Agreement between children and parents in rating oral health-related quality of life using the Swedish versions of the short-form Child Perceptions Questionnaire 11–14 and Parental Perceptions Questionnaire

Objective: To explore the agreement between children and parents on children’s oral health-related quality of life (OHRQoL) when using the Swedish short forms of CPQ_11–14 and P-CPQ, and to evaluate the impact on agreement of oral health including malocclusion and background characteristics (dental fear, family situation, gender of informant).

Material and methods: A total of 257 children and their accompanying parents were asked to fill in the Swedish versions of the short-form CPQ_11–14 and P-CPQ separately in connection with a clinical examination.

Results: The participants comprised 247 child-parent pairs: 116 (47%) boys, 131 (53%) girls, 166 (67%) mothers and 81 (33%) fathers. The agreement between the child and parental ratings of the children’s OHRQoL was low, with an ICC of 0.22 (95% CI: 0.04–0.37) for the total scale.

Conclusions: There was a low agreement between children’s and parents’ answers. For best care, it is advisable to consider perceptions of both children and parents because they can complement each other in estimating the child’s OHRQoL.     

Development of the Japanese version of the Child Perceptions Questionnaire (CPQ8–10_JP)

The purpose of this study was to develop a Japanese version (_JP) of the Child Perceptions Questionnaire for 8–10-year-old children (CPQ_8–10). CPQ_8–10 was translated into Japanese by a forward–backward translation method. Its reliability was investigated among 228 elementary school children who were examined clinically for the status of dental caries, plaque accumulation, and malocclusion. Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.85. Test–retest reliability was substantial (ICCs = 0.90; 95% CI, 0.88–0.92). Regarding validity assessment, significant correlations were observed between the CPQ_8–10_JP score and the global rating of oral health (r = 0.37, p < 0.001), overall well-being (r = 0.46, p < 0.001) and presence of gingivitis (p < 0.05) but not dental caries and malocclusion. These findings suggest that CPQ_8–10_JP is satisfactorily reliable and valid for application in 8–10-year-old Japanese elementary school children.     

Parental–Caregivers Perceptions Questionnaire (P-CPQ): translation and evaluation of psychometric properties of the French version of the questionnaire

Background

The Parental–Caregivers Perceptions Questionnaire (P-CPQ) is a measure of parental/caregivers’ perceptions of the impact of children’s oral health on quality of life. The aim of the study was evaluate the psychometric properties of the French version of the P-CPQ.

Method

The original P-CPQ was developed in English language and has 31 items divided into four sub-scales. This cross-sectional study used the translation-back translation method. The translated questionnaire was pretested on 14 parents-caregivers to obtain the final French version. The psychometric properties were tested on 142 parents/caregivers of three clinical groups of children from 8 to 10?years old without dental/facial anomalies (presumed healthy), with oral-facial clefts and with oral-dental anomalies linked to a rare disease other than cleft, approached in the waiting room of the Centre of the Hospital Rothschild in Paris, France, where the children attended treatment. Internal consistency was assessed by Cronbach’s alpha and test-retest reliability by Intra-class Correlation Coefficient (ICC). Construct validity was measured by correlations between the total scores and the global ratings of oral health and overall wellbeing, and tested using exploratory factor analysis (EFA) and the factorial structure was evaluated by the partial confirmatory factor analysis (PCFA). Discriminant validity was determined using Kruskall-Wallis test.

Results

The mean (standard deviation) P-CPQ score was 18.73(18.79). Internal consistency was confirmed by a Cronbach alpha of 0.85. The test-retest reliability revealed that the responses to items were satisfactorily stable (ICC?=?0.88). Construct validity was demonstrated by significant correlation coefficients between the total scale and the global ratings (r?=?0.54 and 0.46; p?<?0.001). Factor analysis with Principal Component Analysis extracted seven factors explaining 65.23% cumulative variance. Goodness-of-fit indices for partial confirmatory factor analysis were satisfactory for the 7-factors model of the French-PCPQ version. There were statistically significant differences between clinical groups regarding the total scale, thus demonstrating discriminant validity (p?<?0.001).

Conclusion

This French P-CPQ version showed reliability and validity comparable to the previous versions. However, the cross-cultural structure of the subscales should be further evaluated.

     

Is the Child Perceptions Questionnaire for 11–14 year olds sensitive to clinical and self‐perceived variations in orthodontic status?

OBJECTIVES: To assess the association between scores on the Child Perceptions Questionnaire for 11-14 year olds (CPQ11-14) and clinical and self-perceived measures of malocclusion. METHODS: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the CPQ11-14 and a short questionnaire concerning their feelings about the condition of their teeth. Study models were taken and rated according to the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index by two sets of three examiners. Intra and inter-rater reliabilities for the two sets of examiners ranged from 0.80 to 0.99. CPQ11-14 scores were calculated for the full 35-item version and for 16 and 8-item short forms by summing the item response codes. The association between these scores, the DAI and PAR ratings and self-perceived measures of malocclusion were examined using appropriate parametric and nonparametric tests. RESULTS: Complete data were collected for 141 children, 63 boys and 78 girls. The mean age was 12.5 (SD = 1.0). DAI scores ranged from 17.0 to 58.0 with a mean of 35.0 (SD = 8.0). The distribution of subjects across the four severity categories was minor/none - 6.6%, definite - 35.2%, severe - 15.6% and handicapping 42.6%. PAR scores ranged from 8.0 to 66.0 with a mean of 31.4 (SD = 11.1). Eight percent had scores of 50 or above indicating marked deviation from an ideal occlusion. Both the long and the short forms of the CPQ11-14 identified substantial variability in the impacts of malocclusion. Correlations between CPQ11-14 scores and the orthodontic indices ranged from 0.26 to 0.31 (P < 0.01). There was a clear gradient in CPQ11-14 scores across four categories of the PAR based on quartiles. The gradient across the DAI categories was less clear. There were significant associations between all CPQ11-14 scores and the children's self-ratings of oral health, ratings of the extent to which the condition of the teeth affected life overall and expressions of happiness with the appearance and arrangement of the teeth. CONCLUSION: The results provide some evidence of the validity of the CPQ11-14 when used with children needing orthodontic treatment. However, because clinical samples are biased the study needs to be repeated in different treatment settings in order to confirm the utility of the measure.     

Test–retest reliability of MRI-based disk position diagnosis of the temporomandibular joint

This study evaluated the test–retest reliability for determining the temporomandibular joint (TMJ) disk position, diagnosed using magnetic resonance imaging (MRI). These assessments were done as a base-line measurement for a prospective cohort study, which examines the risk factors for precipitation and progression of temporomandibular disorders. Fifteen subjects (mean age, 24.2 ± 0.94 years; male/female = 8/7) were recruited from the students of Okayama University Dental School. Sagittal MR TMJ images were taken with a 1.5-T MR scanner (Magneton Vision, Siemens) in close and maximal open positions twice at about 1-week (6–11 days) interval. The images were displayed using 200% magnification on a computer screen with a commercially available image software package (OSIRIS, UIN/HCUG). Three calibrated examiners diagnosed the disk positions using the standardized criteria. The disk position of each joint was classified as normal, anterior disk displacement with or without reduction, and others. The first and second disk position diagnoses were compared, and the test–retest reliability level was calculated using the kappa index. The second disk position diagnosis was consistent with the first in 27 out of 30 joints. The calculated kappa value representing the test–retest reliability level between the first and second disk position diagnosis was 0.812. These results indicated that the test–retest reliability of MRI-based diagnosis of TMJ disk positions at about 1-week interval was substantially high, even though they were not completely consistent.     

Validation of the Spanish version of the “Questionnaire on the treatment of approximal and occlusal caries”

Objectives

To translate and validate a Spanish version of the “Questionnaire on the treatment of approximal and occlusal caries” as a method of collecting information about treatment decisions on caries management in Chilean primary health care services.

Materials and methods

The original questionnaire proposed by Espelid et al. was translated into Spanish using the forward–backward translation technique. Subsequently, validation of the Spanish version was undertaken. Data were collected from two separate samples; first, from 132 Spanish-speaking dentists recruited from primary health care services and second, from 21 individuals characterised as cariologists. Internal consistency was evaluated by the generation of Cronbach's alpha, test–retest reliability was evaluated by Cohen's kappa, convergent validity was evaluated by comparing the total scale scores to a global evaluation of treatment trends and discriminant validity was evaluated by investigating the differences in total scale scores between the Spanish-speaking dentist and cariologist samples.

Results

Cronbach's alpha indicated an internal consistency of 0.63 for the entire scale. Cohen's kappa correlation coefficient expressed a test–retest reliability of 0.83. Convergent validity determined a Pearson's correlation coefficient of 0.24 (p?<?0.01). The comparison of proportions (chi-squared) indicated that discriminant validity was statistically significant (p?<?0.01), using a one-tailed test.

Conclusions

The Spanish version of the “Questionnaire on the treatment of approximal and occlusal caries” is a valid and reliable instrument for collecting information regarding treatment decisions in cariology.

Clinical relevance

The clinical relevance of this study is to acquire a reliable instrument that allows for the determination of treatment decisions in Spanish-speaking dentists.     

Reliability and Validity of the Digigraph® 100 in Orthodontic Diagnosis

Cephalometric analyses of lateral cephalograms allow important statements to be made on diagnosis and treatment planning. Such radiographs should, however, be taken with a considerable reduction in radiation exposure. With the Digigraph 100 (Dolphin Imaging Systems Inc., USA) a cephalometric technique based on distance measurements of emitted sonic signals is now available. This study was aimed at determining the degree to which this procedure can cope with the requirements of reliability and validity in the field of orthodontics. For this purpose 50 volunteers were examined by conventional cephalometry with manual tracing of lateral cephalograms as well as by sonic cephalometry, with Jarabak analysis in both cases. In addition an option was available for reading lateral cephalograms into the Digigraph by means of a radiograph evaluation program. The 31 evaluated parameters were subjected to modified statistical analysis. Good reliability was recorded in the range between 0.96 and 0.99 for eleven sonic cephalometric measurements, whereas 26 values were between 0.69 and 0.95. The validity was significantly lower in comparison to radiocephalometry. In particular, measurements related to landmarks which were difficult to access or could be only indirectly determined, such as the sella point, the articulare point or the apices of the incisors, proved to be weak points of sonic cephalometry. The device is thus indicated rather in the field of communication with the patient or for intermediate examination without radiation exposure. Cephalometry without radiation exposure would represent decisive progress in orthodontic diagnostics. However, some developmental work on the processing software or even the development of a specific sonic cephalometry which deliberately dispenses with parameters that are difficult to record with this procedure is still needed.     

Is the Child Oral Health Quality of Life Questionnaire Sensitive to Change in the Context of Orthodontic Treatment? A Brief Communication

OBJECTIVE: This study aimed to assess the ability of the Child Oral Health Quality of Life Questionnaire (COHQoL) to detect change following provision of orthodontic treatment. METHODS: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the Child Perception Questionnaire, while their parents completed a copy of the Parents Perception Questionnaire and the Family Impact Scale. Normative outcomes were assessed using the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index. Change scores and effect sizes were calculated for all scales. RESULTS: Complete data were collected for 45 children and 26 parents. The mean age was 12.6 years (standard deviation = 1.4). There were significant pre-/posttreatment changes in DAI and PAR scores and significant changes in scores on all three questionnaires (P < 0.05). Effect sizes for the latter were moderate. Global transition judgments also confirmed pre-/posttreatment improvements in oral health and wellbeing. CONCLUSION: The results provide preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment. However, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure.     

Development,validity and reliability of the Orofacial Esthetic Scale — Spanish version

Purpose

To develop a Spanish version of the Orofacial Esthetic Scale (OES-Sp) and to determine its psychometric properties in dental patients.

The effect of DLC-coating deposition method on the reliability and mechanical properties of abutment’s screws

Objective

To characterize the mechanical properties of different coating methods of DLC (diamond-like carbon) onto dental implant abutment screws, and their effect on the probability of survival (reliability).

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 Sjögren'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 (JFLS) (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.     

A case of Collet–Sicard Syndrome presenting to the Oral and Maxillofacial Surgery Department and a review of the literature

A case of Collet–Sicard Syndrome caused by skull base metastasis of probable breast adenocarcinoma is reported. A 79-year-old lady presented to the Oral and Maxillofacial Surgery Department with progressive left-sided tongue symptoms that she described as swelling. This was initially attributed to local disease, and a biopsy showed the patient was suffering from Necrotizing Sialometaplasia. However, her symptoms rapidly evolved into cranial nerve palsies affecting IX–XII, not initially diagnosed. Subsequent imaging revealed the cause of her worsening symptoms to be a metastatic lesion at her left skull base. Cranial nerve palsies due to metastases to the skull base are rare, and the authors would advise clinicians to adopt a high-index of suspicion in ruling out cranial nerve pathology at the skull base when encountering unusual signs and symptoms in the head and neck region.     

Attitudes and behavioural factors relating to toothbrushing and the use of fluoride toothpaste among caries-active Swedish adolescents – a questionnaire study

Objective: The aim of this study was to identify attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits among caries-active Swedish adolescents.

Materials and methods: This cross-sectional study is based on an earlier clinical, two-year toothpaste intervention study. At the last appointment, 206 adolescents (of 211) answered a questionnaire comprising nine semi-closed questions.

Results: The majority (93%) brushed their teeth every day, while 7% did so only occasionally. Most participants (77%) brushed twice a day, while 12% brushed just once a day. About half of those brushing just once a day forgot to brush in the evening. Similarly, more than half of the adolescents (53%) used 1?cm of toothpaste or less on their toothbrush. Moreover, 49% brushed for less than 2?min, 41% brushed for 2?min and 10% for more than 2?min. The majority (73%) rinsed with water after toothbrushing. A difference between boys and girls was also observed; 87% of the girls brushed twice a day, whereas only 67% of the boys did so and boys more frequently forgot in the evening.

Conclusions: Attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits among caries-active Swedish adolescents are still inadequate after two years of toothpaste intervention. There are several areas where improvements can be made, such as frequency of brushing, brushing time, amount of toothpaste and post-brushing procedures. The majority (81%) included ‘fresh breath’ as a reason for performing oral hygiene and this aspect can be used by dental staff in health promotion.     

Effects of cementum–dentine junction and cementum on the mechanical response of tooth supporting structure

Objectives

The aim of the present work is to investigate the effects of cementum–dentine junction (CDJ) and cementum on the stress distribution in the periodontal ligament (PDL) and alveolar bone.

Methods

Based on the anatomical profiles and the recently reported theories about the tooth attachment mechanism, the finite element (FE) model of a mandibular second premolar along with its detailed supporting structures was developed. The effect of CDJ and cementum was evaluated by comparing the resulting stresses of FE models of the second mandibular premolar with and without CDJ and cementum in tooth supporting structure.

Results

The stress levels are higher in the structure without CDJ and cementum than that with CDJ and cementum. The function of CDJ and cementum is as a cushion pad decreasing the stress in the PDL and alveolar bone under loading.

Conclusions

As a major result of this study, it can be concluded that the CDJ and cementum significantly influence the stress distribution within the tooth supporting structure. However, most of the reported FE analysis did not take CDJ and cementum into account, which possibly resulted in overestimated stress values in the PDL and alveolar bone. From a bio-engineering perspective, the results of this study provide guidance for the design of dental implants and the application of orthodontic force system as well.     

The impact of cement mixing and storage errors on the risk of failure of glass–ceramic crowns

This study evaluated the impact of different mixing ratios and wrongly stored blends of dual-curing composite cements on Empress2 glass–ceramic crowns by means of a flexural strength test and a fracture resistance test. Thermally damaged blends and fresh blends were mixed using different mixing ratios of dual-curing Panavia F and Variolink II composite cement (2:1; 1:1; 1:1.5; 1:1.75; base/catalyst). Sixteen groups of rectangular beams of both cements (two blends, four ratios, chemical-curing, light-curing) were constructed. Their flexural strength was determined in a three-point bending test. Furthermore, 64 Empress2 all-ceramic crowns were luted onto human molars, again using fresh and thermally damaged blends as well as different mixing ratios of the luting agents. After aging, fracture resistance was investigated. The flexural strength of dual-curing composite cements was influenced to a statistically significant extent by mixing ratios and storage conditions. In particular, the chemical curing mode of these cements was affected by the thermal damage of the blends. However, this study could not demonstrate a significant impact on the fracture resistance of Empress2 glass-ceramic crowns when different mixing ratios or wrongly stored cements were used. Dual-curing composite luting agents seem to tolerate a wide range of mixing errors, but their chemical curing mode may be affected by storage errors.     

Children with a cleft lip and palate: An exploratory study of the role of the parent–child interaction

IntroductionHaving a child with an orofacial cleft may be associated with a specific pattern of parenting. In order to investigate the parenting style, the present study assessed parent–child interactions during a problem-solving task performed under pressure.Material and methodsParent–child interactions were video recorded for 15 families with a child with a cleft lip and palate (CLP), which were then compared to 20 healthy families and 20 families with a child suffering from migraines. The children had to solve a puzzle within a specified time with either their mother or father.ResultsIn families with a child with CLP, mothers tried to support their children more often and children demonstrated more autonomous behaviour towards both parents than children in healthy and migraine-affected families. Moreover, the children with CLP relied less on their fathers for help and interrupted their fathers less frequently.ConclusionsAutonomous behaviour among children with CLP which is supported by their parents may represent psychosocial compensatory mechanisms in the family environment.