The potential of the Child Health Utility 9D Index as an outcome measure for child dental health.

BACKGROUND: The Child Health Utility 9D (CHU9D) is a relatively new generic child health-related quality of life measure (HRQoL)-designed to be completed by children-which enables the calculation of utility values.The aim is to investigate the use of the CHU9D Index as an outcome measure for child dental health in New Zealand. METHOD: A survey was conducted of children aged between 6 and 9 years attending for routine dental examinations in community clinics in Dunedin (New Zealand) in 2012. The CHU9D, a HRQoL, was used, along with the Child Perceptions Questionnaire (CPQ), a validated oral health-related quality of life (OHRQoL) measure. Socio-demographic characteristics (sex, age, ethnicity and household deprivation) were recorded. Dental therapists undertook routine clinical examinations, with charting recorded for each child for decayed, missing and filled deciduous teeth (dmft) at the d3 level. RESULTS: One hundred and forty 6-to-9-year-olds (50.7% female) took part in the study (93.3% participation rate). The mean d3mft was 2.4 (SD = 2.6; range 0 to 9). Both CHU9D and CPQ detected differences in the impact of dental caries, with scores in the expected direction: children who presented with caries had higher scores (indicating poorer OHRQoL) than those who were free of apparent caries. Children with no apparent caries had a higher mean CHU9D score than those with caries (indicating better HRQoL). The difference for the CPQ was statistically significant, but for CHU9D the difference was not significant. When the two indices were compared, there was a significant difference in mean CHU9D scores by the prevalence of CPQ and subscale impacts with children experiencing no impacts having mean CHU9D scores closer to 1.0 (representing perfect health). CONCLUSION: The CHU9D may be useful in dental research. Further exploration in samples with different caries experience is required. The use of the CHU9D in child oral health studies will enable the calculation of quality-adjusted life years (QALYs) for use in economic evaluation.

Acceptability of the Hall Technique to parents and children.

OBJECTIVE: To investigate the acceptability of stainless steel crowns placed by dental therapists on children's primary molars using the Hall Technique. DESIGN: Mixed methods approach, using qualitative inductive analysis and quantitative analysis. SETTING: Hawke's Bay Community Oral Health Service METHODS: One focus group was conducted and ten thirty-minute phone interviews were undertaken with parents of children who had previously had a stainless steel crown placed using the Hall Technique (over the period 1 December 2011 to 31 May 2012). An inductive approach was used to analyse the qualitative research data, and the information was arranged into several categories based on the key themes which arose. Children treated with the Hall Technique were asked immediately after treatment whether they had enjoyed their visit to the clinic that day. RESULTS: Common themes were found with regard to appearance, pain, the procedure, and general opinions on acceptability. Nearly all (90%) of the children responded positively about their visit to the clinic. CONCLUSION: There was a high degree of acceptance among both parents and children for stainless steel crown placement using the Hall Technique in this group.

Caries management: is the "seal the deal"?

A barrier to providing sealants has been the concern about inadvertently sealing over caries, but today the management of dental caries has evolved from the domain of techniques based on complete removal of carious tissue prior to tooth restoration or sealant, to include a range of techniques where some, or even all caries is sealed in beneath restorations, sealants or infiltrants. There is a significant, and growing, evidence base supporting these techniques as caries management strategies for children and adolescents. These techniques are not new but build on earlier concepts and research. These concepts offer a real way forward and departure from invasive restorative treatments. Some issues, however, are not completely resolved, and future solutions may herald a new era of restorative dentistry, perhaps with the concept of filling with no drilling since the "seal is the deal". These techniques and issues will be considered in the New Zealand context.

Dental caries in Taranaki adolescents: a cohort study.

OBJECTIVE: To document changes in disease experience among Taranaki adolescents in order to enhance understanding of the natural history of dental caries in a key developmental period. METHOD: A random sample of 430 adolescents first examined in 2003 at age 13 were re-examined at age 16, when 255 (59.3%) took part. Dental caries status (in the permanent dentition) was recorded at each age by a single calibrated examiner following World Health Organization guidelines. The age-13 and 16 data-sets were merged once clinical data collection was completed. Caries increment was determined by comparing the baseline and follow-up status of each surface. RESULTS: Caries prevalence (1+ DMFS) rose from 68% to 79%; mean DMFS rose from 2.9 (SD 4.7) to 3.6 (SD 4.8), and the prevalence of high caries experience (5+ DMFS) rose from 20% to 41%. The 3-year mean net caries increment of 0.5 surfaces (SD 2.6) was dominated by occlusal surfaces and the overall incidence of caries was approximately 46%. Over one-third of the cohort (37%) presented with decayed surfaces at follow-up, and this was significantly higher among Maori and males. CONCLUSION: New Zealand adolescents still appear to be experiencing caries at a considerable rate, with social and ethnic inequalities plainly apparent (and appearing to widen).

Performance and cross-cultural comparison of the short-form version of the CPQ11-14 in New Zealand, Brunei and Brazil.

BACKGROUND: The Child Perception Questionnaire (CPQ11-14) is a self-report instrument developed to measure oral-health-related quality of life (OHRQoL) in 11-14-year-olds. Earlier reports confirm that the 16-item short-form version performs adequately, but there is a need to determine the measure's validity and properties in larger and more diverse samples and settings. AIM: The objective of this study was to examine the performance of the 16-item short-form impact version of the CPQ11-14 in different communities and cultures with diverse caries experience. METHOD: Cross-sectional epidemiological surveys of child oral health were conducted in two regions of New Zealand, one region in Brunei, and one in Brazil. Children were examined for dental caries (following WHO guidelines), and OHRQoL was measured using the 16-item short-form item-impact version of the CPQ11-14, along with two global questions on OHRQoL. Children in the 20% with the greatest caries experience (DMF score) were categorised as the highest caries quintile. Construct validity was evaluated by comparing the mean scale scores across the categories of caries experience; correlational construct validity was assessed by comparing mean scores and children's global ratings of oral health and well-being. RESULTS: There were substantial variations in caries experience among the different communities (from 1.8 in Otago to 4.9 in Northland) and in mean CPQ11-14 scores (from 11.5 in Northland to 16.8 in Brunei). In all samples, those in the most severe caries experience quintile had higher mean CPQ11-14 scores than those who were caries-free (P < 0.05). There were also greater CPQ scores in those with worse self-rated oral health, with the Otago sample presenting the most marked gradient across the response categories for self-rated oral health, from 'Excellent' to 'Fair/Poor' (9.6 to 19.7 respectively). CONCLUSION: The findings suggest that the 16-item short-form item impact version of the CPQ11-14 performs well across diverse cultures and levels of caries experience. Reasons for the differences in mean CPQ scores among the communities are unclear and may reflect subtle socio-cultural differences in subjective oral health among these populations, but elucidating these requires further exploration of the face and content validity of the measure in different populations.

Changes in malocclusion over time in New Zealand adolescents.

BACKGROUND: The Dental Aesthetic Index (DAI) has been used in many cross-sectional studies of population samples, but its use in assessing changes in malocclusion is less common. The aim of the present study was to describe the natural history of malocclusion and investigate the utility of the DAI as a measure for describing changes in malocclusion in a population-based sample of adolescents. METHOD: A repeat examination was conducted of a sample of 430 children first assessed in 2003 at age 13 and re-examined at age 16 (255 or 59.3 per cent of the baseline sample) with their DAI and orthodontic history recorded at each age. RESULTS: Of the adolescents re-assessed, 28 were in active orthodontic treatment, 30 had completed treatment and 197 had not received any treatment. There were substantial changes in the DAI items from age 13 to 16, with the greatest improvement in maxillary anterior irregularity. Overall, almost one-quarter of participants showed an improvement in their DAI treatment need category which was considerably higher among those who had either received treatment or were in treatment. CONCLUSION: The DAI is a valid and responsive tool for measuring change in malocclusion over time. Anterior mandibular irregularity shows the greatest change with age, and orthodontic treatment is effective in treating malocclusion, at least in the short-term.