Pernilla Larsson

Reliability and validity of a Swedish version of the Oral Health Impact Profile (OHIP‐S)

The aim of this study was to translate the Oral Health Impact Profile (OHIP) into Swedish and evaluate the reliability and validity of the Swedish version (OHIP‐S). The OHIP is a 49‐item, self‐administered questionnaire divided into 7 different subscales. The original version in English was translated into Swedish, accompanied by back‐translation into English, after which the Swedish version was revised. A total of 145 consecutive patients participated and answered a questionnaire. The patients comprised five clinically separate groups: temporomandibular dysfunction (TMD) (n = 30), Primary Sjögrens Syndrome (SS) (n = 30), burning sensation and pain in the oral mucosa (oral mucosal pain, OMP) (n = 28), skeletal malocclusion (malocclusion) (n = 27), and healthy dental recall patients (controls) (n = 30). The TMD group and the control group participated in a test–retest procedure. The internal reliability of each subscale was calculated with Cronbachs alpha and found to be high and to range from 0.83–0.91. The stability (test–retest) of the instrument, calculated using the intraclass correlation coefficient, ranged from 0.87 to 0.98. The construct validity of OHIP‐S was compared with subscales of the Symptom Check List (SCL‐90) (rho 0.65) and the Jaw Function Limitation Scale (JFLS) (rho 0.76) and analyzed with Spearmans correlation coefficient. Convergent validity was evaluated by comparing OHIP with self‐reported health using Spearmans correlation coefficient and was found to be acceptable (rho 0.61). In the evaluation of the discriminative ability of the instrument, significant differences were found in the total OHIP‐S score between the controls and the other four groups (P<0.001). We conclude that the reliability and validity of OHIP‐S is excellent. The instrument can be recommended for assessing the impact of oral health on masticatory ability and psychosocial function.

Confirmatory factor analysis of the Oral Health Impact Profile.

Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher-order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health-Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the projects Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four-factor model and a bifactor model that included one general factor and four group factors. Using model-fit criteria and factor interpretability as guides, the four-factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0·05, CFI = 0·99) and interpretability. These results corroborate our previous findings that four highly correlated factors - which we have named Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact - can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four-factor solution suggest that OHRQoL can also be sufficiently described with one score.

Factor analyses of the Oral Health Impact Profile – Overview and studied population

PURPOSE A desideratum of oral health-related quality of life (OHRQoL) instruments - such as the Oral Health Impact Profile (OHIP) - is that they accurately reflect the structure of the measured construct(s). With this goal in mind, the Dimensions of Oral Health-Related Quality of Life (DOQ) Project was proposed to investigate the number and nature of OHRQoL dimensions measured by OHIP. In this report, we describe our aggregate data set for the factor analyses in the project, which consists of responses to the 49-item OHIP from general population subjects and prosthodontics patients from 6 countries, including a large age range of adult subjects and both genders. MATERIALS AND METHODS The DOQ Projects aggregate data set combines data from 35 individual studies conducted in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden. RESULTS The combined data set includes 10778 OHIPs from 9348 individuals (N=6349 general population subjects, N=2999 prosthodontic patients). To elucidate the OHIP latent structure, the aggregated data were split into a Learning Sample (N=5173) for exploratory analyses and a Validation Sample (N=5022) for confirmatory analyses. Additional data (N=583) were assigned to a third data set. CONCLUSION The Dimensions of Oral Health-Related Quality of Life Project contains a large amount of international data and is representative of populations where OHIP is intended to be used. It is well-suited to assess the dimensionality of the questionnaire.

General population norms of the Swedish short forms of Oral Health Impact Profile

We reported the development and psychometric evaluation of a Swedish 14-item and a five-item short form of the Oral Health Impact Profile. The 14-item version was derived from the English-language short form developed by Slade in1997. The five-item version was derived from the German-language short form developed by John et al. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N = 1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N = 1309) were on average 50·1 ± 17.4 years old, and 54% were women. Short form summary scores correlated highly with the 49-item OHIP-S (r ≥ 0.97 for OHIP-S14, r ≥ 0.92 for OHIP-S5) and with self-report of oral health (r ≥ 0.41). Reliability, measured with Cronbachs alpha (0.91 for OHIP-S14, 0.77 for OHIP-S5), was sufficient. In the general population, 50% of the subjects had ≥2 OHIP-S14 score points and 10% had ≥11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had ≥2 OHIP-S14 score points, and 10% had ≥11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP-S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14-item and 5-item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies.

Validation of the Orofacial Esthetic Scale in the general population.

BackgroundThe Orofacial Esthetic Scale (OES) is an eight-item instrument to assess how patients perceive their dental and facial esthetics. In this cross-sectional study we investigated dimensionality, reliability, and validity of OES scores in the adult general population in Sweden.MethodsIn a random sample of the adult Swedish population (response rate: 39%, N=1159 subjects, 58% female, mean age (standard deviation): 49.2 (17.4) years), dimensionality of OES was investigated using factor analytic methods to determine how many scores are needed to characterize the construct. Reliability of scores was calculated using Cronbach’s alpha. Score validity was determined by correlating the OES summary score with a global indicator of orofacial esthetics (OE).ResultsFactor analyses provided support that a single score can sufficiently characterize OE. A Cronbach’s alpha of 0.93 indicated excellent reliability. A validity coefficient of r=0.89 (95% confidence interval: 0.87-0.90) indicated that OES summary scores correlated highly with a global OE assessment.ConclusionsThe OES is a promising instrument to measure the construct OE. Factor analyses supported that this construct can be assessed with one score, offering a feasible and acceptable standardized assessment of OE. The present study extends the OES use to the general population, an important target population for assessment of orofacial esthetics.

Normative values for the oro‐facial Esthetic Scale in Sweden

This study reports the findings and challenges of the assessment of oro-facial aesthetics in the Swedish general population and the development of normative values for the self-reporting Orofacial Esthetic Scale (OES). In a Swedish national sample of 1406 adult subjects (response rate: 47%), OES decile norms were established. The influence of sociodemographics (gender, age, and education), oral health status and general health status on OES scores was analysed. Mean ± standard deviation of OES scores was 50.3 ± 15.6 units (0, worst score; 70, best score); <1% of the subjects had the minimum score of 0, and 11% had the maximum score of 70 OES units. Orofacial Esthetic Scale score differences were (i) substantial (>5 OES units) for subjects with excellent/very good versus good to poor oral or general health status; ii) small (2 units), but statistically significant for gender (P = 0.01) and two age groups (P = 0.02), and (iii) absent for subjects with college versus no college education (P = 0.31) or with and without dentures (P = 0.90). To estimate normative values for a self-reporting health status, instrument is considered an important step in standardisation, and the developed norms provide a frame of reference in the general population to interpret the Orofacial Esthetic Scale scores.

Treatment outcomes and patient-reported quality of life after orthognathic surgery with computer-assisted 2- or 3-dimensional planning: A randomized double-blind active-controlled clinical trial

Introduction Thorough treatment planning is essential for a good clinical outcome in orthognathic treatment. The planning is often digital. Both 2‐dimensional (2D) and 3‐dimensional (3D) software options are available. The aim of this randomized 2‐arm parallel double‐blinded active‐controlled clinical trial was to compare the outcomes of computer‐based 2D and 3D planning techniques according to patient‐reported health related quality of life. The hypothesis was that a 3D technique would give a better treatment outcome compared with a 2D technique. Methods Orthognathic treatment for 62 subjects, aged 18 to 28 years, with severe Class III malocclusion was planned with both 2D and 3D techniques. After treatment planning but before surgery, the patients were randomly allocated via blind collection of 1 enveloped card for each subject in a 1:1 ratio to the test (3D) or the control (2D) group. Thus, the intervention was according to which planning technique was used. The primary outcome was patient‐reported outcome measures. The secondary outcome was relationship between patient‐reported outcome measures and cephalometric accuracy. Questionnaires on the patients health‐related quality of life (HRQoL) were distributed preoperatively and 12 months after surgical treatment. The questionnaires were coded, meaning blinding throughout the analysis. Differences between groups were tested with the Fisher permutation test. The HRQoL was also compared with measurements of cephalometric accuracy for the 2 groups. Results Three subjects were lost to clinical follow‐up, leaving 57 included. Of these, 55 subjects completed the questionnaires, 28 in the 2D and 27 in the 3D groups. No statistically significant difference regarding HRQoL was found between the studied planning techniques: the Oral Health Impact Profile total showed −3.69 (95% confidence interval, −19.68 to 12.30). Consistent results on HRQoL and cephalometric accuracy showed a difference between pretreatment and posttreatment that increased in both groups but to a higher level in the 3D group. A difference between pretreatment and posttreatment HRQoL was shown for both groups, indicating increased quality of life after treatment. This supports recent findings comparing 3D and 2D planning techniques. No serious harm was observed during the study. Conclusions Improvements of HRQoL were shown after treatment independent of which planning technique, 2D or 3D, was used. No statistically significant difference was found between the planning techniques. Registration This trial was not registered. Protocol The protocol was not published before trial commencement. Funding This project was supported by personal grants to Martin Bengtsson from the Scandinavian Association of Oral and Maxillofacial Surgeons (25000 SEK), the Southern Region of the Swedish Dental Association (50000 SEK), and the Swedish Association of Oral and Maxillofacial Surgeons (25000 SEK). The sponsors had no influence on the study design, analysis of the data, or the writing of the article. HighlightsEffects of 2D and 3D orthognathic surgical planning on HRQoL were compared.No statistically significant differences in improvements of HRQoL were found.Both the 2D and 3D planning techniques resulted in improved HRQoL.