Subjective aspects such as oral health-related quality of life (OHRQoL) and depression are important aspects in the periodontal care. The objectives of the study were to test a predictive model of clinical attachment loss and OHRQoL in a pooled sample of dental patients with periodontitis and mental health patients with depressive symptomatology, and test the invariance of the model across both types of patients. Three self-report scales were applied to assess depression, OHRQoL and oral hygiene habits, saliva samples were collected for three proinflammatory biomarkers, and the clinical attachment loss was measured in 35 patients with periodontitis and 26 patients with depressive symptomatology. Data were analyzed through structural equation modeling. The one-group analysis revealed a psychosomatic complaint model of disagreement between the complaint and the clinically observable. In the multi-group analysis, the model was not invariant. It was necessary to introduce a singularity in relation to depressive symptomatology for each population. Thus, a good and equivalent fit was achieved between the six nested models in constraints, as well as equivalent parameters between both types of patients. The study of a dental population in conjunction with a mental health population with a psychosomatic risk factor reveals interesting and unexpected results.
RESUMEN. Introducción: las propiedades métricas del Perfil de Impacto de Salud Oral aplicado a la Enfermedad Periodontal no se han estudiado y existen dudas sobre la estructura factorial del OHIP-14. El objetivo del presente trabajo consistió en estudiar la distribución, discriminabilidad y consistencia interna de los ítems y de la puntuación total del OHIP-14-PD, comprobar su validez discriminante para diferenciar entre pacientes con periodontitis y gingivitis; explorar su estructura factorial, y contrastar varios modelos factoriales propuestos para el OHIP-14, determinando la consistencia interna y la validez convergente y discriminante de sus factores. Métodos: se recolectó una muestra no probabilística de 249 pacientes odontológicos adultos de la ciudad de Monterrey (México). Resultados: la consistencia interna de los 14 ítems fue muy alta (α ordinal = 0,928). La distribución de la puntuación total mostró asimetría y curtosis positivas, esto es, concentración en puntuaciones bajas. La tendencia central de los pacientes con periodontitis fue significativamente mayor que la de los pacientes con gingivitis. El análisis factorial exploratorio reveló dos modelos: uno de un factor y otro de tres factores (impacto físico [ítems del 1 al 4 y 7], discapacidad física [ítems 5 y 6] e impacto psicosocial [ítems del 8 al 14]). Los modelos de factores jerarquizados propuestos para el OHIP-14 presentaron parámetros estandarizados fuera del rango de valores admisibles. Conclusiones: el OHIP-14-PD muestra consistencia interna y validez discriminante. El modelo de un factor constituye el mejor modelo. Su ajuste mejora con la especificación de una correlación entre los residuos de los dos ítems correspondientes al factor de discapacidad física.Palabras claves: análisis factorial, salud bucal, clínicas odontológicas, periodontitis, gingivitis.Moral de la Rubia J, Rodríguez-Franco NI. Validation of the Oral Health Impact Profile applied to patients with periodontal disease.
ResumenEl Perfil de Impacto de Salud Oral (OHIP-14) es el instrumento más empleado para evaluar la eficacia de tratamientos odontológicos. Con el propósito de dilucidar su estructura factorial y establecer la validez cruzada de la escala aplicada a la enfermedad periodontal (OHIP-14-PD), este estudio tiene como objetivos: 1) explorar la estructura factorial del OHIP-14-PD, y 2) contrastar la invarianza de los modelos propuestos para el OHIP-14 y de los derivados del análisis factorial exploratorio (AFE) entre una muestra de población general y una muestra clínica odontológica. Se aplicó el OHIP-14-PD a 249 pacientes adultos odontológicos y 256 adultos de población general de Monterrey, México. El AFE reveló modelos de uno, dos y tres factores. Los modelos jerarquizados propuestos arrojaron soluciones inadmisibles. Se concluye que el modelo unifactorial tuvo las mejores propiedades, aunque el bifactorial (impacto físico [ítems del 1 al 7] y psicosocial [ítems del 8 al 14]) también resultó válido. Los dos modelos fueron invariantes en pesos de medida, pero no en las varianzas de los factores y residuos. En ambos modelos, el ajuste mejoró con la inclusión de la correlación entre los residuos de los ítems 5 y 6. AbstractThe Oral Health Impact Profile (OHIP-14) is the most commonly used instrument to evaluate the effectiveness of dental treatments. In order to elucidate its factor structure and establish the crossvalidity of the scale applied to periodontal disease (OHIP-14-PD), this study aims to: 1) explore the factor structure of the OHIP-14-PD, and 2) contrast invariance of the models proposed for the OHIP-14 and of those derived from exploratory factor analysis (EFA) across a general population -487 -sample (GPS) and a dental clinic sample (DCS). The OHIP-14-PD was applied to 249 adult patients seeking dental care and 256 general population adults from Monterrey, Mexico. The EFA revealed one-, two-and three-factor models. The proposed hierarchical models yielded inadmissible solutions. We conclude that the one-factor model had the best properties, but the two-factor model (physical impact [items from 1 to 7] and psychosocial [items from 8 to 14]) also was valid. The two models were invariant at measurement weights, but not at the variances of factors and residuals. In both models, the fit improved with the inclusion of the correlation between the residuals of items 5 and 6.Keywords: confirmatory factor analysis; cross validity; convergent validity; discriminant validity, dental clinic. limitación funcional, dolor físico y discapacidad física se especificaron anidados a impacto físico; malestar psicológico y discapacidad psicosocial a impacto psicosocial; y discapacidad social y minusvalía a impacto social. En este estudio se dividió la muestra en dos partes iguales para evaluar la estabilidad de los modelos, y se comparó entre personas con o sin prótesis dentales para establecer la validez cruzada.Espala, Montero, Bravo, Vicente, Galindo, López y Albaladejo (2010) señalaron un mejor ajuste de un modelo de tres f...
Background. The effect of depressive symptomatology on periodontitis is not clear in its path of action. Objective. To test a model to predict clinical attachment loss by direct effect of the dental plaque accumulation, which is a direct effect of worse oral hygiene habits and an indirect effect of greater depressive symptomatology. Methods. Three incidental samples were collected: 35 dental patients with periodontitis, 26 mental health patients with depressive symptomatology, and 29 people from the general population. The Beck Depression Inventory-II and the Oral Hygiene Habits Scale were applied. Plaque index and clinical attachment loss were assessed. Path analysis was used to test the model. The parameters were estimated by the maximum-likelihood method. Results. Depressive symptomatology had no direct effect on oral hygiene habits nor an indirect effect (mediated by oral hygiene habits) on the plaque index in any of the 3 samples. Oral hygiene habits had a large-size direct effect on plaque index and a medium-size indirect effect on clinical attachment loss in the general population sample. The plaque index had a direct effect on clinical attachment loss with a large effect size in general population sample and with a medium effect size in dental patients and depressive symptomatology patients. Conclusion. The model shows that dental plaque accumulation has a direct effect on clinical attachment loss in the 3 samples, and oral hygiene habits have an indirect effect on attachment loss mediated by dental plaque accumulation only in the general population sample. However, depressive symptomatology is not a relevant variable.
Periodontal disease is a chronic disease that develops through multiple factors. It is directly associated with the accumulation of biofilm. It is characterized by progressive destruction of the supporting tissues of the teeth. Clinically it can be diagnosed through parameters that are gingival inflammation, loss of clinical attachment, increased probing depth, bleeding on probing, and dental mobility. The figures that have been found are around 1.1 billion cases of severe periodontal disease, in 2019. These amounts are equivalent to 15% of the world population. Radio graphically, vertical, horizontal, or both bone loss may be seen. Periodontal therapy is based on five phases: systemic, hygienic, surgical, restorative and maintenance. Currently, adjuvants to periodontal therapy have been found with favorable results. Oral probiotics, the Lactobacillus strain specifically, have been studied in non-surgical periodontal therapy. It has been shown that in patients with gingivitis plus the use of probiotics and periodontal mechanical therapy, patients have a reduction in the previously mentioned clinical parameters. On the other hand, there are also prebiotics that are non-pathogenic bacteria, their function is to improve the health of the host. This is how systemic homeostasis through vitamins and food, proposes a lower risk of developing periodontal disease.
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