[Kies-voor-Tanden Study: caries among 17-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 17-jarigen in Nederland.

This fourth in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 17-year-olds. 34% of the 17-year-olds had flawless permanent teeth. In 2017, there were still differences in oral health among the socio-economic groups, to the advantage of the high socio-economic group. The oral health of 17-year-olds had stagnated during the previous 6 years and even appeared to be deteriorating according to some indicators. In addition, knowledge about the dental insurance system after the 18th birthday was poor. Conclusion: The oral health of 17-year-olds had not improved in the previous years. This trend must be followed by monitoring research. In addition, interventions to improve the oral health, knowledge and behaviour of adolescents should be set up and evaluated.

[Kies-voor-Tanden Study: caries among 23-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 23-jarigen in Nederland.

This fifth and final in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 23-year-olds. 21% of the 23-year-olds had flawless permanent teeth. In 2017, there were still differences in oral health among the socio-economic (SES) groups, to the advantage of the high SES group. The oral health of the low SES group had shown some improvement in the previous 6 years, while this was not the case within the high SES group. The preventive dental behaviour of 23-year-olds was not optimal and the knowledge about the dental insurance system was poor. Conclusion: the oral health of 23-year-olds had partly improved, partly stagnated. Since not everyone will be able to access information through oral care professionals, other ways of providing information to them must be considered. In the context of public health, to be able to follow trends in oral health and dental preventive behaviour of (young) adults, research monitoring oral health is of great importance.

[Kies-voor-Tanden Study: the incidence of caries among 11-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 11-jarigen in Nederland.

In this third article in a series of 5 in the context of the 2017 Kies-voor-Tanden Study, the results for the 11-year-olds are presented. The study was conducted among 11-year-olds who lived in Alphen aan den Rijn, Gouda, Breda or Den Bosch and consisted of a clinical oral examination and a questionnaire completed by both them and their parents. Of the 11-year-olds, 61% had caries-free permanent teeth. In 2011, this percentage was 73%. In 2017, there were still differences in oral health among socio-economic groups, to the advantage of the higher socio-economic group. The conclusion is that the oral health of 11-year-olds has not improved in the last 6 years. Despite the low prevalence of DMFS, there appears to be a trend towards deterioration. For risk groups, interventions to keep the teeth intact should be aimed primarily at improving preventive behaviour and good oral health self-care.

[Kies-voor-Tanden Study of children and adolescents: motivation and study design]. / Kies-voor-Tandenonderzoek 2017 onder jeugdigen: aanleiding en onderzoeksopzet.

In 2017, Dutch research institute TNO carried out research commissioned by the National Health Care Institute intended to gain an up-to-date and representative picture of the oral health and the preventive dental behaviour of 5, 11, 17 and 23-year-olds in the Netherlands and to identify possible changes therein since previous measurements. Since the motivation, background, study design, material and method were identical for the 4 ages, and the same issues, to a certain extent, are to be considered in the discussion in each of a series of 5 articles, these identical and generic matters will be described in this article.Since there is no system in the Netherlands to structurally monitor oral health, these Kies-voor-Tanden studies are eminently important for following trends in oral health and preventive dental behaviour in children and adolescents over longer periods of time. Data of this kind are indispensable in formulating meaningful policy on oral health. The continuation of research monitoring oral health is therefore strongly recommended.

[Kies-voor-Tanden Study: the incidence of caries among 5-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 5-jarigen in Nederland.

This second in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 5-year-olds. The study was conducted among 5-year-olds living in Alphen aan den Rijn, Gouda, Breda or Den Bosch and consisted of completing a questionnaire and undergoing a clinical oral examination. 76% of the 5-year-olds had a caries-free deciduous dentition. This percentage represented an increase compared to previous research. No change was seen in children with caries experience. In 2017, there were still differences in oral health among the socio-economic groups, in favour of the highest socio-economic group. Conclusion: the oral health of the 5-year-olds seems to be moving in the right direction, but there is still a social gradient and there is still room for improvement. For risk groups, interventions to keep the teeth intact should be aimed primarily at improving behaviour and oral health self-care to prevent caries.

[DSQ-13-youth: measuring instrument for patient satisfaction with dental attendance among adolescents, young adults and parents of young children]. / DSQ-13-jeugd: meetinstrument voor patiënt­tevredenheid van adolescenten, jongvolwassenen en ouders over tandartsbezoek.

The Dental Satisfaction Questionnaire (DSQ) is a questionnaire consisting of 31 items assessing patient satisfaction with dental attendance. By means of factor analysis (principal component analysis), the number of items of the DSQ was reduced to 13, which together constitute the DSQ-13-youth. The first objective was to investigate the psychometric properties of the DSQ-13-youth; the second was to compare the satisfaction scores on the various dimensions between and within subgroups (23-year-olds, 17-year-olds and parents of 5-year-olds). The DSQ-13-youth has 4 domains measuring patient satisfaction with dental attendance. The internal consistency of those domains was high; the correlation between the domains low to moderate and the factor structure was highly congruent in the various subgroups. The differences in satisfaction scores between and within subgroups were small. The DSQ-13-youth is a reliable instrument to assess patient satisfaction with dental attendance among adolescents, young adults and the parents of young children in urban areas.

[Caries in deprived areas 2. Youngsters]. / Cariës in Krachtwijken 2. Jongeren.

In the Netherlands, no epidemiologic data on the oral health of cultural groups of children and adolescents living in deprived areas are available. The aim of the present study was to obtain an impression of the amount of caries experience among poorly educated groups of youngsters in deprived areas, in comparison with a reference group of poorly educated youngsters from the cities of Alphen aan den Rijn, Gouda, 's-Hertogenbosch and Breda. 725 Poorly educated respondents participated in a clinical and sociological study. The reference group had the lowest caries experience and the youngsters living in deprived areas with a non-Dutch cultural affiliation had the largest amount of caries experience. The latter group had more untreated caries and in 20-year-olds, a relatively large number of teeth had been extracted. Despite the low numbers, the difference in average DMFS scores among 14- and 20-year-olds were statistically significant. In the Netherlands a cultural dichotomy in oral health appears to exist, independent of level of education, in which youngsters with a non-Dutch cultural background are at a disadvantage.

[Caries in deprived areas 1. Adults]. / Cariës in Krachtwijken 1. Volwassenen.

In the Netherlands, little epidemiologic data is available on the oral health of the various cultural groups comprising the adult population living in deprived areas. The aim of an investigation carried out in 2013 was to obtain an impression of the extent of caries experience among less well-educated adults in deprived areas by comparison with a reference group of adults from the city of 's-Hertogenbosch. A total of 1,597 less well-educated respondents participated in this research. The reference population had the largest amount of caries experience, mostly due to a relatively large number of filled surfaces. The relatively low caries experience found in the respondents in the deprived areas with a non-Dutch cultural affiliation was due to lower numbers of filled surfaces. The differences in average filled-surface scores were statistically significant in all age categories, except the youngest. The strategy of 'extension for prevention' in caries treatment in the permanent dentition represents a possible explanation for the fact that less well-educated adults in 's-Hertogenbosch had significantly more filled surfaces than those with a non-Dutch cultural affiliation.

[Trends in caries experience of adults in the Netherlands from 1995 to 2013]. / Trends in cariëservaring van volwassenen in Nederland van 1995 tot 2013.

The Dutch National Health Care Institute, formerly CVZ/Ziekenfondsraad, asked TNO to investigate oral health in adults in the Netherlands 4 times in the period from 1995 to 2013 in order to monitor trends in oral health and, if necessary, to be able to adjust their policies accordingly. With the results of these 4 studies, the trends in caries experience of 25- up to and including 54-year-olds during the period 1995 to 2013 were established. In 1995, 2002, 2007 and 2013, the oral health of 25- up to and including 54-year-olds living in 's-Hertogenbosch was determined by means of a questionnaire and a clinical oral examination. In the period 1995-2013 a reduction in caries experience was found in both well- and less well-educated individuals. The outcomes for well-educated individuals were more favourable than those of their less well-educated peers. In 2012, then, oral health still has a socio-economic gradient. The debate on how to reach the high-risk group remains a matter of concern both for the dental profession and for politicians. In order to be able to keep a finger on the pulse monitoring of caries experience is of great importance.

OHRQoL in a Sample of Alcohol and Drug Abusers.

AIMS: To determine oral health related quality of life (OHRQoL) in a large sample of substance abusers and to evaluate the effect of dental treatment on OHRQoL. DESIGN: A longitudinal observational study. SETTINGS: A dental care clinic specialized in treating severely addicted patients. PARTICIPANTS: A sample of severely addicted substance abusers. MEASUREMENTS: OHRQoL was measured using the OHIP-14, which was filled out at baseline (T0), prior to the first treatment session (T1), after about 6 treatment sessions (T2) and on the last day of treatment (T3). FINDINGS: Mean OHIP scores did not change from T0 to T1. At T1, a mean OHIP-14 total score = 37.1 (sd=12.4, N = 392) was found. The highest mean scores were observed for the subscales physical pain and psychological discomfort. Data from 129 patients was available on both T1 and T2. The mean OHIP-14 total score reduced significantly (mean difference = 5.63, 95% CI 3.76 - 7.51), t(128)=5.94, p <0.001. The highest reduction in mean score was found for the subscale physical pain (mean difference = 1.24, 95%CI 0.81 - 1.66). Also between T2 and T3 a significant reduction in OHIP-14 total score (mean difference = 2.41, 95%CI 0.06-4.76) took place. CONCLUSION: The oral health status of substance abusers does have a substantial effect on their quality of life, which can be improved to a great extent by dental treatment based on a model tailored to addicted patients.

Development and validation of the Dutch version of the London Handicap Scale.

BACKGROUND: The London Handicap Scale (LHS) was found to be a valid and reliable scale for measuring participation restrictions in adults. OBJECTIVE: This paper describes the development and assesses the construct-related validity of a Dutch version of the London Handicap Scale (DLHS). METHODS: The DLHS was tested in 798 adults (mean age: 50.7 years, SD=14.5, range 16 to 85) and validated with the 'Impact on Participation and Autonomy' (IPA) questionnaire, the Dutch version of the EQ-5D and questions concerning comorbidity and use of medical devices. The study population consisted of patients with rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), epilepsy, laryngectomy and multiple sclerosis. RESULTS: Feasibility was satisfactory. Large correlations (ρ > 0.6) for the DLHS sum score were found with the IPA subscales 'autonomy outdoors', 'perceiving problems', 'family role', autonomy indoors', 'work and education' and with the EQ-5D. The DLHS sum score differs significantly between subgroups based on the number of chronic diseases, number of medical devices and self-reported burden of disease or handicap (p< 0.001). CONCLUSIONS: Based on this evaluation the questionnaire seems feasible and valid for assessing differences in level of participation between subgroups of chronically ill or disabled persons in the Netherlands.

The role of family functioning in childhood dental caries.

OBJECTIVES: This study investigated the relationship between family functioning and childhood dental caries. Further objectives were (i) to explore whether oral hygiene behaviours could account for a possible association between family functioning dimensions and childhood dental caries and (ii) to explore whether family functioning could mediate the relationship between sociodemographic factors and childhood dental caries. METHODS: A random sample of 630 5- to 6-year-old children was recruited from six large paediatric dental centres in the Netherlands. Children's dmft scores were extracted from personal dental records. A parental questionnaire and the Gezinsvragenlijst (translation: Family Questionnaire) were used to collect data on sociodemographic characteristics, oral hygiene behaviours and family functioning. Family functioning was assessed on five dimensions: responsiveness, communication, organization, partner-relation and social network. Associations with dmft were analysed using multilevel modelling. RESULTS: Bivariate analysis showed that children from normal functioning families on the dimensions responsiveness, communication, organization and social network had significantly lower dmft scores compared with children from dysfunctional families. Poorer family functioning on all dimensions was associated with an increased likelihood of engaging in less favourable oral hygiene behaviours. Children with lower educated mothers, immigrant children and children of higher birth order were more likely to come from poorer functioning families. In multivariate analysis, organization remained a significant predictor of dmft after adjusting for the other family functioning dimensions and the mother's education level, but it lost statistical significance after adjustment for oral hygiene behaviours. CONCLUSION: A relationship between family functioning and childhood dental caries was found, which may have operated via oral hygiene behaviours. Family functioning modestly explained socioeconomic inequalities in child oral health. Organization appeared to be the most important dimension of family functioning that influenced children's caries experience.

[Periodontal disease and quality of life]. / Parodontitis en levenskwaliteit.

In order to gain insight into the degree to which periodontal disease is related to quality of life, research was carried out among 85 patients with moderate or severe periodontal disease in which they were asked to complete the Oral Health Impact Profile-NL49. Their scores on this questionnaire were compared with the scores of 85 control subjects of comparable age and gender. The patients with periodontal disease demonstrated significantly worse scores compared to the control group and patients with severe periodontal disease had scores which were statistically significantly worse than patients with moderate periodontal disease. The results of this study suggest a causal negative association of periodontal disease with quality of life.

[Quality of life related to oral health among addicts]. / Mondgezond heidgerelateerde levenskwaliteit van verslaafden.

In this study, the impact of oral health on the daily functioning of a group of individuals addicted to alcohol and/or drugs that were being treated at a centre for specialized dentistry in Amsterdam was investigated. Every new patient who reported to the clinic received the OHIP-14-questionnaire at home by post with the request that it be filled in and returned. A total of 110 usable questionnaires were returned (response 27.5%). The average OHIP-score (40.6; standard deviation 12.9) can be termed substantial when compared to other patient groups. On the subcategories 'physical pain', 'psychological discomfort' and 'psychological disability; the patients scored highest, and on the subcategory functional limitations' the lowest. The poor oral health of the patient group studied has a substantial impact on daily functioning. These baseline results will be used for measuring the effect of dental health treatment at this centre for specialized dentisty.

[A better life by means of a healthy mouth?]. / Een beter leven door een gezonde mond?

Mortality and morbidity are no longer the only relevant measures of success for preventive and curative health care, because quality of life and the value that people place on their state of health play to an ever greater extent a decisive role in the decision-making process concerning preventive and curative health care. The aim of the academic discipline 'quality of life' (QoL) is to study the relationship between people's quality of life and their health and to make it possible to measure that relationship. It is important to identify the relevant determining factors and to develop cost-effective, evidence-based interventions to secure and improve the quality of life. It has recently been proposed that quality of life should be considered as a model instead of a concept. Problems of definition are part of the past and the issue of considerable nuancing in existing measurement instruments is giving way to the theoretical modelling of the determinants of QoL.

[The complexity of the concept oral health-related quality of life]. / De complexiteit van het concept mondgezondheid-gerelateerde levenskwaliteit.

The methods uses most often for developing and analyzing questionnaires, such as the explorative factor analysis and Cronbach's alpha, presume that psychological constructs are latent (imperceptible) and that there is a reflective-measurement model with the underlying assumption of local independence. Local independence means that the latent variable explains why the variables observed are related. Many questionnaires for measuring oral health-related quality of life are analyzed as if they were based on a reflective-measurement model assuming local independence. This assumption requires these questionnaires to contain solely items reflecting instead of determining oral health-related quality of life. The tenability of this assumption is questionable.

[The impact of oral health on quality of life of Dutch adults]. / De invloed van mondgezondheid op de levenskwaliteit van volwassen Nederlanders.

As part of a large-scale oral health/epidemiological research project among adults in 's-Hertogenbosch, the impact of a number of clinical and demographic variables on quality of life was studied. Quality of life was measured with the help of the Dutch version of the abridged Oral Health Impact Profile. Half of those questioned appeared to experience no negative impact at all from their oral health on their quality of life. Those with poor oral health and a low level of education were especially likely to have a high score on the Oral Health Impact Profile. The average score of 2.8 was lower than the revealed averages in research in Australia (7), England (5) and New Zealand (8). It was concluded that oral health appears to have an impact on the quality of life of a population although the correlational research format did not permit causational judgements.

Maternal exposure to the Dutch famine before conception and during pregnancy: quality of life and depressive symptoms in adult offspring.

BACKGROUND: Gestational exposure to famine has been associated with several chronic diseases in adulthood, but few studies in humans have related prenatal famine exposure to health-related quality of life. We used the circumstances of the Dutch Famine of 1944-1945 (during which official rations were <900 kcal/day for 24 weeks) to assess whether exposure to famine prior to conception or at specified stages of pregnancy was related to self-reported health-related quality of life and depressive symptoms in adulthood. METHODS: We studied 923 individuals, including persons born in western Holland between January 1945 and March 1946, persons born in the same 3 institutions in 1943 and 1947 and same-sex siblings of persons in series 1 or 2. Between 2003 and 2005 (mean age: 59 years), we assessed self-reported quality of life with the Short Form 36 questionnaire and derived mental and physical component scores. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. RESULTS: Mean mental and physical component scores were 52.4 (SD = 9.4) and 48.9 (9.0), respectively. The mean depression score was 11.6 (7.4). Age-, sex-, and schooling-adjusted estimates for mutually adjusted exposures were -2.48 for the mental component score with exposure before conception (95% confidence interval = -4.46 to -0.50) and 0.07 with exposure during pregnancy (-1.15 to 1.29). Adjusted estimates for the physical component score were 1.26 with exposure before conception (-0.67 to 3.19) and -0.73 with exposure during pregnancy (-1.94 to 0.48). Adjusted estimates for the depression score were 2.07 with exposure before conception (0.60 to 3.54) and 0.96 with exposure during pregnancy (0.09 to 1.88). There was no evidence of heterogeneity of effects by specific periods of pregnancy exposed to famine. CONCLUSIONS: A mother's exposure to famine prior to conception of her offspring was associated with lower self-reported measures of mental health and quality of life in her adult offspring.

Is attrition bias a problem in neonatal follow-up?

AIM: To assess whether attrition rate influences outcome in the follow-up of very preterm infants. STUDY DESIGN: In a national follow-up study of infants born alive in 1983 in the Netherlands with a gestational age less than 32 weeks and/or a birth weight less than 1500 g, outcome was assessed separately for adolescents who responded early or late to a follow-up invitation at age 14 years. Neonatal data and outcome results of earlier assessments from early and late responders were compared to those of non-responders by univariate and nominal (polytomous logistic) regression analysis. SUBJECTS: There were 723 (76%) early responders, 130 (14%) late responders and 109 (11%) non-responders. RESULTS: We found significantly more non-Dutch origin and more disabilities and school problems at age 10 years in late- and especially in non-responders. At age 14 years, the health utility index was significantly lower in late responders compared to early responders. School outcome did not show difference in relation to the response groups. CONCLUSION: The results suggest that the incidence of adverse outcome in very preterm infants is underestimated when follow-up is incomplete and hence response rate is not a negligible problem in the assessment of late outcome. Therefore, follow-up studies should include a drop-out analysis to enable comparison to other studies.