Lyndie A. Foster Page

Impact of traumatic dental injuries on the quality of life of schoolchildren.

BACKGROUND  Knowledge of the impact of traumatic dental injuries (TDI) on childrens quality of life is sparse. AIM  To determine the association between TDI and oral health-related quality of life (OHRQoL) among schoolchildren aged 11-14 years. MATERIAL AND METHODS  A cross-sectional study was carried out involving a representative sample of 409 schoolchildren from 13 municipalities in the Midwest Region of the Brazilian Southern State of Santa Catarina. Clinical examination included the presence and type of TDI and the treatment provided (or needed) according to criteria used in the UK Childrens Dental Health Survey. Dental caries in anterior teeth and malocclusion status were also collected according to WHO criteria. OHRQoL was assessed using the short form of the Child Perceptions Questionnaire (CPQ11-14), and the outcome was the prevalence of one or more adverse impacts on quality of life occurring often/very often. RESULTS  The prevalence of TDI was 16.6% (95% CI 13.0-20.2). The prevalence of one or more adverse impacts occurring often/very often was 46.6% (95% CI 41.7-51.5). Logistic regression modeling for the outcome indicated an independent and significant association between the prevalence of one or more adverse impacts occurring often/very often and the presence of TDI even after adjustment for gender, presence of dental caries in anterior teeth and malocclusion. A prevalence ratio of 1.79 (95% CI 1.16-2.76) of one or more adverse impacts occurring often/very often in schoolchildren with TDI was found, compared to those without TDI. CONCLUSIONS  Traumatic dental injuries appear to affect schoolchildrens OHRQoL.

Community Water Fluoridation and Intelligence: Prospective Study in New Zealand

Objectives. This study aimed to clarify the relationship between community water fluoridation (CWF) and IQ. Methods. We conducted a prospective study of a general population sample of those born in Dunedin, New Zealand, between April 1, 1972, and March 30, 1973 (95.4% retention of cohort after 38 years of prospective follow-up). Residence in a CWF area, use of fluoride dentifrice and intake of 0.5-milligram fluoride tablets were assessed in early life (prior to age 5 years); we assessed IQ repeatedly between ages 7 to 13 years and at age 38 years. Results. No clear differences in IQ because of fluoride exposure were noted. These findings held after adjusting for potential confounding variables, including sex, socioeconomic status, breastfeeding, and birth weight (as well as educational attainment for adult IQ outcomes). Conclusions. These findings do not support the assertion that fluoride in the context of CWF programs is neurotoxic. Associations between very high fluoride exposure and low IQ reported in previous studies may have been affected by confounding, particularly by urban or rural status.

Factors influencing adolescents' oral health-related quality of life (OHRQoL)

BACKGROUND OHRQoL comprises an apparently complex array of biological and psychological aspects of oral health. AIM To determine the relative contribution of sociodemographic, psychosocial, or clinical characteristics to OHRQoL in adolescents. DESIGN A cross-sectional study of Dunedin adolescents was carried out. Each participant completed a self-administered questionnaire and underwent a clinical examination. Information collected included sociodemographic characteristics (sex, ethnicity, and household deprivation), psychosocial characteristics (self-esteem, psychological well-being, somatisation, and self-perception scores for body image), and clinical measures (DMFS and Dental Aesthetic Index). OHRQoL was measured using the 16-item impact short-form CPQ₁₁₋₁₄ questionnaire. Linear regression analyses used the CPQ₁₁₋₁₄ as the dependent variable, with independent variables entered in related groups. RESULTS Three hundred and fifty-three children (48.4% females) took part, representing a 58.8% response rate. Linear regression modelling of the CPQ₁₁₋₁₄ score showed that sociodemographic characteristics were predictors, but the models overall explanatory power was low (R(2) = 0.05). This increased slightly with inclusion of the clinical variables. When the psychosocial variables were added, however, the R(2) increased to 0.50; all psychosocial variables (except self-esteem) were strongly associated with the CPQ₁₁₋₁₄ score. Psychological well-being was the strongest predictor. CONCLUSION Psychosocial characteristics are important contributors to OHRQoL in adolescents and appear to be more important than sociodemographic or clinical characteristics.

Short-form versions of the Parental-Caregivers Perceptions Questionnaire and the Family Impact Scale

OBJECTIVE To develop short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS). METHODS Pretest/post-test clinical studies involved parent-completed questionnaires (the P-CPQ and the FIS) before and some weeks after dental care (under general anaesthesia) for early childhood caries (ECCs) in consecutive clinical samples from Wellington and Auckland. Deriving the short-form versions used only the baseline data from the Wellington sample (N = 195), whereas their evaluation used both baseline and follow-up data from the Auckland sample (N = 144 followed up). Item impact analysis was used to identify the 8 and 16 items with the greatest impact. An eight-item short-form FIS version was obtained in the same way. RESULTS In the Wellington sample, Cronbachs α for the full, 16- and 8-item P-CPQ scales was 0.92, 0.89 and 0.82, respectively, and it was 0.88 and 0.85 for the full and eight-item FIS. Cross-sectional concurrent validity in the Wellington sample was acceptable for all short forms. Examining their responsiveness in the Auckland sample, large decreases post-treatment were observed in the short-form P-CPQ scores which were similar in relative magnitude to those seen with the full version. The full and short-form FIS scale scores showed moderate decreases. CONCLUSIONS The reliability, validity and responsiveness of the short-form versions were acceptable in these settings with children suffering from severe ECC; however, before they can be treated as definitive measures for use in health services research to determine the effects of clinical interventions for ECC, their test-retest reliability should be examined and further validation undertaken.

Responsiveness of the Child Perceptions Questionnaire 11–14 for Cambodian children undergoing basic dental care

BACKGROUND Oral-Health-Related Quality of Life (OHRQoL) instruments are useful outcome measures in dental health services research; however, there are no reports of the use OHRQoL measures in evaluating the outcome of basic dental care in children anywhere. AIM The aims of this study are to evaluate the responsiveness of the Khmer version of the Child Perceptions Questionnaire11-14 (CPQ11-14) and to describe changes in OHRQoL associated with the provision of basic dental care. DESIGN A pre-test/post-test design, with a clinical convenience sample of children aged from 8 to 14 years of age who received basic dental care from a local nongovernmental organisation (NGO). RESULTS Of the 140 children in the baseline sample, 116 (82.9%) were followed up. The mean change in CPQ11-14 overall score for those with caries was 1.7, representing a small improvement in OHRQoL. There was a moderate (one in three) statistically significant reduction in the prevalence of impacts across the whole sample (P < 0.001; McNemar test), and one in five improved by the minimally important difference (MID) of five-scale points. CONCLUSIONS The Khmer version of the CPQ11-14 appears to be a valid and responsive measure for assessing treatment-associated changes in OHRQoL in children with dental caries in Cambodia.

Comparison of the ECOHIS and short-form P-CPQ and FIS scales.

BackgroundThe development of short-form versions of child oral–health-related quality of life (OHRQoL) scales has resulted in two closely related sets of measures. We set out to compare the properties and responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS – both “child” and “family” versions) and short-form Parental-Caregiver Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) measures among New Zealand children with early childhood caries who underwent treatment under general anaesthesia (GA).MethodsSecondary analysis of data from pretest/post-test clinical studies of consecutive clinical convenience samples undertaken in Wellington in 2005 and Auckland in 2010/11, with cross-sectional analyses using the former, and longitudinal analyses using the latter.ResultsCronbach’s α values for the ECOHIS-Child, P-CPQ-16 and P-CPQ-8 were 0.80, 0.88 and 0.80 respectively, and 0.83 and 0.68 (respectively) for the FIS-8 and the ECOHIS-Family. All scales showed acceptable cross-sectional construct validity, although that of the ECOHIS-Family was not as marked as that observed with the FIS-8. Responsiveness was acceptable, with the three child-focused measures showing similar effect sizes. The two family-focused measures were also similar.ConclusionsThe ECOHIS-Child and the P-CPQ scales are very similar in their properties, but the ECOHIS-Family falls short of the FIS-8 in some important ways. The ECOHIS scales may be better deployed in epidemiological survey work rather than in health services research, whereas the P-CPQ-8, P-CPQ-16 and the FIS-8 seem to be well suited for the latter (particularly with children suffering from severe caries), but their epidemiological utility remains to be demonstrated.

Do we need more than one Child Perceptions Questionnaire for children and adolescents

BackgroundIn dentistry, measures of oral health-related quality of life (OHRQoL) provide essential information for assessing treatment needs, making clinical decisions and evaluating interventions, services and programmes. The two most common measures used to examine child OHRQoL today are the Child Perceptions Questionnaire at two ages, 8–10 and 11–14 (CPQ8-10, CPQ11-14). The reliability and validity of these two versions have been demonstrated together with that (more recently) of the short-form 16-item impact version of the CPQ11-14. This study set out to examine the reliability and validity of the Child Oral Health Quality of Life Questionnaires (COHQOL) instruments the CPQ8-10 and impact short-form CPQ11-14 in 5-to-8-year-old New Zealand children, and to determine whether a single measure for children aged 5–14 is feasible.MethodA cross-sectional survey was conducted of 5-to-8-year-old children attending for dental treatment in community clinics in 2011. Children were examined for dental caries, with OHRQoL measured using the CPQ8-10 and short-form CPQ11-14. Construct validity was evaluated by comparing mean scale scores across ordinal categories of caries experience; correlational construct validity was assessed by comparing mean CPQ scores across children’s global ratings of oral health and well-being.ResultsThe 183 children (49.7% female) aged 5 to 8 years who took part in the study represent a 98.4% participation rate. The overall mean dmft was 6.0 (SD, 2.0 range 1 to 13). Both questionnaire versions detected differences in the impact of dental caries on quality of life, with the greatest scores in the expected direction. Both versions showed higher scores among those with poorer oral health. There was a very strong and positive correlation between CPQ11-14 scores and CPQ8-10 scores (Pearsons’s r = 0.98; P < 0.01).ConclusionThe performance of both versions of the COHQOL measures (CPQ8-10 and short-form CPQ11-14) appears to be acceptable in this younger age group, and this work represents the first stage in validating this questionnaire in a younger age group. It also further confirms that younger children are capable of providing their own perceptions of oral health impacts. The acceptability of the short-from CPQ11-14 in this younger age group lends support to its use in children between ages 5 and 14.

Differential item functioning related to ethnicity in an oral health-related quality of life measure.

OBJECTIVE To assess whether an oral health-related quality of life (OHRQoL)measure showed differential item functioning (DIF) by ethnicity. METHODS A simple random sample of 12- and 13-year-old schoolchildren enrolled in the Taranaki District Health Boards school dental service, New Zealand. Each child (n = 430) completed the Child Perception Questionnaire (CPQ(11-14)) in the dental clinic waiting room, prior to a dental examination. The dataset included age, gender, ethnicity, and deprivation status. The general principle of the analytic plan was that equal scores from each CPQ(11-14) item were expected from both non-Mäori and Mäori groups regardless of their ethnic group. Ordinal logistic regression was performed. The dependent variables were the CPQ(11-14) items. The ethnicity group and each CPQ(11-14) domain score were the independent variables. Non-uniform DIF was assessed through adding an interaction term for each CPQ(11-14) sub-scale. RESULTS Non-uniform DIF was found in two items, one in the Functional Limitations sub-scale and another in the Social Well-being sub-scale. Uniform DIF was found in one item of the Emotional Well-being sub-scale. CONCLUSION Both non-uniform and uniform DIF by ethnicity was found in three of 37 items of the CPQ(11-14) questionnaire, showing it is important to perform DIF analysis when applying OHRQoL measures.

Should I eXtract Every Six dental trial (SIXES): study protocol for a randomized controlled trial

BackgroundExtraction of lower first permanent molars in children is common. There is uncertainty among clinicians as to whether a ‘compensating extraction’ (removal of the upper first permanent molar to prevent it over erupting) is necessary despite current guidelines recommending this. As a result, unnecessary dental extractions may be carried out or children may be failing to receive extractions required to achieve optimal long-term oral health. In addition, the decision to extract fewer or more teeth affects management options (local anesthetic injections alone, inhalation sedation or general anesthesia) needed to support the child with the surgical procedure(s).The SIXES (Should I eXtract Every Six) dental trial investigates clinical effectiveness and quality of life for conventional treatment (following the guideline of compensation extraction of the upper first permanent molar) compared with the alternative intervention (removal of lower first permanent molars but no extraction of the upper).Methods/DesignThis is a multicenter, two-arm parallel group randomized clinical trial. Allocation will be web-based randomization. Practitioners in primary and secondary care settings, reflecting the points of presentation and treatment of eligible patients, will recruit 400 children, aged 7 to 11 years requiring extraction of lower first permanent molars but who have upper first permanent molars of good prognosis. Baseline measures (prior to treatment) and outcome data (at one and five years, or when the patient reaches 14 years of age) will be assessed through study models and child/parent questionnaires.The primary outcome measure is degree of tipping of the lower second permanent molar, (favorable outcome is tipping less than 15°).The secondary outcomes are type of anesthetic/sedation used, residual spacing (between lower second premolar and second permanent molar), orthodontic treatment requirement, quality of life, and over-eruption in the intervention group. Assessors will be blinded where possible.DiscussionSIXES dental trial investigates whether compensating extraction of upper first permanent molars should be carried out following loss of lower first permanent molars. Currently dentists and orthodontists face a dilemma in clinical decision-making, relying on the lowest level of evidence - expert opinion. SIXES will provide evidence to support decision-making and inform practices and may result in reduced tooth extractions.Trial registrationClinical Trials.gov Identifier: NCT01591265

Differential item functioning of the Spanish version of the Child Perceptions Questionnaire.

AIM Owing to the greater use of translated and adapted instruments for measuring oral health on childrens quality of life, there is a need to ensure that such scales (and then items) function in the same way, irrespective of age, sex, socioeconomic status, language, or ethnicity, so they can be used validly and reliably in cross-cultural research. The aim of the present study was to identify whether the Spanish version of the Child Perceptions Questionnaire 11-14 presents differential item functioning. METHODS Child Perceptions Questionnaire 11-14 data from New Zealand (n = 322) and Mexican (n = 335) school-based surveys were compared. Ordinal logistic regression was undertaken in order to identify uniform or non-uniform differential item functioning. RESULTS Eleven items showed moderate-to-large uniform differential item functioning in the Spanish version of the Child Perceptions Questionnaire 11-14. Non-uniform differential item functioning was not detected. The psychometric properties of the questionnaire, when removing items showing differential item functioning, showed that the free differential item functioning version was good to excellent. CONCLUSIONS The Child Perceptions Questionnaire 11-14 Spanish version showed moderate-to-large uniform differential item functioning; however, further research is needed to identify the causes of differential item functioning.