Assessing oral health-related quality of life in children and adolescents: a systematic review and standardized comparison of available instruments

Semantic segmentation for tooth cracks using improved DeepLabv3+ model

Objective

Accurate and prompt detection of cracked teeth plays a critical role for human oral health. The aim of this paper is to evaluate the performance of a tooth crack segmentation model (namely, FDB-DeepLabv3+) on optical microscopic images.

Method

The FDB-DeepLabv3+ model proposed here improves feature learning by replacing the backbone with ResNet50. Feature pyramid network (FPN) is introduced to fuse muti-level features. Densely linked atrous spatial pyramid pooling (Dense ASPP) is applied to achieve denser pixel sampling and wider receptive field. Bottleneck attention module (BAM) is embedded to enhance local feature extraction.

Results

Through testing on a self-made hidden cracked tooth dataset, the proposed method outperforms four classical networks (FCN, U-Net, SegNet, DeepLabv3+) on segmentation results in terms of mean pixel accuracy (MPA) and mean intersection over union (MIoU). The network achieves an increase of 11.41% in MPA and 12.14% in MIoU compared to DeepLabv3+. Ablation experiments shows that all the modifications are beneficial.

Conclusion

An improved network is designed for segmenting tooth surface cracks with good overall performance and robustness, which may hold significant potential in computer-aided diagnosis of cracked teeth.

Reliability and validity of cross‑culturally adapted oral health‑related quality‑of‑Life instruments for Brazilian children and adolescents: a systematic review

OBJECTIVE

This systematic review aimed to review the reliability and validity of oral health-related quality of life (OHRQoL) questionnaires for Brazilian children and adolescents. Also, the cross-cultural adaptation was evaluated.

METHODS

This systematic review is registered in PROSPERO (CRD42022300018) and was performed based on the COSMIN guideline. Electronic searches were performed in the PubMed/MEDLINE, Web of Science, Lilacs, BVS (BIREME), Scielo, and Embase databases until March 2023 by two independent reviewers. There was no restriction on time or language. The following studies were included: validation studies and cross-cultural adaptation of OHRQoL instruments into Brazilian Portuguese; studies that evaluated the measurement properties of OHRQoL questionnaires in children and adolescents and that reported at least one of the measurement properties: reliability, internal consistency, error measurement, content validity, construct validity, criterion validity, discriminant validity, and/or convergent validity. The following were excluded: studies of systematic reviews of OHRQoL measures; studies reporting OHRQoL assessment through instruments; construction (development) and validation of a new instrument; questionnaires that had a single item; and validation for Portuguese from Portugal. The cross-cultural adaptation process and psychometrics of the included studies were verified.

RESULTS

6556 articles were identified, and 19 manuscripts were included. All studies were conducted in Brazil, and the age of the participants ranged from 2 to 15.42 years old. Sixteen articles presented the cross-cultural validation steps. Cronbach's alpha of the revised instruments ranged from 0.59 to 0.86.

CONCLUSIONS

It can be concluded that most studies provided information and evidence regarding validity, reliability, translation, and cultural adaptation.

Evaluating conceptual model measurement and psychometric properties of Oral health-related quality of life instruments available for older adults: a systematic review

BACKGROUND

Older adults present a variety of oral diseases and conditions, in addition to co-morbidities and limited access to dental care, which significantly impact their oral health-related quality of life (OHRQoL). There are many instruments published to measure OHRQoL. However, it is challenging for clinicians and researchers to choose the best instrument for a given purpose.

PURPOSE

To identify OHRQoL instruments available for older adults and summarize the evidence on the conceptual and measurement model, psychometric properties, interpretability, and administration issues of OHRQoL instruments available for older adults through a systematic review.

METHODS

A systematic search was conducted in MEDLINE, EMBASE, LILACS, and CENTRAL up to February 2023. Articles reporting information on the concept model measurement, psychometric properties, and administration issues of an instrument measuring OHRQoL in older adults were included. Two researchers independently evaluated each instrument using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. The overall score and seven attribute-specific scores were calculated (range 0-100): Conceptual and measurement model, Reliability, Validity, Responsiveness, Interpretability, Burden, and Alternative forms.

RESULTS

We identified 14 instruments evaluated in 97 articles. The overall score varied between 73.7 and 8.9, with only six questionnaires over the threshold score 50.0. EORTC QLQ OH-15 (cancer-specific questionnaire) achieved the highest score (73.7), followed by OHIP (generic OHRQoL questionnaire) (66.9), GOHAI (generic OHRQoL questionnaire) (65.5), and OHIDL (generic OHRQoL questionnaire) (65.2). Overall, the Conceptual and measurement model and Validity showed the best performance, while Responsiveness and Interpretability showed the worst. Insufficient information was presented for an overall evaluation of DSQ and OHAI.

CONCLUSION

The evidence supports using EORTC QLQ-OH15 as a specific instrument to assess OHRQoL in cancer patients and the OHIP-49, GOHAI, or OHIDL as generic instruments to assess OHRQoL either for cross-sectional or longitudinal studies in older adults.

OHIP-5 FOR SCHOOL-AGED CHILDREN

BACKGROUND

Different dental patient-reported outcome measures (dPROMs) exist for children and adults, leading to an incompatibility in outcome assessment in these 2 age groups. However, the dental patient-reported outcomes (dPROs) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the same in the 2 groups, providing an opportunity for compatible dPRO assessment if dPROMs were identical. Therefore, we adapted the 5-item Oral Health Impact Profile (OHIP-5), a recommended dPROM for adults, to school-aged children to allow a standardized dPRO assessment in individuals aged 7 years and above.

AIM

It was the aim of this study to develop a 5-item OHIP for school-aged children (OHIP-5School) and to investigate the instrument's score reliability and validity.

METHODS

German-speaking children (N = 95, mean age: 8.6 years +/- 1.3 years, 55% girls) from the Department of Pediatric Dentistry at the Medical University of Vienna, Austria and a private dental practice in Bergisch Gladbach, Germany participated. The original OHIP-5 was modified and adapted for school going children aged 7-13 years and this modified version was termed OHIP-5School. It's score reliability was studied by determining scores' internal consistency and temporal stability by calculating Cronbach's alpha and intraclass correlation coefficients, respectively. Construct validity was assessed comparing OHIP-5School scores with OHIP-5 as well as Child Perceptions Questionnaire (CPQ-G8-10) scores.

RESULTS

Score reliability for the OHIP-5School was "good" (Cronbach's alpha: 0.81) or "excellent" (Intraclass correlation coefficient: 0.92). High correlations between OHIP-5School, OHIP-5, and CPQ-G8-10 scores were observed and hypotheses about a pattern of these correlations were confirmed, providing evidence for score validity.

CONCLUSION

The OHIP-5School and the original OHIP-5 are short and psychometrically sound instruments to measure the oral health related quality of life in school-aged children, providing an opportunity for a standardized oral health impact assessment with the same metric in school-aged children, adolescents, and adults.

Influence of two caries detection strategies on the quality of life of preschool children: An analysis of secondary outcomes of a 2-Year randomized clinical trial

OBJECTIVE

This randomized clinical trial aimed to evaluate the influence of two caries diagnosis strategies, and subsequent management, on oral health-related quality of life (OHRQoL) of preschoolers. Additionally, the association of the OHRQoL outcomes with the clinician-centred primary outcome used in the main study was also explored.

MATERIALS AND METHODS

This study refers to the OHRQoL secondary outcomes analyses of the so-called RCT 'CARDEC-1'. Three- to 6-year-old children were randomly allocated in two caries detection strategies in primary molars: visual inspection (VIS) or visual + radiographic (RAD) assessment. Participants were diagnosed and treated according to the allocated group and followed up for 2 years. Caregivers answered the Early Childhood Oral Health Impact Scale (ECOHIS) at baseline and after 2 years. Intention-to-treat analysis was performed. ECOHIS scores at baseline and 2 years later were compared using the Mann-Whitney test. Effect sizes, change scores and the minimally important difference (MID) were also compared between groups. Additional analysis was performed to assess if OHRQoL variables could reflect the primary clinical outcome (number of new operative interventions during the follow-up), observing if these met the Prentice criteria.

RESULTS

Two hundred and five children had the ECOHIS answered in both period times (18.7% attrition rate). There was a decrease in total ECOHIS scores, as well as for different domains for both trial groups, with effect sizes varying from 0.43 to 0.77. Comparisons between groups, however, did not show significant differences. In the additional analysis, the OHRQoL variables met the Prentice criteria and presented the same trends observed with the clinician-centred primary endpoint.

CONCLUSION

Caries detection performed by visual inspection alone or associated with radiographic method does not influence the long-term impact on OHRQoL. Furthermore, OHRQoL variables reflect clinical outcomes in this type of clinical trial.

CLINICALTRIALS

gov NCT02078453.

Oral health-related Quality of Life in patients with Oligodontia: a FACE-Q assessment

OBJECTIVES

The present study aimed to investigate the impact of oligodontia on appearance and on the functional and psychosocial aspects of oral health-related quality of life (OHrQoL) in patients aged 8-29 years.

METHODS

62 patients with oligodontia that were registered at -REDACTED- were included. A control group included 127 patients that were referred for a first orthodontic consultation. Participants completed the FACE-Q Dental questionnaire. Regression analyses were performed to explore relationships between OHrQoL and patient-identified gender, age, the number of congenitally missing teeth, active orthodontic treatment, and previous orthodontic treatment.

RESULTS

The only clear significant difference between the oligodontia and control groups was that patients with oligodontia scored lower in the domain, 'eating and drinking' (p<0.001). It was found that, in oligodontia the greater the number of agenetic teeth, the more difficulties eating and drinking. In fact, the Rasch score was reduced by 1.00 (95% CI: 0.23-1.77; p=0.012) for each extra agenetic tooth. Older children scored significantly lower than younger ones on five out of nine scales: appearance of the face, smile, and jaws; social function; and psychological function. Females scored significantly lower than males on four scales: appearance of the face, appearance distress, social function, and psychological function.

CONCLUSION

These findings suggested that, when treating patients with oligodontia, the number of agenetic teeth, age, and gender should be taken into account. These factors could have negative effects on their self-assessment of appearance, their facial function, and their quality of life.

CLINICAL SIGNIFICANCE

The increased difficulty with eating and drinking associated with more agenetic teeth highlighted the importance of functional (re)habilitation.

Impact of dental fluorosis on the oral health related quality of life of adolescents in an endemic area

Introduction

Oral diseases and conditions affect the physical, social, and psychological well-being of an individual. The aim of this study was to determine the association between the severity of dental fluorosis and oral health related quality of life (OHRQoL) among 15-year-old school children residing in an endemic area for dental fluorosis in Sri Lanka.

Design

A cross-sectional study was conducted among 989, 15-year-old school children who were lifetime residents of Kurunegala district. A validated Sinhala version of the Child Perception Questionnaire (CPQ 11-14) was used to assess OHRQoL. Dental fluorosis was assessed using the Thylstrup and Ferjeskov index (TF index) while dental caries and malocclusion were assessed using the WHO Basic Methods and Dental Aesthetics Index (DAI) respectively. In addition, information pertaining to parental level of education, type of toothpaste used, frequency of toothbrushing and use of dental services was also gathered.

Results

The prevalence of dental fluorosis was 52%. The overall prevalence of impacts based on the CPQ was 38.2%. The severity of dental fluorosis was not significantly associated with the overall prevalence of impacts. However, the severity of dental fluorosis was significantly associated with three oral impacts namely "having pain in teeth, lips, jaws, or mouth", "felt irritable or frustrated" and "other children teased or called names". According to the multiple logistic regression analysis, use of dental services and moderate to severe malocclusion were significantly associated with poor OHRQoL but not dental fluorosis.

Conclusion

The severity of dental fluorosis was not associated with OHRQoL of the participants.

Socio-economic inequalities in health-related quality of life among Iranian young people in the middle stage of adolescence: application of Health Equity Assessment Toolkit

BACKGROUND

One of the main concerns of public health is the increasing inequality of health status, which has an adverse effect on people's life.

PURPOSE

The current study aims to analyze the role of socioeconomic inequalities in health-related quality of life (QoL) among Iranian young people in the middle stage of adolescence.

METHODS

A cross-sectional descriptive study was conducted on 576 young people in the middle stage of adolescence. The samples were selected using the Multi-stage sampling method. Data were collected by a demographic checklist, and KIDSCREEN-52 questionnaire and analyzed by SPSS ver.16. The Health Equity Assessment Toolkit (HEAT) Version 4.0 (beta) was used to assess adolescents' QoL inequalities in terms of socio-economic subgroups.

RESULTS

The results show that 27.2 adolescents had low quality of life. The score of physical and autonomy components of QoL was significantly more in male versus school environment in female adolescents. Also, the asset index, father's, and mother's education, and family income in female adolescents, and the assets and family income in male adolescents were significantly related to the quality of life (p < 0.05). The risk of lower QOL in the poorest quintile was 1.12 times more than in the richest quintile. The consideration index of Asset in terms of sex was 4.5 and the modified Gini index was more than 0.5 in females and males.

CONCLUSION

Our findings highlight the significant effects of socioeconomic inequality on the HRQL of Iranian adolescents. Requires a targeted policy approach to reach the poorest quintile for improving the quality of life of adolescents.

OPERATIONALIZING ORAL HEALTH OUTCOME MEASURES TO IMPROVE THE ORAL HEALTH OF PERSONS WITH INTELLECTUAL DISABILITIES

Individuals with intellectual disability (ID) face significant challenges in preventing oral diseases. They also lack access to high-quality oral health care in professional settings. To understand the effects of oral conditions on their lives and health, it is necessary to assess their oral health outcome measures. For those with mild ID, who possess adequate linguistic and cognitive abilities, accessibility features should be incorporated in the dental patient reported outcome (dPRO) measures. But many other individuals often lack the linguistic and cognitive ability to self-report through dPRO measures. While self-reported measures are preferable, requiring dPROs in this population would result in a high amount of missing data and the inability to assess interventions for improving their dental health. Thus, there is a need to use proxy-reported outcome (ProxRO) measures, observer reported outcome (ObsRO) measures, and clinician reported outcome (ClinRO) measures among those with ID. This is also a common approach taken by other specialties that work closely with those with ID, where the measures for activities of daily living and adaptive behavior measures use reporting by caregivers. ProxRO measures in dentistry that were created for infants and young children provide a structure for appropriate adaptations and the creation of relevant outcome measures. Including input from the intensely multidisciplinary teams that provide supports for those with ID is key to creating high-quality measures and oral health interventions for those with ID.

Influence of Cleft Lip and Palate on Oral Health-Related Quality of Life in Northern Italy: Exploring Both the Children's and Caregivers' Perspectives

The aim of this cross-sectional study was to examine whether parents/caregivers' perceptions of oral health-related quality of life (OHRQoL) differ from that of their cleft children, exploring the impact of demographic variables and cleft type on their agreement. Fifty-three primary and secondary schoolchildren, with non-syndromic orofacial cleft, and their parents answered the Child Oral Health Impact Profile (COHIP) questionnaire. Concordance between caregivers' and children's reports was low to moderate. Parents/caregivers had worse perceptions of OHRQoL compared to that of their children, peer interaction and functional well-being domains being statistically significantly different (p = 0.033 and p = 0.005, respectively). Cleft type, gender and parents' country of origin seemed to be potential contributing factors of disagreement. Parents overestimated the impact of unilateral (p = 0.047) and bilateral cleft lip and palate (p = 0.021) on OHRQoL, and they rated more poorly than their male children did. Italian parents were more concerned about the functional well-being of their children (p = 0.014), and foreign parents about peer interaction (p = 0.010) and school environment (p = 0.012) dimensions. These findings suggest that parental assessment of OHRQoL cannot replace that of school-aged children, but they are complementary as they cover different, but equally relevant perspectives.

Exploring associations between oral health measures and oral health-impacted daily performances in 12–14-year-old schoolchildren

Background

Oral health-related quality of life, a prominent topic in dentistry, has been studied extensively. However, the comparison between various self-perceived and clinical oral health measures still needs to be explored. The purpose of the current study is; first, to report the self-perceived and clinically examined oral health measures that are associated with the oral impacts on daily performances. Second, to identify the oral health measure that best predicts greater oral impact scores. Third, to investigate the difference in findings related to the disease experience measures and the treatment measures.

Methods

A cross-sectional study was carried out on children aged 12–14 years. The prevalence, frequency, and oral impact scores of each daily performance were calculated. Thirteen self-perceived OH conditions were assessed. Clinically examined oral health measures included gingival health, oral hygiene status, DMFT, DT, MT, and FT scores and, one or more decay (1 + D), missing (1 + M) and filled (1 + F) teeth. Simple linear and multiple linear regressions were carried out to report the associations.

Results

At least one oral health impacted daily performance was reported by 40% of the total sample of schoolchildren (N = 700). Based on the magnitude and precision of adjusted regression coefficients (RC), decay severity (DT) was identified as a better predictor of a greater oral impact score with regression coefficient values ranging between 0.3 (social contact) and 2.4 (1 + performance). Contrariwise, MT and FT components of DMFT were associated with lower oral impact scores. The self-perceived measures were also associated with oral impact scores and presented similar findings to that of the clinical oral health measures.

Conclusions

Untreated decay significantly impacted daily performances, especially eating, sleeping, studying, and social contact. The findings are of importance to public health practitioners for reporting, treating, and preventing oral health problems in children, and eventually contributing to better oral health-related quality of life.

Emoji as promising tools for emotional evaluation in orthodontics

Background

Emoji are pictograms frequently used in social networks capable of expressing emotions. These tools can provide insights into people's behavior that could not be obtained with the use of textual communication. Recently, emoji have been introduced to various research fields as successful alternatives to word-based questionnaires for measure emotional responses. The objective of this study was to preliminarily evaluate the discriminating ability and relationship of these tools with different occlusal conditions/malocclusions.

Methods

Online surveys were applied to adult individuals (n = 201; mean age = 27.4 ± 5.7; 37.3% males, 62.7% females). Subjects issued acceptance scores (10-point scale) and expressed their emotional status using a 30-emoji list in relation to nine occlusal conditions: C1–crowding, C2–anterior open bite, C3–interincisal diastema, C4–increased overjet + deep bite (Class II div. 1), C5–anterior crossbite (Class III), C6–ideal occlusion, C7–unilateral posterior crossbite, C8–anterior open bite plus bilateral posterior crossbite plus crowding, and C9–deep bite (Class II div. 2). Cochran's Q and McNemar tests were used to compare the frequencies of choice of emoji between conditions. Correspondence analyses were applied to assess the association between occlusal conditions and emoji. Kendall's correlation coefficient was calculated to evaluate the relationship between mean acceptance scores and frequency counts of each emoji.

Results

The frequency of choice between conditions showed a significant difference for 25 of the 30 emoji (P < 0.05), indicating an adequate discriminating ability of these tools. Emoji were grouped predominantly based on their emotional valence (positive/negative) and arousal/activation (high/low). Positive emoji were associated with the most accepted conditions (i.e., C6, C3), while negative emoji with the most rejected ones (i.e., C8, C1, C2). Although only weak, positive correlations between acceptance and positively valenced emoji, and negative correlations between acceptance and negatively valenced emoji were observed (P < 0.05).

Conclusions

Emoji have an adequate discriminatory ability and would allow determining emotional profiles in the face of different occlusal conditions. Further research is necessary to consolidate the use of these tools in an instrument that allows measuring emotional responses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40510-022-00418-3.

Quality of the adaptation procedures and psychometric properties of the scale of oral health outcomes for 5-year-old children (SOHO-5): a systematic review

PURPOSE

The aim of this study was to assess the quality of the cross-cultural adaptations and psychometric properties of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5).

METHODS

A systematic search was performed in three databases, PubMed, SCOPUS, and Dentistry and Oral Science Source (EBSCO). Studies relating to the cross-cultural adaptation and psychometric properties of SOHO-5 were included. The quality of cross-cultural adaptation was assessed in five aspects including translation, synthesis, back-translation, expert committee review, and pretesting. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties in seven domains including responsiveness, internal consistency, reliability, measurement error, and structural, construct, and cross-cultural validity.

RESULTS

The search identified 162 papers for screening; from these, 107 articles and 9 systematic reviews were excluded. 21 full papers were retrieved and 6 studies that met the inclusion criteria were included. Out of six, two reported all five aspects of cross-cultural adaptation procedures. Regarding the psychometric properties, none of the studies evaluated all aspects of psychometric properties. Almost all of the studies reported internal consistency (Cronbach's alpha ranging from 0.71 to 0.90), test-retest reliability (Intraclass Correlation Coefficient 0.46-0.98), and construct validity. None reported the cross-cultural validity and responsiveness of the measures.

CONCLUSION

While these studies provided satisfactory results regarding the validity and reliability of SOHO-5, the majority of the included studies did not report all domains of the cross-cultural adaptations and psychometric properties. Overall, the quality of the cross-cultural adaptations and psychometric properties of the included studies is doubtful. Future research should follow the guidelines to assess all aspects of psychometric properties and adaptation procedures in cross-cultural settings.

Oral health-related quality of life in 4-16-year-olds with and without juvenile idiopathic arthritis

BACKGROUND

Few studies have investigated oral health-related quality of life (OHRQoL) in young individuals with juvenile idiopathic arthritis (JIA). Aims were to investigate whether OHRQoL differs between children and adolescents with JIA compared to controls without JIA, while adjusting for socio-demographic-, behavioral- and oral health-related covariates. Furthermore, to explore whether socio-behavioral and oral health-related covariates of OHRQoL vary according to group affiliation and finally, specifically for individuals with JIA, to investigate whether disease-specific features associate with OHRQoL. We hypothesized that participants with JIA have poorer OHRQoL compared to participants without JIA.

METHODS

In this comparative cross-sectional study participants with JIA (n = 224) were matched to controls without JIA (n = 224). OHRQoL was assessed according to Early Childhood Oral Health Impact Scale (ECOHIS) (4-11-years-olds) and the child version of Oral Impacts on Daily Performances (Child-OIDP) (12-16-years-olds). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-demographic, behavioral and self-reported oral health information collected by questionnaires. Index teeth were examined for caries by calibrated dentists. Multiple variable analyses were performed using logistic regression, reporting odds ratio (OR) and 95% confidence interval (CI). Two-way interactions were tested between group affiliation and the socio-behavioral- and oral health-related variables on the respective outcome variables.

RESULTS

In total, 96 participants with JIA and 98 controls were evaluated according to ECOHIS, corresponding numbers for Child-OIDP was 125 and 124. Group affiliation was not associated with impaired ECOHIS or Child-OIDP in adjusted analyses (OR = 1.95, 95% CI 0.94-4.04 and OR = 0.99, 95% CI 0.46-2.17, respectively). Female adolescents with JIA were more likely than males to report oral impacts according to Child-OIDP. Continued activity or flare was found to adversely affect Child-OIDP, also self-reported outcome measures in JIA associated with Child-OIDP.

CONCLUSIONS

This study did not provide consistent evidence to confirm the hypothesis that children and adolescents with JIA are more likely to have impaired OHRQoL compared to their peers without JIA. However, female adolescents with JIA were more likely than males to report impacts on OHRQoL. Furthermore, within the JIA group, adolescents with continued disease activity, flare or reporting pain, physical disability, had higher risk than their counterparts of impaired OHRQoL.

Premature loss of primary molars: impact on the oral health-related quality of life of schoolchildren

PURPOSE

Evaluate the impact of the premature loss of primary molars due to caries on oral health-related quality of life (OHRQoL) in schoolchildren.

METHODS

A cross-sectional study was conducted with children eight to ten years of age at public schools in the city of Florianópolis selected through cluster sampling. The collection of the clinical data occurred in the school setting by four trained and calibrated examiners (Kappa > 0.7) DMFT/dmft index, PUFA/pufa index, accentuated overjet, and anterior open bite. Sex and age of the child and guardian's schooling (classified as ≤ 8 or > 8 years) were collected through a questionnaire answered by the guardians. OHRQoL was assessed using the Child Perceptions Questionnaire 8-10. The data were submitted to bivariate, multivariate, and hierarchical Poisson analyses.

RESULTS

A total of 1456 children participated in the study. The prevalence of premature tooth loss due to caries was 5.8% (n = 85). The prevalence of negative impact on OHRQoL was 47.4% (n = 691). Negative impact on OHRQoL was significantly associated with the premature loss of primary molars (p < 0.001) as well as the sex (girls), guardian's schooling (> 8 years) and the presence of untreated caries (p < 0.001).

CONCLUSION

The premature loss of primary molars due to caries was associated a negative impact on the OHRQoL of children eight to ten years of age. Negative impact is also associated with untreated caries, sex, and the level of schooling of guardians.

Oral-Health-Related Quality of Life among Non-Syndromic School-Age Children with Orofacial Clefts: Results from a Cross-Sectional Study in Northern Italy

The aim of this cross-sectional study was to determine the influence of orofacial clefts on the oral-health-related quality of life (OHRQoL) in a group of Italian children and adolescents and to examine whether gender, age, cleft type, and surgical protocol were associated with patients’ OHRQoL. A total of 71 patients with cleft lip and/or cleft palate (CLP) and 71 age- and gender-matched controls (aged 8 to 18 years) were asked to complete the Child Oral Health Impact Profile (COHIP), a validated and reliable questionnaire to assess self-reported OHRQoL in children and teenagers. Children with orofacial clefts showed statistically significant lower quality of life scores than controls for total OHRQoL and for each of the subscales. Gender, the type of cleft, and the type of surgical protocol had no significant influence on OHRQoL. The negative impact of CLP on the area of self-image was greater in 12–18-year-olds, indicating a higher need for psychosocial counselling. These findings suggest that Italian CLP children and adolescents experience a poorer OHRQoL in comparison to their non-cleft peers.

Velopharyngeal Inadequacy-Related Quality of Life Assessment: The Instrument Development and Application Review

Objective

For the patient-reported outcome (PRO) measures related to patients with velopharyngeal inadequacy (VPI), different quality of life (QOL) instruments have been developed. The present systematic review was designated to identify current VPI-related QOL instrument development, validation, and applicability.

Methods

Pubmed, Cochrane, Embase, Web of Science, and EBSCO databases were searched in January 2022. “Velopharyngeal” or “palatopharyngeal” and “quality of life” or “life quality” were searched in title, abstract, and keywords. This study followed Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Two investigators independently reviewed abstracts and full texts of the identified literature. An established checklist was used to evaluate the measurement properties of each identified instrument.

Results

A total of 375 articles and 13 instruments were identified, which can be divided into nine types of families according to their development procedures. Developmental and measurement characteristics, evidence of conceptual model, content validity, reliability, construct validity, scoring, interpretation, respondent burden, and presentation for all instruments were shown.

Conclusion

The patient's self-report assessment and parent-proxy assessment are both valuable. The conclusion that any QOL instrument is absolutely the best for patients with velopharyngeal inadequacy could not be drawn. Understanding the development and characteristics of different QOL instruments, including their reliability, validity, aim, target, language, and resource, should be important before application in clinic or research.

Dental caries severity and oral health-related quality-of-life in Brazilian preschool children

The impact of dental caries on oral health-related quality-of-life (OHRQoL) may be influenced by disease severity. This study evaluated the impact of caries severity on OHRQoL in preschool children. A school-based, cross-sectional study was conducted with 205 children (aged 2-5 years) in Southern Brazil. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and provided sociodemographic information. The Caries Assessment Spectrum and Treatment criteria were used to evaluate caries severity, and Poisson regression with robust variance estimation conducted to determine the rate ratio (RR) and 95% confidence intervals (CIs) of the mean OHRQoL scores according to severity level. Most children had at least one tooth in the morbidity (37%) or pre-morbidity (35%) stages, and the prevalence of impacts on OHRQoL was 40%. Caries severity was associated with the impact scores: after adjustments, the mean B-ECOHIS scores were 6.31 (95% CI: 4.24-9.38) higher for children in the morbidity stage, and 10.84 (95% CI: 6.51-18.05) higher in the severe morbidity stage, than for healthy children [RR = 10.84 (95% CI: 6.51-18.05)]. Children with carious lesions into dentine or with pulpally-involved or abscessed teeth had poorer OHRQoL than children without such lesions.

Does the premature loss of primary anterior teeth cause morphological, functional and psychosocial consequences?

Premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence regarding the types and magnitudes of the consequences involved. Morphological, functional, and psychosocial problems may arise from untreated premature loss of primary incisors and canines. The morphological problems include impaction and eruption disturbances of permanent successors; inclination and/or extrusion of adjacent and antagonist teeth, respectively; midline deviation; and crowding. Functional complications, such as speech disorders, aesthetic problems, and development of non-nutritive habits may occur, resulting in psychosocial implications, including a decrease in self-esteem, and even being targeted for bullying. The current critical review aimed to present and discuss the evidence available in the literature about the etiology, characteristics, implications and interventions resulting from the premature loss of primary anterior teeth. It is of utmost importance that future studies be developed to support the clinical decisions made by dental professionals on this topic.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial

INTRODUCTION

This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children.

METHODS

Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T₁), at the end of RPE (T₂), and 1 month after the appliance removal (T₃). Generalized mixed models were used for data analysis (α = 0.05).

RESULTS

Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T₁ and T₂, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T₁ 95% confidence interval [CI], 1.08-1.26; T₂ 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T₃ are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T₃ 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T₃ (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T₁ and T₂.

CONCLUSIONS

Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.

Parental perception on oral health-related quality of life and dental features of ectodermal dysplasia and isolated hypodontia in children

Background

Children missing 6 or more permanent teeth often present with complex dental care needs and significant impacts on their oral health related quality of life (OHRQoL). The most important facet in the overall care for these children is the child’s own experience, but parents primarily make the decisions regarding their child’s dental management. Understanding the parental perspective could have a positive impact on planning and provision of care for these patient groups in the future. The study compared the parental perspectives on OHRQoL impact and dental experience for children with ectodermal dysplasia (ED), severe isolated hypodontia (IH), and matched controls following assessment of their dental features.

Design

A cross-sectional study of 172 children (mean age: 12.4 years old) was conducted; 86 with severe hypodontia (≥ 6 missing teeth; ED: 29; IH: 57) and 86 age and gender matched controls. The Parental-Caregiver Perceptions Questionnaire (P-CPQ), Family Impact Scale (FIS) and a supplemental questionnaire were used to gather information on parental perceptions of OHRQoL and dental experiences, respectively. Clinical examinations were used to assess and compare the dental features between children with ED, IH and their respective controls.

Results

Higher scores (p < 0.05) were found in P-CPQ and FIS scores between the children with ED, IH and their respective controls. P-CPQ scores for males with ED had a moderate correlation with functional limitations (R_s = 0.576; p = 0.001*), oral symptoms (R_s = 0.444; p = 0.016*) and overall QoL (R_s = 0.499; p = 0.006*). The ED group reported earlier awareness of issues, the youngest attendance (3.24 years) and highest perceived number of appointments (“20 or more”; 58.6%). The mean number of missing teeth in the ED group was almost twice that of the IH group (ED: 20.17; IH: 10.68) and the median number of missing teeth (Radiographically: ED = 21; IH = 9; Clinically: ED = 11; IH = 6), was significantly greater in the ED group when compared to the IH group (p < 0.001*).

Conclusion

Parents of children with ED and IH perceive a greater impact on QoL, for both the child and their family. Children with ED need earlier intervention and more extensive treatment than children with IH and their controls.

Impact of the Poor Oral Health Status of Children on Their Families: An Analytical Cross-Sectional Study

The impact of poor oral health may not just be limited to the children themselves but can impact their families. The current study aims to perform psychometric analyses of the Arabic version of the Family Impact Scale and investigate the association of its domains with the oral health status of children. This cross-sectional study was carried out in a sample of 500 parent-child dyads from high schools of Jazan city of the Kingdom of Saudi Arabia. The Arabic version of the Family Impact Scale was subjected to reliability and validity tests. The explanatory variables in the current study are: the oral health status, parents combined income, parents’ education, age and sex of the child. The descriptive analysis was reported using proportions, this was followed by the bivariate and multivariable analyses. About 24.2% of children were reported to have fair, poor, and very poor oral health. A lower frequency of family impact corresponded with better oral health (OH) status of children (p < 0.001). The likelihood of parent’s taking time off from work and having financial difficulties was nearly two-times greater if their children had poor oral health. Similarly, interruption in sleep and other normal activities of parents is four times and five times greater, respectively, if the child has poor oral health status. Thus, the poor oral health of school children in the Jazan region of Saudi Arabia is a matter of grave concern as it is observed to be associated with family impacts; particularly affecting the parent’s work, sleep, and other normal family activities.

Development and validation of a web-based version of the Child Oral Health Impact Profile - Preschool version

BACKGROUND

The Child Oral Health Impact Profile - Preschool version (COHIP-PS) is the first validated questionnaire designed to assess the oral health-related quality of life (OHRQoL) of preschool children with varying oral health-related conditions.

AIM

To cross-culturally adapt the original version of COHIP-PS into Chinese and to assess the psychometric properties of a web-based version of the COHIP-PS (eCOHIP-PS/C).

DESIGN

The eCOHIP-PS/C was first created using current guidelines. Then, the eCOHIP-PS/C was administered to caregivers having children 2-5 years old. The reliability of the eCOHIP-PS/C was estimated using Cronbach's alpha and the intraclass correlation coefficients (ICC). Cross-cultural validity and convergent validity were also investigated.

RESULTS

The study included 260 children (mean age 4.3 years). Cronbach's alpha of eCOHIP-PS/C was 0.903 and the ICC of the scale was 0.862. Confirmatory factor analysis (CFA) demonstrated that a four-component model was the best solution for the eCOHIP-PS/C. The fit indices were as follows: χ² /df = 2.176, TLI = 0.942, CFI = 0.946, GFI = 0.927, and RMSEA = 0.075. In addition, a good relationship was found between the eCOHIP-PS/C and the global oral health question.

CONCLUSION

The eCOHIP-PS/C is a reliable and valid tool for assessing the OHRQoL among Chinese preschool children.

Impact of oral diseases on oral health-related quality of life: A systematic review of studies conducted in Latin America and the Caribbean

Background

We performed a systematic review of studies conducted in Latin America and the Caribbean (LAC) to assess the impact of oral diseases on oral health-related quality of life (OHRQoL).

Materials and methods

Searches were performed of the following PubMed, EMBASE, CINAHL, Scopus, and LILACS databases. Randomized clinical trials, quasi-experimental studies, cohort studies, case and control studies, and cross-sectional studies which included at least 100 participants evaluating the impact of oral diseases on OHRQoL were included. PROSPERO registry number: CRD42020156098.

Results

After exclusion of duplicates, 3310 articles were identified, 40 of which were included in this review. 90% of the studies were conducted in Brazil. The most commonly used OHRQoL measuring instruments were CPQ 11–14 (n = 9), ECOHIS (n-8) and B-ECOHIS (n = 8). The study designs included 32 cross-sectional, 2 cohort and 6 case and control studies. Most of the studies were conducted in children (n = 25) and adolescents (n = 9). Most studies identified an impact on OHRQoL in children, adolescents and adults with oral diseases. Moreover, greater oral disease severity had a greater impact on OHRQoL.

Conclusions

Most studies in LAC report a negative impact of diseases on OHRQoL. More longitudinal studies are required to confirm the results of these studies.

Impact of early childhood caries on oral health-related quality of life: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to conduct a systematic review in order to assess the impact of early childhood caries (ECC) and its severity on Oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

An electronic search was conducted in MEDLINE, EMBASE, Cochrane, SciELO and Lilacs databases. The study eligibility criteria were primary studies published in English, Spanish or Portuguese that assessed OHRQoL in preschool children with dental caries using validated instruments. Two researchers independently performed the selection process and data extraction. The Effective Public Health Practice Project's Quality Assessment Tool was used for the quality assessment. Random effects models were used to estimate the pooled effect for continuous and categorical data.

RESULTS

Of 2,037 identified articles, thirty-five studies (37 articles) met the inclusion criteria. The methodological quality was judged mainly as moderate. Children with ECC were more likely to report any impact on OHRQoL than children without caries (OR: 1.99; 95% CI: 1.51-2.62; 6 studies). Severe ECC (dmft > 5) presented a higher effect (OR: 5.00; 95% CI: 3.70-6.74; 8 studies). Sensitivity analysis including only population studies showed uncertain results on the impact of ECC on OHRQoL (OR: 1.67; 95% CI: 0.99-2.82; I²  = 95%). The symptom and psychological domains were the most affected (SMD: 0.60, 95% CI: 0.38-0.81 and SMD: 0.61, 95% CI: 0.37-0.85 respectively).

CONCLUSIONS

ECC has a negative impact on the OHRQoL of both preschoolers and their families. However, its impact on OHRQoL is diluted when it is evaluated at population level.

Cross-cultural adaptation and psychometric properties of the Mexican version of the Early Childhood Oral Health Impact Scale (ECOHIS)

BACKGROUND

Instruments adapted for the Mexican population to assess oral health-related quality of life (OHRQoL) in preschoolers remain lacking. This study aimed to cross-culturally adapt and evaluate the psychometric properties of the Mexican version of the Early Childhood Oral Health Impact Scale (M-ECOHIS).

METHODS

This cross-sectional study was conducted with preschool children from southern Mexico. The investigation was divided into a transcultural adaptation phase and a validation phase. The M-ECOHIS was completed by the children's guardians, and clinical data were also evaluated. Reliability was evaluated using tests of internal consistency and test-retest measures, while construct validity was assessed through Spearman's correlation coefficient between M-ECOHIS scores and self-reported oral health, and through confirmatory factor analysis (CFA). Construct validity was also evaluated through discriminant validity of the M-ECOHIS, which was determined according to questionnaire scores on oral health measures (e.g., dental caries).

RESULTS

A total of 303 preschool children participated in this study. Regarding internal consistency, Cronbach's alpha was > 0.78 for the child section, family section, and general M-ECOHIS. The general intraclass correlation coefficient (ICC) for test-retest reliability was 0.95. The correlation between the scores obtained on the child and family impact sections was significant with the self-reported oral health status rating. In relation to CFA, all items of the M-ECOHIS confirmed the latent variables. Further, M-ECOHIS scores were associated with the presence of untreated dental caries, indicating that the questionnaire has good discriminant validity.

CONCLUSION

Our findings suggest that the M-ECOHIS is a valid and reliable instrument for assessing the impact of oral health on quality of life in Mexican preschool children.

Psychometric evaluation of the Thai version of the Early Childhood Oral Health Impact Scale (Th-ECOHIS): a cross sectional validation study

Background

Early childhood caries (ECC) is prevalent in Thailand, but no appropriate tool has been available to measure its impact on children’s quality of life. This study translated the Early Childhood Oral Health Impact Scale (ECOHIS), a widely used proxy-reported questionnaire developed in the United States for measuring the oral health-related quality of life of preschool children and their families, into Thai (Th-ECOHIS). The scale’s psychometric properties were investigated in Thai caregivers and their children.

Methods

Cultural adaptation for the scale development within the Thai context was processed using forward–backward translation by experts. A face and content validation was conducted among 20 Thai caregivers to attain the final Th-ECOHIS. Psychometric testing was done on 3-year-old child-caregiver pairs in Bangkok using the interviewer-administered mode. Children’s oral health was determined by caries experience (decayed, missing and filled primary teeth, dmft) and treatment need. The caregivers answered the Th-ECOHIS and global questions regarding their perception of the children’s oral health. Across-items reliability was assessed by internal consistency using the Cronbach’s alpha coefficient. Test-retest reliability was managed at a 2-week interval in 10% of the sample using the intraclass correlation coefficient calculated by two-way analysis of variance. The discriminant validity was tested by the relationship between the severity of dental caries, treatment need and Th-ECOHIS scores, using the Kruskal-Wallis test.

Results

A total of 214 child-caregiver pairs participated. Twenty-two percent had ECC (dmft 1–3) and 17.3% had severe ECC (dmft 4 or higher) with mean (SD) dmft 1.63 (2.92). All items in the original ECOHIS were retained in the Thai version. The test-retest reliability of Th-ECOHIS was 0.87; internal consistency was 0.85; the total Th-ECOHIS scores were significantly correlated with the global rating of oral health question (r = 0.604). Th-ECOHIS scores in both child and family impact sections and the total were significantly associated with the severity of caries (p <  0.001) and treatment need (p <  0.001).

Conclusions

Th-ECOHIS demonstrated good reliability and validity. It could be used on caregivers to assess the impacts of ECC on quality of life of Thai pre-school children and compared to other countries.

Cross cultural adaptation and psychometric properties of the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

BACKGROUND

The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population.

METHODS

The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models.

RESULTS

Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively.

CONCLUSION

This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations.

Dental patient reported outcome and oral health-related quality of life measures: protocol for a systematic evidence map of reviews

AIMS

This research synthesis protocol addresses the question: what is the evidence concerning measurement properties of dental patient reported outcome measures (dPROMs), and regarding the real-world value of dPROMs, and where are the gaps in this evidence? Evidence mapping will systematically examine reviews of quantitative dPROMs used to assess the impact of oral health on the quality of life of dental patients and research participants. Evidence gaps where future research or systematic reviews are required will be identified.

MATERIALS AND METHODS

This protocol accords with the PRISMA-P guideline. Open Science Framework Registration https://doi.org/10.17605/OSF.IO/RZD3N . Biomedical and grey literature databases will be searched, adapting the same search strategy. Published or unpublished reviews evaluating any dPROM will be considered for inclusion. There will be no restriction by date, setting, or language. AMSTAR2 and ROBIS will evaluate risk of bias. Psychometric criteria will be adapted from COSMIN. Data will be summarised separately for specific populations and conditions.

DISCUSSION

The findings will enable clinicians and researchers to identify methodologically robust dPROMs, appropriate for use with relevant populations and conditions. Implications for real-world practice and research will be discussed.

Validating and assessing the oral health-related quality of life among Hungarian children with cleft lip and palate using Child-OIDP scale

AIMS

To validate the Child-Oral Impact on Daily Performance (Child-OIDP) in the Hungarian language and to explore the oral health-related quality of life (OHRQoL) and associated factors among Hungarian children with cleft lip or/and palate (CLP).

METHODS

This cross-sectional study consists of a survey and clinical examination among conveniently selected children with CLP visiting the Pécs cleft lip and palate clinic, Pécs, Hungary. OHRQoL was assessed using the Hungarian version of Child-OIDP. Additionally, a validated structural questionnaire was used for gathering information related to oral hygiene practice. Clinical examination was done to register the dental status using ICDAS criteria, consequences of untreated dental caries (pufa), and bleeding on probing. Results were presented as proportions, means, and standard deviations (SD). Construct validity and internal reliability of the Hungarian Child-OIDP was assessed using the Pearson and Spearman's correlation coefficients, respectively. The logistic regression model examined the association between OHRQoL and explanatory variables.

RESULTS

A total of 45 children with CLP participated in this study. The Hungarian Child-OIDP had the Cronbach's alpha value 0.73, and the Spearman's correlation coefficient was 0.31. The mean (SD) Child-OIDP score among the study participants was 4.4 (7.0) and three-fifths (65.9%, n = 27) of the participants reported impact in one or more items of the OHRQoL scale. Tooth brushing was more frequent among 6-10-year-olds compared to 11-16-year-olds. The proportion of those requiring restorative treatment need (DS ≥ 1) was 90.2% (n = 37), those with PUFA/pufa (score ≥ 1) was 24.4% (n = 10), and those with bleeding on probing (> 15%) was 63.4% (n = 26). Children aged 11-16 years had a higher impact on OHRQoL compared to the younger ones. Girls had a higher impact on OHRQoL compared to boys. Children with clefts involving both lip and palate had poorer OHRQoL than the rest. The same was true for those having a high dental caries rate.

CONCLUSION

The Hungarian Child-OIDP was a reliable and valid measure. There was a substantial impact on OHRQoL among Hungarian children and adolescents with CLP. Age, gender, cleft type and dental caries were associated with poor OHRQoL.

Validating a short form of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) in Finnish language

Aim

This study aimed to adapt the short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ), and the Family Impact Scale (FIS) in the Finnish language and to test its validity and reliability. Another aim was to compare the background factors of parents with respect to P-CPQ and FIS outcomes.

Methods

This study was conducted among a convenient sample of parents who visited the public dental clinic in Sievi, Finland, from May to October 2016. A total of 54 parents of 2–8-year-old children completed the short-form of the P-CPQ questionnaire and 50 parents of 2–8-year-olds completed the FIS questionnaire while visiting for their children’s routine dental check-up. Parents completed the self-administered P-CPQ and FIS questionnaires. Reliability and validity of the short-form of the P-CPQ and FIS were assessed. Differences between gender, and family size were evaluated using the Mann–Whitney U test and the differences between age groups were evaluated using the Kruskal–Wallis one-way ANOVA test.

Result

The Finnish versions of both the short forms of the P-CPQ and FIS had alpha values within the acceptable range. The scales also showed good construct validity. Toddlers (2–4-year olds) had the highest scores for both the P-CPQ and FIS-8 subscales. Likewise, families with 5 or more children had high FIS scores.

Conclusion

The short form of the P-CPQ and FIS in Finnish language are valid and reliable. The oral health of the child seems to have the greatest family impact among parents with five or more children and in families with 2–4-year olds.

Oral Health-Related Quality Of Life of Pre-School Children: Review and Perspectives for New Instruments

This study aimed to describe different approaches for the evaluation of the Oral health-related quality of life (OHRQoL) of preschool children and to discuss perspectives for future instruments. The OHRQoL is a concept that surpasses an exclusively clinical perception and includes functional, social, emotional, and environmental issues. The measure of OHRQoL represents a holistic approach for researchers and clinicians extending their visions beyond the mouth and understanding the entire context of the patient. Negative impacts of oral conditions on OHRQoL in childhood can reflect on health development, especially in a life stage marked by social and cognitive maturation. Instruments have been developed and cross-culturally adapted to evaluate the impact of oral conditions on the OHRQoL of preschool children and their families. Some features distinguish these instruments and influence their selection, such as: self- or proxy-report; generic- or specific-condition; long- or short-form, and less or more established used in literature. Moreover, theoretical framework, construct validation and availability should also be considered. Nine OHRQoL instruments for preschool children were included in the present literature review. They were created between 2003 and 2017 by developed countries in most cases. The shorter instrument has five items, and the larger has 31 items. Most of them are proxy-reported, generic-condition, and have been relatively well established in the literature. The diversity of instruments indicates the evolution of OHRQoL studies, but there are methodological issues still in need to be improved in future developments or cross-cultural adaptations, according to current psychometric evidence.

Association between early childhood oral health impact scale (ECOHIS) scores and pediatric dental surgery wait times

BACKGROUND

Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay that often requires pediatric dental rehabilitative surgery. The Early Childhood Oral Health Impact Scale (ECOHIS) measures oral health-related quality of life (OHRQL). The purpose of this study was to determine whether there is an association between ECOHIS scores and surgery wait times for children undergoing dental treatment for S-ECC under general anesthesia (GA).

METHODS

The hypothesis was that there is no present association between wait times and ECOHIS score. Children under 72 months of age with S-ECC were recruited on the day of their slated dental surgery under GA. Parents/caregivers completed a questionnaire that included the ECOHIS. Data were merged with other ECOHIS scores from a previous study. Wait times were acquired from the Patient Access Registry Tool (PART) database. Data analysis included descriptive statistics and bivariate analyses. A p-value of ≤0.05 was considered statistically significant; 95% confidence intervals (CIs) were reported for each correlation coefficient. This study was approved by the University of Manitoba's Health Research Ethics Board.

RESULTS

Overall, 200 children participated, the majority of whom were Indigenous (63%) and resided in Winnipeg (52.5%). The mean age was 47.6 ± 13.8 months and 50.5% were female. Analyses showed ECOHIS scores were not significantly correlated with children's wait times. Observed correlations between ECOHIS and children's wait times were low and not statistically significant, ranging from ρ = 0.11 for wait times and child impact section (CIS) scores (95% CI: - 0.04, 0.26; p = 0.14), ρ = - 0.08 for family impact section (FIS) scores (95% CI: - 0.23, 0.07; p = 0.28), and ρ = 0.04 for total ECOHIS scores (95% CI: - 0.11, 0.19; p = 0.56).

CONCLUSION

No significant associations were observed between ECOHIS scores and wait times. In fact, those with worse OHRQL appeared to wait longer for surgery. ECOHIS scores could, however, still be used to help prioritize children for dental surgery to ensure that they receive timely access to dental care under GA. This is essential given the challenges posed by COVID-19 on timely access to surgical care.

A reliability generalization meta-analysis of Child Oral Impacts on Daily Performances (C - OIDP) questionnaire

AIM

To evaluate the cumulative estimates of reliability and conduct reliability generalization meta-analysis of Cronbach's alpha for the Child Oral Impacts on Daily Performances (C-OIDP) questionnaire.

METHODOLOGY

Systematic search of four databases from inception to November 30th, 2019 was performed. Studies that reported Cronbach alpha for the C-OIDP were included. Cronbach's alpha for each publication was used for the meta-analysis. I² and Q statistics were calculated to assess heterogeneity. Meta-analysis was performed using a random-effects model to derive a pooled estimate of Cronbach's alpha.

RESULTS

Out of 944 publications, data extraction was done from 33 publications after exclusion. The age range among the included publication was from 6 to 19 years. Cronbach's alpha ranged from 0.53 to 0.9. Majority of the publications (n = 21) reported alpha above the benchmark (0.7 and above). Only two publications used condition-specific C-OIDP questionnaires. Twelve publications used self-administered child-OIDP questionnaires. Most of the studies were at a low risk of bias (n = 29). The cumulative alpha was higher in publications with a low ROB (α = 0.74) than a moderate ROB (α = 0.65) The cumulative alpha was 0.73 (SE = 0.02) with a high heterogeneity among the included publications (I² = 99.28% and Q = 2048.68; P < 0.001).

CONCLUSION

Overall, the RG estimate of Cronbach's alpha for C-OIDP was above the widely accepted benchmark.

Quality of Life Assessment in Patients with Malocclusion Undergoing Orthodontic and Orthognathic Treatment

Introduction

The objective of this study was to assess pre-treatment quality of life and the relevant clinical variables in adult patients with malocclusion in order to improve orthodontic treatment strategies.

Methods

The study was conducted in 240 consecutive adult patients with malocclusions divided into two groups: patients for whom an orthodontic treatment plan was considered, and patients for whom an orthognathic treatment plan was selected. Patients were examined between December 2015 and February 2017, at the School of Dental Medicine, University of Belgrade. Malocclusion severity was recorded using the Peer Assessment Rating index pre-treatment score. Skeletal malocclusion parameters were measured using lateral cephalometric radiographs. Quality of life was assessed by means of a generic questionnaire (Medical Outcomes Study Short Form-36 (SF-36)), and the disease-specific Orthognathic Quality of Life Questionnaire (OQLQ).

Results

There were significant differences in the mean values of the OQLQ domain scores between orthodontic and orthognathic patients. Patients for whom orthodontic treatment was planned had statistically significantly lower scores in comparison to those for whom orthognathic treatment was planned. This was the case in all OQLQ domains except for “Awareness of facial deformity”. Statistically significant correlations (p<0.05) were presented between OQLQ scores and following demographic and clinical variables: gender, age, malocclusion severity, maxillary and mandibular sagittal, maxillary vertical, and lower incisor positions, intermaxillary angle, and the Beck Depression Inventory and Beck Anxiety Inventory levels. The independent predictors for the planning of orthodontic and orthognathic treatment in patients with malocclusion were two OQLQ domains, “Facial aesthetics” and “Awareness of facial deformity”, as well as total OQLQ score, after adjustment for demographic characteristics, skeletal parameters, anxiety and depression.

Conclusions

Our findings suggest that patients for whom orthodontic treatment was planned demonstrated better quality of life according to the OQLQ scores in comparison to those for whom orthognathic therapy was planned.

Association between dental conditions, sliver diamine fluoride application, parental satisfaction, and oral health-related quality of life of preschool children

OBJECTIVES

To investigate the associations between dental conditions, sliver diamine fluoride (SDF) application, parental satisfaction, and oral health-related quality of life (OHRQoL) of preschool children.

MATERIALS AND METHODS

In a clinical trial conducted in Hong Kong, preschool children who had carious lesions into dentine were randomly assigned to receive an application of SDF solution or placebo on their caries lesions 10 weeks before they received restorations. Additionally, a random sample of caries-free children was also recruited. Parents of the study children rated their satisfaction with their child's teeth using a 5-point scale (5 = very satisfied, 1 = very dissatisfied) 10 weeks after SDF or placebo application. Besides, the Chinese version of the Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to assess the children's OHRQoL.

RESULTS

There were 127, 133, and 154 children in the SDF, placebo, and caries-free groups, respectively. The parents whose child had 4 or more decayed teeth reported lower satisfaction scores (mean = 2.0 ± 0.7) with their child's dental health status compared with those of parents whose child had fewer (mean = 2.6 ± 0.9) or no (mean = 3.7 ± 0.7) decayed teeth (p < 0.001). These parents also reported higher C-ECOHIS scores. However, there was no significant difference in parental satisfaction and children's OHRQoL between the SDF and placebo groups (p > 0.05).

CONCLUSIONS

In this study population, parental satisfaction and children's OHRQoL were associated with children's dental caries status but not with SDF application.

CLINICAL RELEVANCE

This study provides valuable information about the factors, including SDF application, that can influence parental satisfaction and OHRQoL of preschool children.

Preschool oral health-related quality of life: A practical guide to measurement tools

OBJECTIVE

The purpose of this paper is to describe currently available measurement tools for assessing oral health-related quality of life (OHQoL) in preschool aged children to aid clinicians and researchers in selection of the appropriate tool for their needs.

METHODS

The authors describe and compare eight OHRQoL tools that were created or adapted for use among preschoolers, including the Child Oral Health Impact Profile-Preschool, Dental Discomfort Questionnaire, Early Childhood Oral Health Impact Scale, Michigan-OHRQoL, Parental-Caregiver Perceptions Questionnaire and Family Impact Scale, Pediatric Quality of Life Inventory-Oral Health Scale, Pediatric Oral Health-Related Quality of Life, and Scale of Oral Health Outcomes for 5-year-old children.

RESULTS

The tools vary by their intended target population, oral condition of interest, intended setting for use, and method of administration. They also vary in the number of items or questions included and the domains covered by those items. Unique features and strengths of each are highlighted.

CONCLUSION

A variety of tools exist for measuring OHQoL in preschoolers, this article provides an overview that can facilitate selection for specific intended uses.

Oral health-related quality of life among 12-year-olds

Aim: To assess oral health-related quality of life (OHRQoL) and associated factors among the 12-year-old population of the state of Minas Gerais, Brazil. Methods: Cross-sectional data from the SB-Minas Gerais 2012 study were used. The presence of poor OHRQoL was assessed using the Oral Impact on Daily Performance (OIDP) and its dimensions (physical, psychological and social domains). Independent variables included sociodemographic factors and variables related to the use of dental care and oral health conditions. The association between the outcomes and the independent variables were tested using logistic regression and the results reported as odds ratio with 95% confidence interval. Results: Prevalence of poor OHRQoL was 31.4%; the psychological domain was the most affected (22.6%). Pain and dissatisfaction with oral health were associated with poor OHRQoL on overall OIDP and all its domains. Non-whites had greater poor OHRQoL than whites on overall OIDP and physical domain. Conclusion: Self-perceived oral health and social inequalities were associated with poor OHRQoL.

Relationships of Dental Caries and Malocclusion with Oral Health-Related Quality of Life in Lithuanian Adolescents Aged 15 to 18 Years: A Cross-Sectional Study

There is a lack of evidence of the moderating effects of caries lesions and malocclusions on oral health-related quality of life (OHRQoL) among older adolescents. This study aimed to evaluate the relationship of dental caries and malocclusion with OHRQoL among Lithuanian adolescents aged 15 to 18 years. A survey in a representative sample of adolescents included a clinical examination to assess dental health status using the DMFT (Decayed, Missing, and Filled Permanent Teeth) index, and malocclusion using the Index of Complexity, Outcome, and Need (ICON). The Child Perceptions Questionnaire (CPQ) was used to evaluate respondents’ OHRQoL. Negative binomial regression was fitted to associate the clinical variables with the CPQ scores. A total of 600 adolescents were examined. The overall mean DMFT score was 2.7. A need for orthodontic treatment was detected among 27.7% of adolescents. Subjects with caries lesions (DMFT > 3) had higher CPQ scores in the domains of functional limitations and social wellbeing (relative risks were 1.35 (95% confidence interval: 1.09–1.67) and 1.30 (1.03–1.64), respectively), while subjects with a need for orthodontic treatment (ICON > 43) had higher CPQ scores in the domains of emotional wellbeing and social wellbeing (relative risks were 1.81 (1.40–2.22), and 1.69 (1.34–2.14), respectively). It was concluded that both dental caries and malocclusion have negative relationships with OHRQoL in adolescents above 15 years, but their effects occur differently in each OHRQoL domain.

Development and Validation of the Greek version of the Early Childhood Oral Health Impact Scale (ECOHIS)

Background:

The oral health of preschool-age children can affect their quality of life (QoL) as well their families. The Early Childhood Oral Health Impact Scale (ECOHIS) is a reliable instrument that has been used to assess the impact of oral health problems and their treatment on the QoL of preschool-age children and their families’.

Objective:

To report the development, evaluation and psychometric properties of the Greek version of ECOHIS (Gr-ECOHIS).

Methods:

Participants of this cross-sectional study were 176 mothers and their young (aged 25-71 months) children, patients of a private pediatric dental practice. During a structured interview, they completed a questionnaire, including a translated, Greek language version of the ECOHIS. Data on children’s oral health were obtained via clinical examinations. The psychometric properties of Gr-ECOHIS evaluated were reliability (internal and test-retest) and construct (convergent and discriminant) validity. Test-retest reliability was determined in an independent sample of 20 mother-child dyads, who completed the Gr-ECOHIS twice within a two-week interval.

Results:

The scale showed excellent internal consistency (Cronbach’s alpha=0.85) and test-retest reliability (Intraclass Correlation Coefficient= 0.97). Gr-ECOHIS showed a strong correlation with dental caries (Spearman’s rho=0.62, p<0.0005) and dental treatment needs. Gr-ECOHIS was also positively associated with dental knowledge, health literacy and parental oral health-related QoL.

Conclusion

The Gr-ECOHIS is a psychometrically reliable and valid Greek language QoL instrument, which demonstrated significant associations with clinical and parent-reported measures of early childhood oral health. As such, it can be used to measure oral health-related QoL among preschool-age children in clinical and public health settings.

Normal variations in personality predict eating behavior, oral health, and partial syndrome bulimia nervosa in adolescent girls

Eating disorders are among the most prevalent disorders in adolescence and can have negative consequences including poor quality of life, medical complications, and even death. This study addresses whether normal variations in personality relate to eating behavior and eating disorder symptomatology in adolescent girls. Participants were a near-representative sample of Australian adolescent girls (n = 1,676). Three personality traits (neuroticism, extraversion, and conscientiousness) were assessed at age 12 and again at age 14, and self-reported eating and weight management behaviors were assessed at age 14. After controlling for sociodemographic factors, higher levels of conscientiousness at age 12, and increases in conscientiousness between ages 12 and 14, were associated with greater fruit and vegetable consumption, a lower intake of high fat foods and high sugar drinks, less frequent meal skipping, better oral health, and decreased risk of partial syndrome bulimia nervosa at age 14. Higher neuroticism at age 12 was associated with more frequent meal skipping, and increases in neuroticism between ages 12 and 14 were associated with more frequent meal skipping and increased risk of partial syndrome bulimia nervosa at age 14. Extraversion was generally unrelated to eating and weight management behaviors. These findings provide evidence that normal variations in personality are related to eating behavior, oral health, and eating disorder symptoms during midadolescence.

Adaptation and validation of the PEDSQL™ oral health scale for toddlers in Chilean population

BACKGROUND

The Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale was developed to measure oral health-related quality of life (OHRQoL). The aim of this study was to cross-culturally adapt the parent-reported version for toddlers of PedsQL™ Oral Health Scale into Spanish and to assess the acceptability, reliability and validity of this version in Chilean preschool population.

METHODS

The PedsQL™ Oral Health Scale for toddlers was cross-culturally adapted for the Spanish language using the recommended standards. To assess metric properties, a cross-sectional study was carried out with 301 children aged 2 to 5 years in Carahue, Chile. Chilean versions of the PedsQL™ Oral Health Scale, PedsQL™ 4.0 Generic Core Scales, and Early Childhood Oral Health Impact Scale (ECOHIS) were completed by the children's parents. Dental caries, malocclusion and dental trauma were examined by trained dentists. The PedsQL™ Oral Health Scale was administrated a second time 14-21 days after. The reliability of the scale was verified by analysis of internal consistency (Cronbach's alpha) and reproducibility (Intraclass correlation coefficient - ICC). The validity of the construct was assessed by confirmatory factor analysis and known groups method. The convergent validity was assessed by calculating the Spearman's correlation with the ECOHIS questionnaire.

RESULTS

The PedsQL™ Oral Health Scale demonstrated good reliability, with Cronbach's alpha coefficient of 0.79 and ICC of 0.85. A moderate-to-strong correlation was found between the PedsQL™ Oral Health Scale and the ECOHIS questionnaire (- 0.64); the PedsQL™ Oral Health Scale score was lower in children with poor than those with excellent/very good oral health (median 100 vs 85, p < 0.001); it also was lower in children with caries than in those caries-free (median 100 vs 90, p < 0.001). No statistically significant differences were found among groups according to malocclusion and traumatic dental injuries.

CONCLUSIONS

The PedsQL™ Oral Health Scale for toddlers in Spanish showed to be equivalent to the original version, and its psychometric properties were satisfactory for application in a Chilean pre-school population.

Validation of the Chinese version of the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC)

BACKGROUND

The Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) is a newly developed child-centred caries-specific quality of life measure.

AIM

We aimed to translate and adapt the CARIES-QC into Chinese and to validate the Chinese version of the CARIES-QC (CARIES-QC/C).

DESIGN

The CARIES-QC/C was first produced according to international guidelines. Then, the CARIES-QC/C was distributed to children with active dental caries to evaluate its psychometric properties. Reliability of the CARIES-QC/C was investigated by internal consistency and test-retest reliability. Cross-cultural validity and convergent validity were performed to analyse the validity of the CARIES-QC/C. Cross-cultural validity was investigated using confirmatory factor analysis (CFA).

RESULTS

A total of 206 children were recruited. Cronbach's alpha value of the CARIES-QC/C was .942, and the intraclass correlation coefficient (ICC) of the measure was .830. The CARIES-QC/C had an acceptable fit to the data in the one-factor model as confirmed by the CFA. The model fit parameters were chi-square/DF = 2.15, RMSEA = 0.07, GFI = 0.92, CFI = 0.98, and TLI = 0.96. For the convergent validity of the CARIES-QC/C, the measure evidenced good relationship with the global question.

CONCLUSION

The CARIES-QC/C displays good reliability and validity through strict performance tests. This measure may be used as an effective tool in future clinical trials.

Impact of uncomplicated traumatic dental injuries on the quality of life of children and adolescents: a systematic review and meta-analysis

BACKGROUND

Traumatic dental injuries (TDIs) are highly prevalent during childhood and adolescence and have a significant effect on their oral health related quality of life (OHRQoL). Uncomplicated TDIs, dental trauma involving enamel, enamel and dentin and tooth discolorations, account for approximately two-thirds of all diagnosed TDIs in children and adolescents. Hence, it may be important to understand the impact of uncomplicated TDIs on OHRQoL, by synthesizing the available literature.

METHODS

Medline, Embase, Web of Science and Scopus databases were systematically searched from January 1966 to April 2018. Studies that evaluated the effect of TDIs on the OHRQoL of children and adolescents using validated methods were selected for analysis. A narrative synthesis and a meta-analysis were performed. The studies were pooled according to age groups and OHRQoL questionnaire used. A random-effect model was applied to calculate the pooled odds ratios (OR) and their respective 95% confidence intervals.

RESULTS

There were 712 identified studies. Of these, 26 articles were selected for the review and included in the narrative synthesis, 20 of these articles concluded that uncomplicated TDIs were not associated with a negative impact in OHRQoL. Seventeen were included in the meta-analysis. The estimates were pooled by age groups: children (OR: 1.01; 95%CI; 0.85-1.19; I² = 51.9%) and adolescents (OR: 1.07; 95%CI; 0.91, 1.26; I² = 50.2%).When pooling all estimates the OR was 0.96 (95% CI: 0.85-1.10; I² = 61.4%).

CONCLUSIONS

Uncomplicated TDIs do not have a negative impact on the OHRQoL of children and adolescents. Further prospective studies are needed to confirm the results of this review. The majority of the studies included were of cross-sectional design, which may have limited the ability to reach conclusions on the nature of this association. The PROSPERO systematic review registry is CRD42018110471.

Effects of restoring SDF-treated and untreated dentine caries lesions on parental satisfaction and oral health related quality of life of preschool children

OBJECTIVES

To find out the effects of placement of atraumatic restorative treatment (ART) restorations on parental satisfaction and oral health related quality of life (OHRQoL) of preschool children with SDF-treated or untreated dentine caries lesions.

METHODS

In a randomized controlled trial conducted in Hong Kong, preschool children who had cavitated dentine caries lesions were randomly assigned to receive application of silver diamine fluoride (SDF) solution or placebo (tonic water) on their caries lesions 10 weeks before receiving ART restorations. Parents were asked to rate their satisfaction with their child's teeth using a 5-point scale (5 = very satisfied, 1 = very dissatisfied) before and six months after the restorative treatment. Besides, the Chinese version of Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to assess the children's OHRQoL.

RESULTS

A total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. There was no significant difference in parental satisfaction and C-ECOHIS score between the SDF and placebo groups at baseline. At the 6-month follow-up, the mean parental satisfaction score regarding their child's dental health status increased significantly (p < 0.001) from 2.2 ± 0.7 to 2.8 ± 1.0 in the SDF group and from 2.3 ± 0.8 to 2.7 ± 0.9 in the placebo group. However, no significant changes (p > 0.05) in C-ECOHIS scores were found in either of the two groups after ART restoration placement.

CONCLUSIONS

Placement of ART restorations can improve parental satisfaction with the health and appearance of their child's teeth but has no significant effect on the OHRQoL.

CLINICAL SIGNIFICANCE

This study provides valuable information about the effects of ART restoration placement on SDF-treated or untreated dentine caries lesions regarding parental satisfaction and OHRQoL of preschool children.

Influence of dental caries on oral health-related quality of life, school absenteeism and school performance among Nepalese schoolchildren

OBJECTIVES

To evaluate the impact of untreated dental caries and its consequences on oral health-related quality of life (OHRQoL), school absenteeism and school performance in Nepal.

METHODS

This is a population-based, national cross-sectional study. This study was conducted among three WHO index age groups (5-6, 12- and 15-year-olds) of schoolchildren from 18/75 randomly selected districts of Nepal. Clinical findings on untreated dental caries lesions (decay in primary and permanent dentition, dt/DT) and its consequences (pufa/PUFA) were recorded, and the participants were graded into four categories based on the severity of untreated dental caries (GUDC). The Nepali version of Child-Oral Impacts on Daily Performances (C-OIDP) was used to assess the information on OHRQoL. Similarly, school-related information (school absenteeism and school performance) was collected from the school registry. Generalized linear mixed models with random effects were used to evaluate the association between dental caries and OHRQoL, school absenteeism and school performance.

RESULTS

Among the study sample, the mean (SD) C-OIDP score was 2.4 (5.0). It was observed that the 15-year-olds, those belonging to the Newari ethnic group, and children with high GUDC grades had poor OHRQoL. After adjusting for confounding factors, high dt + DT or pufa + PUFA was associated with higher impact on OHRQoL. Similarly, lower grades of GUDC (Grade 1 and Grade 2) also had less impact on OHRQoL than the most severe Grade 4. High dt + DT or pufa + PUFA were associated with maximum school absenteeism. Furthermore, high C-OIDP and a grade of GUDC ≥2 score were associated with poor school performance.

CONCLUSION

Untreated dental caries and its consequences have a considerable impact on OHRQoL. These conditions may contribute to high school absenteeism and poor school performance.

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

BACKGROUND

This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018.

AIM

The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy.

DESIGN

This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC.

RESULTS

Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care.

CONCLUSIONS

This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.