Effectiveness of dental services in facilitating recovery from oral disadvantage

被引:16
作者
Fisher, MA
Gilbert, GH
Shelton, BJ
机构
[1] Univ Alabama, Dept Diagnost Sci, Birmingham, AL 35294 USA
[2] Univ Kentucky, Dept Internal Med, Lexington, KY USA
[3] Univ Kentucky, Dept Biostat, Lexington, KY USA
关键词
cohort studies; evidence-based medicine; health services research; longitudinal studies; oral health; outcome assessment (health care); quality of life; randomized controlled trials;
D O I
10.1007/s11136-004-3929-2
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective: To determine the effectiveness of dental health care services in facilitating recovery from quality of life decrements in symptom-specific subgroups with the most prevalent chronic infectious diseases (periodontal disease and dental caries), and a 'stained teeth' subgroup. Methods: Data were taken from the prospective longitudinal Florida Dental Care Study of 873 individuals 45+ years old. Logistic regression modeling quantified associations between recovery from oral health-related quality of life decrements ('recovery') and dental services. Results: Adjusting for age, race, gender, income, approach to dental care, and signs/symptoms, any dental visit (odds ratio, OR: 4.0; 95% confidence interval, CI: 2.3, 6.9), corrective treatment (OR: 3.8; 95% CI: 1.6, 8.7), denture visit (OR: 4.8; 95% CI: 1.1, 21.9), or extraction (OR: 6.2; 95% CI: 2.2, 17.4) were positively associated with recovery. Upon conditioning the analyses on specific symptoms, point estimates increased substantially for most service types, and dental cleaning was associated with recovery for the stained teeth subgroup (OR: 10.9; 95% CI: 1.2, 99.4). Conclusion: Dental care was highly effective in treating quality of life decrements. Treatment effectiveness increased substantially when analyses were restricted to symptom-specific subgroups similar to selection criteria of randomized clinical trials (RCTs). Restricted cohort analyses can be applied to many other health outcomes for which RCTs are not feasible or ethical.
引用
收藏
页码:197 / 206
页数:10
相关论文
共 45 条
[1]
Hill A.B., The environment and disease: Association or causation?, Proc R Soc Med, 58, pp. 295-300, (1965)
[2]
Hennekins C.H., Buring J.E., Epidemiology in Medicine, (1987)
[3]
Kaptchuck T.J., The double-blind, randomized, placebo-controlled trial: Gold standard or golden calf?, J Clin Epidemiol, 54, pp. 541-549, (2001)
[4]
Dumbrigue H.B., Jones J.S., Esquivel J.F., Control of bias in randomized controlled trials published in prosthodontic journals, J Prosthet Dent, 86, pp. 592-596, (2001)
[5]
Black N., Why we need observational studies to evaluate the effectiveness of health care, Br Med J, 312, pp. 1215-1218, (1996)
[6]
Rovers M.M., Straatman H., Ingels K., Van Der Wilt G.J., Van Den Broek P., Zielhuis G.A., Generalizability of trial results based on randomized versus nonrandomized allocation of OME infants to ventilation tubes or watchful waiting, J Clin Epidemiol, 54, pp. 789-794, (2001)
[7]
Schultz K.F., Subverting randomization in controlled trials, JAMA, 274, pp. 1456-1458, (1995)
[8]
Padkin A., Rowan K., Black N., Using high quality clinical databases to complement the results of randomised controlled trials: The case of recombinant human activated protein C, Br Med J, 323, pp. 923-926, (2001)
[9]
Horowitz R.I., Viscoli C.M., Clemens J.D., Sadock R.T., Developing improved observational methods for evaluating therapeutic effectiveness, Am J Med, 89, pp. 630-638, (1990)
[10]
Klungel O.H., Stricker B.H.C., Breteler M.M.B., Seidell J.C., Psaty B.M., De Boer A., Is drug treatment of hypertension in clinical practice as effective as in randomized controlled trials with regard to the reduction of the incidence of stroke?, Epidemiology, 11, pp. 339-344, (2001)