Epidemiological evaluation of short-form versions of the Child Perception Questionnaire.

The objective of the study was to compare the performance of four short-form versions of the Child Perceptions Questionnaire (CPQ(11-14)) with that of the long-form version in a random population sample of 12- and 13-yr-old children from New Zealand in order to determine which short-form version was the most valid. Children (n = 430, participation rate 74.1%) completed the 37-item CPQ(11-14). Two separate 8- and 16-item short-form versions were previously developed using (a) item impact and (b) regression methods. The four different short-form scales were compared with the full CPQ(11-14) on their construct validity. The children were examined for malocclusion (using the Dental Aesthetic Index) and for dental caries by a single examiner (L.F.P.). All short-form versions revealed substantial variability in overall oral health-related quality of life (OHRQoL). Cronbach's alpha ranged from 0.73 (Regression Short Form [RSF]-8) to 0.86 (RSF-16). For all short-form versions, mean scores were positively associated with self-rated oral health and overall wellbeing; associations with the latter were stronger. All short-form versions detected OHRQoL gradients, as hypothesized, across ascending categories of caries and malocclusion. These findings suggest that the short-form versions of the CPQ(11-14) all show acceptable properties, but that the 16-item versions perform better (and are essentially equivalent); however, the stronger theoretical underpinning of the item-impact-derived 16-item short-form version suggests that it shows the most promise.

Changes in parent-assessed oral health-related quality of life among young children following dental treatment under general anaesthetic.

OBJECTIVE: To estimate the nature and magnitude of changes in oral health-related quality of life (OHRQoL) among children having dental treatment under general anaesthetic (GA) and to examine the evaluative properties of the Child Oral Health-related Quality of Life Questionnaire (COHQOL). METHODS: Data from a consecutive clinical sample of the parents/caregivers of children receiving dental treatment under GA at Wellington and Kenepuru Hospitals were collected from parents using the Parental-Caregivers Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS), which both form part of the COHQOL Questionnaire. The first questionnaire was completed before treatment or while the participant's child was undergoing treatment. The follow-up questionnaire was completed 1-4 weeks afterward. Treatment-associated changes in OHRQoL were determined by comparing baseline and follow-up data for the mean scores and the prevalence of impacts. The discriminative properties of the instrument were confirmed and then its evaluative properties were assessed (by examining its test-retest reliability, responsiveness and longitudinal construct validity). The minimally important difference was determined for the overall scale and subscales. RESULTS: Complete baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up rate). The evaluative properties of the P-CPQ and FIS were acceptable. There were substantial and highly statistically significant reductions in mean P-CPQ and FIS scores after treatment, with effect sizes ranging from moderate to large, depending on the subscale being examined. The minimally important difference was shown by almost two-thirds of the children treated. CONCLUSION: The provision of dental treatment under GA for young children with severe dental caries experience is associated with substantial and highly significant improvements in both their OHRQoL and in the impact on their families. The P-CPQ and the FIS show promise as evaluative measures for use in dental health services research.

An evaluation of the Child Perceptions Questionnaire in the UK.

OBJECTIVE: To assess the reliability and validity of the Child Perceptions Questionnaire (CPQ11-14), an oral health related quality of life measure for 11-14 year old children, for use in the UK. BASIC RESEARCH DESIGN: Cross-sectional questionnaire and clinical analytical study. CLINICAL SETTING: Orthodontic and paediatric dentistry clinics at a dental hospital and one general dental practice. PARTICIPANTS: Eighty-nine children between 11 and 14 years of age attending for an examination. MAIN OUTCOMES MEASURES: The children were invited to complete the CPQ11-14, global oral health and impact on life overall ratings. Clinical data on caries status, malocclusion and presence of dental opacities and gingivitis were collected. CPQ11-14 was summarised as the total score (sum of the item codes) and the number of impacts reported often or every day. RESULTS: The Cronbach's alpha for the total scale was 0.87 and ranged from 0.59 to 0.83 for the subscales indicating acceptable internal consistency. The intraclass correlation coefficient on repeated application of the measure was 0.83 (95% CI = 0.76-0.90) suggesting almost perfect agreement. Summary measures of CPQ11-14 correlated with the global oral health rating indicating acceptable criterion validity. Impact on life overall was related to all summary measures of CPQ11-14. Number of impacts correlated with the total number of missing teeth and missing teeth due to caries. No other relationships between clinical and CPQ11-14 data were apparent. CONCLUSION: The CPQ11-14 shows acceptable reliability, criterion and construct validity in relation to life overall. Relationships with clinical data were more tenuous. If this measure is to be used to compare the impacts of oral diseases in similar settings in the UK a large sample will be required.

Validation of the Child Perceptions Questionnaire (CPQ 11-14).

While the use of adult oral-health-related quality-of-life (OHRQoL) measures in supplementing clinical indicators has increased, that for children has lagged behind, because of the difficulties of developing and validating such measures for children. This study examined the construct validity of the Child Perceptions Questionnaire (CPQ(11-14)) in a random sample of 12- and 13-year-old New Zealanders. It was hypothesized that children with more severe malocclusions or greater caries experience would have higher overall (and subscale domain) CPQ(11-14) scores. Children (N = 430) completed the CPQ(11-14) and were examined for malocclusion (Dental Aesthetic Index) and dental caries. There was a distinct gradient in mean CPQ(11-14) scores by malocclusion severity, but there were differences across the four subscales. Children in the worst 25% of the DMFS distribution had higher CPQ(11-14) scores overall and for each of the 4 subscales. The construct validity of the CPQ(11-14) appears to be acceptable.

How well do parents know their children? Implications for proxy reporting of child health-related quality of life.

OBJECTIVES: This study examined parental knowledge of their children's oral-health-related quality of life (OHRQoL) (Objective 1), and the effects of different analytical techniques to manage 'Don't know' (DK) responses on the validity and reliability of the questionnaire (Objective 2) and the level of agreement between parental and child reports (Objective 3). METHODS: The parental (PPQ) and child (CPQ11-14) components of the Child Oral Health Quality of Life Questionnaire were used. Objectives 1 and 2 were addressed in the study that involved 221 parents and Objective 3 in the study that involved 63 pairs of parents and children. Four methods for treating DK responses in the PPQ were tested: listwise deletion, item mean imputation, imputation of the value zero and adjustment of scores to account for items with DK responses. RESULTS: Respectively, 26 and 11% of the parents gave > or = 3 and 6 > or = DK responses to 33 items comprising the PPQ. DK responses were associated with child's age and clinical condition, and parental gender. The methods of managing DK responses did not have differing effects on the measurement properties of the PPQ and the level of agreement between parents and children. CONCLUSION: Some parents have limited knowledge concerning their children's OHRQoL. However, given that parental and child reports are measuring different realities, information provided by parents is useful even if it is incomplete.

Prevention. Part 8: The use of pit and fissure sealants in preventing caries in the permanent dentition of children.

This paper reviews evidence concerning the use of pit and fissure sealants in preventing caries in the permanent dentition of children. While the evidence with respect to some sealant types and application techniques is incomplete, systematic reviews have clearly demonstrated that sealants are an effective preventive technology when used in high risk children, and that with proper application techniques long-term retention rates can be achieved. However, careful selection of patients and teeth for sealant placement is required to ensure cost-effectiveness.

Validity and reliability of a questionnaire for measuring child oral-health-related quality of life.

Oral-health-related quality of life measures that exist are designed for adults. This study aimed to develop and evaluate the CPQ(11-14), a self-report measure of the impact of oral and oro-facial conditions on 11- to 14-year-old children. An item pool was generated with the use of a literature review and interviews with health professionals, parents, and child patients. The 36 items rated the most frequent and bothersome by 83 children were selected for the CPQ(11-14). Validity testing involved a new sample of 123 children. Test-retest reliability was assessed in a subgroup of these children (n = 65). Mean CPQ(11-14) scores were highest for oro-facial (31.4), lower for orthodontic (24.3), and lowest for pedodontic (23.3) patients. There were significant associations between the CPQ(11-14) score and global ratings of oral health (p < 0.05) and overall well-being (p < 0.01). The Cronbach's alpha and intraclass correlation coefficient for the CPQ(11-14) were 0.91 and 0.90, respectively. These results suggest that the CPQ(11-14) is valid and reliable.

Toothbrushing competency among high-risk grade one students: an evaluation of two methods of dental health education.

OBJECTIVE: To evaluate the effectiveness of two methods of dental health education (DHE) for improving toothbrushing competency among grade one students at high risk for dental diseases. METHODS: Fifty elementary schools in the former city of North York, Ontario, Canada, were assigned to one of two groups. In one group, students received a classroom-based DHE lesson that was reinforced by two small group sessions (n = 243). In the other group, students received only a single classroom-based DHE lesson (n = 206). Trained examiners assessed 11 toothbrushing skills at pre- and postintervention. RESULTS: At the preintervention test, few significant differences were found between the groups and many students did not display competency in fundamental oral health skills, such as placing a toothbrush at the gum line. Following DHE interventions, students in both groups demonstrated improvements in most skills. A significantly higher proportion of students who received both classroom and small group sessions displayed gains in competency in three skills, compared to students receiving only a classroom lesson. These skills were brushing anterior lingual surfaces, brushing posterior lingual surfaces, and brushing all areas in a routine fashion. Students receiving only a classroom session did not display greater improvements in any skill areas compared to "classroom plus small group" students. Some students in both groups still lacked fundamental skills at the end of the DHE program. CONCLUSIONS: While one must exercise caution in interpreting the results due to several methodologic limitations, findings suggest that for high-risk grade one students, a classroom-based lesson combined with small group sessions is a more effective method of improving toothbrushing skills compared to a single classroom-based lesson.

Oral hygiene knowledge of high-risk Grade One children: an evaluation of two methods of dental health education.

The effectiveness of two methods of dental health education (DHE) for improving oral hygiene knowledge among high-risk Grade One students was evaluated. Fifty elementary schools in the former City of North York, Canada were assigned to one of two groups. In one group, students received a classroom-based DHE lesson which was reinforced by two small-group sessions (n=243). In the other group, students received only a single classroom-based DHE lesson (n=206). After DHE interventions, students in both groups displayed improved knowledge for most oral hygiene questions (e.g., when should you throw your toothbrush away?). However, for several questions, a significantly higher proportion of "classroom plus small-group sessions" students displayed improved knowledge compared to students receiving only a classroom lesson. These items included: awareness that cavity prevention and removal of germs are two purposes of oral hygiene; and knowledge that teeth help people to eat and talk. Results suggest a classroom-based lesson combined with small-group sessions is a more effective method of improving oral hygiene knowledge among high-risk Grade One students compared to a single classroom-based lesson.

A cross-cultural study of oral health values.

The Oral Health Impact Profile (OHIP) is a measure of oral-health-related quality of life developed in Australia but being used increasingly in other populations. In view of the culturally specific nature of peoples' perceptions of health, if we are to make between-population comparisons of oral-health-related quality of life, cross-cultural equivalency of the relevant instruments needs to be verified. A study was therefore undertaken to compare item weights generated by an Australian sample with those generated by a sample of English-speaking Canadians and another of French-speaking Canadians. In addition, within-group comparisons by age were performed. The items and subscales used for the 2 Canadian samples were identical to those developed in Australia, although a formal French translation was used for the French-speaking sample. The method used for the generation of weights was Thurstone's paired-comparison technique, based on the judgments of convenience samples of subjects drawn from each of the three cultural settings. Comparisons were made by means of intra-subscale weight rankings and magnitude. Spearman's rank correlations of r> or =0.6 were found for 16/21 between-group comparisons and for 12/21, 19/21, and 8/21 within-group comparisons made by age in Australia, Ontario, and Quebec, respectively. Comparisons of the magnitudes of weights found that, even when items were ranked similarly, magnitudes could be quite different. These results suggest a reasonable degree of cross-cultural consistency, and hence validity, for the OHIP.

Reducing variability in treatment decision-making: effectiveness of educating clinicians about uncertainty.

The objective of this study was to investigate whether or not education about the concept of uncertainty reduced variability in treatment decision-making. Three small groups of dentists in North York, Canada were asked to make restorative treatment decisions about simulated bitewing radiographs. They subsequently took part in a seminar about variations in perception and judgement and were given explanations of sensitivity, specificity and receiver operating characteristic (ROC) curve analysis. A repeat reading of the radiographs was then performed by both test and control groups. Results indicated that the intervention increased the accuracy, and decreased the variability of dentists' restorative treatment decisions. Kappa statistics were 0.33, 0.34 and 0.31 before the seminar, and 0.40, 0.43 and 0.41 after the seminar. Standard errors for kappas were 0.06, 0.05 and 0.05 before the seminar, and 0.02, 0.02 and 0.05 after the seminar. The area under the ROC curve was 0.7136 before the seminar and 0.7835 after the seminar. The data demonstrate that the dentists' decisions were less variable and more accurate following the educative intervention. This study suggests that there is potential for improving consistency and accuracy in clinical decision-making through education in probabilistic reasoning.

Three-year changes in self-perceived oral health status in an older Canadian population.

Although change is a central goal of oral health care interventions, little attention has yet been paid to change in self-perceptions of oral health status. This is an important omission, given the current emphasis on assessing health outcomes. This paper reports the results of a study which examined changes over a period of three years in self-perceived oral health among 611 community-dwelling Canadians aged 50 years and over. Change in self-perceptions was measured by means of a global transition item and change scores derived from repeat administrations of four subjective oral health status indicators. Overall, 20.5% reported that their oral health had deteriorated over the three-year observation period, 68.5% that it had remained the same, and 10.5% that it had improved. There was a significant association between these global change categories and change scores for the four subjective indicators. Because of the small number of edentulous subjects, the analysis of baseline characteristics predicting change was confined to dentate subjects. Bivariate and logistic regression analyses were used to compare the two groups reporting change with those whose oral health status remained stable over the observation period. The results suggest that, when compared with this reference group, those who deteriorated and those who improved were similar in some respects but distinct in others. Those who improved appeared to have specific oral conditions at baseline causing pain. Those who deteriorated had poor oral health in general and came from more disadvantaged backgrounds. However, the explanatory power of logistic regression models predicting change in self-perceived oral health was poor when judged in terms of model sensitivities. This was to be expected, given that the models did not include variables documenting the incidence of disease, receipt of dental care, or changes in social and personal circumstances over the observation period.

Dissatisfaction with oral health status in an older adult population.

OBJECTIVES: The aim of this study was to assess dissatisfaction with oral health in an older adult population and to identify factors associated with dissatisfaction. METHODS: Data were obtained from 907 community-dwelling older adults aged 50 years and older using personal interviews and clinical examinations. Bivariate and multivariate analyses examined the relationships among dissatisfaction with oral health and a variety of sociodemographic variables, clinical oral health measures, and measures of the functional and psychosocial impact of oral disorders. RESULTS: Overall, 14.3 percent of respondents were dissatisfied with their ability to chew, 21.6 percent with their dental appearance, and 5.6 percent with their ability to speak clearly. Almost one-third (30.8%) were dissatisfied with at least one of these dimensions of oral health. Edentulous subjects were more likely to be dissatisfied than dentate subjects. The multivariate regression model for dentate subjects contained seven variables that explained 31 percent of the variance in dissatisfaction scores. For the edentulous, the model contained three variables that accounted for 53 percent of the variance. CONCLUSIONS: These results suggest that demographic, clinical, and psychosocial impact variables are associated with dissatisfaction with oral health. However, psychosocial impact variables had by far the strongest independent effect.

The efficacy of nonopioid analgesics for postoperative dental pain: a meta-analysis.

The evidence for the efficacy of nonopioid analgesics in the dental pain model was examined by conducting a meta-analysis. Studies were obtained by searching the literature from August 1996 back to 1975 using the terms pain, analgesics, and dentistry. This led to the review of 294 articles, of which 33 studies met the inclusion criteria. Pain scale results were transformed into a common percent scale and converted to N-weighted means with differences in efficacy considered significant using a 95% confidence interval. Collectively, therapeutic doses of the nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in dentistry were significantly more efficacious than the combination of acetaminophen (600 or 650 mg) with codeine (60 mg). Similarly, specific doses of each of diflunisal, flurbiprofen, ibuprofen, and ketorolac were significantly more efficacious than the commonly used acetaminophen-codeine combination. These quantitative results show that particular NSAIDs may be more efficacious than the acetaminophen-codeine combination for relief of postoperative dental pain.

Life circumstances, lifestyles and oral health among older Canadians.

OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question.

Using subjective oral health status indicators to screen for dental care needs in older adults.

A study was undertaken to assess the ability of a number of subjective oral health status indicators to identify community-dwelling older adults who need dental treatment. The indicators consisted of a single-item self-rating of treatment need, a 15-item psychosocial impact index and the 49-item Oral Health Impact Profile (OHIP). Data for the study were collected as part of an oral health survey of Canadians aged 50 years and over. The associations between these subjective indicators and clinically defined dental treatment needs were assessed using statistics for determining the predictive power of a diagnostic test. Although there were statistically significant associations between the subjective and clinical measures, values for statistics such as sensitivity, positive predictive values and positive likelihood ratios were low. Although the measures did not perform well as screening tests, they did identify a sub-group of individuals whose clinical conditions impacted significantly on daily life and who would probably benefit the most from dental treatment. In this respect, the subjective measures assessed here can themselves be interpreted as indicators of need which complement conventional clinical measures of needs for dental care.