Validation of an improved questionnaire assessing the social cognitive constructs of the Health Action Process Approach among parents regarding brushing their children's teeth.

OBJECTIVE: The Health Action Process Approach (HAPA) describes social cognitive constructs related to behaviour change. A validated questionnaire is needed to measure these constructs in paediatric dentistry. The aim of this study was to improve an existing HAPA-based questionnaire for parents regarding brushing their children's teeth and to assess its validity and reliability in a population of parents of high caries risk children. METHODS: Parents of high caries risk children of 3-10 years filled out the adjusted HAPA-based questionnaire. Mokken scale analysis, graded response model analyses, factor analyses and reliability analyses were performed according to the protocol of Dima. Discriminant validity was assessed by comparing the mean scores of the HAPA constructs between two groups of participants, based on different levels of caries experience, brushing frequency and education level of the mother. RESULTS: The Mokken scale analysis and factor analyses indicated a multidimensional eight factor scale. The graded response model did not fit our data. The subscale action control could be identified as a two-factor subscale. Reliability indices from the Dima protocol varied, for instance Cronbach alpha ranged from 0.73 to 0.96. The constructs coping self-efficacy, action planning and action control discriminated between brushing frequencies. CONCLUSIONS: The adjusted HAPA-based questionnaire is an improved, valid and reliable instrument that could be used to evaluate HAPA-based interventions to improve children's oral health.

Construction of a questionnaire based on the Health Action Process Approach for psycho-social cognitive determinants of parents in brushing children's teeth in the Netherlands.

BACKGROUND: The health action process approach (HAPA) model is promising to increase the frequency of brushing children's teeth by parents to improve their children's oral health. A validated HAPA questionnaire is needed as one of the measures of the effects of such an intervention. OBJECTIVES: The aim of this study was to evaluate whether our data, based on a translated and adopted version of the Health Action Process Approach (HAPA)-based questionnaire on dental flossing, supported the constructs of the HAPA model. If so, a next aim was to assess whether these constructs could be measured reliably. METHODS: In this cross-sectional study, 269 questionnaires filled out in dental offices by parents of children 1-10 years old were analysed. Scale validation was performed according to the 6-step protocol of Dima, including Mokken scale analyses (MSA), graded response model (GRM), factor analyses and reliability measures. Pearson correlation coefficients were calculated to identify divergent validity and test-retest reliability. RESULTS: MSA showed a unidimensional, medium total scale. Three items were removed based on this analysis. The total scale with the remaining 26 items did not fit the GRM. Factor analysis extracted five factors and two components for the total scale. The separate subscales, except the 'intention' construct, fitted the MSA and did not fit the GRM. The data fitted a seven-factor model better than a one-factor model. Reliability measures varied from acceptable to excellent, but were poor for 'action control'. Test-retest reliability (r's 0.60-0.83) was questionable to good. CONCLUSION: Our results did not fully support the constructs of the HAPA model. To support the HAPA constructs, modification to the subscales risk perceptions, intention, action planning, action control and self-reported behaviour are suggested. With these adjustments, the reliability and validity of the questionnaire could be significantly improved".

Volumetric changes in apical radiolucencies of endodontically treated teeth assessed by cone-beam computed tomography 1 year after orthograde retreatment.

INTRODUCTION: Cone-beam computed tomography (CBCT) allows us to assess in 3 dimensions the location and size of periapical radiolucencies. We aimed to assess by CBCT scans the volumetric changes of periapical radiolucencies in endodontically treated teeth 1 year after orthograde retreatment. METHODS: Forty-five root-filled teeth with persistent apical periodontitis requiring endodontic orthograde retreatment from 37 individuals were included in the study. The research protocol was approved by the VU University Medical Center Amsterdam ethics committee (2007/265), and the participants signed a letter of consent. We made 2 CBCT scans for every patient, the first one before retreatment and the second one a year later. Two observers measured independently the volume of radiolucencies on CBCT images by using the AMIRA software. The intraclass correlation coefficient was used to evaluate interobserver agreement, and the Wilcoxon signed rank test was used to assess pretreatment and post-treatment volume size. RESULTS: The intraclass correlation coefficients were 0.994 and 0.998 for the scans before retreatment and 1 year after, respectively. The recall rate was 78% for the teeth and 73% for the patients. The volumetric change in periapical radiolucencies 1 year after retreatment was statistically significant (z = -3.112, P < .005). The volume of periapical radiolucencies reduced in 20 teeth (57%), remained unchanged in 8 (23%), and increased in 7 (20%). CONCLUSIONS: One year after endodontic orthograde retreatment, the volume of periapical radiolucencies reduced significantly in 57% of the teeth.

Detection of vertical root fractures in vivo in endodontically treated teeth by cone-beam computed tomography scans.

INTRODUCTION: The presence of a vertical root fracture (VRF) in an endodontically treated tooth has an immense impact on the treatment's outcome. Early diagnosis of a VRF is imperative to avoid overtreatment and extensive bone loss. Our study aimed to examine the validity of 2 cone-beam computed tomography (CBCT) scanners in detecting VRFs in endodontically treated teeth in vivo. METHODS: Thirty-nine endodontically treated teeth suspected of VRFs from 39 patients were included. No fracture line was visible in periapical radiographs. Two limited-field-of-view scanners were used, the NewTom 3G and the 3D Accuitomo 170. Three observers evaluated the CBCT images independently and twice. The most frequently given score was used to calculate the validity of the CBCT systems. The findings of orthograde retreatment, endodontic microsurgery, or extraction were the gold standard. The intraobserver agreement (Cohen kappa) and the interclass correlation coefficients were calculated. RESULTS: The sensitivity, specificity, and accuracy for the NewTom 3G were 75%, 56%, and 68%, respectively, and for the 3D Accuitomo 170 they were 100%, 80%, and 93%, respectively. The positive predictive value and the negative predictive values were 75% and 55%, respectively, for NewTom 3G and 90% and 100%, respectively, for 3D Accuitomo 170. CONCLUSIONS: The results of our study support the use of 3D Accuitomo 170 for the detection of VRFs in endodontically treated teeth. They also suggest that the reproducibility and accuracy in VRF detection depend on the CBCT system used.

Stressful situations for toddlers: indications for dental anxiety?

UNLABELLED: The present study was undertaken to examine if daily anxiety-provoking situations can predict dental anxiety in a toddler. Parents of 73 toddlers were sent 2 questionnaires: 1) the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS), and 2) the Inventory of Stressful Situations (ISS), a list of 16 questions developed to assess anxiety in daily stressful situations. This investigation was repeated one year later. Forty-eight parents completed all questionnaires. Results show a clear correlation between daily stressful situations at the age of 3 and dental anxiety at the age of 3 (r = .62, p < 0.01, two-tailed) and at the age of 4 (r = .49, p < 0.01, two-tailed). Regression analyses revealed that the ISS at the age of 3 predicted dental anxiety at the age of four; however, it did not contribute additionally if the CFSS-DS score at the age of three was included. CONCLUSION: Daily anxiety-provoking situations in 3-year-old children may be related to dental anxiety at the age of 4.