An empirically derived population-response model of the short form of the Oral Health Impact Profile

OBJECTIVE: The aim of this paper was to model the consequences of dental conditions from an empirical basis and to test the model's ability to predict response combinations. METHODS: The model was derived from responses to the short-form Oral Health Impact Profile (OHIP14) obtained from a UK population sample of 5281 dentate adults. This model was then used to predict OHIP14 response combinations obtained from a sample of 3973 dentate and edentulous adults in Australia. FINDINGS: The empirically derived population-response model accounted for over 98% of response combinations of Australian dentate adults. CONCLUSIONS: The empirically derived model followed a similar hierarchical pattern to the base model underlying the long-form version of the measure (thereby supporting the validity of the OHIP14 measure) and was strongly predictive of the pattern of responses obtained from Australian adults.     

The Oral Health Impact Profile: ranking of items for temporomandibular disorders

The study aimed to rank the Oral Health Impact Profile (OHIP-49) items by relevance to temporomandibular disorders (TMD). A modified version of the OHIP-49 was completed by 110 patients with TMD and by age- and gender-matched TMD-free individuals. Patients were diagnosed using the Research Diagnostic Criteria (RDC) for TMD. The modified OHIP included a reference to the 'jaw' and a 1-month reference period. The difference in item prevalence for problems reported fairly/very often (FOVO) between the two groups was calculated for each OHIP item. The FOVO prevalence differences were ranked to reveal the most relevant problems for TMD. Patients' total OHIP scores were higher (60.6, SD = 31.6) than those of controls (17.1, SD = 18.1). Patients scored higher on all items, with 41 items showing a statistically significant difference between the patient score and the control score. The patient-control difference in FOVO item prevalence varied considerably between different items, ranging from 1 to 67%. Substantial differences were noted between patients and controls for a number of specific items, including those relating to pain and physical impact. Smaller differences across most items were also noted, even those not expected to have an impact. The OHIP provides a starting point for a measure of TMD treatment outcome, once items less attributable to TMD are excluded.     

Derivation and validation of the short version of the Malaysian Oral Health Impact Profile

OBJECTIVES: This paper describes the development of a short version of the Malaysian Oral Health Impact Profile. METHODS: The 45-item OHIP(M) was shortened using a method known as the 'item frequency method'. Here, the two most frequently reported items from each of the seven OHIP(M) subscales were chosen to form the short version, designated as the S-OHIP(M). Field testing was conducted to assess the effect of different modes of administration (mail versus interview) of the short form and to test its measurement properties (reliability and validity). A total of 206 respondents completed the questionnaire. In order to carry out test-retest analysis, a second administration was carried out 15 days after the first administration on a selected subsample. RESULTS: The mail questionnaire had a lower response rate and a higher percentage of missing data than the interview administered questionnaire. However, the mail mode of administration resulted in higher scores than interview. Cronbach's alpha was 0.89 and the ICC was also 0.89. All hypotheses developed to assess validity were confirmed. CONCLUSION: The S-OHIP(M) was found to be valid and reliable and appropriate for use in the cross-sectional studies in Malaysian adult populations.     

An Arabic version of the Oral Health Impact Profile: translation and psychometric properties

OBJECTIVES: To translate the original English version of the Oral Health Impact Profile (OHIP) into an Arabic version, and to investigate the psychometric properties of the translated instrument among adults in Saudi Arabia. METHODS: The original English version of OHIP with 49 items was translated into Arabic following accepted cultural adaptation technique guidelines using a forward-backward method. After pilot testing, the instrument was administered to 426 adults in Saudi Arabia. RESULTS: A priori hypothesised associations between the OHIP summary score, self-reported oral health and five oral disorders were confirmed in a convenience sample of the general population (n = 356). These associations were interpreted as support for construct validity. The instrument's responsiveness, as indicated by a mean OHIP summary score change from 62.27 to 14.00, was established in 30 consecutive patients treated for complete and removable partial dentures. Test-retest reliability was demonstrated by intraclass correlation coefficients of 0.75 - 0.90 for dimensions and summary score (n = 40). Internal consistency was high (Cronbach's alpha > 0.74) in the general population sample. CONCLUSION: Sufficient psychometric properties of the OHIP-A make the instrument suitable for assessment of oral health-related quality of life in Saudi Arabia.     

German short forms of the Oral Health Impact Profile

OBJECTIVES: We report the development and psychometric evaluation of short forms of the Oral Health Impact Profile German version (OHIP-G) - an instrument to assess oral health-related quality of life (OHRQoL). METHODS: A five-item short form was developed using best subset regression in 2050 subjects from a national survey. Two 14-item versions were derived from English-language short forms and a 21-item version from previous factor analytic work. A second sample from the general population (n = 163) and a sample of clinical patients with temporomandibular disorders (TMD; n = 175) were used to investigate validity and internal consistency. Test-retest reliability was evaluated in 30 prosthodontic patients before treatment. Responsiveness was assessed in 67 patients treated for their TMD pain. RESULTS: Associations between short form summary scores and self-report of oral health and four oral disorders in the general population and in TMD patients were interpreted as support for convergent/groups validity. The instruments' responsiveness (effect measures of 0.55-0.98), test-retest reliability (intraclass correlation coefficients: 0.72-0.87), and internal consistency (Cronbach's alpha: 0.65-0.92) were sufficient. CONCLUSIONS: Sufficient discriminative and evaluative psychometric properties of short forms of the OHIP-G make the instruments suitable to assess OHRQoL in cross-sectional as well as longitudinal studies.     

Developing a short form of Oral Health Impact Profile (OHIP) for dental aesthetics: OHIP-aesthetic

OBJECTIVES: To develop and evaluate shortened forms of the Oral Health Impact Profile (OHIP) for discriminating dental aesthetics problems and evaluating dental aesthetic outcomes. METHODS: Eighty-seven subjects self-completed the 49-item OHIP at baseline and 63 at follow up (8 weeks later), with the intervention of applying an array of tooth-whitening products. Expert-based approach and regression analysis (on baseline data) were undertaken to derive two subset questionnaires (OHIP-conceptual and OHIP-regression). Their discriminatory ability for dental aesthetics and their responsiveness to tooth whitening were compared with the original OHIP-49, Slade's OHIP-14 and a Chinese short-form version of OHIP. RESULTS: The measures developed were strongly associated with self-rating of dental aesthetics (P < 0.001) unlike OHIP-49 (P = 0.03) or other OHIP short forms (P > 0.05). The measures were also reliable (Cronbach's alpha 0.86) and comparable with the other OHIP forms. In terms of effect size, OHIP-conceptual was more effective in measuring changes than the one based on the regression analysis, the original OHIP-49, OHIP-14 and the Chinese version of the short-form OHIP. It also exhibited a less susceptibility to floor effects than other OHIP forms. CONCLUSION: A modified short form of the OHIP derived (OHIP-conceptual) was the most favorable in discriminating dental aesthetics, was reliable and most sensitive to the dental aesthetics intervention - tooth whitening.     

Cross-cultural adaptation of the Oral Health Impact Profile (OHIP) for the Malaysian adult population

OBJECTIVE: The aim of this project was to develop an oral health related-quality of life measure for the Malaysian adult population aged 18 and above by the cross-cultural adaption the Oral Health Impact Profile (OHIP). METHOD: The adaptation of the OHIP was based on the framework proposed by Herdman et al (1998). The OHIP was translated into the Malay language using a forward-backward translation technique. Thirty-six patients were interviewed to assess the conceptual equivalence and relevancy of each item. Based on the translation process and interview results a Malaysian version of the OHIP questionnaire was produced that contained 45 items. It was designated as the OHIP(M). This questionnaire was pre-tested on 20 patients to assess its face validity. A short 14-item version of the questionnaire was completed by 171 patients to assess the suitability of the Likert-type response format. Field-testing was conducted in order to assess the suitability of two modes of administration (mail and interview) and to establish the psychometric properties of the adapted measure. RESULTS: The pre-testing revealed that the OHIP(M) has good face validity. It was found that the five-point frequency Likert scale could be used for the Malaysian population. The OHIP(M) was reliable, where the scale Cronbach's alpha was 0.95 and the ICC value for test-retest reliability was 0.79. Three out four construct validity hypotheses tested were confirmed. OHIP(M) works equally well as the English version. CONCLUSION: OHIP(M) was found to be reliable and valid regardless of the mode of administration. However, this study only provides initial evidence for the reliability and validity of the measure. Further study is recommended to collect more evidence to support these results.     

Reliability and validation of a Brazilian version of the Oral Health Impact Profile for assessing edentulous subjects

The aims of this study were to evaluate the reliability and to validate a Brazilian version of Oral Health Impact Profile for assessing edentulous subjects (OHIP-EDENT), an inventory for measuring oral health-related quality of life of edentulous subjects. The sample comprised 65 complete denture wearers (23 men, mean age of 69.1 +/- 10.3 years). The translated OHIP-EDENT was applied on two occasions with a washout period of 3 months. Reliability was assessed by an internal consistency analysis and a test-retest approach. A preliminary validation process was conducted by a qualitative approach/interview. Results of internal consistency showed a Cronbach's alpha of 0.86 or 0.90 for the first or second appointment respectively. Through the test-retest analysis, an intra-class correlation coefficient of 0.57 was found, and individual answers reflected a broad range of agreement. Interviewed volunteers (n = 6) comprehended most questions well. In conclusion, the Brazilian version of OHIP-EDENT is adequate for assessing the oral health-related quality of life for edentulous subjects.     

General population norms of the Swedish short forms of Oral Health Impact Profile

We reported the development and psychometric evaluation of a Swedish 14‐item and a five‐item short form of the Oral Health Impact Profile. The 14‐item version was derived from the English‐language short form developed by Slade in1997. The five‐item version was derived from the German‐language short form developed by John et al. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N = 1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N = 1309) were on average 50·1 ± 17·4 years old, and 54% were women. Short form summary scores correlated highly with the 49‐item OHIP‐S (r ≥ 0·97 for OHIP‐S14, r ≥ 0·92 for OHIP‐S5) and with self‐report of oral health (r ≥ 0·41). Reliability, measured with Cronbach's alpha (0·91 for OHIP‐S14, 0·77 for OHIP‐S5), was sufficient. In the general population, 50% of the subjects had ≥2 OHIP‐S14 score points and 10% had ≥11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had ≥2 OHIP‐S14 score points, and 10% had ≥11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP‐S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14‐item and 5‐item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies.     

Feasibility of oral health-related quality of life assessment in prosthodontic patients using abbreviated Oral Health Impact Profile questionnaires

Summary  To report about the feasibility of oral health-related quality of life assessment using two short forms of the Oral Health Impact Profile – OHIP-J14 and OHIP-J5 – in prosthodontic patients. Using the item pool of the Japanese version of the OHIP, two short forms based on a 14-item English-language version and a 5-item German-language questionnaire were derived. To test construct validity, the associations between summary scores of two short versions and self-reported oral health and self-reported denture quality have been investigated. Responsiveness was tested in 30 patients treated for their removable partial denture. Test–retest reliability using a time interval of 2 weeks and internal consistency were also tested. Associations between the two short form summary scores and self-reported oral health and denture quality supported construct validity of the instruments. Acceptable reliability for OHIP-J14 and OHIP-J5 was indicated by intra-class correlation coefficients of 0·73 and 0·75 (test–retest reliability) and CRONBACH'S alpha of 0·94 and 0·81 (internal consistency) respectively. Responsiveness was sufficient for OHIP-J14 and OHIP-J5 indicated by 'medium' effect sizes (0·50 and 0·57 respectively). In addition to sufficient discriminative psychometric properties, the ability to measure change of perceived oral health make OHIP-J14 and OHIP-J5 suitable for outcomes research.     

Efficiency of arthrocentesis treatment for different temporomandibular joint disorders

This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n = 15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P = 0.016) and significant long-term differences in masticatory efficiency (P = 0.046) and protrusive movement (P = 0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P < 0.001), disruption in daily activities (P = 0.002), maximum mouth opening (P = 0.008), and protrusive movement (P = 0.002) between the groups. Arthrocentesis therapy may be useful to improve clinical symptoms and range of mandibular movement in patients with all three types of TMD. However, the benefit of arthrocentesis may be greater for patients with DDWoR than for those in the other groups.     

The Hungarian version of the Oral Health Impact Profile

Oral health-related quality of life (OHRQoL) is increasingly of interest in dentistry. The current internationally accepted instruments used to measure OHRQoL need to be cross-culturally adapted for use in other cultural environments. It was the aim of the present study to develop a Hungarian version of the Oral Health Impact Profile (OHIP-H) following accepted guidelines. The original English-language version was translated into Hungarian, back-translated into English, and tested for its psychometric properties. Construct validity was tested on 144 prosthodontic patients and 200 randomly selected subjects. A priori hypothesized associations between OHIP summary scores and self-reported oral health and six self-reported oral conditions were investigated. The pattern of the observed associations supported the new instrument's construct validity. Responsiveness tested in 28 oral surgery patients was indicated by a statistically significant mean OHIP score change from 39.2 to 23.0. Test-retest reliability was demonstrated by intraclass correlation coefficients of 0.81-0.90 for OHIP summary scores and subscales in 31 prosthodontic patients. Cronbach's alpha values between 0.71 and 0.96 proved to have high internal consistency. Adequate psychometric properties in typical patient populations make the new instrument suitable for assessment of OHRQoL in Hungary.     

Exploratory factor analysis of the Oral Health Impact Profile

Although oral health‐related quality of life (OHRQoL) as measured by the Oral Health Impact Profile (OHIP) is thought to be multidimensional, the nature of these dimensions is not known. The aim of this report was to explore the dimensionality of the OHIP using the Dimensions of OHRQoL (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Learning Sample (n = 5173), we conducted an exploratory factor analysis on the 46 OHIP items not specifically referring to dentures for 5146 subjects with sufficiently complete data. The first eigenvalue (27·0) of the polychoric correlation matrix was more than ten times larger than the second eigenvalue (2·6), suggesting the presence of a dominant, higher‐order general factor. Follow‐up analyses with Horn's parallel analysis revealed a viable second‐order, four‐factor solution. An oblique rotation of this solution revealed four highly correlated factors that we named Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact. These four dimensions and the strong general factor are two viable hypotheses for the factor structure of the OHIP.     

Confirmatory factor analysis of the Oral Health Impact Profile

Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher‐order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health‐Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four‐factor model and a bifactor model that included one general factor and four group factors. Using model‐fit criteria and factor interpretability as guides, the four‐factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0·05, CFI = 0·99) and interpretability. These results corroborate our previous findings that four highly correlated factors – which we have named Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact – can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four‐factor solution suggest that OHRQoL can also be sufficiently described with one score.     

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提要：颞下颌关节紊乱病（TMD）是口腔临床常见病之一,其治疗方法众多。咬合板作为一种保守、可逆的治疗方法被广泛应用在TMD的治疗上。然而,各类咬合板治疗TMD的疗效尚不完全明确,本文结合近年来国内外文献对其进行综述。     

Assessing change in quality of life using the Oral Health Impact Profile (OHIP) in patients with different dentofacial deformities undergoing orthognathic surgery: a before and after comparison

Dentofacial deformities and their treatment have physical and psychological repercussions on quality of life (QOL). Seventy-four patients were evaluated preoperatively (T0) and at 4–6 months postoperatively (T1). Oral health-related QOL was assessed using the short form of the Oral Health Impact Profile (OHIP-14). There was a statistically significant reduction in the average overall OHIP-14 score between T0 (13.23 ± 6.45) and T1 (3.26 ± 4.19). In addition, there were significant decreases in all seven OHIP-14 domains. Class III patients benefited in all domains evaluated, while a significant improvement was seen only in the psychological disability domain for class I patients. Class II patients showed a significant benefit in all domains except the domain of functional limitation. With regard to the total sample (n = 74) and class III patients (n = 58), correlations between domains were identified for all domains. The same correlation was not identified for class I (n = 5) and II (n = 11) patients. The entire sample and class III patients showed significant improvements in OHIP-14 scores for all degrees of postoperative sensory disturbance in the upper and lower lips, except for patients with degree 5 (extreme) disturbance of the upper lip. Orthognathic surgical treatment had a positive impact on oral health-related QOL in the patients evaluated.     

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.     

Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders

The purpose of this study was to clinically evaluate the efficacies of three treatment methods and to compare their outcomes in patients with painful disc displacement. The study group comprised 45 patients with unilateral temporomandibular disorders who fell into Axis I group II (with limited mouth opening) of the Research Diagnostic Criteria for Temporomandibular Disorders. Magnetic resonance imaging was used for definitive diagnosis. The patients were divided randomly into three groups according to the treatment method: splint therapy, splint therapy with ultrasound-guided arthrocentesis, and splint therapy with low-level laser therapy. Patients were followed up after treatment for 6 months. The groups were compared in terms of pain and functional jaw movements (unassisted mouth opening without pain, maximum unassisted mouth opening, and contralateral movements). At the end of treatment, functional jaw movements were significantly increased while pain values were significantly decreased in all groups (P < 0.05). Group 2 had a quicker improvement in terms of mouth opening scores at the end of the first month, and unassisted mouth opening without pain was found to be more than 35 millimetres in all groups at the end of 6 months. All treatment modalities showed effective results on pain and functional jaw movements in the treatment of temporomandibular disorders.     

Association of tightly locked occlusion with temporomandibular disorders

The association between teeth loss and temporomandibular disorders (TMD) is still inconclusive. A kind of secondary changes of the occlusion after teeth lose called the tightly locked occlusion (TLO), defined as the occluding contact that delivers angled occlusal force on the drifted neighbour and/or the tipped antagonists of the lost posterior teeth, was hypothesized to be association with TMD. The study aimed at investigating the association between the TLO and TMD. A total of 113 posterior-teeth losing patients, 64 with TMD symptoms (group of TMD) and 49 without (group of TMD-Free) were included. Study casts and joint radiographs were made to diagnose the TLO and joint morphological changes. The simultaneous contribution of the potential variables of gender, age, tooth losing number, the TLO, joint symmetry and signs of osteoarthrosis shown on radiographs were tested through binary logistic regression analysis. In women, the TLO entered into logistic model, and had an effect on the incidence of TMD (P = 0.008). The odds ratio of with-TLO versus without-TLO is 2.6 (95% CI: 1.2, 5.8) after controlling for the effect of gender. Age, tooth lose number, joint asymmetry or osseous changes had no effect on the incidence of TMD. The tightly locked occlusion is associated with some signs and symptoms of TMD. Randomized controlled trials will be needed in further studies to test the hypothesis that treatment of a TLO, as defined in the present study, will have a beneficial effect on the signs and symptoms of TMD.