Development and validation of Hong Kong Rapid Estimate of Adult Literacy in Dentistry

Aim: To develop and validate an instrument, the Hong Kong Rapid Estimate of Adult Literacy in Dentistry (HKREALD‐30). Methods: The Rapid Estimate of Adult Literacy in Dentistry (REALD‐99) was translated into Chinese and modified in the pretest. A total of 200 parents of pediatric dental patients were interviewed using this modified scale and administered additional three sets of self‐reported questionnaires. The 99 items of the scale were reduced to 30 (HKREALD‐30). Concurrent validity was tested by comparing the HKREALD‐30 scores with the participants’ educational level, pattern of dental visits and reading habits. Convergent validity was tested by examining the association between HKREALD‐30 and the Test of Functional Health Literacy in Dentistry (TOFHLiD). The test–retest reliability and internal consistency of HKREALD‐30 were also evaluated. Results: A significant correlation (P < 0.01) was found between HKREALD‐30 and participants’ reading habits. HKREALD‐30 was also highly correlated with TOFHLiD (Spearman’s rho = 0.693, P < 0.01). In the regression model, HKREALD‐30 was positively associated with TOFHLiD (P < 0.05) after controlling for participants’ characteristics. The intra‐class correlation coefficient of HKREALD‐30 was 0.78 and the Cronbach’s alpha was 0.84. Conclusion: Initial testing of HKREALD‐30 suggested that it is a valid and reliable instrument for the basic screening of oral health literacy among Chinese people in Hong Kong.     

Development and testing of the Test of Functional Health Literacy in Dentistry (TOFHLiD)

OBJECTIVE: This study aims to evaluate the reliability and validity of the Test of Functional Health Literacy in Dentistry (TOFHLiD), a new instrument to measure functional oral health literacy. METHODS: TOFHLiD uses text passages and prompts related to fluoride use and access to care to assess reading comprehension and numerical ability. Parents of pediatric dental patients (n = 102) were administered TOFHLiD, a medical literacy comprehension test (TOFHLA), and two word recognition tests [Rapid Estimate of Adult Literacy in Dentistry (REALD), Rapid Estimate of Adult Literacy in Medicine (REALM)]. This design provided assessments of dental and medical health literacy by all subjects, both measured with two different methods (reading/numeracy ability and word recognition). Construct validity of TOFHLiD was assessed by entering the correlation coefficients for all pairwise comparisons of literacy instruments into a multitrait-multimethod matrix. Internal reliability of TOFHLiD was assessed with Cronbach's alpha. Criterion-related predictive validity was tested by associations between the TOFHLiD scores and the three measures of oral health in multivariate regression analyses. RESULTS: The correlation coefficient for TOFHLiD and REALD-99 scores (monotrait-heteromethod) was high (r = 0.82, P < 0.05). Coefficients between TOFHLiD and TOFHLA (heterotrait-monomethod: r = 0.52) and REALM (heterotrait-heteromethod: r = 0.53) were smaller than coefficients for convergent validity Cronbach's alpha for TOFHLiD was 0.63. TOFHLiD was positively correlated with OHIP-14 (P < 0.05), but not with parent or child oral health. TOFHLA was not related to dental outcomes. CONCLUSIONS: TOFHLiD demonstrates good convergent validity but only moderate ability to discriminate between dental and medical health literacy. Its predictive validity is only partially established, and internal consistency just meets the threshold for acceptability. Results provide solid support for more research, but not widespread use in clinical or public health practice.     

Reliability and validity of the Modified Dental Anxiety Scale (MDAS) in a Turkish population

OBJECTIVES: Fear of dentistry is a common obstacle to obtaining dental care in Turkey. The aim of this study was to assess the reliability, validity and psychometric characteristics of the Turkish translation of the Modified Dental Anxiety Scale (MDAS) and compare it to the Dental Fear Survey (DFS) scores obtained in the same population. METHODS: The Turkish translated version of the MDAS was administered to 115 dental patients; 21 subjects who suffered from dental phobia, requiring general anesthesia for dental procedures, and 94 who did not have dental anxiety, in addition to 442 subjects from the general population. RESULTS: The Turkish translated version of the MDAS was internally consistent and reproducible. The patients with dentist phobia had the highest score. The Turkish MDAS correlated with the DFS (r = 0.80, P < 0.001). The MDAS scale correlated inversely (r = -0.14, P < 0.005) with level of education; however, it did not correlate with economic status. Women scored higher than men on the scale (mean = 12.3, SD = 5.2 vs. mean = 10.9, SD = 4.5, P < 0.005). At a cut-off point > or = 15, sensitivity was 0.80, specificity 0.74, positive predictive value 0.41 and negative predictive value 0.94. CONCLUSION: Although the specificity values were low, the Turkish MDAS demonstrated acceptable sensitivity, positive and negative predictive values. Thus, high reliability and validity of the MDAS supports its cross-cultural validity and indicated that it may be a valuable tool in quantifying fear of dentistry among Turks.     

Reliability and validity of the Turkish version of the shorter form of the gagging problem assessment questionnaire

Summary  The aim of this study was to evaluate the reliability and validity of the Turkish version of the shorter form of the gagging problem assessment questionnaire. Forty-three patients with gagging problems and 89 patients who showed no signs of gagging during dental examination were included in the study. The patients completed the patient portion of the gagging problem assessment questionnaire, as well as the modified dental anxiety scale, dental fear scale and Spielberger trait anxiety scale for comparison. Two experienced dentists subsequently completed the dentist portion of the gagging problem assessment questionnaire by performing clinical examinations with a dental mirror. The results indicate that patients with gagging problems had significantly higher mean scores than the control group ( P  <   0·001). The internal consistency of the questionnaire was found to be adequate, and good intra- and inter-observer reliability was present. Patients with a gagging reflex had significantly higher anxiety scores, indicating the validity of the questionnaire. The Turkish translation of the shorter form of the gagging problem assessment questionnaire was found to be reliable and valid for distinguishing among patients with and without a gagging reflex.     

The Development and Practice of Social Dentistry in Germany

The traditions of social dentistry in Germany represent early forms of dental public health development. It was promoted in dental care facilities where salaried dentists delivered services to target groups, i.e., schoolchildren and sickness fund members. They enabled larger numbers of patients to receive dental care, especially those of lower class origin who otherwise would have remained untreated because of lack of financial resources or scarcity of manpower. School dental clinics not only delivered dental treatment, but also distributed oral hygiene and nutritional information to school-aged children. Social dentistry in the prefluoride era in Germany pursued an egalitarian and social-class oriented concept of dental care delivery, aiming at compensating the detrimental effects that the private practice-based, fee-for-service financed dental care system had produced in the lower classes of the population. The impact of the Nazi regime nearly abolished the institutions of social dentistry. They never were restored in West Germany after World War II. In East Germany dental care had been organized according to traditions of social dentistry, i.e., delivering services in dental treatment centers. Since the unification of the two German states, the institutions of dental care delivery in former East Germany have been restructured to fit the private practice-based model of former West Germany, eliminating most of the social dentistry institutions in the country.     

Reliability and validity of the short version of the Dental Anxiety Inventory

The present study focused on a newly developed questionnaire to assess dental anxiety. The short version of the Dental Anxiety Inventory (S-DAI) contains nine items of the Dental Anxiety Inventory (DAI), which was designed to take into account three situations that may evoke dental anxiety, four time elements in which dental anxiety may be provoked, and three reactions. The aim was to assess the validity and reliability of the S-DAI in a sample of highly anxious dental patients applying for treatment at a dental fear clinic in the Netherlands. Three hundred and twenty-one patientslled out several questionnaires assessing dental anxiety (S-DAI, DAS, and a 10-point Likert-scale) and psychological complaints. Total mean score on the S-DAI for women (mean=40.5, s =5.7) was some-what higher than for men (mean=38.8, s =6.9) ( t (306)=2.35; P =0.019). Cronbach's α for the present sample was 0.88. Correlations with other measures of dental anxiety were 0.73 with the DAS ( P < 0.001) and 0.69 ( P < 0.001) with the 10-point scale. The results indicated that the S-DAI has good reliability and construct validity. It was concluded that the S-DAI is easy to administer in general dental practices and dental fear clinics and has satisfactory psychometric qualities.     

Refining the Estimate of the Critical Period for Susceptibility to Enamel Fluorosis in Human Maxillary Central Incisors

Purpose : The purpose of this study was to determine an improved estimate of the critical period for susceptibility to fluorosis in human maxillary central incisors. Methods : The fluorosis score, S, of the incisal (I), middle (M), and cervical (C) third divisions on the labial surface of right maxillary central incisors of subjects (a representative sample of 1,085 Hong Kong Chinese children aged 7 to 12 years surveyed in 1986) was determined according to the Chronological Fluorosis Assessment (CFA) Index. Subject data were grouped by month of birth relative to June 1978, when the designated concentration for waterborne fluoride in the community water supply was reduced from 1.0 to 0.7 mg/L. The analytical task was one of finding the correlation maximum in a system of 12 variates and adjustable parameters including the waterborne fluoride concentration, [F^-], and the fluorosis score. Results : The main findings were: (1) the peak correlation of S vs [F^-] for the male incisal third centered at 17.5 months after birth; (2) and six months later for females; (3) the correlation of S with [F^-] is maximized for S(M) following S(I) by two months, and S(C) following S(M) by a further two months for both males and females; and (4) the critical period for exposure to fluoride is of about four months' duration for each third. Conclusions : The maxillary central incisor, as a whole, appears most at risk to fluorosis from dietary fluoride between age 15 and 24 months for males and between 21 and 30 months for females.     

Development of a word recognition instrument to test health literacy in dentistry: the REALD-30--a brief communication

OBJECTIVE: This study aims to develop and pilot test a dental word recognition instrument. METHODS: The development of our instrument was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), an efficient word recognition instrument used to assess health literacy in the medical arena. Our instrument, Rapid Estimate of Adult Literacy in Dentistry (REALD-30), consisted of 30 common dental words with various degrees of difficulty. It was administered to 202 English-speaking adults recruited from outpatient medical clinics. We examined the instrument's internal reliability using Cronbach's alpha and its validity by correlating the REALD-30 score to two dental outcomes (perceived dental health status and oral health-related quality of life) and medical health literacy. RESULTS: REALD-30 scores were significantly correlated with REALM scores. REALD-30 was significantly related to perceived dental health status in the bivariate analysis. It also was significantly related to oral health-related quality of life in a multivariate analysis. In contrast, medical health literacy was not related to either of the dental outcome measures. CONCLUSIONS: The new REALD-30 instrument displays good reliability but only partial validity. Results suggest that dental health literacy may be distinct from medical health literacy and may have an independent effect on dental health outcomes.     

Video-Assisted Clinical Instruction in Dentistry (VACID) enhances real-time visualisation of clinical procedures

AIM: The use of Video-Assisted Clinical Instruction in Dentistry (VACID) in the training of dental students represents an innovative teaching medium. Despite the many advantages that this teaching medium promises to offer, little objective research has been published to substantiate its purported benefits. This article examines the students' response to the application of VACID to enhance real-time visualisation of clinical procedures while observing live clinical procedures in periodontics. METHOD: Forty third-year dental students, observing surgical procedures during their rotation in the Department of Periodontics, were invited to participate in a survey designed to examine perceptions relating to their learning experience to using conventional and video-assisted real-time visualisation of clinical procedures. Students' responses were obtained using a questionnaire administered immediately after the completion of the observational period. The survey employed attitude questions addressing both enabling and outcome criteria. Wilcoxon signed-rank test was used to compare the student's responses. An open-ended question was also included in the survey to give students the opportunity to provide additional feedback regarding their experience and suggestions to improve on it. RESULTS: Results suggest that the implementation of VACID in the clinical setting improves the student's learning experience, interest and satisfaction. Ninety per cent of students strongly agreed to have VACID implemented for their next clinical observation. Responses to the open-ended question indicated that improved visualisation was extremely helpful in understanding the progress of clinical procedures. CONCLUSION: The implementation of VACID in the clinical setting enhances real-time visualisation of surgical procedures beyond what is offered by the conventional observational format.     

Five years of community preventive dentistry and health education in the County of Sutherland, Scotland

Examination of 11-year-old Scots children who had participated in a 5-year, fortnightly dental health education and preventive dentistry programme showed that, compared with a similar age-matched group, the regimen produced mean DMF and DMFS reductions of 48.6% and 42.1%, respectively. In addition, the plaque and gingival indices differed significantly and 22.5% of test children were caries-free compared with only 7.6% of controls.     

5条目口腔健康影响程度量表中文版的信度和效度研究

目的 对5条目口腔健康影响程度量表（OHIP-5）进行信度和效度评价。方法 按照国际生活质量量表准则,形成OHIP-5中文版,该量表包括5个条目。将OHIP-5中文版应用于就诊的患者,最终对调查结果进行统计学分析。采用内部一致性信度、重测信度对量表的信度进行考评;采用结构效度和收敛效度对量表的效度进行评价。结果 共回收有效问卷556份。量表总的克朗巴赫α系数为0.868,重测信度系数为0.831。经过验证性因子分析,修正模型的主要指标中,卡方/自由度=2.419,拟合指数=0.995,调整拟合指数=0.960,标准拟合指数=0.996,增量拟合指数=0.997,塔克-刘易斯指数=0.985,比较拟合指数=0.997,误差平方根近似值=0.070,均达到模型拟合标准。量表总分的Spearman’s等级相关系数为0.674。结论 OHIP-5中文版通过严格的性能测试,信度和效度良好,可在临床研究及流行病学调查中进一步推广应用。     

Changes in oral health-related quality of life (OHRQoL) related to long-term utilization of dental care among older people

Objective: To examine whether long-term utilization of dental care, treatment with fillings and crowns and persistent tooth loss between age 50 and 65 years associate with subsequent changes in OHRQoL from age 65 to 70 years.

Method: In 1992, a census of 50-year-olds received invitation to participate in a questionnaire survey. Of 6346 respondents, 3585 completed follow-ups in 1997, 2002, 2007 and 2012. OHRQoL was measured using the Oral Impacts on Daily Performances (OIDP) inventory.

Results: Around 70.4%, 11.2% and 18.4% confirmed respectively, no change, worsening, and improvement in OIDP scores between age 65 and 70 years. Compared to those being permanent non-routine dental attenders, ORs of improving and worsening of OIDP were respectively, 0.4 and 0.6 if being a permanent routine dental attender. ORs for improving OIDP was 1.6 if reporting persistent specialist attendance and 2.5 if having received crowns and fillings. Participants with permanent tooth loss were most likely to both worsen and improve OIDP.

Conclusion: Long-term routine dental attendance and permanent tooth loss occurred as predictors simultaneously for improvement and worsening of OIDP. Accumulation of advantages and disadvantages throughout the life-course increases and decreases the probability of improvement and worsening in OIDP among older people in Sweden.     

Reliability and validity of a Swedish version of the Oral Health Impact Profile (OHIP-S)

The aim of this study was to translate the Oral Health Impact Profile (OHIP) into Swedish and evaluate the reliability and validity of the Swedish version (OHIP-S). The OHIP is a 49-item, self-administered questionnaire divided into 7 different subscales. The original version in English was translated into Swedish, accompanied by back-translation into English, after which the Swedish version was revised. A total of 145 consecutive patients participated and answered a questionnaire. The patients comprised five clinically separate groups: temporomandibular dysfunction (TMD) (n = 30), Primary Sj?gren's Syndrome (SS) (n = 30), burning sensation and pain in the oral mucosa (oral mucosal pain, OMP) (n = 28), skeletal malocclusion (malocclusion) (n = 27), and healthy dental recall patients (controls) (n = 30). The TMD group and the control group participated in a test-retest procedure. The internal reliability of each subscale was calculated with Cronbach's alpha and found to be high and to range from 0.83-0.91. The stability (test-retest) of the instrument, calculated using the intraclass correlation coefficient, ranged from 0.87 to 0.98. The construct validity of OHIP-S was compared with subscales of the Symptom Check List (SCL-90) (rho 0.65) and the Jaw Function Limitation Scale (FLS) (rho 0.76) and analyzed with Spearman's correlation coefficient. Convergent validity was evaluated by comparing OHIP with self-reported health using Spearman's correlation coefficient and was found to be acceptable (rho 0.61). In the evaluation of the discriminative ability of the instrument, significant differences were found in the total OHIP-S score between the controls and the other four groups (P < 0.001). We conclude that the reliability and validity of OHIP-S is excellent. The instrument can be recommended for assessing the impact of oral health on masticatory ability and psychosocial function.     

Improving the Provision of the Basic Package of Oral Care (BPOC) in Cambodia

Since 1992, 330 medical nurses have been trained to provide basic oral health care (including ART restorations and dental extractions) in remote areas of Cambodia. However, a range of barriers prevent dental nurses from providing these services, especially a lack of dental materials and instruments. Objectives : To increase dental nurse (DN) outputs through the regular provision of dental materials and instruments. To improve cross‐infection control procedures through the provision of necessary equipment, supplies and training. Methods : Six health centres with active DNs participated; three (experimental) health centres received sufficient supplies of dental instruments and materials for one year, and 3‐monthly visits by a dentist from the Ministry of Health. The other three health centres (control) did not. Results : During the project period, the experimental group extractions increased to an average of 119 extractions per quarter (a three‐fold increase compared to the baseline), 51 ART restorations, and improved compliance with cross‐infection infection control protocols. In the control group the number of extractions remained similar to baseline and no ART restorations were placed. Conclusions : The provision of the BPOC increased in the health centres when sufficient supplies of dental materials and instruments were provided. Increased monitoring and communication with MOH dental colleagues was also associated with the increased outputs and resulted in improved compliance with cross‐infection control protocols. The MOH should increase supplies to DNs and provide ongoing monitoring and support in order to improve the access to and quality of dental care provided in rural Cambodia.     

A global perspective on changes in the burden of caries and periodontitis: implications for dentistry

The structure and contents of most oral health care systems and the contents of dental curricula reflect a deep-rooted tradition for attempting to cure oral diseases by refined technological means. However, better oral health conditions for the world's populations necessitate the application of up-to-date scientific knowledge to control the major oral diseases. This review points out that not only should the structure and contents of oral health care delivery systems be based on state-of-the-art knowledge about the biology of the oral diseases; they must also take into account the trends for change in caries and periodontal diseases within and between populations, and acknowledge the impact of changes in treatment philosophies for these trends. The oral disease profiles for populations in low- and high-income countries are briefly described, and it is concluded that the rapidly changing disease profiles observed in high-income countries necessitate re-thinking of the future role and organization of dentistry in such countries. The priorities for low- and middle-income countries must be to avoid repeating the mistakes made in the high-income countries. Instead, these societies might take advantage of setting priorities based on a population-based common risk factor approach. If such an approach is adopted, the training of personnel with oral health care competence must be rethought. The authors suggest three different cadres of dental care providers to be considered for an approach that allows health care planners in different populations around the world to prioritize appropriate oral health care with due respect for the socio-economic conditions prevailing.