Clinical Oral Investigations

, Volume 23, Issue 1, pp 65–79 | Cite as

Assessing oral health-related quality of life in children and adolescents: a systematic review and standardized comparison of available instruments

  • Carlos ZarorEmail author
  • Yolanda Pardo
  • Gerardo Espinoza-Espinoza
  • Àngels Pont
  • Patricia Muñoz-Millán
  • María José Martínez-Zapata
  • Gemma Vilagut
  • Carlos G. Forero
  • Olatz Garin
  • Jordi Alonso
  • Montse FerrerEmail author
Original Article



To obtain a systematic and standardized evaluation of the current evidence on development process, metric properties, and administration issues of oral health-related quality of life instruments available for children and adolescents.

Materials and methods

A systematic search until October 2016 was conducted in PubMed, Embase, Lilacs, SciELO, and Cochrane databases. Articles with information regarding the development process, metric properties, and administration issues of pediatric instruments measuring oral health-related quality of life were eligible for inclusion. Two researchers independently evaluated each instrument applying the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall and seven attribute-specific EMPRO scores were calculated (range 0–100, worst to best): measurement model, reliability, validity, responsiveness, interpretability, burden, and alternative forms.


We identified 18 instruments evaluated in 132 articles. From five instruments designed for preschoolers, the Early Childhood Oral Health Impact Scale (ECOHIS) obtained the highest overall EMPRO score (82.2). Of nine identified for schoolchildren and adolescents, the best rated instrument was the Child Perceptions Questionnaire 11–14 (82.1). Among the four instruments developed for any age, the Family Impact Scale (FIS) obtained the highest scores (80.3).


The evidence supports the use of the ECOHIS for preschoolers, while the age is a key factor when choosing among the four recommended instruments for schoolchildren and adolescents. Instruments for specific conditions, symptoms, or treatments need further research on metric properties.

Clinical relevance

Our results facilitate decision-making on the correct oral health-related quality of life instrument selection for any certain study purpose and population during the childhood and adolescence life cycle.


Oral health Quality of life Questionnaires Psychometrics Outcome assessment Child 



We would like to acknowledge Aurea Martin for her help in the English editing process and figure edition of this manuscript.


Carlos Zaror is a PhD candidate in Methodology of Biomedical Research and Public Health program, Universitat Autònoma de Barcelona, Barcelona, Spain.

Ma. José Martínez is funded by a Miguel Servet research contract from the Instituto de Salud Carlos III and European Social Fund (CP15/00116).

Montse Ferrer is partially funded by the Departament d’Innovació, Universitats i Empresa, Generalitat de Catalunya (2014 SGR 748).

This project was funded by a grant from the Convenio de Desempeño Regional, FRO 1301, Universidad de La Frontera, No. UNT15-0012.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Carlos Zaror
    • 1
    • 2
    • 3
    Email author
  • Yolanda Pardo
    • 3
    • 4
    • 5
  • Gerardo Espinoza-Espinoza
    • 2
    • 6
  • Àngels Pont
    • 4
    • 5
  • Patricia Muñoz-Millán
    • 1
    • 2
  • María José Martínez-Zapata
    • 5
    • 7
  • Gemma Vilagut
    • 4
    • 5
  • Carlos G. Forero
    • 4
    • 5
    • 8
  • Olatz Garin
    • 4
    • 5
    • 8
  • Jordi Alonso
    • 4
    • 5
    • 8
  • Montse Ferrer
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Pediatric Dentistry and Orthodontics, Faculty of DentistryUniversidad de La FronteraTemucoChile
  2. 2.Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of DentistryUniversidad de La FronteraTemucoChile
  3. 3.Universitat Autònoma de BarcelonaBarcelonaSpain
  4. 4.Health Services Research GroupIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  5. 5.CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
  6. 6.Department of Public Health, Faculty of MedicineUniversidad de La FronteraTemucoChile
  7. 7.Iberoamerican Cochrane CentreBiomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain
  8. 8.Universitat Pompeu Fabra (UPF)BarcelonaSpain

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