Rasch validation of the early childhood oral health impact scale

Rasch validation of the oral health impact profile for temporomandibular disorders

OBJECTIVES

This study examined the metric properties of the Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD) using Factor/Rasch analyses and created a short-form version of the measure.

SUBJECTS AND METHODS

Aggregated OHIP-TMD data were obtained from a cross-sectional study involving 844 TMD patients with diagnostic criteria for TMDs defined conditions. The dimensionality of the OHIP-TMD was first evaluated with exploratory factor analysis. An eigenvalue >1.0 and oblique oblimin rotation were applied for extracting the factors. Rasch analysis was subsequently performed on the primary dimension using the ConQuest software.

RESULTS

Multi-dimensionality of the OHIP-TMD was observed with the primary dimension comprising ten items. Adequate fit to the Rasch model was noted after deleting item 8 with infit/outfit mean-square values ranging from 0.75 to 1.40 logits. Item difficulty ranged from -0.75 to 1.05 logits, while participants' ability to respond varied from -4.55 to 5.19 logits. The respondent spread was slightly skewed and satisfactory item-response targeting was present.

CONCLUSIONS

The 22-item OHIP-TMD demonstrated multi-dimensionality with the primary dimension consisting of nine reliable items with adequate fit to the Rasch model. The 9-item short-form version of the OHIP-TMD (SOHIP-TMD) is a promising tool for evaluating OHRQoL.

Cross-cultural adaptation and validation of Malay version of Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) among Orang Asli population in Malaysia

BACKGROUND

The aim of this study was to adapt, translate and validate the Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) instrument for the Orang Asli population in Malaysia.

METHODS

After translation and cross-cultural adaptation, interviews were conducted with 326 participants of the Temuan tribe from village Kampung Tering in Johol, Negeri Sembilan, Malaysia. The instrument's validity was assessed using the scores of MREALD-30, which were compared based on occupation, monthly household income, educational attainment, general literacy, use of dental services, and three dental outcomes. A questionnaire containing socio-behavioral information and validated Malay Oral Health Impact Profile (M-OHIP-14) was also administered. The reliability of the MREALD-30 was assessed by re-administering it to 30 subjects after two weeks. Its correlations evaluated convergent and discriminative validity of MREALD-30 with the level of education and dental visiting habits, monthly household income, respectively. Predictive validity was assessed with M-OHIP-14, while construct validity was evaluated by exploratory factor analysis using the Rasch model.

RESULTS

The internal consistency of the MREALD-30 measured by Cronbach's alpha was 0.89. The test-retest reliability was excellent (ICC 0.95, k = 0.85). MREALD-30 exhibited good construct validity. Rasch analysis showed two factors, and infit mean-square statistics for MREALD-30 were all within the desired range of 0.50-2.0. The discriminant validity and predictive validity were statistically significant (p < 0.05).

CONCLUSIONS

MREALD-30 showed very strong reliability, good construct, discriminant, and predictive validity, but poor convergent validity. Overall, it showed good psychometric properties and can be used in these community settings.

Validation of the Chinese Version of KIDSCREEN-10 Quality of Life Questionnaire: A Rasch Model Estimation

The KIDSCREEN-10 was deemed as a cross-national instrument for measuring Health-Related Quality of Life (HRQoL). However, no empirical endeavor has explored its reliability and validity in the context of China. This study aims to translate and validate the Chinese version of the KIDSCREEN-10 questionnaire. The KIDSCREEN-10 was translated into Chinese (Mandarin) using a blindly bilingual forward–backward–forward technique. A cross-sectional survey, including 1,830 students aged from 8 to 18 years, was conducted in a county located in Gansu province, China. Psychometric properties were evaluated using the Rasch partial credit model, ANOVA, and the correlation analysis. Results indicated that the KIDSCREEN-10 performed good internal consistency, known-group validity, and concurrent validity, but there were still some deficiencies in psychometrics: first, disordered response categories were found between category 2 (seldom) and category 3 (sometimes); second, item 3 (“Have you felt sad?”), item 4 (“Have you felt lonely?”), and item 5 (“Have enough time for self?”) demonstrated misfit to the Rasch model; third, items 3 and 4 exhibited differential item functioning. After collapsing the disordered response categories and removing the three misfit items, the seven-item questionnaire performed good psychometric properties. However, the seven-item version does not cover the psychological well-being dimension of HRQoL, and that may lead to inappropriate measures of HRQoL. Therefore, this paper suggested to use classical test theory to investigate the psychological properties of the KIDSCREEN-10.

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.

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.

Functional, physical and psychosocial impact of Temporomandibular Disorders in adolescents and young adults

Background

This community-based study investigated the functional, physical and psychosocial impact of Temporomandibular Disorders (TMDs) in adolescents and young adults. It also determined the discriminative capacity of a TMDs-specific oral health related quality of life (OHRQoL) instrument and compared three formats of appraising OHRQoL data.

Material and Methods

Subjects were recruited from a local Polytechnic. The presence of TMDs was established with the Fonseca Anamnestic Index (FAI), whilst TMDs-specific OHRQoL was evaluated with the Oral Health Impact Profile–TMDs (OHIP-TMDs). Demographic information, FAI and OHIP-TMDs responses were gathered with an on-line questionnaire. Data was analysed using Mann-Whitney U-test, chi-square test and Spearman’s rho correlation with significance level set at 0.05.

Results

Data from a total of 244 participants were compiled and examined. The “no TMDs” (NT) group consisted of 140 subjects (119 females; 21 males) with a mean age of 20.41±3.29 years, while the “with TMDs” (WT) group composed of 104 subjects (88 females; 16 males) aged 19.82±3.04 years. Significant differences in median severity scores were observed between subjects with and without TMDs for all OHIP-TMDs domains and total OHIP (p values < 0.001). For appraisal of extent and prevalence, significant differences were again observed (p values < 0.05) with the exception of the functional limitation and handicap domains.

Conclusions

TMDs impacted physical and psychosocial well-being of adolescents and young adults. OHIP-TMDs, preferably appraised by severity, extent and prevalence, was able to discriminate between subjects with and without TMDs. It holds promise as a TMDs-specific OHRQoL instrument for epidemiological studies.

Key words:Temporomandibular Disorders, Oral health, Quality of life, Biopsychosocial.

Rasch model of the child perceptions questionnaire in multi-country data

OBJECTIVE

To be fit-for-purpose, oral health-related quality of life instruments must possess a range of psychometric properties which had not been fully examined in the 16-item Short Form Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ_11-14 ISF-16). We used advanced statistical approaches to determine the CPQ's measurement accuracy, precision, invariance and dimensionality and analyzed whether age range could be extended from 8 to 15 years.

METHODS

Fit to the Rasch model was examined in 6648 8-to-15-year-olds from Australia, New Zealand, Brunei, Cambodia, Hong Kong, Malaysia, Thailand, Germany, United Kingdom, Brazil and Mexico.

RESULTS

In all but two items, the initial five answer options were reduced to three or four, to increase precision of the children's selection. Items 10 (Shy/embarrassed) and 11 (Concerned what others think) showed an 'extra' dependency between item scores beyond the relationship related to the underlying latent construct represented by the instrument, and so were deleted. Without these two items, the CPQ was unidimensional. The three oral symptoms items (4 Food stuck in teeth, 3 Bad breath and 1 Pain) were required for a sufficient person-item coverage. In three out of 14 items (21 %), Europe and South America showed regional differences in the patterns of how the answer options were selected. No differential item functioning was detected for age.

CONCLUSION

Except for a few modifications, the present analysis supports the combination of items, the cross-cultural validity of the CPQ with 14 items and the extension of the age range from 8 to 15 years.

CLINICAL SIGNIFICANCE

The valid, reliable, shortened and age-extended version of the CPQ resulting from this study should be used in routine care and clinical research. Less items and a wider age range increase its usability. Symptoms items are needed to precisely differentiate between children with higher and lower quality of life.

Degrees of xerostomia? A Rasch analysis of the Xerostomia Inventory

OBJECTIVE(S)

The global demographic changes resulting in an ageing population require attention on xerostomia, as its prevalence appears to increase with age. The Xerostomia Inventory (XI) is a 11-item instrument developed to evaluate the symptoms and behavioural components of xerostomia, while a shortened 5-item version named Summated Xerostomia Inventory (SXI) was later proposed. The aim of the present study was to evaluate the construct validity of the XI and whether the SXI can provide a shortened version. Since previous studies focused only on dimensionality and reliability, we employed modern psychometric methodology to investigate properties such as differential item functioning (DIF) and targeting.

STUDY DESIGN

The XI was applied to 164 middle-aged to older adults who participated in a randomized controlled trial to investigate the effects of alcohol-containing mouth rinse in Singapore. The psychometric properties of the XI were investigated with the Rasch model (Partial Credit Model). Overall model fit was evaluated with a summary chi-square statistic. Item fit was evaluated with the Fit Residual, and values between -2.5 and 2.5 are considered acceptable. DIF by sex was evaluated through a two-way ANOVA of the residuals.

RESULTS

After collapsing the categories of "Hardly ever" and "Fairly often", the test of global fit (χ² (30) = 34.32, P = .27) indicated overall fit to the Rasch model. Since Fit Residuals were between -2 and 2, the fit of individual items was also adequate. No DIF was found between men and women, and targeting was adequate (μ = -0.56).

CONCLUSION

The current study expanded the evidence on the XI and SXI validity and provides new implications for practice: a 3-point categorization ("Never," "Occasionally" and "Very often") should be preferred rather than the original 5-point categorization; the XI and SXI scores can be compared between men and women and will reflect true differences in xerostomia rather than measurement bias.

Factors influencing the oral health-related quality of life among children with severe early childhood caries in Hong Kong

OBJECTIVE

To assess the oral health-related quality of life among Hong Kong preschool children with severe early childhood caries.

METHODS

A total of 315 Hong Kong preschool children diagnosed with severe early childhood caries (S-ECC) were recruited. Their caries and plaque status were evaluated. Their parents were asked to complete the Early Childhood Oral Health Impact Scale (ECHOIS) and a sociodemographic background questionnaire.

RESULTS

There was a 98.7% response rate. The mean age was 4.7 ± 0.8 years. The mean decayed, missing and filled teeth (dmft) score was 10.2 ± 4.5. Almost all the children (98.7%) had decayed teeth. More than half of the children (61.4%) had a visible plaque index (VPI) score of above 90%. About one quarter (28.9%) were experiencing symptoms of pain. The dmft score of the child was significantly associated with the ECOHIS child impact, child function, family impact and family distress domains (P < .001). The presence of pain was significantly associated with increased ECOHIS child and family impact scores (P < .001). In the multiple regression analyses, the dmft score and presence of pain showed a significant association with the ECOHIS scores (P < .001).

CONCLUSION

The OHRQoL of children with S-ECC was worsened with the presence of pain and severity of the disease. More measures need to be placed to decrease the prevalence of children with S-ECC.

Longitudinal measurement invariance and explanatory IRT models for adolescents' oral health-related quality of life

BACKGROUND

Longitudinal invariance is a perquisite for a valid comparison of oral health-related quality of life (OHRQoL) scores over time. Item response theory (IRT) models can assess measurement invariance and allow better estimation of the associations between predictors and latent construct. By extending IRT models, this study aimed to investigate the longitudinal invariance of the two 8-item short forms of the Child Perception Questionnaire (CPQ_11-14) regression short form (RSF:8) and item-impact short form (ISF:8) and identify factors associated with adolescents' OHRQoL and its change.

METHODS

All students from S1 and S2 (equivalent to US grades 6 and 7) who were born in April 1997 and May 1997 (at age 12) from 45 randomly selected secondary schools were invited to participate in this study and followed up after 3 years. Data on the CPQ_11-14 RSF:8 and CPQ_11-14 ISF:8, demographics, oral health behavior and status were collected. Explanatory graded response models were fitted to both short forms of the CPQ_11-14 data for assessing longitudinal invariance and factors associated with OHRQoL. The Bayesian estimation method - Monte Carlo Markov Chain (MCMC) with Gibbs sampling was adopted for parameter estimation and the credible intervals were used for inference.

RESULTS

Data from 649 children at age 12 at baseline and 415 children at age 15 at follow up were analyzed. For the 12 years old children, healthier oral health behavior, better gum status, families with both parents employed and parents' education level were found to be associated with better OHRQoL. Four items among the 2 short forms lacked longitudinal invariance. With statistical adjustment of longitudinal invariance, OHRQoL were found improved in general over the 3 years but no predictor was associated with OHRQoL in follow-up. For those with decreased family income, their OHRQoL had worsened over 3 years.

CONCLUSIONS

IRT explanatory analysis enables a more valid identification of the factors associated with OHRQoL and its changes over time. It provides important information to oral healthcare researchers and policymakers.

The effect of general anesthesia for ambulatory dental treatment on children in Chongqing, Southwest China

BACKGROUND

The incidence of early childhood caries shows a significant increasing trend. Often, children younger than 6 years need additional help to finish the dental treatment. Therefore, general anesthesia (GA) could help to provide a successful environment for pediatric dental treatment.

OBJECTIVES

The aim of this study was to assess the effect of dental treatment under general anesthesia (DGA) on the patients' oral health in Chongqing, Southwest China using the P-CPQ and the FIS questionnaires.

METHODS

We collected the hospital's records of the children who received DGA from 2013 to 2014 and the questionnaires answered by their parents or caregivers before and after the treatment. Then the data were integrated and analyzed to assess the effect of DGA on the children and their family, the incidence of the complications during or after DGA, and the satisfaction of their parents.

RESULTS

We collected 659 patients' records including 55.4% boys and 44.6% girls. There were 443 children younger than 4 years, and 216 children older than 4 years. The main reason why they chose DGA was the patients' fear for the treatment (95.1%). The mean cost of DGA almost reached a half (61.5%) or a third (15.3%) of the family's monthly earning. The mean P-CPQ score and FIS score significantly decreased after DGA. The highest incidence of complications was emergence agitation, headache, and nausea/vomiting. The incidence of emergence agitation and headache was related to the operation time. The majority of families reported a high degree of satisfaction.

CONCLUSIONS

Children's oral health-related quality of life after DGA improved significantly. Meanwhile DGA showed a positive effect on the whole family and majority of families reported a high degree of satisfaction to it.

Rasch analysis of the Persian version of PedsQL(TM) Oral Health Scale: further psychometric evaluation on item validity including differential item functioning

Background: The study aimed to further evaluate the psychometric properties of one recently developed oral health related quality of life (OHRQoL) instrument (PedsQL Oral Health Scale), including student self-report and parent-proxy report. Specifically, we tested the item validity,threshold order, local dependency, and differential item functioning (DIF) across gender and rater.

Methods: This is a cross-sectional study, and study population was recruited in Qazvin, Iran using one-stage sampling with the unit of school. Students and their parents (1529 dyads) separately completed the Persian version of PedsQL Oral Health Scale. The psychometric properties were analyzed using Rasch rating scale model, including item validity, threshold order for response categories, and DIF across gender (boys vs. girls in student self-report) and rater (student self report vs. parent-proxy report).

Results: All items had satisfactory in fit and outfit mean square error. One disordering category (the response of often) was found in parent-proxy report, while all categories were ordered in student self-report. All items were DIF-trivial across gender and rater.

Conclusion: PedsQL Oral Health Scale is a valid instrument to measure OHRQoL. However, our results indicated that the parent-proxy report was inferior to the student self-report, and healthcare providers should primarily use the student self-report.

Evaluation of psychometric properties and differential item functioning of 8-item Child Perceptions Questionnaires using item response theory

Background

Four-factor structure of the two 8-item short forms of Child Perceptions Questionnaire CPQ_11–14 (RSF:8 and ISF:8) has been confirmed. However, the sum scores are typically reported in practice as a proxy of Oral health-related Quality of Life (OHRQoL), which implied a unidimensional structure. This study first assessed the unidimensionality of 8-item short forms of CPQ_11–14. Item response theory (IRT) was employed to offer an alternative and complementary approach of validation and to overcome the limitations of classical test theory assumptions.

Methods

A random sample of 649 12-year-old school children in Hong Kong was analyzed. Unidimensionality of the scale was tested by confirmatory factor analysis (CFA), principle component analysis (PCA) and local dependency (LD) statistic. Graded response model was fitted to the data. Contribution of each item to the scale was assessed by item information function (IIF). Reliability of the scale was assessed by test information function (TIF). Differential item functioning (DIF) across gender was identified by Wald test and expected score functions.

Results

Both CPQ_11–14 RSF:8 and ISF:8 did not deviate much from the unidimensionality assumption. Results from CFA indicated acceptable fit of the one-factor model. PCA indicated that the first principle component explained >30 % of the total variation with high factor loadings for both RSF:8 and ISF:8. Almost all LD statistic <10 indicated the absence of local dependency. Flat and low IIFs were observed in the oral symptoms items suggesting little contribution of information to the scale and item removal caused little practical impact. Comparing the TIFs, RSF:8 showed slightly better information than ISF:8. In addition to oral symptoms items, the item “Concerned with what other people think” demonstrated a uniform DIF (p < 0.001). The expected score functions were not much different between boys and girls.

Conclusions

Items related to oral symptoms were not informative to OHRQoL and deletion of these items is suggested. The impact of DIF across gender on the overall score was minimal. CPQ_11–14 RSF:8 performed slightly better than ISF:8 in measurement precision. The 6-item short forms suggested by IRT validation should be further investigated to ensure their robustness, responsiveness and discriminative performance.

Impact of untreated dental caries and its clinical consequences on the oral health-related quality of life of schoolchildren aged 8-10 years

OBJECTIVE

This study aims to evaluate the impact of untreated dental caries and its clinical consequences on the quality of life of Brazilian schoolchildren aged 8-10 years.

METHODS

A randomly selected sample of 587 children underwent a clinical oral examination for the assessment of untreated dental caries and clinical consequences. The WHO criteria (decayed component of the decayed, missing, and filled teeth--D-DMFT in permanent teeth or d-dfmt in primary teeth) and the PUFA index, which records the presence of severely decayed permanent (upper case) and primary (lower case) teeth with visible pulpal involvement (P/p), as well as ulceration caused by dislocated tooth fragments (U/u), fistula (F/f), and abscesses (A/a), were used for the oral examination. Oral health-related quality of life (OHRQoL) was evaluated using the Child's Perception Questionnaire (CPQ8-10). Poisson regression was employed to test unadjusted and adjusted associations between untreated dental caries/clinical consequences and OHRQoL.

RESULTS

The prevalence of untreated dental caries was 64.6% (D/d component of DMFT/dmft > 0) and 17.9% of children exhibited clinical consequences of caries (PUFA/pufa index >0). In the adjusted models, untreated caries was significantly associated with the total CPQ8-10 score and all subscale scores. The clinical consequences of dental caries (PUFA/pufa index >0) were significantly associated with the total CPQ8-10 as well as the oral symptoms and functional limitations' subscales.

CONCLUSION

Untreated dental caries and its clinical consequences exerted a negative impact on the OHRQoL of the schoolchildren analyzed.

Reliability and validity of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-30) in Saudi Arabia

Background

To evaluate the reliability and validity of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-30) in Saudi Arabia.

Methods

A convenience sample of 200 subjects was approached, of which 177 agreed to participate giving a response rate of 88.5%. Rapid Estimate of Adult Literacy in Dentistry (REALD-99), was translated into Arabic to prepare the longer and shorter versions of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-99 and AREALD-30). Each participant was provided with AREALD-99 which also includes words from AREALD-30. A questionnaire containing socio-behavioral information and Arabic Oral Health Impact Profile (A-OHIP-14) was also administered. Reliability of the AREALD-30 was assessed by re-administering it to 20 subjects after two weeks. Convergent and predictive validity of AREALD-30 was evaluated by its correlations with AREALD-99 and self-perceived oral health status, dental visiting habits and A-OHIP-14 respectively. Discriminant validity was assessed in relation to the educational level while construct validity was evaluated by confirmatory factor analysis (CFA).

Results

Reliability of AREALD-30 was excellent with intraclass correlation coefficient of 0.99. It exhibited good convergent and discriminant validity but poor predictive validity. CFA showed presence of two factors and infit mean-square statistics for AREALD-30 were all within the desired range of 0.50 - 2.0 in Rasch analysis.

Conclusions

AREALD-30 showed excellent reliability, good convergent and concurrent validity, but failed to predict the differences between the subjects categorized based on their oral health outcomes.

Oral health-related quality of life after dental general anaesthesia treatment among children: a follow-up study

Background

Many young paediatric patients with severe dental caries receive dental treatment under general anaesthesia. Oral health-related quality of life (OHRQoL) can be evaluated to assess the outcome of dental general anaesthesia (DGA) treatment. The aim of our study was to examine the OHRQoL of young Lithuanian children in need of DGA treatment and analyse the impact of DGA treatment on children’s OHRQoL.

Methods

We carried out a prospective clinical follow-up study on OHRQoL among all young Lithuanian child patients who received DGA treatment at the Lithuanian University of Health Sciences Hospital during 2010–2012. The study consisted of clinical dental examinations of patients younger than six years, data collected from their patient files, and an OHRQoL survey completed by their parents prior to the child’s dental treatment. We conducted a follow-up OHRQoL survey one month after the DGA treatment. The Early Childhood Oral Health Impact Scale (ECOHIS) and its effect size (ES) served to evaluate children’s OHRQoL, and the Wilcoxon signed-rank test served for statistical analyses.

Results

We obtained complete baseline and follow-up data for 140 and 122 participants, respectively (84.7% follow-up rate). Pain and eating problems among children and parents feeling upset and guilty were the most frequently reported impacts at baseline. The parents reported greater impacts on boys than on girls. The ECOHIS score decreased significantly (69.5%, p < 0.001) after DGA treatment, revealing a large ES for the child (1.6) and family (2.4) sections of the ECOHIS.

Conclusions

The OHRQoL of young Lithuanian children requiring DGA treatment is seriously impaired. Dental general anaesthesia treatment results in significant improvement of the children’s OHRQoL. The children’s parents also greatly appreciate this treatment modality for its positive impact on the family’s quality of life.

A systematic review of the impact of parental socio-economic status and home environment characteristics on children's oral health related quality of life

Childhood circumstances such as socio-economic status and family structure have been found to influence psychological, psychosocial attributes and Oral Health Related Quality of Life (OHRQoL) in children. Therefore, the aim of this study was to conduct a systematic review of the published literature to assess the influence of parental Socio-Economic Status (SES) and home environment on children's OHRQoL. A systematic search was conducted in August 2013 using PubMed, Medline via OVID, CINAHL Plus via EBSCO, and Cochrane databases. Studies that have analysed the effect of parental characteristics (SES, family environment, family structure, number of siblings, household crowding, parents' age, and parents' oral health literacy) on children's OHRQoL were included. Quality assessment of the articles was done by the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative studies. Database search retrieved a total of 2,849 titles after removing the duplicates, 36 articles were found to be relevant. Most of the studies were conducted on Brazilian children and were published in recent two years. Early Childhood Oral Health Impact Scale and Children's Perception Questionnaire were the instruments of choice in preschool and school aged children respectively. Findings from majority of the studies suggest that the children from families with high income, parental education and family economy had better OHRQoL. Mothers' age, family structure, household crowding and presence of siblings were significant predictors of children's OHRQoL. However, definitive conclusions from the studies reviewed are not possible due to the differences in the study population, parental characteristics considered, methods used and statistical tests performed.

Impact of traumatic dental injury on the quality of life of Brazilian preschool children

This study aimed to assess the impact of traumatic dental injury (TDI) on the quality of life of preschoolers and their families. A cross-sectional study was carried out, with a sample of 814 children, aged three to five years old, in Campina Grande, Brazil. Parents/caregivers were asked to complete the Brazilian Early Childhood Oral Health Impact Scale and a questionnaire on socio-demographic data. Oral examinations of the children were performed by three previously calibrated dentists. Bivariate and multiple Poisson regression analyses were performed (α = 5%). The prevalence of negative impact from oral conditions on quality of life was 31.1% among the children and 24.7% among the families. TDI was not associated with a negative impact on quality of life. Parent/caregiver's assessment of the child's oral health (PR = 1.210; 95% CI: 1.027-1.426) and history of toothache (PR = 4.997; 95% CI: 2.943-8.493) remained in the final model for the child section, whereas only a history of toothache (PR = 2.791; 95% CI: 1.801-4.325) remained in the final model for the family section. TDI exerted no negative impact on quality of life in the present sample. A history of toothache was the only variable associated with a negative impact on the quality of life of the preschoolers and their families.

Caries experience of chinese children with cleft lip and palate

Objective : This study evaluated the caries experience in the primary teeth of children with and without cleft lip and palate (CLP). Design : Observational study. Setting : Dental hospital clinic. Patients : The sample consisted of 132 pairs of Chinese children with and without CLP matched by gender, age, ethnicity, and socioeconomic status. Their ages were between 2 and 7 years. Methods : The children were dichotomized into 2- to 4-year-old (n  =  71) and 5- to 7-year-old groups (n  =  61). The oral examination was performed by one trained and calibrated dentist, and the caries experience was determined using the dmft (decay missing filled teeth) index. Results : For the 2- to 4-year-old group, the dmft values were 1.5 for the cleft group and 1.6 for the non-CLP group, but the difference was not statistically significant. For the 5- to 7-year-old group, the dmft indices were 5.2 for the cleft group compared with 2.9 for the control group; this difference was statistically significant (p  =  .0006). The caries rate for the various tooth types in the 5- to 7-year-old group was higher in the CLP group than in the non-CLP group; the most marked difference was for the lateral incisors, mandibular molars, and maxillary left first molars (p  =  .0001). Conclusions : The 5- to 7-year-old children with CLP had a higher caries experience in the primary dentition than the children without CLP.

Development and validation of Hong Kong Rapid Estimate of Adult Literacy in Dentistry

AIM

To develop and validate an instrument, the Hong Kong Rapid Estimate of Adult Literacy in Dentistry (HKREALD-30).

METHODS

The Rapid Estimate of Adult Literacy in Dentistry (REALD-99) was translated into Chinese and modified in the pretest. A total of 200 parents of pediatric dental patients were interviewed using this modified scale and administered additional three sets of self-reported questionnaires. The 99 items of the scale were reduced to 30 (HKREALD-30). Concurrent validity was tested by comparing the HKREALD-30 scores with the participants' educational level, pattern of dental visits and reading habits. Convergent validity was tested by examining the association between HKREALD-30 and the Test of Functional Health Literacy in Dentistry (TOFHLiD). The test-retest reliability and internal consistency of HKREALD-30 were also evaluated.

RESULTS

A significant correlation (P < 0.01) was found between HKREALD-30 and participants' reading habits. HKREALD-30 was also highly correlated with TOFHLiD (Spearman's rho = 0.693, P < 0.01). In the regression model, HKREALD-30 was positively associated with TOFHLiD (P < 0.05) after controlling for participants' characteristics. The intra-class correlation coefficient of HKREALD-30 was 0.78 and the Cronbach's alpha was 0.84.

CONCLUSION

Initial testing of HKREALD-30 suggested that it is a valid and reliable instrument for the basic screening of oral health literacy among Chinese people in Hong Kong.

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.