 0.0001) and varied across the six communities studied (10.7-29.4%: p < 0.01). There was an association between dental decay experience and traumatic dental injury. Those with more severe injuries had higher mean Decayed, Missing and Filled Teeth (DMFT) scores and were less likely to have a DMFT score of zero than those without injury (p < 0.01). DISCUSSION: The prevalence of traumatic dental injury in this Ontario child population was similar to those reported in national surveys in the US and UK. The association between injury and dental decay may reflect the fact that a subgroup of children live within environments or are prone to behaviours that place them at greater risk of multiple oral disorders. In order to provide a basis for prevention, further research needs to be undertaken to identify the causes of and the personal and environmental risk factors for such injuries in Ontario children.

Adolescent↗
PubMedDate not supplied

A prospective study on immediate loading of implants with mandibular overdentures: patient-mediated and economic outcomes.

PURPOSE: The aims of this report are to present the patient-based outcomes and associated clinical costs of an immediate loading protocol for mandibular overdentures in edentulous patients. MATERIALS AND METHODS: Two groups of patients were selected. Thirty-five consecutively treated patients received an immediate protocol, while 42 patients treated with a conventional protocol served as a historical control. Patient-based concerns for patients in the immediate group were measured at various stages of treatment with 2 questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile. Direct clinical and time costs over a 1-year period were estimated and deflated to 2002 Canadian dollars. Salary rates by occupation, age, and gender were used to evaluate the patients' time costs. Treatment costs were compared between the 2 groups. Additionally, incremental cost-effectiveness ratios for various stages with the immediate protocol were calculated. RESULTS: Significant improvements posttreatment were observed with both the Denture Satisfaction Scale (Wilcoxon signed rank test, P < .05) and the Oral Health Impact Profile (Friedman test, P < .05). The immediate protocol was associated with higher maintenance costs, with resultant higher total costs (Mann-Whitney U test, P < .05). No difference was observed in the time costs associated with the 2 protocols. Within-group analysis of costs at various stages of the immediate protocol suggested that treatment with implant-supported overdentures was more cost-effective than treatment with conventional dentures. CONCLUSIONS: This study suggests that implants in 1 jawbone lead to a substantial improvement in perceived oral health status. Furthermore, the immediate loading protocol was not cheaper than a conventional protocol.

Cohort Studies↗
PubMedDate not supplied

Malnourishment in a population of young children with severe early childhood caries.

PURPOSE: The purpose of this study was to describe the nutritional status of children with severe early childhood caries (S-ECC) using several clinical measurements. METHODS: Children aged 2 to 6 years with S-ECC were measured for height, weight, triceps skinfolds (TSF), and measurement of upper mid-arm circumference (MAC). Blood samples assessed: (1) hemoglobin; (2) mean corpuscular volume (MCV); (3) serum ferritin; and (4) serum albumin. Weight-for-height was converted into ideal body weight (IBW) percentiles. Body mass index (BMI) was calculated as kg/m2. TSF and MAC were converted into measurement of arm muscle circumference (MAMC). All measurements were compared with population reference values. RESULTS: Using weight for height centiles, 17% were diagnosed as being malnourished and 66% as within normal limits. Using BMI centiles, only 4% were identified as being malnourished and 75% as being normal. Conversely, the body fat of 24% was assessed as low (<10th percentile). Serum albumin was low for 16%. The majority had evidence of inadequate iron intake with low serum ferritin (80%), iron depletion (24%), iron deficiency (6%), or iron deficiency anemia (11%). CONCLUSIONS: All tests detected levels of malnutrition, with blood tests finding the most severe cases. The results suggest that severe Early Childhood Caries may be a risk marker for iron deficiency anemia. Since iron deficiency has permanent effects on growth and development, pediatric dentists should recommend assessment of iron levels in S-ECC patients regardless of their anthropometric appearance.

Body Height↗