Robinson Dentine Hypersensitivity

Developing a Person-centred Approach to Oral Health
1. Auflage 2014
ISBN: 978-0-12-801658-9
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 336 Seiten

Dentine Hypersensitivity: Developing a Person-Centred Approach to Oral Health provides a detailed and integrated account of interdisciplinary research into dentine hypersensitivity. The monograph will be of interest to all those working on person centred oral health related research because it provides not only an account of the findings of a series of studies into dentine hypersensitivity drawing on the research traditions of epidemiology, sociology psychology, and dental public health but an integrated study of the benefits of exploring a single oral condition from this range of disciplines. - Provides an introduction to Dentine Hypersensitivity, and uses a multidisciplinary approach to detail interdisciplinary research on the subject - Outlines the clinical presentation of Dentine Hypersensitivity and the underlying physiological mechanisms - Presents a case study of how social and behavioral science can bright new insights into the experience, treatment, and fundamental knowledge of an important dental condition - Written by prominent dentists, psychologists, sociologists, and industry scientists working specifically on the topic of Dentine Hypersensitivity and its subsequent research

Autoren/Hrsg.

Robinson, Peter Glenn

Inhaltsverzeichnis

1;Front Cover;1
2;Dentine Hypersensitivity;4
3;Copyright Page;5
4;Dedication;6
5;Contents;8
6;List of Contributors;16
7;One: Introduction and Background;18
7.1;1 Introduction;20
7.1.1;Diseases, people, and society;20
7.1.2;The operation was a success, but the patient died;21
7.1.3;Biopsychosocial model of health;24
7.1.4;Health-related quality of life;25
7.1.5;Oral health-related quality of life;26
7.1.6;Applications of OHQoL;27
7.1.7;The value of theoretical models;29
7.1.8;This book;32
7.1.9;References;35
7.2;2 Clinical presentation and physiological mechanisms of dentine hypersensitivity;38
7.2.1;Introduction;38
7.2.2;Clinical presentation of DH;38
7.2.2.1;Definition;38
7.2.2.2;Differential diagnosis;39
7.2.2.3;Prevalence;40
7.2.2.4;Distribution;40
7.2.2.5;Etiology and risk factors;41
7.2.3;Physiological mechanisms of DH;44
7.2.3.1;Dentine;44
7.2.3.2;Mechanisms of DH;44
7.2.3.3;“Sensitive” versus “nonsensitive” dentine;45
7.2.3.4;Pain;46
7.2.4;Summary;46
7.2.5;References;47
7.3;3 The burden of dentine hypersensitivity;50
7.3.1;Introduction;50
7.3.2;Diagnosis of dentine hypersensitivity;50
7.3.3;Prevalence of dentine hypersensitivity;54
7.3.4;Acknowledgment;58
7.3.5;References;58
7.4;4 The management of dentine hypersensitivity;62
7.4.1;Introduction/overview;62
7.4.2;Etiology, predisposing factors, and clinical features;65
7.4.3;Methods for product evaluation;67
7.4.4;In-office (professionally applied) treatment modalities;69
7.4.5;Toothpastes, mouth rinse formulations, and topically applied varnishes;72
7.4.6;Recent advances in the management of DH;75
7.4.7;Clinical management of DH;78
7.4.8;Specific DH management strategies;78
7.4.8.1;Gingival recession from mechanical trauma;80
7.4.8.2;DH and tooth wear lesions;80
7.4.8.3;DH and periodontal disease and treatment;80
7.4.9;Conclusion;81
7.4.10;Acknowledgment;81
7.4.11;References;81
7.5;5 The importance of subjective assessments of dentine hypersensitivity;94
7.5.1;Introduction;94
7.5.2;Assessment of dental disease and health;95
7.5.3;How do we measure “health-related quality of life?”;96
7.5.4;Interpretation of OHQoL data and measurement of pain symptoms;99
7.5.5;How to capture clinically relevant change;100
7.5.6;Relevance for measurement of dentine hypersensitivity;101
7.5.7;Conclusion;102
7.5.8;References;102
8;Two: The Subjective Experience of Dentine Hypersensitivity;104
8.1;6 The everyday impact of dentine sensitivity: personal and functional aspects;106
8.1.1;Introduction;106
8.1.2;Materials and methods;108
8.1.3;Data analysis;109
8.1.4;Results;109
8.1.5;The impact of dentine sensitivity on everyday life;110
8.1.6;Predictability;112
8.1.7;Emotional impact;113
8.1.8;Functional impact;114
8.1.9;Social impact;115
8.1.10;Coping with dentine sensitivity;116
8.1.11;Illness beliefs;117
8.1.12;Conclusion;120
8.1.13;Acknowledgment;121
8.1.14;References;122
8.2;7 Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ);126
8.2.1;Introduction;126
8.2.2;Materials and methods;127
8.2.2.1;Stage 1: Theoretical model;127
8.2.2.2;Stage 2: Qualitative interviews;128
8.2.2.3;Stage 3: Questionnaire development;128
8.2.2.4;Stage 4: Focus groups;129
8.2.2.5;Stage 5: Cross-sectional validation;129
8.2.2.6;Analytical procedures;129
8.2.2.7;Stage 6: Follow-up interviews;130
8.2.2.8;Stage 7: Validation in a clinical population;130
8.2.3;Results;131
8.2.3.1;Validation in the general population sample;131
8.2.3.1.1;Descriptive results;131
8.2.3.1.2;Reliability and validity;131
8.2.3.2;Clinical sample validation;138
8.2.4;Discussion;138
8.2.5;Acknowledgment;139
8.2.6;References;140
8.3;8 Ice cream-related quality of life: constructing a questionnaire to capture changes in the impacts of dentine hypersensitivity;142
8.3.1;Introduction;142
8.3.2;Our perspective;143
8.3.3;Explicitly determining the purpose of the measure;144
8.3.4;Selection of a model;145
8.3.5;The value of qualitative data;148
8.3.6;Selection of domains;149
8.3.7;Selection of descriptive system;151
8.3.8;Selection of items;152
8.3.9;Reference period;153
8.3.10;Panel testing;154
8.3.11;Conclusion;154
8.3.12;References;154
8.4;9 The dentine hypersensitivity experience questionnaire (DHEQ): a longitudinal validation study;158
8.4.1;Introduction;158
8.4.2;Methods;159
8.4.2.1;Participants;159
8.4.2.2;Clinical trial overview;159
8.4.2.3;Data analysis strategy;163
8.4.3;Results;164
8.4.3.1;Cross-sectional validation;164
8.4.3.2;Longitudinal validation;164
8.4.3.2.1;Responsiveness over time within individuals;164
8.4.3.2.2;Responsiveness using an external referent;166
8.4.3.2.3;Responsiveness to treatment;166
8.4.4;Discussion;167
8.4.5;References;170
8.5;10 Derivation of a short form of the dentine hypersensitivity questionnaire;172
8.5.1;Introduction;172
8.5.2;Methods;173
8.5.2.1;Development;173
8.5.2.2;Evaluation;174
8.5.3;Results;174
8.5.3.1;Development;174
8.5.3.2;Evaluation;176
8.5.4;Discussion;178
8.5.5;References;181
8.6;11 Development of the chinese version of the dentine hypersensitivity experience questionnaire;182
8.6.1;Materials and methods;183
8.6.1.1;Statistical analysis;185
8.6.2;Results;185
8.6.3;Discussion;189
8.6.4;Acknowledgment;191
8.6.5;References;191
9;Three: Psychology and the Measurement of Pain and Impact;194
9.1;12 Response shift and oral health quality of life in dentine hypersensitivity;196
9.1.1;Introduction;196
9.1.2;What is response shift?;196
9.1.3;Response shift in dentine hypersensitivity;198
9.1.4;Recalibration in a randomized controlled trial for treatments of dentine hypersensitivity;199
9.1.5;Response shift in people with dentine hypersensitivity: a longitudinal qualitative study;203
9.1.6;Conclusion;205
9.1.7;References;206
9.2;13 Development of condition-specific scales for reporting the pain of dentine hypersensitivity;212
9.2.1;Introduction;212
9.2.2;Measurement of subjective pain;212
9.2.3;Development of scales to assess DH pain;213
9.2.3.1;Water stimulation with VAS and focus groups;213
9.2.3.2;Magnitude estimation task;214
9.2.3.3;Assessing the LM scales using water stimulation;215
9.2.3.4;Scale orientation and rating of non-oral pain scenarios;216
9.2.3.5;Comparison of VAS and LM scales using a water stimulation task;216
9.2.3.6;Preference interviews;217
9.2.3.7;Application of the LM scales in clinical research;217
9.2.4;Conclusions;218
9.2.5;References;218
9.3;14 The role of illness beliefs and coping in the adjustment to dentine hypersensitivity;220
9.3.1;Introduction;220
9.3.2;Method;221
9.3.2.1;Participants;221
9.3.2.2;Design;222
9.3.2.3;Measures;222
9.3.2.3.1;Clinical variables;222
9.3.2.3.1.1;Pain-related coping strategies;222
9.3.2.3.1.2;Health anxiety;223
9.3.2.3.1.3;Illness beliefs;223
9.3.2.3.1.4;OHRQoL;223
9.3.2.3.1.5;HRQoL;223
9.3.2.4;Analysis;223
9.3.3;Results;225
9.3.3.1;Participants;225
9.3.3.2;An SRM of dentine hypersensitivity;225
9.3.3.2.1;Model fit acceptability;227
9.3.3.2.2;Direct pathways;227
9.3.3.2.3;Indirect pathways;234
9.3.4;Discussion;234
9.3.5;Acknowledgment;236
9.3.6;References;236
10;Four: Dentine Hypersensitivity and the Construction of Meaning;240
10.1;15 The experience of health and illness: polycontextural meaning and accounts of illness;242
10.1.1;Introduction;242
10.1.2;Luhmann’s social systems theory;246
10.1.3;The study;249
10.1.4;Analytical strategies of Luhmann’s social systems theory;250
10.1.5;Form and semantic analysis;253
10.1.6;The imperative of dentine sensitivity;254
10.1.7;The nonproblem problem of dentine sensitivity;257
10.1.8;The emerging semantics of dentine sensitivity;259
10.1.9;Morality and dentine sensitivity;261
10.1.10;“My teeth,” “the teeth,” and sensitivity;263
10.1.11;The polyphonic unity of accounts of illness;264
10.1.12;Acknowledgment;267
10.1.13;References;267
10.2;16 Differentiation and displacement: unpicking the relationship between accounts of illness and social structure;270
10.2.1;Introduction;270
10.2.2;Theoretical background: sense-making, narratives of illness, semantic displacement, and social structure;272
10.2.3;Methodology;274
10.2.4;Synchronic analysis;275
10.2.5;Diachronic analysis;277
10.2.6;Differentiation and displacement: the emergence of dentine hypersensitivity;278
10.2.7;The market and dentine hypersensitivity;285
10.2.8;Discussion;286
10.2.9;Acknowledgments;287
10.2.10;References;287
10.3;17 Consumer advertising and the meaning of dentine hypersensitivity;292
10.3.1;Introduction;292
10.3.2;Commodification and DH;293
10.3.3;Materials and methods;293
10.3.3.1;Analysis of advertising campaigns;294
10.3.3.2;Data analysis;294
10.3.3.3;Form analysis;294
10.3.3.4;Semiotic analysis;296
10.3.3.5;Process;296
10.3.3.5.1;Establishing a proforma;296
10.3.4;Results;297
10.3.4.1;Broadcast advertisements;297
10.3.4.2;Print advertisements;298
10.3.4.2.1;Before/after;299
10.3.4.2.2;Normal/not normal;301
10.3.5;Discussion;306
10.3.6;References;307
11;Five: Discussion and Conclusion;310
11.1;18 Conclusions;312
11.1.1;Person-centered oral health care and research;312
11.1.2;Dentine hypersensitivity;315
11.1.3;The Dentine Hypersensitivity Experience Questionnaire;316
11.1.4;Subsequent and future work;319
11.1.5;The meaning of DH;320
11.1.6;Multidisciplinarity;321
11.1.7;References;321
12;Appendix 1: The dentine hypersensitivity experience questionnaire;324
12.1;Calculating summary scores;324
12.2;The dentine hypersensitivity experience questionnaire;326
12.2.1;Section one;326
12.3;Dentine hypersensitivity experience questionnaire;329
12.3.1;Section two;329
13;Appendix 2: The 15-item dentine hypersensitivity experience questionnaire (DHEQ-15);334

Leseproben

1

Introduction

Peter G. Robinson, Sarah R. Baker and Barry J. Gibson,    School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK

This chapter presents the case for a person-centred approach in oral health care and oral health research using dentine hypersensitivity as a case-study.

Dentine hypersensitivity is characterized by the presence of pain in the absence of any other cause. Even though the definition requires the effected person to report the pain, it omits any reference to that person. This omission encourages the mistaken belief that the diagnosis of hypersensitivity is objective. Furthermore, despite this key role of the person, very little research has studied what it is like for a person to live with the condition.

This introduction critiques the purely biomedical approach to dentine hypersensitivity and starts to map out how biomedicine should be complemented with an appreciation of the psychosocial aspects of oral health and disease. It describes how this perspective can be implemented using the ideas of health related quality of life and oral health related quality of life and stresses the need for the appropriate use of theory in this work.

Keywords

Concepts of health; Oral Health Related Quality of Life; Patient-Centred

Diseases, people, and society

The purpose of this book is to present a case for adopting a person-centered approach in oral health care and oral health research. We have used dentine hypersensitivity (DH) as a case study, because in many different ways, it exemplifies the interaction between the person and the disease, the part of that person’s body affected by the disease, and the society in which that person lives.

The current definition tells us that “Dentine hypersensitivity is characterized by short, sharp pain arising from exposed dentine in response to stimuli, typically thermal, evaporative, tactile, osmotic, or chemical and which cannot be ascribed to any other dental defect or pathology.”1 This definition reveals that the dental view immediately focuses on pain through abnormal loss of tissue that exposes the underlying dentine. Thus, the definition also tells us something about dentistry; there is no mention of the person who has the condition.

The omission of the person undermines the definition considerably. First, it encourages the mistaken belief that the diagnosis of DH is objective. The definition requires there to be pain in the absence of any other cause. This means that the person with the condition must identify the pain for the condition to be present. That person’s perception of pain is based on his or her experiences, interpretations, and beliefs. That is to say, it is subjective. Consequently, the entire existence of DH in a tooth is, of necessity, based on a subjective opinion, and no matter how much one may wish to, it is impossible to ignore the person. The “person” is central to the diagnosis of the condition. In DH, despite this key role of the person, little research has studied what it is like for a person to live with it.

It might also be worth thinking about the name of the condition. It tells us the dentine is overly sensitive. However, shouldn’t exposed dentine be sensitive? Does the name imply that the person is too sensitive, too? Put another way, does the name reflect professional views on an acceptable level of sensitivity?

There is also the question of why the dentine is exposed. Recession of the gingivae (gums) may be a manifestation of a more severe disease. In which case, why does this person have that disease? Recession often exposes dentine if the person brushes too aggressively or uses a hard toothbrush or abrasive toothpaste. Perhaps the social pressures to keep the mouth clean and fresh and worrying about the appearance of the teeth have led to brushing ferociously or using gritty toothpaste. In all these cases, things happening beyond the person influence the cause of the condition.

The existence of consumer products for DH also reveals how the condition is more than merely dental. It is people, and not teeth or tubules, who buy products. Television advertisements for those products also convey meanings beyond exposed dentine. They show people wincing in pain, whose enjoyment of food or drink or social occasions is spoiled. Some of those advertisements feature dentists in surgeries, whereas others involve an anonymous (but usually decorative) narrator in a public place. The narrator advocates the use of a product that apparently brings immediate and powerful relief. During our research, we discovered that these two advertising styles reflect whether products were conceived as medicaments or cosmetics. Thus, the way a product is placed in a legal framework directly influences the messages received by the public about an oral condition.

The influence of these advertisements on people’s purchasing also shows how the consumer products industry (as part of wider society) affects our personal knowledge and behavior related to DH. If the products reduce pain, then we can congratulate the industry on creating and disseminating effective products. And yet, this industry also carries a danger. If the advertisements draw viewers’ attention to a condition they did not know they had, if they subjective opinions to sensations that they hadn’t noticed, then they will encourage people to identify the pain. In this way, the advertisements will be making people ill!

These examples all illustrate the role of factors outside the mouth regarding the causes, diagnosis, and consequences of DH, and all involve the person. In doing so, they widen the idea of what oral health is. They demonstrate the role of the mouth and oral health, the way it is viewed, and its effect on everyday life, not simply in terms of the consequences of toothache, but what the mouth means, and what it communicates. One very direct result of thinking about the mouth in this way is considering the effect of oral conditions on the everyday life of the person affected.

The operation was a success, but the patient died

It is hardly surprising that dentists and oral health researchers focus so much on disease and the technical aspects of dental treatment. A strong image we all share of dentistry involves someone looking down at us, working on our teeth. The work is clearly very intricate, highly skilled, and demanding of enormous concentration. It is even very difficult for people to communicate with their dentist during these procedures! Young people for whom this kind of work resonates will therefore be attracted to dentistry. At dental school, students must spend a huge amount of time acquiring these necessary and exacting technical skills. Even after graduation, dentists have been paid according to the number of these treatment procedures they undertake. Cumulatively, these processes select and reinforce a biomedical focus.

In contrast, many of us have encountered a clinician, either as a teacher or as someone caring for us, who showed a gift for seeing beyond the teeth and seeing the patient as a person. Clinicians like this know what it is that is bothering their patients, and they regard treatment success as when those problems have been overcome. This difference between concentrating on pathology and the technical aspects of dentistry as opposed to thinking about the person reflects the distinction between two contrasting ideas of health.

The biomedical model of health defines health as the absence of disease. This perspective has been useful in health care, because it directly links clinical signs to the mechanisms of disease, therefore guiding diagnosis and treatment. The model evolved from the premise that diseases are organ-specific pathological processes that affect the function of cells within the organs. Its focus is on clinical, physiological, and biochemical outcomes, and its foundations are in the physical and biological sciences.

In many respects, this approach has served us well. The dominance of the basic sciences of genetics, biology, pathology, physiology, biochemistry, and molecular biology in clinical practice and medical research (including dentistry) has provided the understanding that has underpinned huge advances in health care over the centuries.2 Nevertheless, the model has limitations. Its core problem is that it restricts the way we think about health and health care, because it is reductionist.

The term “reductionist” refers to the reduction of health and disease to their smallest common denominators and the exclusion of “peripheral” or complicating factors. One aspect of reductionism is mind–body dualism, which treats the mind and body as discrete and unrelated objects. Physicians have been known to argue that their responsibility is to treat only “real diseases” rather than to be concerned with psychological and social problems.3 Thus, the physical and biological sciences are seen in isolation from their personal and social etiologies and consequences.

The definition of DH gives us a perfect example of reductionism, where the disease is seen purely as a problem of specific organs (the teeth or the mouth). It exemplifies how the biomedical model characterizes specific diseases when their etiologic and pathogenic processes are obvious, and we have already seen how treatments are specific to the disease. And yet, we also saw how DH, like so many other human diseases, is not a specific disease with a specific etiology. The condition can only be diagnosed when all other diseases have been ruled out, therefore...