Validity and reliability of OIDP and OHIP-14: a survey of Chinese high school students

Background

To determine the impact of oral diseases on everyday life, measures of oral quality of life are needed. In complementing traditional disease-based measures, they assess the need for oral care to evaluate oral health care programs and management of treatment. To assess the reliability and validity of the Oral Impact of Daily Performance (OIDP) and the short-form Oral Health Impact Profile (OHIP-14) among high school students in Xi’an, the capital of Shanxi province, China.

Methods

Cross-sectional one-stage stratified random cluster sample using high schools as the primary sampling unit. Students completed self-administered questionnaires at school. The survey included the OHIP-14 and OIDP inventories, translated and culturally adapted for China, and global oral health and socio-behavioral measures.

Results

A total of 5,608 students participated in the study, with a 93% response rate (mean age 17.2, SD 0.8, 52% females, 45.3% urban residents).The proportion experiencing at least one impact (at any frequency) during the previous six months was 62.9% for the OHIP-14 and 45.8% for the OIDP. Cronbach’s alpha measured internal consistency at 0.85 for OHIP-14 and 0.75 for OIDP while Cohen’s kappa varied between 0.27 and 0.58 for OHIP-14 items and between 0.23 and 0.65 for OIDP items. Kappa scores for the OHIP-14 and OIDP additive scores were 0.52 and 0.66, respectively. Both measures varied systematically and in the expected direction, with global oral health measures showing criterion validity. The correlation between OIDP and OHIP-14 was r_s +0.65. That both measures varied systematically with socio-behavioral factors indicates construct validity.

Conclusion

Both the OIDP and OHIP-14 inventories had reasonable reliability and construct validity in relation to subjective global oral health indicators among adolescents attending high schools in China and thus appear to be useful oral health –related quality of life measures in this context. Overall, the OHIP-14 and OIDP performed equally well, although OHIP-14 had superior content validity due to its sensitivity towards less severe impacts.

     

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.     

Utility of two oral health-related quality-of-life measures in patients with xerostomia

OBJECTIVES: The study compared the validity of the short form of the Oral Health Impact Profile (OHIP) and Oral Impacts on Daily Performance (OIDP) as measures of oral health-related quality of life in patients with xerostomia in the UK. METHODS: A cross-sectional comparison of OHIP14 and OIDP with measures of clinical indicators, xerostomia symptom status, speech function, global oral health ratings and psychological well-being, in 85 patients attending outpatient clinics. RESULTS: Both OHIP14 and OIDP had excellent internal reliability, and good criterion and construct validity when used in this population of xerostomia patients. In regression analyses, salivary gland condition and xerostomia symptom status significantly predicted oral health-related quality of life (OHRQoL), accounting for 29% and 14% of the variance in OHIP and OIDP scores respectively. In turn, OHRQoL predicted global ratings of oral health (26% of variance) and psychological well-being (depression) scores (15%). Sex, ethnicity and age were associated with clinical presentation and patient-reported symptoms. Clinical presentation, OHRQoL (as measured by the OIDP) and speech function were related to duration of symptoms. CONCLUSION: Both OHIP14 and OIDP have good psychometric properties and appear useful measures of OHRQoL in xerostomia. Overall, the OHIP14 performed better than did OIDP. For both measures, the additive scoring method may be more relevant for this population that the number of impacts.     

Oral health-related quality of life of 11- and 12-year-old public school children in Rio de Janeiro

Castro RAL, Portela MC, Leão AT, Vasconcellos MTL. Oral health–related quality of life of 11‐ and 12‐year‐old public school children in Rio de Janeiro. Community Dent Oral Epidemiol 2011; 39: 336–344. © 2010 John Wiley & Sons A/S Abstract – Objectives: The objective of this study was to assess the association between oral health–related quality of life (OHRQoL), measured through the Child‐OIDP, and demographic characteristics, self‐reported oral problems, and clinical oral health measures, among 11‐ to 12‐year‐old school children in the city of Rio de Janeiro, Brazil. Methods: A cross‐sectional study was conducted, having as its target population 11‐ and 12‐year‐old students of both sexes, formally enrolled in 6‐ and 7‐year school classes at public schools. A probabilistic sample with complex design was used. OHRQoL was assessed by the Brazilian version of Child‐OIDP. Oral exams were conducted, and the presence of dental biofilm, gingival bleeding, DMFT, fluorosis, enamel defects, dental trauma, and malocclusion were recorded. Results: A total of 571 school children participated with a mean age of 12.0 years and 95% confidence interval (95% CI) from 11.9 to 12.1. A total of 88.7% of the school children presented the impact of oral problems in at least one of the eight daily performances. The activities that had most impacts were eating (81.3%), cleaning mouth (40.5%), and smiling (32.2%). The mean Child‐OIDP index was 7.1 with 95% CI from 6.2 to 8.1. The highest scores were in relation to eating (mean = 25.0; 95% CI from 22.4 to 27.6), cleaning mouth (mean = 12.0; 95% CI from 9.1 to 14.9), and smiling (mean = 10.0; 95% CI from 7.5 to 12.5). In the logistic regression model, the Child‐OIDP was associated with dental caries experience and with the perception of sensitive teeth, perception of gingival bleeding, and perception of inadequate position of the teeth. In the multinomial regression, we found that the odds of having higher levels of Child‐OIDP were positively associated with dental caries experience. Self‐reported dental caries, mobile milk teeth, tooth position, bleeding gums, and bad breath were associated with worst OHRQoL. Conclusions: It can be concluded that there is an association between dental caries experience and the Child‐OIDP index. This association indicates the impact of this condition on the quality of life of school children. Moreover, the Child‐OIDP index is explained more by self‐reported oral problems than by clinical normative measures.     

Validation of a Hebrew version of the Oral Health Impact Profile 14

OBJECTIVE: This study determined the validity of a Hebrew version of the Oral Health Impact Profile in a cross-sectional study of a general dental practice in Israel. METHODS: The original English version of a short-form oral health impact profile (OHIP-14) was translated into Hebrew using the back-translation technique. Participants were interviewed and examined clinically by a calibrated dentist. Information on the subjects' sociodemographic background and oral health conditions was collected. RESULTS: A total of 142 persons were interviewed and clinically examined. The Cronbach's alpha and the standardized item alpha for OHIP-14 were both 0.88. Cronbach's alpha of the translated OHIP-14 subscales ranged from 0.48 to 0.76. Construct validity of the translated Hebrew version was supported by the finding that the total OHIP score correlated with the number of decayed teeth, missing teeth, need for prosthodontic treatment, and pattern of dental attendance. Participants with oral pain were more likely to report impact on one of the OHIP subscales and to have more impacts than participants who were pain free. CONCLUSIONS: The Hebrew version of OHIP-14 presented acceptable validity and reliability. Further research is needed to assess the value of this measure in Israel.     

Comparative assessment of validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross‐sectional survey among adolescents in Davanagere city,Karnataka, India

Abstract: Aim: To evaluate reliability and validity of an abbreviated version of the Oral Impact on Daily Performance (OIDP) questionnaire and to analyse the interrelationship between OIDP scores, socio‐demographic characteristics and oral health status among high school children in Davanagere city, Karnataka, India. Materials and methods: This cross‐sectional survey was conducted with 900 school children aged between 12 and 15. The subjects were randomly selected from six high schools. Selected subjects completed a survey instrument predesigned to measure subjective oral health indicators including the eight‐item OIDP frequency scores. The study participants were clinically examined for dental caries, and they completed a self‐administered questionnaire about demographic information and oral behaviours. Results: 44% of the students reported at least one oral impact in the previous 6 months. The reliability of the instrument was measured in terms of Cronbach’s alpha for the OIDP frequency. It was found to be 0.81. Eating was the most common performance affected (33%) followed by cleaning teeth (22%) and speaking (20%). The severity of impacts was low for relaxing and carrying out works. Conclusion: The OIDP frequency score has acceptable psychometric properties in the context of an oral health survey among high school children of Davanagere city, Karnataka, India.     

Derivation and validation of a short-form oral health impact profile

Abstract Growing recognition that quality of life is an important outcome of dental care has created a need for a range of instruments to measure oral health-related quality of life. This study aimed to derive a subset of items from the Oral Health Impact Profile (OHIP-49) - a 49-item questionnaire that measures people's perceptions of the impact of oral conditions on their well-being. Secondary analysis was conducted using data from an epidemiologic study of 1217 people aged 60+ years in South Australia. Internal reliability analysis, factor analysis and regression analysis were undertaken to derive a subset (OHIP-14) questionnaire and its validity was evaluated by assessing associations with sociodemographic and clinical oral status variables. Internal reliability of the OHIP-14 was evaluated using Cronbach's coefficient α. Regression analysis yielded an optimal set of 14 questions. The OHIP-14 accounted for 94% of variance in the OHIP-49; had high reliability (α=0.88); contained questions from each of the seven conceptual dimensions of the OHIP-49; and had a good distribution of prevalence for individual questions. OHIP-14 scores and OHIP-49 scores displayed the same pattern of variation among sociodemographic groups of older adults. In a multivariate analysis of dentate people, eight oral status and sociodemographic variables were associated (P<0.05) with both the OHIP-49 and the OHIP-14. While it will be important to replicate these findings in other populations, the findings suggest that the OHIP-14 has good reliability, validity and precision.     

Patient-centred outcome measures in oral medicine: are they valid and reliable?

The present study evaluates the performance of patient-centred outcome measures in the oral medicine setting in patients with oral lichen planus. The study included 48 patients with a histologically confirmed diagnosis of oral lichen planus who completed a questionnaire incorporating two patient-centred outcome measures: the 16-item UK Oral Health Related Quality Of Life Measure (OHQOL-UK) and 14-item Oral Health Impact Profile (OHIP-14). They subsequently underwent an oral examination and rated the pain they experienced on a visual analogue scale (VAS). The impact of oral health on their life quality was considerable with physical, social and psychological consequences. Both OHQOL-UK (P<0.01) and OHIP-14 scores (P<0.01) were associated with clinical findings; demonstrating criterion validity. Patient rating of pain experienced (on a VAS) correlated with OHQOL-UK scores (P<0.01) and OHIP-14 (P<0.01); demonstrating construct validity. The mean inter-item correlation for OHQOL-UK was 0.93 and was 0.90 for OHIP-14; demonstrating high internal consistency reliability. Our results suggest both OHQOL-UK and OHIP-14, patient-centred outcome measures perform well in patients with oral lichen planus, demonstrating validity and reliability. This implies patient-centred outcome measures may be utilized in both oral medicine and oral and maxillofacial surgery to assess patient needs and opinions.     

Subjective impacts of dental caries and fluorosis in rural Ugandan children

OBJECTIVE: Describe the oral health related quality of life among a group of children in rural Uganda and compare impacts on oral health related quality of life associated with dental caries and fluorosis. BASIC RESEARCH DESIGN: Cross-sectional clinical and questionnaire analytical study. PARTICIPANTS: Proportional sample of 174 12 year olds attending primary schools in a rural sub-county of Uganda. OUTCOME MEASURES: Clinical assessments using WHO basic methods and the Thylstrup and Fejerskov index of Fluorosis (TFI). Child Oral Health Related Quality of Life data collected with self-administered child perception questionnaire (CPQ11-14). RESULTS: Two thirds of children reported a dental impact 'often' or 'everyday'. The mean number of impacts per child at this threshold was 2.6 and the mean total CPQ11-14 score was 25.8 (sd 21.1). Mean DMFT was 0.68. No children had fillings. Forty-one children had dental fluorosis with 10 having scores greater than 2. CPQ11-14 showed acceptable criterion validity and reliability. The number of sites with gingivitis or the presence of calculus or trauma were not associated with summary measures of CPQ11-14 whereas having any dental caries or treatment experience was associated with higher total scores and more impacts. Socially noticeable fluorosis (TFI >2) was associated with more impacts but not with higher total scores. CONCLUSIONS: Despite low levels of oral disease these children experience appreciable impacts on oral health related quality of life. The greatest burden was associated with dental caries and to a lesser extent, fluorosis.     

Personality and oral health

We investigated age-26 personality characteristics and age-32 oral health in a prospective study of a complete birth cohort born in Dunedin, New Zealand. Personality was measured using the Multidimensional Personality Questionnaire (MPQ). Oral health was measured using the short-form Oral Health Impact Profile (OHIP-14), a global measure, and dental examinations. Personality profiles were constructed for 916 individuals (50.8% men) using standardized MPQ scores, and multivariate analyses examined their association with oral health. Those reporting 1+ OHIP-14 impacts had higher Negative Emotionality scores (and lower Constraint and Positive Emotionality MPQ superfactor scores) than those who did not. After controlling for gender, clinical status, and the other two MPQ superfactors, those scoring higher on Negative Emotionality had a greater risk of reporting 1+ OHIP-14 impacts, as well as 3+ OHIP-14 impacts and worse-than-average oral health. They also had a greater risk of having lost at least one tooth from caries and of having 3+ decayed surfaces. Personality characteristics appear to shape self-reports of oral health. Personality is also a risk factor for clinical disease status, at least with respect to dental caries and its sequelae. Because the attitudes and values tapped into by personality tests can be altered by brief cognitive interventions, those might be useful in preventive dentistry.     

Evaluation of a Swedish version of the OHIP-14 among patients in general and specialist dental care

The aim of this study was to investigate the Swedish version of an oral health-related quality of life (OHRQL) instrument, the short form of the Oral Health Impact Profile (OHIP-14), and to assess OHRQL among patients in general dental care and specialist clinics (periodontics, TMD and implant dentistry) in G?teborg, Sweden. Consecutively selected patients were asked to answer the OHIP-14, the General Oral Health Assessment Index (GOHAI) and a questionnaire including socio-demographic, general health and oral health questions. 153 patients (50-89 years old) out of 237 (65%) returned the questionnaires. Cronbach's Alpha among the OHIP items was high (0.93) and the corrected item-scale correlation varied between 0.51 and 0.79. The correlation between the OHIP-14 score and the GOHAI was high (-0.83) indicating good criterion validity. The mean additive OHIP-14 score was 22.6 (SD = 10.5). Implant patients scored significantly higher than other patient groups with respect to missing teeth, dentures and mobile teeth. High scores were also associated with perceived poor general health and dissatisfaction with life-situation. The test-retest reliability was assessed in a separate sample (n = 47) and the correlation coefficient was 0.85. The Swedish version of OHIP-14 demonstrated good reliability and validity. The poorer OHRQL reported by the implant patients reflects the strong association found between OHIP score and dentures and missing teeth, while OHIP-14 did not show similar sensitivity to other impacts of oral disorders.     

Comparison of a generic and a specific measure of oral health related quality of life

OBJECTIVES: The aims of the study were to compare the discriminant validity of a generic health state measure, the EuroQol, and a specific oral health measure, the Oral Health Impact Profile. PARTICIPANTS: Patients treated by a random sample of South Australian dentists. BASIC RESEARCH DESIGN: Data were collected in 2001-02 using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental conditions and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D+) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments. Data were available from 375 patients (response rate = 72%). MAIN OUTCOME MEASURES: Three measures (simple counts, additive scores and scale scores) were used for each instrument and compared by oral health, patient demographic and visit factors, and main presenting dental condition. RESULTS: Across all three measures the OHIP-14 was associated with the oral health factors of dentate status, number of teeth, denture wearing and number of decayed teeth while the EuroQol was associated with decayed teeth. For patient demographics both the EuroQol and OHIP-14 were associated with age of patient. For visit factors both the EuroQol and OHIP-14 were associated with visit type and insurance status, while only the EuroQol was associated with time since last visit. Both the EuroQol and OHIP-14 were associated with main dental condition. CONCLUSIONS: There was little difference in the number of associations of either EuroQol or OHIP-14 scores regardless of whether simple counts, additive scores or scale score measures were used. In bivariate analyses the OHIP-14 was more sensitive to oral health factors, but the EuroQol performed as well or better than the OHIP-14 for patient demographics, visit factors and main dental condition, and was associated with the oral health factor of number of decayed teeth. Both measures performed similarly in multivariate analysis.     

A longitudinal study of quality of life of elderly with mandibular implant-supported fixed prostheses

Objectives: To verify the consequences of implant-supported fixed oral rehabilitation on the quality of life (QL) of elderly individuals.
Material and methods: Fifteen patients were studied, being 10 females and five males; all were aged >60 years, were completely edentulous, wore removable dentures on both arches, and were treated with implant-supported fixed dentures. Three QL questionnaires were applied, two related to the oral conditions (Oral Impact on Daily Performance – OIDP – and Oral Health Impact Profile, short version – OHIP-14) and one dealing with global aspects (World Health Organization Quality of Life – WHOQOL-BREF), before 3, 6, and 18 months after surgical placement of implants.
Results: Scores in the OIDP and OHIP-14 questionnaires were better after dental treatment. The WHOQOL-BREF was less sensitive, confirming the higher reliability of specific questionnaires (focal) compared with general questions in such situations.
Conclusion: Treatment with implant-supported fixed prostheses improved QL in the elderly; these effects are better detected by specific instruments focused on the subject.     

Validation of the Korean version of the oral health impact profile among the Korean elderly

OBJECTIVES: This study aimed to validate a Korean version of the oral health impact profile (OHIP) and to develop a short-form of OHIP for the Korean elderly. METHODS: The original English version of OHIP was translated into Korean using a forward-backward method. Internal consistency was measured by Cronbach's alpha among 1098 subjects aged 56 or more. Test-retest reliability was assessed by intraclass correlation coefficients (ICCs) with a 3-month interval among 155 subjects aged 57 or more. The validity of the Korean version of OHIP (OHIP-K) was assessed by comparing OHIP scores with the perceived dental treatment needs and by identifying associations between OHIP scores and the number of natural teeth among 128 subjects aged 54 or more. The short-form of OHIP for the Korean elderly (OHIP-14K) was developed using linear regression models and was also validated and compared with the short-form of OHIP by Slade (OHIP-14S). RESULTS: The Cronbach's alpha value for OHIP-K was 0.97. The ICC for OHIP-K was 0.64. Adults with perceived dental treatment needs had a higher OHIP score than adults without any such needs (P < 0.001). The number of natural teeth was negatively associated with the OHIP score (r = -0.44, P < 0.001). OHIP-14K and OHIP-14S shared seven identical items out of a total of 14 items. OHIP-14K results correlated with OHIP-K almost exactly (r(2) = 0.96), as did OHIP-14S (r(2) = 0.95). CONCLUSIONS: OHIP-K showed excellent reliability and validity. OHIP-14S may be a better choice for the evaluation of oral health-related quality of life among the Korean elderly for an international comparison.     

Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form

OBJECTIVE: The aim of the study is to evaluate the measurement properties of the Brazilian version of the short form of the Oral Health Impact Profile (OHIP14). METHODS: Data were obtained from a cross-sectional study designed to assess the impact of toothache on quality of life during pregnancy. The sample consisted of 504 postpartum women (mean age 24 years; SD 6.2), most of whom had unsolved dental problems and belonged to low-income families. The questionnaire was administered in the form of interviews by two trained interviewers who also performed clinical examinations. Reliability was assessed in terms of internal consistency and stability. Construct validity was evaluated based on comparison of the total scores among groups according to: self-perceived and normative oral health care needs, self-perceived general and oral health status, presence of carious lesions and tooth loss. It was also hypothesized that the scores of OHIP14 and Oral Impacts on Daily Performances (OIDP) would correlate with each other. RESULTS: Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (0.87) and by Cronbach's alpha (0.91), proved to be adequate. Construct validity was confirmed as the correlation between OHIP14 scores with self-perceived general and oral health were in the expected direction, and the differences in scores of the groups formed according to the selected attributes were significant at values of P < or = 0.05 (Mann-Whitney test). Moreover, the correlation coefficient between OIDP and OHIP14 was 0.76 (rs). CONCLUSION: The Brazilian version of OHIP14 has good psychometric properties, which are similar to those of the original instrument.     

Assessing Levels of Agreement between Two Commonly Used Oral Health-Related Quality of Life Measures

Objective: This study aimed to assess the level of agreement between two commonly used oral health-related quality of life (OHRQoL) measures, the short form of the Oral Health Impact Profile (OHIP14) and the Oral Impacts on Daily Performances (OIDP). Methods: A sample of 1,675 15- to 16-year-old students attending all schools in Bauru (Sao Paulo, Brazil) was selected. The impact of oral conditions on quality of life in the last 6 months was reported using both OHIP14 and OIDP. To allow for comparison with the 100 percent OIDP score, OHIP14 scores were converted to percentages. Then, agreement between the two OHRQoL measures was analyzed using the Bland and Altman method. Results: The mean difference between OHIP14 and OIDP was 6.48 percent [confidence interval_95% (6.08; 6.89)], with higher scores reported for OHIP14 than for OIDP. Besides, 95 percent of the differences between the two OHRQoL measures were between −10.59 and 23.56 percent. Finally, differences between OHIP14 and OIDP increased significantly as the magnitude of their average increased ( P <  0.001). Conclusion: There was a moderate level of agreement between OHIP14 and OIDP, which may be partly due to the fact that both OHRQoL measures assess different levels of oral impacts on quality of life in addition to having different scoring systems.     

Relationship between dental status and Oral Impacts on Daily Performances in older Southern Chinese people

Objective: The objective of this study was to assess the relationship between different clinical indicators of dental status and an Oral Health‐Related Quality of Life (OHRQoL) measure, the Oral Impacts on Daily Performances (OIDP) index, using different scoring formats, among older Southern Chinese people. Methods: A total of 1,196 dentate people aged 55 years and older, attending routine annual health checkups at Guangxi Medical University Hospital Health Centre in Guangxi, China, participated in the study. They had a face‐to‐face structured interview and a clinical dental examination. The OIDP index was used to assess the impacts of oral conditions on quality of life. Spearman and Pearson as well as partial correlation coefficients were used to assess, respectively, the unadjusted and adjusted associations of 14 clinical indicators with the overall OIDP score, OIDP intensity, and OIDP extent. Results: All clinical indicators, except number of filled teeth, were significantly correlated with the OIDP index, after controlling for covariates. However, correlations were weak, ranging between 0.07 and 0.26. The strongest correlation was for the relationship between the number of natural plus replaced teeth and the OIDP index, irrespective of whether the overall OIDP score, OIDP intensity, or OIDP extent was used to measure OHRQoL. Conclusions: Clinical dental status indicators were related to OIDP, regardless of the scoring format used to calculate the OIDP index. Clinical indicators that included natural plus replaced teeth were more strongly associated with the OIDP index than their corresponding indicators that included only natural teeth.     

An evaluation of the Child Perceptions Questionnaire in the UK

OBJECTIVE: To assess the reliability and validity of the Child Perceptions Questionnaire (CPQ11-14), an oral health related quality of life measure for 11-14 year old children, for use in the UK. BASIC RESEARCH DESIGN: Cross-sectional questionnaire and clinical analytical study. CLINICAL SETTING: Orthodontic and paediatric dentistry clinics at a dental hospital and one general dental practice. PARTICIPANTS: Eighty-nine children between 11 and 14 years of age attending for an examination. MAIN OUTCOMES MEASURES: The children were invited to complete the CPQ11-14, global oral health and impact on life overall ratings. Clinical data on caries status, malocclusion and presence of dental opacities and gingivitis were collected. CPQ11-14 was summarised as the total score (sum of the item codes) and the number of impacts reported often or every day. RESULTS: The Cronbach's alpha for the total scale was 0.87 and ranged from 0.59 to 0.83 for the subscales indicating acceptable internal consistency. The intraclass correlation coefficient on repeated application of the measure was 0.83 (95% CI = 0.76-0.90) suggesting almost perfect agreement. Summary measures of CPQ11-14 correlated with the global oral health rating indicating acceptable criterion validity. Impact on life overall was related to all summary measures of CPQ11-14. Number of impacts correlated with the total number of missing teeth and missing teeth due to caries. No other relationships between clinical and CPQ11-14 data were apparent. CONCLUSION: The CPQ11-14 shows acceptable reliability, criterion and construct validity in relation to life overall. Relationships with clinical data were more tenuous. If this measure is to be used to compare the impacts of oral diseases in similar settings in the UK a large sample will be required.     

Influence of the usual motivation for dental attendance on dental status and oral health-related quality of life

Objectives: To evaluate the influence of dental visiting patterns on the dental status and Oral Health-related Qua-lity of Life (OHQoL) of patients visiting the University Clinic of Salamanca (Spain). Study Design: This cross-sectional study consisted of a clinical oral examination and a questionnaire-based interview in a consecutive sample of patients seeking a dental examination. Patients were classified as problem-based dental attendees (PB) and regular dental attendees (RB). Clinical and OHQoL (OHIP-14 & OIDP) data were compared between groups. Pair-wise comparisons were performed and a Logistic Regression Model was fitted for predicting the Odds Ratio (OR) of being a PB patient. Results: The sample was composed of 255 patients aged 18 to 87 years (mean age: 63.1 ± 12.7; women: 51.8%). The PB patients had a poorer dental status (i.e. caries, periodontal and prosthetic needs), brushed their teeth less,and were significantly more impaired in their OHQoL according to both instruments. The logistic regression coefficients demonstrated that on average the OR of being a PB patient was high in this dental patient sample, but this OR increased significantly if the patient was a male (OR= 1.1-5.0) or referred pain-related impacts according to the OHIP and, additionally, the OR decreased significantly as a function of the number of healthy fillings and the number of sextants coded as CPI=0. Conclusions: Regular dental check-ups are associated with better dental status and a better OHQoL after controlling for potentially related confounding factors. Key words:Dental attendance, oral health-related quality of life.     

Evaluation of a word recognition instrument to test health literacy in dentistry: the REALD-99

OBJECTIVE: This study aims to evaluate a dental health literacy word recognition instrument. METHODS: Based on a reading recognition test used in medicine, the Rapid Estimate of Adult Literacy in Medicine (REALM), we developed the Rapid Estimate of Adult Literacy in Dentistry (REALD-99). Parents of pediatric dental patients were recruited from local dental clinics and asked to read aloud words in both REALM and REALD-99. REALD-99 scores had a possible range of 0 (low literacy) to 99 (high literacy); REALM scores ranged from 0 to 66. Outcome measures included parents' perceived oral health for themselves and of their children, and oral health-related quality of life of the parent as measured by the short-form Oral Health Impact Profile (OHIP-14). To determine the validity, we tested bivariate correlations between REALM and REALD-99, REALM and perceived dental outcomes, and REALD-99 and perceived dental outcomes. We used ordinary least squares regression and logit models to further examine the relationship between REALD-99 and dental outcomes. We determined internal reliability using Cronbach's alpha. RESULTS: One hundred two parents of children were interviewed. The average REALD-99 and REALM-66 scores were high (84 and 62, respectively). REALD-99 was positively correlated with REALM (PCC = 0.80). REALM was not related to dental outcomes. REALD-99 was associated with parents' OHIP-14 score in multivariate analysis. REALD-99 had good reliability (Cronbach's alpha = 0.86). CONCLUSIONS: REALD-99 has promise for measuring dental health literacy because it demonstrated good reliability and is quick and easy to administer. Additional studies are needed to examine the validity of REALD-99 using objective clinical oral health measures and more proximal outcomes such as behavior and compliance to specific health instructions.