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The Impact of Development Defects of Enamel on Young People Zoe The Impact of Development Defects of Enamel on Young People Zoe Marshman Doctor of Philosophy Department of Oral Health and Development November 2007 1 Acknowledgements I would first like to thank my supervisors Professor Peter Robinson and Dr Barry Gibson. They have devoted a great deal of thought, time and energy to my thesis and have supported me both academically and personally. I am grateful for the way they have challenged me, but also for allowing themselves to be challenged throughout the process. I am also very grateful for the support and advice of other colleagues in the Department of Oral Health and Development including Helen Owen, Tom Dyer and Sarah Baker. Special mention should be made of my running partner, Professor Helen Rodd, who has provided 'miles' of encouragement and inspiration. I would like to express my appreciation to my sister, parents and grandparents for their kindness and understanding over the past five years. Finally, I am most grateful to Matthew for his devotion and kindness. Abstract Background: in order to ascertain whether Developmental Defects of Enamel (DDE) constitute a public health problem it is necessary to consider whether the condition impacts on the lives of affected individuals. Aim: to describe the impact of DDE on individual young people. Objectives: 1) Describe the extent to which contemporary dental research on DDE has included the perspective of children and young people. 2) Describe the impact of DDE on the oral health-related quality of life (OHRQoL) of young people. 3) Explore, in detail, the impact of DDE on young people. Methods: a systematic review of the literature, a cross sectional study and a qualitative interview study were conducted. Results: Little research about DDE has previously attempted to capture the subjective experience of those with the condition. The impact of DDE, as measured with a child specific OHRQoL measure, was generally of low frequency and was equivalent to that of young people with relative oral health. In qualitative interviews the impact of DDE varied markedly between young people. DDE impacted on individuals' whose sense of self was defined by appearance and who depended on perceived approval from others about their appearance. No links between gender, age, severity of DDE and impact were apparent. Discussion: The impact of DDE was generally of low frequency with marked variation in impact between individuals. This research is the first to discover that some of this variation can be accounted for by young people's sense of self. This concept has not been identified in relation to the impact of visibly different conditions before. More research is needed to further investigate the impact of DDE. 3 Contents 1. Chapter One Introduction ............................................................................... 7 1. 1 Background ................................................................................................... 7 1.2 Aim and objectives ........................................................................................ 8 2. Chapter Two Literature Review ..................................................................... 10 2.1 Introduction ................................................................................................. 10 2.2 Developmental Defects of Enamel (DDE) .................................................... 10 2.3 Aetiology of DDE ........................................................................................ 11 2.3.1 Localised causes ...................................................................................... 12 2.3.2 Generalised causes ................................................................................... 13 2.3.3 Aetiology of fluorosis .............................................................................. 15 2.4 Are DDE a public health problem? ............................................................... 16 2.4.1 Prevalence ................................................................................................ 18 2.4.2 Impact of the condition on the individual ................................................. 31 2.4.3 Impact of the condition on wider society ................................................. .42 2.4.4 Condition is preventable and effective treatments are available ............... .43 2.4.5 Conclusion ............................................................................................... 45 2.5 Approaches available to investigate the impact of dental conditions ............ .47 2.5.1 Models of health ...................................................................................... 47 2.5.2 Investigating impact ................................................................................. 50 2.5.3 Oral health-related quality of life (OHRQoL) ........................................... 56 2.5.4 Qualitative approaches to impact.. ............................................................ 63 2.5.5 Research with children ............................................................................. 70 2.5.6 Methodological considerations of research with children .......................... 72 2.5.7 Contemporary approaches to research with children ................................. 74 2.5.8 Measurement of HRQoL of children ........................................................ 75 2.5.9 Measurement of OHRQoL in children ...................................................... 77 2.5.10 OHRQoL measures for children ........................................................... 79 2.5.11 Qualitative research of the impact of oral health on children ................. 85 2.5.12 Conclusion ........................................................................................... 87 2.6 Rationale ...................................................................................................... 87 2.7 Aim and objectives ...................................................................................... 88 2.8 Publications arising from the work in this chapter ........................................ 89 3. Chapter Three .................................................................................................... 90 The extent to which contemporary dental research on DDE has included the perspectives of children & young people .................................................................. 90 3. 1 Introduction ................................................................................................. 90 3.1.1 Objectives of the study ............................................................................. 91 3.2 Methods ....................................................................................................... 91 3.2.1 Objective a) Developing the classification ................................................ 91 3.2.2 Objective b) Identify research papers ....................................................... 93 4 3.2.3 Objective c) Application of categories ...................................................... 96 3.3 Results ......................................................................................................... 96 3.3.1 DDE literature .......................................................................................... 96 3.3.2 General child dental literature ................................................................ 100 3.3.3 Comparison ofDDE and child dental literature ...................................... 102 34. D'ISCUSSlon . ................................................................................................. 102 3.5 Publications arising from the work in this chapter ...................................... 105 4. Chapter Four ................................................................................................... 106 The impact of DDE on the OHRQoL of young people ........................................... 106 4.1 Introduction ............................................................................................... 106 4.l.1 Objectives of the study ........................................................................... 107 4.1.2 CPQII-14 ................................................................................................. 107 4.1.3 P-CPQ .................................................................................................... 109 4.2 Method ...................................................................................................... 11 0 4.2.1 General clinic-based sample ................................................................... 110 4.2.2 DDE Sample .......................................................................................... 112 4.3 Results ....................................................................................................... 113 4.3.1 Results of the evaluation of CPQII-14 and P-CPQ from the general clinic- based sample ..................................................................................................... 114 4.3.2 Results of the impact ofDDE on young people ...................................... 123 4.3.3 Results of the impact ofDDE using P-CPQ ............................................ 128 4.4 Discussion ................................................................................................. 128 4.5 Publications arising from the work in this chapter ...................................... 137 5. Chapter Five .................................................................................................... 138 Exploring
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