Social gradients in periodontal diseases among adolescents

Exploring pathways for socio-economic inequalities in self-reported oral symptoms among Korean adolescents

OBJECTIVE

This study aimed to assess socio-economic inequalities in self-reported oral symptoms in Korean adolescents and to assess the association of health behaviours, psychosocial factors and material factors on social gradients in oral symptoms.

METHOD

Cross-sectional data were from the national 2007 Korean Youth Risk Behavior Web-based Survey (KYRBWS). Self-reported oral symptoms included toothache, bad breath, and fractured teeth. Self-assessed socio-economic status (SES) was selected as a measure of SES. To assess socio-economic inequalities in oral symptoms, we used logistic regression models for toothache, bad breath and fractured teeth, and ordinal logistic regression models for the aggregate variable on oral symptoms. We used models adjusting for socio-demographic factors (Model 1) and compared them to models additionally adjusting for health behaviours (Model 2), psychosocial factors (Model 3) and material factors (Model 4).

RESULTS

A total of 78,834 students were invited to participate, and the response rate was 94.8% (n = 74,698). We found that lower self-assessed SES was significantly associated with higher prevalence of each of the three self-reported oral symptoms. Social gradient in the prevalence of each oral symptoms persisted when adjusted for behavioural, psychosocial and material factors. The odds ratio (OR) for the aggregate variable on oral symptoms in the lower SES group was 2.25 (95% CI 2.04, 2.49), and the respective figures after adjusting for behavioural, psychosocial and material factors were 2.17 (95% CI 1.96, 2.39), 1.90 (95% CI 1.73, 2.10) and 2.26 (95% CI 2.04, 2.50). While adjusting for psychosocial factors decreased the OR in the aggregate variable on oral symptoms for lower SES groups, adjusting for health behaviours and material factors hardly changed the OR.

CONCLUSION

There were clear social gradients in three self-reported oral symptoms (toothache, bad breath and fractured teeth) in Korean adolescents. Psychosocial factors explained part of the social inequalities in oral symptoms. Future longitudinal research is required to better address the pathways that explain socio-economic inequalities in oral symptoms during adolescence.

Socioeconomic differences in obesity among Mexican adolescents

OBJECTIVE

We investigate socioeconomic disparities in adolescent obesity in Mexico. Three questions are addressed. First, what is the social patterning of obesity among Mexican adolescents? Second, what are the separate and joint associations of maternal and paternal education with adolescent obesity net of household wealth? Third, are there differences in socioeconomic status (SES) gradients among Mexican boys and girls, rural residents and non-rural residents?

METHODS

Using data from the Mexican National Health Survey 2000 we examined the slope and direction of the association between SES and adolescent obesity. We also estimated models for sub-populations to examine differences in the social gradients in obesity by sex and non-rural residence.

RESULTS

We find that household economic status (asset ownership and housing quality) is positively associated with adolescent obesity. High paternal education is related to lower obesity risk, whereas the association between maternal education and obesity is positive, but not always significant.

CONCLUSION

The household wealth components of SES appear to predispose Mexican adolescents to higher obesity risk. The effects of parental education are more complex. These findings have important policy implications in Mexico and the United States.

Conventional versus asset approaches: comparative appraisal of socioeconomic indicators for oral health research among adolescents in a developing country

The aim of the study was to assess the value of different indicators of socioeconomic status for oral health research among Sri Lankan adolescents. Six indicators of socioeconomic status were assessed in terms of their relationship to 2 oral health outcomes. The sample consisted of 15-year-old students (n = 1218) selected from 48 schools in the Colombo district using a stratified cluster sampling technique. Data collection included oral examinations of students and questionnaires to both students and their parents. The correlations between the 6 indicators were low to moderate. The indicators of household material assets and parental educational status emerged as significant predictors of the 2 oral health outcomes. Therefore, it is concluded that indicators of material assets-namely, the family affluence scale and the asset index-could be used as optimal measures of socioeconomic status in oral health research among adolescents in Sri Lanka.

Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania

BACKGROUND

There is a lack of studies considering social disparity in oral health emanating from adolescents in low-income countries. This study aimed to assess socio-demographic disparities in clinical- and self reported oral health status and a number of oral health behaviors. The extent to which oral health related behaviors might account for socio-demographic disparities in oral health status was also examined.

METHODS

A cross-sectional study was conducted in Kilwa district in 2008. One thousand seven hundred and forty five schoolchildren completed an interview and a full mouth clinical examination. Caries experience was recorded using WHO criteria, whilst type of treatment need was categorized using the ART approach.

RESULTS

The majority of students were caries free (79.8%) and presented with a low need for dental treatment (89.3%). Compared to their counterparts in opposite groups, rural residents and those from less poor households presented more frequently with caries experience (DMT>0), high need for dental treatment and poor oral hygiene behavior, but were less likely to report poor oral health status. Stepwise logistic regressions revealed that social and behavioral variables varied systematically with caries experience, high need for dental treatment and poor self reported oral health. Socio-demographic disparities in oral health outcomes persisted after adjusting for oral health behaviors.

CONCLUSIONS

Socio-demographic disparities in oral health outcomes and oral health behaviors do exist. Socio-demographic disparities in oral health outcomes were marginally accounted for by oral health behaviors. Developing policies and programs targeting both social and individual determinants of oral health should be an urgent public health strategy in Tanzania.

Millennium development goals and oral health in cities in Southern Brazil

OBJECTIVES

To investigate social determinants of oral health, analysing the occurrence of associations between millennium development goals (MDG) indicators and oral health (OH) indicators.

METHODS

An ecological study was performed in two distinct phases. In Phase 1, MDG indicators and related covariates were obtained from the demographic census of the Brazilian Institute of Geography and Statistics, the Ministry of Health database and the 2000 Human Development Atlas, making up the whole set of independent variables. Principal component analysis was carried out for the independent variables showing the correlations among the variables comprising the main components, and generating a synthetic index allowing the performance of the cities to be known with regard to the MDG (MDG index). In Phase 2, the DMFT index (mean number of decay, missing or filled permanent teeth) and the CF index (prevalence of caries-free individuals), in 12 years old were obtained from the epidemiological survey undertaken in 2002-2003, in 49 cities in southern Brazil, and were analysed in relation to the MDG index using Spearman's correlation.

RESULTS

  A statistically significant correlation was found for the DMFT and CF indices, respectively, with: the MDG index (R(2)=0.49 and 0.48; P = 0.00); the socioeconomic status of the population (R(2)= 0.12 and 0.12; P = 0.02); the socioenvironmental characteristics (R(2)=0.41 and 0.46; P= 0.00).

CONCLUSIONS

  The MDG synthetic index of the cities analysed and the respective components relating to their socioeconomic and socioenvironmental status demonstrated a positive correlation with OH indicators. As such, intersectoral public policies based on population strategies that act on social determinants of general and oral health need to be integrated so as to impact on the MDG and OH outcomes.

Periodontal therapy for pregnant women and cases of low birthweight: an intervention study

BACKGROUND

Over the past decade, strong evidence for an association between maternal periodontitis and low birthweight has started to appear. However, few intervention studies have been proposed for investigating this hypothesis. The aim of this study was to evaluate whether periodontal therapy among pregnant women would reduce the incidence of low birthweight.

METHODS

A nonrandomized intervention study was performed, with two control groups. The sample comprised 339 pregnant women: 141 in the experimental group (treated for periodontitis), 145 in control group 1 (without periodontitis) and 53 in control group 2 (with untreated periodontitis). The experimental group received periodontal treatment throughout pregnancy, whereas control group 1 was only monitored over the same period. After delivery, birthweight information on the newborns was obtained. The analysis procedures consisted of stratified analysis followed by logistic regression.

RESULTS

The frequency of low birthweight among the women with treated periodontitis was 9.22%, while it was 13.10% in the group without periodontal disease. However, the difference was not statistically significant (RR 0.72; 95% CI 0.36-1.45). The occurrence of this outcome in the group with untreated periodontitis (24.53%) was greater than in the other two groups.

CONCLUSION

This suggests that periodontal therapy is a protective factor for birthweight.

The impact of educational level on oral health-related quality of life in older people in London

There are socioeconomic inequalities in oral health, but the relationship between education and oral health-related quality of life (OHRQoL) among older adults has not been adequately studied. This study assessed whether there is an educational gradient in OHRQoL among older people in London. We employed secondary analysis of baseline data (n = 1,090) from a randomized controlled trial of health-risk appraisal on community-dwelling non-disabled people 65 yr of age and older, registered with three group medical practices in suburban London. Multiple linear regressions were used to analyze the association between OHRQoL [measured using the Geriatric Oral Health Assessment Index (GOHAI)] and education, adjusted for age, gender, pension status, and denture wearing. Overall, 30.6% reported low levels of OHRQoL. Eating discomfort was the most frequent problem (24% reported 'often/always'), while concerns about appearance were also prevalent. Significant variations in OHRQoL existed between socioeconomic groups. In adjusted analyses, there was a clear education gradient in OHRQoL, with worse perceptions at each lower level of education. Low educational level has an independent negative impact on OHRQoL in older people, which is not explained by differences in income or in denture wearing between educational groups. Policies targeting lower educated groups should be complemented with whole-population strategies for the reduction of oral health inequalities.

Poverty, social exclusion and dental caries of 12-year-old children: a cross-sectional study in Lima, Peru

BACKGROUND

Socioeconomic differences in oral health have been reported in many countries. Poverty and social exclusion are two commonly used indicators of socioeconomic position in Latin America. The aim of this study was to explore the associations of poverty and social exclusion with dental caries experience in 12-year-old children.

METHODS

Ninety families, with a child aged 12 years, were selected from 11 underserved communities in Lima (Peru), using a two-stage cluster sampling. Head of households were interviewed with regard to indicators of poverty and social exclusion and their children were clinically examined for dental caries. The associations of poverty and social exclusion with dental caries prevalence were tested in binary logistic regression models.

RESULTS

Among children in the sample, 84.5% lived in poor households and 30.0% in socially excluded families. Out of all the children, 83.3% had dental caries. Poverty and social exclusion were significantly associated with dental caries in the unadjusted models (p = 0.013 and 0.047 respectively). In the adjusted model, poverty remained significantly related to dental caries (p = 0.008), but the association between social exclusion and dental caries was no longer significant (p = 0.077). Children living in poor households were 2.25 times more likely to have dental caries (95% confidence interval: 1.24; 4.09), compared to those living in non-poor households.

CONCLUSION

There was support for an association between poverty and dental caries, but not for an association between social exclusion and dental caries in these children. Some potential explanations for these findings are discussed.

Cannabis use and destructive periodontal diseases among adolescents

AIM

The aim of this experiment was to investigate the association between cannabis use and destructive periodontal disease among adolescents.

MATERIAL AND METHODS

Data from a population screening examination carried out among Chilean high school students from the Province of Santiago were used to determine whether there was an association between the use of cannabis and signs of periodontal diseases as defined by (1) the presence of necrotizing ulcerative gingival (NUG) lesions or (2) the presence of clinical attachment loss (CAL) > or =3 mm. The cannabis exposures variables considered were "Ever use of cannabis" (yes/no) and "Regular use of cannabis" (yes/no). The associations were investigated using multiple logistic regression analyses adjusted for age, gender, paternal income, paternal education, frequency of tooth-brushing and time since last dental visit.

RESULTS

Multiple logistic regression analyses showed that "Ever use of cannabis" was significantly negatively associated with the presence of NUG lesions (OR=0.47 [0.2;0.9]) among non-smokers only. No significant associations were observed between the presence of CAL > or =3 mm and cannabis use in either of the smoking groups.

CONCLUSIONS

There was no evidence to suggest that the use of cannabis is positively associated with periodontal diseases in this adolescent population.

The role of cognitive ability in socio-economic inequalities in oral health

Studies have postulated a role for cognitive ability in socio-economic inequalities in general health. This role has not been examined for oral health inequalities. We examined whether cognitive ability was associated with oral health, and whether it influenced the relationship between oral health and socio-economic position. Data were from the Third National Health and Nutrition Examination Survey (1988-1994), for participants aged 20-59 years. Oral health was indicated by extent of gingival bleeding, extent of loss of periodontal attachment, and tooth loss. Simple reaction time test, symbol digit substitution test, and serial digit learning test indicated cognitive ability. Education and poverty-income ratio were used as markers of socio-economic position. Participants with poorer cognitive ability had poorer oral health for all indicators. The association between oral health and socio-economic position attenuated after adjustment for cognitive ability. Cognitive ability explained part, but not all, of the socio-economic inequalities in oral health.

Risk factors and risk indicators in relation to incipient alveolar bone loss in Swedish 19-year-olds

OBJECTIVE

To investigate incipient alveolar bone loss and subgingival calculus on a subject-based level in Swedish 19-year-olds, with special reference to risk factors and risk indicators.

MATERIAL AND METHODS

Subjects (n=686) with different socio-economic profiles enrolled at seven public dental clinics in suburban Stockholm answered a questionnaire on general health, tobacco habits, oral hygiene habits, and their parents' socio-economic background. The clinical and radiographic examination included registration of plaque, bleeding on probing (GBI), supra- and subgingival calculus, caries, and restorations. Incipient alveolar bone loss was recorded when the distance from the cemento-enamel junction to the alveolar crest was > or =2.0 mm.

RESULTS

The prevalence of incipient alveolar bone loss was 5.1%; multivariate analysis disclosed the associated variables to be "subgingival calculus" (odds ratio (OR) 4.2) and "proximal restoration > or =1" (OR 2.1). The cumulative probability of exhibiting incipient alveolar bone loss was 19.6%. The prevalence of subgingival calculus was 14.3% and subgingival calculus was associated with "GBI > 25%" (OR 6.0), "supragingival calculus" (OR 4.6), and "father born abroad" (OR 2.8). The cumulative probability of exhibiting subgingival calculus was estimated to be 65.3%.

CONCLUSIONS

Adolescents with subgingival calculus as well as proximal restorations are at higher relative risk of exhibiting incipient alveolar bone loss than are those without subgingival calculus. In contrast to incipient alveolar bone loss, immigrant background was significantly associated with subgingival calculus among Swedish adolescents.

The Effects of Social Class and Dental Attendance on Oral Health

The relationship between socio-economic status (SES) and oral health is well-established. We investigated whether the association between SES and the number of sound teeth in adults is explained by dental attendance patterns, in turn determined by the effect of SES on barriers to dental attendance. Data on 3817 participants from the 1998 Adult Dental Health Survey in the UK were analyzed. Using structural equation modeling, we found a model with 4 factors (aging, SES, attendance-profile, and barriers-to-dental-attendance) providing an adequate fit to the covariance matrix of the 9 covariates. The final model suggests that the association between SES and the number of sound teeth in adults in the UK is partially explained by the pathway [SES → barriers-to-dental-attendance → dental-attendance-profile → number-of-sound-teeth]. A direct relationship, SES → number-of-sound-teeth, is also significant.

Oral Health Impact of Periodontal Diseases in Adolescents

The need for treatment of destructive periodontal diseases is based on observations made by oral health professionals, who, prompted by clinical findings, recommend treatment. We hypothesized that clinical signs of periodontal destruction have an impact on the oral-health-related quality of life of adolescents. We conducted a cross-sectional study among 9203 Chilean high school students sampled by a multistage random cluster procedure. We recorded clinical attachment levels and the presence of necrotizing ulcerative gingivitis. The students answered the Spanish version of the Oral Health Impact Profile and provided information on several socio-economic indicators. The results of multivariable logistic regression analyses (adjusted for age, gender, and tooth loss) showed that both attachment loss [OR = 2.0] and necrotizing ulcerative gingivitis [OR = 1.6] were significantly associated with higher impact on the Oral Health Related Quality of Life of adolescents. Individuals in lower socioeconomic positions systematically reported a higher impact on their oral-health-related quality of life.

Is there a gradient by job classification in dental status in Japanese men?

The objective of this study was to assess whether there is a gradient in dental health status by job classification in male Japanese workers. The study subjects were 16,261 male Japanese workers aged 20-69 yr. Jobs were classified into seven job groups. Oral examination was conducted using World Health Organization criteria for decayed, missing or filled teeth (DMFT). Professionals, managers, and office workers had a better oral status than those in service occupations and drivers. Professionals had significantly more natural and sound teeth than those in other job classes. The DMFT of professionals was significantly lower than in workers of other job classes. Professionals had a significantly higher restorative index than did workers of other job classes. The restorative index of office workers was significantly higher than that in managers, skilled workers, salespersons, those in service occupations, and drivers. Drivers were 1.8 times, and those in service occupations 1.3 times, more likely to have one or more carious teeth compared with professionals. Skilled workers, salespersons, those in service occupations, and drivers were 1.3, 1.3, 1.4, and 2.1 times, respectively, more likely to have a missing tooth compared with professionals. Skilled workers, those in service occupations, and drivers were 1.7, 1.9, and 3.1 times, respectively, more likely not to have 20 or more teeth compared with professionals aged 50-69 yr.

Social gradients in oral and general health

There are social gradients in general health and oral health. However, there have been few studies addressing whether similarities exist in the gradients in oral and general health in the same individuals. We set out to test, using data from NHANES III, whether there are social gradients in oral health, and whether they resemble the gradients in general health. Income, indicated by poverty-income ratio, and education gradients were examined in periodontal diseases, ischemic heart disease, and perceived oral/general health. Our analysis demonstrated consistent income and education gradients in all outcomes assessed. In the adjusted regression models, the probabilities of having poorer clinical and perceived health were attenuated, but remained significantly higher at each lower level of income and education for most outcomes. The results showed similar income and education gradients in oral and general health, implying commonalities of the social determinants of both oral and general health.

Socio-demographic determinants of participation in mammography screening

Our objective was to use individual data on socio-demographic characteristics to identify predictors of participation in mammography screening and control to what extent they can explain the regional difference. We used data from mammography screening programmes in Copenhagen, 1991-1999, and Funen, 1993-2001, Denmark. Target groups were identified from the Population Register, screening data came from the health authority, and socio-demographic data from Statistics Denmark. Included were women eligible for at least 3 screens. The crude RR of never use versus always use was 3.21 (95%CI, 3.07-3.35) for Copenhagen versus Funen, and the adjusted RR was 2.55 (95%CI, 2.43-2.67). The adjusted RR for never use among women without contact to a primary care physician was 2.50 (95% CI, 2.31-2.71) and 2.89 (95% CI, 2.66-3.14), and for women without dental care 2.94 (95% CI, 2.77-3.12) and 2.88 (95% CI, 2.68-3.10) for Copenhagen and Funen, respectively. Other important predictive factors for nonparticipation were not being married and not being Danish. In conclusion, to enhance participation in mammography screening programmes special attention needs to be given to women not using other primary health care services. All women in Copenhagen, irrespective of their socio-demographic characteristics, had low participation. Screening programmes have to find ways to handle this urbanity factor.

Gradients in periodontal status in Japanese employed males

AIM

The objective was to assess whether there was a social gradient in periodontal status by job classification in Japanese male workers.

MATERIAL AND METHODS

Study participants were 15,803 Japanese male workers aged 20-69 years. There were seven groups classified by jobs. Oral examinations were conducted using community periodontal index (CPI).

RESULTS

The percentages of sextants with a CPI score of 3 or 4 of professionals were significantly lower than for other job classes. The gradient also existed for the percentage of sextants with CPI score 4. After adjusting for age, a history of diabetes mellitus and smoking status, those lower on the gradient, namely, drivers, service occupations, salespersons and managers were 2.0, 1.5, 1.4 and 1.4, times, respectively more likely to have one or more sextants with CPI score 3 or 4 compared with professionals. Odds ratios of having more than one or more sextants with CPI score 4 after adjusting for age, clinical history of diabetes mellitus and smoking status for drivers, service occupations, salespersons and managers were 2.1, 1.5, 1.5 and 1.2, respectively, compared with professionals.

CONCLUSIONS

There was a gradient in periodontal status by job classification. Professional and office workers had better periodontal status than salespersons, service occupations and drivers.

Factors associated with dental attendance among adolescents in Santiago, Chile

Background

Dental treatment needs are commonly unmet among adolescents. It is therefore important to clarify the determinants of poor utilization of dental services among adolescents.

Methods

A total of 9,203 Chilean students aged 12–21 years provided information on dental visits, oral health related behavior, perceived oral health status, and socio-demographic determinants. School headmasters provided information on monthly tuition and annual fees. Based on the answers provided, three outcome variables were generated to reflect whether the respondent had visited the dentist during the past year or not; whether the last dental visit was due to symptoms; and whether the responded had ever been to a dentist. Aged adjusted multivariable logistic regression models were used to assess the influence of the covariates gender; oral health related behaviors (self-reported tooth brushing frequency & smoking habits); and measures of social position (annual education expenses; paternal income; and achieved parental education) on each outcome.

Results

Analyses showed that students who had not attended a dentist within the past year were more likely to be male (OR = 1.3); to report infrequent tooth brushing (OR = 1.3); to have a father without income (OR = 1.8); a mother with only primary school education (OR = 1.5); and were also more likely to report a poor oral health status (OR = 2.0), just as they were more likely to attend schools with lower tuition and fees (OR = 1.4). Students who consulted a dentist because of symptoms were more likely to have a father without income (OR = 1.4); to attend schools with low economic entry barriers (OR = 1.4); and they were more likely to report a poor oral health status (OR = 2.9). Students who had never visited a dentist were more likely to report infrequent tooth brushing (OR = 1.9) and to have lower socioeconomic positions independently of the indicator used.

Conclusion

The results demonstrate that socioeconomic and behavioral factors are independently associated with the frequency of and reasons for dental visits in this adolescent population and that self-perceived poor oral health status is strongly associated with infrequent dental visits and symptoms.

From victim blaming to upstream action: tackling the social determinants of oral health inequalities

The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.

Periodontal treatment in pregnant women improves periodontal disease but does not alter rates of preterm birth

DESIGN

This was a multicentre randomised controlled trial (RCT).

INTERVENTION

Pregnant women were divided into two groups. Those to whom dental treatment was given had up to four visits of periodontal scaling and root planing using ultrasonic and hand instruments, with local anaesthesia as needed. Treatment recipients were also given instruction in oral hygiene and monthly tooth polishing and re-instruction in oral hygiene, with scaling and planing as needed. Control patients received only a brief oral examination at monthly follow-ups but attended the same number of visits as the treatment group. Patients in the control group were offered the same periodontal therapy after delivery.

OUTCOME MEASURE

The primary outcome was gestational age at delivery. Secondary outcomes included birth weight, the proportion of infants who were small for gestational age, Apgar scores, and admissions to a neonatal intensive care unit.

RESULTS

Preterm birth (before 37 weeks of gestation) occurred in 49 out of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 out of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery [P 0.70; hazard ratio for treatment group versus control group, 0.93; 95% confidence interval (CI), 0.63-1.37]. There were no significant differences between the treatment and control groups in mean babies' birth weights (3239 g versus 3258 g; P 0.64) or in the rate of delivery of infants who were small for gestational age (12.7% versus 12.3%; odds ratio, 1.04; 95% CI, 0.68-1.58). There were five spontaneous abortions or stillbirths in the treatment group, compared with 14 in the control group (P 0.08).

CONCLUSIONS

Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight or foetal growth restriction.

Spanish version of the Oral Health Impact Profile (OHIP-Sp)

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.