Quality of life and
implant-based treatment
Björn Söderfeldt
Dept of Oral Public Health Malmö University, Sweden
Two questions:
• What is Quality of Life?
Starting point: The clinical encounter
Dentist Patient E n c o u n t e r Gender Age Training Personality Care organization Work loadControl over work Financing system Clinical judgment Health Fear Selfesteem Social class Education Resources Ethnicity Gender Age Training Personality
The encounter is not any human
relation, but with a specific objective:
Health and quality of life!
The health concept
International declarations
• WHO charter 1948 • Lalonde report 1974
WHO 1948
Health is ”a complete state
of physical, mental, and
social well-being, and not
just the absence of
The New Public Health
Health is not a condition but a dynamic process where new needs emerge. Health is an essential resource for a good life.
Health for all will be achieved by the people
themselves. A well informed , well motivated and
actively participating community is a key element for the attainment of the common goal
Oral health
Inglehart, Bagramian 2002 Oral health related quality of life Functioning -Mastication -Speech Psychological aspects -Appearance -Self-esteem Pain/discomfort -Acute -Chronic Social aspects -Communication -Social interactionsSome measures of oral health and quality of life
(review by Johansson, Söderfeldt 2004)
Cushing et al 1986 SIDD, The Social Impact of Dental disease
Atchison & Dolan, 1990 GOHAI, The General Oral Health Assessment Index
Dolan et al 1991 DHQ, Dental Health Questions
Strauss & Hunt 1993 DIP, The Dental Impact Profile
Locker & Miller 1994 SOSHI, Subjective Oral Health Status Indicators
Slade & Spencer 1994 OHIP, Oral Health Impact Profile
Allen & Locker 2002 OHIP 20 for edentulous patients
Burke & Wilson 1995 OHX, Oral Health Index
Kressin et al 1996 OHRQOL, Oral Health-Related Quality of Life
Leao & Sheiham 1996 DIDL, The Dental Impact on Daily Living
Adulyanon & Sheiham 1996 OIDP, Oral Impacts on Daily Performances
Cornell et al 1997 OH-QoL, The Oral Health Quality of Life Inventory
Östberg et al 1999 POH, Self-perceived Oral Health
McGrath & Bedi, 2000 OHQoL-UK, Oral Health-Related Quality of life measure
What is then the impact of implants
on quality of life?
Literature search starting at the year 2000 yielded only 6 empirical studies assessing the effect of implants on OHRQoL
Authors, year Design Subjects OHRQoL measure
Results Journal
Packer et al 2009
Before-after 9 Parkinson pat. DIDL Improved Gerodont. Nickenig et al 2008 Before-after with control group 219 part edent, 124 dentate
OHIP G21 From 17.1 to 5.4 Craniomaxillofac Surg Berretin-Feliz et al 2008 Follow-up 15 patients >60 years old OIDP, OHIP-14, WHOQoL Improved, WHO measure less sensitive Clin Oral Implants Res Jokstad 2006 RCT, pre-post 12 implant pat vs
15 conventional
OHIP, dent satisf
Change greater for implant pat
Evid Based Dent Heidecke et al 2003 Before-after with control group 60 edentulous, 30 implants, 30 conventional dentures OHIP-20, SF 36 Improvement on both measures Community Dent Oral Epdemiol Melas et al 2001 Follow-up 83 pat OIDP Improvement for
those with implant overdentures
Int J
Oralmaxillofac Implants
In addition, there were 6
measurement/methodological studies and 4 reviews
• Design and quality greatly varying • One attempt to develop a specific
In a qualitative study in Gothenburg
by Ulrika Trulsson(Hallberg) 2005,
new ideas were brought forward
• Grounded theory interviews (a metod for discovery rather than for justification)
• For patients with implants, new categories emerged in addition to those addressed in OHRQoL measures:
Becoming the person one once was Relief from a sense being maimed
Conclusions
• All evidence, although weak, points to dramatic effects on quality of life from implant therapy
• Further research is urgent, improving evidence and developing SPECIFIC
measures, able to capture the uniqueness of implant therapy
