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1.  Association between perceived chewing ability and oral health-related quality of life in partially dentate patients 
Background
One of the most immediate and important functional consequences of many oral disorders is a reduction in chewing ability. The ability to chew is not only an important dimension of oral health, but is increasingly recognized as being associated with general health status. Whether perceived chewing ability and oral health-related quality of life (OHRQoL) are correlated to a similar degree in patient populations has been less investigated. The aim of this study was to examine whether perceived chewing ability was related to OHRQoL in partially dentate patients.
Methods
Consecutive partially dentate patients (N = 489) without signs or symptoms of acute oral disease at Tokyo Medical and Dental University's Prosthodontic Clinic participated in the study (mean age 63.0 ± 11.5, 71.2% female). A 20-item chewing function questionnaire (score range 0 to 20) was used to assess perceived chewing ability, with higher scores indicating better chewing ability. The 14-item Oral Health Impact Profile-Japanese version (OHIP-J14, score range 0 to 56) was used to measure OHRQoL, with higher scores indicating poorer OHRQoL. A Pearson correlation coefficient was calculated to assess the correlation between the two questionnaire summary scores. A linear regression analysis was used to describe how perceived chewing ability scores were related to OHRQoL scores.
Results
The mean chewing function score was 12.1 ± 4.8 units. The mean OHIP-J14 summary score was 13.0 ± 9.1 units. Perceived chewing ability and OHRQoL were significantly correlated (Pearson correlation coefficient: -0.46, 95% confidence interval [CI]: -0.52 to -0.38), indicating that higher chewing ability was correlated with lower OHIP-J14 summary scores (p < 0.001), which indicate better OHRQoL. A 1.0-unit increase in chewing function scores was related to a decrease of 0.87 OHIP-J14 units (95% CI: -1.0 to -0.72, p < 0.001). The correlation between perceived chewing ability and OHRQoL was not substantially influenced by age and number of teeth, but by gender, years of schooling, treatment demand and denture status.
Conclusion
Patients' perception of their chewing ability was substantially related to their OHRQoL.
doi:10.1186/1477-7525-8-118
PMCID: PMC2974665  PMID: 20955614
2.  Oral health-related quality of life in diabetic patients: comparison of the Persian version of Geriatric Oral Health Assessment Index and Oral Health Impact Profile: A descriptive-analytic study 
Background
Diabetes mellitus is one of the systemic disease which is show important oral manifestation and influence oral health. This study describes how diabetes mellitus affects oral health and oral health-related quality of life. The aim of this study was to evaluate the oral health and oral health-related quality of life of diabetic patients and compare the discriminative capability of Persian versions of two GOHAI and OHIP-14 questionnaires in these patients.
Methods
A total of 350 patients with Type II diabetes mellitus, referring to the Diabetes Clinic, were selected and data were collected by GOHAI and OHIP-14 questionnaires completed by patients and clinical examinations. Oral health parameters (CAL,BI,GI,PLI,DMFT and xerostomia) were measured, also concurrent validity and conformity of two questionnaires were assessed. In order to test Discriminant analysis capabilities of two questionnaires, ADD and SC scores of questionnaires were divided into two parts and a logistic regression model was designed, which included subjective and objective variables.
Results
Mean patients age was 55 years (with 75.4% female patients). The results showed that some oral conditions such as xerostomia, clinical attachment loss, number of missing teeth and plaque index were correlated to diabetes control level (HbA1c) and type of anti-diabetic medication. ADD and SC scores of two questionnaires were at high level. However, the effect of oral problems on decreasing OHRQoL was evident. Both questionnaires had acceptable concurrent validity and conformity. Moreover, there was a strong correlation between GOHAI and OHIP-14. OHIP-14 questionnaire had a higher discriminant analysis capability compared to GOHAI and better diagnosed patients who needed dental treatments: patients with higher GI, xerostomia and those wearing partial dentures.
Conclusion
Diabetic patients did not show acceptable oral health status and in some extent, oral problems affected oral health-related quality of life. Psychotherapy courses and solving oral problems of the patients can improve OHRQoL. OHIP-14 had higher discriminant analysis capability and was more effective in diagnosing oral problems.
doi:10.1186/2251-6581-13-32
PMCID: PMC4015305  PMID: 24495383
Diabetes mellitus; Type 2; Oral health; Quality of Life; GOHAI; OHIP-14
3.  Quality of life measured by OHIP-14 and GOHAI in elderly people from Bialystok, north-east Poland 
BMC Oral Health  2014;14:106.
Background
The Oral Health Impact Profile-14 (OHIP-14) and the Geriatric/General Oral Health Assessment Index (GOHAI) have never been compared for a group of the same subjects in the Polish population. The aim of the study was to compare the OHIP-14 and GOHAI measures.
Methods
178 independently living people over the age of 55 were included in the study. The GOHAI and OHIP-14 measures were used. Other variables included age, gender, self-ratings of oral general health, education, number of missing teeth, chewing problems and dry mouth.
Results
The mean age of respondents was 70.8 years. The internal reliability (Cronbach’s alpha) showed a high internal consistency for both measures. Spearman’s rank correlation coefficient between the GOHAI and OHIP-14 scores was 0.81. Using the additive method of creating scores, 1.1% of respondents had the GOHAI score of zero, indicating no impact from oral conditions, while 13.5% of them had an OHIP-14 score of zero. Dental status, partial dentures, chewing problems, dry mouth and self-rated oral health were significantly associated with the results of the GOHAI and the OHIP-14 (Kruskal–Wallis test, Mann–Whitney U test). The numbers of preserved and missing teeth significantly correlated with the GOHAI and the OHIP-14, while DMF was significantly associated with the GOHAI only. 6 individuals with discrepant results were revealed. After the exclusion of the abovementioned patients, the internal reliability (Cronbach’s alpha) still showed a high internal consistency, and the correlation between the GOHAI and OHIP-14 scores using Spearman’s rank-correlation coefficient increased to 0.87. This phenomenon was identified as a “fatigue effect”.
Conclusions
There was a strong correlation between the GOHAI and the OHIP-14. Both instruments demonstrated good discriminant properties and helped capture the respondents’ oral health problems. The questionnaires should be randomly distributed to avoid the influence of “fatigue effect” on the results of a comparison of different measures.
doi:10.1186/1472-6831-14-106
PMCID: PMC4145358  PMID: 25141902
Oral health-related quality of life; OHIP-14; GOHAI; Quality of life; Elderly; Poland; “Fatigue effect”
4.  Impact of tooth loss related to number and position on oral health quality of life among adults 
Background
The objective of this study was to evaluate the impact of tooth loss on oral health-related quality of life (OHRQoL) in adults with emphasis on the number of teeth lost and their relative position in the mouth.
Methods
The study population was a cross-sectional household probability sample of 248, representing 149,635 20–64 year-old residents in Piracicaba-SP, Brazil. OHRQoL was measured using the OHIP-14. Socioeconomic, demographic, health literacy, dental services use data and clinical variables were collected. Oral examinations were performed using WHO criteria for caries diagnosis, using the DMFT index; that is, the sum of decayed, missing and filled teeth (DMFT). An ordinal scale for tooth loss, based on position and number of missing teeth, was the main explanatory variable. The total OHIP score was the outcome for negative binomial regression and OHIP prevalence was the outcome for logistic regression at 5% level. A hierarchical modeling approach was adopted according to conceptual model.
Results
OHIP score was 10.21 (SE 1.16) with 48.1% (n=115) reporting one or more impacts fairly/very often (OHIP prevalence). Significant prevalence rate ratios (PRRs) for OHIP severity were observed for those who had lost up to 12 teeth, including one or more anterior teeth (PRR=1.63, 95%CI 1.06–2.51), those who had lost 13–31 teeth (PRR=2.33, 95%CI 1.49–3.63), and the edentulous (PRR=2.66, 95%CI 1.55–4.57) compared with fully dentate adults. Other significant indicators included those who only sought dental care because of dental pain (PRR=1.67, 95%CI 1.11–2.51) or dental needs (PRR=1.84, 95%CI 1.24–2.71) and having untreated caries (PRR=1.57 95%CI 1.09–2.26). Tooth loss was not significantly associated with OHIP prevalence; instead using dental services due to dental pain (PR=2.43, 95%CI 1.01–5.82), having untreated caries (PR=3.96, 95%CI 1.85–8.51) and low income (PR=2.80, 95%CI 1.26–6.42) were significant risk indicators for reporting OHIP prevalence.
Conclusion
Our analyses showed OHRQoL gradients consistent with the number and position of teeth missing due to oral disease. These findings suggest that the quantity of teeth lost does not necessarily reflect the impact of tooth mortality on OHRQoL and that future studies should take this into consideration.
doi:10.1186/s12955-014-0165-5
PMCID: PMC4263115  PMID: 25433483
Adults; Oral health; Quality of life; OHIP14; Regression analysis
5.  Oral health-related quality of life in complete denture wearers depending on their socio-demographic background, prosthetic-related factors and clinical condition 
Objectives: To investigate the differences in impact on oral health-related quality of life (OHRQoL) among complete denture wearers depending on their socio-demographic characteristics, prosthetic-related factors and oral status. Study Design: 51 patients aged 50-90 years treated, from 2005 to 2010, with at least one complete denture at the Department of Buccofacial Prostheses of the Complutense University (Madrid) were enrolled in this cross-sectional study. All of the participants answered the Oral Health Impact Profile (OHIP-14sp) questionnaire. The additive scoring method was used. The prevalence of impacts was calculated by using the occasional threshold (OHIP-14sp score≥2). Socio-demographic and prosthetic-related variables were gathered. Patients underwent clinical examination to assess their oral condition. Descriptive probes and Chi-Square tests were run (p≤0.05). Results: The predominant participants’ profile was that of a man with a mean age of 69 years wearing complete dentures in both the maxilla and the mandible. The prevalence of impact was 23.5%, showing an average score of 19±9.8. The most affected domains were “functional limitation” and “physical pain”, followed by “physical disability”. Minor impacts were recorded for the psychological and social subscales (“psychological discomfort”, “psychological disability”, “social disability” and “handicap”). The prosthesis’ location significantly influenced the overall patient satisfaction, the lower dentures being the less comfortable. Having a complete removable denture as antagonist significantly hampered the patient satisfaction. Patients without prosthetic stomatitis and those who need repairing or changing their prostheses, recorded significantly higher OHIP-14sp total scores. Conclusions: The use of conventional complete dentures brings negative impacts in the OHRQoL of elderly patients, mainly in case of lower prostheses that required reparation or substitution, with a removable total denture as antagonist. The prosthetic stomatitis in this study was always associated to other severe illness, which may have influenced the self-perceived discomfort with the prostheses, as those patients were daily medicated with painkillers.
Key words:Oral Health Impact Profile (OHIP), oral health-related quality of life (OHRQoL), patient satisfaction, complete denture, elderly patients.
doi:10.4317/medoral.18648
PMCID: PMC3668860  PMID: 23385509
6.  Validation of a Greek version of the oral health impact profile (OHIP-14) for use among adults 
Background
To test the validity of the short form of the Oral Health Impact Profile (OHIP-14) for use among adults in Greece.
Methods
The original English version of the OHIP-14 was translated using the forward-backward technique, pilot-tested, and then applied to 211 adults aged 35 years and above. The questionnaire was filled out during face-to-face interviews conducted by one dentist, while individuals were asked to undergo a clinical examination. The internal consistency of the questionnaire was evaluated using Cronbach's alpha (α) coefficient and inter-item and item-total correlations. Discriminant and convergent validities were assessed.
Results
Cronbach's α was estimated to be 0.90. Inter-item correlations coefficients ranged from 0.10 to 0.83, while item-total correlations coefficients from 0.44 to 0.76. Significant associations were found between OHIP-14 and the decayed, missing and filled teeth (DMFT) and oral hygiene, supporting the ability of the questionnaire to discriminate between individuals with and without impacts. The OHIP-14 total score was highly associated with self-perceived oral health status (rs = 0.57; p = 0.01), as well as with self-assessment of oral satisfaction (rs = 0.55;p = 0.01). Similar results were observed by investigating the relationship between the latter questions and each domain score as well as in various sub-groups analyses.
Conclusions
The OHIP-14 is a reliable and valid questionnaire for the assessment of OHRQoL among adults in Greece.
doi:10.1186/1477-7525-10-7
PMCID: PMC3278380  PMID: 22244162
7.  Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan 
BMC Oral Health  2015;15:1.
Background
Although the use of removable dentures can improve oral function and esthetics for elderly people, compared to those who do not wear removable dentures, those wearing removable dentures could have worse oral health related-quality of life (OHRQoL). Additional information is required to assess which factors related to denture wearing influence the OHRQoL of elderly individuals. The purpose of this study is to evaluate the association between denture wearing and OHRQoL in a sample of elderly individuals in Taiwan.
Methods
The study population included 277 elderly people wearing removable dentures (mean age = 76.0 years). Using face-to-face interviews, we collected data on the participants’ socio-demographic characteristics, dental care service usage (regular dental checkups, treatment during toothache, dental visits in the last year), and factors related to denture wearing (perceived oral pain, perceived loose denture, perceived oral ulcer, perceived halitosis, perceived dry mouth, and perceived total denture satisfaction scores). OHRQoL was measured using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The location and number of remaining natural teeth and the type of denture were also recorded. Hierarchical multiple regression analysis was performed using GOHAI-T scores as the dependent variable.
Results
All the predictors together accounted for 50% of the variance in GOHAI-T scores. Further, education level, number of natural teeth, denture status, perceived loose denture, perceived oral ulcer, and perceived total denture satisfaction scores had statistically significant influences on OHRQoL. When compared with other variables, factors related to denture wearing, especially perceived total denture satisfaction scores, had the greatest impact on GOHAI-T scores.
Conclusions
Of the factors analyzed in this study, denture satisfaction was the strongest predictor of OHRQoL. This suggests that denture satisfaction is useful for assessing the effect of denture treatment on the OHRQoL of elderly individuals wearing removable dentures.
doi:10.1186/1472-6831-15-1
PMCID: PMC4298049  PMID: 25559722
Elderly; Removable dental prostheses; Oral health-related quality of life; Geriatric oral health assessment index; Denture satisfaction; Dental care service
8.  How Valid are the Psychometric Properties of the Oral Health Impact Profile-14 Measure in Adult Dental Patients in Ibadan, Nigeria? 
Background
The Oral Health Impact Profile (OHIP) is the most widely used quality of life (QoL) measure to evaluate the influence of oral diseases on individuals. QoL measures have been noted to be context and environment specific, and there is a need to cross-culturally adapt a scale before its introduction into any community. This study aimed to evaluate the psychometric properties, validity and internal consistency of the OHIP-14 measure in an adult patient population in Ibadan, Nigeria.
Methods
A cross-sectional study was conducted over a four-month period on 204 adult patients using OHIP-14 structured questionnaire, global self-report indicator of oral conditions and perceived treatment need. Oral examinations were performed to assess periodontal status, caries experience and attachment loss. Data were analyzed using SPSS and p-value for statistical significance was set at < 0.05.
Results
A total of 204 patients participated in the study with a mean OHIP score of 11.2 (± 9.8). OHIP scores were not related to the sociodemographic characteristics. Perception of need for treatment was greater among those who reported impacts on their QoL (89.3% vs. 14.3%, p < 0.001). The OHIP scores correlated negatively with global self rating of oral health status (rho = −0.23, p < 0.01). Higher OHIP scores were associated with having carious teeth (p = 0.023). The Cronbach's alpha for the 14 inventory items ranged from 0.857 to 0.871.
Conclusion
The OHIP-14 measure showed good psychometric properties with satisfactory validity and internal consistency in adult patients in Ibadan, Nigeria.
PMCID: PMC4141227  PMID: 25183930
Oral health; quality of life; OHIP-14; validity; internal consistency
9.  Oral health-related quality of life in a birth cohort of 32-year olds 
Objectives
To describe oral health-related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well-established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services.
Methods
A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14). The questionnaire also collected data on each study member’s occupation, self-rated oral health and reasons for seeing a dental care provider. SES was determined from each individual’s occupation at age 32 years.
Results
The mean total OHIP-14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems ‘fairly often’ or ‘very often’. When the prevalence of impacts ‘fairly/very often’ was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and ‘episodic’ dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts.
Conclusions
OHIP-14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age- and sex-standardized estimates from Australia (18.2%) and the UK (15.9%).
doi:10.1111/j.1600-0528.2007.00395.x
PMCID: PMC2288569  PMID: 18650957
adult; dental caries; oral health; Oral Health Impact Profile; periodontal diseases; prevalence; quality of life; tooth loss
10.  Oral health-related quality of life in partially edentulous patients before and after implant therapy: a 2-year longitudinal study 
Oral & Implantology  2013;6(2):37-42.
SUMMARY
Objectives.
The aim of this study was to measure the Oral Health-Related Quality of Life (OHRQoL) before and after a prosthodontic implant therapy so to determine the physical and psychological impact of implant-supported fixed partial dentures (IFPD) rehabilitation among edentulous patients.
Methods.
50 partially edentulous patients aged 40–70 years, treated with IFPD, completed the OHRQoL questionnaire before the implant surgery (Time 0) and 2 years after their whole implant-prosthetic rehabilitation (Time 1). The questionnaire was proposed in a short version of Oral Health Impact Profile (OHIP-14, range 0–56) and analyzed through the ‘additive method’. We evaluated statistical mean, standard deviation, median, variance and mode of all OHIP-14 domains and the statistical significance about oral changes at Time 0 and Time 1 using the Chi-square test (p-values < 0.05).
Results.
Patients reported significant changes in mean OHIP scores (Time 0: 2.15; Time 1: 0.65; p < 0.01). The most prevalently affected domain was “functional limitation”, followed by “psychological discomfort” and “physical pain”. There were no significant differences dependent on age, gender and antagonistic teeth (p > 0.05). Patients with I and IV Kennedy’s class edentulism showed better improvement (p < 0.05).
Conclusions.
Preoperative and post-treatment assessments of OHRQoL exhibited significant differences. The IFPD treatment had a positive effect on the OHRQoL, which improved better in patients with I and IV Kennedy’s edentulous class.
PMCID: PMC3808938  PMID: 24175052
oral health-related quality-of-life; OHIP-14; dental implants; prosthodonti; missing teeth
11.  The relationship of oral health literacy with oral health-related quality of life in a multi-racial sample of low-income female caregivers 
Background
To investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants.
Methods
Participants (N = 1,405) enrolled in the Carolina Oral Health Literacy (COHL) study completed the short form of the Oral Health Impact Profile Index (OHIP-14, a measure of OHRQoL) and REALD-30 (a word recognition literacy test). Socio-demographic and self-reported dental attendance data were collected via structured interviews. Severity (cumulative OHIP-14 score) and extent of impact (number of items reported fairly/very often) scores were calculated as measures of OHRQoL. OHL was assessed by the cumulative REALD-30 score. The association of OHL with OHRQoL was examined using descriptive and visual methods, and was quantified using Spearman's rho and zero-inflated negative binomial modeling.
Results
The study group included a substantial number of African Americans (AA = 41%) and American Indians (AI = 20%). The sample majority had a high school education or less and a mean age of 26.6 years. One-third of the participants reported at least one oral health impact. The OHIP-14 mean severity and extent scores were 10.6 [95% confidence limits (CL) = 10.0, 11.2] and 1.35 (95% CL = 1.21, 1.50), respectively. OHL scores were distributed normally with mean (standard deviation, SD) REALD-30 of 15.8 (5.3). OHL was weakly associated with OHRQoL: prevalence rho = -0.14 (95% CL = -0.20, -0.08); extent rho = -0.14 (95% CL = -0.19, -0.09); severity rho = -0.10 (95% CL = -0.16, -0.05). "Low" OHL (defined as < 13 REALD-30 score) was associated with worse OHRQoL, with increases in the prevalence of OHIP-14 impacts ranging from 11% for severity to 34% for extent. The inverse association of OHL with OHIP-14 impacts persisted in multivariate analysis: Problem Rate Ratio (PRR) = 0.91 (95% CL = 0.86, 0.98) for one SD change in OHL. Stratification by race revealed effect-measure modification: Whites--PRR = 1.01 (95% CL = 0.91, 1.11); AA--PRR = 0.86 (95% CL = 0.77, 0.96).
Conclusions
Although the inverse association between OHL and OHRQoL across the entire sample was weak, subjects in the "low" OHL group reported significantly more OHRQoL impacts versus those with higher literacy. Our findings indicate that the association between OHL and OHRQoL may be modified by race.
doi:10.1186/1477-7525-9-108
PMCID: PMC3248838  PMID: 22132898
oral health literacy; oral health-related quality of life; OHIP-14; racial differences; effect measure modification
12.  Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life 
Acta Odontologica Scandinavica  2012;70(4):331-336.
Objective.
The aim of the study was to evaluate the association between psychosocial aspects of temporomandibular disorders (TMD) and oral health-related quality-of-life (OHRQoL) and, secondly, to investigate the gender differences in these associations using patient and non-patient groups.
Materials and methods.
The sample of the study consisted of 79 patients with TMD and 70 non-patients. The data was collected by Finnish versions of the RDC/TMD Axis II profile and Oral Health Impact Profile (OHIP-14) questionnaires. The associations between Axis II profile sub-scales and OHIP prevalence were evaluated using chi-square tests, as stratified by group status (TMD patients and non-patient controls) and by gender. The association between OHIP prevalence and Axis II profile sub-scales were evaluated using logistic regression analysis, adjusted by age, gender and group.
Results.
OHIP prevalence (those reporting at least one problem) was 90.9% in the patient group and 33.3% in the non-patient group (p < 0.001, chi-squared test). OHIP prevalence was higher among those scoring higher on all RDC/TMD Axis II profile sub-scales, i.e. graded chronic pain status, depression and non-specific physical symptoms with pain items included and with pain items excluded. The associations were significant in the non-patient group. Women showed statistically significant associations of OHIP prevalence with all Axis II sub-scales. Among men, OHIP prevalence associated with GCPS and somatization. The logistic regression analysis showed that OHIP prevalence associated significantly with somatization and depression.
Conclusions.
TMD associate with OHRQoL through multiple ways, linked with depression and somatization. These findings emphasize the importance of early and effective treatment of TMD.
doi:10.3109/00016357.2011.654241
PMCID: PMC3793272  PMID: 22300221
temporomandibular disorders; oral health-related quality-of-life; Oral Health Impact Profile; psychosocial factors
13.  Oral Health-Related Quality of Life in institutionalized elderly in Barcelona (Spain) 
Objective: The objective of this study is to describe the oral health status and the factors associated with oral health-related quality of life (OHRQoL) in people aged 65 and older institutionalized in Barcelona in 2009. Study Desing: Cross sectional study in 194 elderly. The dependent variable was poor OHRQoL, according to the Geriatric Oral Health Assessment Index (GOHAI). The independent variables were socio-demographic data, last dental visit, subjective and objective oral health status. Robust Poisson regression analysis was used to determine the factors associated with OHRQoL as well as the strengths of association (Prevalence Ratios with respective confidence intervals at 95%). Results: According to GOHAI, 94 women (68.1%) and 36 men (64.3%) had poor OHRQoL. The average DMFT index (number of decayed, missing and filled teeth) was 22.8, with mean 10.2 remaining teeth. According to the Community Periodontal Index only 1.9% were healthy. 33.8% of the sample (35.5% of women and 30.4% of men) presented edentulism, 54.2% needed upper dental prostheses (51.1% of women and 60.7% of men) and 64.7% needed lower ones (61.6% of women and 71.4% of men). Only 7.2% had visited a dentist in the past year (8.8% of women and 3.6% of men). After fitting several multivariate adjusted robust Poisson regression models, poor OHRQoL was found to be associated to self-reporting problems with teeth or gums, self-reporting poor opinion about teeth/gums/denture and also associated to functional edentulism, needing upper denture, but not to socio-demographic factors or time since last dental visit. Conclusions: The study population has poor objective oral health. A high percentage has poor OHRQoL associated to subjective and objective oral health conditions. Dental care is required and these services should be included in the Spanish National Health System.
Key words:Oral health, homes for the aged, elderly, self-assessment, quality of life, geriatric oral health assessment index (GOHAI).
doi:10.4317/medoral.18280
PMCID: PMC3613882  PMID: 23385501
14.  Functional dental status and oral health-related quality of life in an over 40 years old Chinese population 
Clinical Oral Investigations  2012;17(6):1471-1480.
Objectives
This study aimed to assess oral health-related quality of life (OHRQoL) related to dental status.
Material and methods
One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. OHIP-14CN scores were used to assess OHRQoL and analyzed using multivariable logistic regression including five dental conditions (‘≥10 teeth in each jaw’; ‘complete anterior regions’; ‘sufficient premolar regions’ (≥3 posterior occluding pairs (POPs)); ‘sufficient molar regions’ (bilaterally ≥1 POP); and tooth replacement) after adjustment for five background variables. Likelihood ratios for impaired OHRQoL (OHIP total score ≥5) were assessed at each level of the classification system.
Results
In the hierarchical scheme, OHIP-14CN total scores were highest in branch ‘<10 teeth in each jaw’ (8.5 ± 9.5 to 12.3 ± 13.2). In branch ‘≥10 teeth’ scores ranged from 6.2 ± 7.7 to 8.3 ± 9.3. The most important dental condition discriminating for impact on OHRQoL was ‘≥10 teeth in each jaw’ (Likelihood ratio 1.59). In this branch subsequent levels were discriminative for impaired OHRQoL (Likelihoods 1.29–1.69), in the branch ‘<10 teeth in each jaw’ they were not (Likelihoods 0.99–1.04). Tooth replacements were perceived poorer as their natural counterparts (odd ratios, 1.30 for fixed and 1.47 for removable appliances).
Conclusions
OHRQoL was strongly associated with the presence of at least 10 teeth in each jaw. The hierarchical classification system predicted approximately 60 % of subjects correctly with respect to impaired OHRQoL.
Clinical relevance
From an OHRQoL perspective, natural teeth were preferred over artificial teeth.
doi:10.1007/s00784-012-0834-x
PMCID: PMC3691481  PMID: 23015025
Oral health-related quality of life; Occlusal status; Hierarchical dental functional classification system; Chinese adults
15.  Level of oral health impacts among patients participating in PEARL: a dental practice-based research network 
Objectives
To determine whether participants of a dental practice-based research network (PBRN) differ in their level of oral health impact as measured by the Oral Health Impact Profile (OHIP) questionnaire.
Methods
A total of 2410 patients contributed 2432 OHIP measurements (median age = 43 years; interquartile range = 28) were enrolled in four dental studies. All participants completed the Oral Health Impact Profile (OHIP-14) during a baseline visit. The main outcome of the current study was the level of oral health impact, defined as follows: no impact (“Never” reported on all items); low (“Occasionally” or “Hardly ever” as the greatest frequency score reported on any item); and high (“Fairly often” or “Very often” as the greatest frequency reported on any item). Polychotomous logistic regression was used to develop a predictive model for the level of oral health impact considering the following predictors: patient’s age, gender, race, practice location, type of dentist, and number of years the enrolling dentist has been practicing.
Results
A high level of oral health impacts was reported in 8% of the sample; almost a third (29%) of the sample reported a low level of impacts, and 63% had no oral health impacts. The prevalence of impacts differed significantly across protocols (P<0.001). Females were more likely to be in the high oral impact group than the no impact group compared to males (OR=1.46; 95% CI= 1.06–1.99). African-Americans were more likely to report high oral impacts when compared to other racial/ethnic groups (OR=2.11; 95% CI = 1.26–3.55). Protective effects for being in the high or in the low impact groups were observed among patients enrolled by a solo practice (P<0.001) or by more experienced dentists (P=0.01). A small but highly significant statistical association was obtained for patient age (P<0.001). In the multivariate model, patient’s age, practice size and gender were found to jointly be significant predictors of oral health impact level.
Conclusions
Patients’ subjective report of oral health impact in the clinical setting is of importance for their health. In the context of a dental PBRN, the report of oral health-related quality of life (OHRQoL) was different across four dental studies. The observed findings validate the differential impact that oral health has on the patients’ perception of OHRQoL particularly among specific groups. Similar investigations to elucidate the factors associated with patient’s report of quality of life are warranted.
doi:10.1111/j.1600-0528.2012.00676.x
PMCID: PMC3380181  PMID: 22390788
Oral-Health Impact; OHRQoL; Dental PBRN; OHIP-14; Patient Reported Outcomes; Subjective Health
16.  Effect of malocclusion or orthodontic treatment on oral health-related quality of life in adults 
Korean Journal of Orthodontics  2014;44(6):304-311.
Objective
The purpose of this study was to evaluate the effect of malocclusion or orthodontic treatment on oral health-related quality of life (OHRQoL) in adults.
Methods
The sample consisted of 860 adults (378 men and 482 women, aged 18-39 years) who were clinically evaluated for malocclusion or orthodontic treatment experience. Participants were divided into 4 groups as follows: normal occlusion, malocclusion, fixed treatment, and retention. OHRQoL was assessed with the short form of the Oral Health Impact Profile (OHIP-14) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ).
Results
The malocclusion group and the fixed treatment group had significantly higher OHIP-14 scores than the normal occlusion group and the retention group (p < 0.001). The malocclusion group had the highest PIDAQ score, while the normal occlusion group and the retention group had the lowest PIDAQ score (p < 0.001). Women had higher OHIP-14 and PIDAQ scores than men. A significant positive correlation was found between OHIP-14 and PIDAQ scores (p < 0.01).
Conclusions
Malocclusion has a negative impact on OHRQoL, but this could be improved in adults through orthodontic treatment. These OHRQoL questionnaires can provide additional useful information on specific aspects of orthodontic patients' psychological state.
doi:10.4041/kjod.2014.44.6.304
PMCID: PMC4250664  PMID: 25473646
Psychology; Orthodontic treatment; Malocclusion; Quality of life
17.  Factor Analyses of the Oral Health Impact Profile - Overview and studied population 
Purpose
A desideratum of oral health-related quality of life (OHRQoL) instruments - such as the Oral Health Impact Profile (OHIP) - is that they accurately reflect the structure of the measured construct(s). With this goal in mind, the Dimensions of Oral Health-Related Quality of Life (DOQ) Project was proposed to investigate the number and nature of OHRQoL dimensions measured by OHIP. In this report, we describe our aggregate data set for the factor analyses in the project, which consists of responses to the 49-item OHIP from general population subjects and prosthodontics patients from 6 countries, including a large age range of adult subjects and both genders.
Material and methods
The DOQ Project's aggregate data set combines data from 35 individual studies conducted in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden.
Results
The combined data set includes 10,778 OHIPs from 9,348 individuals (N=6,349 general population subjects, N=2,999 prosthodontic patients). To elucidate the OHIP latent structure, the aggregated data were split into a Learning Sample (N=5,173) for exploratory analyses and a Validation Sample (N=5,022) for confirmatory analyses. Additional data (N=583) were assigned to a third data set.
Conclusion
The Dimensions of Oral Health-Related Quality of Life Project contains a large amount of international data and is representative of populations where OHIP is intended to be used. It is well-suited to assess the dimensionality of the questionnaire.
doi:10.1016/j.jpor.2013.11.002
PMCID: PMC4024446  PMID: 24440578
Oral Health Impact Profile; Factor analysis; questionnaire; general population; prosthodontic patients
18.  Spanish version of the Oral Health Impact Profile (OHIP-Sp) 
BMC Oral Health  2006;6:11.
Background
The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aims of this study were to develop a Spanish version (OHIP-Sp) of the Oral Health Impact Profile and to evaluate its convergent and discriminative validity, and its internal consistency.
Methods
The original 49-items OHIP was translated to Spanish, revised for understanding and semantics by two independent dentists, and then translated back to English by an independent bilingual dentist. The data originated in a cross sectional study conducted among high school students from the Province of Santiago, Chile. The study group was sampled using a multistage random cluster procedure yielding 9,203 students aged 12–21 years. All selected students were invited to participate and all filled a questionnaire with information on socio-demographic factors; oral health related behaviors; and self-reported oral health status (good, fair or poor). From this group, 9,163 students also accepted to fill a detailed questionnaire on socio-economic indicators and to receive a clinical examination comprising direct recordings of clinical attachment levels (CAL) in molars and incisors, tooth loss, and the presence of necrotizing ulcerative gingival lesions.
Results
The participation rate and the questionnaire completeness were high with OHIP-Sp total scores being computed for 9,133 subjects. Self-perceived oral health status was associated with the total OHIP-Sp score and all its domains (Spearman rank correlation). The OHIP-Sp total score was also directly associated with the 4 dental outcomes investigated (Mann-Whitney test) and the largest impact was found for the outcomes, 'tooth loss' with a mean OHIP-Sp score = 13.5 and 'CAL >= 3 mm' with a mean OHIP-Sp score = 13.0.
Conclusion
The OHIP-Sp revealed suitable convergent and discriminative validity and appropriate internal consistency (Cronbach's α). Further studies on OHIP-Sp warrant the inclusion of populations with a higher disease burden; and the use of test-retest reliability exercises to evaluate the stability of the test.
doi:10.1186/1472-6831-6-11
PMCID: PMC1534011  PMID: 16827940
19.  Measuring and decomposing oral health inequalities in an UK population 
Objectives
With health inequalities high on the policy agenda, this study measures oral health inequalities in the UK.
Methods
We compare an objective clinical measure of oral health (number of natural teeth) with a self-reported measure of the impact of oral health (the Oral Health Impact Profile, OHIP) to establish whether the type of measure affects the scale of inequality measured. Gini coefficients and Concentration Indices (CIs) are calculated with subsequent decompositions using data from the 1998 UK Adult Dental Health Survey. Because the information on OHIP is only available on dentate individuals, analyses on the number of natural teeth are conducted for two samples – the entire sample and the sample with dentate individuals only, the latter to allow direct comparison with OHIP.
Results
We find considerable overall pure oral health inequalities (number of teeth: Gini = 0.68 (including edentate), Gini = 0.40 (excluding edentate); OHIP: Gini = 0.33) and income-related inequalities for both measures (number of teeth: CI = 0.35 (including edentate), CI = 0.15 (excluding edentate); OHIP: CI = 0.03), and the CI is generally higher for the number of teeth than for OHIP. There are differences across age groups, with CI increasing with age for the number of teeth (excluding edentate: 16–30 years: CI = 0.01, 65 + years: CI = 0.11; including edentate: 16–30 years: CI = 0.01, 65 + years: CI = 0.19). However, inequalities for OHIP were highest in the youngest age group (CI = 0.05). Number of teeth reflects the accumulation of damage over a lifetime, while OHIP records more immediate concerns.
Conclusions
There are considerable pure oral health inequalities and income-related oral health inequalities in the UK. Using sophisticated methods to measure oral health inequality, we have been able to compare inequality in oral health with inequality in general health. The results provide a benchmark for future comparisons but also indicate that the type of health measure may be of considerable significance in how we think about and measure oral health inequalities.
doi:10.1111/cdoe.12071
PMCID: PMC3812409  PMID: 23992442
concentration index; decomposition; gini index; health inequality; oral health; oral health impact profile
20.  Measuring and decomposing oral health inequalities in a UK population 
Community dentistry and oral epidemiology  2013;41(6):10.1111/cdoe.12071.
Objectives
With health inequalities high on the policy agenda, this study measures oral health inequalities in the UK.
Methods
We compare an objective clinical measure of oral health (number of natural teeth) with a self-reported measure of the impact of oral health (the Oral Health Impact Profile, OHIP) to establish whether the type of measure affects the scale of inequality measured. Gini coefficients and Concentration Indices (CI) are calculated with subsequent decompositions using data from the 1998 UK Adult Dental Health Survey. Because the information on OHIP is only available on dentate individuals, analyses on the number of natural teeth are conducted for two samples – the entire sample and the sample with dentate individuals only, the latter to allow direct comparison with OHIP.
Results
We find considerable overall pure oral health inequalities (number of teeth: Gini=0.68 (including edentate), Gini=0.40 (excluding edentate); OHIP: Gini=0.33) and income-related inequalities for both measures (number of teeth: CI=0.35 (including edentate), CI=0.15 (excluding edentate); OHIP: CI=0.03) and the CI is generally higher for the number of teeth than for OHIP. There are differences across age groups, with CI increasing with age for the number of teeth (excluding edentate: 16–30yrs: CI=0.01, 65+yrs: CI=0.11; including edentate: 16–30yrs: CI=0.01, 65+yrs: CI=0.19). However, inequalities for OHIP were highest in the youngest age group (CI=0.05). Number of teeth reflects the accumulation of damage over a lifetime, while OHIP records more immediate concerns.
Conclusions
There are considerable pure oral health inequalities and income-related oral health inequalities in the UK. By using sophisticated methods to measure oral health inequality, we have been able to compare inequality in oral health with inequality in general health. The results provide a benchmark for future comparisons but also indicate that the type of health measure may be of considerable significance in how we think about and measure oral health inequalities.
doi:10.1111/cdoe.12071
PMCID: PMC3812409  PMID: 23992442
Health inequality; Gini index; Concentration index; Decomposition; Oral Health Impact Profile (OHIP); Oral health
21.  Validating an alternate version of the chewing function questionnaire in partially dentate patients 
BMC Oral Health  2009;9:9.
Background
The aim of this study was to investigate the dimensionality, reliability, and validity of an alternate version of the chewing function questionnaire in partially dentate patients in Japan.
Methods
Subjects were partially dentate patients who attended the prosthodontic clinic at Tokyo Medical and Dental University (N = 491, 71% women, mean age (± SD): 63.0 ± 11.5 years). The questionnaire asked each subject to rate his or her ability to chew 20 common Japanese foods. For each individual, responses were combined to yield a chewing function summary score, with higher scores indicating better self-reported chewing ability. We used exploratory factor analysis to investigate the scores' dimensionality. For validity assessment, we computed the correlations between the chewing function score and oral health-related quality of life (OHRQoL, as measured by the Japanese 14-item Oral Health Impact Profile (OHIP-14)) Internal consistency of scores and test-retest reliability were investigated by asking a subset of subjects (N = 62) to complete the questionnaire twice, 2 weeks apart.
Results
Exploratory factor analysis provided some evidence that self-reported chewing ability can be characterized by a summary score as the original authors suggest. Support for the validity of chewing function scores using the alternate version of the questionnaire was derived from correlations with OHIP-14 scores (r = -0.46, 95% confidence interval (CI): -0.53 to -0.39); thus, better chewing ability was associated with less impaired OHRQoL. Internal consistency was 'satisfactory,' with a Cronbach's alpha of 0.90 (lower limit of 95% CI: 0.89). The test-retest reliability was 'good,' with an intraclass correlation coefficient of 0.69 (95% CI: 0.56 to 0.82).
Conclusion
The alternate version of the chewing function questionnaire can be used as a stand-alone instrument because of the demonstrated reliability and validity of scores obtained using the questionnaire in partially dentate patients.
doi:10.1186/1472-6831-9-9
PMCID: PMC2667387  PMID: 19291293
22.  Psychometric Properties of Croatian and Slovenian Short Form of Oral Health Impact Profile Questionnaires 
Croatian medical journal  2008;49(4):536-544.
Aim
To develop Croatian and Slovenian versions of the 14-item Oral Health Impact Profile (OHIP) Questionnaire.
Methods
The English original version of the OHIP questionnaire was translated into Croatian (OHIP-CRO14) and Slovenian (OHIP-SVN14) language by a forward-backward translation method. The psychometric properties of the OHIP-CRO14 and OHIP-SVN14 were tested. Concurrent validity was tested on 623 subjects (193 Croatian and 430 Slovenian), test-retest reliability on 115 subjects (55 Croatian and 60 Slovenian), internal consistency on 678 subjects (218 Croatian and 460 Slovenian), and responsiveness on 51 patients (21 Croatian and 30 Slovenian) in demand of treatment (toothache).
Results
Concurrent validity was confirmed by the association between the OHIP summary scores and self-reported oral health (correlation coefficients ranged from 0.40 to 0.60, P<0.001). Test-retest reliability showed high intraclass correlation (correlation coefficients, 0.79-0.94). Internal consistency showed high Cronbach α (0.77-0.91). Responsiveness was confirmed by a significant difference between the mean OHIP score at baseline and follow-up (P<0.001 for both Croatian and Slovenian patients) and high effect size in Croatian and Slovenian patients in demand of treatment (3.00 and 0.57, respectively).
Conclusion
Psychometric properties of OHIP-CRO14 and OHIP-SVN14 render these instruments suitable for the assessment of Oral Health Related Quality of Life in Croatia and Slovenia.
doi:10.3325/cmj.2008.4.536
PMCID: PMC2525826  PMID: 18717001
23.  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.
doi:10.1186/1477-7525-11-12
PMCID: PMC3598229  PMID: 23363450
OHIP; Response format; OHRQoL; Assessment
24.  Validation of the Spanish version of the Oral Health Impact Profile (OHIP-14Sp) in elderly Chileans 
BMC Oral Health  2014;14:95.
Background
The OHIP-49 is widely used to assess oral health-related quality of life, but its length makes it time-consuming and difficult to use. An abbreviated version of the OHIP-49 with fourteen items has been validated for older adults, but not in Chile. The aim was to develop and validate the Spanish version of the OHIP-14 in an elderly Chilean population.
Methods
Two studies were conducted; a cross sectional to develop and a retrospective study to validate the OHIP-14Sp. The OHIP-49Sp was applied to 490 older adults and the fourteen questions with the higher impact on oral health-related quality of life were selected through linear regression. These items were applied on a retrospective dataset of 85 older adults to test internal consistency (Cronbach’s alpha). A discriminative validity analysis was performed along with the assessment of sociodemographic (age and gender, educational level) and clinical variables (number of teeth, caries lesions, CPITN, prosthetic needs and prosthetic functionality). Data were analyzed using Mann–Whitney U, Student’s t and one-way ANOVA tests with a 95% confidence level and finally were analyzed by a Multivariate Logistic Regression Model.
Results
High internal consistency values were obtained for the OHIP-14Sp instrument (0.91). There was an association between the OHIP-14Sp scores and the presence of caries (p = 0.003), need for complex periodontal treatment (p = 0.002), prosthetic needs (p < 0.0001) and age younger than 70 years-old (p < 0.0001). Subjects with periodontal treatment need were more likely to report reduced oral health-related quality of life (PR = 2.10).
Conclusions
The OHIP-14Sp proved to be a consistent and valid tool to assess oral health-related quality of life when tested in Chilean older adults.
doi:10.1186/1472-6831-14-95
PMCID: PMC4128544  PMID: 25091189
Quality of life; Oral health; OHIP; Validation studies; Aging; Chile
25.  Oral health literacy comparisons between Indigenous Australians and American Indians 
Community dental health  2013;30(1):52-57.
Objectives
To compare oral health literacy (OHL) levels between two profoundly disadvantaged groups, Indigenous Australians and American Indians, and to explore differences in socio-demographic, dental service utilisation, self-reported oral health indicators, and oral health-related quality of life (OHRQoL) correlates of OHL among the above.
Methods
OHL was measured using REALD-30 among convenience samples of 468 Indigenous Australians (aged 17–72 years, 63% female) and 254 female American Indians (aged 18–57 years). Covariates included socio-demography, dental utilisation, self-reported oral health status (OHS), perceived treatment needs and OHRQoL (prevalence, severity and extent of OHIP-14 ‘impacts’). Descriptive and bivariate methods were used for data presentation and analysis, and between-sample comparisons relied upon empirical contrasts of sample-specific estimates and correlation coefficients.
Results
OHL scores were: Indigenous Australians - 15.0 (95% CL=14.2, 15.8) and American Indians - 13.7 (95% CL=13.1, 14.4). In both populations, OHL strongly correlated with educational attainment, and was lower among participants with infrequent dental attendance and perceived restorative treatment needs. A significant inverse association between OHL and prevalence of OHRQoL impacts was found among American Indians (rho=−0.23; 95% CL=−0.34, −0.12) but not among Indigenous Australians.
Conclusions
Our findings indicate that OHL levels were comparable between the two groups and lower compared to previously reported estimates among diverse populations. Although the patterns of association of OHL with most examined domains of correlates were similar between the two groups, this study found evidence of heterogeneity in the domains of self-reported OHS and OHRQoL.
PMCID: PMC3709981  PMID: 23550508
oral health literacy; oral health; Indigenous populations; Australian Indigenous; Native American; American Indian; quality of life

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