Parental perceptions of oral health-related quality of life for children with special needs: impact of oral rehabilitation under general anesthesia

PURPOSE: The purposes of this study were to: (1) describe the symptoms, daily life problems and parental concerns related to oral health for children with special health care needs; and (2) examine the effectiveness of oral rehabilitation under general anesthesia at improving quality of life (QOL). METHODS: A single-group design measuring change over time was used. Family caregivers of 107 children with special needs, for whom oral rehabilitation under general anesthesia was recommended, completed a QOL survey upon dental examination. RESULTS: Seventy-three children underwent oral rehabilitation, and 50 completed a follow-up survey. The most frequent survey responses before oral rehabilitation were: (1) spontaneous toothache and pain with hot/cold temperatures (oral symptoms); (2) difficulty eating and sleeping (daily life problems); and (3) worrying about eating and nutrition (parental concerns). Severity ratings for oral symptoms, daily life problems, and parental concerns were significantly lower (P<.001), and scores for oral well-being were significantly higher (P<.001) following oral rehabilitation. CONCLUSIONS: Family caregivers of special health care needs patients report a variety of oral symptoms, daily life problems, and concerns attributable to their child's oral health that impact QOL. Oral rehabilitation under general anesthesia is effective at improving QOL for special health care needs children and their families.     

Interpreting oral health-related quality of life data

The most common way of presenting data from studies using quality of life or patient-based outcome (PBO) measures is in terms of mean scores along with testing the statistical significance of differences in means. We argue that this is insufficient in and of itself and call for a more comprehensive and thoughtful approach to the reporting and interpretation of data. PBO scores (and their means for that matter) are intrinsically meaningless, and differences in means between groups mask important and potentially different patterns in response within groups. More importantly, they are difficult to interpret because of the absence of a meaningful benchmark. The minimally important difference (MID) provides that benchmark to assist interpretability. This commentary discusses different approaches (distribution-based and anchor-based) and specific methods for assessing the MID in both longitudinal and cross-sectional studies, and suggests minimum standards for reporting and interpreting PBO measures in an oral health context.     

Impact of oral diseases and disorders on oral health-related quality of life of preschool children

Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP. Impact of oral diseases and disorders on oral health‐related quality of life of preschool children. Community Dent Oral Epidemiol 2011; 39: 105–114. © 2010 John Wiley & Sons A/S Abstract – Background: The presence of oral diseases and disorders can produce an impact on the quality of life of preschool children and their parents, affecting their oral health and well‐being. However, socioeconomic factors could confound this association, but it has not been yet tested at this age. Objective: To assess the impact of early childhood caries (ECC), traumatic dental injuries (TDI) and malocclusions on the oral health‐related quality of life (OHRQoL) of children between 2 and 5 years of age adjusted by socioeconomic factors. Methods: Parents of 260 children answered the Early Childhood Oral Health Impact Scale (ECOHIS) (six domains) on their perception of the children’s OHRQoL and socioeconomic conditions. Two calibrated dentists (κ > 0.8) examined the severity of ECC according to dmft index, and children were categorized into: 0 = caries free; 1–5 = low severity; ≥6 = high severity. TDI and malocclusions were examined according to Andreasen & Andreasen (1994) classification and for the presence or absence of three anterior malocclusion traits (AMT), respectively. OHRQoL was measured through ECOHIS domain and total scores, and poisson regression was used to associate the different factors with the outcome. Results: In each domain and overall ECOHIS scores, the severity of ECC showed a negative impact on OHRQoL (P < 0.001). TDI and AMT did not show a negative impact on OHRQoL nor in each domain (P > 0.05). The increase in the child’s age, higher household crowding, lower family income and mother working out of home were significantly associated with OHRQoL (P < 0.05). The multivariate adjusted model showed that the high severity of ECC (RR = 3.81; 95% CI = 2.66, 5.46; P < 0.001) was associated with greater negative impact on OHRQoL, while high family income was a protective factor for OHRQoL (RR = 0.93; 95% CI = 0.87, 0.99; P < 0.001). Conclusions: The severity of ECC and a lower family income had a negative impact on the OHRQoL of preschool children and their parents.     

Oral health-related quality of life of children with oligodontia

Objectives.  To assess the functional and psychosocial impact of oligodontia in children aged 11–14 years.
Methods.  Children aged 11–14 years with oligodontia were recruited from orthodontic clinics when they presented for orthodontic evaluation. All completed a copy of the Child Perceptions Questionnaire for 11- to 14-year olds, a measure of the functional and psychosocial impact of oral disorders. Information on the number and pattern of missing teeth for each child were obtained from charts and radiographs.
Results.  Thirty-six children were included in the study. The number of missing teeth ranged from one to 14 (mean = 6.8). Just over three-quarters of the subjects reported experiencing one or more functional and psychosocial impacts 'Often' or 'Everyday/almost everyday'. Correlations between scale and sub-scale scores and the number of missing teeth were weak and nonsignificant.
Conclusions.  Children with oligodontia experience substantial functional and psychosocial impacts from the condition. When compared with other clinical groups, children with oligodontia appear to have worse oral health-related quality of life than children with dental decay and malocclusion, but better oral health-related quality of life than children with oro-facial conditions.     

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.     

儿童口腔健康相关生存质量量表信度与效度的验证研究

目的 通过对8～15岁儿童口腔健康相关生存质量量表(COHIP)中文版信度与效度的验证研究,探讨其在中国适龄儿童中应用的可行性.方法 按照国际生存质量评价项目的标准程序,对英文原版COHIP系列问卷中的儿童问卷、父母问卷分别进行翻译、回译、文化调适和改造,建立中文版COHIP,形成适应儿童口腔健康和治疗需求的自我评估问卷、内容效度指数(CvI)合格的评估量表.使用该系列量表对8～15岁的儿童及其家长进行儿童口腔健康相关生存质量调查,考评量表的信度和效度.结果 1 189对儿童及家长接受问卷调查,收回有效问卷1 143份,量表完成率为96.1％.COHIP儿童表内部一致性Cronbach's α[系数为0.903,条目-量表相关系数为0.134～0.611,Guttman分半信度系数为0.798,组内相关系数(ICC)为0.926.COHIP家长表内部一致性Cronbach'sα系数为0.796,条目-量表相关系数为0.121～0.614,Guttman分半信度系数为0.796,ICC为0.931.因子分析显示中文版量表所包含的条目存在预想的逻辑关系.结论 中文版COHIP具有良好的信度和效度,其良好的心理测量学性质为其在中国适龄儿童中的应用提供了理论依据.     

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.     

Questionnaire for measuring oral health-related quality of life in eight- to ten-year-old children

PURPOSE: This study measured oral health-related quality of life for children, which involved the construction of child perceptions questionnaires (CPQs) for ages 6 to 7, 8 to 10, and 11 to 14. The purpose of this study was to present the development and evaluation of the CPQ for 8- to 10-year-olds (CPQ8-10). METHODS: Questions (N=25) were selected from the CPQ for 11- to 14-year-olds based on the child development literature and input from parents, child psychologist, and teacher of grades 3 and 4. Validity and reliability were evaluated on 68 and 33 children, respectively. RESULTS: There was a positive moderate correlation between the CPQ8-10 score and overall well-being rating (R=.45). The level of impact was slightly higher in the orofacial than in the pediatric dentistry group (mean score=19.1 vs 18.4, respectively). Hypotheses concerning the relationship between the CPQ8-10 score and number of decayed surfaces were confirmed with R=.29, and the mean score higher in caries-afflicted than caries-free children (21.1 vs 14.7). The Cronbach's alpha and intraclass correlation coefficients were 0.89 and 0.75, respectively. CONCLUSIONS: Results suggest good construct validity, internal consistency, reliability and test-retest reliability, but do not demonstrate discriminative validity. This is consistent, however, with theoretical models of oral disease and its consequences. Further research is required, as these are preliminary findings based on convenience sampling.     

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.     

The complexity of the concept oral health-related quality of life

The methods uses most often for developing and analyzing questionnaires, such as the explorative factor analysis and Cronbach's alpha, presume that psychological constructs are latent (imperceptible) and that there is a reflective-measurement model with the underlying assumption of local independence. Local independence means that the latent variable explains why the variables observed are related. Many questionnaires for measuring oral health-related quality of life are analyzed as if they were based on a reflective-measurement model assuming local independence. This assumption requires these questionnaires to contain solely items reflecting instead of determining oral health-related quality of life. The tenability of this assumption is questionable.     

Oral health-related quality of life of children with craniofacial conditions

Objective: Evaluation of the Dutch Child Oral Health Impact Profile (COHIP), assessing the level of concordance between parents and children. The internal consistency and the predictive validity of the COHIP for self-reported general health were examined. Methods: Sample size was 35 pairs of parents and children age 11 to 14 with craniofacial conditions. Cronbach alphas were calculated and the level of concordance between parents and children was studied using t tests and intraclass correlations. Predictive validity was assessed using Pearson correlations and linear regression analyses. Results: The COHIP and its subscales, except for one, had satisfactory to high Cronbach alphas (.59 to .94). Parents and children did not differ significantly. Correlations between parents and children were high (.62 to .91). Only "Oral symptoms" proved to be a significant predictor of general health, but only in the parent sample. Conclusions: In spite of the high level of concordance found, proxy reports have to be considered complementary to the reports of the children themselves. The Dutch version of the COHIP performs adequately, but could use some further psychometric evaluation and revision. It does not seem advisable to use the subscales separately as predictors in the same regression model, since they are strongly intercorrelated. For use in craniofacial patients, further validation is needed on a larger sample and some items need to be revised or removed. Finally, given the small number of cases, conclusions must be drawn with caution.     

Developing and evaluating an oral health-related quality of life index for children; the CHILD-OIDP

OBJECTIVE: To develop an oral health-related quality of life index in Thai children and evaluate its psychometric properties. DESIGN: Cross-sectional study of children aged 11-12 years, attending the final year of primary school (grade-six). Development and evaluation process was conducted on non-random sample in U-thong District, Suphan-buri province, Thailand. Re-evaluation of the index included all target group children in a municipal area of Suphan-buri province, Thailand. The psychometric properites evaluated in this study refer to face, content and concurrent validity and internal and test-retest reliability. PARTICIPANTS: 513 children in the development process. 1,100 children in the re-evaluation. RESULTS: Throughout the development process, the OIDP index was modified and its psychometric properties evaluated. The final test revealed excellent validity and reliability. Weighted kappa was 0.93. There was no negative correlation between any item, corrected item-total correlation coefficients were between 0.4-0.7, Standardised Cronbach's alpha coefficient was 0.82. The index showed very significant associations with perceived oral treatment need (p < 0.001) and perceived oral health problems (p < 0.001). The validity and reliability of the index was confirmed by similar results in the re-evaluation study. CONCLUSIONS: This study has demonstated that the CHILD-OIDP index is a valid, reliable and practical measure of oral health-related quality of life in 12 year old Thai children.     

Factors associated with oral health-related quality of life in institutionalized elderly

OBJECTIVE: The aim of this study was to investigate factors associated with the oral health-related quality of life (OHRQoL) of institutionalized elderly in Germany. MATERIAL AND METHODS: One-hundred-and-fifty-eight subjects from old people's homes were selected (mean 82.8 years). OHRQoL was measured using the Oral Health Impact Profile (OHIP). Denture characteristics (kind and age of denture, retention of removable denture, number of teeth in static occlusion) and general issues (age, gender, education level, and general pain status) were assessed. All factors were subjected to bivariate testing for their effects on the OHIP summary score (OHIP-SC) and to multivariate testing in subjects with removable dentures (n = 128); a linear regression model with backward elimination was used, with OHIP-SC as the dependent variable. RESULTS: In the context of other studies, a median OHIP-SC of 29 indicated highly impaired OHRQoL. According to the bivariate analysis, retention, age of denture, number of teeth in static occlusion, general pain status, and education all exhibited significant influence on OHIP-SC. In the final linear regression model, general pain status, education level, and retention of denture remained at a statistically significant level. The model explained 34% (R2 = 0.34) of the variance of the OHIP-SC. The kind of denture had no significant impact on OHIP-SC. CONCLUSIONS: In contrast to other groups, the kind of denture exhibited little impact on OHIP-SC for this highly specific collective. However, there were functional aspects of dentures which seemed to be important. Non-dental factors had a striking effect on OHRQoL.     

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。     

Factors associated with oral health-related quality of life in institutionalized elderly

Objective. The aim of this study was to investigate factors associated with the oral health-related quality of life (OHRQoL) of institutionalized elderly in Germany. Material and Methods. One-hundred-and-fifty-eight subjects from old people's homes were selected (mean 82.8 years). OHRQoL was measured using the Oral Health Impact Profile (OHIP). Denture characteristics (kind and age of denture, retention of removable denture, number of teeth in static occlusion) and general issues (age, gender, education level, and general pain status) were assessed. All factors were subjected to bivariate testing for their effects on the OHIP summary score (OHIP-SC) and to multivariate testing in subjects with removable dentures (n=128); a linear regression model with backward elimination was used, with OHIP-SC as the dependent variable. Results. In the context of other studies, a median OHIP-SC of 29 indicated highly impaired OHRQoL. According to the bivariate analysis, retention, age of denture, number of teeth in static occlusion, general pain status, and education all exhibited significant influence on OHIP-SC. In the final linear regression model, general pain status, education level, and retention of denture remained at a statistically significant level. The model explained 34% (R²=0.34) of the variance of the OHIP-SC. The kind of denture had no significant impact on OHIP-SC. Conclusions. In contrast to other groups, the kind of denture exhibited little impact on OHIP-SC for this highly specific collective. However, there were functional aspects of dentures which seemed to be important. Non-dental factors had a striking effect on OHRQoL.