122 Journal of Public Health Dentistry z Validation of Self-reported Oral Health Measures zy .____ _____- - -- ~ zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Waranuch Pitiphat, DDS, MPHM, MS; Raul 1. Garcia, DMD, MMedSc; Chester W. Douglass, DMD, PhD; Kaumudi J. Joshipura, BDS, SD Abstract zyxwvutsr Objectives: zyxwvutsrqp To assess the validity of self-reportedoral disease and health care measures in two populations. Methods: Telephone interviews were conducted among a subsample of participants in the VA Dental Longitudinal Study (VADLS) asking them about periodontal disease status and treatment.Radiographic alveo- lar bone loss evaluated at all the interproximal sites was used as the standard. A separate study was carried out among first-time patients at the Harvard School of Dental Medicine (HSDM) student clinic. Self-reported measures were obtained by a self-administeredquestionnaire and compared with clinical and radiograph examinations. The measures used were based on published work that demon- strated good validity of self-reported periodontal measures among health profes- sionals. zyxwvutsrqpo Results: Among 145 VADLS participants, self-reports of periodontal disease showed a good specificity zyxwvut (59.8%-90.7%), but low sensitivity (1 7.7%-64.7%). Among 58 HSDM patients, the self-reported numbers of remain- ing teeth, fillings, root canal therapy, and prosthesis were strongly correlated with clinical records (r=O. 744.0); self-report was less accurate for measures of periodontal disease (r=0.56) and decayed teeth (k0.47). Conclusions: Self-re- ports provide reasonably valid estimates for numbers of remaining teeth, fillings, root canal therapy, and fixed and removable prostheses. However, they appear to be less useful for the assessment of dental caries and periodontal disease in the two populations we have studied. There remains a need and potential to further develop self-report oral health measures that are valid for use in large population studies. Such self-report measures would yield great cost and time savings. [J Public Health Dent 2002;62(2): 122-81. _______- __--. - - __-______~___ . Key Words: validity, questionnaires, interviews, epidemiologic methods, perio- dontitis, dental caries, oral health measures, root canal therapy, dentalprosthesis. Self-reported measures such as diet and physical activity have been vali- dated and used routinely in the medi- cal literature (1-6). However, less in- formation is available regarding the validity of self-reported oral health measures. Previous studies showed that the general population could pro- vide accurate estimates of self-re- ported number of teeth present (7-13) and the presence of dentures (8,11,13,14), but the reporting of re- placed teeth was prone to error (14). There are very few published stud- ies relating subjects’ perceived oral health with dentists’ ratings (15,16), and with indicators of dentition status and periodontal diseases (17-20). Brunswick and Nikias (15) found a considerable agreement between ado- lescents’ self-rating of teeth and zyxw gum conditions and dentists’ evaluation of overall oral health. In this study, clini- cal examination showed gum condi- tion to be worse than that described by self-report. In contrast, a study con- ducted among dentate elders showed that while 30 percent of the partici- pants rated their oral health identi- cally to the dentist’s ratings, half of them rated their oral health lower than the dentist’s ratings (16). Gooch et al. (19) demonstrated that self-reported dental health index of pain, worry, and conversation avoidancewas related to presence of dental caries and report of toothache. Atchison et al. (16) and Matthias et al. (21) also showed that patient’s self-rating of oral health was associated with a variety of clinically evaluated conditions including number of missing teeth and the pres- ence of dental caries. Studies directly evaluating peri- odontal disease measures are very limited and inconsistent. Early valida- tion studies of self-reported gingival health suggested that self-report is clearly associated with clinical status; however, in most studies, self-report underestimated the prevalence of gin- gival disease (17,22,23). Kallio et al. (24) showed that self-reports of ”gin- givitis’’ and ”bleeding from gums” by adolescents had low levels of agree- ment with clinical measures. Gilbert and Nuttal (25) tested a battery of questions as predictors of sub- sequently clinically assessed peri- odontal status among adult patients. Questions regarding whether patients had been told by a dentist that they had gum disease, whether patients thought they had gum disease, or whether they were aware of being treated for it had high specificity (2.88), but low sensitivity (5.32). The results suggest that many patients with periodontal disease appeared to be unaware of their conditions. In our study among health professionals,we found a good validity of self-reported measures with positive and negative predictive values of 76 percent and 74 percent among dentists (26), and 83 percent and 69 percent among other health professionals (27). This study assessed the validity of ~ ~ ~~ ~ Send correspondence and reprint requests to Dr. Joshipura,Department of Oral Health Policy and Epidemiology, Harvard school of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115. E-mail: kaumudi_joshipura@hms.hard.edu. Drs. Pitiphat and Doujjass are with the Harvard School of Dental Medicine as well as Harvard School of Public Health. &. Pitiphat is ah with the Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand. Dr. Garcia is with the VA Dental Longitudinal Study, Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, as well as the Department of Health Policy and Health Services Research, Boston University GoldmanSchool of Dental Medicine. The VA Dental Lon@udinalStudy is supported by the VA CSPIERIC program and by VA Medical Research Service.Manuscript received: 1/2/01; returned to authors for revision: 2/20/01; accepted for publication: 9/25/01.