Cross-Cultural Validation of the Scale of Oral Health-Related Outcomes for 5-Year-Old-Children with a Low-Income Sample from the Dominican Republic

An interdisciplinary intervention program to prevent early childhood caries in the Dominican Republic

Objective

The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists.

Materials and methods

After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria.

Results

At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460).

Conclusion

The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC.

Cross cultural adaptation and psychometric properties of the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

BACKGROUND

The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population.

METHODS

The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models.

RESULTS

Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively.

CONCLUSION

This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations.