Impact of Maxillofacial Prostheses on Oral Health Related Quality Of Life ( OHRQoL )

Published by Oriental Scientific Publishing Company © 2018 This is an Open Access article licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-nc-sa/4.0/ ), which permits unrestricted Non Commercial use, distribution and reproduction in any medium, provided the original work is properly cited. Impact of Maxillofacial Prostheses on Oral Health Related Quality Of Life (OHRQoL )

Maxillofacial defect can result in, functional, cosmetic and Psychological impairment greatly affecting the patient's quality of life 1 .Maxillary defect can be rehabilitated with either tissue grafting or using obturator prosthesis 2 .
Although, surgical reconstructions 3 have some advantages but it is not always possible because of the condition of the patient.So, prosthetic rehabilitation may be one of the possible solutions 4,5 .
Prosthetic intervention 6 , with a maxillary obturator prosthesis, is necessary to restore form and contours of the defect and to recreate the functional separation of the oral and nasal cavity.
In 2001, Okay and colleagues 7 proposed a maxillectomy defect classification system with a view toward the assessment of functional outcome, prosthetic retention, and patient satisfaction.Based on a retrospective review of 47 consecutive maxillectomy defects, this classification scheme also was the first to take the status of the zygomatic arch and orbital floor into direct consideration.They classified palato-maxillary defects into 3 major classes and 2 sub-classes.
A variety of instruments have been developed to measure Oral health related quality of life (OHRQoL) 8,9 .The oral health impact profile 10,11 (OHIP) is a self-administered instrument specifically designed to measure the impact of oral health on psychological wellbeing and quality of life .This questionnaire includes 49 items that includes seven domains; functional limitation ,physical pain ,psychological discomfort, physical disability ,psychological disability ,social disability and handicap 12,13 .
Accordingly, a new subscales of 19-OHIP statements specifically for edentulous patients was developed -the Oral Health Impact Profile for Edentulous subjects 14 (OHIP-EDENT) (Allen and  Locker, 2002).The item impact method is used to select items that are most relevant to edentulous patients.The five categories of responses are 1) never, 2) hardly ever, 3) occasionally, 4) fairly often and 5) very often.They are scored from 0 for never 1 to 5 for very often, with lower scores representing a better OHRQol.This instrument has been tested for reliability and validity.
Oral health related Quality of life has become the focus of attention during recent years in maxillofacial rehabilitation; patient's psychological wellbeing and the patients' vitality are increasingly contributing to the evaluation of therapeutical success.
Keeping the above factors in mind the present study was carried out to compare and evaluate the impact of Definitive Obturator prosthesis on oral health related quality of life in maxillary defects by oral health impact profile (OHIP-Edent) and obturator functioning scale (OFS)

Study design
This descriptive cross sectional study was conducted at Vinayaga mission's dental college, Salem in the period between 2015 to 2017.A total of twenty five (25) patients with acquired maxillary defects based on Okay classification have been selected for this study (Table 1 & Bar Chart 1).
The patients were provided written informed consent prior to their participation after obtaining ethical clearance.Definitive Obturator prostheses were carried out for acquired maxillary defects.OHRQoL was measured using the Oral Health Impact Profile -Edent (OHIP-Edent-19), and Obturator functioning scale (OFS) with standardized questionnaire after 2 weeks & 3months of Obturator prosthesis insertion.
The OHIP-EDENT consists of 19 statements derived from the OHIP using an item impact method.Oral Health Impact Profile (OHIP-EDENT) which includes seven domains /items Functional limitation, Physical pain, Psychological discomfort, Physical disability Psychological disability, social disability &Handicap (Table 2).
A 15 item obturator functioning scale (OFS) designed by kornblith et al to assess the masticatory ability, speech, communication difficulties and cosmetic satisfaction (Table 3).
Patients were asked serious of questions.All the answers to the questions were coded and entered into a excel sheet by a single operator.

Statistical analysis
The collected data were analysed with IBM.SPSS statistics software 23.0 Version.
To describe about the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean & S.D were used for continuous variables.To find the significant difference between the bivariate samples in Paired groups the Wilcoxon signed rank test was used.In the above statistical tool the probability value .05 is considered as significant level.

RESuLTS
With respect to oral health impact profile -Edent 19 scale, the mean functional limitation score were 6.72 and 5.20 indicates that there is significant improvement in chewing performance after 2 weeks and 3 months of prosthesis function respectively (Table 4) Even though improvement in denture comfort (Mean =8.24) was observed in 2 weeks When observed with obturator functioning scale, the mean of 4.84 and 3.60 for chewing performance indicates that they were hardly ever problems with leakage of foods during chewing (Table 5).
Likewise, there is significant improvement in obturator functioning scale was noticed in phonetics, appearance and miscellaneous aspects.
Since rehabilitation with definitive obturator prostheses showed marked positive subjective responses to the each subscale.
When analysing the OHIP -Edent-19 scale and obturator functioning scale (OFS-15), statistically significant differences (Wilcoxon rank test p value = 0.0005) were observed (Table 6) Rehabilitation of maxillofacial defects with definitive obturator had an enormous positive impact of oral health related quality of life (OHRQol) in terms of functional, physical, psychological and social aspects.

DIScuSSION
In modern years, there has been growing interest in using patient-reported psychosocial problems, and to observe a patient's progress over a period of time.
Maxillo -Facial defects as a result of a congenital or acquired origin can have overwhelming effects on the functional, economic,  esthetic and psychosocial aspects of a person's life.Maxillofacial prosthetics, as an alternative to surgery, offer prosthodontic rehabilitation, seeking to provide satisfactory function ,aesthetics and quality of life (QOL), and thus to facilitate restoration of patients in in their family situations and social environments 15 .
Earlier studies have shown that patients with acquired maxillofacial defects had greater physical, psychological and social impairment of QOL than patients with congenital defects 16,17 .
Because of this, in a clinical setting, the identification of the need for prosthetic rehabilitation in these patients, a process which can restore QOL, is most important.The evaluation of patients oral health related QOL related to prosthetic rehabilitation may provide valuable information to assist the maxillofacial prosthodontic team in treatment planning, monitoring, and outcome assessment 18 .
Maxillectomy patients with definitive obturator rehabilitation; their mean score of functional limitation in this study 7 and 5 were

Table 1 .
Represent frequency distribution of Okay classification for maxillary defects

Table 2 .
Represent mean, standard deviation of Oral Health Impact Profile-Edent -19 (OHIP-EDENT) sub scales after 2 weeks and 3 months of prosthesis insertion

Table 3 .
Represent shown of mean, standard deviation of obturator functioning scale (OFS-15) after 2 weeks and 3 months of prosthesis insertion

Table 4 .
Represent level of significance of Oral Health Impact Profile-Edent -19 (OHIP-EDENT sub scales after 2 weeks and 3 months of prosthesis insertion

Table 5 .
Represent Bar chart 1. Represent frequency distribution of Okay classification of maxillary defectsBar chart 2. Represent comparison of average of Oral Health Impact Profile-Edent -19 sub scales after 2 weeks and 3 months of prosthesis insertion