Testing responsiveness to change for the early childhood oral health impact scale (ECOHIS)

Does orthodontic treatment improve the Oral Health-Related Quality of Life when assessed using the Malocclusion Impact Questionnaire-a 3-year prospective longitudinal cohort study

OBJECTIVES

To assess the change in Oral Health-Related Quality of Life (OHRQoL) following orthodontic treatment using the Malocclusion Impact Questionnaire (MIQ) and to test the responsiveness of MIQ to treatment-associated changes.

METHODS

A longitudinal prospective cohort study, in an orthodontic postgraduate centre, Kerala, India. Patients under 18 years were invited to complete the MIQ before the start of treatment (T0) and 1 month after treatment completion (T1). TheIndex of Orthodontic Treatment Need and Peer Assessment Rating (PAR) scores were assessed at both time periods as well as a global transition judgement at T1.

RESULTS

Two hundred and ten participants were recruited and 162 completed both questionnaires (45.1% males; 54.9% females; age = 12-18 years, mean = 16.8; SD = 1.7). There was large reduction in MIQ scores from T0 (mean = 28.1, SD = 6.1) to T1 (mean = 3.7, SD = 2.6). 53% reported a large improvement in oral health and related life quality after treatment, 32% minimal change, and 15% no change. None reported worsening in OHRQoL at T1. There was a significant positive correlation between change in MIQ score and change in PAR score (r = 0.358), pretreatment aesthetic component (rho = 0.467) and dental health component (rho = 0.491) of the index of orthodontic treatment (IOTN-DHC), and treatment time (rho = 0.502). Regression analysis revealed the change in PAR score and pretreatment IOTN-DHC to be independent predictors of change in MIQ score. Standardized effect size (4.0) and standardized response mean (2.9) were large and the minimal important difference was 7.7. Receiver operating characteristic analysis reported a high diagnostic accuracy of MIQ.

CONCLUSIONS

There was a significant improvement in OHRQoL following orthodontic treatment when assessed using a condition-specific measure for malocclusion. MIQ was found to be responsive to changes associated with orthodontic treatment.

Children oral health and parents education status: a cross sectional study

INTRODUCTION

Oral diseases are common and affect millions of people worldwide. They can range from mild and easily treatable conditions to more severe and serious diseases. Proper oral hygiene and regular dental monitoring are essential for maintaining good oral health. When it comes to children's health and well-being, parents' education level plays a critical role. Research has shown that parents' higher educational attainment is associated with better health outcomes for their children. Our aim is to evaluate whether parents' education level and employment influence children oral health and its impact on the family.

METHODS

We enrolled consecutively healthy subjects aged between 0-16 and their parents at the Dental Clinic of the University of Campania "L. Vanvitelli". The Italian version of the ECOHIS (I-ECOHIS) was administered to parents of the enrolled subjects referred to the Dental Clinic of the University of Campania "L. Vanvitelli". Linear regression models, adjusted for age and sex, were used to explore the association between parents' employment or education level and the ECOHIS scores. Statistical significance was accepted when p value < 0.05.

RESULTS

We found a significative association of a higher I-ECOHIS total score (coeff. 4.04244; CI 95%: 1.530855-6.554026; p = 0,002) and higher I-ECOHIS children section score (coeff. 3.2794; CI 95%: 1.29002-5.268; P = 0,002) and the father unemployed status. We also found that a higher education level of the father was associated with a lower ECOHIS total score (coeff. -1.388; IC 95%: -2.562115--0.214 p = 0.021) and a higher education level of the mother was associated with a lower ECOHIS in children section (coeff. -0.972; IC95%: -1.909356-0.034; p = 0.042).

CONCLUSIONS

Father unemployed status and a lower educational level for both parents may negatively affect oral health status.

Psychometric properties of the Child Oral Impacts on Daily Performances (C-OIDP) index: a cross-sectional and an intervention study of adolescents in Bosnia and Herzegovina

BACKGROUND

The clinical measures are not sufficient to assess oral health because they don't tell us anything about functional and psychosocial aspects of oral health and do not reflect person's concerns and subjectively perceived symptoms. This study aimed to investigate the validity, reliability and responsiveness of the child Oral Impacts on Daily Performances (C-OIDP) index among Bosnian 12-14 years old schoolchildren.

METHODS

The study population comprised 203 primary schoolchildren aged 12-14 years attending three schools in the eastern part of Bosnia and Herzegovina. Data were collected through: a clinical oral examination, oral health questionnaire and C-OIDP questionnaire. The validity and reliability of the C-OIDP were tested on a sample of 203 school-going children while responsiveness of the C-OIDP was assessed on 42 randomly chosen participants requiring a dental treatment.

RESULTS

In terms of reliability, Cronbach's alpha coefficient and the intraclass correlation coefficient were 0.86 and 0.85, respectively. Regarding the testing of construct validity, the C-OIDP score was increased as children's self-reported oral health changed from excellent to very bad and from very satisfied to dissatisfied. There was a significant improvement in C-OIDP post-treatment score compared with C-OIDP pre-treatment score. Overall, 63.4% of participants reported at least one oral impact in the last 3 months. The most affected performances were "eating" (38.4%) and "speaking" (25.1%).

CONCLUSION

The Bosnian version of the C-OIDP showed satisfactory validity, reliability and responsiveness and can be used as an appropriate OHRQoL measure for further epidemiological researches.

Responsiveness of the B-ECOHIS to detect changes in OHRQoL following dental treatment of children with autism spectrum disorder

The Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) is an oral health-related quality of life (OHRQoL) questionnaire. This paper aims to investigate the responsiveness of the B-ECOHIS to dental treatment in individuals diagnosed with autism spectrum disorder (ASD) and determine if dental treatment has an impact on OHRQoL. The survey targeted 27 ASD individuals aged 4 to 14 years attending the Acolher Project of the University Federal Fluminense. This project provides children and adolescents with disabilities with oral health services. A group of randomly selected caregivers self-completed the B-ECOHIS before and 14 days after their children's dental treatment. The dental treatment included meticulous screening, preventive treatment, and restorative treatment. Responsiveness was assessed by investigating the effect size (ES) and standardized response mean (SRM). Wilcoxon test was used to evaluate internal responsiveness (distribution-based approach). The B-ECOHIS showed significant changes in the total score (p<0.001) and in all domains. The ES of the total B-ECOHIS after treatment was 1.28 and ranged between 0.70 and 1.14 for the domains. The SRM for each of the domains was large, except for the symptom domain. The B-ECOHIS is sensitive and responsive to ASD individuals undergoing dental treatment. Individuals with ASD showed improvement in their OHRQoL score after dental treatment.

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.

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.

Evaluation of the ECOHIS and the CARIES-QC among an Australian "Aboriginal" population

PURPOSE

An evaluation of the reliability and validity of two child oral health-related quality of life (COHRQoL) measures among Australian Aboriginal children who participated in a randomised trial was undertaken.

METHODS

Study participants completed the Early Childhood Oral Health Impact Scale (ECOHIS) and the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The questionnaires were completed a second time to test the scales' test-retest reliability. Internal consistency, convergent and discriminant validity were evaluated through Cronbach's alpha, correlation of the scale scores with the global oral health evaluation, and comparison of scale scores among children with varying levels of caries experience, respectively.

RESULTS

Worse COHRQoL was reported by parents who rated their child's oral health as poor and by children who rated their teeth as being a lot of problem. Cronbach's alpha for the child impact section (CIS), family impact section (FIS), total ECOHIS score and the total CARIES-QC scale were 0.88, 0.81, 0.91 and 0.84, respectively. Spearman's correlations between scale scores and global oral health ratings of the CIS, FIS, total ECOHIS and the CARIES-QC were 0.42, 0.34, 0.45 and 0.70, respectively, p < 0.001. The Kruskal-Wallis test of scale scores with grouped caries experience was statistically significant, p < 0.005. Test-retest reliabilities for the ECOHIS were CIS ICC = 0.91, FIS ICC = 0.89, total ECOHIS ICC = 0.93 and for the CARIES-QC, ICC = 0.61.

CONCLUSIONS

Both the ECOHIS and the CARIES-QC were reliable and valid scales for use among an Australian Aboriginal population for assessing COHRQoL of preschool children.

TRIAL REGISTRATION

ACTRN12616001537448, date of registration-08 November 2016.

The Effect of Dental Treatment under General Anesthesia on Quality of Life and Growth and Blood Chemistry Parameters in Uncooperative Pediatric Patients with Compromised Oral Health: A Pilot Study

BACKGROUND

The effect of untreated dental caries and their treatment under general anesthesia (GA) on the quality of life, growth, and blood chemistry parameters in uncooperative pediatric patients has not been extensively elucidated. The aims are to evaluate the impact of dental treatment under GA on oral health-related quality of life (OHRQoL) in uncooperative pediatric patients with severe dental caries and to assess the effect of dental treatment under GA on children's weight (Wt), height (Ht), Body Mass Index (BMI), and blood chemistry parameters.

METHODS

Forty-three uncooperative children aged 3-14 years were selected. OHRQoL, through ECOHIS (Early Childhood Oral Health Impact Scale) and COHRQoL (Child Oral Health-Related Quality of Life) questionnaires, Wt, Ht, BMI, and blood chemistry parameters were measured at baseline and eight months after dental treatment under GA.

RESULTS

At follow up, the reductions in the ECHOIS and the COHRQoL components were statistically significant (p < 0.0001), there was significant improvement in the anthropometric measures: 76.5% of children increased the percentile curves for weight, 68.6% for height, and 51.4% for BMI; for the blood chemistry parameters: ferritin improved in 68.6% of the samples, PCR in 65.7%, ESR in 68.6%, Vitamin D in 68.6%, and IGF-1 in 65.7%.

CONCLUSIONS

Oral health status significantly influences OHRQoL, growth, and blood chemistry parameters in uncooperative pediatric patients.

Teledentistry as a novel pathway to improve dental health in school children: a research protocol for a randomised controlled trial

BACKGROUND

Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children.

METHODS/DESIGN

We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4-15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care.

DISCUSSION

The current project seeks to take advantage of mobile technology to acquire dental images from a child's mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.

Responsiveness of Oral Health-Related Quality of Life Questionnaires to Dental Caries Interventions: Systematic Review and Meta-Analysis

This systematic review and meta-analysis were undertaken to assess the responsiveness of validated oral health-related quality of life (OHRQoL) questionnaires to dental caries interventions in children, adolescents, and young adults. Studies eligible were randomized clinical trials (RCTs), controlled clinical trials (CCTs), and prospective case series (PCS), which had OHRQoL questionnaires answered before and after caries intervention(s). The main outcome was improvement in OHRQoL mean scores following caries intervention. Twenty-six studies were selected for the quality assessment and 14 were selected for the meta-analysis. Most of the studies were PCS with a single group pretest and posttest study design (n = 19). Five studies were CCT and only 2 were RCT. The numbers of participants were 3,522 in the control group (baseline = 2,002; final = 1,520) and 5,917 in the test group (baseline = 3,102; final = 2,815). The age of the subjects ranged from 3 to 19 years. All studies showed significant improvement in OHRQoL following caries intervention. Most of nonrandomized studies (n = 15) had low or moderate risk of bias. The meta-analysis showed the effect of caries interventions (standardized weighted mean differences = -1.24; 95% CI: -1.68 to -0.81; p < 0.001). However, high heterogeneity between the studies was found. The Grading of Recommendations Assessment, Development and Evaluation approach classified the quality of evidence as very low and its strength weak. In conclusion, there is evidence that the OHRQoL of children and adolescents improved following caries intervention procedures, but the quality of the evidence was very low. In spite of that, caries interventions are highly recommended as abstaining from treatment is likely to result in a deterioration of OHRQoL.

Responsiveness to change of the Malay-ECOHIS following treatment of early childhood caries under general anaesthesia

OBJECTIVES

To evaluate the sensitivity and responsiveness of the Malay version of Early Childhood Oral Health Impact Scale (Malay-ECOHIS) to dental treatment of early childhood caries (ECC) under general anaesthesia (GA) and determine the minimally important difference (MID) for the Malay-ECOHIS.

METHODS

A sample of 158 preschool children with ECC awaiting dental treatment under GA was recruited over an 8-month period. Parents self-completed the Malay-ECOHIS before and 4 weeks after their child's dental treatment. At 4 weeks follow-up, parents also responded to a global health transition judgement item. Data were analysed using independent and paired samples t tests, ANOVA and Pearson correlation coefficients.

RESULTS

The response rate was 87.3%. The final sample comprised 76 male (55.1%) and 62 female (44.9%) preschool children with mean age of 4.5 (SD = 1.0) years. Following treatment, there were significant reductions in mean scores for total Malay-ECOHIS, child impact section (CIS), family impact section (FIS) and all domains, respectively (P < 0.001). The effect size (ES) for the Malay-ECOHIS was +1.0; across the domains, it ranged from +0.4 to +1.9. There was a weak, positive correlation for Malay-ECOHIS change scores (r = 0.165) and CIS change scores (r = 0.175) with the number of decayed teeth (dt), respectively. Similar correlation was also observed between Malay-ECOHIS change scores and the number of extracted teeth (r = 0.129). Based on the global health transition judgement, 62.3% of parents reported their child's oral condition to be "a little improved" while 37.7% reported it to be "much improved" following treatment, with Malay-ECOHIS mean change scores of 6.7 (ES = +1.1) and 9.6 (ES = +1.2), respectively. There was an observed gradient in the Malay-ECOHIS change scores and ES in relation to parents' perception of their child's oral health improvement after treatment, supporting the responsiveness of the measure. The Malay-ECOHIS MID was found to be 7 scale points.

CONCLUSION

The Malay-ECOHIS is empirically shown to be sensitive and responsiveness to dental treatment of ECC under GA.

Sensitivity of an oral health-related quality-of-life questionnaire in detecting oral health impairment in preschool children

AIM

This two-year cohort study evaluated whether the Early Childhood Oral Health Impact Scale (ECOHIS) is responsive to detect changes related to dental caries.

DESIGN

Preschool children were examined in 2010 regarding dental caries, and their parents responded to the ECOHIS. After 2 years, 352 children (response rate = 73.6%) were re-examined and a new ECOHIS was responded. Children were categorized according to caries increment (no new caries, 1-3 surfaces with new lesions, and four or more decayed surfaces). The outcome variables were related to the decline of quality of life as determined via ECOHIS: decline, severe decline, and differences between baseline and follow-up scores. Effect sizes (ES) were calculated, and the associations were evaluated through Poisson regression.

RESULTS

ES was small for children with 1-3 new lesions (ES = 0.19) and moderate for children with four or more new carious lesions (ES = 0.61). Children who developed 1-3 new lesions were significantly associated with all outcome variables compared to children with no new lesions, but the associations were stronger for children with four or more new carious lesions.

CONCLUSIONS

The ECOHIS is sensitive to the deterioration of quality of life due to caries increments in preschool children.

Responsiveness of the Arabic version of the ECOHIS to dental rehabilitation under general anaesthesia

BACKGROUND

The Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) has been validated, but its ability to detect change was not tested.

AIM

To evaluate the responsiveness of the A-ECOHIS to dental rehabilitation under general anaesthesia (DRGA).

DESIGN

A consecutive sample of 131 parents of children aged 6 years or younger, scheduled for DRGA were recruited from three public hospitals. The parents completed the A-ECOHIS before and 4 weeks following DRGA. The responsiveness of the A-ECOHIS was assessed by evaluating changes in scores before and after DRGA, and by measuring the change in scores in relation to the global question.

RESULTS

The A-ECOHIS scores were higher among parents who reported poor oral health on the global question than those reporting better oral health (P = 0.001). There was a significant reduction in the scores at follow-up (P < 0.001). The effect size was 1.5 for the total scale, and 1.3 and 1.6 for the child and family impacts, respectively. After DRGA, the child and family impact section scores decreased by 78.6% and 77.9%, respectively. The majority of parents reported improvement in children's overall oral health-related quality of life post-operatively (94%).

CONCLUSION

The A-ECOHIS was responsive to DRGA.

Influence of full mouth rehabilitation on oral health-related quality of life among disabled children

The efficacy of full mouth rehabilitation (FMR) on oral health-related quality of life of physically disabled children was assessed. This prospective study was performed at Dental Department of Sultan Bin Abdulaziz Humanitarian City, Riyadh, and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, during May 2012 to September 2014. A total of 186 physically disabled children aged 11-14 years were assigned to a test group (n = 97) or a control group (n = 89). FMR was applied for test group children at baseline and 3 months' visits, whereas those in the control group did not receive FMR. Both group children received dental kits and oral hygiene instructions. Children were asked to complete the Child Perceptions Questionnaire, whereas Parental-Caregiver Perceptions Questionnaire and Family Distress Domain questionnaire were completed by the parents/caregivers at baseline and 6 months' visits. Children in both groups showed positive trends in oral symptoms at 6 months compared with those at baseline. However, when they were compared to control, significant improvement in oral symptoms was observed in the test group at 6 months' visit (p < .05). Also when they were compared to control, significant improvements were observed in the functional limitation, emotional, and social well-being subscales of the Child Perceptions Questionnaire and on the Parental-Caregiver Perceptions Questionnaire scales at the end of the study (p < .05). Compared to the parents/caregivers of the control children, the parents/caregivers of the test-group children reported insignificant but positive trends in Family Distress Domain at the end of the study (p < .05). FMR in children reduced oral-related problems subsequently to a better oral health-related quality of life.

Responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) is related to dental treatment complexity

BACKGROUND

The responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) has varied greatly across studies; hence, we hypothesized that this discrepancy could be related to the complexity of dental treatment received. Thus, we aimed to evaluate the responsiveness of the ECOHIS to changes in oral health-related quality of life (OHRQoL) following dental treatments of varying complexity in preschool children.

METHODS

Preschool children aged 3 to 6 years were selected; their parents responded to the ECOHIS at baseline. The parents responded to the ECOHIS again and a global transition question 30 days after the children were treated. The type of treatment received by the children was categorized according to complexity, as follows: 1) non-operative treatment only, 2) restorative treatment, and 3) endodontic treatment and/or tooth extraction. Change scores and effect sizes (ES) were calculated for total scores, as well as considering the different treatment types and global transition question responses.

RESULTS

Of the 152 children who completed the study, the ECOHIS yielded large ES for total scores (0.89). The children showed increasing ES values associated with better perception of improvement, assessed by the global transition question. The magnitude of ES after treatment was related to treatment complexity (0.53, 0.92 and 1.43, for children who received non-operative treatment only, restorative treatment, and endodontic treatment and/or tooth extraction, respectively).

CONCLUSIONS

Parents whose children required more complex dental treatment are more likely to perceive treatment-related changes to OHRQoL assessed with the ECOHIS.

Quality of life changes in children following emergency dental extractions under general anaesthesia

OBJECTIVES

To assess the changes in the oral health-related quality of life (OHRQoL) of 221 preschool children who presented to the emergency department with the consequences of untreated dental caries requiring dental extractions under general anaesthesia (DEGA).

METHODS

Two hundred and twenty-one healthy preschool children, who required emergency DEGA, were recruited over a period of 12 months. The same parent or caregiver completed the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire; both, prior to the DEGA and at the 2-week post-treatment visit. Data were analysed using repeated anova with adjustments for multiple comparisons using the Bonferroni tests with the significance level set at 5%.

RESULTS

One hundred and twenty-six participants, with a mean age of 4.02 and a mean dmft score of 8.27 (SD = 4.13), completed the 2-week post-treatment questionnaires. The overall ECOHIS, CIS, and FIS scores decreased significantly (P < 0.001) after emergency DEGA, demonstrating large effect sizes. The biggest decrease in prevalence after emergency DEGA was observed for the items of pain in teeth, trouble sleeping, being irritated or frustrated, difficulty drinking food, and parents being upset.

CONCLUSIONS

The OHRQoL of preschool children, who presented to the emergency department with the consequences of untreated dental caries, was significantly improved following emergency DEGA.

Impact of a dental care program on the quality of life of children with and without caries

The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p < 0.0001) in the DTG over time, but no significant changes (p > 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p < 0.05) over time. In conclusion, dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

Changes in preschool children's OHRQoL after treatment of dental caries: responsiveness of the B-ECOHIS

BACKGROUND

Oral health-related quality of life (OHRQoL) measures should be tested for responsiveness to change if they are to be used as outcomes in randomized clinical trials.

AIM

To assess the responsiveness of the Brazilian ECOHIS (B-ECOHIS) to dental treatment of dental caries.

METHODS

One hundred parents of 3- to 5-year-old children completed the B-ECOHIS prior to their children's treatment and 7-14 days after completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed parent's perceptions of change in their children's oral health following treatment. Change scores, longitudinal construct validity, standardized effect sizes (ES) and standardized response mean (SRM) were calculated.

RESULTS

Improvements in children's oral health after treatment were reflected in mean pre- and post-treatment B-ECOHIS scores. They declined considerably significantly from 17.4 to 1.6 (P < 0.0001), as did the individual domain scores (P < 0.0001). There were significant differences in the pre- and post-treatment scores of children who reported little improvement (P < 0.0001) as well as in those who reported large improvements (P < 0.0001). The ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were large.

CONCLUSIONS

Dental treatment resulted in significant improvement of the preschool children's OHRQoL. The B-ECOHIS is responsive.

Comparison of the ECOHIS and short-form P-CPQ and FIS scales

BACKGROUND

The development of short-form versions of child oral-health-related quality of life (OHRQoL) scales has resulted in two closely related sets of measures. We set out to compare the properties and responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS--both "child" and "family" versions) and short-form Parental-Caregiver Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) measures among New Zealand children with early childhood caries who underwent treatment under general anaesthesia (GA).

METHODS

Secondary analysis of data from pretest/post-test clinical studies of consecutive clinical convenience samples undertaken in Wellington in 2005 and Auckland in 2010/11, with cross-sectional analyses using the former, and longitudinal analyses using the latter.

RESULTS

Cronbach's α values for the ECOHIS-Child, P-CPQ-16 and P-CPQ-8 were 0.80, 0.88 and 0.80 respectively, and 0.83 and 0.68 (respectively) for the FIS-8 and the ECOHIS-Family. All scales showed acceptable cross-sectional construct validity, although that of the ECOHIS-Family was not as marked as that observed with the FIS-8. Responsiveness was acceptable, with the three child-focused measures showing similar effect sizes. The two family-focused measures were also similar.

CONCLUSIONS

The ECOHIS-Child and the P-CPQ scales are very similar in their properties, but the ECOHIS-Family falls short of the FIS-8 in some important ways. The ECOHIS scales may be better deployed in epidemiological survey work rather than in health services research, whereas the P-CPQ-8, P-CPQ-16 and the FIS-8 seem to be well suited for the latter (particularly with children suffering from severe caries), but their epidemiological utility remains to be demonstrated.

Effects of dental rehabilitation under general anesthesia on children's oral health-related quality of life using proxy short versions of OHRQoL instruments

AIM

To examine the impact of comprehensive dental treatment under general anesthesia (GA) on oral health-related quality of life (OHRQoL) in children using short form versions of the Parental-Caregivers Perceptions questionnaire (P-CPQ) and Family Impact Scale (FIS).

DESIGN

A pretest/posttest study involved parents whose children (N = 67) were affected with severe childhood caries and completed comprehensive dental treatment under GA. All parents completed the short form versions of the P-CPQ and FIS at baseline and 4-8 weeks following the dental treatment. To examine test-retest reliability, a convenience sample of 38 parents repeated the pretreatment questionnaires 1-2 weeks after they completed them at baseline. Statistical tests including the Kruskal-Wallis test, Cronbach's alpha, and paired t-test were used to examine cross-sectional construct validity, internal consistency, and responsiveness of the instruments, respectively.

RESULTS

Cross-sectional construct validity and internal consistency were acceptable. Test-retest reliability was excellent. Large decreases in posttreatment scores were observed along with moderate to large effect sizes.

CONCLUSIONS

Dental treatment under GA is associated with considerable improvement in OHRQoL of children and their families, as demonstrated by short form versions of the P-CPQ and FIS completed by the children's parents.

Impact of Malocclusion on Oral Health-Related Quality of Life among Brazilian Preschool Children: a Population-Based Study

The purpose of the present study was to evaluate the impact of malocclusion on Oral Health-Related Quality of Life (OHRQoL) of children and their families. A population-based cross-sectional study was carried out in Belo Horizonte, MG, Brazil. A representative sample of 1069 male and female preschoolers aged 60 to 71 months was randomly selected from public and private preschools and daycare centers. Data were collected using the B-ECOHIS. In addition, a questionnaire addressing socioeconomic and demographic data was self-administered by the parents/guardians. The criteria used to diagnose malocclusion were based on Foster and Hamilton (1969), Graboswki et al. (2007) and Oliveira et al. (2008). Descriptive, univariate and multiple Poison logistic regression analyses were carried out. The prevalence of malocclusion was observed in 46.2% of the children and deep overbite was the most prevalent type of malocclusion (19.7%), followed by posterior crossbite (13.1%), accentuated overjet (10.5%), anterior open bite (7.9%) and anterior crossbite (6.7%). The impact of malocclusion on OHRQoL was 32.7% among the children and 27.1% among the families. In Poisson multiple regression model adjusted for socioeconomic status, no significant association was found between malocclusion and OHRQoL of the children (PR=1.09, 95% CI: 0.96-1.24) and their families (PR=1.11, 95% CI: 0.94-1.31). It is concluded that children with malocclusion in this sample did not have a negative impact on their OHRQoL and of their families.

Responsiveness to change for the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

BACKGROUND

The responsiveness of oral health-related quality of life (OHRQoL) instruments has become relevant, given the increasing tendency to use OHRQoL measures as outcomes in clinical trials and evaluations studies. The purpose of this study was to assess the responsiveness of the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) to dental treatment.

METHODS

One hundred and fifty-four children and their parents completed the child self- and parental' reports of the SOHO-5 prior to treatment and 7 to 14 days after the completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed subject's perceptions of change in their oral health following treatment. Change scores were calculated by subtracting post-treatment SOHO-5 scores from pre-treatment scores. Longitudinal construct validity was assessed by using one-way analysis of variance to examine the association between change scores and the global transition judgments. Measures of responsiveness included standardized effect sizes (ES) and standardized response mean (SRM).

RESULTS

The improvement of children's oral health after treatment are reflected in mean pre- and post-treatment SOHO-5 scores that declined from 2.67 to 0.61 (p<0.001) for the child-self reports, and 4.04 to 0.71 (p<0.001) for the parental reports. Mean change scores showed a gradient in the expected direction across categories of the global transition judgment, and there were significant differences in the pre- and post-treatment scores of those who reported improving a little (p<0.05) and those who reported improving a lot (p<0.001). For both versions, the ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were moderate to large.

CONCLUSIONS

The Brazilian SOHO-5 is responsive to change and can be used as an outcome indicator in future clinical trials. Both the parental and the child versions presented satisfactory results.

Impact of dental caries on preschool children's quality of life: an update

The literature reports that dental caries can cause functional, physical and aesthetic impairment, often with repercussions on children's general health at an early age. Moreover, recent studies have investigated how caries lesions can compromise children's quality of life. This paper aims to describe the current situation of dental caries prevalence in children and how this oral health disease can impact their quality of life.

Validation of the Parental-Caregiver Perceptions Questionnaire: agreement between parental and child reports

OBJECTIVES

To test the validity and reliability of Brazilian Portuguese version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) (Aim 1) and to assess the agreement between parents and children concerning the child's oral health-related quality of life (OHRQoL) (Aim 2).

METHODS

The P-CPQ and the Brazilian Portuguese versions of the Child Perceptions Questionnaires (CPQ8-10 and CPQ11-14 ) were used. Objective 1 addressed in the study that involved 210 (validity and internal reliability) and 20 (test-retest reliability) parents and Objective 2 in the study that involved 210 pairs of parents and children. Construct validity was calculated using the Spearman's correlation and the Mann-Whitney/Kruskal-Wallis tests. Reliability was determined using Cronbach's alpha and intraclass correlation coefficient (ICC). Agreement between overall and subscale scores derived from the P-CPQ and CPQ was assessed in comparison and correlation analyses.

RESULTS

The P-CPQ discriminated among the categories of malocclusion and dmft. The P-CPQ showed good construct validity, good internal consistency reliability, and excellent test-retest reliability. There was systematic under- and overreporting in parents' assessments for younger and older children, respectively. However, the magnitude of the directional differences was just small. At individual level, agreement between parents and children was excellent. However, it ranged from excellent to moderate or substantial in subscales for CPQ8-10 and CPQ11-14 groups, respectively.

CONCLUSIONS

The Portuguese version of P-CPQ is valid and reliable. Some parents have limited knowledge about child OHRQoL. Given that parental and child reports measure different realities concerning the child's OHRQoL, information provided by parents can complement the child's evaluation.

Caregivers' oral health literacy and their young children's oral health-related quality-of-life

OBJECTIVES

To investigate the association of caregivers' oral health literacy (OHL) with their children's oral health related-quality of life (C-OHRQoL) and explore literacy as a modifier in the association between children's oral health status (COHS) and C-OHRQoL.

METHODS

This study relied upon data from structured interviews with 203 caregivers of children aged 3-5 from the Carolina Oral Health Literacy (COHL) Project. Data were collected for OHL using REALD-30, caregiver-reported COHS using the NHANES-item and C-OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS). This study also measured oral health behaviors (OHBs) and socio-demographic characteristics and calculated overall/stratified summary estimates for OHL and C-OHRQoL. Spearman's rho and 95% confidence intervals (CI) were computed as measures of correlation of OHL and COHS with C-OHRQoL. To determine whether OHL modified the association between COHS and C-OHRQoL, this study compared literacy-specific summary and regression estimates.

RESULTS

Reported COHS was: excellent-50%, very good-28%, good-14%, fair-6%, poor-2%. The aggregate C-OHRQoL mean score was 2.0 (95% CI: 1.4, 2.6), and the mean OHL score 15.9 (95% CI: 15.2, 16.7). There was an inverse relationship between COHS and C-OHRQoL: ρ = -0.32 (95% CI: -0.45, -0.18). There was no important association between OHL and C-OHRQoL; however, deleterious OHBs were associated with worse C-OHRQoL. Literacy-specific linear and Poisson regression estimates of the association between COHS and C-OHRQoL departed from homogeneity (Wald χ(2) p < 0.2).

CONCLUSION

In this community-based sample of caregiver/child dyads, a strong correlation was found between OHS and C-OHRQoL. The association's magnitude and gradient were less pronounced among caregivers with low literacy.

Cross - cultural adaptation and preliminary validation of the Turkish version of the early childhood oral health impact scale among 5-6-year-old children

Background

In Turkey, formal pre-primary education for children 5- 6 years old provides the ideal setting for school-based oral health promotion programs and oral health care services. To develop effective oral health promotion programs, there is a need to assess this target group's subjective oral health needs as well as clinical needs. The Early Childhood Oral Health Impact Scale (ECOHIS) is a well-known instrument for assessing oral health quality of life in children aged 0-5 years old and their families. This study aimed to adapt the ECOHIS for children 5-6 years old in a Turkish-speaking community and to undertake a preliminary investigation of its psychometric properties.

Methods

The Turkish version of the ECOHIS was obtained with forward/backward translations, expert panels and pre-testing and it was tested in a convenience sample of 121 parents of 5- 6 year-old children attending nursery classes of three public schools. Data were collected through clinical examinations and self-completed questionnaires. The main analyses were carried out on the imputed data set. The validity of content, face, construct, discriminant and convergent and as well as the reliability of internal and test-retest of the ECOHIS were evaluated. Sensitivity analysis was performed to examine the effect of the complete case analysis for managing "Don't know" responses on the validity and reliability of the ECOHIS.

Results

The analysis of the imputed data set showed that Cronbach's alphas for the child and family sections were 0.92 and 0.84 respectively, and for the whole scale was 0.93. The intraclass correlation coefficient for test-retest was 0.86. The scale scores on the child and parent sections indicating worse quality of life were significantly associated with poor parental ratings of their child's oral health, high caries experience, higher gingival index scores and problem-orientated dental attendance, supporting its construct, convergent and discriminant validity. Sensitivity analysis showed that the mean imputation method and the complete case analysis did not have differing effects on the validity and reliability of the ECOHIS.

Conclusions

This study provided preliminary evidence concerning validity and reliability of the Turkish version of the scale among 5-6-year-old children. Future studies should be conducted on the ECOHIS to evaluate fully its psychometric properties in both community- based and clinically-based studies among parents of children younger than five. This study provides initial evidence that the ECOHIS aimed at children aged 0-5 years may be a useful tool for assessing the oral health quality of life in 6 year - old preschool children.

Oral health-related quality of life in Hong Kong preschool children

OBJECTIVES

To assess the impact of early childhood caries (ECC) on the quality of life in a population of preschool children and their families in Hong Kong.

METHODS

A random sample of 1,296 Chinese preschool children participated in the survey and were subjected to an oral examination for their ECC status by 2 trained examiners. The parents were asked to respond to the Early Childhood Oral Health Impact Scale (ECOHIS) and an extra set of questions concerning their sociodemographic background.

RESULTS

The final data analysis included 1,261 children with a mean (±SD) age of 3.9 ± 0.66 years. The prevalence figures for ECC and severe ECC were 19.9 and 15.2%, respectively. Decayed teeth were found in 34.3% of the children while only 5.2% had filled teeth. The mean (±SD) dmft in this group of children was 1.5 ± 2.98. Higher ECOHIS scores were found in parents with lower education or income level, or with children who were born in mainland China (p < 0.05), or with children who had decayed, missing, or filled teeth (p < 0.001). In multiple regression analyses, decayed teeth and filled teeth in primary dentition were the better predictors (p < 0.001) of the ECOHIS score among the various parent and child characteristics collected in this survey.

CONCLUSIONS

The findings of this study showed that parents of young children with dental caries experience perceived that both the children and other family members had poorer quality of life.

Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder

BACKGROUND

Oral health-related quality of life (OHRQoL) in children and adolescents with signs and symptoms of temporomandibular disorder (TMD) has not yet been measured. This study aimed to evaluate the validity and reliability of OHRQoL measure for use in children and preadolescents with signs and symptoms of TMD.

METHODS

Five hundred and forty-seven students aged 8-14 years were recruited from public schools in Piracicaba, Brazil. Self-perceptions of QoL were measured using the Brazilian Portuguese versions of Child Perceptions Questionnaires (CPQ)8-10 (n = 247) and CPQ11-14 (n = 300). A single examiner, trained and calibrated for diagnosis according to the Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD), examined the participants. A self-report questionnaire assessed subjective symptoms of TMD. Intraexaminer reliability was assessed for the RDC/TMD clinical examinations using Cohen's Kappa (κ) and intraclass correlation coefficient (ICC). Criterion validity was calculated using the Spearman's correlation, construct validity using the Spearman's correlation and the Mann-Whitney test, and the magnitude of the difference between groups using effect size (ES). Reliability was determined using Cronbach's alpha, alpha if the item was deleted and corrected item-total correlation.

RESULTS

Intraexaminer reliability values ranged from regular (κ = 0.30) to excellent (κ = 0.96) for the categorical variables and from moderate (ICC = 0.49) to substantial (ICC = 0.74) for the continuous variables. Criterion validity was supported by significant associations between both CPQ scores and pain-related questions for the TMD groups. Mean CPQ8-10 scores were slightly higher for TMD children than control children (ES = 0.43). Preadolescents with TMD had moderately higher scores than the control ones (ES = 0.62; p < 0.0001). Significant correlation between the CPQ scores and global oral health, as well as overall well-being ratings (p < 0.001) occurred, supporting the construct validity. The Cronbach's alphas were 0.93 for CPQ8-10 and 0.94 for CPQ11-14. For the overall CPQ8-10 and CPQ11-14 scales, the corrected item-total correlation coefficients ranged from 0.39-0.76 and from 0.28-0.73, respectively. The alpha coefficients did not increase when any of the items were deleted in either CPQ samples.

CONCLUSIONS

The questionnaires are valid and reliable for use in children and preadolescents with signs and symptoms of temporomandibular disorder.

Validation of a Farsi version of the early childhood oral health impact scale (F-ECOHIS)

Background

The Early Childhood Oral Health Impact Scale (ECOHIS) has recently been developed to assess oral health-related quality of life (OHRQoL) of pre-school children in English speaking communities. This study aimed to translate the ECOHIS into Farsi and test its psychometric properties for use on 2- to 5-year-old children of Farsi speaking Iranian families.

Methods

EHOHIS questionnaire was translated into Farsi using a standardized forward-backward linguistic translation method. Its face and content validity was tested in two small pilot studies. In the main study, a convenience sample of 260 parents of 2- to 5-year-old children in Isfahan and Tehran were invited to complete the final Farsi version of the ECOHIS (F-ECOHIS) and answer two global self-rating questions about their children's dental appearance and oral health. Association between F-ECOHIS scores and answers to the two self-rating questions, and the correlation between child (9 items) and family (4 items) sections of the F-ECOHIS were used to assess the concurrent and convergent validity of the questionnaire. Internal consistency reliability of the F-ECOHIS was tested using Cronbach's alpha coefficient test and item total and inter-item correlations. One third of participants were invited to complete the F-ECOHIS again after 2 weeks to evaluate the test-retest reliability of the questionnaire.

Results

Two hundred and forty six parents were included in the main study. The association between the F-ECOHIS scores and the two self-rating questions and the correlation between its child and family sections were significant (P < 0.001). Cronbach's alpha coefficient of the F-ECOHIS and its child and family sections were 0.93, 0.89, and 0.85 respectively. Coefficients did not increase by deleting any item. The corrected item total correlation coefficient ranged from 0.52 to 0.74. The inter-item correlation coefficient ranged between 0.30 and 0.73. Seventy three parents participated in the follow up study for re-testing the questionnaire. Comparison of their test and re-test scores had a weighted kappa of 0.81 and inter-class correlation (ICC) of 0.82.

Conclusion

The F-ECOHIS questionnaire was valid and reliable for assessing the OHRQoL of 2- to 5-year-old pre-school children of Farsi speaking parents.

Update on early childhood caries since the Surgeon General's Report

The 2000 Surgeon General's Report on Oral Health included a limited discussion of the condition known as early childhood caries. Because of its high prevalence, its impact on young children's quality of life and potential for increasing their risk of caries in the permanent dentition, early childhood caries is arguably one of the most serious and costly health conditions among young children. A necessary first step in preventing dental caries in preschool children is understanding and evaluating the child's caries risk factors. Previous caries experience and white spot lesions should automatically classify a preschool child as high risk for caries. Microbial factors, such as presence of visible plaque and tests that identify a child as having high levels of mutans streptococci, also predict caries in young children. Frequency of sugar consumption, enamel developmental defects, social factors such as socioeconomic status, psychosocial factors, and being an ethnic minority also have shown to be relevant in determining caries risk. On the basis of this knowledge of specific risk factors for an individual, different preventive strategies and different intensities of preventive therapies can be implemented. Caries preventive strategies in preschool children include fluoride therapy, such as supervised tooth brushing with a fluoridated dentifrice, systemic fluoride supplement to children who live in a nonfluoridated area and who are at risk for caries, and professional topical fluoride with fluoride varnish. There is emerging evidence that intensive patient counseling or motivational interviews with parents to change specific behaviors may reduce caries prevalence in their children. Findings regarding antimicrobial interventions, efforts to modify diets, and traditional dental health education are less consistent.