Validation of the response format of the Oral Health Impact Profile

ORAL HEALTH IMPACT OF DENTAL HYGIENE AND DENTAL THERAPY PATIENT POPULATIONS-AN EVIDENCE UPDATE IN 2024

OBJECTIVES

Dental patient-reported outcomes, especially the Oral Health-Related Quality of Life (OHRQoL) construct, are vital for evidence-based dentistry. This construct includes four dimensions (4D): Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. This study updates previous work characterizing 4D OHRQoL impairment among patients in dental hygiene (DH) and dental therapy (DT) settings.

METHODS

An expert panel revised previously determined DH and DT patient population groups to align them with current scopes of practice. An updated systematic review was then conducted to incorporate recent studies using the Oral Health Impact Profile (OHIP) to assess 4D OHRQoL in these populations. The search spanned 6 databases from January 1, 2023, to April 16, 2024.

RESULTS

The panel identified 20 patient populations, representing the scope of DH and DT practice. The systematic review contained 19 studies (17 from the previous review and 2 new ones). Studies' OHRQoL data covered only 30 % of dental hygiene and dental therapy patient populations identified by the panel. The most frequently studied group was "therapeutic periodontal treatment-patients with periodontitis" (n = 17, 89 %), followed by "oral hygiene instructions-all patients" (n = 13, 68 %). Only four studies provided 4D OHRQoL data, showing the greatest impacts in Orofacial Pain (baseline OHIP: 3.10-4.20; follow-up: 1.52-3.60) and Orofacial Appearance (baseline OHIP: 0.44-2.50; follow-up: 0.91-2.25). Among studies reporting summary OHIP scores only (n = 15), overall OHRQoL impairment ranged from 1.40 to 42.35 at baseline and 1.50-40.56 at follow-up. All studies demonstrated a general trend of reduced OHRQoL impairment over time with treatment. Risk of bias was low, with no evidence of publication bias.

CONCLUSION

Current evidence on OHRQoL impairment in DH and DT patient populations is limited, covering only a third of those treated by dental hygienists and therapists. Especially, scarce 4D OHRQoL data prompts the need for more research in this format. Despite these limitations, the findings show promising trends of reduced OHRQoL impairment over time for DH and DT patient populations.

Neurocognitive Functioning in Patients with Painful Temporomandibular Disorders

Aim

To investigate psychosocial factors in painful TMD (pTMD) which could have consequences for mastering chronic pain.

Methods

Our study included 22 patients (20 women, 2 men) with pTMD, refractory to conservative treatment, and 19 healthy controls. The control group was matched for gender, age, and educational level, and IQ tested on the Wechsler Abbreviated Scale of Intelligence. Neurocognitive function was tested with the Color-Word Interference Test (CWIT). Pain intensity was reported according to the General Pain Intensity Questionnaire (GPI), using the Numeric Rating Scale (NRS). Self-perceived cognitive difficulties were reported by the Perceived Deficits Questionnaire-Depression 5-item (PDQ-5). Two measures of rumination were included: the Rumination-Reflection Questionnaire (RRQ) and the Ruminative Response Scale (RRS). The Montgomery Åsberg Depression Rating Scale Self-report (MADRS-S) was used to measure depressive symptoms, and the Oral Health Impact Profile-TMD (OHIP-TMD) to measure QoL related to oral health.

Results

There were no statistical differences in age (median pTMD: 55 years, median control: 53 years), educational level, and IQ between pTMD and controls. Median pain intensity in pTMD was NRS 8 at maximum and the median pain duration was 18 years. There were no significant differences in CWIT between pTMD and controls. Self-perceived cognitive function (PDQ) was significantly poorer in pTMD. Rumination scores from both measures, and the depression score from MADRS, were significantly higher in pTMD. The OHIP-TMD score revealed a significantly poorer QoL in pTMD.

Conclusion

The group of pTMD patients have self-perceived cognitive difficulties that may make it more difficult to master chronic pain and common everyday tasks. They reported significantly more self-perceived cognitive difficulties, higher rumination, more depressive symptoms, and lower QoL compared to healthy controls, suggesting that these psychosocial factors could be targeted in treatment and interventions. However, the tested neurocognitive performance was equivalent to the control group.

DENTAL PATIENT-REPORTED OUTCOMES -- THE PROMISE OF DENTAL IMPLANTS

In general dental practice, the use of implants is focused mostly on prosthodontic issues. That is, the replacement of missing teeth or the support of dental prostheses. However, there are other dental fields using implants such as orthodontics or maxillofacial prosthodontics. A classic way to measure success in implant dentistry is to look how long implants and the corresponding superstructure survive and are in function. Nevertheless, this alone is a very crude parameter. Therefore, biological and technical complications are taken in account additionally. Nonetheless, these objective measures do not well replicate the perception of the patient. That why, subjective measures, reflecting the perception of the patient are recommended to complement objective parameters. If these dental patient-reported outcome measures (dPROMs) are wisely chosen, they offer a wide variety of options. Besides comparing therapeutic effects by using the instruments' summary score only, dPROMs such as the Oral Health Impact Profile (OHIP) provide the opportunity to additionally assess patients` perceptions in the 4 dimensions of oral health-related quality of life. These are functional limitations, pain, esthetic issues as well as psychosocial impairment. Even the 5-item short form of the OHIP captures these dimensions and provides an efficient way to assess patients' perception with low administrative burden. This in turn offers new insights into the patient perspective and therefore helps improving shared decision making.

Effects of Aloe vera in adults with mucocutaneous problems: A systematic review and meta-analysis

AIMS

To analyse the different types of Aloe vera (AV) effects on various mucocutaneous problems among adults.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

An exhaustive scanning of PubMed, Medline, ScienceDirect, and Google Scholar databases was conducted from January 2000-December 2019.

REVIEW METHODS

Randomized controlled trials (RCTs) publishing reports on the effects of AV in various mucocutaneous problems, psoriasis, burn, wound-healing were included. The standardized mean differences (SMD) with 95% confidence Intervals (CIs) were determined for the main outcomes, heterogeneity was analysed using the I² test and the risk of bias in the studies was reviewed by the Cochrane risk of bias assessment tool.

RESULTS

The study included 23 trials with a total of 4,023 participants. Six trials were included in the meta-analysis. The results indicated no significant differences in pain scores as assessed by the Visual Analog Scale (VAS) (SMD = 0.11, 95% CI: -0.37 to 0.59). The Psoriasis Area Severity Index (PASI) scores were significantly lower following AV gel application in two of the studies (SMD = -1.32 95% CI: -1.86 to -0.78). Considering results in a systematic manner, AV accelerated tissue epithelialization and wound-healing process (N = 3), reduced oral mucositis (N = 3), and improved quality of life (N = 1).

CONCLUSION

AV might have beneficial effects in reducing pain scores and the severity of mucocutaneous problems compared with placebo, especially with limited mild to moderate adverse effects.

IMPACT

AV may be used as an alternative and integrative approach to reducing symptom severity in mucocutaneous problems and the wound-healing process. High quality and well-designed RCTs are still needed to elucidate the effects of AV in a variety of dosages and forms among adults with mucocutaneous problems.

Methodological considerations when measuring oral health-related quality of life

BACKGROUND

Dental patient-reported outcomes (dPROs) and their measures, dPROMs, are fundamental for evidence-based dentistry. However when selecting, applying and evaluating an instrument with a focus on OHRQoL assessment for adults, several methodological considerations are essential to derive valid and meaningful results.

METHODS

In this review article, criteria for selecting the appropriate OHRQoL instrument, aspects of administering the instrument and how to evaluate resulting scores of single and multiple assessments are presented and critically assessed.

RESULTS

Oral disease-generic and dimension-generic instruments capturing the entire construct OHRQoL allow for best comparability of findings across different diseases, settings and populations, with the Oral Health Impact Profile (OHIP) being the most often used and methodologically best investigated one. It is available in several versions with the 5-item version being the one with the lowest burden for the patient. Responses are given on a 5-point ordinal rating scale, the recommended response scale for dPROMs. A 7-day recall period allows for assessment of short-term effects. Clinically relevant effects of item or instrument order or administration method on OHIP scores do not seem to be likely. OHIP summary and dimension scores can be compared to norms from general population or different patient populations. Change scores should be set into context with the minimal important difference of the instrument.

CONCLUSION

OHIP-5 has greatest potential to be used across all settings for assessment and evaluation of OHRQoL in adults. It allows a comprehensive characterising of patients suffering from oral diseases and of this impact using OHRQoL dimensions.

Functional oral health-related quality of life impact: A systematic review in populations with tooth loss

Patients perceive the impact of oral disorder in four major areas, the dimensions of oral health-related quality life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. The functional aspect is essential given the need of chewing, biting, speech and swallowing. The objective of this study was to identify OHRQoL information for dental subjects with functional oral health problems. In a systematic review, distinct and clinically relevant groups of dental subject samples, in this study called "population groups," with such functional OHRQoL information based on the Oral Health Impact Profile (OHIP) were identified (PROSPERO registration: CRD42017064033). The search strategy was "Oral Health Impact Profile" or OHIP. Searches were conducted in the PubMed interface of the Medline database, EMBASE, Cochrane, CINAHL and PsyINFO on 8 June 2017 and updated on 14 January 2019. Published OHIP domain data of different versions were recalculated into OHIP-14`s Physical Disability domain score, characterising the subject's Oral Function impact. 3,653 potentially abstracts were screened. We identified 78 publications reporting dimensional information on 154 subject samples with 52 populations. A typical mean functional impact for partially dentate subjects was 1.6 units on a 0 to 8 unit metric, while for edentate subjects, the mean functional impact was 2.6 units. The functional impact score ranged from 0 to 7.9 units with 50% of the patient samples located between 0.8 and 2.6 units. For the first time, we provide normalised and therefore comparable metric information about the functional OHRQoL impact for a substantial number of functional oral conditions.

The Spanish Language 5-Item Oral Health Impact Profile

OBJECTIVE

To test validity and reliability of the Spanish version of the 5-item Oral Health Impact Profile (OHIP-Sp5).

METHODS

Spanish-speaking dental patients (n = 331, response rate = 61%, age: 42.9 + 12.3 years, 59% female) with a scheduled appointment at HealthPartners dental clinics in Minnesota, USA, were investigated. To assess score reliability, we computed Cronbach's alpha, expecting 'good' reliability (alpha > 0.70). To assess score validity, we correlated the OHIP-Sp5 summary score with five OHRQoL measures [49- and 14-item OHIP-Sp, the Spanish version of the General Oral Health Assessment Index (GOHAI-Sp), the Spanish version of the Oral Impacts on Daily Performances (OIDP-Sp) and a Global Oral Health Assessment]. We expected a pattern of 'very large' (r > 0.70) correlation coefficients for OHIP-Sp5 relationships with the two longer OHIP-Sp versions and 'large' (r > 0.50) correlation coefficients for the other three measures.

RESULTS

Patients had a mean OHIP-Sp5 score of 3.7 (SD = 4.0). The Instrument's reliability was, as expected, 'good', according to the Cronbach's alpha statistic of 0.83. The Instrument's validity was supported by the expected pattern of validity coefficients. OHIP-Sp5 summary scores correlated with OHIP-Sp14 as well as with OHIP-Sp49 (both r = 0.95: 'very large' effect) and with GOHAI-Sp, OIDP and the Global Oral Health Assessment with r = -0.80, 0.73, and -0.56 (absolute effect magnitude all 'very large' or 'large'), respectively.

CONCLUSIONS

The Spanish version of OHIP-5 is a brief and psychometrically sound instrument to measure oral health-related quality of life (OHRQoL) in Spanish-speaking populations. It can effectively replace longer OHIP instruments and would be applicable across all settings of clinical practice and research.

Assessment of oral health-related quality of life as a function of non-invasive treatment with high-fluoride toothpastes for root caries lesions in community-dwelling elderly

PURPOSE

Non-invasive treatment of root caries lesions (RCLs) may impact oral health-related quality of life (OHRQoL), but no evidence is available. The purpose of the study was to assess changes in OHRQoL among patients exposed to non-invasive treatment of RCLs with conventional or high-fluoride dentifrices.

METHODS

To be eligible, subjects had to be ≥60 years of age, independently living, with at least five teeth and one RCL. The 14-item Oral Health Impact Profile for adults in Spanish (OHIP-14Sp), oral examination and sociodemographic data were documented at the beginning of the study (T0). The presence and activity of RCLs were detected and diagnosed. Subjects were randomly assigned to either the control (1,450 ppm fluoride) or the experimental (5,000 ppm fluoride) treatment group. A new set of measurements was obtained at 12 months (T1). Mean comparisons were carried out using the Student's t-test for total OHIP-14Sp scores. To determine whether T1 OHRQoL scores were different regarding sex, age, educational level and socio-economic status, mean OHIP-14Sp scores were obtained and compared with those variables at 12 months.

RESULTS

An overall improvement in OHRQoL after the non-invasive treatment of RCLs was verified when T1 was compared with T0 (P < 0.0001). Regarding treatment type, no significant differences were detected between groups (P = 0.114). Subjects with higher income and more years of formal education had better OHRQoL than those with a lower salary (P < 0.0001) and with fewer years of education (P = 0.0006).

CONCLUSIONS

Non-invasive treatment for RCLs in community-dwelling elders appears to cause a positive impact on OHRQoL. Better OHRQoL was associated with higher socio-economic status and educational level. No significant differences were detected regarding the fluoride concentration in the dentifrices.

Influence of a face-bow on oral health-related quality of life after changing the vertical dimension in the articulator: a randomized controlled trial. Part II

OBJECTIVES

In a double-blind randomized controlled clinical trial, the impact of face-bow registration for remounting complete dentures (CDs) on oral health-related quality of life (OHRQoL) was evaluated.

MATERIALS AND METHODS

New CDs of 32 subjects were clinically remounted using intraoral pin registration. CDs were transferred into a semi-adjustable articulator corresponding to group #1: mean settings with Bonwill triangle and Balkwill angle, and group #2: arbitrary hinge axis with a face-bow registration. After occlusal adjustment, subjects were followed up after 3 (T1) and 84 (T2) days. The primary outcome was the change of OHRQoL by OHIP-G49, while as secondary outcome, mucosal alterations were evaluated over time. Mean values of OHIP-G49 total sum scores and OHIP-dimensions were calculated for baseline (T0) and days 3 (T1) and 84 (T2) after intervention. Based on bootstrapping methods (changes of total OHIP sum score) and the Wilcoxon test (changes of sum scores of OHIP dimensions), analyses of between-group differences were performed.

RESULTS

Mean values (MV) of OHIP-G49 sum scores decreased in both groups from T0 (#1 48.56; #2 45.46) to T1 (#1 31.43 (p = 0.012); #2 43.20) and to T2 (#1 29.06; #2 29.40), which represents an improvement in OHRQoL. MV of OHIP-dimension sum scores decreased from T0 to T1 in both groups (#1 seven dimensions; #2 four dimensions); the decrease of sum scores was tested as not statistically significant (p > 0.05).

CONCLUSIONS

From the patient's perspective, mean-value-based remounting methods are of value. The use of a face-bow was not perceived as superior.

CLINICAL RELEVANCE

From the patient's perspective, remounting of CDs will be positively perceived, irrespective of the use of a face-bow.

Validation of the English-language version of 5-item Oral Health Impact Profile

PURPOSE

The Oral Health Impact Profile (OHIP) is currently the most widely used oral health-related quality of life (OHRQoL) instrument. The study validated the English-language 5-item OHIP by investigating its psychometric properties of dimensionality, reliability, and validity in the adult general population.

METHODS

In 405 subjects (mean age 45+15.7 years, 63% female) from the 2014 Minnesota State Fair, dimensionality was investigated by confirmatory factor analysis. Construct validity was assessed by using a structural equation model correlating OHRQoL and self-reported global oral health status. Reliability was calculated using Cronbach's alpha for OHIP5 total scores.

RESULTS

In the confirmatory factor analysis, the unidimensional model fit OHIP5 well as indicated by fit indices (RMSEA: 0.07, SRMR: 0.03, comparative fit indices: >0.95). In the structural equation model, self-reported global oral health status correlated with 0.46 with the latent OHRQoL factor, indicating sufficient construct validity. Cronbach's alpha, a measure of score reliability, was "satisfactory" with 0.75.

CONCLUSION

We validated the English-language version of OHIP5 in the adult general population. Ultrashort instruments such as the 5-item OHIP provide a conceptually appealing and technically feasible opportunity to measure the impact of oral disorders and dental interventions in settings such as general dental practice where the burden to collect and interpret OHRQoL information needs to be minimized.

The role of orthodontics in the regeneration of the degenerated dentition

The demand for regeneration of a degenerated dentition has been increasing as a result of the development of societies, where the life expectancy is increasing and fighting age-related changes is in focus. Whereas removable dentures were acceptable and considered a norm earlier, patients do, to an increasing degree,demand fixed prosthetics; consequently, the development of implants has had an important impact. The balance in the chewing organ will change with time, due to age-related changes within the bone and the loss of teeth due to caries or periodontal disease, and malocclusions may develop or aggravate. The re-establishment of an aesthetical and functional satisfactory solution cannot be reached by replacing teeth by fixed prosthodontics and implants. The aim of this update was threefold: firstly, to demonstrate that age-related changes, often unnoticed by both the patient and the general dentist, can lead to degeneration of the dentition; secondly, to explain how an interdisciplinary approach can make regeneration of even severe degeneration possible; and finally, to show the importance of the general dentist in the maintenance of the obtained results. Treatments should not aim for short-term results but focus on maintainable results.

Validation of the Spanish version of the Oral Health Impact Profile (OHIP-14Sp) in elderly Chileans

Background

The OHIP-49 is widely used to assess oral health-related quality of life, but its length makes it time-consuming and difficult to use. An abbreviated version of the OHIP-49 with fourteen items has been validated for older adults, but not in Chile. The aim was to develop and validate the Spanish version of the OHIP-14 in an elderly Chilean population.

Methods

Two studies were conducted; a cross sectional to develop and a retrospective study to validate the OHIP-14Sp. The OHIP-49Sp was applied to 490 older adults and the fourteen questions with the higher impact on oral health-related quality of life were selected through linear regression. These items were applied on a retrospective dataset of 85 older adults to test internal consistency (Cronbach’s alpha). A discriminative validity analysis was performed along with the assessment of sociodemographic (age and gender, educational level) and clinical variables (number of teeth, caries lesions, CPITN, prosthetic needs and prosthetic functionality). Data were analyzed using Mann–Whitney U, Student’s t and one-way ANOVA tests with a 95% confidence level and finally were analyzed by a Multivariate Logistic Regression Model.

Results

High internal consistency values were obtained for the OHIP-14Sp instrument (0.91). There was an association between the OHIP-14Sp scores and the presence of caries (p = 0.003), need for complex periodontal treatment (p = 0.002), prosthetic needs (p < 0.0001) and age younger than 70 years-old (p < 0.0001). Subjects with periodontal treatment need were more likely to report reduced oral health-related quality of life (PR = 2.10).

Conclusions

The OHIP-14Sp proved to be a consistent and valid tool to assess oral health-related quality of life when tested in Chilean older adults.

Psychometric Properties of the Oral Health Impact Profile and New Methodological Approach

OBJECTIVE

Evaluate the validity, reliability, and factorial invariance of the complete Portuguese version of the Oral Health Impact Profile (OHIP) and its short version (OHIP-14).

METHODS

A total of 1,162 adults enrolled in the Faculty of Dentistry of Araraquara/UNESP participated in the study; 73.1% were women; and the mean age was 40.7 ± 16.3 yr. We conducted a confirmatory factor analysis, where χ(2)/df, comparative fit index, goodness of fit index, and root mean square error of approximation were used as indices of goodness of fit. The convergent validity was judged from the average variance extracted and the composite reliability, and the internal consistency was estimated by Cronbach standardized alpha. The stability of the models was evaluated by multigroup analysis in independent samples (test and validation) and between users and nonusers of dental prosthesis.

RESULTS

We found best-fitting models for the OHIP-14 and among dental prosthesis users. The convergent validity was below adequate values for the factors "functional limitation" and "physical pain" for the complete version and for the factors "functional limitation" and "psychological discomfort" for the OHIP-14. Values of composite reliability and internal consistency were below adequate in the OHIP-14 for the factors "functional limitation" and "psychological discomfort." We detected strong invariance between test and validation samples of the full version and weak invariance for OHIP-14. The models for users and nonusers of dental prosthesis were not invariant for both versions.

CONCLUSION

The reduced version of the OHIP was parsimonious, reliable, and valid to capture the construct "impact of oral health on quality of life," which was more pronounced in prosthesis users.

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.

MATERIALS 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 10778 OHIPs from 9348 individuals (N=6349 general population subjects, N=2999 prosthodontic patients). To elucidate the OHIP latent structure, the aggregated data were split into a Learning Sample (N=5173) for exploratory analyses and a Validation Sample (N=5022) 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.

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.

A computer-based readability analysis of patient-reported outcome questionnaires related to oral health quality of life

OBJECTIVE

The purpose of this study was to examine the readability of published patient-related outcome (PRO) questionnaires completed by persons with oral disease and to compare the readability results to existing data about average reading levels for adults living in the United States.

METHODS

A search was conducted via Pubmed and Google Scholar to identify PRO oral health-related questionnaires completed by patients. Reading grade levels were analyzed for 10 oral health-related PRO questionnaires using three readability formulas.

RESULTS

The most significant results were as follows:

CONCLUSION

Developers of PRO questionnaires should consider readability as another testable construct.

PRACTICE IMPLICATIONS

To obtain the most useful information for treatment planning and outcomes assessments, the dental professional should consider the reading level needed to understand a particular PRO questionnaire.