In both dental research and clinical practice, how patients perceive the effects of dental interventions is essential, and one standard instrument should exist to measure and compare these effects. Here, oral health- related quality of life (OHRQoL) is the most promising concept. The most widely used OHRQoL instrument for adults, the 49-item Oral Health Impact Profile (OHIP), combines items into 7 scores that putatively measure 7 latent dimensions of perceived oral health. This set of 7 scores has been used for almost 20 years but has never been validated. In fact, recent evidence indicates that the OHIP dimensional structure is not correct, which creates a fundamental measurement problem for the assessment of OHRQoL using OHIP. The major goals of this proposal are (i) to determine which OHRQoL dimensions exist and to derive a new OHIP dimensional structure, (ii) to derive 2 new OHIP short forms and a computer adaptive testing version based on these revised dimensions, and (iii) to validate the revised OHIP dimensional structure and the newly derived versions. Existing OHIP data from 6,628 general-population subjects and 2,502 dental patients from 6 countries will be used both to derive revised OHIP dimensions by applying factor analysis and to test the newly identified dimensions. In addition, 2 new shorter OHIP forms and a computer adaptive testing version (all aimed at reducing self-reporting burden) will be developed using item response theory. Finally, a new sample of 2,000 dental patients in Minnesota will be used to validate the derived OHIP dimensions and new OHIP forms in cross-sectional and longitudinal analyses using other measures of self-reported oral health and clinical oral-health indicators. During the validation process, items from 2 other OHRQoL instruments will be integrated into the instrument to create one standard OHRQoL instrument. A unified framework for OHRQoL assessment based on OHIP will be created, and methodologies such as item response theory and bifactor analysis will ensure that scores from newly derived short-form OHIP versions are compatible with scores from longer OHIPs (score equating). The relationship of OHIP scores to health-related quality of life outcome measures will be explored using methodology from NIH's Patient-Reported Outcomes Measurement Information System (PROMIS). The revised OHIP will measure perceived oral health with a valid set of OHIP dimension scores from instruments with different lengths that will nevertheless be compatible across settings. A profile of sound OHIP dimension scores can become dentistry's standard tool for assessing oral health and treatment effects from the patient's perspective. The revised OHIP will allow effects from all oral interventions to become comparable, aiding dentists and patients in their evaluation of treatment alternatives and informing health care systems for setting resource priorities.

Public Health Relevance

How people perceive their oral health and the effects of dental treatments on their oral health is often assessed with specialized questionnaires. The proposed study aims to revise the most widely used questionnaire in this area, the Oral Health Impact Profile, and to combine it with 2 other often-used questionnaires. This work will lead to the development of an improved, standard questionnaire that researchers, health care systems, and dentists will be able to use to measure and compare individuals'perceptions of their oral health.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-HDM-Q (54))
Program Officer
Clark, David
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Minnesota Twin Cities
Schools of Dentistry
United States
Zip Code
Simancas-Pallares, Miguel; John, Mike T; Prodduturu, Swati et al. (2018) Development, validity and reliability of the Orofacial Esthetic Scale - Spanish version. J Prosthodont Res 62:456-461
Naik, Amruta; John, Mike T; Kohli, Nidhi et al. (2016) Validation of the English-language version of 5-item Oral Health Impact Profile. J Prosthodont Res 60:85-91
John, Mike T; Reissmann, Daniel R; ?elebi?, Asja et al. (2016) Integration of oral health-related quality of life instruments. J Dent 53:38-43
Waller, Niels; John, Mike T; Feuerstahler, Leah et al. (2016) A 7-day recall period for a clinical application of the oral health impact profile questionnaire. Clin Oral Investig 20:91-9
Reissmann, Daniel R; John, Mike T; Feuerstahler, Leah et al. (2016) Longitudinal measurement invariance in prospective oral health-related quality of life assessment. Health Qual Life Outcomes 14:88
John, M T; Rener-Sitar, K; Baba, K et al. (2016) Patterns of impaired oral health-related quality of life dimensions. J Oral Rehabil 43:519-27
John, M T; Feuerstahler, L; Waller, N et al. (2014) Confirmatory factor analysis of the Oral Health Impact Profile. J Oral Rehabil 41:644-52
John, Mike T; ReiƟmann, Daniel R; Feuerstahler, Leah et al. (2014) Factor analyses of the Oral Health Impact Profile - overview and studied population. J Prosthodont Res 58:26-34
John, M T; Reissmann, D R; Feuerstahler, L et al. (2014) Exploratory factor analysis of the Oral Health Impact Profile. J Oral Rehabil 41:635-43