Validation of the Brazilian version of the Halitosis Associated Life-Quality Test (HALT)

Abstract The present study aimed to validate (cross-culturally adapt and test psychometric properties) the Brazilian version of the Halitosis Associated Life-Quality Test (HALT). A process of translation and cross-cultural adaptation was conducted by a group of dental researchers. The first draft of the Brazilian Portuguese version was pre-tested on a sample of 33 individuals leading up to the final version of the questionnaire. The Brazilian version of the HALT (B-HALT) was applied to 100 individuals with halitosis (organoleptic score ≥ 2) and 100 individuals without halitosis (organoleptic score < 2). Exploratory factor analysis (EFA) was performed to evaluate the dimensionality of B-HALT. Cronbach's alpha (α) and interclass correlation coefficient (ICC) were used to measure its reliability. For convergent validity, Spearman's correlation was conducted between the B-HALT and the organoleptic scores. The discriminant validity was evaluated through the Mann-Whitney and Kruskal-Wallis tests. EFA confirmed the unidimensionality of B-HALT, which has also demonstrated excellent internal consistency (α = 0.96) and test-retest reliability (ICC = 0.93). There was a positive correlation between B-HALT and organoleptic scores (r = 0.33; p < 0.001). B-HALT was able to discriminate between the groups with and without halitosis measured by the organoleptic method (p < 0.001) and self-reported halitosis (p < 0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.

Halitose: adaptação trascultural, validação do questionário e impacto emocional na qualidade de vida dos indivíduos / Halitosis: cross-cultural adaptation, questionnaire validation and emotional impact on individuals quality of life

Halitose é um termo geral para definir um odor desagradável que emana da cavidade bucal, que é perceptível por outras pessoas, muitas vezes causando constrangimento que podem afetar a comunicação e as relações sociais. Essa condição pode ser causada por problemas sistêmicos, psicológicos e, principalmente bucais, tais como gengivite, periodontite e saburra lingual. A qualidade de vida auto relatada relacionada à saúde bucal (Oral Health-Related Quality of Life ­ OHRQoL) visa a captação do aspecto subjetivo da saúde bucal, considerando a percepção do próprio indivíduo sobre sua condição, suas limitações e sua qualidade de vida. Assim, por meio de medidas de desfechos relatados pelos pacientes em questionários padronizados e validados, podemos medir opiniões e averiguar percepções do seu estado de saúde, nível de comprometimento, incapacidade e qualidade de vida relacionada à saúde. O questionário Halitosis Associated Life-Quality Test (HALT) foi desenvolvido no idioma inglês por Kizhner et al. (2011) como uma ferramenta específica para avaliar a qualidade de vida associada a halitose, com avaliação abrangente dos impactos físicos, sociais e psicossociais negativos da halitose em adultos. Escores mais altos do HALT indicam pior impacto da halitose na qualidade da vida. Neste cenário, o objetivo principal deste estudo foi adaptar transculturalmente o HALT para o idioma Português do Brasil, e testar a validade e a confiabilidade da versão brasileira do HALT (B-HALT). Assim, após tradução e adaptação transcultural o B-HALT foi aplicado em 100 indivíduos com halitose (escore organoléptico ≥2) e 100 indivíduos sem halitose (escore organoléptico <2). Dimensionalidade, confiabilidade, validade convergente e discriminante foram respectivamente testadas por: análise fatorial exploratória (AFE), alfa de Cronbach (α), coeficiente de correlação intraclasse (CCI), correlação de Spearman e testes de Mann-Whitney e Kruskal-Wallis. O B-HALT demonstrou excelente consistência interna (α=0,96) e confiabilidade teste-reteste (CCI=0,93). Houve correlação positiva entre escores do B-HALT e os escores pelo método organoléptico (r= 0,33; p<0,001). O B-HALT foi capaz de discriminar entre os grupos de halitose diagnosticada pelo método organoléptico (p<0,001), halitose autorrelatada (p<0,001) e renda familiar (p<0,001). O B-HALT demonstrou ser um instrumento válido e confiável para avaliar a qualidade de vida associada a halitose em adultos brasileiros. O segundo objetivo foi a aplicação da versão brasileira do HALT (B-HALT) em uma amostra de 200 indivíduos selecionados aleatoriamente, adultos de ambos os sexos, com 18 anos de idade ou mais, que frequentavam as clínicas de Odontologia da UFMG, para determinar os fatores associados à limitação emocional causada pela halitose. A percepção do impacto negativo da halitose na OHRQoL foi investigada, por meio de análise multivariada em uma abordagem hierárquica para a seguinte pergunta: Ficar preocupada (a) ou constrangido com o meu hálito. Os resultados do presente estudo indicaram que o modelo final totalmente ajustado para as variáveis independentes idade, renda familiar, hábito de fumar, IMC e halitose autorrelatada demonstraram que indivíduos que possuíam o hábito de fumar (RP=1,375; 95%IC=1,040-1,817; p= 0,025,) e autorrelataram halitose (RP=2,755; 95%IC=2,038- 3,777; p<0,001) tinham maior probabilidade de reportar limitação emocional. Concluise que à limitação emocional está associada ao tabagismo e ao autorrelato de halitose.

Halitosis is a general term to describe the malodor emanating from the oral cavity, being perceptible by others, and in many times creating personal discomfort that could affect communication and experience social embarrassment. This can be caused by psychological problems, as well as systemic and oral diseases, such as gingivitis, periodontitis and tongue coating. The self-reported Oral Health-Related Quality of Life (OHRQoL) aims to capture the subjective aspect of the oral health, taking into consideration the individual's own perception of their conditions, limitations and their quality of life. Through a validated and standardized patient-reported outcome measure questionnaire were we able to evaluate their opinion and investigate their own perceptions of their health condition, perceived level of compromising, incapacity and health-related quality of life. The Halitosis Associated Life-Quality Test (HALT) questionnaire was developed originally in English by Kizhner et al (2011) as a tool to evaluate the quality of life related to halitosis, with wide evaluation of physical, social and psychosocial negative impacts of halitosis in adults. Higher scores of HALT indicate worse impact of halitosis in the quality of life. In this scenario, the main aim of this study was to cross-culturally adapt HALT to a Brazilian Portuguese version (BHALT), and test its validity and reliability. After being translated and cross culturally adapted, B-HALT was applied to 100 individuals with halitosis (organoleptic score ≥2) and 100 individuals without halitosis (organoleptic score <2). It's dimensionality, reliability and convergent and discriminant validity were tested respectively by exploratory factor analysis (EFA), Cronbach's Alpha (α), Intraclass Correlation Coefficient (ICC), Spearman's correlations and the Mann-Whitney and Kruskal-Wallis tests. B-HALT has demonstrated excellent internal consistency (α=0.96) and testretest reliability (ICC=0.93). There was a positive correlation between B-HALT and organoleptic scores (r= 0.33; p<0.001). B-HALT was able to discriminate between the groups with organoleptic method diagnosed halitosis (p<0.001), self-reported halitosis (p<0.001) and family income (p<0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.The second aim of this study was to apply B-HALT on a randomly selected sample of 200 individuals that attended the dental clinics at the School of Dentistry from UFMG. They were all 18 years old or more from both genders, and were used to determine associated risk factors to the emotional limitation caused by halitosis. The perception of negative impact of halitosis in OHRQoL was investigated through a multi-investigated analysis on a hierarchical approach to the following question: Are you worried or embarrassed due to your bad breath? The results of this study have indicated that the totally-adjusted final model to independent variables such as age, family income, smoking, BMI and self-reported halitosis has shown that individuals who smoked (RP=1,375; 95%IC=1,040-1,817; p= 0,025,) and self-related halitosis (RP=2,755; 95%IC=2,038-3,777; p<0,001) had higher probability of reporting emotional limitation. We can conclude that emotional limitation is associated to smoking and self-reported halitosis.

Níveis comparativos pré- e pós-tratamento de CSV, carga bacteriana total subgengival e sangramento gengival / Pre-and post-treatment comparative levels of VSC, subgingival total bacterial load and gingival bleeding

O objetivo deste ensaio clínico randomizado de 3 meses de duração foi avaliar os efeitos da combinação de procedimentos mecânicos e químicos sobre os níveis de sangramento gengival, Compostos Sulfurados Voláteis (CSV) e carga total bacteriana de pacientes com gengivite. Sessenta voluntários sistemicamente saudáveis com gengivite foram divididos em dois grupos: raspagem profissional associada ao uso diário de óleos essenciais (20ml/2x/dia) ou solução placebo (20ml/2x/dia). Todos os participantes receberam instruções de higiene bucal. Índice de sangramento gengival, carga bacteriana total subgengival (PCR em tempo real) e concentrações de CSV (dosador portátil Halimeter) foram mensurados antes e 90 dias após o tratamento gengival. Os dados foram comparados estatisticamente pelos teste t-Student e teste t-pareado (p < 0,05). Resultados: Finalizaram o estudo 27 indivíduos no grupo teste e 25 no grupo placebo. A carga bacteriana total e o IG reduziram mais evidentemente no grupo teste do que no grupo placebo. No grupo teste os valores médios de CSV reduziram de 94,62ppb (inicial) para 62,19ppb (3 meses) enquanto no grupo placebo eles se mantiveram estáveis entre as mensurações inicial (93,46ppb) e de 3 meses (95,00ppb). Conclusões: o tratamento gengival seguido de 90 dias de uso de solução de óleos essenciais acarretou melhora dos parâmetros monitorados, IG, carga total bacteriana e CSV.

The aim of this 3-month randomized clinical study was to evaluate the effects of the combination of mechanical and chemical procedures over the levels of gingival bleeding, VSC and total bacterial load in patients with gingivitis. Sixty systemically healthy individuals with gingivitis were randomized in two groups: professional debridement along with the daily use of essential oils (20ml/2x/day) or of a placebo solution (20ml/2x/day). All participants received oral hygiene instructions. Gingival Index, total bacterial load (real time PCR) and VSC concentration (portable Halimeter) were measured at baseline and at 90 days after gingival treatment. Data were statistically compared by Student-t test and paired-t test (p < 0.05). Results: Twenty-seven individuals finished the study in the test group and 25 in the placebo group. Total bacterial load and GI were greatest reduced in the test group than in the placebo group. Mean VSC values in the test group were reduced from 94,62ppb (at baseline) to 62,19ppb (3 months) while in the placebo group measures continued stable between baseline (93,46ppb) and (95,00ppb) 3-month examinations. Conclusions: Gingival treatment followed by the use of essential oils for 90 days lead to an improvement in the monitored parameters, GI, total bacterial load and VSC.

Pseudoartrose congênita da clavícula / Congenital pseudartrosis of the clavicle

A pseudoartrose congênita da clavícula é uma doença rara de etiologia desconhecida. Trata-se de uma patologia não familiar, em geral unilateral, com alta predominância pelo lado direito e pelo sexo masculino. Foi descrita inicialmente por Fitzwillians em 1910. Existem até o momento aproximadamente 200 relatos de caso na literatura. O diagnóstico diferencial inclui a pseudoartrose pós-traumática (tocotraumatismo), a disostose cleidocranial, a osteogênese imperfeita e a neurofibromatose. Os autores apresentam um paciente, masculino, de 28 dias de vida, com uma massa indolor situada no terço médio da clavícula direita.

Congenital pseudartrosis of the clavicle is a rare disease of unknown etiology. It is a non-familial disorder which is usually unilateral, with a high prevalence for the right side and males. It was first reported by Fitzwillians in 1910. There are up to now about 200 case reports in the literature. The differential diagnosis includes post-traumatic pseudartrosis (birth trauma), cleidocranial disostosis, imperfect osteogenesis, and neurofibromatosis. The authors report the case of a 28-day old male patient with a painless mass at the medium third of the right clavicle.