Oral health-related quality of life in adult patients with end-stage kidney diseases undergoing renal replacement therapy – a systematic review

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Abstract

Background

The oral health of patients undergoing renal replacement therapy (RRT) is insufficient. Poor oral health and its components can affect the oral health-related quality of life (OHRQoL) of these patients. The aim of this systematic review was to assess the OHRQoL of adult patients under RRT.

Methods

A systematic literature search was performed using the terms: dialysis OR “renal disease” OR kidney OR “renal failure” OR “kidney transplantation” OR hemodialysis OR “peritoneal dialysis” OR “renal replacement therapy” AND “oral health-related quality of life”, complemented by manual search. Clinical studies including adults (age ≥ 18 years) that were published between 2009 and 2019 were included in qualitative analysis.

Results

Twelve out of 20 studies were included in the qualitative analysis. The majority (11/12 studies) included patients undergoing haemodialysis (HD), with a sample size between 47 and 512 participants. Two studies included patients after kidney transplantation. Only one-quarter of the investigations included a healthy control group. The overall OHRQoL was found to be reduced. The majority of studies found relationships between OHRQoL and different oral health parameters. Furthermore, several relationships between OHRQoL and general quality of life as well as disease related parameters including age, gender, diabetes, blood parameters and dialysis duration were found. OHRQoL subscales psychological/psychosocial impairment and pain were predominantly affected.

Conclusions

Patients under RRT suffer from a reduced OHRQoL, which is potentially influenced by oral health and disease related parameters. Interdisciplinary dental care is needed and should consider both physical and psychosocial issues.

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Most cited references 58

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Oral health-related quality of life: what, why, how, and future implications.

L Sischo, H L Broder (2011)

Despite its relatively recent emergence over the past few decades, oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research. OHRQoL is a multidimensional construct that includes a subjective evaluation of the individual's oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self. It has wide-reaching applications in survey and clinical research. OHRQoL is an integral part of general health and well-being. In fact, it is recognized by the World Health Organization (WHO) as an important segment of the Global Oral Health Program (2003). This paper identifies the what, why, and how of OHRQoL and presents an oral health theoretical model. The relevance of OHRQoL for dental practitioners and patients in community-based dental practices is presented. Implications for health policy and related oral health disparities are also discussed. A supplemental Appendix contains a Medline and ProQuest literature search regarding OHRQoL research from 1990-2010 by discipline and research design (e.g., descriptive, longitudinal, clinical trial, etc.). The search identified 300 articles with a notable surge in OHRQoL research in pediatrics and orthodontics in recent years.

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Tooth loss and oral health-related quality of life: a systematic review and meta-analysis

Anneloes E. Gerritsen, P Finbarr Allen, Dick Witter … (2010)

Background It is increasingly recognized that the impact of disease on quality of life should be taken into account when assessing health status. It is likely that tooth loss, in most cases being a consequence of oral diseases, affects Oral Health-Related Quality of Life (OHRQoL). The aim of the present study is to systematically review the literature and to analyse the relationship between the number and location of missing teeth and oral health-related quality of life (OHRQoL). It was hypothesized that tooth loss is associated with an impairment of OHRQoL. Secondly, it was hypothesized that location and distribution of remaining teeth play an important role in this. Methods Relevant databases were searched for papers in English, published from 1990 to July 2009 following a broad search strategy. Relevant papers were selected by two independent readers using predefined exclusion criteria, firstly on the basis of abstracts, secondly by assessing full-text papers. Selected studies were grouped on the basis of OHRQoL instruments used and assessed for feasibility for quantitative synthesis. Comparable outcomes were subjected to meta-analysis; remaining outcomes were subjected to a qualitative synthesis only. Results From a total of 924 references, 35 were eligible for synthesis (inter-reader agreement abstracts κ = 0.84 ± 0.03; full-texts: κ = 0.68 ± 0.06). Meta-analysis was feasible for 10 studies reporting on 13 different samples, resulting in 6 separate analyses. All studies showed that tooth loss is associated with unfavourable OHRQoL scores, independent of study location and OHRQoL instrument used. Qualitative synthesis showed that all 9 studies investigating a possible relationship between number of occluding pairs of teeth present and OHRQoL reported significant positive correlations. Five studies presented separate data regarding OHRQoL and location of tooth loss (anterior tooth loss vs. posterior tooth loss). Four of these reported highest impact for anterior tooth loss; one study indicated a similar impact for both locations of tooth loss. Conclusions This study provides fairly strong evidence that tooth loss is associated with impairment of OHRQoL and location and distribution of tooth loss affect the severity of the impairment. This association seems to be independent from the OHRQoL instrument used and context of the included samples.

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Development of the Geriatric Oral Health Assessment Index.

K Atchison, T Dolan (1990)

The development of measures for assessing oral health status is essential to the evolution and maturation of a scientific knowledge base in geriatric dentistry. The literature suggests a high prevalence of dental diseases in older adults, yet valid and reliable instruments to assess the impact of oral diseases on older individuals or populations are lacking. This paper describes the rationale for and the development of the Geriatric Oral Health Assessment Index (GOHAI), a self-reported measure designed to assess the oral health problems of older adults. Following a review of the literature and consultation with health care providers and patients, a pilot instrument was developed. The GOHAI was initially tested on a convenience sample of 87 older adults. A revised instrument was then administered to a sample of 1755 Medicare recipients in Los Angeles County. The GOHAI demonstrated a high level of internal consistency and reliability as measured by a Cronbach's alpha of 0.79. Associations of the GOHAI with a single-item rating of dental health and with clinical and sociodemographic supported the construct validity of the index. Having fewer teeth, wearing a removable denture and perceiving the need for dental treatment were significantly related to a worse (lower) GOHAI score. Respondents who were white, well educated, and with a higher annual household income were more likely to have a high GOHAI score, indicating fewer dental problems. Additional applications of the GOHAI are necessary to further evaluate the instrument's validity and reliability, and to establish population norms of oral health in older adult populations as measured by the GOHAI.

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Contributors

Gerhard Schmalz:

ORCID: http://orcid.org/0000-0002-6602-377X

Gerhard.schmalz@medizin.uni-leipzig.de

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 29 April 2020

Publication date PMC-release: 29 April 2020

Publication date Collection: 2020

Volume: 21

Electronic Location Identifier: 154

Affiliations

[1 ]GRID grid.9647.c, ISNI 0000 0001 2230 9752, Department of Cariology, Endodontology and Periodontology, , University of Leipzig, ; Liebigstr. 12, D 04103 Leipzig, Germany

[2 ]Department of Cardiology, Angiology and Nephrology, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Neuruppin, Brandenburg Germany

Author information

Gerhard Schmalz http://orcid.org/0000-0002-6602-377X

Article

Publisher ID: 1824

DOI: 10.1186/s12882-020-01824-7

PMC ID: 7191826

PubMed ID: 32349691

SO-VID: 9884c4b2-7c30-4e7b-a2c1-2199778dba56

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 30 January 2020

Date accepted : 21 April 2020

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ScienceOpen disciplines: Nephrology

Keywords: oral health,oral health-related quality of life,renal replacement therapy,haemodialysis,kidney transplantation

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ScienceOpen disciplines: Nephrology

Keywords: oral health, oral health-related quality of life, renal replacement therapy, haemodialysis, kidney transplantation

Oral health-related quality of life in adult patients with end-stage kidney diseases undergoing renal replacement therapy – a systematic review

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Most cited references 58

Oral health-related quality of life: what, why, how, and future implications.

Tooth loss and oral health-related quality of life: a systematic review and meta-analysis

Development of the Geriatric Oral Health Assessment Index.

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