Parent and child perceptions of the impact of malocclusion

Objectives: To assess agreement between parents and children concerning the impact of malocclusion. Methods: 123 children aged 11 to 14 years with malocclusion and one of their parents (100 mothers, 23 fathers) completed the child and parental components of the Child Oral Health Quality of Life Questionnaire. These are analogous questionnaires with 31 common items. The severity of malocclusion was assessed using the Dental Aesthetic Index (DAI). Agreement between overall and sub-scale scores derived from the questionnaires were assessed in comparison and correlation analyses. The former used mean directional differences between mothers and children to assess systematic bias and mean absolute differences to assess agreement at the group level. The latter used intraclass correlations coefficients to assess agreement at the level of individual pairs. Results: The mean age of the children was 12.7 years. The DAI scores ranged from 17 to 58 (Mean=35, SD=8.0); the distribution was as follows: ‘minor/none' – 7.2%, ‘definite' – 35.2%, ‘severe' – 17.4% and ‘handicapping' – 40.2%. At the group level, agreement between parents and children was good. CPQ11-14 scores were higher for children than parents. However, the mean directional difference of 2.6 was not statistically significant. There was no systematic bias in parents' assessments when compared to those of the children. The mean absolute difference in overall scores constituted 9% of the possible range of scores. The ICC for CPQ11-14 scores was 0.63, indicating borderline moderate-substantial agreement between pairs. However, the agreement was borderline fair-moderate for the oral symptoms (ICC=0.42) and moderate substantial for the other three sub-scales (ICCs of 0.59 to 0.63). Agreement was better for girls, older children and those with less severe malocclusion. Conclusion: Agreement was good at the group level but only moderate at the level of individual pairs. This has implications for when parent reports may substitute for those of the child.