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1.  Psychometric Properties of Croatian and Slovenian Short Form of Oral Health Impact Profile Questionnaires 
Croatian medical journal  2008;49(4):536-544.
To develop Croatian and Slovenian versions of the 14-item Oral Health Impact Profile (OHIP) Questionnaire.
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).
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).
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.
PMCID: PMC2525826  PMID: 18717001
2.  Validation of a Greek version of the oral health impact profile (OHIP-14) for use among adults 
To test the validity of the short form of the Oral Health Impact Profile (OHIP-14) for use among adults in Greece.
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.
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.
The OHIP-14 is a reliable and valid questionnaire for the assessment of OHRQoL among adults in Greece.
PMCID: PMC3278380  PMID: 22244162
3.  Validity and reliability of the Persian version of the oral health impact profile (OHIP)-14  
Background: The need for assessment of oral health related quality of life has been increased over the last decades. The aim of this study was to develop a Persian version of the Oral Health Impact Profile (OHIP)-14 and to evaluate its reliability and validity for its use in Persian-speaking communities.
Methods: The original version of the OHIP-14 was translated into the Persian language using the back-translation technique. To establish the reliability of the translated instrument, internal consistency and test-retest reliability trials were performed on 20 subjects (at 4-week intervals); Cronbach’s alpha was used. One hundred sixty adults over 50 years of age who attended Health Care Centers in Sari and Babol were recruited to fill out the questionnaires and received a clinical examination by a single dentist. The socio-demographic and oral health information was also collected.
Results: The test-retest reliability was excellent (Cronbach’s alpha = 0.095). In the main study, Cronbach’s reliability coefficient for all 14 questions in each dimension was more than 70%. The individuals in need of dental treatment showed significantly higher OHIP scores than the individuals not requiring treatment. The individuals with hopeless teeth, negative self-perceived oral had significantly higher OHIP scores.
Conclusion: The Persian version of the OHIP-14 is a comprehensive and accurate instrument with acceptable reliability and validity for measuring oral health–related quality of life.
PMCID: PMC3895829  PMID: 24551438
Quality of life; QOL questionnaire; OHIP-14
4.  Interpreting one oral health impact profile point 
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.
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.
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.
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.
PMCID: PMC3598229  PMID: 23363450
OHIP; Response format; OHRQoL; Assessment
5.  The Dutch version of the Oral Health Impact Profile (OHIP-NL): Translation, reliability and construct validity 
BMC Oral Health  2008;8:11.
The purpose of this study was to make a cross-culturally adapted, Dutch version of the Oral Health Impact Profile (OHIP), a 49-item questionnaire measuring oral health-related quality of life, and to examine its psychometric properties.
The original English version of the OHIP was translated into the Dutch language, following the guidelines for cross-cultural adaptation of health-related quality of life measures. The resulting OHIP-NL's psychometric properties were examined in a sample of 119 patients (68.9 % women; mean age = 57.1 ± 12.2 yrs). They were referred to the clinic of Prosthodontics and Implantology with complaints concerning their partial or full dentures or other problems with missing teeth. To establish the reliability of the OHIP-NL, internal consistency and test-retest reliability (N = 41; 1 – 2 weeks interval) were examined, using Cronbach's alpha and intraclass correlation coefficients (ICC), respectively. Further, construct validity was established by calculating ANOVA.
Internal consistency and test-retest reliability were excellent (Cronbach's alpha = 0.82 – 0.97; ICC = 0.78 – 0.90). In addition, all associations were significant and in the expected direction.
In conclusion: the OHIP-NL can be considered a reliable and valid instrument to measure oral health-related quality of life.
PMCID: PMC2329613  PMID: 18405359
6.  Validation of a Persian Version of the Oral Health Impact Profile (OHIP-14) 
Iranian Journal of Public Health  2010;39(4):135-139.
The oral health-related quality of life indicators are increasingly used to measure the impact of the oral conditions on quality of life. One of the most used indicators is the Oral Health Impact Profile (OHIP-14), but it has never been applied in Iran. The aim of this study was to validate the usage of OHIP-14 among Iranians.
A cross-sectional study was performed in Kerman (Iran). A consecutive sample (n= 400) of the Kerman Dental School Clinics attending patients participated in this study. All participants self-completed the translated OHIP-14. Reliability analyses, validity tests, and responsiveness were carried out to evaluate the psychometric properties of the OHIP-14.
The reliability coefficient (Cronbach’s alpha) of the OHIP-14 was above the recommended 0.7 threshold and considered excellent (alpha: 0.85). The coefficient of the test-retest reliability measured by ICC was 0.88 (CI 95%: 0.80–0.93). Poorer oral condition was strongly associated with OHIP scores of the patients, supporting construct validity. Moreover, for evaluation of responsiveness, the ES was measured to be 0.43 and the SRM was 0.67.
The Persian version of OHIP-14 is a precise, valid and reliable instrument for assessing oral health-related quality of life among Persian population.
PMCID: PMC3481693  PMID: 23113047
Oral health; Quality of life; Validity; Iran
7.  Dimensional structure of the oral health-related quality of life in healthy Spanish workers 
Oral health-related quality of life (OHQoL) is conceived as a multidimensional construct. Here our aim was to investigate the dimensional structure of OHQoL as measured by the Spanish versions of the Oral Impacts on Daily Performance (OIDP) and the Oral Health Impact Profile (OHIP-14) questionnaires applied simultaneously.
We recruited a consecutive sample of 270 healthy Spanish workers visiting the Employment Risk Prevention Centre for a routine medical check-up. OHIP-14 was self-completed by participants but the OIDP was completed in face-to-face interviews. An Exploratory Factor Analysis (EFA) was performed to identify the underlying dimensions of the OHQoL construct assessed by both instruments. This factorial structure was later confirmed by Confirmatory Factor Analysis (CFA) using several estimators of goodness of fit indices.
EFA and the CFA identified and respectively confirmed a set of 3 underlying factors in both questionnaires that could be interpreted as functional limitation, pain-discomfort, and psychosocial impacts. The model achieved was seen to fit properly for both instruments, but the factorial structure was clearer for the OIDP.
The results provide evidence for construct equivalence in the latent factors assessed by both OIDP and OHIP-14, suggesting that OHQoL is a three-dimensional construct. The prevalence of impact on these three factors was coherent between both indicators, pain-discomfort having the highest prevalence, followed by psycho-social impact, and functional limitation.
PMCID: PMC2833145  PMID: 20170546
8.  Validation of the oral health impact profile (OHIP-20sp) for Spanish edentulous patients 
Objectives: The purposes of this study are to validate the indicator of Oral Health Impact Profile for edentulous patients (OHIP-20sp) in the Spanish population and to analyze the factorial construct of the prosthetic well-being. Study Desing: A total of twenty-one (n=21) edentulous patients wearing mandibular implant-over dentures on Locator® (LO) and twenty (n=20) with complete dentures (CD) were retrospectively evaluated in this study. All participants were recruited consecutively and were treated in the previous academic year 2009-2010 by professors of the University of Salamanca. Reliability analyses and validity tests were performed in order to evaluate the psychometric properties of OHIP-20sp employing two different total score methods (additional and simple count). A retrospective evaluation of the impact of the prosthetic treatment was captured with an evaluative instrument derived from OHIP-20, and named POST-OHIP-13. Results: The reliability coefficient (Cronbach’s alpha = 0.91) has shown a high internal consistency. Item-total correlations coefficients ranged from 0.46 and 0.81. Five factors, named as disability, functional comfort, psychosocial impact, pain-discomfort and functional limitations were identified as principal components of the construct, explaining almost 85% of the variance. The 48% of the sample felt at least one impact in an occasional or more frequently manner (generally food packing). The global transition judgment of the prosthetic treatment using the POST-OHIP-13 was significantly higher in group LO than in the CD group. Conclusions: OHIP-20 seems to be a reliable and valid indicator to measure oral impact and satisfaction in the Spanish edentulous population. The underlying construct is comprised by 5 factors named as disability, functional comfort, psychosocial impact, pain-discomfort and functional limitations.
Key words:Oral health-related quality of life, edentulous, satisfaction, validation.
PMCID: PMC3476106  PMID: 22143713
9.  Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life 
Acta Odontologica Scandinavica  2012;70(4):331-336.
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.
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.
TMD associate with OHRQoL through multiple ways, linked with depression and somatization. These findings emphasize the importance of early and effective treatment of TMD.
PMCID: PMC3793272  PMID: 22300221
temporomandibular disorders; oral health-related quality-of-life; Oral Health Impact Profile; psychosocial factors
10.  Perceived influence of oral health upon quality of life in heart transplant patients 
Objective: A study was made of heart transplant patient perception of the influence of oral health upon quality of life, based on the Oral Health Impact Profile (OHIP-49) questionnaire validated for Spanish speaking subjects. Design: A cross-sectional evaluation was made of the heart transplant patients followed-up on in the Heart Transplantation Unit of Reina Sofía University Hospital (Spain), using the OHIP-49 questionnaire. The included patients were all over age 18 and signed the corresponding informed consent to participation in the study. The data were entered in a database and analyzed using the SPSS statistical package. Results: A total of 150 heart transplant patients (118 males and 32 females, with a mean age of 54.94 years; range 19-79) were studied. The subjects showed a poor perceived influence of oral health upon quality of life, with a mean score of 24.43 out of a possible total of 196 points. Women showed significantly improved perception of the influence of oral health upon quality of life versus men. Conclusions: The subjects in our study showed a poor perceived influence of oral health upon quality of life.
Key words:Perception, oral health, quality of life, heart transplant.
PMCID: PMC3476104  PMID: 22143721
11.  Level of oral health impacts among patients participating in PEARL: a dental practice-based research network 
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.
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.
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.
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.
PMCID: PMC3380181  PMID: 22390788
Oral-Health Impact; OHRQoL; Dental PBRN; OHIP-14; Patient Reported Outcomes; Subjective Health
12.  Oral health in the Japan self-defense forces - a representative survey 
BMC Oral Health  2011;11:14.
The oral health of military populations is usually not very well characterized compared to civilian populations. The aim of this study was to investigate two physical oral health characteristics and one perceived oral health measure and their correlation in the Japan self-defense forces (JSDF).
Number of missing teeth, denture status, and OHRQoL as evaluated by the Japanese 14-item version of the Oral Health Impact Profile (OHIP-J14) as well as the correlation between these oral health measures was investigated in 911 personnel in the JSDF.
Subjects did not have a substantial number of missing teeth and only 4% used removable dentures. The mean OHIP-J14 score was 4.6 ± 6.7 units. The magnitude of the correlation between the number of missing teeth with OHIP-J14 scores was small (r = 0.22, p < 0.001). Mean OHIP-J14 scores differed between subjects with and without dentures (8.6 and 4.4, p < 0.001).
Compared to Japanese civilian populations, personnel of the JSDF demonstrated good oral health. Two physical oral health characteristics were associated with perceived oral health.
PMCID: PMC3100240  PMID: 21501526
13.  The relationship of oral health literacy with oral health-related quality of life in a multi-racial sample of low-income female caregivers 
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.
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.
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).
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.
PMCID: PMC3248838  PMID: 22132898
oral health literacy; oral health-related quality of life; OHIP-14; racial differences; effect measure modification
14.  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.
PMCID: PMC3668860  PMID: 23385509
15.  Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment: a cross-sectional study 
BMC Oral Health  2012;12:53.
There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT).
330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables and dental aesthetic index. Socio-economic background, body mass index, time with orthodontic appliances, and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models.
Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index > 25 (RR 1.14; 95% CI 1.01-1.29), and showed a dental aesthetic index > 30 (RR 1.32; 95% CI 1.20-1.46).
Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment.
PMCID: PMC3534331  PMID: 23186371
Quality of life; Epidemiology; Risk factors; Orthodontics; Gingivitis; Gingival hyperplasia
16.  Dimensions of oral health related quality of life measured by EQ-5D+ and OHIP-14 
The aims of the study were to compare the dimensions of oral-health-related quality-of-life measured by a generic health state measure, the EuroQol, and a specific oral health measure, the Oral Health Impact Profile.
Data were collected in 2001–02 from a random sample of South Australian dentists using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental problems and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D+) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments.
Data were available from 375 patients (response rate = 72%). The EuroQol items of mobility, self care and usual activities formed a separate cluster of variables, as did anxiety/depression and cognition, while pain clustered with items from the OHIP physical pain subscale. OHIP items tended to form clusters consistent with the subscales of social disability, physical disability, physical pain, functional limitation and psychological discomfort. The OHIP handicap items clustered between the OHIP social disability and physical disability subscales. The OHIP psychological disability items split between the social disability and psychological discomfort subscales.
The observed clusters of variables empirically supported most of the conceptual dimensions of the OHIP. Both instruments covered symptom experience of pain indicating overlapping domains. However there was partial separation of the generic and specific items, EuroQol covered daily activities such as self-care and usual activities and OHIP covered oral health-specific aspects of functional limitation and physical disability as well as psychological and social aspects of disability and handicap.
PMCID: PMC479699  PMID: 15248893
17.  Patient-Centered Endodontic Outcomes: A Narrative Review 
Iranian Endodontic Journal  2013;8(4):197-204.
Root canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults.
Materials and Methods
Patient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis.
Application of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is “fair” to “very much” prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses.
Dentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical, practical and psychosocial aspects of RCT.
PMCID: PMC3808681  PMID: 24171029
Cost and Cost Analysis; Dental Anxiety; Fear; Patient-Centered Care; Personal Satisfaction; Quality of Life; Root Canal Therapy
18.  Mapping oral health related quality of life to generic health state values 
A summary utility index is useful for deriving quality-adjusted life years (QALY) for cost analyses or disability weights for burden of disease studies. However, many quality of life instruments provide descriptive profiles rather than a single utility index. Transforming quality of life instruments to a utility index could extend the use of quality of life instruments to costs analyses and burden of disease studies. The aims of the study were to map a specific oral health measure, the Oral Health Impact Profile to a generic health state measure, the EuroQol, in order to enable the estimation of health state values based on OHIP data.
Data were collected from patients treated by a random sample of South Australian dentists in 2001–02 using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental conditions and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments. Data were available from 375 patients (response rate = 72%). A random two-thirds sample of patients was used in tobit regressions of EQ-5D health state values estimated using OHIP-14 in a model with categories of OHIP responses as indicator variables and in a model with OHIP responses as continuous variables. Age and sex were included as covariates in both models. The remaining one-third sample of patients was used to test the models.
The OHIP item 'painful aching in mouth' was significantly related to health state values in both models while 'life less satisfying' was also significant in the continuous model. Mean forecast errors relative to the mean observed health state value were higher when fitted to the categorical model (17.4%) compared to the continuous model (15.2%) (P < 0.05).
The findings enable health state values to be derived from OHIP-14 scores for populations where utility has not or cannot be measured directly.
PMCID: PMC1570134  PMID: 16893470
19.  The internal responsiveness of the Oral Health Impact Profile-14 to detect differences in clinical parameters related to surgical third molar removal 
Quality of Life Research  2011;21(7):1241-1247.
The present study examined the internal responsiveness of the short-form Oral Health Impact Profile (OHIP-14) and its ability to differentiate between patients with and without pre- and postoperative complaints as well as other clinical variables.
The sample consisted of 97 patients undergoing surgical third molar removal. The OHIP-14 was filled in preoperatively, on each postoperative day for a week and once more after 1 month. In addition, pre- and postoperative status was measured along with other clinical variables.
The OHIP-14 is able to differentiate between the first preoperative day (M = 16.85, SD = 5.35) and all the days within the postoperative week (first day M = 29.46, SD = 9.32). One month postoperatively, mean OHIP scores are reduced to preoperative levels. In addition, differences could be shown between patients with and without pre- (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9) and postoperative complaints (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9), partial (preop; M = 17.8, SD = 6.8, postoperative; M = 27.4, SD = 7.7) and complete mucosa coverage (preop; M = 15.9, SD = 3.2, postoperative; M = 29.5, SD = 10.6) and the level of impaction (Pell and Gregory classification) of the third molar (3B showing the highest increase in the mean OHIP score).
The OHIP-14 can be considered internally responsive to changes in impacts of oral conditions as a result of surgical third molar removal and is able to differentiate the effect of several clinical variables.
PMCID: PMC3427486  PMID: 21964947
Impact of oral conditions; Third molar surgery; Internal responsiveness
20.  Oral Health-Related Quality of Life of Greek Adults: A Cross-Sectional Study 
Purpose. The aim of the present study was to investigate the impact of oral health status on the quality of life of adults in different regions of Greece, using the Oral Health Impact Profile-short form (OHIP-14). Methods. A random sample consisting of a total of 504 Greek adults between the ages of 35–44 years (mean 39.1 ± 3.5) was selected from different urban and rural areas, and face-to-face interviews were conducted using the validated Greek language OHIP-14. Associations of the total OHIP-14 score and its 7 sub-scales along with the self-perceived quality of life were evaluated with Spearman's correlations. Results. The subjects had an overall weighted OHIP-14 score of 1.1 (sd 1.9). No significant differences were found for either rural or non-metropolitan areas when compared to urban or metropolitan regions. High scores of above 2 were determined for functional limitation, physical pain, handicap, and the psychological discomfort scales. The education level of the subjects had a significant positive impact on the quality of life of the subjects. Conclusions. Dental and oral health conditions are factors that do impact on the quality of life of individuals.
PMCID: PMC3167183  PMID: 21904551
21.  Generic and oral quality of life is affected by oral mucosal diseases 
BMC Oral Health  2012;12:2.
The generic and oral health-related quality of life (QoL) has provided opportunity for investigation of the interrelations among generic health, oral health, and related outcomes. The purpose of this study was to identify the generic and oral QoL in the patients with oral mucosal disease (OMD).
Five hundred and thirty-eight OMDs were recruited in this study. The instruments applied were Chinese version of the 36-item short form health survey (SF-36) and the short-form of Oral Health Impact Profile (OHIP-14).
The mean score of sum OHIP-14 was significantly higher in the patients with OMD (10.81 ± 9.01) compared with those in the healthy subjects (HS) (6.55 ± 6.73) (p < 0.001, Mann-Whitney U test). 56.51% of the OMD patients and 12.94% of the HS reported at least one oral negative impact (p < 0.001, Chi-square test). The overall mean score of SF-36 was significantly lower in the patients with OMD (74.54 ± 12.77) compared with those in the HS (77.97 ± 12.39) (p = 0.021, t-test).
Administration of specific and generic questionnaires of QoL can provide us a detailed picture of the impact of OMDs on patients, and both generic and oral QoL were impaired in the patients with OMD.
PMCID: PMC3280167  PMID: 22225834
22.  Oral health-related quality of life in an aging Canadian population 
The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada.
This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45–64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14) in a random digit dialing telephone survey (for community residents) or a face-to-face interview (for LTC residents). Intra-oral examinations were performed by one of six dentists calibrated to W.H.O. standards.
Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. The most commonly reported impacts were within the dimensions ‘physical pain’ and ‘psychological discomfort’. It was found that 12.2% of LTC residents found it uncomfortable to eat any foods ‘fairly/very’ often compared to 7.7% in the community, and 11.6% of LTC residents reported being self-conscious ‘fairly/very often’ compared to 8.2% in the community. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%); but there were no significant differences in OHRQoL between pre-seniors (21.2%) and seniors (25.3%) in LTC. Pre-seniors living in the community scored significantly higher than community dwelling seniors on prevalence, extent and severity of OHIP-14 scores. Logistic regression revealed that for the community dwelling sample, individuals living in rural areas in addition to those being born outside of Canada were approximately 2.0 times more likely to report an impact ‘fairly/very often’, whereas among the LTC sample, those having a high school education or less were 2.3 times more likely to report an impact.
Findings indicate that the oral health and OHRQoL of both pre-seniors and seniors in LTC residents is poor. Community dwelling pre-seniors have the highest prevalence rate of oral impacts.
PMCID: PMC3480903  PMID: 22587387
Oral health; Quality of life; Elderly; Aging; Seniors; Pre-seniors; Canada
23.  How Do Age and Tooth Loss Affect Oral Health Impacts and Quality of Life? A Study Comparing Two State Samples of Gujarat and Rajasthan 
Age and tooth loss are expected to have a complex relationship with oral health-related quality of life. So the purpose of this study was to explain the impact of age and tooth loss on oral health-related quality of life using the short form 14-item oral health impact profile (OHIP-14) among two population samples of Gujarat and Rajasthan.
Materials and Methods:
A cross-sectional questionnaire-based survey was conducted among 1441 subjects collected from two major cities of Gujarat and Rajasthan. Both questionnaire approaches using OHIP-14 scale and clinical examination were conducted in accordance with WHO criteria using type III procedure on the same day. Chi square test, ANOVA and stepwise multiple regression analysis were applied using SPSS software version 15.0.
With the increase of age, OHIP mean score in both states increased, but that among Rajasthan state was higher, depicting poor oral health. Whereas, in the remaining 23–27 number of teeth both states showed higher OHIP mean, however again the score was much higher among Rajasthan subjects showing worse oral hygiene. Hence, overall all mean OHIP score for Gujarat was lower indicating good oral health; whereas, that among Rajasthan was higher indicating poor oral health-related quality of life.
Both age and tooth loss are associated with each other, but they have an independent effect on the oral health-related quality of life. Thus, all studied populations with complete natural dentition showed good oral health-related quality of life.
PMCID: PMC3466767  PMID: 23066478
Age Distribution; Tooth Loss; Oral Health; Quality of Life
24.  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.
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.
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).
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).
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
25.  Oral health-related quality of life in a birth cohort of 32-year olds 
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.
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.
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.
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%).
PMCID: PMC2288569  PMID: 18650957
adult; dental caries; oral health; Oral Health Impact Profile; periodontal diseases; prevalence; quality of life; tooth loss

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