BackgroundInformation on the impact of oral health on quality of life of children younger than 8 years is mostly based on parental reports, as methodological and conceptual challenges have hindered the development of relevant validated self-reported measures. This study aimed to develop and assess the reliability and validity of a new self-reported oral health related quality of life measure, the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5), in the UK.MethodsA cross-sectional study of two phases. First, consultation focus groups (CFGs) with parents of 5-year-olds and review by experts informed the development of the SOHO-5 questionnaire. The second phase assessed its reliability and validity on a sample of grade 1 (5-year-old) primary schoolchildren in the Greater Glasgow and Clyde area, Scotland. Data were linked to available clinical oral health information and analysis involved associations of SOHO-5 with subjective and clinical outcomes.ResultsCFGs identified eating, drinking, appearance, sleeping, smiling, and socialising as the key oral impacts at this age. 332 children participated in the main study and for 296 (55% girls, mean d3mft: 1.3) clinical data were available. Overall, 49.0% reported at least one oral impact on their daily life. The most prevalent impacts were difficulty eating (28.7%), difficulty sleeping (18.5%), avoiding smiling due to toothache (14.9%) and avoiding smiling due to appearance (12.5%). The questionnaire was quick to administer, with very good comprehension levels. Cronbach’s alpha was 0.74 and item-total correlation coefficients ranged between 0.30 and 0.60, demonstrating the internal consistency of the new measure. For validity, SOHO-5 scores were significantly associated with different subjective oral health outcomes (current toothache, toothache lifetime experience, satisfaction with teeth, presence of oral cavities) and an aggregate measure of clinical and subjective oral health outcomes. The new measure also discriminated between different clinical groups in relation to active caries, pulp involvement, and dental sepsis.ConclusionsThis is the first study to develop and validate a self-reported oral health related quality of life measure for 5-year-old children. Initial reliability and validity findings were very satisfactory. SOHO-5 can be a useful tool in clinical studies and public health programs.

BackgroundDental decay remains one of the world's most prevalent diseases in childhood. It is unfortunate that the proportion of children suffering from oral disease is so high, given that dental decay is almost entirely preventable. The objective of this study was to examine dental inspection data from three-year old children to assess the extent to which the dental health in Greater Glasgow and Clyde had improved during the initial years of the Childsmile intervention programme.MethodsDental inspections of three-year old children in Greater Glasgow and Clyde were undertaken in the academic years of 2006/7 and 2007/8 (the baseline years), and again in 2008/9 and 2009/10 (after the intervention had begun). A standardised protocol suitable for the age group was used. The number of decayed, missing and filled teeth was calculated (ie d3mft). If d3mft was > 0 then a child was said to have 'obvious decay experience' into the dentine. Additional results examined the effect of socioeconomic status using the Scottish Index of Multiple Deprivation (SIMD).ResultsWe inspected 10022 children (19% of the population). The weighted percentage of children with decay experience was 26% in 2006/7, 25% (2007/8), reducing to 18% (2007/8) and 17% (2009/10). When compared to the first baseline year of 2006/7, the OR was 0.91 for 2007/8 (0.79-1.06, p = 0.221), 0.63 for 2008/9 (0.55-0.72, p < 0.001), and 0.50 for 2009/10 (0.43-0.58, p < 0.001). The weighted mean d3mft was 1.1 in 2006/7, 1.0 in 2007/8 (p = 0.869), 0.6 in 2008/9 (p < 0.001) and 0.4 in 2009/10 (p < 0.001). Reductions in decay were seen in all socioeconomic groups.ConclusionsThis study demonstrates that it is possible to impact upon the prevalence and morbidity of dental decay across the socioeconomic spectrum in a population. The dental health of young children in the Greater Glasgow and Clyde area has improved in recent years.

Dental health improvements were observed in pilot districts and across all DepCat 7 communities following the roll-out of the programme. This change was of sufficient magnitude to impact upon area-wide statistics for Glasgow.

A simple, inexpensive microbiological assay for objective measurement of denture hygiene has been devised. Small individual filter paper discs were applied to the fitting surface of dentures for 20 seconds, eluted in phosphate buffered saline and bacterial counts on blood agar plates performed on the eluate. There was a strong positive correlation between denture cleanliness (graded on a scale of 0 to 4) and both total anaerobic count (r = 0.829; P < 0.001) and total aerobic count (r = 0.786; P < 0.001) following logarithmic transformation. Yeasts in the eluted disc specimens could be used as an aid to diagnose oral candidiasis. The method provided an objective measure of denture hygiene among elderly patients in longstay hospitals and daycare community places. It may be applicable to audit studies following implementation of new oral health care policies.

This study compared and assessed the utility of tests of inequality on a series of very large population caries datasets. National cross-sectional caries datasets for Scotland’s 5-year-olds in 1993/94 (n = 5,078); 1995/96 (n = 6,240); 1997/98 (n = 6,584); 1999/00 (n = 6,781); 2002/03 (n = 9,747); 2003/04 (n = 10,956); 2005/06 (n = 10,945) and 2007/08 (n = 12,067) were obtained. Outcomes were based on the d3mft metric (i.e. the number of decayed, missing and filled teeth). An area-based deprivation category (DepCat) measured the subjects’ socioeconomic status (SES). Simple absolute and relative inequality, Odds Ratios and the Significant Caries Index (SIC) as advocated by the World Health Organization were calculated. The measures of complex inequality applied to data were: the Slope Index of Inequality (absolute) and a variety of relative inequality tests i.e. Gini coefficient; Relative Index of Inequality; concentration curve; Koolman & Doorslaer’s transformed Concentration Index; Receiver Operator Curve and Population Attributable Risk (PAR). Additional tests used were plots of SIC deciles (SIC10) and a Scottish Caries Inequality Metric (SCIM10). Over the period, mean d3mft improved from 3.1(95%CI 3.0–3.2) to 1.9(95%CI 1.8–1.9) and d3mft = 0% from 41.1(95%CI 39.8–42.3) to 58.3(95%CI 57.8–59.7). Absolute simple and complex inequality decreased. Relative simple and complex inequality remained comparatively stable. Our results support the use of the SII and RII to measure complex absolute and relative SES inequalities alongside additional tests of complex relative inequality such as PAR and Koolman and Doorslaer’s transformed CI. The latter two have clear interpretations which may influence policy makers. Specialised dental metrics (i.e. SIC, SIC10 and SCIM10) permit the exploration of other important inequalities not determined by SES, and could be applied to many other types of disease where ranking of morbidity is possible e.g. obesity. More generally, the approaches described may be applied to study patterns of health inequality affecting worldwide populations.