Date of Award

5-21-2026

Thesis Type

PhD

Document Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Divisions

Faculty of Dentistry

Department

Department of Community Oral Health & Clinical Prevention

Institution

Universiti Malaya

Abstract

Background: Oral health-related quality of life (OHRQoL) is the impact of oral diseases/conditions on daily activities and quality of life. The Child Oral Impacts on Daily Performances (Child-OIDP) scale assesses oral impacts across eight daily activities among 11-12-year-old schoolchildren. In Pakistan, oral diseases have an enormous impact on schoolchildren's daily activities and OHRQoL. Various socioeconomic and individual factors may further influence this burden. However, a validated tool to measure oral impact among 11-12-year-old children in Pakistan is lacking, and no study has assessed factors associated with schoolchildren’s OHRQoL. Objectives: The study objectives were: 1) To undertake a cross-cultural adaptation of the Child-OIDP scale into the Urdu language, 2) To evaluate the psychometric properties of the Urdu Child-OIDP scale, 3) To assess oral impacts on daily activities of 11-12-year-old Pakistani schoolchildren, including impact prevalence, score, intensity, causes, and extent of impact, 4) To assess the condition-specific impacts on daily performances, 5) To assess the individual, environmental, and biological factors related to OHRQoL, and 6) To identify the factors associated with oral impacts among 11-12-year-old schoolchildren in Lahore, Pakistan. Methods: This study comprised two phases. In Phase 1, the English Child-OIDP scale was translated into Urdu. Its psychometric properties were assessed by distributing it to 264, 11-12-year-old schoolchildren from different schools in Lahore. In Phase 2, a validated Urdu questionnaire assessing demographic characteristics, oral health knowledge, attitudes, and behaviours was administered to 1,145 schoolchildren and their parents. Children also completed the Urdu versions of the dental fear scale and the Child-OIDP. Children completed the survey in classroom settings, followed by an oral examination by a calibrated dentist to assess oral disease and conditions. Data were analysed using SPSS version 29.0. Descriptive and multivariate statistics were used in the analyses. Results: The Child-OIDP scale was translated into Urdu. The linguistic validation of the Urdu version was confirmed by experts. It had achieved the item and conceptual equivalence with the original English version. The standardised Cronbach’s alpha was 0.77, the weighted Kappa was 0.94, and the intraclass correlation coefficient (ICC) was 0.98. The scale showed associations with subjective outcome measures, history of dental problems, and dental caries status (p = 0.001). The prevalence of oral impacts was 80.8% (mean impact score = 23.8, standard deviation (SD) = 17.5). Eating was the most affected performance (51.6%), while speaking was the least affected (10.7%). The mean impact score of speaking performance was the highest (mean = 39.9, SD = 20.0), while that of eating and cleaning teeth was the lowest (mean = 26.2, SD = 17.5 and mean = 29.8, SD = 17.4, respectively). On the contrary, the intensity of impact on eating was highest among schoolchildren who reported that at least one of their daily performances was affected. Regarding the extent of impact, 11.5% of the schoolchildren reported having up to 4 daily performances with impact. Toothache was the primary cause of condition-specific impact and was responsible for most oral impacts. Socioenvironmental factors associated with oral impact include the mother's education, social status, type and location of school, the child’s parents/guardians, ethnicity, and parental attitude towards their child’s oral health. Child-level factors include the child’s oral health knowledge, tooth brushing frequency, use of oral hygiene aids, oral hygiene level, sweet and carbonated drinks consumption, child smoking habit, last dental visit, perceived oral health status, perceived satisfaction with oral health, and perceived oral impacts. Conclusion: The Urdu Child-OIDP scale is valid and reliable for assessing oral impacts among 11-12-year-old schoolchildren in Lahore, Pakistan. Its validation ensures cultural relevance and linguistic accuracy, thereby enabling more robust, precise, and contextually meaningful assessment of OHRQoL among children. Poor OHRQoL is prevalent among Pakistani schoolchildren and is associated with individual, environmental, and biological factors.

Initial

khm

Additional Information

Thesis (PhD) – Faculty of Dentistry, Universiti Malaya, 2026.

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