Search

This study aimed to investigate associations between psychosocial factors, obesity, and oral health in a study population of 10- to 18-year-old adolescents who participated in the LIFE Child study. Psychosocial information (socioeconomic status (SES) based on parents’ education, occupation and household income, Strengths and Difficulties Questionnaire (SDQ), health-related quality of life) and physical activity behavior were obtained. Nutritional status was classified based on age- and sex-adjusted body mass index into underweight, overweight, normal weight and obese. Clinical dental examinations were performed and scored with respect to caries experience (CE), oral hygiene (OH), and periodontal status (periodontal health score: PERIO-S). Age-adjusted regression analysis under the assumption of a double Poisson distribution was performed with and without adjusting for SES (α = 5%). A total of 1158 study participants (590 girls, 568 boys; mean age 13.2 ± 2.3 years) were included (17.2% were classified as obese). CE was 20% higher for moderate and 60% higher for low SES compared to high SES (p < 0.05). PERIO-S was 10% higher for moderate and 30% higher for low compared to high SES (p < 0.05). Poor OH was associated with higher CE (Ratio R = 2.3, p < 0.0001) and PERIO-S (R = 3.1, p < 0.0001). Physical activity in a sports club was associated with lower CE-S and PERIO-S (R = 0.85, p < 0.001). Obesity was associated with increased CE (R = 1.3, p < 0.001) compared to normal weight. For low but not high SES, more reported difficulties were associated with higher CE. In conclusion, low SES, poor OH, and obesity are associated with unfavorable oral health conditions, whereas physical activity and high SES are potentially protective.

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Oral health is related to major chronic diseases and contributes to general health. Oral health-related quality of life (OHRQoL) is, therefore, an essential part of well-being. Measurement of OHRQoL over the lifetime requires accurate and comparable outcome measures that are suitable for different age groups. The most frequently used instrument for children aged 11 through 14 years is the Child Perceptions Questionnaire (CPQ-11-14). The authors aimed to examine the psychometric properties of the CPQ-11-14 using modern statistical approaches., Methods: The authors carried out a psychometric analysis of 2 population-representative data sets from Germany (N = 2,658) and a randomly selected smaller sample (n = 300) on the basis of the Rasch model., Results: The authors detected a right-skewed distribution of the CPQ-11-14 total scores. The instrument items did not match the level of OHRQoL of the study participants. Moreover, a large number of questionnaire items (range, 51.4%-94.3%) had so-called disordered thresholds, meaning that the answer categories did not work as intended. Unidimensionality was achieved via splitting the CPQ-11-14 into 2 subscales, namely socioemotional and oral symptoms and functioning., Conclusions: Despite its classic validation, the CPQ-11-14 needs adaptions for meaningful clinical use. More items on the better end of the scale are needed to better differentiate between children with higher and lower OHRQoL., Practical Implications: The Rasch model addresses psychometric properties of questionnaires on an item-based level, which were not detected via classic approaches. The results reported by the authors are needed to generate a well-calibrated outcome measure for accurate clinical and public health assessment of OHRQoL., (Copyright © 2019 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.

Purpose: Aim of this exploratory study was to investigate whether a retrospective assessment of oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP) is susceptible to bias such as implicit theory of change and cognitive dissonance., Methods: In this prospective clinical study, a sample of 126 adult patients (age 17-83 years, 49% women) requiring prosthodontic treatment was consecutively recruited. The OHRQoL was assessed using the 49-item OHIP at baseline and at follow-up. Additionally, patients were asked at follow-up to retrospectively rate their oral health status at baseline (retrospective pretest or then-test) and the change in oral health status using a global transition question. Furthermore, patients' ratings of overall oral health and general health were used as validity criteria for the OHRQoL assessments. Response shift was calculated as the difference between the initial and retrospective baseline assessments., Results: Baseline and retrospective pretest did not differ substantially in terms of internal consistency and convergent validity. Response shift was more pronounced when patients perceived a large change in OHRQoL during treatment. Retrospective pretests were more highly correlated with the baseline than with the follow-up assessment., Conclusion: Findings suggest that retrospective assessments of OHRQoL using the OHIP-49 are susceptible to bias. Cognitive dissonance is more likely to appear as a source of bias than implicit theory of change.

Background: Usually, morphological parameters of the teeth are recorded to help assess the indication for orthodontic treatment. It is assumed that significant deviations from average values compromise the quality of life. The aim of this study is to analyse the impact of overbite and overjet on oral health-related quality of life (OHRQoL) of children and adolescents., Patients and Methods: A total of 748 subjects, aged 9.5-15.5 years, participated in the LIFE child project of the University of Leipzig, where they underwent a general medical and dental examination. Overbite and overjet were measured, and aberrations of the OHRQoL were recorded by the probands themselves, who completed the German version of the Child Perceptions Questionnaire (CPQ-G11-14). The OHRQoL is divided into four domains ("oral symptoms", "functional limitations", "emotional well-being" and "social well-being") and is analysed by means of a CPQ score depending on age, gender, socioeconomic status and orthodontic treatment., Results: On average, the participants listed 10.5 (±13.1) problem issues on a CPQ scale ranging from 0 to 140. Subjects with current orthodontic treatment had a CPQ score about 2.5 (±2.4) higher than those without treatment. The aberrations were mainly observed in the domains "oral symptoms" and "functional limitations". Multiple linear regression showed that deviations of the overbite had only little influence on the OHRQoL, but deviations of an overjet-especially of >6 mm increased the CPQ summary score about 6 points., Conclusion: Children and adolescents with overjet deviations of >6 mm in comparison to the norm are associated with significant limitations of the OHRQoL. However, overbite deviations have only little influence.

Objective: To examine the factor structure and other psychometric characteristics of the most commonly used child oral-health-related quality-of-life (OHRQoL) measure (the 16-item short-form CPQ 11-14 ) in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts., Methods: Secondary data analyses used subnational epidemiological samples of 11- to 14-year-olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ 11-14 across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted., Results: Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well-being and social well-being items. The first was designated the 'symptoms/function' subscale, and the second was designated the 'well-being' subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item 'Food stuck in between your teeth' having greatest impact; in the well-being subscale, the 'Felt shy or embarrassed' item had the greatest impact. Repeating the analyses by world region gave similar findings., Conclusion: The CPQ 11-14 performed well cross-sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four-factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Questionnaires that measure oral health-related quality of life (OHRQoL) in children and adolescents have emerged in recent years as an important source of patient-reported outcomes. The aim of this study was to investigate potential effects of the method of administration (face-to-face interview, telephone interview, or self-administered questionnaire) in 11- to 14-year-old children and adolescents on OHRQoL information obtained using the Child Perceptions Questionnaire (CPQ)., Materials and Methods: OHRQoL was measured using the German version of the CPQ (CPQ-G11-14). The instrument was administered to 42 children and adolescents aged 11 to 14 years using the three different methods in a randomized order with an interval of 1 week between each administration. Test-retest reliability for the repeated CPQ-G11-14 assessments across the three methods of administration, internal consistency, and convergent validity were determined., Results: The CPQ-G11-14 mean summary scores did not vary statistically significantly across the three administration methods (P = 0.274). Test-retest reliability was moderate to good (ICC 0.69-0.82), internal consistency was satisfactory (Cronbach's alpha 0.85-0.88), and CPQ-G11-14 mean summary scores were correlated in the expected direction with a global measure of self-reported oral health for all the three administration methods., Conclusion: In conclusion, the method of administration (face-to-face interview, telephone interview, or self-administered questionnaire) did not influence CPQ-G11-14 scores in 11- to 14-year-old children and adolescents to a significant extent., Clinical Relevance: Investigators in German-speaking countries can choose between all three methods of administration to obtain valid and reliable OHRQoL information.

The literature presents conflicting findings on whether health-related quality of life (HRQoL) measures have sufficient evaluative properties to assess changes caused by dental interventions. The aim of our study was to compare sensitivity to change in HRQoL and OHRQoL in prosthodontic patients. In this prospective intervention study, a total of 165 consecutively recruited patients completed the Short Form-36 (SF-36) and the 49-item Oral Health Impact Profile (OHIP), as self-administered questionnaires, before prosthodontic treatment and 1 month after treatment was finished. Differences in SF-36 and OHIP scores between baseline and follow up were tested for statistical significance using paired t-tests. Effect sizes (Cohen's d) were calculated. Health-related quality of life improved during prosthodontic treatment, indicated by a slight, but statistically significant, increase in the SF-36 physical component (difference: 1.0 points), whereas perceived mental health did not change substantially (difference: −0.5 points). Improvement in OHRQoL (difference in OHIP sum score: −6.7 points) was statistically significant. Although the OHIP effect size (of 0.2) was considered as small, according to guidelines, it was greater than for the SF-36 component scores (physical: 0.1; mental: 0.1). Sensitivity to change in quality of life measures was greater for OHRQoL than for HRQoL, limiting the usefulness of HRQoL as an outcome measure in dentistry.

Objectives: Oral health-related quality of life is a relatively new but rapidly growing concept in dentistry. It is an aspect of dental health addressing the patient's perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DHS), which is a common condition of transient tooth pain associated with a variety of exogenous stimuli, may disturb the patient during eating, drinking, toothbrushing and sometimes even breathing. The resulting restrictions on everyday activities can have an important effect on the patient's quality of life. The aims of this paper were to consider the concept of oral health-related quality of life and to review and discuss the literature on oral health-related quality of life and DHS., Material and Methods: A PubMed literature research was conducted using the terms ("dentin sensitivity" [MeSH Terms] OR ("dentin" [All Fields] AND "sensitivity" [All Fields]) OR "dentin sensitivity" [All Fields]) AND (("oral health" [MeSH Terms] OR ("oral" [All Fields] AND "health" [All Fields]) OR "oral health" [All Fields]) AND related [All Fields] AND ("quality of life" [MeSH Terms] OR ("quality" [All Fields] AND "life" [All Fields]) OR "quality of life" [All Fields])). Furthermore, a manual search was carried out. Any relevant work published presenting pertinent information about the described issue was considered for inclusion in the review., Results: The combination of the search terms resulted in a list of only three titles. The few published studies convincingly demonstrated that oral health-related quality of life is negatively affected in patients suffering from DHS., Conclusions: Patients with sensitive teeth report substantial oral health-related quality of life (OHRQoL) impairment. Nevertheless, knowledge about the influence of DHS on oral health-related quality of life is incomplete and, therefore, needs further research., Clinical Relevance: Oral diseases can lead to physical, psychological and social disability. This paper shows that DHS can have a negative impact on the patients' OHRQoL.

The assessment of changes in oral health-related quality of life (OHRQoL) is challenging because individuals' concepts and internal standards of OHRQoL may change over time. The aim of this study was to detect response shifts in OHRQoL assessments made using the Oral Health Impact Profile (OHIP). Oral health-related quality of life was assessed in a consecutive sample of 126 patients seeking prosthodontic care. Patients were asked to rate their OHRQoL before treatment started and 1 month after treatment was finished, using the German 49-item version of the OHIP. When rating their OHRQoL after treatment, patients were also asked to rate their pre-treatment OHRQoL without having access to their baseline data. The response shift was calculated as the difference in OHIP summary scores between the initial assessment and the retrospective baseline assessment. The OHIP mean scores decreased from 31.8 at the initial baseline assessment to 24.4 after treatment. The retrospective baseline assessment resulted in an OHIP mean score of 38.1, corresponding to a response shift of 6.3 OHIP points. The effect size (Cohen's d = 0.21) of the response shift was considered small. The response shift phenomenon and its magnitude have important implications for dental practice, where patients and dentists often assess perceived treatment effects retrospectively., (© 2012 Eur J Oral Sci.)

The aims of this study were to develop a German version of the Child Perceptions Questionnaire (CPQ11-14, a measure of oral health-related quality of life in 11-14-year-old children) and to assess the instrument's reliability and validity in German children ages 11-14. The English original version of the CPQ11-14 questionnaire was translated into German (CPQ-G11-14) by a forward-backward translation method. Reliability was investigated in 1,061 subjects aged 11-14 years from a regional sample (Wernigerode, Saxonia-Anhalt, Germany) who were recruited during the annual dental public health examination. The subjects completed the CPQ-G11-14 and were clinically examined for the presence of dental caries, plaque accumulation, and malocclusion. In the reliability assessment, questionnaire summary score test-retest reliability was excellent (intraclass correlation coefficient, 95% confidence interval (CI) = 0.83, 0.73-0.94) and internal consistency was satisfactory (Cronbach's alpha, lower limit of CI = 0.87, 0.86). Validity of the CPQ-G11-14 questionnaire was supported by correlations with global ratings of oral health and overall well-being that were moderate in magnitude and met expectations (r = 0.35; 95% CI, 0.30-0.40 and r = 0.30; 95% CI, 0.24-0.35, respectively). In conclusion, the German version of the CPQ11-14 was reliable and valid in a general population of 11-14-year-old German children.

Objective: The aim of this study was to determine the frequency of oral health-related quality of life (OHRQoL) impairment and to establish norm values for the German version of the Child Perceptions Questionnaire (CPQ-G11-14, 35 questions) in the general population aged 11 to 14 years., Subjects and Methods: Data were collected in a national survey (n=1,597, mean age: 12.5 ± 1.2 years, 49.3% female) and subjects sampled using a multistage technique. OHRQoL was measured with the CPQ-G11-14, which was presented in a personal interview. Norm values were computed for the CPQ-G11-14 summary score (simple sum of all item responses). The CPQ-G11-14 summary score distribution was described by empirical cumulative distribution functions. Because orthodontic treatment was closely associated with CPQ-G11-14 summary scores, percentile-based norms were stratified by this variable., Results: The CPQ-G11-14 mean was 12.6 ± 15.9 units. There was no influence of age (p>0.05) or gender (p>0.05) on the CPQ-G summary scores, but the summary scores varied according to orthodontic treatment status (p<0.001). Among the general population sample, CPQ-G11-14 scores of the 50% less-impaired subjects were ≤7. The same percentage of subjects undergoing orthodontic treatment had scores of ≤13 and those without orthodontic treatment had scores of ≤5. We observed scores of ≤32 points in 90% of the population. That figure was ≤50 points for subjects undergoing orthodontic treatment and ≤21 points for those without orthodontic treatment. The most frequent problems the children and adolescents reported (CPQ-G answers "often" and "very often") were "breathing through the mouth" (13.0%), "mouth sores" (4.4%) and "bad breath" (4.3%)., Conclusion: The norm values we present provide a frame of reference for future cross-sectional studies in the general population and in patient populations with specific oral conditions when measuring OHRQoL by CPQ-G11-14 in children and adolescents aged 11 to 14 years old.

The aim of the present study was to evaluate oral health-related quality of life (OHRQoL) impairment in patients seeking care for their hypersensitive teeth in comparison with general population subjects and to investigate the influence of gender and age on OHRQoL in these populations. Study participants were 656 patients without removable prosthodontics who sought treatment for their hypersensitive teeth in German dental offices. These patients were asked to complete the German form of the Oral Health Impact Profile (OHIP-G) prior to treatment. The sum of OHIP-G item responses (OHIP-G49, 0-196) characterized the OHRQoL impairment. Patients' OHIP summary scores were compared with those in a sample of the German general population (n = 1541). The influence of population (patients vs. general population subjects), gender and age was investigated using a multivariable linear regression model. Age presented a curvilinear association with OHRQoL, with lower OHIP scores associated with younger and older adults and higher OHIP scores (indicating impaired OHRQoL) associated with middle-aged adults in both the patient and general populations. Gender influence depended on the population, i.e. female general population subjects had lower OHIP scores than male general population subjects and female patients had higher OHIP scores than male patients. Mean OHIP summary scores indicated that patients with hypersensitive teeth reported considerably more impaired OHRQoL (approximately 22 OHIP units) than subjects in the general population. The present study suggests that the oral condition of hypersensitive teeth is significantly associated with impaired OHRQoL.