Validation of a measuring instrument for the perception of oral health in women

Psychometric Properties of General Oral Health Assessment Index Across Ages: COSMIN Systematic Review

OBJECTIVES

To systematically review the psychometric properties of the Geriatric Oral Health Assessment Index (GOHAI) across age groups using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

METHODS

Data: English peer-reviewed articles reporting studies of the development, translation, or validation of GOHAI.

SOURCES

PubMed, Web of Science, and EMBASE from Jan 1990 until December 31, 2023. Methodological evaluation: based on COSMIN methodology. The results are presented overall and for 4 age groups (≥60 years, all ages, <60 years, ≤45 years). Structural validity was summarized qualitatively. Internal consistency and reliability were synthesized via random-effects meta-analysis of T-transformed Cronbach α values, and Fisher's Z transformed correlation coefficients. Construct validity and responsiveness were assessed using effect sizes.

RESULTS

Four hundred ninety-seven records were identified, 72 underwent full-text assessment, resulting in 60 included reports. Structural validity was inconsistent across all age groups and overall. Internal consistency was sufficient with overall α = 0.81, and high evidence quality. Test-retest reliability was consistently sufficient across age groups with overall r = 0.84. For construct validity 361 hypotheses were assessed (37.4% for convergent-, 62.6% for known-groups validity). The percentage of confirmed hypotheses in ≥60-years, all ages, <60-years and ≤45-years were 75.5%, 66.7%, 78.9%, and 88.9%, respectively. Responsiveness was not assessed in the <60-years and ≤45-years age groups, leading to indeterminate overall rating with very low evidence quality.

CONCLUSIONS

This review affirms that GOHAI has sufficient psychometric properties as an oral health-related quality of life instrument in various age groups, but its responsiveness is scarcely researched and its utility for individual-level follow-up is limited. The measurement properties of oral health-related quality of life tools must be scrutinized in the changing demands of personalized and value-based dental care. (PROSPERO registration: CRD42022384132).

Assessment of the severity of temporomandibular disorders in females: Validity and reliability of the Fonseca anamnestic index

OBJECTIVE

To evaluate the validity and reliability of the Fonseca anamnestic index (FAI) over time in Turkish females.

METHODS

Four hundred-fourteen patients who visited the otorhinolaryngology clinic were initially included in the study between January 1, 2018 and January 1, 2019. The Turkish version of the FAI is a self-report instrument that was completed by all of the patients after a brief explanation from the clinician. Cronbach's alpha was calculated using data from the first questionnaire.

RESULTS

The results of the first assessment showed 243 patients had no TMD (58.7%), 40 had mild TMD (9.7%), 87 had moderate TMD (21%), and 44 had severe TMD (10.6%). At the second assessment, the respective values were 243 (58.7%), 37 (8.9%), 98 (23.7%), and 36 (8.7%). The internal consistency of the first test was high.

CONCLUSION

The FAI can be used to collect a large amount of data easily, at minimal cost.

GOHAI and OHIP-EDENT Evaluation in Removable Dental Prostheses Users: Factorial Analysis and Influence of Clinical and Prosthetic Variables

PURPOSE

To assess the degree of satisfaction and quality of life of patients with removable prostheses using the Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Profile in Edentulous Adults (OHIP-EDENT), in addition to evaluating the questionnaires for their validation.

MATERIALS AND METHODS

Eighty patients participated in the study after completing prosthetic rehabilitation treatment. Patients were evaluated using the OHIP-EDENT and GOHAI questionnaires to assess the criteria for quality of life, esthetics, phonetics, masticatory function, stability, comfort, and alteration of taste and pain related to the completed prostheses. The results were subjected to the chi-squared test, Fisher's exact test, and a multinomial logistic regression model, with a significance level of 5%.

RESULTS

The most commonly used removable prosthesis was mandibular removable partial denture (RPD) (n = 43, 53.8%), followed by maxillary RPD (n = 42, 52.5%), maxillary complete denture (CD) (n = 33, 41.3%), and mandibular CD (n = 31, 38.8%). Most patients had to have one (n = 29, 36.3%), two (n = 21, 26.3%), or none (n = 18, 23.8%) adjustments in their prostheses. Five (6.3%) patients' prostheses required three adjustments, and six (7.5%) required four or more adjustments. All reported improvement in esthetics after using the prostheses (p < 0.05). The validation of the questionnaire proved to be more viable when completed without the presence of specific domains.

CONCLUSION

The results of this study indicated that removable prostheses improved the quality of life of rehabilitated patients. The questionnaires used need to be answered and evaluated in their entirety for validation.

Association between periodontitis and Alzheimer's disease and its impact on the self-perceived oral health status: a case-control study

PURPOSE

To test the hypothesis that periodontitis is associated with AD and search whether periodontal and other variables would negatively impact the oral health-related quality of life (OHRQoL) perception.

MATERIALS AND METHODS

Oral examinations and interview on self-perceived oral health status (Geriatric Oral Health Assessment Index (GOHAI) questionnaire (higher score corresponds to better perceived oral status)) were carried out and socio-demographic data were collected from outpatients with mild to moderate AD (cases, n = 50) and from their age- and sex-matched family caregivers (controls, n = 52). Full-mouth periodontal examination was performed. Significance of differences between groups was sought by chi-square, Student's t, or the Mann-Whitney test. The association between the variables periodontitis, probing depth (PD) ≥ 5 mm, and clinical attachment loss (CAL) ≥ 5 mm with the variable group was tested in binary logistic regression models (LRMs). LRMs were used to test the association of oral findings, demographics, and group with GOHAI.

RESULTS

Cases had fewer teeth and greater CAL than controls. Cases had a superior percentage of sites with plaque, calculus, and bleeding on probing than controls. Cases had greater GOHAI scores than controls. Periodontitis was a variable most likely associated with AD (OR = 11.08, p < 0.001). None of the oral findings or demographics, but group, was associated with GOHAI (OR = 14.45, p < 0.001).

CONCLUSION

Periodontitis is associated with AD, but not with patients' OHRQoL.

CLINICAL RELEVANCE

Health care professionals must be aware that AD patients should have a periodic thorough oral examination and preventive intervention aiming at their welfare and maintenance of a pain-free functional dentition.

Clinical and self-perceived oral health assessment of elderly residents in urban, rural, and institutionalized communities

OBJECTIVES

This study aims to evaluate the self-perception of oral health according to the physical, psychosocial and pain/discomfort dimensions related to clinical conditions and orofacial pain of elderly people living in three different environments.

METHODS

This was an observational, cross-sectional, quantitative study with a population-based approach and nonprobabilistic convenience sampling that included 81 elderly people: 27 resided in institutional homes for elderly individuals, 27 resided in an urban area and 27 resided in a rural area in the interior of Paraíba (PB) in northeastern Brazil.

RESULTS

The Geriatric Oral Health Assessment Index (GOHAI) was used to assess self-perception of oral health, while the Questionnaire for Screening of Patients with Temporomandibular Disorders (QST/TMD) was used to assess the influences of orofacial pain and the biofilm indexes of teeth and prostheses. There was a statistically significant difference in the GOHAI scores among the places of residence, with the worst values associated with the rural area. According to the QST/TMD, the majority of individuals were affected by TMDs, with statistical differences for both sex and income.

CONCLUSION

The biofilm analysis showed a higher incidence of clinical conditions in the rural population. The place of residence also influenced self-perception and the clinical oral health condition of elderly people; the rural population presented the worst results.

Tooth loss and its relationship with protein intake by elderly Brazilians-A structural equation modelling approach

OBJECTIVE

This study aimed at assessing the relationship between self-perceived tooth loss and wearing dentures, on the one hand, and the consumption of protein, on the other hand, among the elderly population of Botucatu, SP. Food consumption tends to decrease with ageing, especially protein intake, and one of the causes could be the precariousness of oral health. Several risk factors associated with deficient dietary protein intake have been identified, namely greater physical dependence, reduced caloric intake and food insecurity, but no studies have analysed whether tooth loss and prostheses interfere with protein intake.

METHODS

An interview was conducted among 365 elderly individuals, in which we examined oral health-related quality of life (OHRQoL) as the only latent variable, in a 24-hour nutritional assessment dietary recall repeated 3 times, conducted in person by a trained nutritionist and also performed an analysis of nutritional needs using the Nutrition Data System Research (NDSR) Program.

RESULTS

The structural equation model, performed using Stata v.14, showed that lack of teeth (standardised coefficient [SC] = 0.21, P < .001), and prosthesis use (SC = -0.21, P < .001) was associated with OHRQoL. Lack of teeth had a direct effect on the consumption of animal protein (SC = 0.08, P = .02), a strong total effect on animal protein intake (SC = 0.51, P = .04) and a medium effect on total protein intake (SC = 0.20, P = .03), adjusted for confounders (depression and medical problems).

CONCLUSION

Tooth loss had a strong and significant total effect on animal protein intake and a medium effect on total protein intake among elderly Brazilians.

General Oral Health Assessment Index: A new evaluation proposal

OBJECTIVES

To validity the General Oral Health Assessment Index (GOHAI) among adults who sought dental care and to present a new proposal for calculating scores on self-perception of oral health.

BACKGROUND

There is no study that presents a GOHAI scores using weight of the items.

MATERIALS AND METHODS

The one-factor model, the three-factor model (physical function, psychosocial/psychological function and pain/discomfort) and the second-order hierarchical model (SOHM) were evaluated from confirmatory factor analysis (λ, χ² /df, CFI,GFI and RMSEA). The reliability (CR,α) was estimated. Concurrent validity was assessed using the Oral Health Impact Profile (OHIP-14). The invariance of the models was estimated in independent samples. The calculation of an overall score using the factor scores was proposed to obtain the overall weighted scores. These overall weighted scores were compared to the scores estimated as the simple arithmetic mean (overall unweighted scores) using a repeated measures analysis of variance.

RESULTS

A total of 1000 individuals participated (74.1% female; age: 40.7 (SD=14.3) years). Three items of the GOHAI were excluded (λ<0.40). The one-factor model (λ=0.40-0.77; χ² /df=6.291; CFI=0.947; GFI=0.960; RMSEA=0.073) and the three-factor model (λ=0.40-0.78; χ² /df=8.321; CFI=0.932; GFI=0.954; RMSEA=0.086) each presented an adequate fit. Reliability was adequate (one-factor: CR=0.83/α=0.83; three-factor: CR=0.53-0.76/α=0.53-0.73), with the exception of the pain/discomfort factor. The GOHAI was invariant in independent samples, and the concurrent validity was adequate. The overall unweighted scores overestimated self-perceptions of oral health when compared with the weighted scores.

CONCLUSION

Both the one-factor and three-factor models of the GOHAI were found to be valid, reliable and invariant for the sample after the exclusion of three items. The use of overall weighted scores is recommended for calculating the score of self-perception of oral health.

Oral health perception in veterans with self-identified disabilities: National Survey of Veterans, 2010

OBJECTIVE

This study examines the relationship of self-identified disability and oral health perception in a veteran population.

METHODS

The National Survey of Veterans, 2010, database was used to conduct a cross-sectional study of 8,303 participants. Questionnaires were mailed to the veterans, and the questions were developed to assess sociodemographic information, health perception, and health status, among other areas of interest. The Andersen Behavioral Model was used as the framework for the study. The outcome of interest was perceived oral health, and the main variable of interest was self-identified disability. The data were analyzed for descriptive, and bivariate analyses, and logistic regression.

RESULTS

There were 1,904 participants (21.2 percent) with self-identified disability. There were 2,505 participants (41.0 percent) who indicated negative oral health perception. In logistic regression, individuals with self-identified disability had an unadjusted odds ratio of 1.63 (95 percent CI: 1.44, 1.85) and an adjusted odds ratio of 1.69 (95 percent CI: 1.44, 1.99) for negative oral health perception as compared with participants who did not self-identify disability.

CONCLUSION

Oral health perception in a veteran population is affected by predisposing and enabling factors among which is self-identified disability.

Validation of the Geriatric Oral Health Assessment Index in complete denture wearers

To perform a validation of the Geriatric Oral Health Assessment Index (GOHAI) for complete denture wearers and present a proposal for estimation of perceived oral health. This is a cross-sectional study with non-probabilistic sampling. A total of 211 subjects with a mean age of 62·5 (s.d. = 11·4) years participated, being 169 female. The GOHAI was applied in a personal interview. The construct/convergent/discriminant validity was tested using structural equation modelling. Confirmatory factor analysis was used to verify the fit of three proposals of the GOHAI: three-factor, one-factor and second-order hierarchical models. The stability of the models was evaluated in independent samples. The three-factor model presented an inadequate fit, and items 3, 4 and 9 were removed. The new structure presented an acceptable fit and strong invariance in independent samples. The convergent, discriminant validity and internal consistency were below adequate. The one-factor model presented an adequate fit to the sample. Convergent validity was compromised. A strong invariance of the one-factor model was observed. To calculate the overall scores of the GOHAI factors (three-factor model) or of the oral health perception (one-factor model), a matrix of regression weights for each item in the model was presented as a suggestion. We found an adequate fit of the both structures of the GOHAI for denture wearers, but the three-factor structure was more parsimonious. We suggested considering the weights of the regression model to calculate the overall score of perceived oral health or of its factors in different samples.