Bias in retrospective assessment of perceived dental treatment effects when using the Oral Health Impact Profile.

PURPOSE: Aim of this exploratory study was to investigate whether a retrospective assessment of oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP) is susceptible to bias such as implicit theory of change and cognitive dissonance. METHODS: In this prospective clinical study, a sample of 126 adult patients (age 17-83 years, 49% women) requiring prosthodontic treatment was consecutively recruited. The OHRQoL was assessed using the 49-item OHIP at baseline and at follow-up. Additionally, patients were asked at follow-up to retrospectively rate their oral health status at baseline (retrospective pretest or then-test) and the change in oral health status using a global transition question. Furthermore, patients' ratings of overall oral health and general health were used as validity criteria for the OHRQoL assessments. Response shift was calculated as the difference between the initial and retrospective baseline assessments. RESULTS: Baseline and retrospective pretest did not differ substantially in terms of internal consistency and convergent validity. Response shift was more pronounced when patients perceived a large change in OHRQoL during treatment. Retrospective pretests were more highly correlated with the baseline than with the follow-up assessment. CONCLUSION: Findings suggest that retrospective assessments of OHRQoL using the OHIP-49 are susceptible to bias. Cognitive dissonance is more likely to appear as a source of bias than implicit theory of change.

Oral health-related quality of life of children and adolescents with and without migration background in Germany.

OBJECTIVES: To compare oral health-related quality of life (OHRQoL) in children and adolescents with and without migration background, and to assess whether potential differences in OHRQoL can be sufficiently explained by oral health characteristics. MATERIALS UND METHODS: A consecutive sample of 112 children and adolescents was recruited in a German university-based orthodontic clinic, and a convenience sample of 313 children and adolescents of German public schools was enrolled in the study (total N = 425, age range 7-17 years). However, 29 participants were excluded due to insufficient information regarding migration background. Accordingly, the non-migrant group consisted of 262 participants (61.6%). For children with migration background, two groups were classified: (i) one parent born in a foreign country (N = 41, 9.6%, single-sided migration background), and (ii) both parents and/or child born in a foreign country ( N= 93, 21.9%, double-sided migration background). OHRQoL was assessed using the German 19-item version of the Child Oral Health Impact Profile (COHIP-G19). Additionally, physical oral health of 269 children with classified migration background was determined in a dental examination. RESULTS: Overall, OHRQoL was significantly lower in the group with double-sided migration background indicated by lower COHIP-G19 summary scores (mean: 58.6 points) than in the group with single-sided migration background (mean: 63.3 points) or the non-migrant group (mean: 63.2 points). Likewise, the summary scores of the subscale "oral health well-being" and the subscale "social/emotional, school, and self-image" were also lower in the double-sided migrant group than in the other two groups. Linear regression analysis showed an association between double-sided migration background and impaired OHRQoL, even after statistically controlling for demographic, socioeconomic, and oral health characteristics. CONCLUSION: Children and adolescents with double-sided migration background have poorer OHRQoL than comparably aged migrants with single-sided migration background or non-migrations. Between-group differences in OHRQoL could not be sufficiently explained by effects of socioeconomic status or physical oral health characteristics. Thus, other methodological, cultural, or immigration-related factors might also play an important role for the observed effects.

Impact of administration mode on Oro-facial Appearance assessment using the Oro-facial Esthetic Scale.

BACKGROUND: Oro-facial Appearance is increasingly recognised as an important component of patient-reported outcomes in dentistry. While the Oro-facial Esthetic Scale (OES) has sufficient psychometric properties to characterise dental patient's global assessment of Oro-facial Appearance, the equivalence of alternative methods of administration has not been demonstrated so far. OBJECTIVE: Aim of this study was to investigate whether and to what extent method of administration affects OES scores. METHODS: Participants were recruited as convenience sample of 42 adult dental patients registered for a regular recall visit and with no actual need of dental interventions. Oro-facial Appearance was assessed using the German version of the OES applying three methods of administration: (a) face-to-face interview, (b) self-administered questionnaire and (c) telephone interview, in a randomised order with a period of about one week between assessments. RESULTS: Oro-facial Esthetic Scale summary scores did not differ substantially or statistically significantly between the different methods of administration (two-way ANOVA; P = 0.209). Intraclass correlation coefficients (ICC) for pairwise comparisons of administration modes ranged from 0.67 to 0.84 indicating fair to excellent test-retest reliability. Internal consistency was satisfactory with lower limits of the 95% confidence interval (CI) of Cronbach's alpha ranging from 0.82 to 0.88 for the administration modes. Correlations of the OES summary score with a single item assessing global Oro-facial Appearance supported convergent validity with lower limits of the CI of the correlation coefficients ranging between 0.58 and 0.75. CONCLUSION: The administration mode has no significant impact on Oro-facial Appearance assessment when using the OES.

Diagnostic accuracy of parents' ratings of their child's oral health-related quality of life.

PURPOSE: Oral health-related quality of life (OHRQoL) in children and adolescents can be assessed with two different approaches: children can directly report their own perceptions or parents can serve as proxies and rate their child's OHRQoL from their perspectives. It was the aim to investigate whether parents can accurately rate their children's OHRQoL and to compare agreement between OHRQoL domains and between age groups. METHODS: In this cross-sectional study, a sample of 140 children aged 7-17 years was consecutively recruited at a university-based orthodontic clinic and a public school. OHRQoL was assessed with the 19-item Child Oral Health Impact Profile (COHIP) with one version for the child and one for the parent. Correlation between child and parent ratings and diagnostic accuracy of the parental rating to assess children's OHRQoL was calculated, and findings were compared between 7-11- and 12-17-year-old children. RESULTS: COHIP summary score differed only slightly between parents (mean 60.7 ± 9.8 points) and children (mean 61.9 ± 8.9 points). Correlation of summary scores was r = 0.38, corresponding to a moderate agreement. Median of item prevalence of all 19 items was 29.5 % for children and 41.7 % for parents. Median of positive predictive values was 50.9 % and median of negative predictive values 76.7 %, with no substantial differences in age groups. CONCLUSIONS: Parents' perception of their children's OHRQoL is not accurate enough to detect oral health problems in an individual child aged between 7 and 17 years, and therefore, proxy OHRQoL assessment for individuals in this age group cannot be recommended.

The German 19-item version of the Child Oral Health Impact Profile: translation and psychometric properties.

OBJECTIVES: This study seeks to develop and validate the 19-item German version of the Child Oral Health Impact Profile (COHIP-G19), an instrument to assess the oral health-related quality of life (OHRQoL) in children and adolescents. MATERIALS AND METHODS: The 19 items of the original English-language COHIP were translated into German using an established forward-backward approach. For the assessment of the psychometric properties of the COHIP-G19, children and adolescents aged 7-17 years came from two samples: 112 patients were consecutively recruited at a university-based orthodontic clinic and 313 came from a convenience sample of students in public schools. RESULTS: Internal consistency of the COHIP-G19 was satisfactory in both populations (Cronbach's alpha, 0.78/0.80; average inter-item correlation, 0.16/0.17). The COHIP-G19 summary scores were correlated in the expected direction with a global oral health rating (r = 0.46/0.40) and two measures for perceived general health (EQ-5D-Y: r = 0.26/0.29; KIDSCREEN-27: r = 0.40/0.33). While COHIP-G19 summary scores did not significantly differ with respect to the presence of caries or gingivitis (p > 0.05), malocclusion and insufficient oral hygiene behavior were related to more impaired OHRQoL, represented in significantly lower COHIP-G19 summary scores in students in public schools (p < 0.05), but not in orthodontic patients. CONCLUSIONS: While this study revealed some potential to improve reliability and validity in scores of the German version of the COHIP-19, overall, the study proved the instrument has sufficient psychometric properties and is well comparable to the original English-language version. CLINICAL RELEVANCE: The COHIP-G19 is a valid and reliable instrument to assess OHRQoL in German children and adolescents in clinical and community settings.

Development and validation of the German version of the Orofacial Esthetic Scale.

OBJECTIVES: This study aimed to develop the German version of the Orofacial Esthetic Scale (OES-G) and to assess its psychometric properties. METHODS: The OES is an eight-item instrument with seven items directly addressing esthetic impacts of the orofacial region and an eighth item for a global assessment. It applies an 11-point ordinal rating scale, with summary scores ranging from 0 (worst) to 70 (best). The original OES items were translated into German using a forward-backward method. A de novo development of German items (n = 21 patients) and a cross-cultural adaptation after pilot testing (n = 15 patients) established content validity. Internal consistency and construct validity (structural, convergent, known-groups) of the OES-G were assessed in a sample of 165 prosthodontic patients. The OES was applied in 42 patients on two occasions, with a temporal distance of 2-4 weeks apart to determine test-retest reliability. RESULTS: Internal consistency of the OES-G was considered as satisfactory (Cronbach's alpha 0.94; average inter-item correlation 0.64). Intraclass correlation coefficient of 0.95 (95 % confidence interval 0.92-0.98) indicated excellent test-retest reliability. Correlation matrix and exploratory factor analysis provided support for unidimensionality of the measured construct. The OES-G summary score was correlated with the patients' global assessment of their esthetics (r = 0.87) and external ratings of the expert group (r = 0.55) and discriminated patients with treatment need (39.4 points) from patients without (58.4 points; p < 0.001) and with a large effect size. CONCLUSION: The OES-G has good psychometric properties and is a valuable instrument for the assessment of self-perceived orofacial esthetics.

Interpreting one oral health impact profile point.

BACKGROUND: Interpretation of scores from oral health-related quality of life (OHRQoL) instruments, such as the Oral Health Impact Profile (OHIP) is challenging. It was the aim of this study to determine how many oral impacts correspond to one point of the 49-item OHIP using a new approach which translates numeric problem counts into the traditionally used ordinal OHIP response categories. METHODS: A sample of 145 consecutively recruited prosthodontic patients seeking treatment or having a routine examination completed the German version of the 49-item OHIP with the original ordinal response format as a self-administered questionnaire. In addition, the numerical frequencies of impairment during the previous month were requested in personal interviews. Based on a multilevel mixed-effects linear regression, we estimated the mean difference with 95% confidence interval (CI) in numerical frequency between two adjacent ordinal responses. RESULTS: A numerical frequency of 15.2 (CI: 14.8 - 15.7) impacts per month corresponded to one OHIP point. This translates to approximately one impact every other day in the past month. CONCLUSIONS: The oral problem count per day that corresponds to one OHIP-49 point can be used to interpret this instrument's scores in cross-sectional and longitudinal studies. This number can help to better understand OHRQoL burden for patients, clinicians, and researchers alike.

Validation of the response format of the Oral Health Impact Profile.

The study investigated the validity of the response format of the Oral Health Impact Profile 49 (OHIP-49). The OHIP-49 was completed by 145 consecutive prosthodontic patients. For each OHIP item, subjects completed the standard ordinal response format (with responses given as never, hardly ever, occasionally, often, or very often, and scored from 0 to 4, respectively). Subjects also separately reported the absolute frequency of impacts for each item (numerical response format) in a personal interview. Response codes for the standard ordinal response format (0-4) and for the numerical response format were summed to give two separate OHIP summary scores. The reliability and validity of the scores generated from each response format were compared using the numerical response format as the standard. Score reliability was high and almost identical for both response formats. Score validity was also satisfactory with a high correlation of scores between response methods. There was also a moderate correlation of scores from both response methods with a single global rating of perceived oral health. These data support the validity of the standard ordinal response format of the OHIP and suggest the use of the numerical response format in order to help capture impacts on oral health when they are infrequent.

Measuring patients' orofacial appearance: Validity and reliability of the English-language Orofacial Esthetic Scale.

BACKGROUND: This study aimed to determine the psychometric properties of the English-language version of the Orofacial Esthetic Scale (OES-E) in a population of dental patients. METHODS: In this cross-sectional study, 1,784 English-speaking, adult dental patients (mean age, 56.7 [standard deviation, 15.8] years; 60.0% women) were included. The 8-item OES-E was used to assess orofacial appearance. Dimensionality of the OES was investigated through an analysis of the items' correlation matrix, a parallel analysis, and an exploratory factor analysis. Convergent validity was determined by means of several correlations between the OES and items of the Oral Health Impact Profile measuring orofacial appearance. Reliability of the OES was assessed as the instrument's internal consistency by means of computing Cronbach α and average interitem correlation. RESULTS: All analyses for dimensionality revealed that the OES is sufficiently represented by a single factor. Convergent validity was supported by means of the correlations of the OES summary score with the other measures of the construct with Pearson product moment and Spearman rank correlation coefficients of the expected size and direction. Cronbach α (lower boundary of 95% confidence interval, 0.94) and average interitem correlation (0.70) revealed that the scale's internal consistency was excellent. CONCLUSION: This study found that the OES-E has sufficient psychometric properties to characterize dental patient's global assessment of orofacial appearance. PRACTICAL IMPLICATIONS: The brevity and the easy application make the OES a pragmatic tool to clinically appraise the important construct of orofacial appearance in dental patients.

Interaction Between Awake and Sleep Bruxism Is Associated with Increased Presence of Painful Temporomandibular Disorder.

AIMS: To explore whether awake and sleep bruxism interact in their associations with painful temporomandibular disorders (TMD) and whether the interaction is multiplicative or additive. METHODS: In this case-control study, all participants (n = 705) were part of the multicenter Validation Project and were recruited as a convenience sample of community cases and controls and clinic cases. Logistic regression analyses were applied to test for the association between self-reported bruxism (sleep and/or awake) and the presence of painful TMD, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were computed. Regression models included an interaction term to test for multiplicative interaction, and additive interaction was calculated as the relative excess risk due to interaction (RERI). RESULTS: Based on logistic regression analyses adjusted for age and gender, the main effects for both awake (OR = 6.7; 95% CI: 3.4 to 12.9) and sleep (OR = 5.1; 95% CI: 3.1 to 8.3) bruxism were significant. While the multiplicative interaction (OR = 0.57; 95% CI: 0.24 to 1.4) was not significant, the results indicated a significant positive additive interaction (RERI = 8.6; 95% CI: 1.0 to 19.7) on the OR scale. CONCLUSION: This study has demonstrated that awake and sleep bruxism are associated with an increased presence of painful TMD, and that both types of bruxism are not independently associated, but interact additively. As such, the presence of each factor amplifies the effect of the other.

A model of blended learning in a preclinical course in prosthetic dentistry.

The aim of this study was to evaluate the use of blending learning that added online tools to traditional learning methods in a preclinical course in prosthetic dentistry at one dental school in Germany. The e-learning modules were comprised of three main components: fundamental principles, additional information, and learning objective tests. Video recordings of practical demonstrations were prepared and cut into sequences meant to achieve single learning goals. The films were accompanied by background information and, after digital processing, were made available online. Additionally, learning objective tests and learning contents were integrated. Evaluations of 71 of 89 students (response rate: 80%) in the course with the integrated e-learning content were available for the study. Compared with evaluation results of the previous years, a substantial and statistically significant increase in satisfaction with learning content (from 30% and 34% to 86%, p<0.001) and learning effect (from 65% and 63% to 83%, p<0.05) was observed. Satisfaction ratings stayed on a high level in three subsequent courses with the modules. Qualitative evaluation revealed mostly positive responses, with not a single negative comment regarding the blended learning concept. The results showed that the e-learning tool was appreciated by the students and suggest that learning objective tests can be successfully implemented in blended learning.

Association of overjet and overbite with esthetic impairments of oral health-related quality of life.

OBJECTIVE: Esthetics is an important part of quality of life and a frequent reason for orthodontic treatment demand. It was the aim of this study to investigate whether esthetic impairments, related to overjet and overbite, can be assessed with an established oral health-related quality of life instrument. MATERIALS AND METHODS: Data from 1968 participants (age: 16-90 years; 69.8% female) from three German surveys were analyzed. Esthetic impairments of oral health-related quality of life were measured with four questions of the Oral Health Impact profile (OHIP), which comprise esthetic aspects of oral health-related quality of life. Higher values represent greater esthetic impairment (sum score: 0-16). Overbite and overjet values were categorized (≤ - 1 mm, 0-1 mm, 2-3 mm, 4-5 mm, ≥ 6 mm). The specific impact of each category on esthetic impairment, in relation to the reference category (2-3 mm), was calculated in linear regression analyses. The type of relationship and the specific impact of overbite and overjet were evaluated in regression analyses with fractional polynomials. RESULTS: Overbite ranged from - 5 to 15 mm (mean: 3.2 mm) and overjet from - 7 to 19 mm (mean: 3.1 mm). Both an increase and a decrease in overjet, in relation to the reference category, resulted in more esthetic-related oral health-related quality of life impairments. However, in this model, only the effect for increased overjet was statistically significant (4-5 mm: + 0.4 OHIP points; ≥ 6 mm: + 0.9 OHIP points). In the regression analysis with fractional polynomials, both an increase and a decrease in overjet resulted in more esthetic impairments, characterized by a U-shaped relationship. No association could be verified for overbite. CONCLUSION: A substantial increase or decrease of overjet from the reference values is associated with esthetic impairments of oral health-related quality of life, whereas the extent of overbite seems to have no impact on esthetics.

Association of temporomandibular disorder pain with awake and sleep bruxism in adults.

OBJECTIVES: Parafunctional habits such as clenching or grinding (bruxism) during daytime and at night are considered to have a great impact on the etiopathogenesis of temporomandibular disorders (TMD). However, the size of the effect and how daytime activities interact with nocturnal activities is not yet clear. The aim of this study was to assess the association of TMD pain with both awake and sleep bruxism in adults. MATERIALS AND METHODS: In this case-control study, data of a consecutive sample of 733 TMD patients (cases; mean age ± SD: 41.4 ± 16.3 years; 82% women) with at least one pain-related TMD diagnosis according to the German version of the Research Diagnostic Criteria for TMD (RDC/TMD) and of a community-based probability sample of 890 subjects (controls; mean age ± SD: 40.4 ± 11.8 years; 57% female) without TMD were evaluated. Clenching or grinding while awake and/or asleep was assessed with self-reports. Association of TMD pain with awake and sleep bruxism was analyzed using multiple logistic regression analyses and controlled for potential confounders. Odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS: While 11.2% of the controls reported clenching or grinding while awake, this proportion was significantly higher in TMD patients (33.9%; p < 0.001). Nocturnal clenching or grinding was reported by 23.5% of the controls and 49.4% of the TMD patients (p < 0.001). Risk for TMD pain did not differ substantially for the separate reports of awake (OR 1.7; CI 1.0-2.7) or sleep bruxism (OR 1.8; CI 1.4-2.4). However, risk for TMD pain substantially increased in cases of simultaneous presence of awake and sleep bruxism (OR 7.7; CI 5.4-11.1). CONCLUSION: When occurring separately, awake and sleep bruxism are significant risk factors for TMD pain. In case of simultaneous presence, the risk for TMD pain is even higher.