Oral health-related quality of life of stroke survivors on discharge from hospital after rehabilitation

The study aimed to investigate oral health-related quality of life (OHR-QoL) of stroke survivors on hospital discharge after rehabilitation. It was a cross-sectional study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. The Medical Outcomes Short Form 36 (SF-36) measure, the General Oral Health Assessment Index (GOHAI) and an oral health transition scale were administered prior to a dental examination. Median SF-36 subscale scores were significantly different between groups (P < 0.05). In physical function, role-physical, role-emotional and mental health domains, stroke survivors had significantly lower scores indicating poorer health. The median GOHAI score for the stroke group was 52 and 54 for the comparison group with no significant difference between groups although more stroke survivors had difficulty speaking compared with the comparison group. About 75% of stroke survivors considered their appearance to be worse, half of them felt that speech was worse and about a third had difficulty chewing hard food compared with the pre-stroke condition (P < 0.05). Most participants were partially dentate with no significant difference in DMFT scores or prosthetic status between groups (P > 0.05). Health-related quality of life in general was significantly poorer after stroke although patients were considered physically well enough to be discharged from hospital. There was some impairment of OHR-QoL. The nature of the stroke, the hospital environment including diet, coping strategies and elderly Chinese peoples' perception of health should be taken into account when interpreting measures of health status in stroke survivors.     

Agreement between mothers and children aged 11-14 years in rating child oral health-related quality of life

OBJECTIVES: To assess the agreement between mothers and children concerning the child's oral health-related quality of life. METHODS: A total of 42 pairs of mothers and children aged 11-14 years with oral and orofacial conditions completed the parental (PPQ) and child (CPQ(11-4)) components of the Child Oral Health Quality of Life Questionnaire. The PPQ and CPQ(11-14) are analogous questionnaires with 31 common items. Agreement between overall and subscale scores derived from the questionnaires were assessed in comparison and in correlation analyses. The former used mean directional differences between mothers and children to assess bias and mean absolute differences to assess agreement at the group level. The latter used intraclass correlation coefficients (ICCs) to assess agreement at the level of individual mother-child pairs. RESULTS: At the group level, agreement between mothers and children was good. There was little evidence of bias in mothers' reports compared to those of their children. The mean absolute difference in overall scores constituted 9% of the possible range of scores. However, the significance of this difference is difficult to interpret. The ICC for overall scores was 0.70 indicating substantial agreement between mother and child pairs. However, the ICCs for the emotional and social well-being subscales indicated moderate agreement only. There was a suggestion that the level of agreement varied according to the characteristics of the child. CONCLUSION: Although mothers may be used as proxies for their children in some circumstances and for some purposes, the views of both should be obtained in order to fully represent child oral health-related quality of life.     

Validity of two oral health-related quality of life measures

OBJECTIVES: To assess the validity of the Oral Impacts on Daily Performance (OIDP) and the short form of the Oral Health Impact Profile (OHIP 14) in the UK. SETTING: Primary care department at a UK dental hospital. SAMPLE: Consecutive patients. METHOD: Cross-sectional comparison of impacts using OIDP and OHIP 14 against clinical findings, Global Oral Health Ratings and pain. RESULTS: A total of 179 patients participated (83.2% response rate). OIDP had weak face validity because it contained contingency questions. Both instruments were developed from the same theoretical model and appeared to have reasonable content validity. In regression analyses, the number of impacts detected by each measure and the total score using OHIP 14 were related to the presence of oral disease and inversely related to age. No suitable transformation could be found to allow regression analysis of OIDP total scores. OHIP 14 correlated more closely with Global Oral Health Ratings but both measures correlated similarly to the experience of pain (0.43 < r < 0.47). The correlation between OHIP and OIDP scores was +0.78. The use of a simple additive method for calculating the total OHIP 14 score did not compromise its validity. CONCLUSION: Both instruments have some validity as measures of Oral Health-Related Quality of Life (OHRQoL) among dental hospital patients. The superior face, criterion and convergent validity and greater amenability to analysis of OHIP 14 render it more suitable for questionnaire-based research and for comparing groups. The additive method may be used to calculate the total score for OHIP 14.     

大学生错畸形与口腔健康相关生存质量的相关性

目的调查错畸形与大学生口腔健康相关生存质量(OHRQoL)的相关性。方法从秦皇岛地区4所高校随机抽取610名无正畸史、缺失牙和颌面部畸形的大学生为研究对象。选用正畸治疗需要指数(IOTN)行牙颌检查,以口腔健康相关生存质量影响程度量表(OHRQoL-UK)对样本进行评估。结果 8.7%受试者自诉在过去1个月中,16个条目中至少有一项受到错畸形的负面影响。在生理、心理和社会三分项中,心理方面的分值最低。OHRQoL-UK表在总分值及三分项上与牙齿健康分值(IOTN-DHC)和牙齿美学分值(IOTN-AC)均呈负相关。结论错畸形客观检查的IOTN牙齿健康部分(IOTN-DHC)和主观自评的IOTN牙齿美学部分(IOTN-AC)均与OHRQoL呈负相关关系。IOTN-DHC与生理方面相关性最大,而IOTN-AC与心理方面相关性最大且无性别差异。     

The association between dental anxiety and oral health-related quality of life in Britain

OBJECTIVE: The aim of this study was to identify associations between level of dental anxiety and the impact of oral health on quality of life (OHQOL) in Britain, controlling for sociodemographic and oral health status (self-reported) factors. METHODS: The basic research design included a cross-sectional study involving a random probability sample of 3000 UK residents. The outcome measures were: levels of dental anxiety, which were measured on the Corah Dental Anxiety Scale (DAS), and the impact of OHQOL, which was assessed using UK oral health-related quality of life instrument (OHQoL-UK (W)). Results: DAS was correlated with OHQoL-UK (W) scores (P < 0.01). Having controlled for sociodemographic factors (age, gender and social class) and oral health status factors (self-reported number of teeth possessed and denture status), known confounding factors associated with OHQOL, those with high levels of dental anxiety (DAS > or = 15) were approximately two times as likely to be among those experiencing the poorest OHQOL (below the population median OHQoL-UK (W) score) in Britain (P < 0.001; OR = 1.93; 95% CI 1.41, 2.65). CONCLUSION: Dental anxiety is associated with the impact oral health has on life quality. Those experiencing high levels of dental anxiety are among those with the poorest oral health-related quality of life in Britain.     

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.     

Factors affecting oral health-related quality of life among pregnant women

Abstract: Objectives: To assess oral health status and to describe the possible factors that could affect the oral health‐related quality of life (OHRQoL) among a group of pregnant rural women in South India. Materials and methods: A total of 259 pregnant women (mean age 26 ± 5.5 years) who participated in the cross‐sectional study were administered the Oral Health Impact Profile (OHIP‐14) questionnaire and were clinically examined for caries and periodontal status. Results: The highest oral impact on quality of life was reported for ‘painful mouth’ (mean: 1.7) and ‘difficulty in eating’ (mean: 1.1). On comparing the mean OHIP‐14 scores against the various self‐reported oral problems, it was seen that the mean OHIP‐14 scores were significantly higher among those who reported various oral problems than those who did not. Those with previous history of pregnancies had more severe levels of gingivitis than those who were pregnant for the first time. Also gingival index scores, community periodontal index of treatment needs scores and previous pregnancies was associated with poorer OHRQoL scores. Conclusion: Increased health promotion interventions and simple educational preventive programmes on oral self‐care and disease prevention during pregnancy can go a long way in improving oral health and lessening its impact on the quality of life in this important population.     

Work stress and oral health-related quality of life among Indian information technology workers: an exploratory study

Objectives: To assess the relationships among work stress, oral health and oral health‐related quality of life (OHRQoL) in information technology (IT) professionals in south India. Methods: The study population consisted of 134 IT industry workers in four mid‐size IT companies in south India. A self‐administered questionnaire consisting of the eight‐item Oral Impact on Daily Performance (OIDP) scale and a 25‐item modified version of the original 167‐item Work Stress Questionnaire was given, following which an oral examination was carried out. Results: Mean ± standard deviation scores on the Work Stress Questionnaire, the decayed, missing and filled teeth (DMFT) index and the Community Periodontal Index of Treatment Needs (CPITN) for the sample population were 53.82 ± 15.07, 4.23 ± 3.47 and 1.81 ± 0.58, respectively. A comparison of clinical oral health status data against respondents’ work stress and OIDP scores showed that mean DMFT and CPITN scores were significantly greater among those who reported oral impact on their daily performance. However, although participants who reported oral problems had consistently higher work stress scores, the differences were statistically significant only for gingival bleeding and sensitive teeth. Multivariate analysis after controlling for age and sex showed that higher levels of work stress and periodontal disease were significant predictors for poor OHRQoL in the sample population. Conclusions: Work stress may be an important predictor for poor OHRQoL and hence requires to be studied in greater detail.     

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。     

Measuring parental perceptions of child oral health-related quality of life

OBJECTIVES: The aim of this study was to develop and evaluate the P-CPQ, a measure of parental/caregiver perceptions of the oral health-related quality of life of children. This forms one component of the Child Oral Health Quality of Life Questionnaire (COHQOL). METHODS: An item pool was developed through a review of existing child health questionnaires and interviews with parents/caregivers of children with pedodontic, orthodontic, and orofacial conditions. The resulting 47 items were used in a study in which 208 parents/caregivers provided data on their frequency and importance. The 31 items rated the most frequent and important were selected for the final questionnaire (P-CPQ). The P-CPQ validity and reliability were assessed by a new sample of 231 parents, 79 of whom completed two copies for the assessment of test-retest reliability. RESULTS: The P-CPQ discriminated among the three clinical groups included in the expected direction. Within-group analyses using clinical data provided some evidence that scores were associated with the severity of the condition. The P-CPQ also showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.94 and demonstrated perfect test-retest reliability (ICC=0.85). CONCLUSION: The study provides data to indicate that the P-CPQ is valid and reliable.     

Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders

Abstract – Objective The aim of this study was to assess the association of chewing ability to oral health‐related quality of life (OHRQoL) measured by the Oral Health Impact Profile‐14 (OHIP‐14) controlling for clinical oral health status, self‐reported health status, demographic factors, and socioeconomic conditions among community‐dwelling and institutionalized Korean elders. Methods This cross‐sectional study comprised a sample of 307 community‐dwelling and 102 institutionalized people over the age of 60, using a cluster sampling procedure. A questionnaire was implemented and a clinical oral examination was completed for each subject. The outcome variable of interest was the OHIP‐14 score, and its associations with chewing ability, objective oral health status, self‐reported health status, demographic factors, and socioeconomic conditions were assessed. Because of highly‐skewed distribution of the OHIP‐14 scores, nonparametric analytic methods were used. The final model was developed using a multivariable two‐level logistic regression model for a dichotomized OHIP‐14 score to account for the cluster sampling method applied to this study. Results The mean age of the participants was 75.4 years, with 67.7% being women. The median OHIP‐14 score was 7. Negative oral health impacts were experienced fairly often or very often by a total of 36.4% of elderly. In the final model, elders who could chew none to three and four to six foods among seven indicator foods were 3.4 (P = 0.010) and 2.0 (P = 0.040) times more likely, respectively, to have worse OHRQoL compared with elders who could chew all seven food types. Also significant associations with worse OHRQoL were shown for being concerned about oral health [Odds Ratio (OR) = 4.9, P = 0.002], fair or better self‐reported oral health (OR = 0.12, P = 0.002), very good/good self‐reported general health (OR = 0.38, P = 0.008), being married (OR = 2.0, P = 0.054), and having a favourable economic status (OR = 0.43, P = 0.042). Conclusions This study showed highly significant association between chewing ability and OHRQoL measured by the OHIP‐14 score after controlling for related factors. Amelioration of chewing ability might independently contribute to improving the OHRQoL of elders.     

Demographic factors, denture status and oral health-related quality of life

OBJECTIVES: This study investigated the association between denture status, demographic factors, and oral health-related quality of life (OHRQoL). METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G, 53 items), which was administered in a personal interview to 2050 subjects (60% of eligible subjects responded) 16-79 years of age in a national survey. Median regression was used to analyze the influence of denture status (no, removable, complete dentures), age, gender, education (less than 10 years of schooling, 10-12 years, more than 12 years), and residential area (rural, urban) on the OHIP-G summary score. RESULTS: In bivariable analyses, compared to the base category, the OHIP-G median increased 8.0 U for subjects with removable dentures, 20.0 U for subjects with complete dentures, 1.7 U for each 10-year age period, 2.0 U for men, 3.0 U for less than 10 years of schooling (compared to > or =10 years.), and 1.0 U for urban areas (P < 0.05 for all effects except for residential area). In the multivariable analysis, compared to subjects without dentures, subjects with removable dentures had a 7.5 (95% CI: 5.2-9.8) higher OHIP-G median and subjects with complete dentures had a 18.5 (95% CI: 14.7-22.4) higher median when demographic variables were controlled. No demographic variables were statistically significant except for residential area (P = 0.04). CONCLUSIONS: Denture status was a stronger predictor for impaired OHRQoL than demographic variables and rendered age and education almost negligible in their influence on OHRQoL.     

Influence of children's oral health-related quality of life on school performance and school absenteeism

Objective: This study assessed the relation of child oral health‐related quality of life with school performance and school absenteeism. Methods: We followed a cross‐sectional design with a multistage random sample of 312 12‐year‐old schoolchildren living in Brazil. The participants completed the child perceptions questionnaire (CPQ_11–14) that provides information about psychological factors, while their parents or guardians answered questions on their socioeconomic status measured by parents' education level and household income. A dental examination of each child provided information on the prevalence of caries and dental trauma. Data on school performance, which included the results of baseline Brazilian language (Portuguese) tests, and school absenteeism (school days missed) were obtained from the school register. Multilevel linear regression was used to investigate the association among psychological and socioeconomic status and children's school performance. Results: In the multiple model, after adjusting for individual covariates, being a girl was associated with higher school performance (P < 0.05), whereas low household income (P < 0.05), higher mean of CPQ_11–14 (P < 0.05), and higher school days missed (P < 0.001) were identified as individual determinants of lower school performance. When the school‐level covariates were included in the model, the association between subjects' level characteristics and school performance still persisted. Conclusion: Children's school performance and absence were influenced by psychological and socioeconomic conditions.     

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.     

Halitosis and oral health-related quality of life: a case report

To cite this article:
Int J Dent Hygiene 10 , 2012; 3–8
DOI: 10.1111/j.1601‐5037.2011.00512.x
Buunk‐Werkhoven YAB, Dijkstra‐le Clercq M, Verheggen‐Udding EL, de Jong N, Spreen M. Halitosis and oral health‐related quality of life: a case report. Abstract: Objectives: This is a clinical case of a 36‐year‐old Dutch male, patient in the Dr. S. van Mesdag Forensic Psychiatric Centre in Groningen. It demonstrates a short‐time effect of a tailored oral hygiene self‐care intervention in three sessions over a period of 3 months on halitosis and a patient’s oral health‐related quality of life (OH‐QoL). Methods: In addition to a dental screening and professional oral hygiene care, a semi‐structured interview was conducted by the dental hygienist, and questionnaires were administered. The questionnaires included were; the Dutch version of the Oral Health Impact Profile‐14 (OHIP‐14‐NL; used as a measurement of OH‐QoL), scales for expected social outcomes for having healthy teeth, attitudes towards oral hygiene behaviour (OHB) and dental anxiety. Results: Clinical observations showed an improvement in patient’s OHB, while the extreme foetor‐ex‐ore was reduced to an acceptable level. A retrospective assessment showed that patient’s attitude towards the recommended OHB together with his self‐perceived OH‐QoL had positively increased. Conclusions: This case highlights the value of professional individual oral hygiene instructions performed by a dental hygienist. It also illustrates that a patient’s effective OHB may play an important role in the reduction in halitosis and self‐perceived OH‐QoL. Finally, the retrospective version of the OHIP‐14‐NL may be an adequate method to assess self‐perceived OH‐QoL within a relative short period of time.