Rasch validation of the early childhood oral health impact scale

Wong HM, McGrath CPJ, King NM. Rasch validation of the early childhood oral health impact scale. Community Dent Oral Epidemiol 2011; 39: 449–457. © 2011 John Wiley & Sons A/S Abstract – Objectives: The early childhood oral health impact scale (ECOHIS), a proxy measure to assess the impact of oral health problems and on the quality of life of preschool children and their families, has been translated into Chinese and validated employing the classical test theory. However, some invariable problems are related to this theory. The objective of this study was to assess the metric properties of the ECOHIS by applying the item response theory. Methods: A random sample of 1296 Chinese preschool children in Hong Kong participated in the study and were subjected to an oral examination for their caries status. Their parents were asked to respond to the ECOHIS and an extra set of questions concerning their socio‐demographic backgrounds. The collected data were analysed using Rasch model. Results: The obtained results support the interpretation of adequate total fit of persons and items, because the mean infit MNSQ (1.08) and outfit MNSQ (0.94) for persons, and the mean infit MNSQ (0.99) and outfit MNSQ (0.94) for items, are within the acceptable ranges (0.6–1.4). The difficulty spread of the items was between ?0.81 and 1.96 logits, and the levels of respondents spanned from ?5.56 to 6.72 logits on the person–item map. The spread of respondents was skewed and mistargeting, between the items and respondents, was confirmed. Combination of responses of ‘often’ and ‘very often’ was suggested because of their flat probability showing on the characteristic curves. Conclusions: Rasch model has been shown to be a feasible and practicable way of assessing the metric properties of the ECOHIS. The results allow the use of ECOHIS to be recommended for clinical research in oral health‐related quality of life in young children with minor modifications.     

口腔健康影响程度量表的验证研究

目的通过对口腔健康影响程度量表（OHIP-14中文版）的验证研究及其性质的考评，对该量表的信度、效度作出评价，探讨其在中国人群中进一步应用的可行性。方法按照国际生存质量评价（IQOLA）项目的标准程序，对OHIP-14进行翻译、回译、文化调适和改造，建立口腔健康影响程度量表。使用该量表和《口腔健康自我评价表》，对广东省部分地区年龄在18～65岁之间的居民应用多阶段简单随机抽样法，共抽取592个个体进行口腔健康相关生存质量调查，对调查结果进行统计学分析，考评量表的信度和效度。结果共有592位个体接受调查。回收有效问卷550份，其中数据缺失问卷38份。口腔健康影响程度量表内部一致性Cronbach’s α系数为0．93，条目与量表间的相关系数在0．53～0．71之间。因子分析提取的4个维度显示，口腔健康影响程度量表存在预想的连带关系和逻辑关系。量表得分与自我评价的口腔健康、自我感觉的治疗需要间呈显著正相关，相关系数分别为0．54、0．49（P〈0．0001）。结论口腔健康影响程度量表具有良好的信度、效度，其良好的心理测量学性质，为该量表在中国人群中的进一步推广应用提供了理论依据。     

赫尔老年人口腔健康评价指数与口腔健康影响程度量表评价中国西南地区农村中老年人口腔生存质量的对比研究

目的 使用赫尔老年人口腔健康评价指数(GOHAI)和口腔健康影响程度(OHIP-14)量表评价中国西南地区农村中老年人的口腔健康生存质量,检验两量表信度,选出更适合评价中老年人口腔健康生存质量的量表.方法 随机抽取四川青川县和贵州习水县45岁以上中老年人,进行入户面对面的GOHAI和OHIP-14量表问卷调查,采用配对样本t检验,比较两量表在各个维度中老年人的得分,并分别计算两量表的克朗巴哈值进行信度比较.结果 GOHAI和OHIP-14量表对同一对象的口腔健康生存质量评价上一致性较高.中年人和老年人在这2个量表中各维度的得分中,除了GOHAI量表的心理维度得分无差异之外,其他维度得分在两表中均存在差异.信度分析发现OHIP-14量表内在稳定性和可靠性更高.结论 OHIP-14量表更适用于评价中老人的口腔健康生存质量.     

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.     

The self-assessed oral health status of individuals from White,Indian, Chinese and Black Caribbean communities in South-east England

OBJECTIVES: To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity. METHOD: Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups. MEASURES: Subjective Oral Health Status Indicators (SOHSI). PARTICIPANTS: Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis. FINDINGS: Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores. CONCLUSIONS: Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.     

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.     

Measuring the impact of oral health on life quality in two national surveys - functionalist versus hermeneutic approaches

OBJECTIVES: This study compares a functionalist (quantitative) versus a hermeneutic (qualitative) approach to assessing the impact of oral health on life quality in two United Kingdom national surveys. METHODS: The vehicles for this study were two Office for National Statistics' Omnibus Surveys completed in 1998 and 1999. In both studies a random probability sample of 3000 household addresses was selected from the British Postcode Address File (PAF). The data were collected by face-to-face interviews with respondents in their homes about how their oral health status affected their quality of life employing a qualitative, hermeneutic approach (1998) and a functionalist, quantitative approach using a battery of questions (1999). RESULTS: Irrespective of study design, in both studies it was apparent that the majority of the public perceived their oral health as affecting their life quality (P > 0.05). Likewise, both approaches identified that oral health affected life quality most frequently through physical aspects of oral health rather than social or psychological. However, using the hermeneutic approach, respondents were less likely to cite that their oral health affected specific aspects of their oral health compared to when a battery of questions were used (P < 0.01). Furthermore, socio-demographic variations in oral health-related quality of life were more apparent when a battery of questions were employed compared to an open-ended approach. CONCLUSIONS: Different approaches to assessing oral health-related quality of life yield similar findings in terms of prevalence of oral health's impact and affected ways (domains). However, the different methods influenced the ability to identify socio-demographic disparities.     

Perceived impact of oral health conditions among minority adolescents

OBJECTIVES: This study assessed the perceived impact of oral health conditions, and the relationship of two measures of self-reported outcome, the RAND SF-36 and the Oral Health Impact Profile (OHIP), to clinical indicators of oral health among inner-city adolescents. METHODS: A convenience sample of 93 minority adolescents completed the RAND SF-36 and the OHIP and 76 of them completed a clinical dental examination assessing DMFS. RESULTS: Participants averaged 14.4 (SD = 1.2) years old; 52 percent were female; and 86 percent were African-American. The mean DMFS was 8.8 (SD = 6.3). Participants reported relatively poor general health on the SF-36 as well as poor oral health on the OHIP. None of the SF-36 subscales were significantly related to DMFS. OHIP subscales were consistently related to DMFS--those with worse oral health reported more impacts. With the exception of the bodily pain subscale of the SF-36, the SF-36 and OHIP subscales were significantly correlated with Pearson's correlations ranging from -.21 to -.57 (P < .05). CONCLUSIONS: Although the SF-36 and the OHIP were correlated, the OHIP appears to be more highly associated with the impacts of oral health conditions than the SF-36 among inner-city adolescents who reported low general and oral health quality of life.     

Assessing oral health-related quality of life in general dental practice in Scotland: validation of the OHIP-14

OBJECTIVES: To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice. METHODS: Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals. RESULTS: A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients. CONCLUSIONS: The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.     

Late-life depression: its oral health significance

Late-life depression (LLD) initially occurs after age 65 and is a major public health concern because elderly people who are at high risk constitute an ever-expanding segment of the population. LLD is a mental illness in which mood, thought content, and behavioural patterns are impaired, causing individual distress, compromising social function and impairing self-maintenance skills (e.g. bathing, dressing, hygiene). It is characterised by marked sadness, or a loss of interest or pleasure in daily activities and may be accompanied by weight change, sleep disturbance, fatigue, difficulty concentrating, and high suicide rate. Individuals under treatment for LLD and those whose illness has not been diagnosed or treated often present to the dentist with significant oral disease. LLD is frequently associated with a disinterest in performing oral hygiene, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education programme, the use of artificial salivary products, antiseptic mouthwash, daily fluoride mouthrinse and special precautions when administering local anaesthetics with vasoconstrictors and prescribing analgesics.     

Oral health and quality of life of children and adolescents with juvenile idiopathic arthritis according to their caregivers’ perceptions

The aim of this study was to assess the correlation between oral health indicators and oral health‐related quality of life (OHRQoL) of children and adolescents with juvenile idiopathic arthritis (JIA) according to their caregivers’ perceptions. Parents or guardians (mean age, 40.6 years; standard deviation [SD] = 10.97 years) of children and adolescents with JIA (n = 17; mean age, 9.8 years; SD = 2.86) and parents or guardians of healthy children and adolescents (n = 15; mean age, 10.7 years; SD = 2.16) filled the short form of the Brazilian Parental‐Caregiver Questionnaire (SF: 13 – B‐PCPQ). Dental evaluations were performed on all children. There was no significant difference in SF: 13 – B‐PCPQ scores of the two groups. Children and adolescents with JIA had fewer caries in their primary dentition and more gingival bleeding after probing than those without JIA. The frequency of temporomandibular disorders was 50.0% for JIA patients and 46.7% for their healthy counterparts. There was no correlation between oral health indicators and SF: 13 – B‐PCPQ scores. As perceived by caregivers, JIA did not negatively impact the well‐being of their children and adolescents as related to oral health, and their OHRQoL did not correlate with oral health status.     

Assessing the impact of oral health on the life quality of children: implications for research and practice

Traditionally, child oral health has been assessed using clinical parameters of disease and deformity. However, there is a growing interest in the psychosocial impact of oral health among children. This commentary outlines the value and need for assessing child oral health-related quality of life (COHQoL). COHQoL has implications for oral health needs assessment (at an individual and population level) and for evaluating outcomes from specific treatments, initiatives and dental services overall. In addition, it could prove to be a useful adjunct tool for evidence-based dentistry research and practice. Theoretical and practical considerations in assessing the complex psychosocial construct of oral health among children are discussed: the use of general versus oral health-specific measures, the development of tools for children, the use of generic versus condition-specific measures, and the measurement of 'positive' oral health. Recommendations for research and practice are presented.     

Measuring the impact of oral health on quality of life in Britain using OHQoL-UK(W)

OBJECTIVES: This study assessed the impact of oral health on quality of life (OHQoL) in Britain and identified disparities in OHQoL among subgroups of the population. METHODS: A national survey involved a random probability sample of 2,667 households. Participants were interviewed about their oral health status and sociodemographic information was collected. The impact of oral health on life quality was measured utilizing the OHQoL-UK(W). RESULTS: The response rate was 68 percent. Most people in Britain (73%) claimed their oral health did affect their life quality, most frequently through physical influences rather than social or psychological. Disparities in perceived influences of oral health on life quality among subgroups of the population were apparent by age, sex, and social class; OHQoL also was influenced by oral health status (self-reported). CONCLUSION: Most Britons claim their oral health affects their life quality and OHQoL was associated with sociodemographic and oral health factors.     

Translation and validation of the Chinese version of GOHAI

OBJECTIVE: To translate and validate the Chinese version of General Oral Health Assessment Index (GOHAI) for elderly in Hong Kong and to investigate factors that possibly may influence the GOHAI scores. METHODS: The English version of GOHAI was translated into Chinese. Persons aged 60-80 years were interviewed by two trained interviewers and clinically examined by a dentist. Information on subjects' demographic background and oral health conditions was collected. RESULTS: Altogether 1,023 elderly were interviewed and clinically examined. The mean GOHAI score was 48.9 (SD = 7.2). Cronbach's alpha of the translated GOHAI was 0.81; item-scale correlation ranged from 0.28-0.61. It was found that the mean GOHAI scores were lower for subjects with poorer perceived oral health (rs = 0.57, P < .001). Elderly who had perceived dental treatment need had a lower mean GOHAI score than those who did not (P < .001). It was also found that elderly who lived in elderly homes, those who received social welfare assistance, those who had recent dental visits, and those with higher DMFT scores had higher mean GOHAI scores. CONCLUSION: The translated Chinese version of GOHAI demonstrated acceptable reliability and validity. It is available for use by researchers in oral health-related quality of life studies on Chinese elderly population.