Cross-National Study on Oral Health-Related Quality of Life: An investigation on measure scales, orofacial appearance, and aesthetic treatment in Finland and Brazil

Lucas Arrais De Campos

Research output: Book/ReportDoctoral thesisCollection of Articles


Oral health-related quality of life (OHRQoL) refers to an individual’s perception of their oral health and is an important aspect of patient-centered dentistry. Psychometric scales such as the 14-item Oral Health Impact Profile (OHIP-14), Orofacial Esthetic Scale (OES), and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) are used for measuring OHRQoL dimensions. Ensuring their data validity and reliability requires assessing psychometric properties across diverse samples and in different clinical and cultural settings.

The demand for aesthetic dental treatment has significantly increased recently. Studying self-perception of orofacial appearance (OA), an OHRQoL dimension assessed by OES and PIDAQ, helps understand these changes in dental practice. Both treatment demand and OA can impact individuals’ well-being and are influenced by cultural and socioeconomic factors. Investigating these impacts and influences across diverse populations can elucidate the role of OA in one’s life and the healthcare professionals’ role in promoting health through aesthetic treatments.

This dissertation consists of four publications aiming to investigate OHRQoL in a cross-national context between Finland and Brazil. Publication I estimated the psychometric properties of OHIP-14 in dental and non-dental patient samples. Publication II proposed and estimated the psychometric properties of the Finnish versions of OES and PIDAQ. Publication III studied the measurement invariance of OES and PIDAQ and compared their scores between Finland and Brazil. Publication IV compared the self-perception OA and the demand for aesthetic dental treatment by sociodemographic characteristics in both countries. Additionally, the impact of OA on life satisfaction among Finns and Brazilians was estimated.

These publications are validation and cross-sectional studies using demographic questionnaire and psychometric scales. Data collection was conducted using paper- and-pencil for the Brazilian sample in Publication I (n = 1,930) and online for the Finnish sample in all publications (n = 3,636) and the Brazilian sample in Publications III and IV (n = 3,979). Psychometric properties were estimated using a confirmatory strategy. Cross-national measurement invariance was tested using multigroup analysis. Scale scores were compared between the countries and by sex, age group, and income level. The probability of seeking or receiving aesthetic dental treatment was calculated for sociodemographic categories. Structural equation models estimated the impact of OA on life satisfaction.

As results, OHIP-14 data were not valid and reliable for non-dental patient samples, indicating that this scale is unsuitable for individuals not undergoing dental treatment. For dental patients, OHIP-14 presented adequate psychometric properties, however, these results were influenced by cultural factors and age. Finnish versions of OES and PIDAQ had adequate psychometric properties. OES presented measurement invariance, with no score differences between Finns and Brazilians. On the other hand, PIDAQ did not have measurement invariance; therefore, its scores are not directly comparable between the countries. Significant differences in self-perception of OA were observed concerning income level in Brazil, with those with low incomes experiencing a more negative psychosocial impact of OA on their lives.

Regarding the demand for aesthetic dental treatment, women were more likely to seek such treatment in both countries, reflecting the social pressure on the female body. In addition, younger and richer individuals in Brazil had a higher demand for this treatment. In general, Brazilians sought and received more aesthetic dental treatments than Finns. The structural model showed that OA had a significant impact on individuals’ well-being, contributing to approximately 10% of the life satisfaction of Finnish and Brazilian adults.

In conclusion, individual and clinical characteristics may affect the validity and reliability of data from psychometric scales, potentially leading to misinterpretations. Aesthetic treatments in the orofacial region should consider patient perspectives and social context, as sociodemographic and cultural factors may influence self- perception of OA and the demand for the treatment. Furthermore, this dissertation provides evidence to advance the understanding of OHRQoL and foster discussion on its practical applications.
Original languageEnglish
Place of PublicationTampere
ISBN (Electronic)978-952-03-3329-4
Publication statusPublished - 2024
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028


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