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Feasibility Little is known about implementation protocols targeted at reducing adverse pregnancy outcomes. Treatment of periodontitis is routinely performed in many healthcare systems across the world, and therefore is in itself feasible, accepting the limitations outlined inR12.1. Ethical considerations Evaluation of the efficacy of the treatment of periodontitis on adverse pregnancy outcomes is ethically challenging as it would entail compar- ison with no treatment or treatment delayed until post-partum. There is another potential ethical dilemma in that patient preference may conflict with the clinician's recommendation in terms of mode of treatment delivery or timing of treatment. Patient autonomy should be respected. Economic considerations Insufficient evidence exists on the cost-effectiveness of the treat- ment of periodontitis when evaluating adverse pregnancy outcomes.
scales or questionnaires for patient satisfaction (12 different methods). Quality of life instruments used to analyse general health status included EORTC QLQ-C30, EORTC QLQ-H&N35, GHQ, SIQ, SF-36, WHOQol-BREF, GSS and EQ-5D ( n = 8). For explanations of the abbreviations of questionnaires/tools, the reader should read the referred systematic review (Gennai et al., 2021).
12.2.1 | In people with a minimum of five teeth missing for any reason (including stage IV periodontitis patients), does prosthetic rehabilitation of edentulous spaces improve quality of life?
R12.5. Does prosthetic rehabilitation of partial edentulism improve quality of life in people with tooth loss (for any reason, including periodontitis)?
PICOS question addressed by a SR
R12.5: Evidence-based recommendation (1), Evidence-based statements (2, 3) 1. We recommend rehabilitation of people with partial edentulism of at least 5 teeth (including those affected by periodontitis) to improve quality of life . 2. Rehabilitation of partial edentulism with tooth-supported , fixed or removable prostheses improves quality of life . 3. Rehabilitation of partial edentulism with implant-supported prostheses improves quality of life . Supporting literature (Gennai et al., 2021) Quality of evidence Moderate Grade of recommendation GradeA — "" (1); Statements (2, 3) Strength of consensus Strong consensus (1.9% of the group abstained due to potential CoI)
Legal considerations Not applicable.
12.2 | Prosthetic rehabilitation in fully or partially edentulous patients: Impact on systemic health and quality of life A systematic review (Gennai et al., 2021) explored the impact of treating partial or complete edentulism in patients with periodontitis and those with tooth loss from any cause, on OHRQoL and general health. The review considered the impact of rehabilitation of edentulous spaces of 5 or more teeth, in order to identify patients with stage IV peri- odontitis. However, only 13 studies recorded data from periodontitis patients, and even in these studies, the reasons for the tooth loss were not documented. Forty-three studies were available that met the criteria of analysing oral health quality of life outcomes and specific measures of general health (cognitive impairment, nutritional status, frailty, systemic serum markers) in patients with edentulous spaces of 5 or more teeth. The recommendations made by the workshop focussed on the available data from 13 studies of periodontitis patients. However, as periodontitis is a major cause of tooth loss in adults (overall preva- lence 45% – 50% and severe periodontitis on 7% – 11%), data were also considered from 43 studies where the presence of periodontitis was not specified, on the assumption that it is likely to have contributed to tooth loss in a number of cases studied. This decision reflected the limitations of the available literature, but the guideline group endorsed this pragmatic approach. OHRQoL was analysed using various validated tools including: OHIP-14, OHIP-20, OHIP-49, OHIP-54, OHIP-EDENT, OHIP- EDENT-21, OHQoL-UK, OIDP, DIDL and GOHAI, and VAS, Likert
Background
Intervention
Partially edentulous spaces may be left un-restored or may be restored using a variety of approaches, including fixed or removable prostheses, which may or may not be supported by teeth or dental implants. Such restorations provide numerous benefits that are reported to provide positive impacts beyond the oral cavity including but not limited to function and aes- thetics. There is also a body of evidence suggesting improve- ments in quality of life following the restoration of partially edentulous spaces. OHRQoL has been measured with psychometric questionnaires. Restoration of edentulous spaces appears to incur significant changes in OHRQoL and such changes appear tangible to those patients treated by such reconstructions.
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