Fiona Gilchrist

Assessment of the quality of measures of child oral health-related quality of life

BackgroundSeveral measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures.MethodsA systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group.ResultsThe search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis.ConclusionThe three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change.

The impact of dental caries on children and young people: what they have to say?

BACKGROUND Dental caries affects 60-90% of children across the world and is associated with a variety of negative impacts. Despite its ubiquity, there has been surprisingly little exploration of these impacts from the childs perspective. AIM The aim was to allow children to describe the impact of dental caries on their daily lives and to describe the terminology they used. DESIGN Children, aged 5-15 years, with caries experience were purposively sampled from primary and secondary care dental clinics. Focus groups (n = 5) and in-depth interviews (n = 16) were recorded and transcribed verbatim. Data analysis took a narrative approach, and themes were derived from the data using framework analysis. RESULTS Pain was the main theme to emerge. Within this, three subthemes were identified: impacts related to pain, strategies adopted to reduce pain, and emotional aspects resulting from pain. A second theme was also identified relating to the aesthetic aspects of caries. CONCLUSION Children as young as 5 years of age were able to competently discuss their experiences of dental caries. Participants reported a number of impacts affecting various aspects of their lives. These will be incorporated into the future development of a caries-specific measure of oral health-related quality of life.

Impact of the Hall technique for preformed metal crown placement on undergraduate paediatric dentistry experience

The Hall technique, a novel method of placing preformed metal crowns (PMCs) without local anaesthesia or tooth preparation, was introduced to our undergraduate dental curriculum in 2009. This study aimed to describe student experience of, and attitudes towards, PMCs before and after exposure to this new technique. Clinical data were extracted from student logbooks to determine the number of PMCs placed for cohorts graduating in 2005 (n = 55), 2009 (n = 61) and 2010 (n = 75). Five focus groups were also conducted with 29 final-year dental students. Students graduating in 2005, 2009 and 2010 had placed a mean (range) of 0.03 (0-1), 0.63 (0-5) and 1.15 (0-9) PMCs, respectively. The proportion of students who had placed a PMC increased significantly from only 1.9% in 2005 to 75% in 2010 (P < 0.05, ANOVA). Students reported some positive experiences of the Hall technique. However, concern over perceived lack of future clinical support, an anticipated increase in time and financial pressures, and the ease of use of glass-ionomer cement as an alternative were described as potential barriers to PMC use. Findings suggest that the introduction of the Hall technique has had a marked impact on the use of PMCs as a treatment modality for carious primary teeth.

Involving children in research, audit and service evaluation.

UK health and social policy advocates active involvement of children in service development and decision making and this is increasingly seen worldwide. The purpose of this paper is to give an overview of the ethical considerations and methods that can be employed in child-centred research, audit and service evaluation.

Development of the Malocclusion Impact Questionnaire (MIQ) to measure the oral health- related quality of life of young people with malocclusion: part 2 - cross-sectional validation

Objective To test the items, identified through qualitative inquiry that might form the basis of a new Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life (OHQoL) of young people with malocclusion. Methods Piloting with 13 young people reduced the number of items from 37 to 28. Cross-sectional testing involved a convenience sample aged 10–16 years, attending the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield. The fit and function of the initial MIQ questions were examined using item response theory. Result 184 participants (113 females; 71 males) completed a questionnaire (response 85%), seven participants were excluded due to missing responses. The mean age of participants was 12·9 years (SD 1·4) and they had a wide range of malocclusions. The majority were White British (67·4%). Data from 47 participants were used to analyse test–retest reliability. Rasch analysis was undertaken, which further reduced the number of items in the questionnaire from 28 to 17. Unidimensionality of the scale was confirmed. The analysis also identified that the original 5-point response scale could be reduced to three points. The new measure demonstrated good criterion validity (r = 0·751; P < 0·001) and construct validity with the two global questions (‘Overall bother’ ρ = 0·733 and ‘Life overall’ ρ = 0·701). Internal consistency (Cronbachs alpha = 0·906) and test–retest reliability Intraclass correlation coefficient (ICC = 0·78; 95% CI 0·61–0·88) were also good. Conclusion Cross-sectional testing has shown the new MIQ to be both valid and reliable. Further evaluation is required to confirm the generalisability as well as the ability of the new measure to detect change over time (responsiveness).

Development and evaluation of the children's experiences of dental anxiety measure

BACKGROUND Existing measures of childrens dental anxiety have not been developed with children or based on a theoretical framework of dental anxiety. AIM To develop the childrens experiences of dental anxiety measure (CEDAM) and evaluate the measures properties. DESIGN The measure was developed from interviews with dentally anxious children. Children recruited from a dental hospital and secondary school completed the CEDAM and Modified Child Dental Anxiety Scale (MCDAS). A subgroup of children completed the CEDAM before and after receiving an intervention to reduce dental anxiety to examine the measures responsiveness. Rasch and Classical test analyses were undertaken. RESULTS Children were aged between 9 and 16 years (N = 88 recruited from a dental hospital and N = 159 recruited from a school). Rasch analysis confirmed the measures unidimensionality. The CEDAM correlated well with the MCDAS (rho = 0.67, P < 0.01) and had excellent internal consistency (Cronbachs alpha = 0.88) and test-retest reliability (ICC = 0.98). The CEDAM was also able to detect changes in dental anxiety following the intervention (baseline mean = 22.36, SD = 2.57 and follow-up mean = 18.88, SD = 2.42, t(df = 37) = 9.54, P < 0.01, Cohens d = 1.39). CONCLUSIONS The results support the reliability, validity and responsiveness of the CEDAM. Initial findings indicate it has potential for use in future intervention trials or in clinical practice to monitor childrens dental anxiety.

Communication and the Use of Language

Communication has both verbal (35 %) and non-verbal (65 %) elements. Non-verbal communications or cues are more readily believed than those of the spoken word. It is the case, for people in general, that “actions speak louder than words” [1]. However, the benefits of understanding both non-verbal and verbal cues are essential in understanding and communicating with your child and adolescent patients. Non-verbal communication is taught well in the dental undergraduate curriculum and so this chapter aims to include information which complements this knowledge.

Does orthodontic treatment improve oral health-related quality of life?

Data sourcesPubMed, Embase, Cochrane Central Register of Controlled Trials, China Biology Medicine disc and Goggle-Scholar databases and the journals; American Journal of Orthodontics and Dentofacial Orthopedics, European Journal of Orthodontics, Angle Orthodontist, Journal of Orthodontics and World Journal of Orthodontics.Study selectionStudies in patients receiving orthodontic treatment (fixed, removable appliance or interceptive) with outcomes that showed changes in oral health-related quality of life (OHRQoL) from baseline (pre-treatment) to follow-up after at least one month were considered.Data extraction and synthesisTwo reviewers independently selected studies and abstracted data. Pooling of data was based on study design, population characteristics, outcomes and OHRQoL-domains affected. A narrative summary was planned.ResultsEleven studies were included (six cohort studies, four cross-sectional studies, one case-control study). The majority (seven studies) were conducted among child/adolescent populations. An observed association between quality of life and orthodontic treatment was generally detected irrespective of how they were assessed. However, the strength of the association could be described as modest at best.ConclusionsFindings of this review suggest that there is an association (albeit modest) between orthodontic treatment and quality of life. There is a need for further studies of their relationship, particularly studies that employ standardised assessment methods so that outcomes are uniform and thus amenable to meta-analysis.