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.

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.

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.

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.

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.

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.

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.

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.

Assessment of differential item functioning across English and Spanish versions of the Orofacial Esthetic Scale.

OBJECTIVES: To investigate differential item functioning across the Spanish and English versions of the Orofacial Esthetic Scale (OES). METHODS: OES data were collected from a consecutive sample of a total of 622 adult dental patients (311 English- and 311 Spanish-speaking adults) from HealthPartners dental clinics in Minnesota. We inspected boundary characteristic curves (BCCs) based on item response theory (IRT) in English speakers and Spanish speakers to examine differential item functioning (DIF). Using the Samejima's graded response model, we used the item response theory log-likelihood ratio (IRTLR) approach to test whether DIF was statistically significant. RESULTS: Inspection of the BCCs did not reveal substantial differences in item difficulty and discrimination between English speakers and Spanish speakers. When IRTLR tests were performed for the seven OES items, no item was flagged with significant DIF after P-values were adjusted for multiple comparisons. CONCLUSIONS: Pooling of Orofacial Esthetic Scale (OES) data from English and Spanish-speaking dental patients for analysis and interpretation is supported by the absence of differential item functioning (DIF) across the two language groups.

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.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations.

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

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.

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.

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.

Foundations of oral health-related quality of life.

Oral health-related quality of life (OHRQOL) is the component of health-related quality of life that relates to the effects of oral diseases and dental interventions on patients. This article describes why OHRQOL is important and how it is measured. The conceptual basis for OHRQOL is discussed. A four-dimensional structure consisting of Oral Function, Orofacial Pain, Orofacial Appearance and Psychosocial Impact as the OHRQOL dimensions has emerged as psychometrically sound and clinically intuitive. Consequently, when the impact of oral diseases or the effects of dental interventions are measured, four dimension scores capturing these attributes need to be used.

Bayesian Network Meta-analysis of Multiple Outcomes in Dental Research.

OBJECTIVES: Dental research typically targets multiple outcomes. Interdental cleaning devices such as interdental brushes (IB) and water jet devices (WJ) share a sizable portion of the medical device market. However, recommendations for device selection are limited by the conflicting evidence from multiple outcomes in available studies and the lack of an appropriate synthesis approach to summarize evidences taken from multiple outcomes. In particular, both pairwise meta-analyses and single-outcome network meta-analyses can give discordant results. The purpose of this multioutcome, Bayesian network meta-analysis is to introduce this innovative method to the dental research community using data from interdental cleaning device studies for illustrative purposes. METHODS: We reanalyzed a network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation, which included 22 trials assessing 10 interproximal oral hygiene aids. We focused on the primary outcome of gingival inflammation, which was measured by 2 correlated outcome variables, the Gingival Index (GI) and bleeding on probing (BOP). RESULTS: In our previous single-outcome analysis, we concluded that IB and WJ rank high for reducing gingival inflammation while toothpick and flossing rank last. In this multioutcome Bayesian network meta-analysis with equal weight on GI and BOP, the surface under the cumulative ranking curve was 0.87 for WJ and 0.85 for IB. WJ and IB remained ranked as the 2 best devices across different sets of weightings for the GI and BOP. CONCLUSION: In conclusion, multioutcome Bayesian network meta-analysis naturally takes the correlations among multiple outcomes into account, which in turn can provide more comprehensive evidence.

Why Patients Visit Dentists - A Study in all World Health Organization Regions.

OBJECTIVE: The dimensions of oral health-related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions. METHODS: Dentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated. RESULTS: For every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering. CONCLUSION: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.

Prevalence and normative values for jaw functional limitations in the general population in Sweden.

OBJECTIVES: For jaw functional limitations measured by the Jaw Functional Limitation Scale (JFLS), (a) determining prevalence in the Swedish general adult population, (b) investigating the influence of demographic factors and self-reported dental status and (c) deriving normative values. METHODS: A random sample of the general adult population in Sweden was approached (response rate: 46%, N = 1,372). Prevalence was determined for the JFLS summary score and individual items. The influence of age, gender and dental status was investigated with regression analyses and normative values presented. RESULTS: The JFLS median score was 0, and all items had prevalences ≤30%. Age and gender did not influence jaw functional limitations but dental status did. Normative JFLS scores were 1, 9 and 28 for the 7th, 8th and 9th deciles, respectively. In dental status-stratified norms, 9th deciles were 20, 43 and 100, for subjects with natural teeth only, removable and complete dentures, respectively. CONCLUSIONS: The Swedish general adult population had excellent jaw function, but dental status was major determinant. In the absence of information linking JFLS scores to important patient concerns, the score distribution can serve as a reference with the 9th decile as threshold for functional limitation.