Shortened dental arch and oral health related quality of life

The concept of the shortened dental arch (SDA) was proposed more than 30 years ago and it is consistent with the WHO goal for developing countries of 20 functional, aesthetic natural teeth without resorting to a prosthesis. The aim of this study was to assess the prevalence of adults with shortened dental arches (SDA) in Brazil and assess the affects of the SDA on oral health related quality of life (OHRQoL).

Method

The data was collected as part of a national cross-sectional study conducted in Brazil. The sample involved individuals aged 5, 12, 15–19, 35–44 and 65–74 years. All 35-44 yr old adults were eligible for the present study. Oral examinations were performed at households by a dental surgeon and a recording clerk, who were specifically trained and calibrated to apply the basic methods standardised by the World Health Organization for oral health surveys. Socio-demographic data was obtained using questionnaires with OHRQoL being assessed by the modified version of the oral impacts on daily performance (OIDP) index, which was validated in Brazil.

The assessment of SDA used two alternative definitions: having 3-5 natural occlusal units (OUs) in posterior teeth or having 4 OUs in posterior teeth. Both definitions included having intact anterior region and no dental prosthesis. The analysis was weighted, and a complex sampling design was used. Negative binomial regression models assessed associations as adjusted for socio-demographic conditions and dental outcomes.

Results

9779 adults completed the OIDP questionnaire, provided socio-demographic information and underwent an oral examination.
Almost 10% of 35-44 yr-old has a SDA according to the first definition and just under 4% using the second definition.
There were no statistically significant differences for oral impacts or OIDP severity when data were adjusted for socio-demo- graphic characteristics and dental outcomes.

	First definition of SDA	Second definition of SDA
Proportion with SDA	9.9% (95% CI; 8.7–11.2%)	3.8% (95% CI; 3.1–4.6%)
Oral impact in adults with SDA (Prevalence ratio-unadjusted)	1.22 (95% CI; 1.09–1. 36)	1.21 (95% CI; 1.03–1.41)
Oral impact in adults with SDA (Prevalence ratio-adjusted)	1.04 (95% CI; 0.92–1.17)	1 05 (95% CI; 0.91–1.21)
OIDP severity (unadjusted-count ratio)	1.43 (95% CI; 1 19–1.72)	1 50 (95% CI; 1 07–2.10)
OIDP severity (adjusted-count ratio)	1.09 (95% CI; 0.91– 1.30)	1 13 (95% CI; 0.91–1.40)

Conclusions

The authors concluded

This study presented evidence indicating that adults with SDA have no poorer OHRQoL than those with more teeth. This finding suggests that individuals with SDA can do without treatment, which may influence decision-making in oral rehabilitation. Our findings challenge the traditional approach of replacing any missing tooth without questioning why it should be performed if function and well-being are preserved for those with SDA.

Comments

This large well-conducted cross-sectional study suggests that having a shortened dental arch does not have any significant impact on OHRQoL. We have recently report on another trial and review both of which suggest that the shortened dental arch does not have an impact on OHRQoL (Dental Elf 15^th Jul 2014). As the authors note in their discussion because of the cost of dental care the findings of this and other studies suggests that adopting the SDA as part of oral health care priorities would reduce cost and not significantly impact on OHRQoL. As the authors also note because of variations in the definitions of the SDA a clearer consensus would be helpful.

Primary paper

Antunes JL, Tan H, Peres KG, Peres MA. Impact of shortened dental arches on oral health-related quality of life. J Oral Rehabil. 2015 Oct 27. doi: 10.1111/joor.12364. [Epub ahead of print] PubMed PMID: 26506211.