David Locker

Validity and Reliability of a Questionnaire for Measuring Child Oral-health-related Quality of Life

Oral-health-related quality of life measures that exist are designed for adults. This study aimed to develop and evaluate the CPQ11-14, a self-report measure of the impact of oral and oro-facial conditions on 11- to 14-year-old children. An item pool was generated with the use of a literature review and interviews with health professionals, parents, and child patients. The 36 items rated the most frequent and bothersome by 83 children were selected for the CPQ11-14. Validity testing involved a new sample of 123 children. Test-retest reliability was assessed in a subgroup of these children (n = 65). Mean CPQ11-14 scores were highest for oro-facial (31.4), lower for orthodontic (24.3), and lowest for pedodontic (23.3) patients. There were significant associations between the CPQ11-14 score and global ratings of oral health (p < 0.05) and overall well-being (p < 0.01). The Cronbachs alpha and intraclass correlation coefficient for the CPQ11-14 were 0.91 and 0.90, respectively. These results suggest that the CPQ11-14 is valid and reliable.

Age of Onset of Dental Anxiety

Little attention has been given to the issue of the age of onset of dental anxiety, even though it may have a bearing on the origins of this type of fear. This study aimed to identify the age of onset of dental anxiety and to identify differences by age of onset with respect to potential etiological factors, such as negative dental experiences, family history of dental anxiety, and general psychological states. Data were collected by means of two mail surveys of a random sample of the adult population. Of 1420 subjects returning questionnaires, 16.4% were dentally anxious. Half, 50.9%, reported onset in childhood, 22.0% in adolescence, and 27.1% in adulthood. Logistic regression analyses indicated that negative dental experiences were predictive of dental fear regardless of age of onset. A family history of dental anxiety was predictive of child onset only. Adolescent-onset subjects were characterized by trait anxiety and adult-onset subjects by multiple severe fears and symptoms indicative of psychiatric problems. The three groups were similar in terms of their physiological, cognitive, and behavioral responses to dental treatment. However, adolescent- and adult-onset subjects were more hostile toward and less trusting of dentists. These results indicate that child-onset subjects were more likely to fall into the exogenous etiological category suggested by Weiner and Sheehan (1990), while adult-onset subjects were more likely to fall into the endogenous category.

Measuring the Effect of Intra-oral Implant Rehabilitation on Health-related Quality of Life in a Randomized Controlled Clinical Trial

The importance of assessing the impact of treatments for chronic conditions on an individuals quality of life has been well-established. In this randomized clinical trial, oral-health-rclated quality of life, measured with the Oral Health Impact Profile (OHIP), was compared between two groups of edentulous patients. One group (n = 54) received mandibular implant-supported overdentures, and the other group (n = 48) received conventional dentures. Assessments were performed pre-treatment and two months after the prostheses were delivered. The multivariate model showed that implant treatment was significantly associated with lower post-treatment OHIP scores (p = 0.0002), indicating a better quality of life. In addition, pre-treatment OHIP scores, treatment allocation, age, sex, and marital status explained 31% of the variation in post-treatment OHIP scores (F = 0.0001). These results suggest that implant treatment provides significant short-term improvement over conventional treatment in oral-health-related quality of life.

Risk Factors for Dental Fluorosis in a Fluoridated Community

We conducted a case-control study to determine the sources of fluoride which are particular risk factors to dental fluorosis. Cases and non-cases were identified by the screening of 8-, 9-, and 10-year-old schoolchildren in the fluoridated community of East York, Ontario-Parents were interviewed about the childs first five years of residence and about diet and preventive caries practices. The Mantel-Haenszel odds ratio and associated chi-square tests were used to assess the association of fluorosis with several potential sources, controlling for other sources of fluoride and mothers education. The prevalence of mild fluorosis [1-4 on the Thylstrup and Fejerskov (1978) Index] was 13%. Those who brushed their teeth before the age of 25 months had 11 times the odds of fluorosis compared with those beginning toothbrushing later; prolonged use of infant formula (≥ 13 months) was associated with 3.5 times the risk of fluorosis, compared with no, or shorter duration of, formula use. We estimate that these factors were responsible for 72% and 22%, respectively, of the cases in our population. Dental fluorosis is not a public health problem in East York, but parents should be advised to supervise toothbrushing by children under 2 years of age.

Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly

OBJECTIVES This paper compares the performance of the GOHAI and the OHIP-14 as measures of the oral health-related quality of life of the compromised elderly. METHODS Data were obtained from a cross-sectional survey of 225 participants, most of whom lived in a large geriatric care centre. RESULTS The mean age of subjects was 83 years and the majority had one or more chronic medical conditions and physical disabilities. Their main oral problems were high rates of tooth loss and xerostomia. Additive and simple count methods were used to derive GOHAI and OHIP-14 scores. Using the additive method, 8.4% had a GOHAI score of zero and 30.3% an OHIP-14 score of zero. Using the simple count method the percentage with a score of zero was 15.1% and 45.8%. Both measures discriminated between dentate subjects with and without one or more dentures, with and without a chewing problem and with and without dry mouth. Both also showed significant associations with self-rated oral health and satisfaction with oral health status. Associations tended to be stronger between GOHAI scores and these variables. The measures were equally good at predicting overall psychological well-being and life satisfaction. Although the GOHAI identified more oral functional and psychosocial impacts than the OHIP-14, neither was markedly superior to the other when used as discriminatory measures. However, the high prevalence of subjects with zero scores may compromise the ability of the OHIP-14 to detect within-subject change.

Validation of the Child Perceptions Questionnaire (CPQ11-14)

While the use of adult oral-health-related quality-of-life (OHRQoL) measures in supplementing clinical indicators has increased, that for children has lagged behind, because of the difficulties of developing and validating such measures for children. This study examined the construct validity of the Child Perceptions Questionnaire (CPQ11-14) in a random sample of 12- and 13-year-old New Zealanders. It was hypothesized that children with more severe malocclusions or greater caries experience would have higher overall (and subscale domain) CPQ11-14 scores. Children (N = 430) completed the CPQ11-14 and were examined for malocclusion (Dental Aesthetic Index) and dental caries. There was a distinct gradient in mean CPQ11-14 scores by malocclusion severity, but there were differences across the four subscales. Children in the worst 25% of the DMFS distribution had higher CPQ11-14 scores overall and for each of the 4 subscales. The construct validity of the CPQ11-14 appears to be acceptable.

Risk Indicators and Risk Markers for Periodontal Disease Experience in Older Adults Living Independently in Ontario, Canada

This study examined risk indicators and risk markers for periodontal disease experience in 624 adults aged 50 years and over living independently in four communities in Ontario, Canada. The data were collected as part of the baseline phase of a longitudinal study of the oral health and treatment needs of this population. Periodontal disease experience was assessed in terms of attachment loss, measured at two sites on each remaining tooth. Bivariate and multivariate analyses were used to examine the relationship between a number of sociodemographic, general health, psychosocial, and oral health variables and three indicators of periodontal disease experience. These were: mean attachment loss, the proportion of sites examined with loss of 2 mm or more, and the probability of the subjects having severe disease, arbitrarily defined as a mean attachment loss in the upper 20th percentile of the distribution. Mean attachment loss was 2.95 mm (SD = 1.41 mm), and 76.6% of sites examined had loss of 2 mm or more. In bivariate analyses, the most consistent predictors of periodontal disease experience were: age, education, income, smoking, dental visiting, the number of remaining teeth, the number of decayed coronal surfaces, and the number of decayed root surfaces. In multivariate analyses, age, education, current smoking status, and the number of teeth had the most consistent independent effects. These data confirm the results of recent US studies indicating that periodontal disease experience is influenced by social and behavioral factors.

Incidence of and Risk Factors for Tooth Loss in a Population of Older Canadians

Data on the incidence of tooth loss in community-dwelling older Canadians have not previously been reported. Since recent US studies of older adults were conducted in predominantly rural communities, their results may not be generalizable to Canada, where the majority of older adults live in major metropolitan or urban settings. This paper describes a study designed to estimate the incidence of tooth loss in older Canadians and to identify factors predictive of that loss. Using personal interviews and clinical examinations, we obtained baseline and three-year follow-up data from 491 dentate subjects. Overall, 23.2% lost one or more teeth between baseline and follow-up. Only six, or 1.2%, became edentulous. Twelve baseline factors were significantly associated with the probability of loss. However, in a logistic regression analysis, only five had significant independent effects. These were gender, marital status, self-rating of oral health status, the number of decayed root surfaces, and a mean periodontal attachment loss of 4 mm or more. The predictive ability of the model was poor, largely because tooth loss is a complex outcome which depends on decisions taken by dentists and patients. Since this decision-making process cannot be captured in epidemiological studies, observational studies are needed to cast further light on tooth loss in this population.

Long-term Dental Visiting Patterns and Adult Oral Health

To date, the evidence supporting the benefits of dental visiting comes from cross-sectional studies. We investigated whether long-term routine dental visiting was associated with lower experience of dental caries and missing teeth, and better self-rated oral health, by age 32. A prospective cohort study in New Zealand examined 932 participants’ use of dentistry at ages 15, 18, 26, and 32. At each age, routine attenders (RAs) were identified as those who (a) usually visited for a check-up, and (b) had made a dental visit during the previous 12 months. Routine attending prevalence fell from 82% at age 15 to 28% by 32. At any given age, routine attenders had better-than-average oral health, fewer had teeth missing due to caries, and they had lower mean DS and DMFS scores. By age 32, routine attenders had better self-reported oral health and less tooth loss and caries. The longer routine attendance was maintained, the stronger the effect. Routine dental attendance is associated with better oral health.

Changes in parent‐assessed oral health‐related quality of life among young children following dental treatment under general anaesthetic

OBJECTIVE To estimate the nature and magnitude of changes in oral health-related quality of life (OHRQoL) among children having dental treatment under general anaesthetic (GA) and to examine the evaluative properties of the Child Oral Health-related Quality of Life Questionnaire (COHQOL). METHODS Data from a consecutive clinical sample of the parents/caregivers of children receiving dental treatment under GA at Wellington and Kenepuru Hospitals were collected from parents using the Parental-Caregivers Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS), which both form part of the COHQOL Questionnaire. The first questionnaire was completed before treatment or while the participants child was undergoing treatment. The follow-up questionnaire was completed 1-4 weeks afterward. Treatment-associated changes in OHRQoL were determined by comparing baseline and follow-up data for the mean scores and the prevalence of impacts. The discriminative properties of the instrument were confirmed and then its evaluative properties were assessed (by examining its test-retest reliability, responsiveness and longitudinal construct validity). The minimally important difference was determined for the overall scale and subscales. RESULTS Complete baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up rate). The evaluative properties of the P-CPQ and FIS were acceptable. There were substantial and highly statistically significant reductions in mean P-CPQ and FIS scores after treatment, with effect sizes ranging from moderate to large, depending on the subscale being examined. The minimally important difference was shown by almost two-thirds of the children treated. CONCLUSION The provision of dental treatment under GA for young children with severe dental caries experience is associated with substantial and highly significant improvements in both their OHRQoL and in the impact on their families. The P-CPQ and the FIS show promise as evaluative measures for use in dental health services research.