Malocclusion and oral health-related quality of life in Brazilian school children: A population-based study

Objective:To test the hypothesis that malocclusion and its impact on quality of life has no effect on 8- to 10-year-old Brazilian schoolchildren as measured by an oral health-related quality of life (OHRQoL) instrument.Materials and Methods:A cross-sectional study was carried out with a population-based sample of 1204 8- to 10-year-old children attending elementary schools in Belo Horizonte, Brazil. Dental examinations were carried out by two calibrated examiners. OHRQoL was assessed using the Brazilian version of the Child Perceptions Questionnaire. The Dental Aesthetic Index was used for the clinical assessment of malocclusion. Dental caries and socioeconomic factors were used as controlling variables. Bivariate analysis involved the chi-square test and the Fisher exact test. A Poisson regression model was employed for the multivariate analysis (P < .05).Results:Anterior segment spacing and anterior mandibular overjet were significantly associated with impact on OHRQoL (P < .05). Schoolchildren with malocclusion were 1.30-fold (95% CI: 1.15–1.46; P < 0.001) more likely to experience a negative impact on OHRQoL than those without malocclusion. Children belonging to families with an income less than or equal to two times the minimum wage were 1.59-fold (95% CI: 1.35–1.88; P < 0.001) more likely to experience a negative impact on OHRQoL than those belonging to families with the highest income.Conclusions:Schoolchildren with malocclusion from lower-income families experience a greater negative impact on OHRQoL.     

Orthodontic treatment and its impact on oral health-related quality of life in Brazilian adolescents

Abstract

Objective: To assess whether Brazilian adolescents who had completed orthodontic treatment had lower levels of impacts on their oral health-related quality of life.

Design: A cross-sectional study.

Setting: The study was conducted in public and private secondary schools in Bauru-SP, Brazil.

Participants: 1675 randomly selected adolescents aged between 15 and 16 years.

Methods: Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess adolescents’ oral health-related impacts. Multiple logistic regression was used in the data analysis.

Results: A response rate of 100% was obtained. Adolescents who had completed orthodontic treatment had fewer oral health-related impacts compared to the other two groups. They were 1.85 times (95% CI 1.30 to 2.62) less likely to have an oral health impact on their daily life activities than adolescents currently under treatment or 1.43 (1.01 to 2.02) times than those who never had treatment.

Conclusions: Adolescents who had completed orthodontic treatment had a better oral health-related quality of life than those currently under treatment or those who never had treatment.     

Model specification in oral health-related quality of life research

The aim of this study was to analyze conventional wisdom regarding the construction and analysis of oral health-related quality of life (OHRQoL) questionnaires and to outline statistical complications. Most methods used for developing and analyzing questionnaires, such as factor analysis and Cronbach's alpha, presume psychological constructs to be latent, inferring a reflective measurement model with the underlying assumption of local independence. Local independence implies that the latent variable explains why the variables observed are related. Many OHRQoL questionnaires are analyzed as if they were based on a reflective measurement model; local independence is thus assumed. This assumption requires these questionnaires to consist solely of items that reflect, instead of determine, OHRQoL. The tenability of this assumption is the main topic of the present study. It is argued that OHRQoL questionnaires are a mix of both a formative measurement model and a reflective measurement model, thus violating the assumption of local independence. The implications are discussed.     

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口腔健康相关生活质量是近20年来口腔医学研究中备受关注的领域之一,然而相关研究在国内开展较少。本文对常用口腔健康相关生活质量量表、量表的翻译和验证、国内外口腔健康相关生活质量研究情况做一简要介绍。     

大学生错畸形与口腔健康相关生存质量的相关性

目的调查错畸形与大学生口腔健康相关生存质量(OHRQoL)的相关性。方法从秦皇岛地区4所高校随机抽取610名无正畸史、缺失牙和颌面部畸形的大学生为研究对象。选用正畸治疗需要指数(IOTN)行牙颌检查,以口腔健康相关生存质量影响程度量表(OHRQoL-UK)对样本进行评估。结果 8.7%受试者自诉在过去1个月中,16个条目中至少有一项受到错畸形的负面影响。在生理、心理和社会三分项中,心理方面的分值最低。OHRQoL-UK表在总分值及三分项上与牙齿健康分值(IOTN-DHC)和牙齿美学分值(IOTN-AC)均呈负相关。结论错畸形客观检查的IOTN牙齿健康部分(IOTN-DHC)和主观自评的IOTN牙齿美学部分(IOTN-AC)均与OHRQoL呈负相关关系。IOTN-DHC与生理方面相关性最大,而IOTN-AC与心理方面相关性最大且无性别差异。     

Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders

Abstract – Objective The aim of this study was to assess the association of chewing ability to oral health‐related quality of life (OHRQoL) measured by the Oral Health Impact Profile‐14 (OHIP‐14) controlling for clinical oral health status, self‐reported health status, demographic factors, and socioeconomic conditions among community‐dwelling and institutionalized Korean elders. Methods This cross‐sectional study comprised a sample of 307 community‐dwelling and 102 institutionalized people over the age of 60, using a cluster sampling procedure. A questionnaire was implemented and a clinical oral examination was completed for each subject. The outcome variable of interest was the OHIP‐14 score, and its associations with chewing ability, objective oral health status, self‐reported health status, demographic factors, and socioeconomic conditions were assessed. Because of highly‐skewed distribution of the OHIP‐14 scores, nonparametric analytic methods were used. The final model was developed using a multivariable two‐level logistic regression model for a dichotomized OHIP‐14 score to account for the cluster sampling method applied to this study. Results The mean age of the participants was 75.4 years, with 67.7% being women. The median OHIP‐14 score was 7. Negative oral health impacts were experienced fairly often or very often by a total of 36.4% of elderly. In the final model, elders who could chew none to three and four to six foods among seven indicator foods were 3.4 (P = 0.010) and 2.0 (P = 0.040) times more likely, respectively, to have worse OHRQoL compared with elders who could chew all seven food types. Also significant associations with worse OHRQoL were shown for being concerned about oral health [Odds Ratio (OR) = 4.9, P = 0.002], fair or better self‐reported oral health (OR = 0.12, P = 0.002), very good/good self‐reported general health (OR = 0.38, P = 0.008), being married (OR = 2.0, P = 0.054), and having a favourable economic status (OR = 0.43, P = 0.042). Conclusions This study showed highly significant association between chewing ability and OHRQoL measured by the OHIP‐14 score after controlling for related factors. Amelioration of chewing ability might independently contribute to improving the OHRQoL of elders.     

口腔健康相关生活质量调查在正畸学中的应用

口腔健康相关生活质量是反映口腔疾病及其防治对患者的身体功能、心理功能和社会功能等方面影响的综合评估.口腔正畸治疗对患者的生活质量有着显著影响,正畸患者在疗程中感受到功能限制、生理疼痛、心理不适、社会功能障碍和治疗后整体生活质量的改善.本文就口腔健康相关生活质量量表及正畸学相关的口腔健康相关生活质量研究方面作一综述.     

口腔扁平苔藓患者口腔健康相关生活质量的初步研究

目的通过口腔健康影响程度量表（OHIP）-14中文版了解口腔扁平苔藓患者口腔健康相关生活质量情况,探讨其应用于口腔扁平苔藓临床诊疗的可靠性和准确性。方法采用OHIP-14中文版对51例口腔扁平苔藓患者进行问卷调查,同时采用视觉类比标尺（VAS）对疼痛程度进行评分,REU评分系统对病损情况进行评分。通过SPSS 16.0软件对量表的信度和效度进行统计分析。结果OHIP-14的得分为21.67±9.45,量表的内部一致性Cronbach’s α系数为0.901,因子分析提取的5个公因子与量表各领域有密切的逻辑关系,量表得分与REU分值和VAS分值间呈正相关关系（r=0.608,0.807;P<0.000）。结论OHIP-14中文版评测口腔扁平苔藓患者的口腔健康相关生活质量具有较好的信度和效度,可为病情评估提供参考。     

The relationship between oral conditions,masticatory performance and oral health-related quality of life in children

Objective

To evaluate the association between oral conditions, masticatory performance (MP) and oral health-related quality of life (OHRQoL) in 8–12 year-old children.

Design

150 Brazilian scholars were examined for caries and malocclusions. MP was evaluated based on the ability to comminute an artificial test food followed by the determination of the median particle size (X₅₀) and particle distribution in different-sized sieves (“b”). OHRQoL was measured using the Brazilian versions 8–10 and 11–14 of the child perceptions questionnaire (CPQ), considering the following domains: oral symptoms (OS), functional limitations (FL), emotional well-being (EW) and social well-being (SW). Higher scores indicated worse OHRQoL. Data were submitted to Spearman's correlation test and multiple linear regression analysis.

Results

There were significant positive correlations between the psychosocial and OS domains scores of the CPQ_8–10 and the number of decayed and missing teeth, respectively. The number of decayed teeth positively correlated with the number of missing teeth and the CPQ_11–14 scores. The number of decayed and missing teeth was significantly associated with higher CPQ_8–10 scores. Higher CPQ_11–14 overall scores were associated with female gender, higher FL domain scores were associated with the number of missing teeth, and higher X₅₀ values and EW domain scores were associated with female gender and the number of decayed teeth.

Conclusions

A higher number of missing teeth correlated with an inferior MP in older children. Children with a higher number of caries rated their oral health less favourably. Older females and those who broke the test material into smaller sizes were also more likely to report a worse OHRQoL, suggesting that the time allowed to reduce food appears to be a more influential factor on children’ perception of oral health than their ability to break down the test material into smaller sizes. Moreover, the subjectivity of functional domain and artificial nature of chewable test material could have influenced the test sensitivity.     

Assessing the responsiveness of measures of oral health-related quality of life

OBJECTIVES: This paper illustrates ways of assessing the responsiveness of measures of oral health-related quality of life (OHRQoL) by examining the sensitivity of the oral health impact profile (OHIP)-14 to change when used to evaluate a dental care program for the elderly. METHODS: One hundred and sixteen elderly patients attending four municipally funded dental clinics completed a copy of the OHIP-14 prior to treatment and 1 month after the completion of treatment. The post-treatment questionnaire also included a global transition judgement that assessed subjects' perceptions of change in their oral health following treatment at the clinics. Change scores were calculated by subtracting post-treatment OHIP-14 scores from pre-treatment scores. The longitudinal construct validity of these change scores were assessed by means of their association with the global transition judgements. Measures of responsiveness included effect sizes for the change scores, the minimal important difference, and Guyatt's responsiveness index. An receiver operating characteristic (ROC) curve was constructed to determine the accuracy of the change scores in predicting whether patients had improved or not as a result of the treatment. RESULTS: Based on the global transition judgements, 60.2% of subjects reported improved oral health, 33.6% reported no change, and only 6.2% reported that it was a little worse. These changes are reflected in mean pre- and post-treatment OHIP-14 scores that declined from 15.8 to 11.5 (P < 0.001). Mean change scores showed a consistent gradient in the expected direction across categories of the global transition judgement, but differences between the groups were not significant. However, paired t-tests showed no significant differences in the pre- and post-treatment scores of stable subjects, but showed significant declines for subjects who reported improvement. Analysis of data from stable subjects indicated that OHIP-14 had excellent test-retest reliability with an intraclass correlation coefficient (ICC) of 0.84. Effect size based on change scores for all subjects and subgroups of subjects were small to moderate. The ROC analysis indicated that OHIP-14 change scores were not good "diagnostic tests" of improvement. The minimal important difference for the OHIP-14 was of 5-scale points, but detecting this difference would require relatively large sample sizes. CONCLUSIONS: OHIP-14 appeared to be responsive to change. However, the magnitude of change that it detected in the context described here was modest, probably because it was designed primarily as a discriminative measure. The psychometric properties of the global transition judgements that often provide the "gold standard" for responsiveness studies need to be established.     

The impact of the National Denture Service on oral health-related quality of life among poor elders

The objective of this study was to assess the effects of the Korean National Denture Service (NDS) for poor elderly people requiring dentures on oral health-related quality of life (OHRQOL). Data from follow-up studies were collected from 439 subjects at eight public health centres who answered every question of a questionnaire, and the OHRQOL was measured at the baseline and at 3-month follow-up after receiving the NDS according to the type of denture provision. The multivariate linear mixed model with a public health centre as a random effect for the score change of Oral Health Impact Profile (OHIP)-14K was carried out to confirm the factors related to the improvement in OHRQOL. The mean OHIP-14K was 28.60 at the baseline time points, and there was a decrease in the OHIP-14 scores to 21.14 ± 12.52 at the 3-month follow-up of the removable partial denture beneficiaries. The changes in OHIP-14K among complete denture beneficiaries were 21.53 ± 12.01 for previously dentate subjects and 22.54 ± 11.12 for edentate subjects. The multivariate linear mixed model of dentate subjects demonstrated that the improvement in the OHRQOL was associated with the number of remaining teeth, satisfaction with denture and self-reported oral health status after 3 months. In the case of the edentate model, satisfaction with denture was the only factor related to the improvement in OHRQOL. This study revealed considerable improvement in OHRQOL among poor elderly people after NDS. Satisfaction with provision of dentures was associated with improvement in the OHRQOL.     

Demographic factors, denture status and oral health-related quality of life

OBJECTIVES: This study investigated the association between denture status, demographic factors, and oral health-related quality of life (OHRQoL). METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G, 53 items), which was administered in a personal interview to 2050 subjects (60% of eligible subjects responded) 16-79 years of age in a national survey. Median regression was used to analyze the influence of denture status (no, removable, complete dentures), age, gender, education (less than 10 years of schooling, 10-12 years, more than 12 years), and residential area (rural, urban) on the OHIP-G summary score. RESULTS: In bivariable analyses, compared to the base category, the OHIP-G median increased 8.0 U for subjects with removable dentures, 20.0 U for subjects with complete dentures, 1.7 U for each 10-year age period, 2.0 U for men, 3.0 U for less than 10 years of schooling (compared to > or =10 years.), and 1.0 U for urban areas (P < 0.05 for all effects except for residential area). In the multivariable analysis, compared to subjects without dentures, subjects with removable dentures had a 7.5 (95% CI: 5.2-9.8) higher OHIP-G median and subjects with complete dentures had a 18.5 (95% CI: 14.7-22.4) higher median when demographic variables were controlled. No demographic variables were statistically significant except for residential area (P = 0.04). CONCLUSIONS: Denture status was a stronger predictor for impaired OHRQoL than demographic variables and rendered age and education almost negligible in their influence on OHRQoL.     

Disparities in oral health-related quality of life in a population of Canadian children

OBJECTIVES: To assess socioeconomic disparities in the oral health-related quality of life in a group of Canadian children. METHODS: Data were obtained as part of a study designed to assess the functional and psychosocial impact of traumatic dental injury. Clinical data were collected on a random sample of children during a school-based dental screening program that included measures of dental decay experience, treatment needs, dental trauma, fluorosis, and malocclusion. Children with dental trauma and a comparison group of trauma-free children were selected for follow-up. Their parents were mailed a questionnaire concerning the child's personal and family characteristics. Also enclosed was a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire (CPQ) 11-14. Bivariate and multivariate analyses were undertaken to determine whether there were disparities in oral health-related quality of life according to household income. RESULTS: Complete data were collected from 370 children. Mean CPQ11-14 scores showed a gradient across income categories with children from low income households having poorer oral health-related quality of life. Children from households containing only one adult also had higher scores than children living with two or more adults. In both linear and logistic regression analyses household income and family structure remained significant predictors of CPQ11-14 scores after controlling for oral disease variables. Further analyses suggested that oral disorders had little impact on the health-related quality of life of higher income children but a marked impact on lower income children. The highest mean CPQ11-14 scores were observed among low income children with the more severe levels of oral disease. CONCLUSION: The data indicate that in this group of children there were socioeconomic disparities in oral health-related quality of life. A potential explanation may be differences in psychological assets and psychosocial resources.     

Oral health-related quality of life of children with neutropenia

This study evaluated the oral health-related quality of life (OHQoL) in children with neutropenia. Twenty-seven children with neutropenia were compared to 33 healthy, age-matched control subjects. Previously validated age- specific, multidimensional and self -reporting child OHQoL questionnaires were used. Overall and subscale scores were compared between the two groups. Respondents in the group of children with neutropenia reported that their disease had a significant impact on their oral health in terms of oral symptoms (p<0.0001), functional limitations (p<0.0001), and social well-being (p<0.0001). In global ratings, they rated their oral health to be markedly worse than that of the healthy subjects (p<0.0001). However, there was no difference between the groups in the extent to which their oral condition affected their lives overall. These results, along with responses to individual measures of social and emotional well-being, suggest that children in this group with neutropenia have psychologically adapted to the oral health challenges they experience because of their condition.     

Developing short-form measures of oral health-related quality of life

OBJECTIVES: Using the item-impact method, we developed an alternative short-form Oral Health Impact Profile (OHIP) that has good psychometric properties and minimal floor effects. METHODS: OHIP data were collected from a sample of older Canadians at two points in time. Data from the first administration were used to develop a 14-item short-form measure; data from the second compare the latter's psychometric properties with those of the original short form developed by Slade (1997), who used a controlled regression procedure. RESULTS: The short form based on the item-impact method had only two items in common with the short form derived from the regression approach and contained more high-prevalence items. The regression short form was subject to marked floor effects, while the impact short form had floor effects comparable to those of the full 49-item OHIP. The former discriminated between dentate and edentulous subjects, while the latter did not. Both discriminated between dentate subjects who did and did not wear dentures, those with and without dry mouth, and those with and without chewing problems. Both were also significantly associated with self-ratings of oral health, satisfaction with oral health, and self-perceived need for dental treatment. The strength of the associations was somewhat stronger with the regression short form, indicating that it performed better as a discriminatory instrument. However, because of its floor effects, it was markedly less sensitive to change than the impact short form. There was an indication that item-impact methods of shortening oral health-related quality of life measures produced more stable results across samples than the statistical approach. CONCLUSIONS: Because the content validity of short-form measures is always compromised, different short forms are required for different purposes and different patient populations. The regression short form developed by Slade (1997) is likely to be better when the aim is to discriminate, while the impact short form developed here may be preferable when the aim is to describe the oral health-related quality of life of populations or to detect change.     

Two-year incidence of oral disadvantage,a measure of oral health-related quality of life

Dental research has progressed from describing the burden of oral disease using traditional epidemiologic measures of incidence and prevalence, to measuring how oral disease, oral signs, and oral symptoms affect the daily activities and the overall quality of life of the individual. However, longitudinal evaluation of these associations remains rare. OBJECTIVES: To (i). describe the 2-year incidence and patterns of oral disadvantage; (ii). identify dimensions of oral health measures that are significant antecedents of oral disadvantage; and (iii). determine which oral health dimensions are the most strongly predictive of oral disadvantage. METHODS: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth and were 45 years or older. Incidence rates, odds ratios, and 95% confidence intervals were used to describe oral disadvantage and its relation to other measures of oral health. RESULTS: Nearly one-half of the participants experienced oral disadvantage at least once during 24 months of follow-up. The strongest antecedents associated with oral disadvantage were toothache pain and chewing difficulty. CONCLUSIONS: The incidence of oral disadvantage is substantial and consistent with the notion that oral health has a substantial impact on quality of life. Measures of oral pain and oral functional limitation were more strongly predictive of oral disadvantage than disease and tissue damage antecedents.     

Racial and socioeconomic disparities in oral disadvantage,a measure of oral health-related quality of life: 24-month incidence

OBJECTIVES: This paper estimates the incidence of oral disadvantage based on the subject's approach to dental care, sex, race, and financial status; identifies demographic and socioeconomic characteristics that were associated with oral disadvantage; and determines if these characteristics were differentially associated with the three domains of oral disadvantage. METHODS: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth, were 45 years or older, and were either African American or non-Hispanic white. Incidence rates, odds ratios, and 95 percent confidence intervals were used to describe oral disadvantage and its relation to race, income, and other key sociodemographic characteristics. RESULTS: The strongest independent predictors of oral disadvantage were approach to dental care (problem-oriented attenders or regular), and situation if faced with an unexpected $500 dental bill. Demographic and socioeconomic characteristics were differentially associated with each disadvantage domain. CONCLUSIONS: African Americans, females, rural residents, individuals who did not graduate from high school, individuals with limited financial resources, and problem-oriented dental attenders had significantly higher occurrences of oral disadvantage. Racial and sex disparities in oral disadvantage were largely explained by differences in approach to dental care and financial resources between these groups.     

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.