Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation☆

Prado, Gema Ruíz-López del; Blaya-Nováková, Vendula; Saz-Parkinson, Zuleika; Álvarez-Montero, Óscar Luis; Ayala, Alba; Muñoz-Moreno, Maria Fe; Forjaz, Maria João

doi:10.1016/j.bjane.2015.08.007

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Scientific Articles • Rev. Bras. Anestesiol. 67 (1) • Jan-Feb 2017 • https://doi.org/10.1016/j.bjane.2015.08.007 copy

Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation^☆ ☆ This work shall be attributed to the Department of Preventive Medicine and Public Health, Clinic University Hospital, Valladolid, Spain, and National School of Public Health, Institute of Health Carlos III, Madrid, Spain. The clinical part of the study was carried out at the Department of Anesthesiology and Resuscitation, Infanta Leonor University Hospital, Madrid, Spain.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives:

Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health.

Methods:

Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale.

Results:

The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points.

Conclusions:

The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

KEYWORDS
Patient safety; Dental injury; Oral health; Oral hygiene; Questionnaire

	Mean ± SD; n (%)
Age	55.1 ± 19.1

Sex
Male	58 (50.4)
Female	57 (49.6)

BMI (kg/m²)	26.8 ± 4.2

BMI categorized (kg/m ² )
<25	41 (35.7)
25–30	51 (44.3)
>30	23 (20)

Nationality
Spanish	93 (80.9)
Other	22 (19.1)

Education level
None	31 (27.0)
Primary studies	37 (32.2)
Secondary studies	27 (23.5)
University studies	20 (17.4)

Oral health (based on an oral examination)
Good	32 (28.1)
Fair	37 (32.5)
Poor	45 (39.5)

Value	0	1	2	3
1. How frequently do you use mouthwash?	More than once a day	Once a day	Sometimes	Never
2. How often do you brush your teeth?	3 or more times a day	1–2 times a day	Sometimes	Never
3. When was the last time you went to the dentist?	Less than 1 year ago	1 year ago	More than 2 years ago
4. What was the reason for your last visit to the dentist?	Check-up/cleaning	Fillings/root canal treatment	Tooth extraction	Placement of a crown, bridge or prosthesis
5. How many teeth do you have missing?	None	1–2 teeth	More than 2 teeth	Most teeth
6. Do you experience gum bleeding?	Never	Sometimes	Very often
7. Do you experience pain on chewing?	Never	Sometimes	Very often	Always
8. Do you experience tooth mobility?	No	Only 1 tooth	2–5 teeth	Almost all teeth
	0	1
9. Are you diabetic?	No	Yes
10. Do you have any of the following diseases? Cancer, Osteoporosis, HIV, Rheumatoid arthritis, Liver disease (cirhosis)	No	Yes
11. Do you take any of the following medications? Corticoids, Phenytoin (antiepileptic), Bisphosphonates (Fosamax, Boniva)	No	Yes

Final score ^a a Calculation of the final score: Step 1, Sum up the score of items marked with the value 1 (A = 5); Step 2, Sum up the score of items marked with the value 2 (B = 6); Step 3, Sum up the score of items marked with the value 3 (C = 6); Step 4, Obtain the initial raw score (A + B + C = 17); Step 5, Find the linear measure associated with this raw score in the conversion table (Table 5). In our example, with a raw score of 17, the associated linear measure is of 66.861 on a 0–100 scale.		Column sumscore A = 5	Column sumscore B = 6	Column sumscore C = 6	Raw score = A + B + C = 17	Linear measure = 66.861

Item	Difficulty	SE	Residuals	χ² (df = 4)	Probability
Frequency of mouthwash use	-1.814	0.141	0.262	2.663	0.616
Tooth brushing frequency	-1.084	0.152	-1.478	6.170	0.187
Last visit to the dentist	-0.858	0.154	1.919	12.006	0.017
Reason for visiting the dentist	-0.849	0.129	0.445	4.777	0.311
Number of missing teeth	-0.495	0.132	-0.895	2.314	0.678
Gum bleeding frequency	0.200	0.169	1.104	2.425	0.658
Diseases	0.551	0.236	-0.780	7.747	0.101
Pain on chewing	0.840	0.141	1.339	5.732	0.220
Diabetes	0.999	0.252	-0.576	6.550	0.162
Tooth mobility	1.098	0.145	-1.965	6.192	0.185
Medication	1.412	0.273	0.918	7.594	0.108

Raw score	Linear measure (logits)	Linear measure (0–100)	Raw score	Linear measure (logits)	Linear measure (0–100)
0	-5.250	0.000	13	0.015	57.908
1	-4.024	13.484	14	0.218	60.141
2	-3.190	22.657	15	0.420	62.363
3	-2.623	28.894	16	0.623	64.595
4	-2.198	33.568	17	0.829	66.861
5	-1.854	37.352	18	1.041	69.193
6	-1.559	40.596	19	1.264	71.645
7	-1.296	43.489	20	1.504	74.285
8	-1.054	46.150	21	1.771	77.222
9	-0.826	48.658	22	2.082	80.642
10	-0.607	51.067	23	2.474	84.954
11	-0.396	53.388	24	3.036	91.135
12	-0.189	55.664	25	3.842	100.000

Variable	Frequency (n)	Mean	SD
Age (years)	<0.001
≤58	58	38.7	16.7
>58	57	59.5	11.9

Sex	0.209
Male	58	51.1	13.2
Female	57	46.9	21.5

Nationality	0.017^a a Non-significant when adjusted by age.
Spanish	93	50.9	17.7
Other	22	40.9	16.5

Education level	<0.001
None	31	63.4	11.1
Primary studies	37	53.1	9.7
Secondary studies	27	45.4	10.6
University studies	20	24.0	18.4

BMI (kg/m ² )	<0.001
<25	41	40.0	22.0
25–30	51	51.2	12.9
>30	23	60.2	9.8

Oral health	<0.001
Good	32	30.7	17.1
Fair	37	45.8	11.4
Poor	45	64.1	7.6

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:jforjaz@isciii.es (M.J. Forjaz).