Income, dental insurance coverage, and financial barriers to dental care among Canadian adults.

OBJECTIVES: To explore the issue of affordability in dental care by assessing associations between income, dental insurance, and financial barriers to dental care in Canadian adults. METHODS: Data were collection from a national sample of adults 18 years and over using a telephone interview survey based on random digit dialing. Questions were asked about household income and dental insurance coverage along with three questions concerning cost barriers to accessing dental care. These were: "In the past three years...has the cost of dental care been a financial burden to you?...have you delayed or avoided going to a dentist because of the cost?...have you been unable to have all of the treatment recommended by your dentist because of the cost?" RESULTS: The survey was completed by 2,027 people, over half of which (56.0%) were covered by private dental insurance and 4.9 percent by public dental programs. The remainder, 39.1 percent, paid for dental care out-of-pocket. Only 19.3 percent of the lowest income group had private coverage compared with 80.5 percent of the highest income group (P < 0.001). Half (48.2%) responded positively to at least one of the three questions concerning cost barriers, and 14.8 percent responded positively to all three. Low income subjects (P < 0.001) and those without dental insurance (P < 0.001) were most likely to report financial barriers to care. While private dental insurance reduced financial barriers to dental care, it did not entirely eliminate it, particularly for those with low incomes. Those reporting such barriers visited the dentist less frequently and had poorer oral health outcomes after controlling for the effects of income and insurance coverage. CONCLUSIONS: Canadian adults report financial barriers to dental care, especially those of low income. These barriers appear to have negative effects with respect to dental visiting and oral health outcomes. For policy, appropriateness will be key, as clarity needs to be established in terms of what constitutes actual need, and thus which dental services can then be considered a public health response to affordability.

Does psychological well-being influence oral-health-related quality of life reports in children receiving orthodontic treatment?

INTRODUCTION: Although the associations between oral biologic variables such as malocclusion and oral-health-related quality of life (OHRQOL) have been explored, little research has been done to address the influence of psychological characteristics on perceived OHRQOL. The aim of this study was to assess OHRQOL outcomes in orthodontics while controlling for individual psychological characteristics. We postulated that children with better psychological well-being (PWB) would experience fewer negative OHRQOL impacts, regardless of their orthodontic treatment status. METHODS: One hundred eighteen children (74 treatment and 44 on the waiting list), aged 11 to 14 years, seeking treatment at the orthodontic clinics at the University of Toronto, participated in this study. The child perception questionnaire (CPQ11-14) and the PWB subscale of the child health questionnaire were administered at baseline and follow-up. Occlusal changes were assessed by using the dental aesthetic index. A waiting-list comparison group was used to account for age-related effects. RESULTS: Although the treatment subjects had significantly better OHRQOL scores at follow-up, the results were significantly modified by each subject's PWB status (P <0.01). Furthermore, multivariate analysis showed that PWB contributed significantly to the variance in CPQ11-14 scores (26%). In contrast, the amount of variance explained by the treatment status alone was relatively small (9%). CONCLUSIONS: The results of this study support the postulated mediator role of PWB when evaluating OHRQOL outcomes in children undergoing orthodontic treatment. Children with better PWB are, in general, more likely to report better OHRQOL regardless of their orthodontic treatment status. On the other hand, children with low PWB, who did not receive orthodontic treatment, experienced worse OHRQOL compared with those who received treatment. This suggests that children with low PWB can benefit from orthodontic treatment. Nonetheless, further work, with larger samples and longer follow-ups, is needed to confirm this finding and to improve our understanding of how other psychological factors relate to patients' OHRQOL.

Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ).

AIM: To develop and validate a condition specific measure of oral health-related quality of life for dentine hypersensitivity (Dentine Hypersensitivity Experience Questionnaire, DHEQ). MATERIALS AND METHODS: Questionnaire construction used a multi-staged impact approach and an explicit theoretical model. Qualitative and quantitative development and validation included in-depth interviews, focus groups and cross-sectional questionnaire studies in a general population (n=160) and a clinical sample (n=108). RESULTS: An optimized DHEQ questionnaire containing 48 items has been developed to describe the pain, a scale to capture subjective impacts of dentine hypersensitivity, a global oral health rating and a scale to record effects on life overall. The impact scale had high values for internal reliability (nearly all item-total correlations >0.4 and Cronbach's α=0.86). Intra-class correlation coefficient for test-retest reliability was 0.92. The impact scale was strongly correlated to global oral health ratings and effects on life overall. These results were similar when DHEQ was validated in a clinical sample. CONCLUSIONS: DHEQ shows good psychometric properties in both a general population and clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.

Oral health-related quality of life of children with oligodontia.

OBJECTIVES: To assess the functional and psychosocial impact of oligodontia in children aged 11-14 years. METHODS: Children aged 11-14 years with oligodontia were recruited from orthodontic clinics when they presented for orthodontic evaluation. All completed a copy of the Child Perceptions Questionnaire for 11- to 14-year olds, a measure of the functional and psychosocial impact of oral disorders. Information on the number and pattern of missing teeth for each child were obtained from charts and radiographs. RESULTS: Thirty-six children were included in the study. The number of missing teeth ranged from one to 14 (mean = 6.8). Just over three-quarters of the subjects reported experiencing one or more functional and psychosocial impacts 'Often' or 'Everyday/almost everyday'. Correlations between scale and sub-scale scores and the number of missing teeth were weak and nonsignificant. CONCLUSIONS: Children with oligodontia experience substantial functional and psychosocial impacts from the condition. When compared with other clinical groups, children with oligodontia appear to have worse oral health-related quality of life than children with dental decay and malocclusion, but better oral health-related quality of life than children with oro-facial conditions.

Differential item functioning related to ethnicity in an oral health-related quality of life measure.

OBJECTIVE: To assess whether an oral health-related quality of life (OHRQoL)measure showed differential item functioning (DIF) by ethnicity. METHODS: A simple random sample of 12- and 13-year-old schoolchildren enrolled in the Taranaki District Health Board's school dental service, New Zealand. Each child (n = 430) completed the Child Perception Questionnaire (CPQ(11-14)) in the dental clinic waiting room, prior to a dental examination. The dataset included age, gender, ethnicity, and deprivation status. The general principle of the analytic plan was that equal scores from each CPQ(11-14) item were expected from both non-Mäori and Mäori groups regardless of their ethnic group. Ordinal logistic regression was performed. The dependent variables were the CPQ(11-14) items. The ethnicity group and each CPQ(11-14) domain score were the independent variables. Non-uniform DIF was assessed through adding an interaction term for each CPQ(11-14) sub-scale. RESULTS: Non-uniform DIF was found in two items, one in the Functional Limitations sub-scale and another in the Social Well-being sub-scale. Uniform DIF was found in one item of the Emotional Well-being sub-scale. CONCLUSION: Both non-uniform and uniform DIF by ethnicity was found in three of 37 items of the CPQ(11-14) questionnaire, showing it is important to perform DIF analysis when applying OHRQoL measures.

Validation of the Persian short version of the Oral Health Impact Profile (OHIP-14).

PURPOSE: The Oral Health Impact Profile (OHIP) questionnaire measures oral health-related quality of life and is widely used for assessing subjective oral health status. The objective of the present study was to describe the translation and validation of the shortened 14-item OHIP for native Persian (Farsi) speakers living in Iran. MATERIALS AND METHODS: The authors translated the OHIP-14 into Persian (OHIP-14-P), followed by back-translation into English, after which the Persian version was revised and modified. They administered the questionnaire to native Persian-speaking clients at a university-based dental clinic in Tehran, Iran (n = 240, 123 females and 117 males, mean age 39, range 18 to 76). They examined the convergent validity and discriminative validity of OHIP by analysing their association with various self-reported health outcomes. They evaluated the test­retest reliability by administering the instrument to 37 patients a second time. They analysed the internal consistency and reliability using a intraclass correlation coefficients (ICC) and Cronbach's reliability coefficient, respectively. RESULTS: The associations between scores of OHIP-14-P and its subscales with self-reported general (r(s) [Spearman's rank correlation coefficient] range 0.38 to 0.52) and oral health (r(s) range 0.25 to 0.45) confirmed convergent validity. Discriminative validity was confirmed through the significant relationship between OHIP-14-P scores with both the experience of pain and satisfaction with oral health (P < 0.001). The instrument's test­retest reliability (ICCs: 0.75 to 0.88) and internal consistency (Cronbach's α: 0.45 to 0.73 and Cronbach's α if subscale deleted: 0.88 to 0.85) were satisfactory. CONCLUSIONS: The Persian version of OHIP-14 was found to be a valid and reliable measure, and appropriate to be used among native Persian speakers visiting a dental clinic.

Evaluation of computer-aided learning in orthodontics.

INTRODUCTION: Studies of computer-aided learning (CAL) in orthodontics have documented both objective and subjective outcomes; however, to date, no studies have attempted to correlate these 2 outcome measures. METHODS: The main objective outcome measured was performance on a written test covering material in the orthodontic diagnosis electronic tutorial (ODET) administered to 92 fourth-year undergraduate dental students. The main subjective outcome measured was a 12-statement questionnaire to elicit students' perception of the ODET and CAL as teaching modalities. RESULTS: In the male and female subgroups, a statistically significant difference in mean lecture test scores favoring women (72.46%) over men (67.08%) was observed (P = 0.05). This difference was not observed for mean ODET test scores (P = 0.52). Although responses to the questionnaire were mostly positive, the students are not prepared to replace lectures with CAL tutorials. Responses showed that male students preferred self-instruction as a mode of learning more than female students did (P = 0.05). When linking objective and subjective outcomes, the mean ODET test score had a statistically significant (P = 0.025), but weak, positive correlation (r = 0.243) with self-reported time spent reviewing the ODET but not with any other statement in the questionnaire. CONCLUSIONS: Despite a difference in lecture test scores between male and female students, there was no difference in mean ODET test scores between the 2 subgroups. This might be explained by sex differences: male students preferred self-instruction more than female students did. Improved performance on the ODET test was noted for students who reported longer times spent reviewing the tutorial. Because students are not prepared to replace lectures with CAL tutorials, from their perspective, the ODET should continue to be used with traditional modes of learning.

Determining the minimally important difference for the Oral Health Impact Profile-20.

In the context of clinical trials, measurement of change is critical. The aim of this study was to determine the minimally important difference (MID) for the Oral Health Impact Profile-20 (OHIP-20) when used with partially dentate patients undergoing treatment that included the provision of removable partial dentures. In a prospective clinical trial, 51 consecutive patients were provided with removable partial dentures. In addition to demographic and dental status data, patients completed an OHIP-20 prior to treatment. One month postoperatively, patients completed a post-treatment OHIP-20 and a global transition scale. Domains assessed in the global transition scale were appearance, ability to chew food, oral comfort, and speech. The MID for the OHIP-20 was calculated using the anchor-based approach. From the initial sample of 51 patients, 44 completed post-treatment questionnaires and were included in the analysis. Change scores in the four transition domains indicated that new dentures had a positive impact in the majority of subjects, especially in perceived impact on chewing and appearance. The study provided a guideline as to what constitutes the MID for the OHIP-20. This benchmark can be used when interpreting the impact of clinical intervention for replacing missing teeth and for power calculation in statistical analyses.

Public opinions on community water fluoridation.

BACKGROUND: Community water fluoridation (CWF) is currently experiencing social resistance in Canada. Petitions have been publicly registered, municipal plebiscites have occurred, and media attention is growing. There is now concern among policy leaders whether the practice is acceptable to Canadians. As a result, this study asks: What are public opinions on CWF? METHODS: Data were collected in April 2008 from 1,005 Canadian adults by means of a national telephone interview survey using random digit dialling and computer-assisted telephone interview technology. Descriptive and bivariate and multivariate logistic regression analyses were undertaken. RESULTS: Approximately 1 in 2 Canadian adults surveyed knew about CWF. Of these, 80% understood its intended use, approximately 60% believed that it was both safe and effective, and 62% supported the idea of having fluoride added to their local drinking water. Those with greater incomes [OR=1.4; p<0.001] and education [OR=1.6; p<0.001] were more likely to know about CWF. Those with greater incomes [OR=1.3; p<0.03] and those who visited the dentist more frequently [OR=1.8; p<0.002] were more likely to support CWF, and those with children [OR=0.5; p<0.02], those who accessed dental care using public insurance [OR=0.2; p<0.03], and those who avoided fluoride [OR=0.04; p<0.001] were less likely to support CWF. CONCLUSION: It appears that Canadians still support CWF. In moving forward, policy leaders will need to attend to two distinct challenges: the influence of anti-fluoride sentiment, and the potential risks created by avoiding fluoride.

Self-esteem and socioeconomic disparities in self-perceived oral health.

OBJECTIVE: To determine if psychosocial factors explain the socioeconomic disparities in self-perceived oral health that persist after controlling for oral status variables. METHODS: Data came from the participants in the Canadian Community Health Survey 2003 who were residents in the city of Toronto. Oral health variables included self-rated oral health, a 13-item oral health scale, denture wearing, and having a tooth extracted in the previous year. The last two measures were regarded as proxy indicators of tooth loss. Psychosocial variables included a self-esteem scale, a depression scale, and single items measuring life satisfaction, life stress, and sense of cohesion. Socioeconomic status was assessed using total annual household income. RESULTS: Interviews were completed with 2,754 dentate persons aged 20 years and over. Bivariate analyses confirmed that there were income gradients in self-rated oral health and scores on the oral health scale. Linear regression analyses confirmed that these persisted after controlling for age, gender, denture wearing, and having a tooth extracted in the previous year. In the model predicting self-rated oral health self-esteem, life satisfaction, stress, a sense of cohesion, and depression also contributed to the model, increased its explanatory power, and reduced the strength of but did not eliminate the association between income and self-rated oral health. Broadly, similar results were obtained when the oral health scale score was used as the dependent variable. In both analyses and all models, denture wearing had the strongest and most enduring effect. CONCLUSION: Psychosocial factors partly but do not wholly explain the socioeconomic disparities in self-perceived oral health in this population after controlling for tooth loss and denture wearing. Other variables need to be added to the models to increase their explanatory power.

Canadian dentists' opinions on publicly financed dental care.

OBJECTIVE: The aim of this study was to inform policy leaders of the opinions of Canada's major dental care service provider regarding publicly financed dental care. METHODS: Using provincial/territorial dental regulatory authority listings, a 26-item questionnaire was sent to a representative sample of Canadian dentists (n = 2219, response rate = 45.8 percent). Descriptive statistics were produced, and bivariate and multivariate logistic regressions were conducted to assess what predicts dentists' responses. RESULTS: Canadian dentists support governmental involvement in dental care, preferring investments in prevention to direct delivery. The majority of dentists have less than 10 percent of their practice represented by publicly insured patients, with a small minority having greater than 50 percent. The majority would accept new publicly insured patients, preferring fee for service remuneration. Dentists generally appear dissatisfied with public forms of third-party financing. CONCLUSIONS: Dentists prefer a targeted effort at meeting public needs and are influenced in their opinions largely in relation to ideology. In order to move forward, policy leaders will need to devote some attention to the influence and complexity of public and private tensions in dentistry At the very least, public and private practitioners must come to appreciate each other's challenges and balance public and private expectations in public programming.

What frames of reference underlie self-ratings of oral health?

OBJECTIVES: This study aimed to investigate the referents and meanings that underlie self-ratings of oral health and to determine whether they vary by participants' characteristics. METHODS: Semistructured interviews were conducted with a convenience sample of 80 adults who were asked to rate their oral health and explain the reasons for their ratings. The interviews were tape-recorded, transcribed in full, and subject to a content analysis that involved identification and coding of their frames of reference. These codes were collapsed to create a smaller number of categories to allow for comparisons of the proportions invoking each frame of reference. RESULTS: There was considerable variation in the accounts offered to support the self-ratings of oral health. The most common referents used were biomedical, involving current oral problems, treatment needs and treatment histories, and behavioral, which included oral self-care practices, other health behaviors, and dental visiting patterns. Pain and tooth loss were also common. Most notable was the absence of functional and psychosocial referents that are prominent in contemporary definitions and measures of "oral-health-related quality of life." There was some variation in the referents used according to sociodemographic characteristics, with age being the main source of variation. There was also variation according to the category of the self-rating used; those with favorable ratings tended to use different frames of reference than those with unfavorable ratings. CONCLUSIONS: The biomedical model and professional ideologies and values provide the main frames of reference that give meaning to self-ratings of oral health. Variations in the meanings of the self-ratings have some implications for the use of this item in quantitative studies, which warrants further investigation.

Functional and psychosocial impacts of oral disorders in Canadian adults: a national population survey.

BACKGROUND: In Canada, national health surveys do not usually include questions pertaining to self-perceived oral health. Those that do use ad hoc sets of questions rather than standardized and validated measures of the functional and psychosocial impacts of oral disorders. AIMS: To collect national data on the impacts of oral disorders from a representative sample of Canadian adults and to compare the results with similar national surveys conducted in the United Kingdom and Australia. METHODS: Data were collected from adults by means of a telephone interview survey based on random-digit dialing. Oral health was measured with the short-form Oral Health Impact Profile (also known as the OHIP-14 questionnaire), which asks about the frequency of 14 functional and psychosocial impacts that people have experienced in the previous year as a result of problems with their teeth, mouth or dentures. RESULTS: Of 3,033 interviews conducted, data were sufficient for analysis for 3,019 respondents. Just under one-fifth of the 3,019 respondents (19.5%) reported 1 or more of the 14 impacts "fairly often" or "very often" in the previous year. The prevalence was higher among edentulous respondents (30.7%) than among dentate respondents(18.6%), as were the extent and severity scores. The prevalence of impacts was lowest in Atlantic Canada (16.1%) and highest in the Prairies (23.3%), although the difference was not statistically significant. Prevalence rates and extent and severity scores were highest among those who wore dentures, recipients of public dental care and irregular dental visitors. Considerable income disparities were also observed, with 34.9% of those from the lowest-income households reporting impacts. The prevalence of effects and the extent and severity scores in Canada were similar to those reported from the United Kingdom and Australia. CONCLUSIONS: One in 5 Canadian adults experienced adverse impacts from oral disorders. Further work is needed to identify the material and psychological determinants of these impacts.

Oral-health-related quality of life among children with and without dental fear.

OBJECTIVES: This study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured. MATERIAL AND METHODS: The participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register (n = 51) and schoolchildren (n = 82). Dental fear was measured with 'Treatment of dental decay' and 'Attending dentist' dimensions of the modified Children's Fear Survey Schedule-Dental Subscale and a single question. ORHQoL was measured with CPQ(11-14). Background variables were gender and the dental care experienced. RESULTS: The response rates were 87% and 51% in the schoolchildren's and CLP groups, respectively. Those who were afraid of 'Treatment of dental decay' had higher mean CPQ(11-14 )total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics. CONCLUSION: Dental fear may have a negative effect on a child's ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.

On the pediatric oral health therapist: lessons from Canada.

OBJECTIVES: To review the development of dental therapy in Canada. METHODS: Historical review. RESULTS: Over its 35-year history in Canada, this model of service delivery experienced a period of great success, but has since degraded, not fulfilling its potential. CONCLUSIONS: To ensure the success of the paediatric oral health therapist, US policy leaders will need to mitigate the challenges that degraded the viability of this form of service provision in Canada.

Is the child oral health quality of life questionnaire sensitive to change in the context of orthodontic treatment? A brief communication.

OBJECTIVE: This study aimed to assess the ability of the Child Oral Health Quality of Life Questionnaire (COHQoL) to detect change following provision of orthodontic treatment. METHODS: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the Child Perception Questionnaire, while their parents completed a copy of the Parents Perception Questionnaire and the Family Impact Scale. Normative outcomes were assessed using the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index. Change scores and effect sizes were calculated for all scales. RESULTS: Complete data were collected for 45 children and 26 parents. The mean age was 12.6 years (standard deviation = 1.4). There were significant pre-/posttreatment changes in DAI and PAR scores and significant changes in scores on all three questionnaires (P < 0.05). Effect sizes for the latter were moderate. Global transition judgments also confirmed pre-/posttreatment improvements in oral health and wellbeing. CONCLUSION: The results provide preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment. However, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure.

Early childhood caries and access to dental care among children of Portuguese-speaking immigrants in the city of Toronto.

OBJECTIVE: To determine the influence of accessibility of dental services and other factors on the development of early childhood caries (ECC) among Toronto children 48 months of age or younger with at least one Portuguese-speaking immigrant parent. METHODS: This population-based case-control study involved 52 ECC cases and 52 controls (i.e., without ECC) identified from community centres, churches and drop-in centres by a process of network sampling. Caries status (dmft/s) was assessed by clinical examination. Access to dental care and risk factors for ECC were determined through a structured interview with the Portuguese-speaking parent. RESULTS: Forty (77%) of the children with ECC but only 28 (54%) of controls had never visited a dentist. Thirty (58%) mothers of children with ECC but only 13 (25%) mothers of controls had not visited a dentist in the previous year. Bivariate analyses revealed that low family income, no family dentist, no dental insurance, breastfeeding, increased frequency of daily snacks and low parental knowledge about harmful child feeding habits were associated with ECC. Non-European-born parents and parents who had immigrated in their 20s or at an older age were 2 to 4 times more likely to have a child with ECC than European parents and those who had immigrated at a younger age. Lack of insurance, no family dentist and frequency of snacks were factors remaining in the final logistic regression model for ECC. CONCLUSIONS: The strongest predictors of ECC in this immigrant population, after adjustment for frequent snack consumption, were lack of dental care and lack of dental insurance. These findings support targeting resources to the prevention of ECC in children of new immigrants, who appear to experience barriers to accessing private dental care and who are exposed to many of the determinants of oral disease.

Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren.

This study reports on the etiology and environment where dental injuries occurred and assesses the relationship between dental trauma, socio-economic status and dental caries experience. A population-based, matched case-comparison study was undertaken in 30 schools in two Ontario communities. Dental hygienists calibrated in the use of the Dental Trauma Index (DTI) screened 2422 children aged 12 and 14 years using DTI and Decayed, Missing and Filled Teeth indices. Cases (n = 135) were children with evidence of dental injury. Controls (n = 135) were children randomly selected after screening and matched with cases according to age and gender. Questionnaires were mailed to parents and children. Prevalence of dental injury was 11.4%, mostly minor injuries 63.7% (enamel fracture not involving dentin), affecting one upper central incisor (70.4%). The mean age at the time of dental injuries was 9.5 years (SD = 1.49; range: 6-13 years). Dental trauma most often occurred among boys at school because of falls or while playing sports. The relationship between dental injuries and the socio-economic indicators chosen was not statistically significant. However, a statistically significant direct relationship (P < 0.001) was shown between increased caries experience and dental injuries. This should focus attention on possible common-risk factors such as health-related behavioral problems that may affect both dental disease and dental injuries.

Impact of treated and untreated dental injuries on the quality of life of Ontario school children.

A population-based, matched case-comparison study was undertaken in 30 schools in two Ontario communities to measure the impact of dental trauma on quality of life (QoL) in Canadian school children. Dental hygienists screened 2422 children aged 12-14 years using the dental trauma index, the decayed, missing and filled teeth index (DMFT) and the aesthetic component of the index of orthodontic treatment needs (AC-IOTN). Cases (n = 135) were children with evidence of previous dental trauma. Controls (n = 135) were classmates matched for age and gender. Oral-health-related QoL was assessed using mailed Child Perception Questionnaires (CPQ(11-14)) completed by all children. Data were analyzed using simple and multiple conditional logistic regressions after adjusting for DMFT and AC-IOTN, CPQ(11-14), overall impact and item-specific impacts. Approximately 64% of injuries were untreated enamel fractures and just over 30% were previously injured restored teeth. Untreated children experienced more chewing difficulties (P = 0.026), avoided smiling (P = 0.029) and experienced affected social interactions (P = 0.032) compared with their non-injured peers. When treated and non-injured groups were compared, the only statistically significant effect was difficulty in chewing (P = 0.038). Injured children who were untreated experienced more social impact than their non-injured peers. Restoration of injured teeth improved aesthetics and social interactions but functional deficiencies persisted as a result of periodontal or pulpal pain.

Validity of single-item parental ratings of child oral health.

OBJECTIVE: The aim of this study was to assess the validity of single-item parental ratings of child oral heath. METHODS: Data were collected during a study to assess the impacts of dental injury. Clinical examinations of children aged 11-14 years were undertaken that included measures of trauma, decay, treatment needs, and fluorosis. Children with trauma and a group of trauma-free children were followed-up. Parents were mailed a questionnaire along with a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire 11-14 (CPQ11-14). Bivariate analyses examined associations between parents' ratings of their child's oral health, measures of dental disease, clinically defined treatment needs, and scores on the CPQ11-14. Logistic regression was used to see if the associations observed remained after controlling for access to dental care variables. RESULTS: Complete data were collected from 370 children and their parents. Parental ratings showed significant associations with most of the clinical indicators used and CPQ11-14 scores. Similar results were obtained when the data were analysed for subgroups defined by household income and mother's education. These associations remained after controlling for access to dental services. CONCLUSION: The data suggest that single-item parental ratings of child oral health have adequate construct validity.