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ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1327-1332  

Oral health related quality of life changes in standard cleft and surgery patients- A clinical study


1 Department of Orthodontics and Dentofacial Orthopaedics, Maharana Pratap Dental College, Kanpur, Uttar Pradesh, India
2 Department of Orthodontics and Dentofacial Orthopaedics, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
3 Department of Pedodontics and Preventive Dentistry, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
4 Department of Oral and Maxillofacial Surgery, Sarjug Dental College and Hospital, Darbhanga, Bihar, India
5 Department of Oral Medicine and Radiology, Sarjug Dental College and Hospital, Darbhanga, Bihar, India
6 Department of Public Health Dentistry, Government Dental College, Raipur, Chhattisgarh, India

Date of Submission05-Mar-2021
Date of Decision15-Mar-2021
Date of Acceptance25-Mar-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Jaideep Singh
Department of Orthodontics and Dentofacial Orthopaedics, Maharana Pratap Dental College, Kanpur, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_142_21

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   Abstract 


Background: Malocclusions are expected to affect subjective attraction, social recognition, and intellect. For dentofacial deformities, functional concerns can also arise. The previous research has established a gradient on oral health-related quality of life (OHRQoL) scores through malocclusion intensity, particularly in the social and emotional realms. This study is used to assess the quality of oral health. Materials and Methods: A total of sixty patients began orthodontic therapy at a tertiary-care facility. Treatment in the orthodontic clinic is restricted to serious malocclusions. The study was selected from patients who meet the qualifying requirements of extreme malocclusion and orofacial clefting. The research removed patients with diagnosed hereditary syndromes. Patients got either single-arch or double-arch fixed equipment during their orthodontic procedure. Subjects were categorized as orthodontic patients with extreme malocclusions, needing orthodontic therapy, and severe spinal discrepancies, requiring both orthodontic treatment and orthognatic surgery. The overall score of one subject was 0–56, while the domain score was 0–8. Higher ratings for oral health profiles reflect a stronger effect on the relative quality of life of oral health. Results: For the 14 objects, the mean baseline Oral Health Impact Profile-14 (OHIP-14) score for all three categories was not statistically different for about half of the items. For surgery participants, the OHIP-14 baseline scores were nearly twice as large as the scores of the other two categories for each of these things (P = 0.05). There were a lot of statistically important variations involving the categories, and the three most significant ones are revealing pattern here. The multiple comparison power of nonsignificant predictive variables was extremely weak for the area of physical pain is 5.2%; 41.2% of remaining tests, and 84% for the functional limitation and mental deficiency domain. Conclusion: Patients receiving a mixture of orthognathic surgery and orthodontic therapy have comparatively low OHRQoL baseline; however in contrast with normal and cleft patients, they still gain the most from care.

Keywords: Cleft, orthodontics, orthognathic surgery


How to cite this article:
Singh J, Kumar A, Sodani V, Kumar A, Jawaid M, Wasnik M. Oral health related quality of life changes in standard cleft and surgery patients- A clinical study. J Pharm Bioall Sci 2021;13, Suppl S2:1327-32

How to cite this URL:
Singh J, Kumar A, Sodani V, Kumar A, Jawaid M, Wasnik M. Oral health related quality of life changes in standard cleft and surgery patients- A clinical study. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 11];13, Suppl S2:1327-32. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1327/329978




   Introduction Top


Malocclusion may inflict adverse effects on the overall operation and well-being of the individual. The overwhelming number of orthodontic disorders does not match the classical “disease-symptom” paradigm. Malocclusions are expected to affect subjective attraction, social recognition, and intellect. For dentofacial deformities, functional concerns can also arise. The previous research has established a gradient on oral health-related quality of life (OHRQoL) scores through malocclusion intensity, particularly in the social and emotional realms.[1]

A major part of the explanation people pursue care is because of esthetic factors. Self-report and patient-centered cares have contributed to the conceptual change in considering psychological aspects of health and result. In orthodontic domains, OHRQoL devices are often beneficial due to their capacity to reach a broad variety of domains including the psychological, social facets, and functional. In certain malocclusions, the usage of orthodontic devices has demonstrated that have a major effect on mental and social well-being status of the patient. Teeth with broken teeth, overjets, and positioning are especially vulnerable to weak quality of life (QoL). There tends to be a separate OHRQoL score in each of the malocclusion intensity groups.[1]

For the patients with dentofacial deformities, the degree of change in OHRQoL can get differ [Figure 1], [Figure 2], [Figure 3]. Orthodontic and orthognathic therapy has proven to enhance life function and QoL in people with significant jaw size differences. Despite serious dentofacial deformities, cleft lip and palate (CL/P) patients do not often undergo changes in QoL as do patients in the general community. Patients with cleft lip perform lower on general well-being tests than do patients without clefts. As a result, so far the effect of orthodontic care on QoL has not been studied in various samples. No trials have yet explored the effects of orthodontic therapy on OHRQoL through epidemiologic and diagnostic backgrounds.
Figure 1: Sociodemographic distribution

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Figure 2: Oral Health Impact Profile-14

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Figure 3: Gender distribution

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In addition, tests that assess particular kinds of malocclusion or dentofacial deformities are typically not comparisons, nor are they used in reference studies. The aim of this research was to analyze the change in OHRQoL in patient groups treated with orthodontic and general anesthesia. We predicted that patient groups will undergo different degrees of change in OHRQoL following orthodontic care. Based on prior studies, we predicted the largest change in patients who underlying problems were more addressed through medication.

Few researches have studied the long-term effect of orthodontic therapy on well-being and OHRQoL. Much of these long-term researches also suffered from substantial survey depletion or were not clear on the duration of recall times. Efficacy of orthognathic surgery has been shown to increase general QoL for up to 5 years. However, it is uncertain if orthognathic surgery equally enhances QoL in serious cases of malocclusion. Longitudinal OHRQoL trials of individuals with CL/P are especially relevant because of their multidisciplinary care. Oftentimes, age-related shifts in facial development affect a cleft patient's understanding of oral activity and general QoL. Recently, there has been increased need for longitudinal evidence for treated individuals with serious cleft and dentofacial deformities. In order to determine long-term care effectiveness, it is necessary to measure health- and patient-oriented results over prolonged periods of time, to figure out how quality of living improves over time, and to assess perceived attraction and perceived need for more treatment. We suggested that patients' trajectory profiles could be impacted by their presumed beauty and their desire for more care.[2]


   Materials and Methods Top


A total of sixty patients began orthodontic therapy at a tertiary care facility. Treatment in the orthodontic clinic is restricted to serious malocclusions. The study was selected from patients who meet the qualifying requirements of extreme malocclusion and orofacial clefting. The research removed patients with diagnosed hereditary syndromes. Patients got either single-arch or double-arch fixed equipment during their orthodontic procedure.

Subjects were categorized as orthodontic patients with extreme malocclusions, needing orthodontic therapy, and severe spinal discrepancies, requiring both orthodontic treatment and orthognatic surgery.

The people involved in the analysis were placed into three categories: (1) patients who wanted orthodontic care and orthognathic surgical repair, (2) average patients with extreme malocclusions needing orthodontic and orthognathic treatment, and (3) patients who required correction of skeletal differences.

Third, the patients with craniofacial deformities along with cleft lip for them orthodontic surgery should be included. There were mostly good findings on OHRQoL improvements in the cleft population up to the last level of orthodontic therapy.

A common index to score one's dental presentation on a continuous scale is the Dental Aesthetic Index (DAI). To achieve a weighted score, the DAI consists of ten intraoral scales combined by a coefficient. There are ten weighted scores in the index overall, which are then summarized with a constant of 13. Before treatment, the oral health scores of the patient are calculated. The score was used in four separate groups to classify malocclusion: slight, definite, severe, and hamstringing. “Oral Health Impact Profile-14 (OHIP-14)” is a widely used questionnaire for self-reporting. OHIP is a tool that has been extracted from the original 49 items. Profile of the effects of oral health: 14 items correspond to employment, pain, physical injury, psychiatric disorder, psychological injury, social weakness, and disability. The applicants were asked to complete the oral health effect profile-14 for specifics of pre- and post-care details (within a 3-month window). The analysis revealed that there was an impact score of 5 for each item (4 – quite frequently; 3 – very frequently; 2 – occasionally; 1 – barely ever; and 0 – never). The overall score of one subject was 0–56, while the domain score was 0–8. Higher ratings for oral health profiles reflect a stronger effect on the relative QoL of oral health.


   Results Top


The proportion of the sexes was close to those of the two other groups, with the most women and most men in the regular patient category, and the most women and the most men in the cleft lip group. The surgery people had longer duration for recovery times than the normal and cleft lip patients, in certain instances, since the patients had difficulty in getting into surgery early. Like the people who endured a procedure, the surgical patients too are prone for dehydration and salty, moist skin. For the 14 objects, the mean baseline OHIP-14 score for all three categories was not statistically different for about half of the items. For surgery participants, the OHIP-14 baseline scores were nearly twice as large as the scores of the other two categories for each of these things (P = 0.05). There were a lot of statistically important variations involving the categories, and the three most significant ones are revealing pattern here. The posttreatment paroxysmal nocturnal dysruptive disorder (CL/P) patients had a slightly higher score for several things than the nontreatment control group including “trouble pronouncing words,” “self-conscious,” “feeling tense,” “difficulty relaxing,” “irritable with others,” and “unsatisfying life.”[3] The average mean increases in OHIP-14 score after surgery are represented. Here, on the table, we see a huge percentage of progress around the board. In the surgical community, the researches estimated the impact size to be 11.25–12.73, which suggested that the patients experienced a substantial increase in the OHRQoL[1] during operation. In the cardiovascular surgery community, the highest impact sizes were in the “evaluation of pain” domain (12.73) and “disability after surgery” domain (12.65). When the regular patients were tested with these tests, they demonstrated substantial changes in all the self-reported physical distress, handicap, psychological impairment, and psychological deficiency metrics. In the regular category, the highest impact sizes (most important results) were also observed in the psychological pain (11.21) and injury (11.15) spheres.[4],[5] Getting higher OHIP-14 scores at baseline, participants in the CL/P community experienced no substantial variations from baseline to posttreatment in scores in the seven subscales of the OLPS. The small-to-moderate impact sizes for the Clinical Global Impression scale in the CL/P patients ranged from 0.03 to 10.63.

Based on the findings, the operation and normal procedure patients observed significant increases in their overall OHIP-14 ratings, with mean range of 12.59 and 11.11. The CL/P group saw significantly less changes at the conclusion of the trial than the Cleft Malocclusion Patient group (effect size, 10.52). In domains, the likelihood that a random occurrence might happen in the final category if the group had not already occurred did not exceed statistical significance, which implies that even in that domain, the probability that the chance event happened was minimal. It was observed in this analysis that, in the cleft lip community, the multiple comparison power of nonsignificant predictive variables was extremely weak for the area of physical pain is 5.2%; 41.2% of remaining tests and 84% for the functional limitation and mental deficiency domain. The CL/P community scores increased more from the original analysis. He examined by cleft form. No statistically relevant variations were observed between the groups in terms of age, sex, or the Delta A (Daytime Alphas1 or presentra1) (P = 0.05). Patients of clefting either had a CL/P or only a cleft lip had a comparable baseline OHIP rate 14 score to patients who did not have clefting. Urinary catheter users, those with clefting, those with clefting on the lip alone, and those with only clefting but no CL/P, ranked higher on each of the OHIP-14 domains than those without clefting, but this was not statistically important (P = 0.0.05). However, as seen when the post hoc power was poor, the similarities were often similar to being marginal.[6]


   Discussion Top


Over the years, the assessment of the results of orthodontics has been carried out mainly in clinic-related trials. While, reports say that it is increasingly popular for patients to merge these traditional indices with the OHRQoL instruments to help gauge their impression of their current physical image. In this analysis, the OHIP-14 is one of the devices.

The OHIP-14 was selected to use because it is a straightforward scale that is easy to grasp and effective at differentiating issues with people with common care requirements as well as those that have extreme deformities. In comparison, the oldest age ranges have been shown to be most likely to profit from OHIP. Thus, on a dietary basis, it was understandable that OHIP-14, in accordance with the “DAI,” will include some valuable and valid indicators of dental care in our varied sample of normal, surgical, and cleft patients. The research in question is valuable since while it does not detect particular subgroups of the population, it is able to detect a potential disparity in outcomes. Therefore, allowing any subgroup distinctions should be viewed with care. Any orthognathic patients might pursue care for functional difficulties as well as for esthetic concerns, although there is some indication that they mostly seek treatment to enhance the overall appearance of their face. It is assumed that the patients feel a loss of appetite for greater esthetic changes because of lack of social contact and psychological functioning.[7]

While the impact on depression will vary between the various surgical patients, a majority of patients show much healthier sleep, less and/or stronger sleep disturbances, and a decrease in their nightmares. As predicted, it turns out that enhanced esthetics and psychological processing in patients who undergo orthognathic surgery have a greater influence on patient's OHRQoL than the other variables. Among certain patients, it makes completely no sense whether these drugs operate, or if they are just a medication that the patients are utilizing for their own psychological purposes. All that takes up electronic cigarettes have various separate profiles and so this has a lot to do with their diminished QoL. First, the magnitude of malocclusion, as a measure, plays a part in the overall QoL. The more serious the malocclusions, the better the overall QoL. The participants of our study had significantly greater baseline DAI ratings. Unlike other oral health-care patients in general, patients receiving orthodontic care are frequently nongrowing older adult patients who are more self-conscious regarding their orthodontic issues and facial appearance. If the people undergo medication for a psychiatric disorder is often motivated by the effects of the symptoms, though other considerations, such as their psychological characteristics and background, may often play a part in their determination and degree of compliance.[8],[9]

Clinicians who handle patients suffering from this condition should therefore be reminded to consider and to take into consideration any underlying social or psychological problems that may create the motivation of this patient population. The above, which involve assumptions for physical and nonphysical improvements, tends to play a major role in how a patient thinks about their care. After surgery, the surgical patients showed a significant decrease in the scores of all the OHIP-14 domains, suggesting a marked increase in their OHRQoL. This is a predicted result and is compatible with the progression of a previous research. On the other hand, another study revealed that the standard of life increased following orthognathic surgery. The fact that OHIP-14 was conducted by our patients during orthodontic surgery and not immediately after surgery means that the positive effects of surgery on the OHRQoL of a patient can be expected to continue, at minimum in the short to medium term. After orthognathic surgery, people find their lives to have little to no effects on their health in addition to positive life changes.[10]

One significant finding of this experiment was the comparatively minor shift in OHRQoL that occurred in the minimal lumen size (CL) category. The control group – whose test scores were identical and whose ages and drinking habits mirrored those of the study group – reported significant changes in OHRQoL during therapy. The explanation for this loss of expected benefit from an oral prescription and why patients stop going for daily follow-ups to their orthodontist could be because of the timeconsuming care of a cleft patient, usually requiring drugs and specialist appointments. Throughout that long phase, cleft patients frequently undergo orthodontic care with an aspect of coercion since it is part of a prolonged and structured multidiscipline treatment. Unlike the surgical patients, the rapid and pronounced psychological well-being and satisfaction in the plastic surgery patients is more likely to result in reasonably good result and quite significant satisfactory shifts in the emotional well-being. Visual clefts include both the mouth and the tongue. The individuals who have these clefts appear to have a detrimental effect on their life. Cleft people who have this condition do not only have difficulty with the nose or mouth, but rather, it applies to anyone else as well such as professionals, parents, and the general public. When narrowing the spectrum of improvement ratings, we noted that individuals with dentofacial clefts affecting the lip showed little to no change in health-dependent QoL following care. While cleft palate patients have an enhanced appearance of dental anomalies, including an upper lip reduction, they observed marginally improved QoL. The results of this analysis of the subgroup are focused on a very limited number of patients with cleft and can thus be viewed with care. However, our findings are compatible with those of a broader study that concluded that there was an association between the type of cleft and the QoL.[10]

Any treatment-related causes may also be responsible for the lack of progress in the CL/P group's OHRQoL. It is well acknowledged that the effect of primary cleft surgery, usually done in the first year of existence, has a strong influence on the subsequent facial esthetic appeal and the need for more surgical care. In terms of the QoL encountered by cleft patients, facial esthetics tends to play an especially significant function. Primary surgical efficiency in kids with CL/P has been recorded to be lower in New Zealand than in other, while we have not assessed the satisfaction of patients with care, it is likely that in the CL/P community, disappointment with facial appearance might have contributed to minimal progress in OHRQoL. Clinicians should be conscious, though, that people with clefts who are not happy with their facial presentation do not usually need additional care. In comparison, patient satisfaction with care does not seem to align with the OHRQoL tests in the psychological and social realms. Consequently, where both OHRQoL and comfort with face features are regarded, the requirement for more care can be well measured.[11],[12],[13],[14],[15],[16]


   Conclusion Top


Patients receiving a mixture of orthognathic surgery and orthodontic therapy have comparatively low OHRQoL baseline; however, in contrast with normal and cleft patients, they still gain the most from care. On the other side, during orthodontic surgery, cleft patients undergo the least improvement in oral health QoL, especially where the exterior structures of the face are involved. In patients whose root problems are dealt with through care, the biggest increase in OHRQoL appears to arise. These issues are resolved in surgical patients (and to a lesser degree in normal patients) by the enhanced social and psychological roles that arise from the dramatic transformation in facial appearance. To analyze the effect of cleft-specific treatment conditions, including the burden of care, on the QoL, both quantitative and qualitative research are appropriate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Benson P. The impact of malocclusion on quality of life. Br Dent J 2007;202:88-9.  Back to cited text no. 1
    
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Mehta A, Kaur G. Oral health-related knowledge, attitude, and practices among 12-year-old schoolchildren studying in rural areas of Panchkula, India. Indian J Dent Res 2012;23:293.  Back to cited text no. 11
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Ryan FS, Barnard M, Cunningham SJ. Impact of dentofacial deformity and motivation for treatment: A qualitative study. Am J Orthod Dentofacial Orthop 2011;90:1264-1270.  Back to cited text no. 14
    
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Wehby GL, Ohsfeldt RL, Murray JC. Health professionals' assessment of health-related quality of life values for oral clefting by age using a visual analogue scale method. Cleft Palate Craniofac J 2006;43:383-91.  Back to cited text no. 15
    
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