Qualidade de vida relacionada à saúde bucal de crianças e adolescentes: análise bibliométrica e adaptação dos instrumentos POQL E TOQOL para o português brasileiro

Abstract

Oral health-related quality of life (OHRQoL) is a multidimensional construct that refers to the impact of oral conditions on the physical, emotional, social, and functional aspects of life. These dimensions are especially relevant during childhood and adolescence, as they influence development, self-esteem, and social interaction. Bibliometric studies are essential for evaluating the impact of scientific output on OHRQoL and for identifying trends and key publications in the field. The Pediatric Oral Health-Related Quality of Life (POQL) and the Teen Oral Health-Related Quality of Life (TOQOL) are two instruments specifically developed for children and adolescents, with a focus on low-income or minority populations, aiming at both research and clinical applications. However, these tools are not yet available for use in Brazil. Thus, the objectives of this study were: (i) to conduct a bibliometric analysis of the 100 most-cited articles on OHRQoL in children and adolescents, assessing changes in their citation ranks over three years; (ii) to evaluate the psychometric properties of the Brazilian version of the POQL2-7 (B-POQL2-7); and (iii) to carry out the semantic equivalence process of the Brazilian version of the TOQOL (B-TOQOL). The bibliometric study was conducted using the Web of Science Core Collection (WoS-CC). From each article, the following data were extracted: number of citations (in 2020 and 2023), authors, institutions, journals, topics, and instruments. Authorship and keyword maps were generated using the VOSviewer software. To validate the B-POQL2-7, a cross-sectional study was conducted with 144 children (aged 2 to 7 years) and their parents/guardians in Divinópolis, Brazil. Data collection included the administration of the questionnaires and a dental clinical examination of the children for the diagnosis of dental caries, using the dmft /DMFTindex. Confirmatory factor analysis (CFA) was performed to assess the dimensionality of the instrument. Reliability was tested through internal consistency and test-retest reliability. Validity was evaluated through convergent and discriminant validity. The semantic equivalence process of the TOQOL followed established guidelines in the literature, including: (1) translation into Brazilian Portuguese; (2) synthesis of translations; (3) back-translation into English; (4) synthesis of back-translations; (5) review by the original instrument’s authors; (6) expert committee evaluation based on received feedback; (7) pretesting with 20 participants from the target population (adolescents and their parents/guardians); and (8) final review by the expert committee to produce the Brazilian version (B-TOQOL). Regarding the bibliometric study, the selected articles accumulated 7,225 citations in 2020 and 9,483 in 2023. Brazil was the leading country in number of publications (33%), David Locker (Canada) was the most productive author (19 papers), and the Child Perceptions Questionnaire was the most frequently used instrument (33%). Cross-sectional studies predominated (61%), and 46% addressed the impact of oral conditions on OHRQoL. Citation rank variation ranged from -34 to +68, with systematic reviews and recent studies standing out. Regarding the B-POQL2-7, CFA showed good CFI/TLI indices, although some scales presented high RMSEA values. The confirmatory factor analysis demonstrated variable model fit (CFI = 0.966–0.981; TLI = 0.928–0.969; RMSEA = 0.08–0.23). Internal consistency was satisfactory (α: 0.711-0.799; ω: 0.664-0.801), item-total correlations were adequate (–0.037 a 0.720), and test-retest reliability ranged from low to excellent (ICC: 0.243-0.801). Convergent validity was confirmed by positive correlations with the Brazilian version of the ECOHIS (B-ECOHIS) (r = 0.449-0.607) and negative correlations with the global health question (r = -0.268 to -0.449). Discriminant validity was supported by significantly higher scores in children with dental caries (p < 0.05). For the TOQOL, the translations and back-translations were highly consistent, requiring only minor adjustments, which were incorporated into the final version after pretesting with the target population. All modifications were approved by the original authors. In conclusion: (i) the bibliometric study mapped relevant aspects of the scientific production on OHRQoL in children and adolescents; (ii) the B-POQL2-7 was found to be valid and reliable for use in Brazil; and (iii) the B-TOQOL demonstrated semantic equivalence with the original version.