The German version of Early Childhood Oral Health Impact Scale (ECOHIS-G): translation, reliability, and validity

Dental caries and oral health-related quality of life in Preschoolers - introducing the Swedish version of the early childhood oral health impact scale (ECOHIS)

OBJECTIVE

Experience of caries has a clearly negative impact on the quality of life in preschool children. The instrument Early Childhood Oral Health Impact Scale (ECOHIS) measures the oral health-related quality of life in preschool children (Child Impact Section) and their families (Family Impact Section). The aims of the study were to develop a Swedish version of ECOHIS and to evaluate the instrument's reliability, validity, and internal consistency. Additionally, to analyse the oral health-related quality of life (OHRQoL) among preschool children who have experienced caries.

METHODS

The original ECOHIS questionnaire was translated into Swedish. Caregivers of preschool children aged 2-5 years were recruited at dental clinics in Sweden, to participate in the study and answer the Swedish version of the ECOHIS (S-ECOHIS). The internal consistency and reliability were assessed by using Cronbach's Alpha coefficient. In order to measure the consistency of the study, the questionnaire was re-tested two weeks later for 10 of the caregivers and assessed by using intra-class correlation coefficients (ICCs). The results from S-ECOHIS were described as descriptive data and independent t-test was performed. All data were calculated using SPSS (Statistical Package for the Social Sciences).

RESULTS

S-ECOHIS was developed by translating the original English version using a double-blinded technique. A total of 274 caregivers participated in the study and completed the questionnaire. Cronbach's Alpha was 0.84 for S-ECOHIS, 0.83 for CIS, and 0.66 for FIS. The ICCwas 0.95 for the test-retest of S-ECOHIS. Among the respondents, 117 (43%) had children diagnosed with caries, while 157 (57%) had children without caries. The children with caries reported a higher total score of 5.97 (SD 6.16) of S-ECOHIS, compared to the score of the non-caries children 0.77 (SD 1.38) (p < 0.001).

CONCLUSION

The Swedish version of ECOHIS that was developed demonstrates good validity, test-retest reliability, and internal consistency. The findings show that the oral health-related quality of life is adversely affected in preschool children with caries, with particular vulnerability observed among children with untreated caries. These results indicate that S-ECOHISis suitable for use in future clinical and research endeavors.

ABBREVIATIONS

S- ECOHIS: Swedish version of the Early Childhood Oral Health Impact Scale; OHRQoL: Oral Health-Related Quality of Life; ICC: Intraclass correlation coefficient; CIS: Children Impact Section; FIS: Family Impact Section.

Tools Evaluating Child Oral Health-Related Quality of Life

OBJECTIVES

This study aimed to systemically review the tools developed for evaluating oral health-related quality of life (OHRQoL) in preschool children.

METHODS

Two reviewers systematically searched English-language publications within PubMed, Embase, Scopus, and Web of Science. They screened the titles and abstracts and retrieved the full texts of the selected publications. Studies which developed, validated, or culturally adapted an OHRQoL tool used in preschool children were included. They recorded information regarding tool characteristics, item configuration, discriminative validation, the aim of assessment, and the target group.

RESULTS

The study included 59 publications and identified 12 tools for assessing OHRQoL in preschool children. Seven tools were tailored for preschool ages. Most of the scales were generic oral health measures. Dental caries was the most commonly used oral condition for assessing a tool's discriminative validity. Eight tools required parental proxy reports. Three tools were both child-administrated and parent-administrated. One tool was designed to be answered solely by children. Ten tools assessed the oral health-related impact on children, including oral condition-related, functioning, environmental, and emotional/social domains. Four tools included items regarding the impact on both children and family.

CONCLUSIONS

This review identified 12 tools developed for evaluating OHRQoL in preschool children, 7 of which were tailored for preschool age. The 12 tools were validated but incomprehensive due to the subjective and multidimensional nature of the OHRQoL concept. Researchers can choose a suitable tool for their studies by understanding the basic characteristics and item setting of the tools. Researchers can have an overview of the tools developed for evaluating OHRQoL in preschool children. They can use the findings from this review to choose a suitable tool for their studies regarding the OHRQoL in preschool children.

The Development and Evaluation of the Slovenian Version of the Early Childhood Oral Health Impact Scale (ECOHIS-SVN)

Introduction

There has been no valid and reliable instrument available to measure the impact of oral health on the quality of life of Slovenian preschool children. The main aim of this study was to develop and evaluate the validity and reliability of the first Slovenian instrument assessing Oral Health-Related Quality of Life (OHRQoL) preschool children: the ECOHIS-SVN.

Methods

The ECOHIS-SVN was developed using forward-backward translations and with the participation of children aged under six and their parents. The children's teeth were examined, and parents were asked to complete questionnaires, including the ECOHIS-SVN. The internal consistency of ECOHIS-SVN was evaluated through the calculation of Cronbach's alpha (α), test-retest reliability with an intra-class-correlation coefficient (ICC), convergent validity with Spearman's rank correlation (r) and criterion validity with the Mann-Whitney test. The association between the ECOHIS-SVN score and parents' age, educational level, self-reported oral health and OHIP-SVN14 was estimated using multiple linear regression.

Results

In the study, 255 children participated, with a mean age of 4.8 years (±0.8). The ECOHIS-SVN questionnaire was completed by the parents of all 255 children and re-filled by 71 parents. The results of the total ECOHIS-SVN scale include α=0.85, ICC=0.85, and r=0.6-0.75. A statistically significant association was found between the ECOHIS-SVN and parents' age and between the ECOHIS-SVN and parents' OHIP-SVN14 in the whole group and in the subgroup of children with no teeth affected by cavitated caries (dmft=0) (p=0.025, p=0.028), respectively.

Conclusion

ECOHIS-SVN enables further studies to assess the OHRQoL of preschool children in the Slovenian-speaking population.

The Early Childhood Oral Health Impact Scale (ECOHIS): psychometric properties and application on preschoolers

Background

The concept of oral health related to quality of life involves the impact that oral health has on an individual's well-being. The Early Childhood Oral Health Impact Scale (ECOHIS) was developed to measure the impact of oral health problems on the lives of children and their families.

Objective

To evaluate the psychometric properties of ECOHIS applied to mothers of preschool children and estimate the influence of demographic characteristics, caries experience, and plaque index on the ECOHIS score.

Methods

The fit of ECOHIS to the data was assessed by confirmatory analysis. Chi-square for degrees of freedom ratio (χ2/df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA) were used. Reliability was estimated by the ordinal coefficients alpha (α) and omega (ω). The factorial invariance was estimated by the difference in CFI (ΔCFI). Comparisons of the ECOHIS mean scores according to the demographic characteristics, caries experience, and plaque index was performed using analysis of variance (ANOVA).

Results

A total of 371 children participated in the study. Mothers' mean age was 33.0 (SD = 7.04) years. The ECOHIS presented a good fit to the data (χ2/df = 4.31; CFI = 0.95; TLI = 0.94; RMSEA = 0.09) and a strict model invariance. Children without caries and from higher income class had lower oral health impact.

Conclusion

The data obtained with the ECOHIS were valid, reliable, and invariant. Children with caries experience and from lower income families had a greater impact of oral problems.

The Impact of Dental Pain on the Oral Health-Related Quality of Life (OHRQoL) of Preschool Children in Austria

Dental pain in children is a global public health burden with psychosocial and economic implications, challenging families and pediatric dentists in daily clinical practice. Previous studies have addressed the exclusive impact of either caries, dental trauma, malocclusion, or socioeconomic status on OHRQoL. Even though such examples can surely cause dental pain in children, so far only little research on the correlation of dental pain as a general symptom of different underlying causes and OHRQoL has been published. The aim of this study was to evaluate the impact of dental pain on the oral health-related quality of life (OHRQoL) of children between the ages of 0 and 6 years old and subsequently compare the results to a control group free of tooth ache. Children and their adult caregivers were recruited from the Emergency unit of the Department of Pediatric Dentistry at the University Clinic of Dentistry in Vienna. The caregivers completed the German version of the Early Childhood Oral Health Impact Scale (ECOHIS-G). Afterwards, the children were clinically examined. The cause for dental pain, dmf-t index, and plaque accumulation were collected. In total, 259 children with a mean age of 4.2 years (SD ± 1.5 years) were included in the study group. Their mean ECOHIS-G score was 9.0 (SD ± 7.4), while the control group only amounted to a score of 4.9 (SD ± 5.6). The difference between the two groups was statistically significant in both ECOHIS-G subsections, the child impact scale (CIS) and the family impact scale (FIS) as well as the ECOHIS-G sum score (p < 0.05). Dmf-t index and plaque accumulation significantly correlated with CIS and ECOHIS sum score (p ≤ 0.05). The reduction in quality of life was nearly twice as great in the children with dental pain as in the control children. The ECOHIS-G is a valid instrument for measuring the OHRQoL of children with dental pain between the ages of 0 to 6.

Changes in Oral-Health-Related Quality of Life of Egyptian Children Treated under Dental General Anesthesia: A Prospective Study

BACKGROUND

Treatment of young children under dental general anesthesia (DGA) is sometimes necessary due to lack of cooperation and the complexity of dental treatment. The aim of this study was to assess the changes in oral-health-related quality of life (OHRQoL) in children following treatment under DGA.

METHODS

A consecutive sample of 88 children aged 5 and younger who were referred to the department of pediatric dentistry, Cairo university, Egypt, for treatment under DGA was included. Parents were asked to complete the Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) questionnaire before and 4 weeks after treatment. The Wilcoxon signed-rank test was used to compare baseline and follow up scores. Effect sizes (ES) were also calculated.

RESULTS

The overall ECOHIS scores decreased significantly from 16.72 (±7.07) to 0.9 (±3.08); (p < 0.001, Wilcoxon signed-rank test) after treatment under DGA, demonstrating a large effect size of 2.2. The scores of the two subscales of the ECOHIS, the child impact scale (CIS) and the family impact scale (FIS), also decreased significantly (p < 0.001).

CONCLUSIONS

Treatment under DGA not only improved the OHRQoL of the Egyptian children in our sample significantly, but also had a positive effect on their families' quality of life.

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.

Impact of Silver Diamine Fluoride Therapy on the Oral Health-Related Quality of Life of Preschool Children with Behavioral Problems after Three Months: A Pilot Study

Background: In Austria, almost every second child has caries. The consequences of untreated carious lesions are infections, pain, and limitations in everyday life. The aim of this study was to evaluate the influence of silver diamine fluoride (SDF) treatment on the oral health-related quality of life (OHRQoL) of uncooperative children aged 0−5 years using the German version of the Early Childhood Oral Health Impact Scale (ECOHIS-G). Methods: This prospective study was conducted at the Department of Paediatric Dentistry at the Medical University of Vienna. Preschool children with behavioral problems and carious lesions that required SDF application were included. The ECOHIS-G questionnaire was given to the caregiver before (T0) and three months (T1) after treatment. Using descriptive analysis and the Wilcoxon Signed-Rank test, changes in the ECOHIS scores were evaluated and tested for significance. Results: A total of 30 children aged 0−5 years were enrolled and received SDF treatment. At baseline, the total ECOHIS score was 21.4 (±8.5). Three months after therapy, a significant improvement was achieved (16.3 [±5.6], p < 0.05). Significantly better scores were observed in six subdomains, especially in “child function” (3.9 [±2.0]) and “child symptoms” (2.0 [±1.3]) (p < 0.05). Conclusions: Treatment of carious lesions with SDF in the primary dentition resulted in an improvement in the OHRqoL of children with behavioral problems.

Dimensional Structure of the Early Childhood Oral Health Impact Scale

Background:

Detecting the latent dimensions of quality of life as affected by oral diseases is essential for promoting oral health in children. This study aimed to test the Early Childhood Oral Health Impact Scale (ECOHIS) via an appropriate method to detect its dimensions of quality of life as affected by oral diseases.

Methods:

An analytical cross-sectional study was carried out in Shiraz, Iran, between 2014 and 2015. A multistage stratified design was used to select 830 parents or the guardians of primary school children aged six years. The Farsi version of the Early Childhood Oral Health Impact Scale (F-ECOHIS) was used to evaluate the children’s oral health-related quality of life. The parents were interviewed to collect data on ECOHIS. Mplus, version 7, was employed for descriptive and analytical analyses in the present study. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to extract and verify the latent dimensions of ECOHIS.

Results:

Out of the 830 invited parents or guardians, 801 participated in this study. The mean ECOHIS score was 21.95±7.45. The mean child impact score and the mean family impact score were 14.25±5.72 and 7.70±3.62, respectively. EFA yielded a 3-factor model: symptom and function, social interaction, and family impact. CFA confirmed the 3-dimensional model (root mean square error of approximation=0.045). The fit indices of the 1- and 2-dimensional models (the child and family domains) were not within the acceptable range.

Conclusion:

F-ECOHIS is a 3-dimensional model rather than the hypothetical 6-dimensional model. ECOHIS appears to be a useful scale for measuring the multidimensional impact of oral diseases in children.

Effect of method of administration on the oral health-related quality of life assessment using the Early Childhood Oral Health Impact Scale (ECOHIS-G)

Objectives

The influence of the administration method used to collect oral health–related quality of life (OHRQoL) in children remains largely unknown. The aim of this study was to determine whether the OHRQoL information obtained using the Early Childhood Oral Health Impact Scale (ECOHIS) differed with different methods of data collection (face-to-face interview, telephone, or self-administered questionnaire).

Materials and methods

The OHRQoL of 38 preschool children, aged 1 to 5 years, was measured using the German version of the ECOHIS. The instrument was administered to the caregivers of these children using three different methods, with an interval of 1 week between each administration. Test-retest reliability for the repeated ECOHIS-G assessments across the three methods of administration, agreement, and convergent validity was determined.

Results

Kappa coefficients for agreement between two different methods of administration, respectively, ranged from moderate to substantial (0.47 to 0.65). Test-retest reliability was moderate (ICC 0.65–0.79).

Conclusion

In conclusion, the three methods of administration (face-to-face interview, telephone interview, or self-administered questionnaire) of the ECOHIS-G were comparable in 1- to 5-year-old preschool children.

Clinical relevance

All three methods of administration can be used to obtain valid and reliable OHRQoL information in German speaking countries.

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.

Sustainability of Improvement in Oral Health-Related Quality of Life in Children After Dental Treatment

PURPOSE

Dental treatment has been associated with improvement in the oral health-related quality of life (OHRQoL) in children. There is little evidence of whether the effect of treatment is sustainable over time or not. The aim of this study was to determine whether the effect of dental treatment on OHRQoL is maintained or diminishes over time.

MATERIALS AND METHODS

A consecutive sample of parents of 47 children between 2 and 6 years who received comprehensive dental treatment at a postgraduate dental clinic were recruited. Parents completed the Early Childhood Oral Health Impact Scale (ECOHIS) prior to treatment and at 1 and 4 months after treatment. Parents were also asked three global questions. Score changes (overall and for each section) between time points were analyzed by a repeated-measures analysis of variance and Bonferroni tests.

RESULTS

The children's mean age was 4.7 ± 1.1, and 60% were females. ECOHIS scores were significantly improved from baseline (22.2 ± 6.9) to 1 month after treatment (8.7 ± 6.8) and were further improved at 4 months after treatment (1.9 ± 2.7), P < 0.001, with large effect sizes (2.8 for the child impact section and 2.2 for the family impact section). Parents' perception of changes in the OHRQoL of their children obtained from a global question indicated an improvement in OHRQoL that was sustained over the follow-up period; at 1-month and 4-month follow-up, 89% and 94% of mothers reported that their child's oral health improved a lot after dental treatment, respectively.

CONCLUSION

The impact of dental treatment on OHRQoL continued to remarkably improve during the 4 months following dental treatment.

Translation and validation of Taiwanese version of the Early Childhood Oral Health Impact Scale (ECOHIS)

BACKGROUND/PURPOSE

Treating and preventing dental caries in children have been major health concerns in Taiwan. However, little discussion on oral health-related quality of life in Taiwanese preschooler exists. This study aimed to construct and validate a Taiwanese version of the Early Childhood Oral Health Impact Scale (ECOHIS) for preschool children in Taiwan.

MATERIALS AND METHODS

A Taiwanese version of the ECOHIS was developed using the forward-backward translation method. Our study population (n = 251) comprised children aged 3-6 years old. Parents of the children signed informed consent and self-completed ECOHIS. Data were analyzed for internal reliability using Cronbach's alpha coefficient, and item-to-total correlation was determined. Criterion validity was tested for the relationship between ECOHIS scores and caries experience (dmft). A multiple linear regression model was used to assess the independent variables of the ECOHIS.

RESULTS

Cronbach's alpha for the total score of the Taiwanese version of ECOHIS was 0.76. The validity of the ECOHIS was tested, and scores of both the total scale and family impact section were found to be statistically significantly related to dmft (P < 0.005). Multiple linear regression analysis revealed that with an increase in dmft, the total score of the ECOHIS significantly increased (95% CI = 0.22-0.63, P < 0.001).

CONCLUSION

The Taiwanese version of the ECOHIS is a valid and reliable tool to assess the oral health-related effect on 3- to 6-year-old children in Taiwan.

Changes in oral health-related quality of life among Austrian preschool children following dental treatment under general anaesthesia

Objectives

To analyse possible changes in oral health-related quality of life (OHRQoL) before and after dental treatment under dental general anaesthesia (DGA) among Austrian preschool children.

Methods

A consecutive sample of 89 parents of children aged 2 to 5 years, suffering from early childhood caries (ECC) and scheduled for DGA, were recruited from two locations in Austria (Vienna and Salzburg). Parents self-completed the German version of the ECOHIS before (baseline) and 4 weeks (T4) after their child’s dental treatment. The ECOHIS consists of 13 questions and is divided into two main parts, namely, the child impact section (9 items) and the family impact section (4 items).

Results

A total of 80 children (89%) completed a sufficient number ECOHIS questions at baseline and the follow-up assessment after 4 weeks. “Pain in the teeth, mouth, and jaws” and “difficulty eating some foods” from the child section and parents’ ratings of “feeling upset” and “guilty” were the most frequently reported impacts at baseline. The ECOHIS total score decreased significantly from a mean of 14.60 to 9.89 (p < 0.001) after DGA treatment, revealing a large effect size for the child (0.8) section, family (0.6) section, and the total score (0.8). Parents rated their child’s overall and oral health significantly higher after the DGA treatment (p < 0.001).

Conclusions

Significant improvements in oral health-related quality of life were observed 4 weeks after DGA in children suffering from ECC.

Clinical relevance

ECC has an impact on OHRQoL. Rehabilitation under general anaesthesia makes a sustainable improvement.

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.

Early Childhood Oral Health Impact Scale (ECOHIS): Literature review and Italian validation

OBJECTIVE

The Early Childhood Oral Health Impact Scale (ECOHIS) is a questionnaire to elucidate the relationship between parental perception of the quality of life of their preschool children and their oral health status. Aim of the present work was to validate an Italian ECOHIS version and review the literature.

METHODS

After adapting the original ECOHIS questionnaire from English to Italian (I-ECOHIS), I-ECOHIS was administered to parents of children afferent to the Dental Clinic of the University of Campania "Luigi Vanvitelli," regardless of age. Children under 6 years of age underwent anamnestic survey and physical examination, to correlate the dmft index with the ECOHIS score.

RESULTS

366 children have come to our observation. I-ECOHIS was administered to all parents to establish its comprehensibility. 87 children (44 females and 43 males) under 6 years (5.2 ± 1.4 years) underwent dmft evaluation to determine I-ECOHIS/oral health status correlation. Among the 87 children examined, the higher total score reached was 25/50. ANOVA analysis confirmed statistically significant correlations between ECOHIS score and dmft = 0 vs dmft equal/higher than 4.

CONCLUSION

The present pilot study validated the I-ECOHIS questionnaire and revealed to be a good tool to distinguish children without caries experience from those with a high dmft. However, it was not correlated with the intermediate dmft level, thus confirming the importance of screening for caries.

Quality of life in early age Spanish children treated for cleft lip and/or palate: a case-control study approach

OBJECTIVE

The objectives of this study were to evaluate health-related quality of life (HRQoL) in 4-7-year-old children treated for cleft lip and/or palate (CL/P) compared to healthy controls and to estimate a possible association with cleft type, gender, age, and surgical re-interventions.

MATERIALS AND METHODS

A total of 171 children with CL/P (mean age 5.7 years) and 186 healthy controls (mean age 5.5 years) were included in the study. Sixty-four (37.4%) children experienced both cleft lip and palate, 56 (32.8%) cleft lip only, and 51 (29.8%) cleft palate only. HRQoL in children was assessed by Kiddy-KINDL and COHIP-14 questionnaires and in parents by KINDL-p. Total score and dimensions of each questionnaire were compared between cleft children, their parents, and controls.

RESULTS

The total scores and dimension scores of Kiddy-KINDL showed similar values between CL/P and control groups, except for "self-esteem" dimension (p = 0.036). The comparison of Kiddy-KINDL and KINDL-p showed a statistically significant total score (82.11 vs. 80.44, p = 0.047). The CL/P group presented significantly worse values with respect to controls in total score of COHIP-14 (10.53 vs 5.01, p < 0.001) and in all its dimensions.

CONCLUSIONS

Children treated for CL/P had a negative impact on HRQoL at early age compared to controls. Significant differences were found in the psychological and functional dimensions related to lip and palatal affectation, respectively. Parents reported significantly worse scores than their children. HRQoL measurement provided valuable complementary information to better inform to parents and make clinical decisions in children with CL/P at early age.

CLINICAL RELEVANCE

Our findings suggested that Spanish children between 4 and 7 years of age with a history of surgically treated CL/P experienced a poorer HRQoL when compared with their non-cleft peers.