Development and validation of the Child Oral Health Impact Profile - Preschool version.

OBJECTIVE: The Child Oral Health Impact Profile (COHIP) is a validated instrument created to measure the oral health-related quality of life of school-aged children. The purpose of this study was to develop and validate a preschool version of the COHIP (COHIP-PS) for children aged 2-5. BASIC RESEARCH DESIGN: The COHIP-PS was developed and validated using a multi-stage process consisting of item selection, face validity testing, item impact testing, reliability and validity testing, and factor analysis. PARTICIPANTS: A cross-sectional convenience sample of caregivers having children 2-5 years old from four groups completed item clarity and impact forms. Groups were recruited from pediatric health clinics or preschools/daycare centers, speech clinics, dental clinics, or cleft/craniofacial centers. Participants had a variety of oral health-related conditions, including caries, congenital orofacial anomalies, and speech/language deficiencies such as articulation and language disorders. MAIN OUTCOME MEASURE: COHIP-PS. RESULTS: The COHIP-PS was found to have acceptable internal validity (a = 0.71) and high test-retest reliability (0.87), though internal validity was below the accepted threshold for the community sample. While discriminant validity results indicated significant differences across study groups, the overall magnitude of differences was modest. Results from confirmatory factor analyses support the use of a four-factor model consisting of 11 items across oral health, functional well-being, social-emotional well-being, and self-image domains. CONCLUSIONS: Quality of life is an integral factor in understanding and assessing children's well-being. The COHIP-PS is a validated oral health-related quality of life measure for preschool children with cleft or other oral conditions.

Quality-of-Life in Children with Orofacial Clefts and Caregiver Well-being.

Quality of life is a valid patient-reported parameter that provides an assessment of treatment need or outcomes complementary to standard clinical measures. Such patient-reported assessments are particularly salient when examining chronic conditions with prolonged treatment trajectories, such as cleft lip and palate. This critical review identifies key questions related to ongoing research on the oral health-related quality of life (OHRQoL) in children with cleft and caregiver well-being. Details of the design and results from 2 longitudinal multicenter studies are presented. This article also provides an update on recent published reports regarding OHRQoL in individuals with cleft. Methodological issues in OHRQoL research are discussed, including condition-specific versus generic instruments, incorporating positive items in OHRQoL instruments, calculating minimally important differences in OHRQoL, implementing mixed methods design, and utilizing validated short assessment forms in OHRQoL research. Finally, new directions for research in cleft as a chronic condition are identified and discussed.

Type II diabetes and oral health: perceptions among adults with diabetes and oral/health care providers in Ghana.

OBJECTIVE: This study sought to examine oral health beliefs and attitudes, and utilisation of oral health care services among individuals with diabetes and health professionals who serve them in Ghana. BASIC RESEARCH DESIGN: A qualitative study using grounded theory was conducted. CLINICAL SETTING: University of Ghana Dental School at Korle Bu, University of Ghana School of Public Health, National Diabetes Research and Management Centre at Korle Bu, and New York University College of Dentistry. PARTICIPANTS: A convenience sample of 59 patients comprised 7 focus groups conducted in either Twi or English. Seven key informant interviews with healthcare professionals and one spiritual leader were completed. RESULTS: Data from the focus groups and interviews reveal: 1, half of the participants with diabetes have oral manifestations (e.g., bleeding gums) and participants are generally unaware of interrelationship between diabetes and oral health; 2, dental treatment utilisation is minimal and associated almost exclusively with reparative and emergency care; and 3, medical health providers do not acknowledge the interrelationship between oral health and diabetes nor do they incorporate oral health issues into diabetes screening/treatment. CONCLUSION: Oral health knowledge and practices are limited among patients with diabetes in Accra, Ghana. Collaborative efforts for in-service education and training for oral health and medical professionals may be beneficial in serving the oral and general health care needs as well as improving the oral health-related quality of life of Ghanaians with diabetes.

An overview of children's oral health-related quality of life assessment: from scale development to measuring outcomes.

The objectives of this paper are to present an overview of children's oral health-related quality of life and include specific applications for using quality of life assessment in dental research. The process of developing pediatric oral health- related quality of life measures, in particular the Child Oral Health Impact Profile, is outlined. Examples of children's oral health-related quality of life measurement in caries research are also provided. Quality of life outcomes are presented and discussed in the context of caries research. Lastly, the relevance of measuring clinically meaningful difference in the context of measuring outcomes research is highlighted with recommendations for future research.

Oral health-related quality of life: what, why, how, and future implications.

Despite its relatively recent emergence over the past few decades, oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research. OHRQoL is a multidimensional construct that includes a subjective evaluation of the individual's oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self. It has wide-reaching applications in survey and clinical research. OHRQoL is an integral part of general health and well-being. In fact, it is recognized by the World Health Organization (WHO) as an important segment of the Global Oral Health Program (2003). This paper identifies the what, why, and how of OHRQoL and presents an oral health theoretical model. The relevance of OHRQoL for dental practitioners and patients in community-based dental practices is presented. Implications for health policy and related oral health disparities are also discussed. A supplemental Appendix contains a Medline and ProQuest literature search regarding OHRQoL research from 1990-2010 by discipline and research design (e.g., descriptive, longitudinal, clinical trial, etc.). The search identified 300 articles with a notable surge in OHRQoL research in pediatrics and orthodontics in recent years.

Developing a behavior rating scale for comparing teachers' ratings of children with and without craniofacial anomalies.

OBJECTIVE: Published psychometric tools are often insensitive to the experience of children with craniofacial anomalies (CFAs). The purposes of this study were to develop a valid and reliable assessment of behavior among children with and without CFAs and to compare teacher ratings of these two groups of children. METHODS: Teachers were asked prospectively to assess social competence and peer acceptance among 99 consecutively evaluated school-aged patients with CFAs and 99 "controls" (classmates without CFA matched by race, gender, intellectual status, general socioeconomic status, and grade). Sixth grade was the median grade of the subjects. OUTCOME MEASURE: Child Behavior Rating Scale (CBRS). RESULTS: Using oblique promax rotation, four factors emerged from the CBRS with the CFA patient group and controls. The factors explained 67% of the total variance and 69% of the variance of the two groups, respectively. The four factors were: (1) self-maintenance, (2) social adjustment, (3) independence, and (4) teasing. Cronbach alpha results averaged 0.77 for the CFA group and 0.83 for the controls; test-retest reliability estimates were .93. Results demonstrate the consistency of the factors and high level of interrelationship among the items across subject groups. Expected differences (p <.05) were found among subject groups on the total score and factor 4. CONCLUSIONS: The CBRS demonstrates psychometric worthiness. The findings indicated that patients with CFA had lower total scores on the CBRS, and they were rated as experiencing more teasing than their matched peers.

Using psychological assessment and therapeutic strategies to enhance well-being.

OBJECTIVE: To provide an overview of the psychological assessment; results from studies examining psychological issues among individuals with craniofacial anomalies (CFA) and other chronic conditions; resilience; and therapeutic strategies to enhance psychological well-being. CONCLUSIONS: The literature on chronic conditions and findings from studies with people having CFA and their families demonstrate a range of effective adaptation patterns and strategies to enhance issues having an impact on quality of life.

Perceived impact of oral health conditions among minority adolescents.

OBJECTIVES: This study assessed the perceived impact of oral health conditions, and the relationship of two measures of self-reported outcome, the RAND SF-36 and the Oral Health Impact Profile (OHIP), to clinical indicators of oral health among inner-city adolescents. METHODS: A convenience sample of 93 minority adolescents completed the RAND SF-36 and the OHIP and 76 of them completed a clinical dental examination assessing DMFS. RESULTS: Participants averaged 14.4 (SD = 1.2) years old; 52 percent were female; and 86 percent were African-American. The mean DMFS was 8.8 (SD = 6.3). Participants reported relatively poor general health on the SF-36 as well as poor oral health on the OHIP. None of the SF-36 subscales were significantly related to DMFS. OHIP subscales were consistently related to DMFS--those with worse oral health reported more impacts. With the exception of the bodily pain subscale of the SF-36, the SF-36 and OHIP subscales were significantly correlated with Pearson's correlations ranging from -.21 to -.57 (P < .05). CONCLUSIONS: Although the SF-36 and the OHIP were correlated, the OHIP appears to be more highly associated with the impacts of oral health conditions than the SF-36 among inner-city adolescents who reported low general and oral health quality of life.

Oral health perceptions and adherence with dental treatment referrals among caregivers of children with HIV.

Results from a 3-year longitudinal study on the oral manifestations of AIDS (OMA) among seropositive children and their siblings indicated poor adherence with recommendations for dental treatment (Broder, Catalanotto, Reisine, & Variagiannis, 1996). The purposes of this study were to (a) to examine oral health behaviors, attitudes, and perceived barriers to care among caregivers of children with HIV and their siblings who were referred for dental care, and (b) develop and evaluate a 5-week summer pilot program to increase adherence with referral for dental treatment. Telephone interviews with caregivers were conducted to identify barriers to care and to implement services to increase attendance in the dental clinic for their children. Interviews were completed with 28 of the 38 (74%) caregivers recruited from the OMA study (previously cited) who had children referred for dental treatment at the final (sixth) oral health research exam. Twelve of their 58 children (21%) had obtained dental care privately, 25 (62.5%) initiated treatment and 2 (6.3%) completed treatment at the referred dental school during the 5-week pilot program. Although caregivers of children with HIV and their siblings were responsive to the initial efforts of the program's service coordinators, follow-up data from the coordinators' records and chart abstraction revealed that the majority of the participants did not appear for their second or third appointments. The interview reports suggested that caregivers expect dental treatment, such as restorations, at each appointment and do not regard exams/treatment planning as treatment. Personal/family and health care delivery system factors were expressed barriers to dental care. Implications for future programs and investigations are discussed.

Dentofacial disharmony: psychological status of patients seeking treatment consultation.

A sample of 194 patients whose dentofacial disharmonies were severe enough to warrant an orthognathic surgical treatment option completed the SCL-90-R, a 90-item assessment tool used to measure current level of psychological distress. Two global and nine primary dimension scores of psychological distress were computed. The average interpersonal sensitivity, psychoticism, and obsessive-compulsive dimension scores were higher than the nonpsychiatric patient population norms for both males and females, but the confidence intervals for these dimensions were still in the upper end of the normal range of functioning (< 1 SD above the normative mean). No statistically significant differences by gender or age group were observed. Over 15% of the patients were clinically elevated on obsessive-compulsive behavior, interpersonal sensitivity problems, hostility, paranoid ideation, and psychoticism; and 24.7% qualified as a positive diagnosis for a psychiatric disorder. It appears that a surprisingly large number of individuals with dentofacial disharmonies who are seeking treatment consultation are experiencing a level of psychological distress that warrants intervention.

Learning disability, school achievement, and grade retention among children with cleft: a two-center study.

OBJECTIVE: This study examined the prevalence of learning disability (LD), level of school achievement; and prevalence of grade retention by type of cleft and gender at two craniofacial centers. SETTING: The setting included two university-based craniofacial centers. DESIGN/PATIENTS: Participants included 84 consecutively evaluated patients from one center who were matched by cleft type, age, and gender with 84 patients evaluated at the second center. OUTCOMES: The outcomes included learning disability, school achievement, and grade retention. RESULTS: The results revealed that 46% of subjects with cleft had LD, 47% had deficient educational progress, and 27% had repeated a grade (excluding kindergarten) in school. Males with cleft palate only (CPO) had a significantly higher rate of LD than any other subject group. Males with CPO and females with cleft lip and palate (CLP) were more likely to repeat a grade in school than were females with CPO and males with CLP. CONCLUSIONS: Children with cleft are at risk for learning disability, low school achievement, and grade retention.

Dentofacial disharmony: motivations for seeking treatment.

Patients whose skeletal disharmony was severe enough to warrant a surgical treatment option completed a 24-item Motives for Treatment questionnaire. Each item was rated from (1) not at all a reason to (4) very much a reason. Items were grouped to form six dimensions. An average score of 3.0 or greater on a given dimension was considered a strong motivation. Of the 135 patients who completed the questionnaire, 16% of the patients had primarily a self-image motivation, 4% primarily an oral function motivation, and 6% strong dual self-image/oral function motivations. Males and females differed significantly on the social well-being and temporomandibular joint (TMJ) dimensions. A strong social motivation occurred 4.5 times more frequently among males than among females, while a higher proportion of females than males reported TMJ concerns. Patients older than 25 scored higher on oral function, future health, and TMJ dimensions. Patients who elected surgery had higher scores on oral function, nasal function, and TMJ dimensions. Approximately 1.5 times as many patients who elected surgery scored on average of 3.0 or higher on the self-image and oral function dimensions.

Implementing and evaluating a patient instructor program.

A Patient Instructor (PI) program designed to improve students' data-gathering and interpersonal skills is evaluated. Each student in two consecutive classes of third-year students (class of 1996, n = 60; class of 1997, n = 72) interviewed four patient instructors (PIs) during a three-hour rotation. Each PI portrayed one of six scenarios. PIs assessed students using content checklists and an abbreviated Arizona Clinical Interview Rating Scale (ACIR). After the interview, each PI gave student constructive feedback regarding interpersonal behavior and ability to identify salient content items from the patient's history. Significant improvement was observed on content checklists (p < 0.01) between the first and second rounds. Significant improvement was also noted on the ACIR (p < 0.01) between rounds one, two and three. The results indicate that data-gathering and interpersonal skills can be enhanced by using patient instructors. Student evaluation of the program was positive.

Self-concept, Class II malocclusion, and early treatment.

Increased overjet has been associated with teasing, negative stereotyping, and low self-concept. Early treatment for children with Class II malocclusion is often recommended under the assumption that an improved dental appearance may benefit a child by increasing his or her social acceptance and hence self-concept. The self-concept of 208 patients, age 7 to 15 years and with increased overjet, was measured before treatment using the Piers-Harris self-concept scale; a subset of 87 of these children were measured again after 15 months of early growth modification. The mean self-concept score for these children was above the population norm, and there was no association between the child's score and the magnitude of his or her overjet or age. Although some significant associations were found between Class II malocclusion features and self-concept scores, the explained variation in self-concept scores was low (R2 from 5% to 8%). There was no change in the mean self-concept score of these children during early treatment, nor was there any association between reduction of Class II malocclusion features and improved self-concept. These findings suggest that children with Class II malocclusion do not generally present for treatment with low self-concept and, on average, self-concept does not improve during the brief period of early orthodontic treatment.

Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender.

Self-ratings of satisfaction with appearance and accomplishment of psychosocial tasks were examined by age and gender among school aged children with visible defects (cleft lip and/or palate, n = 272), or invisible defects (cleft palate only, n = 159), and dental patients (n = 128) without clefts. Using weighted least squares ANOVA and logistic regressions, the results revealed that subjects with visible defects expressed greater dissatisfaction with their appearance than those subjects with invisible defects (p < .001). Subjects with invisible defects consistently expressed lower problem solving ability than subjects with visible defects (p < .001) and dental patients with no defects (p < .05). Both groups with clefts expressed less social independence (p < .001); and subjects with clefts reported having more friends than other children (p < .01). Implications for clinicians and further research are discussed.

Habilitation of patients with clefts: parent and child ratings of satisfaction with appearance and speech.

This study examined ratings regarding satisfaction with facial appearance and speech performance from 495 parent-child pairs. Data were obtained from school-aged children (5-18 years old) and their parents using standardized independent interviews. Results revealed that 54 percent of the children with cleft lip (CL) or cleft lip and palate (CLP) were very pleased with their appearance, and 62 percent of the cleft palate or CLP subjects were very pleased with speech. Low, but statistically significant correlations exist between the female subjects and their parents in satisfaction with appearance. Although older cleft lip and/or palate patients reported increased satisfaction with speech, no age differences in patient satisfaction with appearance were observed in subjects with CL/CLP. Parents of females expressed more concern about their daughters' appearance than parents of males, while parents of males were more concerned about speech. Implications for craniofacial habilitation teams and research suggestions are discussed.