Linking patient-reported oral and general health-related quality of life.

Background: The relationship between oral and overall health is of interest to health care professionals and patients alike. This study investigated the correlation between oral health-related quality of life (OHRQoL) and health-related quality of life (HRQoL) in a general adult population. Methods: This cross-sectional study used a convenience sample of adult participants (N = 607) attending the 2022 Minnesota County and State fairs in USA, the 5-item Oral Health Impact Profile (OHIP-5) assessed OHRQoL, and the 10-item PROMIS v.1.2 Global Health Instrument assessed HRQoL. Spearman and Pearson correlations were used to summarize the bivariable relationship between OHRQoL and HRQoL (both physical and mental health dimensions). A structural equation model determined OHRQoL-HRQoL correlations (r). Correlations' magnitude was interpreted according to Cohen's guidelines (r = 0.10, 0.30, and 0.50 to demarcate "small," "medium," and "large" effects, respectively). Results: OHRQoL and HRQoL correlated with r = 0.52 (95% confidence interval, CI: [0.50-0.55]), indicating that the two constructs shared 27% of their information. According to Cohen, this was a "large" effect. OHRQoL, and the physical and mental HRQoL dimensions correlated with r = 0.55 (95% CI: [0.50-0.59]) and r = 0.43 (95% CI: [0.40-0.46]), respectively, indicating a "large" and a "medium" effect. OHRQoL and HRQoL were substantially correlated in an adult population. Conclusion: Using OHIP-5 to assess their dental patients' oral health impact allows dental professionals to gain insights into patients' overall health-related wellbeing.

DENTAL PATIENT-REPORTED OUTCOMES IN GERIATRIC DENTISTRY : A call for clinical translation.

As the proportion of older adults in the world population increases, there is an increasing need to provide adequate dental care for this very heterogeneous group of individuals. The relationship between oral and systemic health, the impact of medication on oral health, and the influence of accessibility to dental care and other social and environmental factors shape the provision of dental care for older adults more than in children, younger, and middle-aged adults. However, while dental care for older adults is shaped by these factors and is often different from the care for other adults, what matters to older dental patients does not differ from what matters to dental patients in general. The four dimensions of oral health-related quality of life (OHRQoL)-Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-capture dental patients' suffering from oral disorders. OHRQoL questionnaires can be used to assess this impact and to achieve results that are compatible with adults in general. More than in other age groups, cognitive impairments or dementia limit the usefulness of questionnaires or interviews for oral health impact assessment. In these situations, family members or caregivers can assess the patient's oral health impact, and oral health care providers need to rely more on physical oral health characteristics for clinical decision-making than in other dental patients. While the tools to measure oral health impact change, the targets for dental care stay the same. Prevention and reduction of functional, painful, aesthetical, and broader psychosocial impact related to oral disorders are the central tasks for geriatric dentistry as they are for dentistry in general. The aim of the manuscript is to highlight the importance of patient-reported outcome measures in geriatric dentistry, addressing challenges and opportunities for their application.

GLOSSARY FOR DENTAL PATIENT-CENTERED OUTCOMES.

Dental patient-centered outcomes can improve the relevance of clinical study results to dental patients and generate evidence to optimize health outcomes for dental patients. Dental patient-reported outcomes (dPROs) are of great importance to patient-centered dental care. They can be used to evaluate the health outcomes of an individual patient about the impact of oral diseases and treatment, and to assess the quality of oral health care delivery for a health care entity. dPROs are measured with dental patient-reported outcome measures (dPROMs). dPROMs should be validated and tested before wider dissemination and application to ensure that they can accurately capture the intended dPROs. Evidence suggests inadequate dPRO usage among dental trials, as well as potential flaws in some existing dPROMs. This Glossary presents a collection of main terms in dental patient-centered outcomes to help clinicians and researchers read and understand patient-centered clinical studies in dentistry.

OHIP-5 FOR SCHOOL-AGED CHILDREN.

BACKGROUND: Different dental patient-reported outcome measures (dPROMs) exist for children and adults, leading to an incompatibility in outcome assessment in these 2 age groups. However, the dental patient-reported outcomes (dPROs) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the same in the 2 groups, providing an opportunity for compatible dPRO assessment if dPROMs were identical. Therefore, we adapted the 5-item Oral Health Impact Profile (OHIP-5), a recommended dPROM for adults, to school-aged children to allow a standardized dPRO assessment in individuals aged 7 years and above. AIM: It was the aim of this study to develop a 5-item OHIP for school-aged children (OHIP-5School) and to investigate the instrument's score reliability and validity. METHODS: German-speaking children (N = 95, mean age: 8.6 years +/- 1.3 years, 55% girls) from the Department of Pediatric Dentistry at the Medical University of Vienna, Austria and a private dental practice in Bergisch Gladbach, Germany participated. The original OHIP-5 was modified and adapted for school going children aged 7-13 years and this modified version was termed OHIP-5School. It's score reliability was studied by determining scores' internal consistency and temporal stability by calculating Cronbach's alpha and intraclass correlation coefficients, respectively. Construct validity was assessed comparing OHIP-5School scores with OHIP-5 as well as Child Perceptions Questionnaire (CPQ-G8-10) scores. RESULTS: Score reliability for the OHIP-5School was "good" (Cronbach's alpha: 0.81) or "excellent" (Intraclass correlation coefficient: 0.92). High correlations between OHIP-5School, OHIP-5, and CPQ-G8-10 scores were observed and hypotheses about a pattern of these correlations were confirmed, providing evidence for score validity. CONCLUSION: The OHIP-5School and the original OHIP-5 are short and psychometrically sound instruments to measure the oral health related quality of life in school-aged children, providing an opportunity for a standardized oral health impact assessment with the same metric in school-aged children, adolescents, and adults.

Validation of the HeLD-14 functional oral health literacy instrument in a general population.

Background: Oral health literacy (OHL) is recognized as an important determinant of oral outcomes. Measuring OHL with a valid and reliable instrument that accurately captures the functional nature of this construct across cultures is needed. The short version of the Health Literacy in Dentistry scale (HeLD-14) shows promise as an appropriate instrument due to its inclusion of comprehensive domains hypothesized to comprise OHL. While studies validating the instrument in several languages have occurred, the number of dimensions in the various analyses range from one to seven. Validation of the HeLD-14 in a general English-speaking population is also lacking. The purpose of this study was to explore and confirm the dimensionality of the HeLD-14 in a general US English-speaking population. Methods: The psychometric properties of HeLD-14 were evaluated in a sample of 631 participants attending the Minnesota State Fair. Construct validity was assessed using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) on the data set split into two groups. Internal consistency reliability was assessed using the Cronbach's alpha coefficient. Concurrent validity was established between the HeLD-14 and the Oral Health Inventory Profile (OHIP-5) using Pearson's correlation. Results: EFA found, and CFA reinforced, a unidimensional structure of the HeLD-14. Cronbach's alpha was acceptable at 0.92. Fit assessment also supported a unidimensional structure, comparative fit index = 0.992, Tucker-Lewis index = 0.991, root mean square error of approximation = 0.065, and standardized root mean square residual = 0.074. Concurrent validity analyses showed that the HeLD-14 correlated with the OHIP-5. Conclusions: The HeLD-14 is a unidimensional reliable and valid instrument for measuring the oral health literacy in the general US English-speaking adult population.

MEASURING PATIENT EXPERIENCE OF ORAL HEALTH CARE: A CALL TO ACTION.

BACKGROUND: Surveys to measure patients' experiences of health care are common practice in general medical care to improve patient centered care. However, such questionnaires are not consistently used to capture the patient's experience of oral health care. Because patient experience is an important component of oral health care, there is an urgent need to measure it in the oral health care setting. PURPOSE: The purpose of this article is to illustrate the need for patient experience measurement in oral health care, highlight the challenges such measurement in this setting faces, and provide a set of next steps to advance care experience measurement for dental patients. BASIC PROCEDURES: We conducted a comprehensive review of the literature examining patient experience measurement in medical and oral health care. This focused on studies aimed at understanding the current measurement landscape and existing measurement tools. We also gathered additional information and perspectives through discussions with key informants and stakeholders. MAIN FINDINGS: There is a critical need for patient experience measurement in oral health care. To develop a program to measure patient experiences of oral care, the following should be done: (1) convene stakeholders and get their buy-in; (2) develop a patient experiences of oral health conceptual framework; (3) develop a survey tool that captures key aspects of patient experiences of oral health; (4) pilot the survey tool; (5) assess the survey tool...s psychometric properties; and (6) refine and finalize the survey tool. PRINCIPLE CONCLUSIONS: To advance the measurement of the quality of oral health care, we outline a stepwise methodology that captures dental patient experiences of oral health care.

HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH.

BACKGROUND: When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets. AIM: Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA). METHODS: This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns. RESULTS: Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated. CONCLUSIONS: Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

Cross-cultural adaptations of the oral health impact profile - An assessment of global availability of 4-dimensional oral health impact characterization.

OBJECTIVE: The 4-dimensional (4D) structure of oral health-related quality of life (OHRQoL), comprising of the dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact, is clinically plausible and psychometrically solid. The original Oral Health Impact Profile (OHIP) instrument and its short-form versions have been proven to lend themselves well to the assessment of these 4 OHRQoL dimensions. However, whether this 4-dimensional approach to oral health impact characterization can be performed on a global scale, that is, for most of the world's population, is not known. The purpose of this study was perform a systematic review to identify all cross-cultural adaptations of OHIP versions with 49, 20/19, 14, and 5 items. The global availability of 4D oral health impact characterization was investigated. METHODS: We performed searches of electronic databases- Scopus, Pubmed, Web of Science, along with hand searching in June 2022 to identify all cross-cultural language adaptations of the different OHIP versions available in the literature. Whether the 4D oral health impact assessment can be considered a global approach was judged based on the criteria whether 4D psychometric information was available for at least 75% of the most widely spoken languages with an OHIP version. RESULTS: We identified 82 studies with a total of 90 individual OHIP language versions for 45 languages. Among the top 20 languages with most first-language (native) speakers, 16 (80%) had OHIP versions. Among the top 20 languages with the most first- and second-language speakers, also 16 (80%) had OHIP versions. Of these 16 OHIP versions, across both language categories, 13 versions (81%) allowed for 4D oral health impact characterization. CONCLUSION: Four-dimensional oral health impact assessment using the dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact can be considered a globally available approach given that OHIP versions with 4D information are readily available for most widely spoken languages. Thus, psychometrically sound, practical, and internationally comparable oral health impact characterization can be easily performed to study population oral health and determine oral disease impact and treatment efficacy for dental patients.

Differential Item Functioning of the Jaw Functional Limitation Scale

AIMS: To assess the differential item functioning (DIF) of the Jaw Functional Limitation Scale (JFLS) due to gender, age, and language (English vs Spanish). METHODS: JFLS data were collected from a consecutive sample of 2,115 adult dental patients from HealthPartners dental clinics in Minnesota. Participants with missing data were excluded, and analyses were performed using data from 1,678 participants. Whether the item response theory (IRT) model assumptions of essential unidimensionality and local independence held up for the JFLS was examined. Then, using Samejima's graded response model, the IRT log-likelihood ratio approach was used to detect DIF. The magnitude and impact of DIF based on Raju's noncompensatory DIF (NCDIF) cutoff value of 0.096, Cohen's effect sizes, and test (or scale) characteristic curves were also assessed. RESULTS: Essential unidimensionality was confirmed, but locally dependent items were found on the JFLS. A few items were flagged with statistically significant DIF after adjustment for multiple comparisons. The NCDIF indices associated with all DIF items were < 0.096, and they had small effect sizes of ≤ 0.2. The differences between the expected scores shown in the test characteristic curves were little to none. CONCLUSION: The present results support the use of the JFLS summary score to obtain psychometrically robust score comparisons across English- and Spanish-speaking, male and female, and younger and older dental patients. Overall, the magnitude of DIF was relatively small, and the practical impact minimal.

Comparison of two rating scales with the orofacial esthetic scale and practical recommendations for its application.

PURPOSE: We compared measurement properties of 5-point and 11-point response formats for the orofacial esthetic scale (OES) items to determine whether collapsing the format would degrade OES score precision. METHODS: Data were collected from a consecutive sample of adult dental patients from HealthPartners dental clinics in Minnesota (N = 2,078). We fitted an Item Response Theory (IRT) model to the 11-point response format and the six derived 5-point response formats. We compared all response formats using test (or scale) information, correlation between the IRT scores, Cronbach's alpha estimates for each scaling format, correlations based on the observed scores for the seven OES items and the eighth global item, and the relationship of observed and IRT scores to an external criterion using orofacial appearance (OA) indicators from the Oral Health Impact Profile (OHIP). RESULTS: The correlations among scores based on the different response formats were uniformly high for observed (0.97-0.99) and IRT scores (0.96-0.99); as were correlations of both observed and IRT scores and the OHIP measure of OA (0.66-0.68). Cronbach's alpha based on any of the 5-point formats (α = 0.95) was nearly the same as that based on the 11-point format (α = 0.96). The weighted total information area for five of six derived 5-point response formats was 98% of that for the 11-point response format. CONCLUSIONS: Our results support the use of scores based on a 5-point response format for the OES items. The measurement properties of scores based on a 5-point response format are comparable to those of scores based on the 11-point response format.

Commonalities among dental patient-reported outcomes (dPROs)-A Delphi consensus study.

Improvement of patients' oral health-related quality of life (OHRQoL) is the main goal of oral health care professionals. However, OHRQoL is not a homogenous construct and how to assess it is challenging because of the large number of currently available instruments. Investigating available instruments and what they have in common would be necessary for consolidation and standardization of these instruments into a smaller set of tools. If the OHRQoL dimensions including Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the fundamental building blocks of the dental patient's oral health experience, then these dimensions should be measured by generic multi-item dPROMs. In this study, a panel of 11 international dentists use the Delphi consensus process to determine how well 20 of these instruments measured the four OHRQoL dimensions. All 20 dPROMs questionnaires assessed at least one OHRQoL dimension while all four OHRQoL dimensions were measured by at least one dPROM instrument, i.e., the four OHRQoL dimensions were essential components of the patient's oral health experience. This shows that the currently available generic multi-item dPROMs have a lot in common, in that they share Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact as targeted dimensions. Based on these commonalities, it is plausible and desirable to move towards a single four-dimensional metric to assess oral health impact in all clinical, community-based, and research settings. This step is necessary to advance evidence-based dentistry and value-based oral health care.

Should the frequency, severity, or both response scales be used for multi-item dental patient-reported outcome measures?

BACKGROUND: The Oral Impacts on Daily Performances (OIDP) index asks the respondents to indicate both, the frequency and severity of the impact. However, it is not clear if the two scaling methods are correlated, and if using one scale is sufficient. The purpose of the study was to investigate the correlation between frequency and severity rating scales of the OIDP instrument, and whether only one of the rating scales can be used instead of both. METHODS: A battery of patient-reported outcome questionnaires were administered to a consecutive sample of adult dental patients from HealthPartners dental clinics in Minnesota (N = 2,115). Only those who responded to any of the OIDP items were included in the analysis for this study (N = 873). We assessed correlations between the frequency and severity scales for all OIDP items, and for the summary scores of the two OIDP response scales. We additionally fit a categorical structural equation model (SEM) (or an item factor analysis model) and examined the correlation between two latent variables (Frequency and Severity). RESULTS: The correlation estimates for all OIDP items were greater than 0.50, indicating large correlations between the frequency and severity scores for each OIDP item. The correlation estimate between the two summary scores was 0.85 (95% CI [0.82-0.86]). When we calculated the correlation coefficient using a latent variable model, the value increased to 0.96 (95% CI [0.93-1.00]). CONCLUSION: Our study findings show that OIDP frequency and severity scores are highly correlated, which indicates the use of one scale only. Based on previous evidence, we recommend applying the frequency rating scale only in research and clinical settings.

Development of a one-item version of the Orofacial Esthetic Scale.

OBJECTIVES: Orofacial appearance is increasingly recognized as an important dental patient-reported outcome making instrument development and refinement efforts to measure the outcome better necessary. The aim of this study was to derive a one-item version of the Orofacial Esthetic Scale (OES). MATERIALS AND METHODS: OES data were collected from a consecutive sample of a total of 2113 adult English- or Spanish-speaking dental patients from HealthPartners dental clinic in Minnesota. Participants with missing data were excluded and analysis were performed using data from 2012 participants. Orofacial appearance was assessed with the English and the Spanish language version of the OES. Linear regression analysis was performed, with the OES item 8 ("Overall, how do you feel about the appearance of your face, your mouth, and your teeth?") as the predictor variable and the OES summary score as the criterion variable, to calculate the adjusted coefficients of determination (R2). RESULTS: The value of adjusted R2 was 0.83, indicating that the OES item 8 score explained about 83% of the variance of the OES summary score. The difference in R2 scores between the two language groups was negligible. CONCLUSION: The OES item 8 can be used for the one-item OES (OES-1). It is a psychometrically sound instrument for measuring orofacial appearance. CLINICAL RELEVANCE: Due to its easy application and sufficient psychometric properties, the OES-1 can be used effectively as an alternative to longer OES instruments in all areas of dental practice and research.

Frequency of Four-dimensional Oral Health Problems across Dental Fields - a Comparative Survey of Slovenian and International Dentists.

OBJECTIVES: To compare the frequency of patients' oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions. METHODS: An anonymous electronic survey in the English language was designed using Qualtrics software. A probability sampling for Slovenia and a convenience sampling strategy for dentist recruitment was applied for 31 countries. Dentists engaged in six dental fields were asked to categorize their patients' oral health problems and prevention needs into the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). Proportions of patients' problems and prevention needs were calculated together with the significance of Slovenian and international dentists' differences based on dental fields and WHO regions. RESULTS: Dentists (n=1,580) from 32 countries completed the survey. There were 223 Slovenian dentists (females: 68%) with a mean age (SD) of 41 (10.6) years and 1,358 international dentists (females: 51%) with a mean age (SD) of 38 (10.4). Pain-related problems and prevention needs were the most prevalent among all six dental fields reported by dentists; Slovenian (37%) and 31 countries (45%). According to Cohen, differences between Slovenia, the broader European Region, and 31 countries were considered non-significant (<0.1). CONCLUSION: According to the dentists' responses, the frequency of patients' oral health problems and prevention needs are proportionate between Slovenia and 31 countries, regionally and globally. The four OHRQoL dimensions can be considered universal across all dental fields.

IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE.

BACKGROUND: A shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars. OBJECTIVE: Purpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement. METHODS: Patients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed. RESULTS: After an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions. CONCLUSIONS: In patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients' preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

Is assessment of oral health-related quality of life burdensome? An item nonresponse analysis of the oral health impact profile.

AIM: This study aimed to investigate if in the 49-item Oral Health Impact Profile (OHIP): (i) more missing data occurred when participants answered more questions, (ii) more missing data occurred in a particular item or set of related items, and (iii) item missingness was associated with the demographic characteristics and oral health-related quality of life (OHRQoL) impairment level. METHODS: We used OHIP data from the Dimensions of OHRQoL (DOQ) project, which consolidated data from 35 individual studies. Among these studies, we analyzed OHIP data from 19 studies (4,847 surveyed individuals, of which 3,481 were completed under supervision and 1,366 were completed unsupervised) that contained some missing information. We computed descriptive statistics to investigate the OHIP missingness. We also used logistic regression analyses, with missing information as the dependent variable, and number of questions filled in (OHIP item rank) as the independent variable for samples with and without supervision. To investigate whether missing data occurs more in a particular item or set of related items we fitted regression models with individual OHIP items and the OHRQoL dimensions as indicator variables. We also investigated age, gender, and OHRQoL level as predictor variables for missing OHIP items. RESULTS: We found very low levels of missingness across individual OHIP items and set of related items, and there was no particular item or set of related items that was associated with more missing data. Also, more missing data did not depend on whether the participants answered more questions. In studies without supervision, older persons and females were 5.47 and 2.66 times more likely to have missing items than younger persons and females. However, in studies with supervision, older persons, and participants with more OHRQoL impairment were 1.70 and 2.65 times more likely to have missing items. CONCLUSION: The study participants from general and dental patient populations did not find OHIP-49 burdensome. OHIP item missingness did not depend on a particular OHIP item or set of related items, or if the study participants responded to a greater number of OHIP items. We did not find a consistent pattern of the influence of sociodemographic and OHRQoL magnitude information on OHIP missingness. The amount of missing OHIP information was low making any potential influence likely small in magnitude.

Including the patient's oral health perspective in evidence-based decision-making.

BACKGROUND: How to approach the assessment of patient-perceived oral health is of fundamental importance for the evaluation of clinical and public health interventions because the patient's assessment should be used as an adjunct to objective dental findings in order to decide which interventions work. AIM: This review article aims to provide an overview of the principles, current status, and future outlook for how a patient's oral health perception can and should be assessed. REVIEW FINDINGS: The hierarchical position of dental patient-reported outcomes, oral health-related quality of life (OHRQoL), and dental patient-reported outcome measures within the hierarchical concepts of quality of life and its component, health-related quality of life, is presented. The Mapping Oral Disease Impact with a Common Metric project is outlined as an international effort to describe current approaches to standardize the measurement of oral impact using the four OHRQoL dimensions of oral function, orofacial pain, orofacial appearance, and psychosocial impact. CONCLUSION: Ultimately, these four dimensions of OHRQoL provide a practical and psychometrically solid way to collect and analyze OHRQoL data for all oral diseases in all settings, and eventually for all treatments through the use of a standardized, universal measurement tool. This universal impact metric capturing the patient's oral health perspective is the key to moving evidence-based dentistry and value-based oral health care forward.

Pediatric patients' reasons for visiting dentists in all WHO regions.

BACKGROUND: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. METHODS: Dentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients' oral health problems and prevention needs were computed. FINDINGS: Data from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories. CONCLUSIONS: The study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

Nonmalignant Oral Disease--Specific Dental Patient-Reported Outcome Measures for Adult Patients: A Systematic Review.

OBJECTIVES: Dental patient-reported outcome measures (dPROMs) can be differentiated into outcome measures for all oral diseases, so-called disease-generic dPROMs, and measures for specific oral diseases, so-called disease-specific dPROMs. The aim of this systematic review was to identify the psychometrically validated nonmalignant disease-specific dPROMs for adult patients and the dental patient-reported outcomes (dPROs) they measure. METHODS: This systematic review searched Ovid MEDLINE, Embase, PsycINFO, and the Cochrane databases along with hand searching, through July 28, 2020, to identify original articles of English language, multi-item dPROMs for adult dental patients with a specific oral disease, condition, or oral manifestations of systemic diseases. We analyzed the questionnaires for content commonalities, the reference or recall period, and the dimensionality. RESULTS: We retrieved 4228 unique references and identified 34 questionnaires; of which, 31 questionnaires captured impacts from oral diseases or conditions and three from oral manifestations of systemic diseases. All questionnaires together contained 102 dPROMs, measuring 75 dPROs. Oral health-related quality of life was a broader dPRO, which was measured by 24 dPROMs. The 74 narrower dPROs were measured by 78 dPROMs. The dPRO names suggested that essentially four dPROs were measured: Oral Function (N = 19), Orofacial Pain (N = 7), Orofacial Appearance (N = 11), and Psychosocial Impact (N = 37). CONCLUSIONS: Many psychometrically validated tools (N = 102) are available to measure the impact of specific nonmalignant oral disease on patients. While these tools intend to measure the particular patient-perceived impact profile of the oral disease, all tools measure in essence only four, more general concepts - the dimensions of oral health-related quality of life.

Dental patients' functional, pain-related, aesthetic, and psychosocial impact of oral conditions on quality of life-Project overview, data collection, quality assessment, and publication bias.

BACKGROUND: Knowledge about the magnitude of Oral Health-Related Quality of Life (OHRQoL) impairment across dental patient populations is essential for clinical practice, public health and research. Within the project Mapping Oral Disease Impact with a Common Metric, this systematic review aimed to describe functional, pain-related, aesthetic and broader psychosocial impact of oral conditions with a single metric using OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact. METHODS: A search using PubMed, EMBASE, Cochrane, CINAHL and PsycINFO was performed on 8 June 2017, and updated on 14 January 2019. Only publications in the English language were considered. To characterise the extent of available standardised and clinically relevant OHRQoL information, we determined the number of publications, dental patient populations, which are clinically similar, and patient samples within each population with four-dimensional OHRQoL information using the Oral Health Impact Profile (OHIP) questionnaire. A quality assessment and a publication bias assessment were performed. RESULTS: We identified 171 publications that characterised 199 dental populations and 329 patient samples with four-dimensional OHRQoL information. The vast majority of populations were only characterised by one patient sample. Study quality was not related to OHRQoL magnitude, and substantial publication bias could be excluded. CONCLUSIONS: Standardised and clinically relevant information using the four OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact was available for a significant number of dental patient populations. Findings can provide a framework to interpret OHRQoL impairment of individual patients, or groups of patients, for clinical practice, public health and research.