Quantifying Oral Health Related Quality of Life Hans Gjrup Aarhus University Hospital

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Quantifying Oral Health Related Quality of
LifeHans GjørupAarhus University Hospital
The 4th Nordic Conference on Orofacial Therapy
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Aarhus University HospitalÅrhus Sygehus
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Oral health and quality of life- any relation?
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Quality of life (QoL)

• QoL is related to health
• Health and ability to function
• Vital functions in the orofacial area

• Oral Health Related Quality of life

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WHO definition of health

• WHO Constitution 1946
• Health is a state of complete physical, mental
  and social wellbeing and not merely the absence
  of disease or infirmity

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WHO definition of health

• WHO 1998
• Health is a ressource for everyday life, not the
  object of living. It is a positive concept
  emphasizing social and personal ressources as
  well as physical capabilities.

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Theoretical referenceHolistic theories

• Disease or sickness
• Physical changes of organs in the body
• Lack of an organ or part of the body
• Malfunction of organs
• Lack of function

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Theoretical referenceHolistic theories

• Health is the ability of the individual to
  achieve vital aims in daily life
• Acceptabel health
• An individual definition

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Disease versus illness

• Diseased or sound
• Objective
• Biomedical items
• Functional limitations
• Impairment
• Disease
• Death

• Illness or wellbeing
• Subjective
• Sociomedical items
• Discomfort
• Incompetence
• Handicap

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Lockers model for Oral HealthREFLocker D.
Measuring oral health a conceptual framework.
Community Dent Health 1988 53-18
Functional limitation

• Disability
• Physical
• Psychological
• Social

Disease
Impairment
Handicap
Discomfort pain
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Quantifying oral health

• Biomedical items
• DMFS/T
• Gingival index, Löe and Silness 1963
• PAR index, Richmond 1992
• Research diagnostic criteria, Dvorkin and LeReche
  1992

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Quantifying oral health

• Sociomedical items
• Research diagnostic criteria, Dvorkin and LeReche
  1992
• OHQoL indices
• Oral Health related Quality of Life

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www.qolid.org/proqolid
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OHQoL for adults

• GOHAI. General Oral Health Assessment Index,
  Atchinson and Dolan, 1990
• Dental Impact Profile, Strauss and Hunt 1993
• OHIP, Oral Health Impact Profile, Slade and
  Spencer 1994
• DIDL Dental Impact on Daily Living, Leao and
  Sheiham 1996
• OIDP, Oral Impacts on Daily Performances,
  Adulyanon and Sheiham 1997

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OHQoL for children

• Child Health Questionnaire
• Landgraf et al 1996
• Childhood Asthma Questionnaires
• French and Christies 1996

• Child-OIDP, Child Oral Impact on Daily
  Performances
• Gherunpong, Tsakos, Sheiham 2004
• COHQoL, Child Oral Health related Quality of Life
• Jokovic, Slade et al 2002

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Pub MED searchAdults/adolescents Quality of
Life - and

• DIDL 3 hits
• GOHAI 19 hits
• OIDP 23 hits
• OHIP 101 hits

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OHIP translated into

• English / American
• Hungarian
• Brazil
• German
• Portugese
• Swedish
• Hebrew

• Spanish
• Malaysian
• Sri Lanka
• Chinese
• Japanese
• Danish

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Translation procedures
Translation english to danish
Backtranslation danish to english
Comparing the 2 english versions
Adjustment of the danish version
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Pub MED searchChildren Quality of Life and

• Child - OIDP 8 hits (2004-2007)
• CPQ 12 hits (2002-2007)

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Quantifying the impact of oral health on quality
of life

• OHIP (Slade 1994)
• Oral Health Impact Profile
• COHQoL (Jokovic 2002)
• Child Oral Health Quality of Life

• Standardized questionnaires
• Frequency of symptoms or experiences
• Score 0 4
• 0 never
• 4 daily / always
• Validation studies performed

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OHIP(Slade Spencer 1994)

• 49 questions
• 7 domaines
• Functional limitations
• Physical pain
• Psychological discomfort
• Physical disability
• Psychological disability
• Social disability
• Handicap

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Questions

• Functional limitations
• Have you felt that your sense of taste was
  worsened because of problems with your teeth,
  mouth or denture?
• Physical pain
• Have you had toothache?
• Psychological impact
• Have you felt uncomfortable about the appearance
  of your teeth, mouth or denture?

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Questions

• Physical disability
• Have you been unable to brush your teeth
  properly due to problems with your teeth, mouth
  or denture?
• Psychological disability
• Have you felt depressed because of problems with
  your teeth, mouth or dentures?
• Social disability
• Have you had difficulty doing your usual jobs
  because of problems with your teeth, mouth or
  dentures?.

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Reliability and validity of a Sweedish version of
Oral Health Impact Profile Larson P, List T, et
al 2004Acta Odontol Scand 62 148-152

• OHIP-S
• 5 groups
• TMD (n30)
• Sjøgren Syndrom (n30)
• Oral mucosal pain (n28)
• Skeletal malocclusion (n27)
• Healthy controls (n30)

• Mean OHIP total-score
• 61,0
• 42,4
• 45,6
• 41,3
• 9,3

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Larson P 2004Acta Odontol Scand 62 148-152

• Conclusions
• The reliability of the OHIP-S appears to be good
• The validity of the OHIP-S is acceptable
• OHIP-S can differentiate between groups of
  patients with different kinds of functional
  limitations and healthy individuals
• The use of OHIP-S in future studies is recommended

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COHQoL(Jokovic Locker 2002)

• 4 types
• CPQ 6 7 (child perception questionnarie)
• CPQ 8 10 (child perception questionnarie)
• CPQ 11 14 (child perception questionnarie)
• PPQ (parental perception
  questionnarie)
• 29 49 questions
• 4 domaines
• Oral symptoms
• Functional limitations
• Psychological well-being
• Social well.being

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Validity and reliability of a questionnaire for
measuring Child Oral-helath-related Quality of
Life Jokovic A et al. 2002 J Dent Res,
81(7)459-463

• CPQ 11-14
• 3 groups
• Pedodontic (n32)
• Orthodontic (n52)
• Orofacial (n39)

• Mean CPQ total-scores
• 23,3 (SD 18,4)
• 24,3 (SD 14,5)
• 31,4 (SD 17,1)

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Jokovic A et al. 2002J Dent Res, 81(7)459-463

• Conclusions
• CPQ 11-14 is valid
• CPQ 11-14 has excellent reliability
• Orofacial conditions have substantial impact on
  functional and psychosocial well-being
• Psychometrically acceptabel accounts of the
  impact can be achieved
• CPQ 11-14 performs well as a discriminant measure

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Boy, 14 year, AIImpact upon QoL ?
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AI-boy, 14 yearCPQ 11-14
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CPQ profile, AI-boy
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CPQ_5 boys with HEDPedo and ortho group_Jokovic
2002
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Male, 20 year, AMCImpact upon QoL ?
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OHIP, male, 20 years, AMCSweedish control
groupLarsson P, List T, Lundström I, Marcusson
A, Ohrbach R. Reliability and validity of a
Sweedish version of the Oral Health Impact
Profile (OHIP-S). Acta Odontol Scand 2004
62147-152.
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OHIP, male, 20 year, AMCSweedish control
groupLarsson P, List T, Lundström I, Marcusson
A, Ohrbach R. Reliability and validity of a
Sweedish version of the Oral Health Impact
Profile (OHIP-S). Acta Odontol Scand 2004
62147-152.
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Female, 59 years, Ehlers Danloss syndrome
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Oral Health Impact ProfilesEDS-pt vs TMD group
(30)
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Impact of oligodontia on OoL?

• Patients referred to the Centre for Oral Health
  in Rare Diseases
• Agenesis of 13 teeth or more
• 9 patients answered the OHIP questionnaire in
  2006-2007
• 16 37 years of age
• 3 females
• 6 males

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OHIP 9 individuals with agenesis
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Agenesis group (N9) vs.3 groups in the OHIP-S
study
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OHQoL indices- conclusions

• A diagnostic tool in treatment planning
• Complement to objective needs assessment
• Evaluate outcome of treatment
• The ultimate parameter in evaluation of quality
  of treatment
• Part of population studies
• An issue in national population surveys and
  public health care planning

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Thank you for your attention