Results
The combination of the search terms resulted in a list of only three titles [
38‐
40]. Two of these articles were published in English, and one was published in German (Table
1). The German publication and one of the English publications were carried out by the same study group. Although the number of articles was limited, a considerable heterogeneity was found between both study groups with regard to study design and patient characteristics. Furthermore, different instruments were used for the assessment of OHRQoL. One study group used the widely used OHIP to describe OHRQoL in patients with DHS and then to measure the efficacy of treatment intervention on OHRQoL in these patients. The other study group developed a completely new instrument, the Dentine Hypersensitivity Experience Questionnaire (DHEQ).
Table 1
Characteristics of the three published studies examining dentine hypersensitivity and OHRQoL
| OHIP-G49 | Dental offices in Germany that participated in previous oral hygiene studies conducted by GABA International | Patients presenting at dental offices because of hypersensitive teeth and reacting positive to an air stimulus applied by the dentist | Patients with removable partial dentures, with more than five missing OHIP questionnaire answers overall, with more than two missing answers in any OHIP domain | 656 | Patients with dentine hypersensitivity showed statistically significantly higher OHIP summary scores compared with the general population | The oral condition of hypersensitive teeth is significantly associated with impaired OHRQoL |
General population: subjects without removable partial dentures from a national German general population sample | 1,541 (control) |
| OHIP-G49 | | | | 713; no control | 90 % of the patients showed an improvement of OHRQoL | A 21-day home use of the elmex SENSITIVE Care System improves OHRQoL in subjects with hypersensitive teeth |
| DHEQ | Patients with clinically diagnosed dentine hypersensitivity recruited at preintervention stage in a sponsored randomised controlled trial, before the participants received any interventions or other study procedures | More than 10 % of the item missing in the questionnaire | 108 | DHEQ shows good psychometric properties in both a general population and clinical sample | The use of DHEQ can further the understanding of the subjective impacts of dentine hypersensitivity |
General population: adults recruited from the general population via online advertisements at the University of Sheffield and across the UK | More than 10 % of the item missing in the questionnaire | 160 (control) |
Using the German version of the OHIP, the OHIP-G, Bekes et al. [
38] evaluated OHRQoL impairment in patients seeking care for their hypersensitive teeth in comparison with general population subjects [
12,
17]. Study participants were 656 patients without removable prosthodontics who sought treatment for their hypersensitive teeth in German dental offices. These patients were asked to complete the OHIP-G prior to treatment. The sum of OHIP-G item responses (OHIP-G49, 0–196) characterised the OHRQoL impairment. Patients’ OHIP summary scores were analysed and compared with those in a sample of the German general population (
n = 1,541). It was found that the distribution of OHIP-G summary scores in patients with DHS and in general population was different. The general population subjects had an OHIP-G median score of 5, while the patient group had an OHIP-G median score of 30. The 10 % of the subjects with the highest OHIP-G summary scores presented scores of 36 or higher (general population) and 66 or higher (patients). The mean OHIP-G summary score value of the study participants from the general population was 12.2 (±18.4), while the patients’ mean OHIP-G summary score was 34.5 (±22.6). The difference was statistically significant (
P < 0.001). Mean OHIP summary scores indicated that patients with hypersensitive teeth reported considerably more impaired OHRQoL (approximately 22 OHIP units) than subjects in the general population. It was also found that the influence of gender depended on the population (i.e. female general population subjects had lower OHIP scores than male general population subjects, and female patients had higher OHIP scores than male patients). A relationship between age and OHIP-G summary scores was also observed in both patients with hypersensitive teeth and general population subjects. In the general population, older subjects (40+ years) reported statistically significantly (
P < 0.001) more problems (i.e. higher OHIP-G summary scores) than younger subjects (15–39 years). In the patient group, the difference between younger and older patients was similar in magnitude to that in the general population and close to statistical significance (
P = 0.08).
The results show that DHS is related to substantially impaired OHRQoL. Moreover, this study is the first one evaluating the impact of this oral condition with a widely used patient-centred outcome measure, such as the OHIP, to characterise the broader influence of this condition on patients’ perceived oral health. The authors discuss that the results refer to patients seeking care for their condition and that they cannot be generalised to individuals suffering from DHS but not seeking care. Moreover, they note that it has to be taken into account that the results refer to general dentists and may not be generalised to health professionals who are more trained or calibrated in the assessment of DHS. However, the authors suggest that the setting is representative for typical patients where the general dentist is confronted with providing diagnosis and treatment for the challenging clinical problem of DHS.
In a second investigation, the same study group used the OHIP-G to describe OHRQoL in patients with hypersensitive teeth before and after treatment intervention [
40]. In a field trial, 713 patients from Germany presenting at 161 dental offices and seeking care for DHS were given the elmex SENSITIVE Care System to use for their oral hygiene twice a day for 21 days. The system included elmex SENSITIVE toothpaste, elmex SENSITIVE dental rinse and the elmex interX SENSITIVE toothbrush. The patients completed the OHIP-G before and after treatment intervention. The authors found a considerable improvement of OHRQoL in 90 % of patients, with 50 % of the patients showing a decrease of 11 or more OHIP units. The mean change was 13.5 OHIP-G units and was statistically significant (
P < 0.001). Little difference based on gender or age was present. The results showed that a 21-day home use of the elmex SENSITIVE Care System improved OHRQoL in subjects with hypersensitive teeth. Certainly, the study has limitations. It was not randomised and did not include a control or placebo group. Nevertheless, it is the first study evaluating the effect of a DHS treatment not only from the clinical view of the dentist, but also from the patient’s perspective. The results suggest that it is possible to measure the success of a treatment for DHS with the OHIP.
The third study focusing on OHRQoL and DHS found in the literature was conducted by Boiko et al. [
39] in the UK. These authors did not use the well-established OHIP as an OHRQoL instrument, but instead developed and validated a new condition-specific measure of OHRQoL for DHS, the DHEQ. This instrument aims to measure particular everyday impacts on OHRQoL related to DHS. The study group constructed a questionnaire using a multistaged impact approach and an explicit theoretical model. As a result, the DHEQ questionnaire has 48 items containing a description of the pain, a scale to capture subjective impacts of DHS, a global oral health rating and a scale to record effects on overall life. The description of the pain contains nine items and each item is treated separately. The impact scale has six subscales based on the initial domains of the Wilson and Cleary model [
41]: restrictions, approach coping, avoidance coping, social impact, emotional impact and identity. Two summary measures can be created for the impact scale and its subscales. The total score is calculated as the sum of the item scores per participant (possible range 0–243). Subscale scores for each of the subscales can be created in the same way. The extent of impacts are calculated as the number of impacts per participant to which each participant broadly agrees (“strongly agree” to “strongly disagree”). The global oral health rating contains one item, the scale to record effects on overall life four items. The higher the total score of the DHEQ is, the more impaired is the patient’s OHRQoL. In the study, the DHEQ was applied in a general population sample (
n = 160) and in a sample of patients clinically diagnosed with DHS (
n = 108). The DHEQ showed good psychometric properties in both samples and demonstrated that patients with DHS had higher scores on the DHEQ than the general population, indicating that these patients have impaired OHRQoL. The authors concluded that the DHEQ provides an alternative to generic OHRQoL instruments because of its direct reference to the problems associated with sensitive teeth, and its use can further the understanding of the subjective impacts of DHS.
As this publication introduced this new instrument and focused on the psychometric properties of the instrument, it has not been applied in any other study yet. In addition, the effects of DHS treatment interventions on OHRQoL have yet to be measured using the DHEQ. Future studies will need to examine this measurement tool translated in other languages so that results can be compared cross-culturally before it will be accepted internationally. Because this instrument is a special measurement tool that can only be used for the condition of DHS, its utility is limited to this special patient group. Therefore, it is not possible—in contrast to the OHIP—to use the DHEQ to measure OHRQoL in patients with other oral diseases.