Original Paper Received: September 13, 2014 Accepted: January 17, 2015 Published online: April 1, 2015
Caries Res 2015;49:266–274 DOI: 10.1159/000375377
Do Oral Health Conditions Adversely Impact Young Adults? Joana C. Carvalho a Heliana D. Mestrinho b Sophie Stevens a Arjen J. van Wijk c
a
School of Dentistry, Faculty of Medicine and Dentistry, Catholic University of Louvain, Louvain, Belgium; b Department of Odontology, Faculty of Health Sciences, University of Brasília, Brasilia, Brazil; c Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
Abstract This study assessed the extent to which clinically measured oral health conditions, adjusted for sociodemographic and oral health behavior determinants, impact adversely on the oral health-related quality of life (OHRQoL) in a sample of Belgian young adults. The null hypothesis was that, among young adults, the oral health conditions would have no impact on their quality of life. The participants were 611 new patients aged 16–32 years seeking consultation at the SaintLuc University Hospital in Brussels in 2010–2011. The patients (56.0% female) were examined for their oral health conditions and answered a validated questionnaire about sociodemographic and oral health behavior determinants in addition to questions about their OHRQoL. The abridged Oral Health Impact Profile-14 was used to assess the OHRQoL. Interexaminer reliability for caries was 0.86 (95% CI 0.84– 0.89, nonweighted κ). The outcome was a high score on the OHRQoL (median split). Hierarchical logistic regression analysis showed that young adults with clinical absolute D1MFS scores between 9 and 16 (OR = 2.14, p = 0.031) and between 17 and 24 (OR = 3.10, p = 0.003) were significantly more likely to report a high impact on their quality of life than those with lower scores. Also, periodontal conditions compro-
© 2015 S. Karger AG, Basel 0008–6568/15/0493–0266$39.50/0 E-Mail [email protected] www.karger.com/cre
mised significantly (OR = 1.79, p = 0.011) the quality of life of young adults. In conclusion, this study identified oral health conditions with a significant adverse effect on the OHRQoL of young adults. However, the prevalence of young adults reporting impacts on at least 1 performance affected fairly often or very often was limited to 18.7% of the sample. © 2015 S. Karger AG, Basel
Traditionally, oral health outcomes have been measured through clinical assessments of the oral health conditions for the presence/absence of diseases as well as for the evaluation of treatments performed [López and Baelum, 2007; Oscarson et al., 2007; Montero-Martín et al., 2009; Carvalho et al., 2014]. Currently, this approach is considered limited due to a growing recognition that patient-reported outcome such as the oral health-related quality of life (OHRQoL) is an important measure of an individual’s oral health, daily functioning and well-being [Sheiham and Steele, 2001; Locker, 2004; Locker and Allen, 2007; Oscarson et al., 2007; Montero-Martín et al., 2009; Krisdapong et al., 2012]. In the last decade, the appraisal of OHRQoL has increasingly gained attention in observational cross-sectional and longitudinal epidemiological studies in addition to clinical intervention studies [Bernabé and Marcenes, 2010; Verrips and Schuller, 2011; Tsakos et al., 2012; Joana C. Carvalho School of Dentistry, Faculty of Medicine and Dentistry, Catholic University of Louvain Av. Hippocrate 10 BE–1200 Brussels (Belgium) E-Mail joana.carvalho @ uclouvain.be
Downloaded by: John Rylands Library 130.88.90.140 - 5/13/2015 3:44:43 PM
Key Words Dental caries · Sociodemographic determinants · Quality of life · Young adults
number 340320097.77), and it conformed to the STROBE guidelines [Vandenbroucke et al., 2014]. The study was designed as a prospective cohort study, and the sample size, estimated to be 520 participants, was calculated on the basis of the following: provided that 20% of young adults would have an impact on their OHRQoL, 200 participants would give a total width of 11% for the 95% confidence interval. This number was doubled to take into account the clustering of the observations, and finally the sample was increased by 30% to account for any loss in the follow-up examinations. Participants were recruited among new patients seeking consultation at the Saint-Luc University Hospital in Brussels in 2010–2011. Inclusion and Exclusion Criteria Inclusion criteria were the ability to understand and fill in questionnaires, being a young adult, i.e. between the age of 15 and 35 years [United Nations Department of Economic and Social Affairs, 2014], willingness to participate in the study and accepting to be called for a control visit in the future. Participants with a serious chronic illness affecting their caries activity and/or their periodontal status were excluded. Participants were informed about the study and signed a written consent at their enrollment.
Ethics, Study Design and Sample The study protocol was approved by the Ethical Committee of the Catholic University of Louvain, Belgium (Belgian register
Examinations, Reliability, Instrument and Outcome Patients from all over the country, but mainly from Brussels, seek consultation and treatment at the University Hospital in Brussels on a regular basis. Routine procedures for new patients seeking consultation at the University Hospital include anamnesis, clinical and radiographic examinations for the elaboration of a treatment plan and further treatment according to the individual needs. In the framework of the consultation routine, participants of the present study were clinically examined for dental and periodontal conditions in addition to receiving a radiographic examination which consisted of at least panoramic and bitewing views. Only baseline clinical data are presented, taking into account the complete dentition but excluding third molars. The periodontal condition was defined as either being sound (no bleeding on probe), having gingivitis (proximal sites with bleeding on probe), having a proximal pocket depth of at least 4 mm or having a proximal attachment loss of at least 3 mm. Examination was carried out at 6 sites of permanent molars and incisor teeth. Any of these conditions, if observed in at least 2 sites of a tooth, was summarized as a periodontal problem. Prior to the clinical examination for caries, the participants received dental prophylaxis including flossing. Dental caries was diagnosed according to its activity and severity. The surface was classified as sound when it showed normal enamel translucency after drying. Active noncavitated lesion was defined as an opaque area with a dull-whitish surface without loss of surface continuity. Active cavitated lesion was identified as a cavity in enamel or in dentine with soft consistency. A lesion was considered inactive when it was seen on an enamel/dentine area which appeared shiny, smooth, of hard consistency and having different degrees of brownish discoloration. A dental probe was used to differentiate between soft and hard consistency of cavitated lesions. A tooth was considered extracted due to caries when there were clear indications of this, otherwise it was considered as missing due to reasons other than caries [Carvalho et al., 2009]. The definition of caries free used in the present study was that the participant was free from any form of untreated or treated caries and its consequences at a clinical level.
Do Oral Health Conditions Adversely Impact Young Adults?
Caries Res 2015;49:266–274 DOI: 10.1159/000375377
Subjects and Methods
267
Downloaded by: John Rylands Library 130.88.90.140 - 5/13/2015 3:44:43 PM
Nammontri et al., 2013; Visscher et al., 2014]. The OHRQoL measures most frequently used were developed for studies in adult and senior populations, namely the abridged Oral Health Impact Profile-14 (OHIP-14) [Slade, 1997] and the Geriatric Oral Health Assessment Index (GOHI) [Atchison and Dolan, 1990], respectively. The OHIP-14 measures the adverse impact of oral health conditions associated to teeth, mouth or dentures on physical, psychological and social dimensions [Locker, 2004]. This instrument has been thoroughly tested and recommended for its reliability and validity [Slade and Spencer, 1994; Allen et al., 1999], its responsiveness [Locker et al., 2004; Kieffer et al., 2012] and its cross-cultural consistency [Locker and Quiñonez, 2009]. The OHIP-14 has also been used in studies that measured the OHRQoL in young adults, though the information available is not as consistent as in adults [López and Baelum, 2007; Lawrence et al., 2008] and the age groups vary from one study to another [Lawrence et al., 2008; Brennan and Spencer, 2009; Locker and Quiñonez, 2009; Yiengprugsawan et al., 2013]. In this respect, the definition of young adults is one of the most controversial and ambiguous life stages as exemplified by the fact that several United Nations entities, instruments and regional organizations have somewhat different definitions of young people. Young adults encompass people between 15 and 35 years of age [United Nations Department of Economic and Social Affairs, 2014]. Since oral health conditions are expected to be better in young adults than in middle-aged adults and seniors, it is important to know whether OHRQoL measurements are able to discriminate between oral health conditions in the former. Such information seems warranted, as the usefulness of OHRQoL measures in supplementing clinical outcome measurement in young adults with low caries prevalence has been questioned [Oscarson et al., 2007]. The aim of the study was to assess the extent to which clinically measured oral health conditions, adjusted for sociodemographic and oral health behavior determinants, impact adversely on the OHRQoL in a sample of Belgian young adults. The null hypothesis was that, among young adults, oral health conditions would have no impact on their quality of life.
Missing Data The number of missing answers in the questionnaire is described in table 1. Missing answers did not show an apparent pattern, and therefore none of the questionnaires were removed from the study.
268
Caries Res 2015;49:266–274 DOI: 10.1159/000375377
Statistical Analysis Descriptive statistics in terms of percentage, mean (± standard deviation) were used to describe the distribution of oral health conditions and sociodemographic and oral health behavior determinants. D1MFS absolute scores were categorized in 5 groups (0– 4, 5–8, 9–16, 17–24 and ≥25), and periodontal conditions were dichotomized in 2 categories (no, yes). Young adults were grouped into 2 age groups (16–24 years and 25–32 years old) following closely the age group distribution recommended by the World Health Organization [1997]. The median OHIP-14 total was also calculated. The χ2 test was performed to verify whether categorical variables and oral health conditions were associated. In order to control for type I error rate, Bonferroni correction was applied (0.05/20 = 0.0025), so associations were considered statistically significant when p < 0.0025. The outcome measure, a high score on OHRQoL (dependent variable), was established as follows. Initially, the total OHIP-14 score was calculated for each patient. Then, the median OHIP-14 score (=4) was determined. The patients were classified as having a low OHRQoL with scores in the range from 0 to 4 and a high OHRQoL with scores ≥5. Table 2 describes the theoretical hierarchical model used to analyze the impact of oral health conditions on OHRQoL. In the applied Hierarchical Logistic Regression Model, the independent variables were categorized into 4 blocks and forced into the model (table 3). In the first block, gender was entered besides age. In the second block, the effect of adding the patients’ and parents’ sociodemographic determinants was evaluated. In the third block, determinants of oral health-related behavior were entered. Finally, in the fourth block, the periodontal and dental conditions were selected using the forward logistic regression method (it only enters when significant at the 0.05 level). Data analyses were carried out using IBM SPSS Statistics (version 21.0.01, USA).
Results
A total of 623 patients were eligible for the study. Seven potential participants refused to participate due to lack of interest and 4 others, under treatment for serious health conditions, were excluded. Overall, 612 patients underwent clinical as well as radiographic examination and answered the self-applied questionnaire. One patient was excluded because of double and different records in the database. Thus, 611 patients aged from 16 to 32 years and resident in 148 different municipalities (8% of Belgian municipalities) in Belgium were included in the study. In age groups, the patients were distributed as follows: 16–24 years old (n = 370) and 25–32 years old (n = 240). A limited percentage of patients were diagnosed as caries free at both D1MFT level (7.4%) and D3MFT level (14.1%). The mean D1MFT/S scores were 7.32 (SD ± 5.71) and 14.26 (SD ± 14.49). No differences in D1MFT scores between female and male were found (χ2 test, p = 0.13). The values of the mean D3MFT/S scores were 5.53 (SD ± Carvalho/Mestrinho/Stevens/van Wijk
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About 5% of the sample (n = 30) was examined twice by 2 independent observers. Interexaminer reliability was 0.86 (95% CI 0.84–0.89, nonweighted κ). The caries experience was considered according to the following case status: (1) D1MFT/S (D1: the decayed component represented both active and inactive noncavitated as well as cavitated lesions, M = missing due to caries, F: filled, T: tooth, S: surface) or (2) D3MFT/S (D3: the decayed component represented active and inactive cavitated lesions, M = missing due to caries, F: filled, T: tooth, S: surface). The patients answered a questionnaire about sociodemographic determinants of oral health behavior in addition to OHRQoL. Sociodemographic determinants were reported in terms of: patients’ age in years; gender (female; male); country of birth (Belgian, other); region of residence (Brussels, Wallonia, Flanders), level of education (technical school or university completed; high school completed and primary completed or less); occupation (employee, student, worker or none); parents’ level of education (technical school or university completed; high school completed and primary completed or less). The patients’ oral health behavior determinants were measured as: brushing frequency (>1/day; 1/day; 1 year up to 2 years; ≥3 years); tobacco use ever of at least 100 cigarettes (no; yes), and consumption of soft drinks (at least 1/day; several times per week, seldom or never). The instrument applied to assess the OHRQoL was the abridged version of the original Oral Health Impact Profile, namely, the OHIP-14 [Slade, 1997]. The OHIP-14 French was first employed in a national telephone interview survey in Canadian adults by Locker and Quiñonez [2009]. The instrument was validated for face and content by the Interuniversity Consortium of Epidemiology in Belgium within the framework of the development and implementation of an oral health data registration and evaluation system in the country [Declerck et al., 2013]. To prevent a possible reduction of the sensitivity of the OHIP-14 instrument in young adults, the recall memory period of ‘during the past 12 months’ was replaced by ‘during your adolescence/adulthood’ in the present study. The OHIP-14 measures several oral health dimensions including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. The questions are answered on a 5-point ordinal scale as never (score 0), ‘hardly ever’ (score 1), occasionally (score 2), ‘fairly often’ (score 3) or ‘very often’ (score 4). The possible total sum of scores given to each individual may vary from 0 to 56. The outcome measure was a high score on OHRQoL (using a median split) indicating an adverse impact of oral health conditions [López and Baelum, 2007]. The reliability of the complete self-applied questionnaire was assessed using a test-retest procedure. Thirty-nine patients attending university hospitals in Belgium filled in the questionnaire twice with a minimal interval of 1 week. Reliability was excellent (κ >0.8) for 28.3% of the surveyed items, good (κ = 0.6–0.8) for 40.0%, fair (κ = 0.4–0.59) for 22.5% and poor (κ
Caries Res 2015;49:266–274 DOI: 10.1159/000375377
Do Oral Health Conditions Adversely Impact Young Adults? Joana C. Carvalho a Heliana D. Mestrinho b Sophie Stevens a Arjen J. van Wijk c
a
School of Dentistry, Faculty of Medicine and Dentistry, Catholic University of Louvain, Louvain, Belgium; b Department of Odontology, Faculty of Health Sciences, University of Brasília, Brasilia, Brazil; c Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
Abstract This study assessed the extent to which clinically measured oral health conditions, adjusted for sociodemographic and oral health behavior determinants, impact adversely on the oral health-related quality of life (OHRQoL) in a sample of Belgian young adults. The null hypothesis was that, among young adults, the oral health conditions would have no impact on their quality of life. The participants were 611 new patients aged 16–32 years seeking consultation at the SaintLuc University Hospital in Brussels in 2010–2011. The patients (56.0% female) were examined for their oral health conditions and answered a validated questionnaire about sociodemographic and oral health behavior determinants in addition to questions about their OHRQoL. The abridged Oral Health Impact Profile-14 was used to assess the OHRQoL. Interexaminer reliability for caries was 0.86 (95% CI 0.84– 0.89, nonweighted κ). The outcome was a high score on the OHRQoL (median split). Hierarchical logistic regression analysis showed that young adults with clinical absolute D1MFS scores between 9 and 16 (OR = 2.14, p = 0.031) and between 17 and 24 (OR = 3.10, p = 0.003) were significantly more likely to report a high impact on their quality of life than those with lower scores. Also, periodontal conditions compro-
© 2015 S. Karger AG, Basel 0008–6568/15/0493–0266$39.50/0 E-Mail [email protected] www.karger.com/cre
mised significantly (OR = 1.79, p = 0.011) the quality of life of young adults. In conclusion, this study identified oral health conditions with a significant adverse effect on the OHRQoL of young adults. However, the prevalence of young adults reporting impacts on at least 1 performance affected fairly often or very often was limited to 18.7% of the sample. © 2015 S. Karger AG, Basel
Traditionally, oral health outcomes have been measured through clinical assessments of the oral health conditions for the presence/absence of diseases as well as for the evaluation of treatments performed [López and Baelum, 2007; Oscarson et al., 2007; Montero-Martín et al., 2009; Carvalho et al., 2014]. Currently, this approach is considered limited due to a growing recognition that patient-reported outcome such as the oral health-related quality of life (OHRQoL) is an important measure of an individual’s oral health, daily functioning and well-being [Sheiham and Steele, 2001; Locker, 2004; Locker and Allen, 2007; Oscarson et al., 2007; Montero-Martín et al., 2009; Krisdapong et al., 2012]. In the last decade, the appraisal of OHRQoL has increasingly gained attention in observational cross-sectional and longitudinal epidemiological studies in addition to clinical intervention studies [Bernabé and Marcenes, 2010; Verrips and Schuller, 2011; Tsakos et al., 2012; Joana C. Carvalho School of Dentistry, Faculty of Medicine and Dentistry, Catholic University of Louvain Av. Hippocrate 10 BE–1200 Brussels (Belgium) E-Mail joana.carvalho @ uclouvain.be
Downloaded by: John Rylands Library 130.88.90.140 - 5/13/2015 3:44:43 PM
Key Words Dental caries · Sociodemographic determinants · Quality of life · Young adults
number 340320097.77), and it conformed to the STROBE guidelines [Vandenbroucke et al., 2014]. The study was designed as a prospective cohort study, and the sample size, estimated to be 520 participants, was calculated on the basis of the following: provided that 20% of young adults would have an impact on their OHRQoL, 200 participants would give a total width of 11% for the 95% confidence interval. This number was doubled to take into account the clustering of the observations, and finally the sample was increased by 30% to account for any loss in the follow-up examinations. Participants were recruited among new patients seeking consultation at the Saint-Luc University Hospital in Brussels in 2010–2011. Inclusion and Exclusion Criteria Inclusion criteria were the ability to understand and fill in questionnaires, being a young adult, i.e. between the age of 15 and 35 years [United Nations Department of Economic and Social Affairs, 2014], willingness to participate in the study and accepting to be called for a control visit in the future. Participants with a serious chronic illness affecting their caries activity and/or their periodontal status were excluded. Participants were informed about the study and signed a written consent at their enrollment.
Ethics, Study Design and Sample The study protocol was approved by the Ethical Committee of the Catholic University of Louvain, Belgium (Belgian register
Examinations, Reliability, Instrument and Outcome Patients from all over the country, but mainly from Brussels, seek consultation and treatment at the University Hospital in Brussels on a regular basis. Routine procedures for new patients seeking consultation at the University Hospital include anamnesis, clinical and radiographic examinations for the elaboration of a treatment plan and further treatment according to the individual needs. In the framework of the consultation routine, participants of the present study were clinically examined for dental and periodontal conditions in addition to receiving a radiographic examination which consisted of at least panoramic and bitewing views. Only baseline clinical data are presented, taking into account the complete dentition but excluding third molars. The periodontal condition was defined as either being sound (no bleeding on probe), having gingivitis (proximal sites with bleeding on probe), having a proximal pocket depth of at least 4 mm or having a proximal attachment loss of at least 3 mm. Examination was carried out at 6 sites of permanent molars and incisor teeth. Any of these conditions, if observed in at least 2 sites of a tooth, was summarized as a periodontal problem. Prior to the clinical examination for caries, the participants received dental prophylaxis including flossing. Dental caries was diagnosed according to its activity and severity. The surface was classified as sound when it showed normal enamel translucency after drying. Active noncavitated lesion was defined as an opaque area with a dull-whitish surface without loss of surface continuity. Active cavitated lesion was identified as a cavity in enamel or in dentine with soft consistency. A lesion was considered inactive when it was seen on an enamel/dentine area which appeared shiny, smooth, of hard consistency and having different degrees of brownish discoloration. A dental probe was used to differentiate between soft and hard consistency of cavitated lesions. A tooth was considered extracted due to caries when there were clear indications of this, otherwise it was considered as missing due to reasons other than caries [Carvalho et al., 2009]. The definition of caries free used in the present study was that the participant was free from any form of untreated or treated caries and its consequences at a clinical level.
Do Oral Health Conditions Adversely Impact Young Adults?
Caries Res 2015;49:266–274 DOI: 10.1159/000375377
Subjects and Methods
267
Downloaded by: John Rylands Library 130.88.90.140 - 5/13/2015 3:44:43 PM
Nammontri et al., 2013; Visscher et al., 2014]. The OHRQoL measures most frequently used were developed for studies in adult and senior populations, namely the abridged Oral Health Impact Profile-14 (OHIP-14) [Slade, 1997] and the Geriatric Oral Health Assessment Index (GOHI) [Atchison and Dolan, 1990], respectively. The OHIP-14 measures the adverse impact of oral health conditions associated to teeth, mouth or dentures on physical, psychological and social dimensions [Locker, 2004]. This instrument has been thoroughly tested and recommended for its reliability and validity [Slade and Spencer, 1994; Allen et al., 1999], its responsiveness [Locker et al., 2004; Kieffer et al., 2012] and its cross-cultural consistency [Locker and Quiñonez, 2009]. The OHIP-14 has also been used in studies that measured the OHRQoL in young adults, though the information available is not as consistent as in adults [López and Baelum, 2007; Lawrence et al., 2008] and the age groups vary from one study to another [Lawrence et al., 2008; Brennan and Spencer, 2009; Locker and Quiñonez, 2009; Yiengprugsawan et al., 2013]. In this respect, the definition of young adults is one of the most controversial and ambiguous life stages as exemplified by the fact that several United Nations entities, instruments and regional organizations have somewhat different definitions of young people. Young adults encompass people between 15 and 35 years of age [United Nations Department of Economic and Social Affairs, 2014]. Since oral health conditions are expected to be better in young adults than in middle-aged adults and seniors, it is important to know whether OHRQoL measurements are able to discriminate between oral health conditions in the former. Such information seems warranted, as the usefulness of OHRQoL measures in supplementing clinical outcome measurement in young adults with low caries prevalence has been questioned [Oscarson et al., 2007]. The aim of the study was to assess the extent to which clinically measured oral health conditions, adjusted for sociodemographic and oral health behavior determinants, impact adversely on the OHRQoL in a sample of Belgian young adults. The null hypothesis was that, among young adults, oral health conditions would have no impact on their quality of life.
Missing Data The number of missing answers in the questionnaire is described in table 1. Missing answers did not show an apparent pattern, and therefore none of the questionnaires were removed from the study.
268
Caries Res 2015;49:266–274 DOI: 10.1159/000375377
Statistical Analysis Descriptive statistics in terms of percentage, mean (± standard deviation) were used to describe the distribution of oral health conditions and sociodemographic and oral health behavior determinants. D1MFS absolute scores were categorized in 5 groups (0– 4, 5–8, 9–16, 17–24 and ≥25), and periodontal conditions were dichotomized in 2 categories (no, yes). Young adults were grouped into 2 age groups (16–24 years and 25–32 years old) following closely the age group distribution recommended by the World Health Organization [1997]. The median OHIP-14 total was also calculated. The χ2 test was performed to verify whether categorical variables and oral health conditions were associated. In order to control for type I error rate, Bonferroni correction was applied (0.05/20 = 0.0025), so associations were considered statistically significant when p < 0.0025. The outcome measure, a high score on OHRQoL (dependent variable), was established as follows. Initially, the total OHIP-14 score was calculated for each patient. Then, the median OHIP-14 score (=4) was determined. The patients were classified as having a low OHRQoL with scores in the range from 0 to 4 and a high OHRQoL with scores ≥5. Table 2 describes the theoretical hierarchical model used to analyze the impact of oral health conditions on OHRQoL. In the applied Hierarchical Logistic Regression Model, the independent variables were categorized into 4 blocks and forced into the model (table 3). In the first block, gender was entered besides age. In the second block, the effect of adding the patients’ and parents’ sociodemographic determinants was evaluated. In the third block, determinants of oral health-related behavior were entered. Finally, in the fourth block, the periodontal and dental conditions were selected using the forward logistic regression method (it only enters when significant at the 0.05 level). Data analyses were carried out using IBM SPSS Statistics (version 21.0.01, USA).
Results
A total of 623 patients were eligible for the study. Seven potential participants refused to participate due to lack of interest and 4 others, under treatment for serious health conditions, were excluded. Overall, 612 patients underwent clinical as well as radiographic examination and answered the self-applied questionnaire. One patient was excluded because of double and different records in the database. Thus, 611 patients aged from 16 to 32 years and resident in 148 different municipalities (8% of Belgian municipalities) in Belgium were included in the study. In age groups, the patients were distributed as follows: 16–24 years old (n = 370) and 25–32 years old (n = 240). A limited percentage of patients were diagnosed as caries free at both D1MFT level (7.4%) and D3MFT level (14.1%). The mean D1MFT/S scores were 7.32 (SD ± 5.71) and 14.26 (SD ± 14.49). No differences in D1MFT scores between female and male were found (χ2 test, p = 0.13). The values of the mean D3MFT/S scores were 5.53 (SD ± Carvalho/Mestrinho/Stevens/van Wijk
Downloaded by: John Rylands Library 130.88.90.140 - 5/13/2015 3:44:43 PM
About 5% of the sample (n = 30) was examined twice by 2 independent observers. Interexaminer reliability was 0.86 (95% CI 0.84–0.89, nonweighted κ). The caries experience was considered according to the following case status: (1) D1MFT/S (D1: the decayed component represented both active and inactive noncavitated as well as cavitated lesions, M = missing due to caries, F: filled, T: tooth, S: surface) or (2) D3MFT/S (D3: the decayed component represented active and inactive cavitated lesions, M = missing due to caries, F: filled, T: tooth, S: surface). The patients answered a questionnaire about sociodemographic determinants of oral health behavior in addition to OHRQoL. Sociodemographic determinants were reported in terms of: patients’ age in years; gender (female; male); country of birth (Belgian, other); region of residence (Brussels, Wallonia, Flanders), level of education (technical school or university completed; high school completed and primary completed or less); occupation (employee, student, worker or none); parents’ level of education (technical school or university completed; high school completed and primary completed or less). The patients’ oral health behavior determinants were measured as: brushing frequency (>1/day; 1/day; 1 year up to 2 years; ≥3 years); tobacco use ever of at least 100 cigarettes (no; yes), and consumption of soft drinks (at least 1/day; several times per week, seldom or never). The instrument applied to assess the OHRQoL was the abridged version of the original Oral Health Impact Profile, namely, the OHIP-14 [Slade, 1997]. The OHIP-14 French was first employed in a national telephone interview survey in Canadian adults by Locker and Quiñonez [2009]. The instrument was validated for face and content by the Interuniversity Consortium of Epidemiology in Belgium within the framework of the development and implementation of an oral health data registration and evaluation system in the country [Declerck et al., 2013]. To prevent a possible reduction of the sensitivity of the OHIP-14 instrument in young adults, the recall memory period of ‘during the past 12 months’ was replaced by ‘during your adolescence/adulthood’ in the present study. The OHIP-14 measures several oral health dimensions including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. The questions are answered on a 5-point ordinal scale as never (score 0), ‘hardly ever’ (score 1), occasionally (score 2), ‘fairly often’ (score 3) or ‘very often’ (score 4). The possible total sum of scores given to each individual may vary from 0 to 56. The outcome measure was a high score on OHRQoL (using a median split) indicating an adverse impact of oral health conditions [López and Baelum, 2007]. The reliability of the complete self-applied questionnaire was assessed using a test-retest procedure. Thirty-nine patients attending university hospitals in Belgium filled in the questionnaire twice with a minimal interval of 1 week. Reliability was excellent (κ >0.8) for 28.3% of the surveyed items, good (κ = 0.6–0.8) for 40.0%, fair (κ = 0.4–0.59) for 22.5% and poor (κ
