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1.  Mapping oral health related quality of life to generic health state values 
Background
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.
Methods
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.
Results
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).
Conclusion
The findings enable health state values to be derived from OHIP-14 scores for populations where utility has not or cannot be measured directly.
doi:10.1186/1472-6963-6-96
PMCID: PMC1570134  PMID: 16893470
2.  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
3.  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
4.  Oral health-related quality of life in an aging Canadian population 
Background
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1477-7525-10-50
PMCID: PMC3480903  PMID: 22587387
Oral health; Quality of life; Elderly; Aging; Seniors; Pre-seniors; Canada
5.  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.
doi:10.4317/medoral.17498
PMCID: PMC3476106  PMID: 22143713
6.  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
7.  Does maternal oral health predict child oral health-related quality of life in adulthood? 
Background
A parental/family history of poor oral health may influence the oral-health-related quality of life (OHRQOL) of adults.
Objectives
To determine whether the oral health of mothers of young children can predict the OHRQOL of those same children when they reach adulthood.
Methods
Oral examination and interview data from the Dunedin Study's age-32 assessment, as well as maternal self-rated oral health data from the age-5 assessment were used. The main outcome measure was study members' short-form Oral Health Impact Profile (OHIP-14) at age 32. Analyses involved 827 individuals (81.5% of the surviving cohort) dentally examined at both ages, who also completed the OHIP-14 questionnaire at age 32, and whose mothers were interviewed at the age-5 assessment.
Results
There was a consistent gradient of relative risk across the categories of maternal self-rated oral health status at the age-5 assessment for having one or more impacts in the overall OHIP-14 scale, whereby risk was greatest among the study members whose mothers rated their oral health as "poor/edentulous", and lowest among those with an "excellent/fairly good" rating. In addition, there was a gradient in the age-32 mean OHIP-14 score, and in the mean number of OHIP-14 impacts at age 32 across the categories of maternal self-rated oral health status. The higher risk of having one or more impacts in the psychological discomfort subscale, when mother rated her oral health as "poor/edentulous", was statistically significant.
Conclusions
These data suggest that maternal self-rated oral health when a child is young has a bearing on that child's OHRQOL almost three decades later. The adult offspring of mothers with poor self-rated oral health had poorer OHRQOL outcomes, particularly in the psychological discomfort subscale.
doi:10.1186/1477-7525-9-50
PMCID: PMC3150239  PMID: 21736754
oral health; oral health-related quality of life: OHIP-14; intergenerational; risk; family history
8.  Health-related quality of life after mandibular resection for oral cancer: Reconstruction with free fibula flap 
Objectives: Mandibular resection for oral cancer is often necessary to achieve an adequate margin of tumor clearance. Mandibular resection has been associated with a poor health-related quality of life (HRQOL), particularly before free fibula flap to reconstruct the defect. The aim of this study was to evaluate health-related quality of life in patients who have had mandibular resections of oral cancer and reconstruction with free fibula flap. Study Designs: There were 115 consecutive patients between 2008 and 2011 who were treated by primary surgery for oral squamous cell carcinoma, 34 patients had a mandibular resection. HRQOL was assessed by means of the 14-item Oral Health Impact Profile (OHIP-14) and University of Washington Quality of Life (UW-QOL) questionnaires after 12 months postoperatively. Results: In the UW-QOL the best-scoring domain was mood, whereas the lowest scores were for chewing and saliva. In the OHIP-14 the lowest-scoring domain was social disability, followed by handicap, and psychological disability. Conclusions: Mandible reconstruction with free fibula flap would have significantly influenced on patients’quality of life and oral functions. The socio-cultural data show a fairly low level of education for the majority of patients.
Key words:Health-related quality of life, free fibula flap, mandibulectomy, UW-QOL, OHIP-14.
doi:10.4317/medoral.19399
PMCID: PMC4119320  PMID: 24608209
9.  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
10.  Assessment of quality of life in giant ameloblastoma adolescent patients who have had mandible defects reconstructed with a free fibula flap 
Background
The reconstruction of mandibular defects after giant ameloblastoma resection is one of the most challenging problems facing reconstructive surgeons. Mandibular resection has been associated with a poor quality of life (QOL), particularly in adolescent patients reconstructed with a free fibula flap. This study aims to evaluate QOL outcomes in adolescent patients who have had mandibular resections of giant ameloblastoma and reconstruction with a free fibula flap and to collect information about their socio-cultural situation.
Methods
The present study assessed 45 adolescent patients who had undergone immediate mandible reconstruction with a free fibula flap for faint ameloblastoma using University of Washington Quality of Life (UW-QOL) and 14-item Oral Health Impact Profile (OHIP-14) questionnaires.
Results
Thirty-five of the 54 questionnaires were returned (64.81%). In the UW-QOL, of the twelve disease-specific domains, the best three scores from the patients related to pain, shoulder and appearance and the worst three scores related to chewing, anxiety and saliva. In the OHIP-14, the lowest-scoring domain was handicap, followed by physical pain and social disability.
Conclusions
Mandibular reconstruction with a free fibular flap significantly influenced the adolescent patients’ QOL. Adolescent patients pay more attention to postoperative facial appearance; this should be considered in surgical planning.
doi:10.1186/1477-7819-12-201
PMCID: PMC4113126  PMID: 25004805
QOL; Free fibula flap; Ameloblastoma; Reconstruction
11.  Cost-effectiveness of silicone and alginate impressions for complete dentures 
Journal of Dentistry  2014;42(8):902-907.
Objective
The aim of this study was to assess the cost effectiveness of silicone and alginate impressions for complete dentures.
Methods
Cost effectiveness analyses were undertaken alongside a UK single centre, double blind, controlled, crossover clinical trial. Taking the perspective of the healthcare sector, effectiveness is measured using the EuroQol (EQ-5D-3L) which provides a single index value for health status that may be combined with time to produce quality adjusted life years (QALYs); and Oral Health Impact Profile (OHIP-EDENT). Incremental cost effectiveness ratios are presented representing the additional cost per one unit gained.
Results
Mean cost was higher in the silicone impression group (£388.57 vs. £363.18). Negligible between-group differences were observed in QALY gains; the silicone group had greater mean OHIP-EDENT gains. The additional cost using silicone was £3.41 per change of one point in the OHIP-EDENT.
Conclusions
The silicone group was more costly, driven by the cost of materials. Changes in the EQ-5D and QALY gains over time and between arms were not statistically significant. Change in OHIP-EDENT score showed greater improvement in the silicone group and the difference between arms was statistically significant. Given negligible QALY gains and low level of resource use, results must be treated with caution. It is difficult to make robust claims about the comparative cost-effectiveness.
Clinical significance
Silicone impressions for complete dentures improve patients’ quality of life (OHIP-EDENT score). The extra cost of silicone impressions is £30 per patient. Dentists, patients and health care funders need to consider the clinical and financial value of silicone impressions. Different patients, different dentists, different health funders will have individual perceptions and judgements.
ISRCTN01528038.
NIHR-RfPB grant PB-PG-0408-16300.


This article forms part of a project for which the author (TPH) won the Senior Clinical Unilever Hatton Award of the International Assocation for Dental Research, Capetown, South Africa, June 2014.
doi:10.1016/j.jdent.2014.03.001
PMCID: PMC4119300  PMID: 24995472
Prosthodontics; Quality-of life; Impression materials; Cost effectiveness; Cost; Resource
12.  Dimensional structure of the oral health-related quality of life in healthy Spanish workers 
Background
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1477-7525-8-24
PMCID: PMC2833145  PMID: 20170546
13.  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
14.  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
15.  Quality of Life Implications of Bisphosphonate-Associated Osteonecrosis of the Jaw 
The Oncologist  2011;16(1):121-132.
Bisphosphonate-associated osteonecrosis of the jaw is a growing clinical concern that affects treatment decisions because of its potential negative impact on quality of life. It significantly affects the quality of life of patients with cancer and may be an important consideration for intravenous and oral bisphosphonate treatment decisions by patients, clinicians, and policy makers.
Purpose.
Potentially debilitating, osteonecrosis of the jaw (ONJ) is an emerging complication of bisphosphonates. However, its effect on quality of life (QoL) is unknown. We determined the ONJ-related QoL decline in a cancer patient cohort.
Patients and Methods.
Thirty-four cancer patients with bisphosphonate-associated ONJ completed a telephone survey (October 2007 through May 2008). The Oral Health Impact Profile 14 (OHIP) retrospectively assessed participant oral health–related QoL before and after ONJ. Standardized ONJ descriptions were developed in a multidisciplinary, iterative process and were evaluated with three frequently used preference-based QoL measurement methods on a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS), Time Trade-Off (TTO), and EQ-5D.
Results.
ONJ significantly (p < .001) increased OHIP scores (worse QoL) for additive (3.56–16.53) and weighted (7.0–17.5) methods. Seven individual OHIP items significantly increased (Bonferroni correction p < .0035): pain, eating discomfort, self-consciousness, unsatisfactory diet, interrupted meals, irritability, and decreased life satisfaction. Mean preference-based QoL values significantly decreased (p < .001) with worsening ONJ stage (VAS, TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82, 0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61, 0.32). As ONJ worsened, EQ-5D domain scores significantly increased (p < .001). Pain/discomfort and anxiety/depression contributed most to declining QoL.
Conclusions.
ONJ significantly affects QoL, a detriment that increases with worsening ONJ. QoL impairments for ONJ stages 2 and 3 are similar to other treatment side effects that influence decision-making. Bisphosphonate-associated ONJ QoL is an important consideration for patients, clinicians, and policy makers.
doi:10.1634/theoncologist.2010-0183
PMCID: PMC3228058  PMID: 21212433
Quality of life; Osteonecrosis; Bisphosphonates; Zoledronic acid; Pamidronate; Utility
16.  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
17.  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”
18.  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.
doi:10.1155/2011/360292
PMCID: PMC3167183  PMID: 21904551
19.  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
20.  Application of an oral health-related quality of life questionnaire in primary care patients with orofacial pain and temporomandibular disorders 
Objectives: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study Design: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diagnosed following the standard criteria accepted by the scientific community – the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) – were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the degree of association between the patients’ OHIP-14 score and pain duration, pain intensity, and various sociodemographic variables. Results: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p<0.05) was found for gender, age, marital status, chronic pain grade, self-perceived oral health status and pain duration. Conclusions: The analysis of self-perceived oral health status in patients with OP and TMD, as measured by the OHIP-14, showed that oral health is perceived more negatively by women. Moreover, a one-point increase in the Chronic Pain Grade indicator increases the OHIP-14 indicator by 4.6 points, while chronic pain, defined as pain suffered by patients for one year or more, increases the OHIP-14 indicator by 3.2 points.
Key words:Orofacial pain, temporomandibular disorders, Oral Health Impact Profile, sociodemographic variables, primary care, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).
doi:10.4317/medoral.19061
PMCID: PMC4015039  PMID: 24121906
21.  Trigeminal Neurosensory Deficit and Patient Reported Outcome Measures: The Effect on Quality of Life 
PLoS ONE  2013;8(10):e77391.
Objectives
To investigate the effect of persistent neurosensory disturbance of the lingual nerve (LN) or inferior alveolar nerve (IAN) on general health and oral health- related quality of life (QoL).
Methods
The study design was a case-control study. Patients with persistent neurosensory deficit of LN or IAN after lower third molar surgery (for 12 months or more) were the study group. The control group was an age and gender matched sample of patients who had dental extractions or lower third molar surgeries without trigeminal neurosensory deficit. The outcome variables were the general health and oral health-related QoL. General health-related QoL was assessed using the 36-item Short Form Health Survey (SF-36) and oral health-related QoL using the 14-item Short Form Oral Health Impact Profile (OHIP-14). Differences in SF-36 scores and OHIP-14 scores between the groups were compared.
Results
Forty-eight subjects (24 cases and 24 controls) were recruited. When compared to the control group, patients with neurosensory deficits had poorer Mental-Health Component Scores (MCS) (p = 0.005), General Health (p = 0.023), Vitality (p = 0.048), Social Functioning (p = 0.003), Role-emotion (p = 0.008) and Mental Health (p = 0.022). The OHIP-14 scores were also significantly worse in this patients with neurosensory deficits compared with the control group (p = 0.002). When compared within the study group, older patient with neurosensory deficit was found to correlate with worse Physical Health Component Scores (PCS) (p = 0.02) and OHIP-14 scores (p = 0.02), while more severe visualized analog scaling rating of numbness was correlated with a worse PCS (p = 0.034).
Conclusions
Patients with persistent LN or IAN deficit after lower third molar surgery have poorer health-related QoL and poorer oral health-related QoL than those without such deficits.
doi:10.1371/journal.pone.0077391
PMCID: PMC3812273  PMID: 24204820
22.  Oral health in the Japan self-defense forces - a representative survey 
BMC Oral Health  2011;11:14.
Background
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).
Methods
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.
Results
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).
Conclusions
Compared to Japanese civilian populations, personnel of the JSDF demonstrated good oral health. Two physical oral health characteristics were associated with perceived oral health.
doi:10.1186/1472-6831-11-14
PMCID: PMC3100240  PMID: 21501526
23.  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
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.
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
25.  Impact of Periodontal Diseases on Health-Related Quality of Life of Users of the Brazilian Unified Health System 
Objective. This study assessed the impact of periodontal diseases on health-related quality of life of adult users of the Brazilian Unified Health System. Study Design. A cross-sectional study was conducted on an outpatient basis. The sample included 151 adults treated in the Periodontics section at Dental Specialty Centres of Juiz de Fora (Minas Gerais, Brazil). The Oral Health Impact Profile (OHIP-14) measured the impact of periodontal disease on quality of life. Participants were interviewed to obtain self-perception of general and oral health and socioeconomic data, and dental records were consulted to obtain periodontal status data. The values of central tendency of the OHIP-14 were compared with socioeconomic, demographic, and self-reported health predictors using nonparametric tests. The final analysis was performed using multiple linear regressions. Results. The results showed that psychological discomfort and physical disability exhibited a negative impact. The following variables can explain approximately 27% of the impact of oral health conditions on health-related quality of life in this group: periodontal disease, self-perceived oral health, and the need to use or replace dental prosthesis. Conclusion. The need for prosthetic rehabilitation and worse periodontal status are associated with health-related quality of life, which can be predicted by the self-perception of health.
doi:10.1155/2013/150357
PMCID: PMC3878420  PMID: 24454375

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