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The multifaceted concept of oral health: Studies on a Swedish general population and perspectives of persons with experience of long-term CPAP-treated obstructive sleep apnea
Jönköping University, School of Health and Welfare, HHJ, Dept. of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.ORCID iD: 0000-0002-5607-9470
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Oral health is a multifaceted and changeable part of our overall health and well-being as it contributes to important everyday functions such as eating, talking, and conveying feelings. Our oral health can be affected by a range of determinants, one of which is obstructive sleep apnea [OSA] treated with continuous positive airway pressure [CPAP]. Even though xerostomia has been frequently reported upon, the possible relationship between oral health and CPAP-treated OSA is not clearly understood. The World Dental Federation [FDI] recently proposed a definition and theoretical framework of oral health, intended to be globally applicable and to move dentistry toward a more promotive approach. By using the FDI’s framework as a basis for exploration, studies in a general population can increase the understanding of different aspects of oral health and set the frame of reference for whether and how CPAP-treated OSA can be experienced to affect a person’s oral health.

The overall aim of this thesis was to gain a deeper understanding of how the FDI’s theoretical framework of oral health can be applied in a general population and how oral health is experienced in a specific population of persons with increased risk for adverse oral health.

The FDI’s framework was explored with empirical data from a general population (N=630) and a population of persons with experience of CPAP-treated OSA (N=18). In papers I and II, the FDI framework was tested and evaluated with quantitative methods (principal component analysis and structural equation modeling), using cross-sectional data from the Jönköping studies. In papers III and IV, qualitative methods (directed content analysis and critical incident technique) were used where personal views and experiences were explored using individual semi-structured interviews.

The findings in paper I showed that factors such as dental caries, periodontal disease, experience of xerostomia, and aesthetic satisfaction can be included in the FDI’s component the core elements of oral health. In paper II, driving determinants and moderating factors were found to have direct effects on all core elements of oral health except aesthetic satisfaction. Three of the core elements of oral health (oral health-related quality of life, aesthetic satisfaction, and xerostomia) had direct effects on the latent variable overall health and well-being. Driving determinants and moderating factors had no direct effect on overall health and well-being, and no indirect effects were found. In paper III, the study participants’ views on oral health determinants were described and could be categorized into all the FDI framework dimensions. The component driving determinants could include a range of determinants affecting a person’s oral health such as CPAP treatment, age, the influence of family and social surroundings, interdental cleaning, willingness to change when needed, and relationship with oral healthcare professionals. In paper IV, the study participants described both negative and positive experiences occurring with or without their CPAP. The negative experiences included increased xerostomia, pain or discomfort, tooth wear, and negative feelings. The positive experiences included decreased xerostomia and improved oral health habits due to improved sleep. Many of the difficulties could be managed by easily accessible facilitators. The experiences the study participants described could be included in all the FDI framework components.

In conclusion, the FDI’s framework can be applied in a general population to describe different components of oral health, and is also useful to describe a person’s views and experiences of oral health in a specific population. CPAP treatment could be considered an oral health determinant as it can affect a person’s oral health. Both positive and negative experiences can contribute to CPAP adherence as negative experiences often can be successfully managed.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2022. , p. 121
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 117
Keywords [en]
adults, CPAP treatment, obstructive sleep apnea, oral health, oral health determinants
National Category
Dentistry
Identifiers
URN: urn:nbn:se:hj:diva-56448ISBN: 978-91-88669-16-2 (print)OAI: oai:DiVA.org:hj-56448DiVA, id: diva2:1657569
Public defence
2022-06-03, Forum Humanum, School of Health and Welfare, Jönköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2022-05-11 Created: 2022-05-11 Last updated: 2022-05-11Bibliographically approved
List of papers
1. Clinical and self-reported measurements to be included in the core elements of the World Dental Federation's theoretical framework of oral health
Open this publication in new window or tab >>Clinical and self-reported measurements to be included in the core elements of the World Dental Federation's theoretical framework of oral health
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2021 (English)In: International Dental Journal, ISSN 0020-6539, E-ISSN 1875-595X, Vol. 71, no 1, p. 53-62Article in journal (Refereed) Published
Abstract [en]

Introduction

Oral health is part of general health, and oral diseases share risk factors with several non-communicable diseases. The World Dental Federation (FDI) has published a theoretical framework illustrating the complex interactions between the core elements of oral health (CEOHs): driving determinants, moderating factors, and general health and well-being. However, the framework does not specify which self-reported or clinical measurements to be included in the CEOHs.

Objectives

To explore oral health measurements relevant for a general adult population to be included in the CEOHs in the FDI's theoretical framework of oral health.

Materials and methods

A psychometric study was performed, using cross-sectional data from Sweden (= 630, 54% women, mean age 49.7 years). The data set initially consisted of 186 self-reported and clinical measurements. To identify suitable measurements, the selection was discussed in different settings, including both experts and patients. Principal component analyses (PCAs) were performed to explore, reduce and evaluate measurements to be included in the three CEOHs. Internal consistency was estimated by Cronbach's Alpha.

Results

The validation process yielded 13 measurements (four clinical, nine self-reported) in concordance with the CEOHs. PCAs confirmed robust validity regarding the construction, predicting 60.85% of variance, representing psychosocial function (number of measurements = 5), disease and condition status (number of measurements = 4), and physiological function (number of measurements = 4). Cronbach's Alpha indicated good to sufficient internal consistency for each component in the constructs (a = 0.88, 0.68, 0.61, respectively).

Conclusion

In a Swedish general adult population, 13 self-reported and clinical measurements can be relevant to include to operationalise CEOHs in the FDI's theoretical framework.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
Oral health measurements, dentistry, theoretical framework, validation studies
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-50212 (URN)10.1111/idj.12614 (DOI)000558552400001 ()32786171 (PubMedID)2-s2.0-85089311951 (Scopus ID)HOA;;1458002 (Local ID)HOA;;1458002 (Archive number)HOA;;1458002 (OAI)
Available from: 2020-08-13 Created: 2020-08-13 Last updated: 2024-01-26Bibliographically approved
2. Applying World Dental Federation Theoretical Framework for Oral Health in a General Population
Open this publication in new window or tab >>Applying World Dental Federation Theoretical Framework for Oral Health in a General Population
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2022 (English)In: International Dental Journal, ISSN 0020-6539, E-ISSN 1875-595X, Vol. 72, no 4, p. 536-544Article in journal (Refereed) Published
Abstract [en]

Introduction: The World Dental Federation (FDI) has recently proposed a new definition and theoretical framework of oral health. The theoretical framework includes 4 main components and describes the relationships amongst them. In 2020, an international work group proposed the minimum Adult Oral Health Standard Set (AOHSS) of variables to measure oral health, which was mapped onto the FDI's theoretical framework. By using an empirical data set, the proposed variables in the AOHSS and the potential interactions amongst the components of the FDI's theoretical framework can be tested. The purpose of this research was to investigate structural relations of the components of the FDI's theoretical framework of oral health based on data from a general adult population.

Methods: Data from a previously conducted Swedish cross-sectional study focusing on oral health were utilised (N = 630; women, 55.2%; mean age, 49.7 years [SD, 19.2]). Variable selection was guided by the AOHSS. Structural equation modeling was used to analyse relationships amongst the components of the FDI's theoretical model (core elements of oral health, driving determinants, moderating factors, and overall health and well-being).

Results: The Oral Health Impact Profile (OHIP)-14, xerostomia, and aesthetic satisfaction had statistically significant direct effects on overall health and well-being (p < .05). Driving determinants and moderating factors had statistically significant direct effects on all core elements of oral health (p < .05) except aesthetic satisfaction (p = .616). The predictors explained 24.1% of the variance of the latent variable overall health and well-being. Based on several indices, the proposed model showed acceptable model fit.

Conclusions: The FDI's theoretical framework can be used to describe different components of oral health and the relationship amongst them in an adult general population. Further research based on the FDI's theoretical framework in other populations and settings is needed to explore complex interactions and possible relationships that form oral health and to investigate other or additional important social determinants.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Adult, General population, Oral health, Structural equation modeling, Theoretical framework
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-55518 (URN)10.1016/j.identj.2021.09.001 (DOI)000861694200015 ()34953571 (PubMedID)2-s2.0-85121709941 (Scopus ID)HOA;;789888 (Local ID)HOA;;789888 (Archive number)HOA;;789888 (OAI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 844881
Available from: 2022-01-12 Created: 2022-01-12 Last updated: 2022-10-21Bibliographically approved
3. Views about oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnea: A qualitative study
Open this publication in new window or tab >>Views about oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnea: A qualitative study
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(English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-56446 (URN)
Available from: 2022-05-11 Created: 2022-05-11 Last updated: 2022-05-11
4. “The terrible dryness woke me up, I had some trouble breathing”- critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea
Open this publication in new window or tab >>“The terrible dryness woke me up, I had some trouble breathing”- critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea
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2022 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 6, article id e13670Article in journal (Refereed) Published
Abstract [en]

Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
adherence; experiences; humidification; management; patient perspective; qualitative
National Category
Neurology
Identifiers
urn:nbn:se:hj:diva-56447 (URN)10.1111/jsr.13670 (DOI)000817789500001 ()35765213 (PubMedID)2-s2.0-85132908291 (Scopus ID)HOA;;1657484 (Local ID)HOA;;1657484 (Archive number)HOA;;1657484 (OAI)
Funder
Medical Research Council of Southeast Sweden (FORSS), 847071
Note

Included in thesis in manuscript form.

Available from: 2022-05-11 Created: 2022-05-11 Last updated: 2023-02-13Bibliographically approved

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