Oral health-related quality of life after dental treatment in patients with intellectual disability

BACKGROUND: The influence of dental treatment on oral health-related quality of life (OHRQOL) has rarely been evaluated in patients with intellectual disability (ID) through validated questionnaires. The aim of this study was to estimate the changes on OHRQOL in patients with ID after the implementation of an institutional dental treatment program under general anesthesia using the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHCOHRQOL-Q). MATERIAL AND METHODS: A prospective longitudinal study was conducted on 85 patients (mean age=24.85 years) classified according to DSM-V whose parents/caregivers completed the FHC-OHRQOL-Q. We analyzed the changes in the questionnaire's overall score and its dimensions from pre-treatment to 12-months of follow-up, considering effect sizes and minimal important differences estimated by the standard measurement error. The impact of clinical and therapeutic factors was evaluated using univariate and multiple linear regression analysis (p < 0.05). RESULTS: Significant improvement of OHRQOL was found after dental treatment in oral symptoms (p ≤ 0.001), daily life problems (p = 0.018), parent's perceptions (p = 0.013) and FHCOHRQOL-Q's overall score (p = 0.001). OHRQOL changes exhibited an intermediate magnitude (0.38-0.21) as estimated by effect sizes. Changes in oral symptoms showed positive correlation with DMFT index (r = 0.375, p = 0.002), decayed teeth (r = 0.244, p = 0.036), dental extractions (r = 0.424, p < 0.001) and number of treatments (r = 0.255, p = 0.019). The improvement was greater in patients with ≥ 4 decayed teeth (p = 0.049) and undergoing ≥ 2 dental extractions (p = 0.002). Multiple regression analysis demonstrated that dental extractions (p < 0.001) and DMFT index ( p= 0.028) were significantly related to oral symptom improvement. CONCLUSIONS: Dental treatment under general anesthesia showed a positive effect on the overall FHC-OHRQOL-Q score and most of its dimensions. At 12-months of follow-up, the improvement of oral symptoms was significantly associated with DMFT index, decayed teeth, dental extractions and number of treatments. In our clinical setting, the implementation of a dental treatment program enhanced the OHRQOL of patients with ID

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Validation of the Spanish version of the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire

BACKGROUND: The Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHC-OHRQOL-Q) is an instrument designed specifically for parents and caregivers of patients with special needs that has not yet been applied in Spain. The aim of this study was to adapt it to Spanish and evaluate its reliability and validity in patients with intellectual disability (ID) treated under general anesthesia. MATERIAL AND METHODS: The study was conducted in two different stages: a) cross-cultural adaptation of the original questionnaire, and b) cross-sectional study on 100 parents and caregivers who completed the piloted FHC-OHRQOL-Q. The patients were examined according to the WHO methodology. Dental treatments performed were recorded. Statistical tests were used to evaluate reliability (internal consistency) and validity (content, criterion, construct and discriminant) of the instrument. RESULTS: The mean age was 24 years (range = 4-71 years). The most frequent causes of ID were psychomotor retardation (25%) and cerebral palsy (24%). The items most frequently answered by parents and caregivers were eating and nutrition problems (80%) and bad breath/taste (57%). Reliability (Cronbach's alpha coefficient) was considered excellent (alpha = 0.80-0.95). The analysis of the factorial validity yielded similar results to the original questionnaire. The high response rate of items (> 96%) allowed content validity. Criterion validity was confirmed by a significant correlation with questions on oral health and oral well-being. Discriminant validity was demonstrated by the significant association of ≥ 21.5 years of age with worse oral symptoms (p = 0.034) and parental concerns (p = 0.005), DMFT index ≥ 3 with daily life problems (p = 0.02), ≥ 4 decayed teeth with daily life problems (p = 0,001= daily life problems (p = 0.002) and parent ́s perceptions (p = 0.043). CONCLUSIONS: The FHC-OHRQOL-Q in Spanish is a reliable and valid instrument to apply in clinical practice to evaluate the impact of OHRQOL in mostly adult patients with ID, accessible to Spanish-speaking parents and caregivers