Global Transition Judgement Research Articles

Impact of dental sedation treatment on the oral health-related quality of life of distressed young children: A secondary analysis of a randomized clinical trial.

Little is known regarding the impact of dental treatment under sedation on distressed young children's oral health-related quality of life (OHRQoL). To evaluate the impact of dental treatment under sedation on the OHRQoL of children and their families. Caregivers of two-to-six-year-old children answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS): (1) before treatment under sedation (T0), (2) two weeks (T1) and (3) 3 months after the completion of treatment (T2). A global transition judgment was included in the posttreatment evaluations to determine the perception of changes in OHRQoL after dental treatment. Bivariate analysis was performed. Changes in scores and effect sizes (ES) were calculated. Reductions were found at both posttreatment evaluations in the total B-ECOHIS scores (median [25th-75th percentile] at T0: 14 [9.8-21.7]; T1: 2.0 [0.0-5.1]; T2: 2.0 [0.0-6.7]); "child impact" section (T0: 8.8 [4.0-13.1]; T1: 0.0 [0.0-2.2]; T2: 0.0 [0.0-4.3]) and "family impact" section (T0: 6.0 [4.0-8.5]; T1: 0.0 [0.0-2.0]; T2: 0.0 [0.0-2.0]) (≤0.001; large ES). In 92.3% of cases at T1 and 88.3% at T2, caregivers reported that their child's oral health improved considerably. Dental treatment under sedation significantly improved the OHRQoL of the children and their families.

Does orthodontic treatment improve the Oral Health-Related Quality of Life when assessed using the Malocclusion Impact Questionnaire-a 3-year prospective longitudinal cohort study.

To assess the change in Oral Health-Related Quality of Life (OHRQoL) following orthodontic treatment using the Malocclusion Impact Questionnaire (MIQ) and to test the responsiveness of MIQ to treatment-associated changes. A longitudinal prospective cohort study, in an orthodontic postgraduate centre, Kerala, India. Patients under 18 years were invited to complete the MIQ before the start of treatment (T0) and 1 month after treatment completion (T1). TheIndex of Orthodontic Treatment Need and Peer Assessment Rating (PAR) scores were assessed at both time periods as well as a global transition judgement at T1. Two hundred and ten participants were recruited and 162 completed both questionnaires (45.1% males; 54.9% females; age = 12-18 years, mean = 16.8; SD = 1.7). There was large reduction in MIQ scores from T0 (mean = 28.1, SD = 6.1) to T1 (mean = 3.7, SD = 2.6). 53% reported a large improvement in oral health and related life quality after treatment, 32% minimal change, and 15% no change. None reported worsening in OHRQoL at T1. There was a significant positive correlation between change in MIQ score and change in PAR score (r = 0.358), pretreatment aesthetic component (rho = 0.467) and dental health component (rho = 0.491) of the index of orthodontic treatment (IOTN-DHC), and treatment time (rho = 0.502). Regression analysis revealed the change in PAR score and pretreatment IOTN-DHC to be independent predictors of change in MIQ score. Standardized effect size (4.0) and standardized response mean (2.9) were large and the minimal important difference was 7.7. Receiver operating characteristic analysis reported a high diagnostic accuracy of MIQ. There was a significant improvement in OHRQoL following orthodontic treatment when assessed using a condition-specific measure for malocclusion. MIQ was found to be responsive to changes associated with orthodontic treatment.

Changes in Adolescents’ Oral Health Status: Responsiveness of the Child Perception Questionnaire11–14

Changes in oral health status following treatment should be assessed clinically as well as by patients’ reported outcomes. This study investigated changes on oral-health-related quality of life (OHRQoL) of adolescents enrolled in a comprehensive oral health care program for caries and gingival conditions. The sensitivity of the Child Perception Questionnaire_11–14 (CPQ_11–14) to detect clinical changes, that is, its responsiveness, was assessed. A total of 618 10–15-year adolescents answered the questionnaire before treatment and 560 at follow-up after 1 year. In the follow-up, 2 additional global transition judgment questions were asked. The adolescents were clinically and radiographically examined. At the baseline, 374 adolescents needed only nonoperative treatment, whereas 274 needed non- and operative treatments. After 1 year, the adolescents were regrouped according to the fulfillment of their treatment needs in Group 1 (n = 363) needing/receiving nonoperative treatment only; Group 2 (n = 98) needing/receiving both non- and operative treatments; Group 3 (n = 99) receiving nonoperative treatment only, while needing also operative treatment. The CPQ_11–14 total mean change scores by the global transition judgment on self-perceived oral health status indicated significant differences (p < 0.001, ANOVA; internal responsiveness). The effect of the program for the treatment groups was significant (p = 0.014, ANCOVA; external responsiveness). The effect size for the change scores was of moderate magnitude. In conclusion, an overall improvement of adolescents’ OHRQoL was observed following 1-year oral health care program for caries and gingival conditions. The CPQ_11–14 was internally and externally sensitive to detect substantial clinical changes. The CPQ_11–14 seems appropriate for measuring long-term changes on adolescents’ OHRQoL.

Responsiveness of the Brazilian versions of CPQ11‐14 and Child‐OIDP

The aim of this study was to investigate the responsiveness of the Brazilian versions of Child Perceptions Questionnaire (CPQ11-14 ) and Child-Oral Impacts on Daily Performances (Child-OIDP). The data were collected from a convenience sample of 209 patients aged 10-15 years, who visited the adolescent dental clinic of Federal University of Santa Maria, Brazil. The subjects answered the CPQ11-14 and the Child-OIDP prior to their dental treatment and 1 month after concluding the treatment. The responsiveness of CPQ11-14 and Child-OIDP was analysed through (a) the mean change observed in scores before and after treatment, (b) an investigation of the effect size, (c) an assessment of the statistical significance of changes within the groups over time, as per the global transition judgement, and (d) the receiver operating characteristic (ROC) curve. Positive changes were observed for both questionnaires. According to global transition judgement, 82.30% of the participants reported an improvement following treatment, 16.75% reported no change, and 0.96% reported deterioration. The effect size was 0.8% and 0.5% for the overall CPQ11-14 and Child-OIDP, respectively. The area under the curve was 0.38 for CPQ11-14 and 0.43 for Child-OIDP. The Brazilian versions of CPQ11-14 and Child-OIDP demonstrated limited responsiveness following dental treatment.

Responsiveness to change of the Malay-ECOHIS following treatment of early childhood caries under general anaesthesia.

To evaluate the sensitivity and responsiveness of the Malay version of Early Childhood Oral Health Impact Scale (Malay-ECOHIS) to dental treatment of early childhood caries (ECC) under general anaesthesia (GA) and determine the minimally important difference (MID) for the Malay-ECOHIS. A sample of 158 preschool children with ECC awaiting dental treatment under GA was recruited over an 8-month period. Parents self-completed the Malay-ECOHIS before and 4weeks after their child's dental treatment. At 4weeks follow-up, parents also responded to a global health transition judgement item. Data were analysed using independent and paired samples t tests, ANOVA and Pearson correlation coefficients. The response rate was 87.3%. The final sample comprised 76 male (55.1%) and 62 female (44.9%) preschool children with mean age of 4.5 (SD=1.0) years. Following treatment, there were significant reductions in mean scores for total Malay-ECOHIS, child impact section (CIS), family impact section (FIS) and all domains, respectively (P<0.001). The effect size (ES) for the Malay-ECOHIS was +1.0; across the domains, it ranged from +0.4 to +1.9. There was a weak, positive correlation for Malay-ECOHIS change scores (r=0.165) and CIS change scores (r=0.175) with the number of decayed teeth (dt), respectively. Similar correlation was also observed between Malay-ECOHIS change scores and the number of extracted teeth (r=0.129). Based on the global health transition judgement, 62.3% of parents reported their child's oral condition to be "a little improved" while 37.7% reported it to be "much improved" following treatment, with Malay-ECOHIS mean change scores of 6.7 (ES=+1.1) and 9.6 (ES=+1.2), respectively. There was an observed gradient in the Malay-ECOHIS change scores and ES in relation to parents' perception of their child's oral health improvement after treatment, supporting the responsiveness of the measure. The Malay-ECOHIS MID was found to be 7 scale points. The Malay-ECOHIS is empirically shown to be sensitive and responsiveness to dental treatment of ECC under GA.

Outreach programs: an adjunct for improving dental education&#x0D;

An important objective of education is to improve clinical competence and hence confidence of students. Ample evidence on effectiveness of medical outreach programs is available but data pertaining to effectiveness of dental outreach, especially from developing countries, are still limited. The present study was undertaken to assess effectiveness of outreach placements on clinical confidence and communication skills of Indian dental students. A non-randomized trial was conducted in three randomly selected dental colleges of Bangalore city, India, amongst 89 students pursuing internship programs. Subjects were put into two groups: outreach (study group) and dental school based only (control group). A pre-tested, self-administered questionnaire was used to evaluate the change in clinical confidence and communication skills of both groups from baseline and after 3 months of follow-up via global self-assessment test, then-test and transition judgment. Outcome measures were analysed using <i>t</i>-test. Global assessment revealed outreach group confidence level was higher in comparison to dental school based group only (4.37±0.49<i> </i>vs 4.04±0.21, <i>p</i><0.001), while using then-test their baseline confidence was observed to be lower (3.42±0.75 vs 3.72±0.72, <i>p</i>=0.04). Transition judgement rated an increase in their confidence significantly higher than the dental school based group only (4.24±0.91 vs 2.54±0.66, <i>p</i><0.001). The outreach group rated increase in communication skills to be higher for the transition judgement. The present trial supports the concept of outreach programs to be incorporated in the existing dental curricula in order to supplement the traditional school-based dental education to achieve an overall professionally trained dentist.

Changes in preschool children's OHRQoL after treatment of dental caries: responsiveness of the B‐ECOHIS

Oral health-related quality of life (OHRQoL) measures should be tested for responsiveness to change if they are to be used as outcomes in randomized clinical trials. To assess the responsiveness of the Brazilian ECOHIS (B-ECOHIS) to dental treatment of dental caries. One hundred parents of 3- to 5-year-old children completed the B-ECOHIS prior to their children's treatment and 7-14days after completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed parent's perceptions of change in their children's oral health following treatment. Change scores, longitudinal construct validity, standardized effect sizes (ES) and standardized response mean (SRM) were calculated. Improvements in children's oral health after treatment were reflected in mean pre- and post-treatment B-ECOHIS scores. They declined considerably significantly from 17.4 to 1.6 (P<0.0001), as did the individual domain scores (P<0.0001). There were significant differences in the pre- and post-treatment scores of children who reported little improvement (P<0.0001) as well as in those who reported large improvements (P<0.0001). The ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were large. Dental treatment resulted in significant improvement of the preschool children's OHRQoL. The B-ECOHIS is responsive.

Assessing Changes in Oral Health-Related Quality of Life Following Dental Rehabilitation under General Anesthesia

To determine whether dental treatment under general anesthesia (GA) improved oral health-related quality of life (OHRQoL) in pre-school children, to evaluate the sensitivity and responsiveness of the Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS) and to examine parental satisfaction with the care received. The parents/caregivers of 120 pre-school children receiving dental treatment under GA, were asked to complete the ECOHIS before and after treatment. Participants were also asked a global transition judgement concerning change in their child's condition after treatment. Global transition judgement and distribution changes in ECOHIS scores were used to assess the sensitivity and responsiveness. 98 children completed the follow-up survey. Between pre- and post-treatment ECOHIS scores, significant reduction was observed (p < 0.001). The effect sizes were moderate and large (0.36 to 1.63). Global transition rating groups were compatible with statistical differences between pre- and posttreatment scores, supporting the responsiveness of the ECOHIS. 91% of parents regarded the experience to be positive. Children's OHRQoL showed significant improvement after treatment. The majority ofparents reported a high degree of satisfaction. Also, Turkish version of the ECOHIS was sensitive to dental treatment under GA for pre-school children and responsive to treatment-associated changes.

Responsiveness to change for the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

BackgroundThe responsiveness of oral health-related quality of life (OHRQoL) instruments has become relevant, given the increasing tendency to use OHRQoL measures as outcomes in clinical trials and evaluations studies. The purpose of this study was to assess the responsiveness of the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) to dental treatment.MethodsOne hundred and fifty-four children and their parents completed the child self- and parental’ reports of the SOHO-5 prior to treatment and 7 to 14 days after the completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed subject’s perceptions of change in their oral health following treatment. Change scores were calculated by subtracting post-treatment SOHO-5 scores from pre-treatment scores. Longitudinal construct validity was assessed by using one-way analysis of variance to examine the association between change scores and the global transition judgments. Measures of responsiveness included standardized effect sizes (ES) and standardized response mean (SRM).ResultsThe improvement of children’s oral health after treatment are reflected in mean pre- and post-treatment SOHO-5 scores that declined from 2.67 to 0.61 (p < 0.001) for the child-self reports, and 4.04 to 0.71 (p < 0.001) for the parental reports. Mean change scores showed a gradient in the expected direction across categories of the global transition judgment, and there were significant differences in the pre- and post-treatment scores of those who reported improving a little (p < 0.05) and those who reported improving a lot (p < 0.001). For both versions, the ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were moderate to large.ConclusionsThe Brazilian SOHO-5 is responsive to change and can be used as an outcome indicator in future clinical trials. Both the parental and the child versions presented satisfactory results.

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 Design: 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.

Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia

This study aimed to investigate the sensitivity and responsiveness of the Chinese version of the Early Childhood Oral Health Impact Scale (ECOHIS) to dental treatment under general anaesthesia (GA). A consecutive sample of primary caregivers of children (aged 5 and younger) with early childhood caries (ECC) attending a university hospital dental clinic for dental treatment under GA was recruited over a 12-month period. Caregivers self-completed the ECOHIS prior to and 3 months following their child dental treatment under GA. In addition, caregivers rated the change in their child's overall health condition compared to before treatment on a global transition scale. Sensitivity of the measure was assessed by determining distribution changes in ECOHIS scores; responsiveness was assessed by investigating whether the observed changes took the form of a gradient according to the global transition judgement, in terms of the observed change in scores and effect size. Following treatment under GA, there was significant changes in ECOHIS scores (P < 0.01) and many of its sub-domains. The magnitude of change (effect size) of the total ECOHIS following treatment was 0.89 and among sub-domains ranged from -0.29 to 1.33. There was an observed gradient in the changes of ECOHIS scores (and effect sizes) in relation to global transition judgement of oral change following treatment, supporting the responsiveness of the measure. The Chinese version of ECOHIS is sensitive and responsive to dental treatment of ECC under GA.

Testing responsiveness to change for the early childhood oral health impact scale (ECOHIS)

The Early Childhood Oral Health Impact Scale (ECOHIS) is a recently developed oral health-related quality of life instrument designed to assess the impact of oral health problems in 0-5-year-old children. It has previously been validated as discriminative instrument. The goal of this study was to investigate the responsiveness to change of the ECOHIS. Data were collected from a convenience sample of 101 parents of 0-5-year-old children attending a hospital dental clinic for dental treatment. The ECOHIS was completed by parents prior to dental treatment and 2 weeks later. Subjects were also asked a global transition judgement concerning change between the second and first completion of the ECOHIS instrument. Responsiveness to change of the ECOHIS was analysed through: (i) a comparison of ECOHIS change scores with a global transition judgment by study subjects; (ii) an assessment of the statistical significance of within-group change in scores over time for groups reporting improvement, stability and deterioration; (iii) an estimation of the ECOHIS's sensitivity; and (iv) an investigation the effect size of the ECOHIS. Of the 101 subjects recruited, 94 had full datasets. Their data were used for the analyses reported in this paper. Pre- and post-treatment distributions of ECOHIS scores were strongly distributed towards no oral health impacts. Among the 94 subjects, 51.1% reported improvement, 42.6% reported no change and 6.4% reported deterioration following treatment, using the global transition judgement. The mean ECOHIS change scores for these three groups were -0/9, +0.7 and +6.5 respectively, although none of the within-group changes were statistically significant. The effect size for those reporting improvement was small (0.15) but for those reporting deterioration was moderate-to-large (0.69). Sensitivity ranged from 0.61-0.79 depending on the size of the cut-off point, with a change of 3 points demonstrating the best sensitivity to false positive ratio (0.79 versus 0.41 respectively). In this sample with low levels of problems, the ECOHIS has demonstrated some limited ability to respond to change. Further work in a larger sample with higher levels of problems is needed to investigate the instrument's ability to respond to change when it has occurred.

Assessing the responsiveness of measures of oral health-related quality of life.

This paper illustrates ways of assessing the responsiveness of measures of oral health-related quality of life (OHRQoL) by examining the sensitivity of the oral health impact profile (OHIP)-14 to change when used to evaluate a dental care program for the elderly. One hundred and sixteen elderly patients attending four municipally funded dental clinics completed a copy of the OHIP-14 prior to treatment and 1 month after the completion of treatment. The post-treatment questionnaire also included a global transition judgement that assessed subjects' perceptions of change in their oral health following treatment at the clinics. Change scores were calculated by subtracting post-treatment OHIP-14 scores from pre-treatment scores. The longitudinal construct validity of these change scores were assessed by means of their association with the global transition judgements. Measures of responsiveness included effect sizes for the change scores, the minimal important difference, and Guyatt's responsiveness index. An receiver operating characteristic (ROC) curve was constructed to determine the accuracy of the change scores in predicting whether patients had improved or not as a result of the treatment. Based on the global transition judgements, 60.2% of subjects reported improved oral health, 33.6% reported no change, and only 6.2% reported that it was a little worse. These changes are reflected in mean pre- and post-treatment OHIP-14 scores that declined from 15.8 to 11.5 (P < 0.001). Mean change scores showed a consistent gradient in the expected direction across categories of the global transition judgement, but differences between the groups were not significant. However, paired t-tests showed no significant differences in the pre- and post-treatment scores of stable subjects, but showed significant declines for subjects who reported improvement. Analysis of data from stable subjects indicated that OHIP-14 had excellent test-retest reliability with an intraclass correlation coefficient (ICC) of 0.84. Effect size based on change scores for all subjects and subgroups of subjects were small to moderate. The ROC analysis indicated that OHIP-14 change scores were not good "diagnostic tests" of improvement. The minimal important difference for the OHIP-14 was of 5-scale points, but detecting this difference would require relatively large sample sizes. OHIP-14 appeared to be responsive to change. However, the magnitude of change that it detected in the context described here was modest, probably because it was designed primarily as a discriminative measure. The psychometric properties of the global transition judgements that often provide the "gold standard" for responsiveness studies need to be established.

Clinical correlates of changes in self-perceived oral health in older adults.

Although numerous investigators have reported on self-perceived oral health status in adult and older adult populations, few have examined how these perceptions change over time. This paper uses data from a longitudinal oral health survey of community-dwelling Canadians aged 50 years and over to explore this issue. Data were collected at baseline and after 3 years. Change was assessed using a global transition judgement and change scores on four subjective oral health status indicators. These indicators addressed chewing capacity, oral and facial pain symptoms, other oral symptoms, and the psychosocial impact of oral disorders. Overall, 23.0% reported that their oral health had worsened over this period, 66.5% that it had remained the same and 10.5% that it had improved. Change scores on the four indicators showed a similar pattern and were significantly associated with these global judgements. Over the same period, substantial proportions lost one or more teeth, acquired new coronal or root DFS increments or experienced loss of periodontal attachment. An additional 17% complained of dry mouth. However, the only clinical indicator associated with changing perceptions of oral health was tooth loss. Of interest was the fact that rates of tooth loss were equally high among those who reported a worsening of oral health and those who reported an improvement. This suggests that the impact of tooth loss on health status may be positive or negative depending upon the condition of the teeth lost.