Oral health-related quality of life in a birth cohort of 32-year olds

Abstract – Objectives: To describe oral health‐related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well‐established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services. Methods: A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14‐item Oral Health Impact Profile questionnaire (OHIP‐14). The questionnaire also collected data on each study member’s occupation, self‐rated oral health and reasons for seeing a dental care provider. SES was determined from each individual’s occupation at age 32 years. Results: The mean total OHIP‐14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems ‘fairly often’ or ‘very often’. When the prevalence of impacts ‘fairly/very often’ was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and ‘episodic’ dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts. Conclusions: OHIP‐14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age‐ and sex‐standardized estimates from Australia (18.2%) and the UK (15.9%).     

Impact of response shift on the assessment of treatment effects using the Oral Health Impact Profile

The assessment of changes in oral health‐related quality of life (OHRQoL) is challenging because individuals' concepts and internal standards of OHRQoL may change over time. The aim of this study was to detect response shifts in OHRQoL assessments made using the Oral Health Impact Profile (OHIP). Oral health‐related quality of life was assessed in a consecutive sample of 126 patients seeking prosthodontic care. Patients were asked to rate their OHRQoL before treatment started and 1 month after treatment was finished, using the German 49‐item version of the OHIP. When rating their OHRQoL after treatment, patients were also asked to rate their pre‐treatment OHRQoL without having access to their baseline data. The response shift was calculated as the difference in OHIP summary scores between the initial assessment and the retrospective baseline assessment. The OHIP mean scores decreased from 31.8 at the initial baseline assessment to 24.4 after treatment. The retrospective baseline assessment resulted in an OHIP mean score of 38.1, corresponding to a response shift of 6.3 OHIP points. The effect size (Cohen's d = 0.21) of the response shift was considered small. The response shift phenomenon and its magnitude have important implications for dental practice, where patients and dentists often assess perceived treatment effects retrospectively.     

A comparison of two questionnaires measuring oral health-related quality of life before and after dental hygiene treatment in patients with periodontal disease

To cite this article:
Int J Dent Hygiene 10 , 2012; 9–14
DOI: 10.1111/j.1601‐5037.2011.00511.x
Öhrn K, Jönsson B. A comparison of two questionnaires measuring oral health‐related quality of life before and after dental hygiene treatment in patients with periodontal disease. Abstract: Aim: The aim of this study was to compare the usefulness of two different questionnaires assessing oral health‐related quality of life (OHRQoL) at the basic examination and after initial dental hygiene treatment (DHtx). Methods: A total of 42 patients referred for periodontal treatment completed the Oral Health Impact Profile (OHIP‐14) and the General Oral Health Assessment Index (GOHAI) at the basic periodontal examination. They underwent DHtx and completed the questionnaires once again after the treatment. Results: No statistically significant differences could be found between the two assessments, neither for the total scores nor for any of the separate items of the OHIP‐14 or the GOHAI. However, the GOHAI questionnaire seems to result in a greater variety in the responses indicating that the floor effect is not as pronounced as for the OHIP‐14. Those who had rated their oral health as good reported significantly better OHRQoL on both questionnaires. The same pattern was found for patients who reported that they were satisfied with their teeth. After DHtx and necessary extractions, there was a statistically significant correlation between the number of teeth and the total scores on both questionnaires. No other statistically significant correlations with periodontal variables could be found. Conclusion: No statistically significant difference could be found after DHtx compared to before in regard to OHRQoL assessed with OHIP‐14 and GOHAI. However, there was a greater variety in the responses with the GOHAI questionnaire; it may hereby be more useful for patients with periodontal disease.     

General population norms of the Swedish short forms of Oral Health Impact Profile

We reported the development and psychometric evaluation of a Swedish 14‐item and a five‐item short form of the Oral Health Impact Profile. The 14‐item version was derived from the English‐language short form developed by Slade in1997. The five‐item version was derived from the German‐language short form developed by John et al. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N = 1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N = 1309) were on average 50·1 ± 17·4 years old, and 54% were women. Short form summary scores correlated highly with the 49‐item OHIP‐S (r ≥ 0·97 for OHIP‐S14, r ≥ 0·92 for OHIP‐S5) and with self‐report of oral health (r ≥ 0·41). Reliability, measured with Cronbach's alpha (0·91 for OHIP‐S14, 0·77 for OHIP‐S5), was sufficient. In the general population, 50% of the subjects had ≥2 OHIP‐S14 score points and 10% had ≥11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had ≥2 OHIP‐S14 score points, and 10% had ≥11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP‐S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14‐item and 5‐item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies.     

Sensitivity to change of oral and general health‐related quality of life during prosthodontic treatment

The literature presents conflicting findings on whether health‐related quality of life (HRQoL) measures have sufficient evaluative properties to assess changes caused by dental interventions. The aim of our study was to compare sensitivity to change in HRQoL and OHRQoL in prosthodontic patients. In this prospective intervention study, a total of 165 consecutively recruited patients completed the Short Form‐36 (SF‐36) and the 49‐item Oral Health Impact Profile (OHIP), as self‐administered questionnaires, before prosthodontic treatment and 1 month after treatment was finished. Differences in SF‐36 and OHIP scores between baseline and follow up were tested for statistical significance using paired t‐tests. Effect sizes (Cohen's d) were calculated. Health‐related quality of life improved during prosthodontic treatment, indicated by a slight, but statistically significant, increase in the SF‐36 physical component (difference: 1.0 points), whereas perceived mental health did not change substantially (difference: ?0.5 points). Improvement in OHRQoL (difference in OHIP sum score: ?6.7 points) was statistically significant. Although the OHIP effect size (of 0.2) was considered as small, according to guidelines, it was greater than for the SF‐36 component scores (physical: 0.1; mental: 0.1). Sensitivity to change in quality of life measures was greater for OHRQoL than for HRQoL, limiting the usefulness of HRQoL as an outcome measure in dentistry.     

Association between oral health‐related and general health‐related quality of life in subjects attending dental offices in Germany

Objectives: To evaluate the GHRQoL and OHRQoL of patients attending dental offices in Germany and to determine correlation coefficients between SF (Short Form)‐12 and OHIP (Oral Health Impact Profile)‐14 scores. Methods: A total of 10,342 dental offices were randomly selected. Each of the 1,113 that consented to participate received 20 questionnaires to be filled in by a convenience sample of the patients. The questionnaire included the OHIP‐14‐form for OHRQoL as well as the SF‐12‐form for GHRQoL. Results: A total of 12,392 completed questionnaires were analyzed. The mean age of the participants (64.9 percent female, 35.1 percent male) was 44.25 years. The mean summary score of OHIP‐14 was 6.30 (SD 7.46). The mean physical component summary scale (PCS) of the SF‐12 was 51.15 (SD 7.23) and the mental component summary scale (MCS) was 50.17 (SD 8.55). The variance of PCS and MCS could be explained to 10 percent each by oral health‐related quality of life (r² = 0.095 and 0.101, P < 0.001). Conclusion: OHRQoL is considerably related to GHRQoL.     

Factors affecting oral health-related quality of life among pregnant women

Abstract: Objectives: To assess oral health status and to describe the possible factors that could affect the oral health‐related quality of life (OHRQoL) among a group of pregnant rural women in South India. Materials and methods: A total of 259 pregnant women (mean age 26 ± 5.5 years) who participated in the cross‐sectional study were administered the Oral Health Impact Profile (OHIP‐14) questionnaire and were clinically examined for caries and periodontal status. Results: The highest oral impact on quality of life was reported for ‘painful mouth’ (mean: 1.7) and ‘difficulty in eating’ (mean: 1.1). On comparing the mean OHIP‐14 scores against the various self‐reported oral problems, it was seen that the mean OHIP‐14 scores were significantly higher among those who reported various oral problems than those who did not. Those with previous history of pregnancies had more severe levels of gingivitis than those who were pregnant for the first time. Also gingival index scores, community periodontal index of treatment needs scores and previous pregnancies was associated with poorer OHRQoL scores. Conclusion: Increased health promotion interventions and simple educational preventive programmes on oral self‐care and disease prevention during pregnancy can go a long way in improving oral health and lessening its impact on the quality of life in this important population.     

Oral health‐related quality of life,measured using the five‐item version of the Oral Health Impact Profile,in relation to socio‐economic status: a population survey in Sweden

Oral health‐related quality of life (OHRQoL) is an important patient‐reported outcome measure in dental research. This study was conducted to analyse the association between OHRQoL, as measured using the five‐item version of the Oral Health Impact Profile (OHIP‐5), and different socio‐economic indices. A national survey of randomly selected adult individuals in Sweden (n = 3,500) was performed using telephone interviews. The questions asked for the purpose of this study were defined by the items of the OHIP‐5, just as questions were asked regarding socio‐economic variables, including education, income, and economic resources. Poor OHRQoL, as identified by an OHIP‐5 score of 3 or higher on at least two of the five items, was statistically significantly associated in multivariate analysis with low income (OR = 1.84) and having no economic resources (OR = 2.19). The statistical models were adjusted for age, gender, ethnicity, marital status, dental‐care utilization, dental anxiety, and smoking. The OHIP‐5 may be used in larger epidemiological surveys because it demonstrates the ability to discriminate for a range of important areas of measurement in dental public health, including social determinants.     

Associations between orthodontic treatment need and oral health‐related quality of life among young adults: does it depend on how you assess them?

Liu Z, McGrath C, Hägg U. Associations between orthodontic treatment need and oral health‐related quality of life among young adults: does it depend on how you assess them? Community Dent Oral Epidemiol 2011; 39: 137–144. © 2011 John Wiley & Sons A/S Abstract – Objective: To determine the association between orthodontic treatment need (OTN) and oral health‐related quality of life (OHRQoL). Methods: A cross‐sectional study involving 273 young adults seeking orthodontic care. OHRQoL was assessed by the short‐form Oral Health Impact Profile (OHIP‐14) and United Kingdom oral health‐related quality of life measure (OHQoL‐UK). Study casts were assessed for OTN by: Dental Aesthetic Index (DAI), Index of Orthodontic Treatment Need (IOTN)‐Aesthetic Component (IOTN‐AC) and Dental Health Component (IOTN‐DHC) and Index of Complexity, Outcome and Need (ICON). Variations in OHIP‐14 and OHQoL‐UK were determined with respect to OTN, and the magnitude of differences was calculated (effect size: ES). Results: There were significant but weak correlations between occlusal indices scores and OHIP‐14 scores (P < 0.05, r < 0.3) and between occlusal indices scores and OHQoL‐UK scores (P < 0.05, r < 0.4). The magnitude of the statistical difference in OHQoL‐UK scores was moderate to large with respect to OTN (ES: 0.36–0.87) and largest when DHC (ES = 0.87) and ICON (ES = 0.74) were used. The magnitude of the statistical difference in OHIP‐14 scores was relatively lower (ES: 0.21–0.69), but also greatest when DHC and ICON were used to determine OTN (ES 0.69 and 0.50, respectively). Conclusion: Orthodontic treatment need was associated with OHRQoL. The magnitude of the statistical difference between those with and without an orthodontic treatment need was larger when OHRQoL was assessed using OHQoL‐UK compared to OHIP‐14. DHC and ICON were more useful indices in identifying greater differences in OHRQoL with respect to orthodontic treatment need.     

The influence of dental attendance on change in oral health-related quality of life

Crocombe LA, Brennan DS, Slade GD. The influence of dental attendance on change in oral health–related quality of life. Community Dent Oral Epidemiol 2012; 40: 53–63. © 2011 John Wiley & Sons A/S Abstract – Background: Few longitudinal studies have investigated the association between dental attendance and oral health–related quality of life (OHRQoL). These studies were limited to older adults, or to study participants with an oral disadvantage and did not assess if dental attendance had a different effect on OHRQoL for different people. Objective: This project was designed to test whether routine dental attendance improved the OHRQoL of survey participants and whether any patient factors influenced the effect of dental attendance on change in OHRQoL. Methods: Collection instruments of a service use log book and a 12 month follow‐up mail self‐complete questionnaire were added to the Tasmanian component of the National Survey of Adult Oral Health 2004/06. The dependent variable was change in OHIP‐14 severity and the independent variable was dental attendance. Many putative confounders/effect modifiers were analysed in bivariate, stratified and three‐model multivariate analyses. These included indicators of treatment need, sociodemographic characteristics, socioeconomic status, pattern of dental attendance and access to dental care. Results: None of the putative confounders were associated with both dental attendance and the change in mean OHIP‐14 severity. The only statistically significant interaction for change in OHIP‐14 severity was observed for dental attendance by residential location (P < 0.01). In multivariate analysis, there was a statistically significant association of dental attendance with change in mean OHIP‐14 severity. It also showed that the difference in association of attendance between Hobart, the capital city of Tasmania, and other places was statistically significant based on the interaction between residential location and attendance (P < 0.05). Conclusion: The effect of dental attendance on OHRQoL was influenced by a patient's residential location.     

Association between self‐assessment of complete dentures and oral health‐related quality of life

The purpose of this study was to determine which factors related to patient self‐assessment of dentures are associated with changes in oral health‐related quality of life (OHRQoL) among edentulous patients after replacement of complete dentures, and to determine whether masticatory performance as determined using an objective method affects the changes in OHRQoL among edentulous patients. As a preliminary study, the existing questionnaire regarding self‐assessment of dentures consisting of 39 question items, measured with a 100‐mm visual analogue scale, was analysed by factor analysis. Then a questionnaire, composed of 22 question items, was developed containing six subscales of ‘function’, ‘lower denture’, ‘upper denture’, ‘expectation’, ‘aesthetic and speech’ and ‘importance’. Final participants in the present study comprised 93 edentulous patients requiring new conventional complete dentures (44 men, 49 women; mean age, 75·0 years). These patients were asked to complete the Japanese version of the Oral Health Impact Profile (OHIP)‐EDENT, comprising 19 question items for assessment of OHRQoL in edentulous patients, along with the developed questionnaire regarding self‐assessment of dentures. Moreover, masticatory performance was measured using a colour‐changeable chewing gum. The questionnaire and measurement were completed twice; before and after replacement of complete dentures. Stepwise multiple regression analysis identified ‘lower denture’ and ‘aesthetic and speech’ as significant independent variables besides OHIP‐EDENT scores before replacement. These results suggest that sufficient retention of lower dentures and appropriate appearance may lead to improved OHRQoL in edentulous patients.     

Dental status and oral health‐related quality of life. A population‐based study

Oral health‐related quality of life (OHRQoL) is associated with tooth wear and tooth loss. This study investigated the association between OHRQoL and dental status (in terms of natural dentition, partial or complete dentures, or edentulism). Sixteen hundred and twenty‐two persons who participated in a large‐scale Dutch dental survey were interviewed. Dentate persons (n = 1407) were additionally invited for a clinical examination (response rate: 69%). Dental status was based upon the combined data from this clinical examination and the questionnaire (seven dental status groups were defined). OHRQoL was measured by the Dutch translation of the short version of the Oral Health Impact Profile, the OHIP‐NL14. Kruskal–Wallis tests and Mann–Whitney U tests were used to investigate differences in OHRQoL between the dental status groups. For all OHIP‐NL14 scales, differences in OHRQoL were found between the dental status groups (all P‐values <0·001). The Mann–Whitney U tests revealed no differences between persons with a complete natural dentition and persons with a fixed prosthetic replacement. The latter group, however, did show a significantly better OHRQoL as compared to persons with a removable partial denture. Surprisingly, edentulous persons with an overdenture had a more impaired OHRQoL than edentulous persons with non‐supported complete dentures. The results demonstrated that impaired dental status is associated with deteriorations in OHRQoL, especially concerning functional limitations, physical pain and social disability.     

The burden of disease of dental anxiety: generic and disease‐specific quality of life in patients with and without extreme levels of dental anxiety

The aim of this study was to compare disease‐specific (oral health‐related) quality of life (OHRQoL), assessed using the Oral Health Impact Profile‐14 (OHIP‐14), and generic (health‐related) quality of life (HRQoL), assessed using the EuroQol5D (EQ‐5D‐5L), in patients with severe dental anxiety (who were visiting a centre for special care dentistry) with a control group from the general population. Seventy‐six patients with severe dental anxiety [Dental Anxiety Scale (DAS) score ≥ 13] were matched, according to age, gender, and socio‐economic status, to a control group of 76 participants in a larger epidemiological study on oral health in the Netherlands (n = 1,125). The Wilcoxon signed‐rank test was used to compare levels of HRQoL and OHRQoL in both groups. The total OHIP score (indicating lower OHRQoL) was higher for the patient group (10th percentile = 30.5; 90th percentile = 46.0) than for the control group (10th percentile = 1.0; 90th percentile = 14.5). The patient group showed higher scores on all seven OHIP domains. Lower utility scores were found in patients with severe dental anxiety (HRQOL: 10th percentile = 0.7; 90th percentile = 0.9) relative to the control group (HRQOL: 10th percentile = 0.9; 90th percentile = 1.0). A disease burden of 74,000 disability‐adjusted life years (DALYs) was calculated for the Netherlands. The findings of this study show differences between patients visiting a dental fear clinic and matched controls from the general population for both OHRQoL and HRQoL, indicating that having severe dental anxiety generates a significant burden of disease.     

Patterns of impaired oral health‐related quality of life dimensions

How dental patients are affected by oral conditions can be described with the concept of oral health‐related quality of life (OHRQoL). This concept intends to make the patient experience measurable. OHRQoL is multidimensional, and Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact were suggested as its four dimensions and consequently four scores are needed for comprehensive OHRQoL assessment. When only the presence of dimensional impact is measured, a pattern of affected OHRQoL dimensions would describe in a simple way how oral conditions influence the individual. By determining which patterns of impact on OHRQoL dimensions exist in prosthodontic patients and general population subjects, we aimed to identify in which combinations oral conditions’ functional, painful, aesthetical and psychosocial impact occurs. Data came from the Dimensions of OHRQoL Project with Oral Health Impact Profile (OHIP)‐49 data from 6349 general population subjects and 2999 prosthodontic patients in the Learning Sample (N = 5173) and the Validation Sample (N = 5022). We hypothesised that all 16 patterns of OHRQoL dimensions should occur in these individuals who suffered mainly from tooth loss, its causes and consequences. A dimension was considered impaired when at least one item in the dimension was affected frequently. The 16 possible patterns of impaired OHRQoL dimensions were found in patients and general population subjects in both Learning and Validation Samples. In a four‐dimensional OHRQoL model consisting Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact, oral conditions’ impact can occur in any combination of the OHRQoL dimensions.     

RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS

BackgroundOHIP's original seven-domain structure does not fit empirical data, but a psychometrically sound and clinically more plausible structure with the four OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact has emerged. Consequently, use and scoring of available OHIP versions need to be revisited.AimWe assessed how well the overall construct OHRQoL and its four dimensions were measured with several OHIP versions (20, 19, 14, and 5 items) to derive recommendations which instruments should be used and how to score them.MethodsData came from the “Dimensions of OHRQoL Project” and used the project's learning sample (5,173 prosthodontic patients and general population subjects with 49-item OHIP data). We computed correlations among OHIP versions’ summary scores. Correlations between OHRQoL dimensions, on one hand, and OHIP versions’ domain scores or OHIP-5′s items, on the other hand, were also computed. OHIP use and scoring recommendations were derived for psychometrically solid but also practical OHRQoL assessment.ResultsSummary scores of 5-, 14-, 19- and 49-item versions correlated highly (r = 0.91–0.98), suggesting similar OHRQoL construct measurement across versions. The OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were best measured by the OHIP domain scores for Physical Disability, Physical Pain, Psychological Discomfort, and Handicap, respectively.ConclusionRecommendations were derived which OHIP should be preferably used and how OHIP versions should be scored to capture the overall construct and the dimensions of OHRQoL. Psychometrically solid and practical OHRQoL assessment in all settings across all oral health conditions can be achieved with the 5-item OHIP.     

Dental fear and subjective oral impacts among adults in Finland

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: ‘How afraid are you of visiting a dentist?’ and subjective oral impacts were measured using the 14‐item Oral Health Impact Profile (OHIP‐14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP‐14 items fairly often or very often, and the ‘extent’ and ‘severity’. Those with high dental fear reported higher levels of prevalence, ‘extent’, and ‘severity’ of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP‐14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.     

Validity of two oral health-related quality of life measures

OBJECTIVES: To assess the validity of the Oral Impacts on Daily Performance (OIDP) and the short form of the Oral Health Impact Profile (OHIP 14) in the UK. SETTING: Primary care department at a UK dental hospital. SAMPLE: Consecutive patients. METHOD: Cross-sectional comparison of impacts using OIDP and OHIP 14 against clinical findings, Global Oral Health Ratings and pain. RESULTS: A total of 179 patients participated (83.2% response rate). OIDP had weak face validity because it contained contingency questions. Both instruments were developed from the same theoretical model and appeared to have reasonable content validity. In regression analyses, the number of impacts detected by each measure and the total score using OHIP 14 were related to the presence of oral disease and inversely related to age. No suitable transformation could be found to allow regression analysis of OIDP total scores. OHIP 14 correlated more closely with Global Oral Health Ratings but both measures correlated similarly to the experience of pain (0.43 < r < 0.47). The correlation between OHIP and OIDP scores was +0.78. The use of a simple additive method for calculating the total OHIP 14 score did not compromise its validity. CONCLUSION: Both instruments have some validity as measures of Oral Health-Related Quality of Life (OHRQoL) among dental hospital patients. The superior face, criterion and convergent validity and greater amenability to analysis of OHIP 14 render it more suitable for questionnaire-based research and for comparing groups. The additive method may be used to calculate the total score for OHIP 14.     

Oral health-related quality of life in patients with dental anxiety

OBJECTIVES: To investigate the frequency of impaired oral health-related quality of life (OHRQoL) in patients with dental anxiety. METHODS: OHRQoL was measured with the German version of the 14-item Oral Health Impact Profile (OHIP) developed by Slade and Spencer (1994) in 173 adult patients with dental anxiety [Dental Anxiety Scale (DAS) score 15 or above and Dental Fear Survey (DFS) score 60 or above]. The OHIP summary scores were characterized with an empirical cumulative distribution function and compared with the level of impaired OHRQoL in the general population (n = 2026, age: 16-79 years). In addition, OHIP item prevalences (responses 'fairly often'/'very often') were compared between patients and population subjects. The correlation between DAS, DFS and OHIP scores was calculated using the Pearson correlation coefficient. RESULTS: A median value of 1 and a 90th percentile value of 13 were observed for general population subjects. In contrast, patients with phobic dental anxiety had a median OHIP-14 of 21 and the 90th percentile of 40. All problems mentioned in the OHIP-14 were more prevalent in patients than in population subjects. The most frequently occurring items in patients were 'self-conscious', 'life in general was less satisfying', and 'feeling tense' with prevalences of 50% or greater. In contrast, these items had prevalences of only 1-3% in the general population. A low to moderate relationship between OHRQoL and both dental anxiety measures (DAS and DFS) was observed (r = 0.25/0.26, P < 0.01). CONCLUSIONS: Patients with dental anxiety/fear suffer considerably from impaired OHRQoL and the degree of this impairment is related to the extent of dental anxiety/fear.     

Dental Caries Experience and Oral Health Related Quality of Life in Working Adults

ObjectiveTo evaluate effect of dental caries experience and untreated dental decay on Oral Health-Related Quality of Life (OHRQoL) in working adults.MethodsThe clinical records of 160 patients were reviewed. Dental health indicators were derived from individual tooth- and surface-level data allowing for calculating the number of decayed surfaces (D), number of decayed missed filled surfaces (DMFS), and significant caries (SiC) indices. A questionnaire was administered to verify demographic factors and OHRQoL. The questionnaire was administered via face-to-face interview, for patients in the hospital; or via telephone interview, for those who could not complete it during their hospital visit. Models were developed using multivariable linear regression to predict total OHIP-14 scores and examine the simultaneous association of independent and outcome variables. The model was adjusted for age, gender, and nationality..ResultsPhysical limitation and psychological discomfort were the most frequent impacted domains, affecting 17.1% and 7.5% of subjects, respectively. Painful aching was the most frequent item to have any impact, affecting 64.4% of the subjects. The results of multivariable analysis indicated that the SiC score could statistically significantly predict the Oral Health Impact Profile (OHIP) score, P=0.0003. In the linear regression model, for participants with DMFS equal to or higher than the SiC, on average, OHIP scores were almost 10 points higher than for participants with DMFS below the SiC.ConclusionThe more the dental decay the higher the impact on OHRQoL. From a dental public health perspective, using OHRQoL as a need assessment tool, along with dental clinical indicator, can be helpful in planning and targeting public health programs for the most in-need adult populations.Clinical SignificanceThis study identified that patients with severe dental caries report poorer OHRQoL. Clinicians should be aware of impacts that dental decay may have on OHRQoL, including physical, psychological concerns, and pain.     

Confirmatory factor analysis of the Oral Health Impact Profile

Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher‐order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health‐Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four‐factor model and a bifactor model that included one general factor and four group factors. Using model‐fit criteria and factor interpretability as guides, the four‐factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0·05, CFI = 0·99) and interpretability. These results corroborate our previous findings that four highly correlated factors – which we have named Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact – can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four‐factor solution suggest that OHRQoL can also be sufficiently described with one score.