Oral health-related quality of life in children attending the pain service at the University Dental Clinic Vienna at the onset of the COVID-19 pandemic in 2020

Oral health-related quality of life in children attending the pain service at the University Dental Clinic Vienna at the onset of the COVID-19 pandemic in 2020 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Oral health-related quality of life in children attending the pain service at the University Dental Clinic Vienna at the onset of the COVID-19 pandemic in 2020 Ali Al Ibraheem, Clara Dürsch, Katrin Bekes This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4905859/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Oral-health-related quality of life (OHRQoL) has become increasingly significant in dentistry. This study examines OHRQoL during the early COVID-19 pandemic in children aged 0–10 who visited the Emergency Unit of the Department of Paediatric Dentistry in Vienna from March to May 2020, focusing on the impact of COVID-19 restrictions on various social and health aspects. Objectives : The study aimed to assess OHRQoL in children during early weeks of the COVID-19 pandemic and correlate it with other health and social conditions. Material & Methods : Children (up to 10 years) and their parents visiting the Emergency unit of the Department completed OHRQoL questionnaires. In children aged 0–6, their parents answered the Early Childhood Oral Health Impact Scale questionnaire (ECOHIS), while 7-10-year-olds completed the Child Perception Questionnaire (CPQ) by themselves. Summary scores and associations between oral and general health subdomains were analyzed. Results : Both the ECOHIS and CPQ groups showed high general summary scores, indicating decreased OHRQoL (ECOHIS 12.22 [± 8.68] and CPQ 18.36 [± 12.35]). The highest scores were in the "oral symptoms" domain, mainly due to "toothache." Significant correlations were observed between "general health" and "oral health" with the "family section" in the ECOHIS group, and between "oral health" and "oral symptoms" and "emotional well-being" in the CPQ group. Conclusions : During the pandemic, both age groups experienced decreased OHRQoL. Family background influenced oral health (ECOHIS), while oral symptoms and emotional well-being correlated with oral health (CPQ). Further research is needed to understand pandemic-related factors affecting OHRQoL and develop preventive strategies. oral health dental pain quality of life Covid-19 general health Introduction With the beginning of the coronavirus, the quality of life in Austria changed significantly[ 1 ]. By October 2020, surveys indicated that 69% of the population found the COVID-19 crisis 'very stressful' or 'rather stressful.' Mobility restrictions, curfews, and quarantine measurements limited oral health care and particularly dental visits. Non-necessary treatments at the University Dental Clinic in Vienna, Austria, were postponed due to high infection risks and staff shortages, allowing only emergency care for urgent dental treatments such as acute traumas or pain [ 2 ]. Initially, dental treatments were limited to emergency services [ 3 ]. However, adequate management and treatment of dental pain are essential in pediatric dentistry, as dental caries is one of the most common problems affecting children, with a prevalence ranging from 30–90%. This condition imposes a heavy burden on patients and their families, potentially impacting their quality of life, general health, and well-being [ 4 , 5 ]. In recent years, the concept of oral health-related quality of life (OHRQoL) has become an essential measure for examining the impact of oral conditions on the psychosocial well-being of both children and adults [ 6 , 7 ]. By including the patient’s or parent’s self-perceived oral health and needs in terms of social or psychological impacts, OHRQoL provides a comprehensive assessment of patients’ oral health, complementing traditional diagnostic criteria in clinical practice. This has also led to the development of various questionnaires and evaluation methods to collect data directly from patients and ultimately helping to improve everyday practice [ 8 , 9 ]. One of the widely used instruments to measure OHRQoL is the Child Perception Questionnaire (CPQ), designed for children aged 8–10. For young patients the Early Childhood Oral Health Impact Scale (ECOHIS) can be applied to investigate the relationship between parental perception of the quality of life of their preschool children and their oral health status. While many studies have investigated quality of life (QoL) under various circumstances, there is a particular need for research on general QoL and oral health-related quality of life (OHRQoL) during COVID-19 and its global impact on both patients and practitioners. Therefore, this study aims to analyze the oral health-related quality of life (OHRQoL) in children who presented at the Emergency Dental Service of the Department of Paediatric Dentistry, University Dental Clinic Vienna, Austria at the beginning of the COVID-19 pandemic from March to early May 2020. Material and Methods The present study was planned and conducted at the Department of Pediatric Dentistry at the University Dental Clinic Vienna, Medical University. A positive ethics vote was obtained (Ethics vote: 1822/2015, 2025/2015). The data collection was initially planned for the first eight weeks of the SARS-CoV-2 pandemic from March to early May 2020. However, it was delayed and conducted from April 3rd to June 2nd, 2020. All pediatric patients and their legal guardians who presented to the Emergency Unit during this period were informed about the possibility of participating in the study. After obtaining written consent from the legal guardians (along with verbal consent from the children), the patients or accompanying persons were provided with the questionnaire standardized for their age. After the allocation of a patient ID (pseudonymization), an OHRQoL questionnaire had to be completed. Additionally, the diagnosis and reason for presentation were noted in the patient file. For children aged 0 to 6 years, the German version of the Early Childhood Oral Health Impact Scale was used, and for those aged 7 to 10 years, the German version of the Child Perceptions Questionnaire in version 8–10 was employed. The questionnaires are included in the appendix of the study. The ECOHIS-G was filled out by the parents or legal guardians, while the CPQ was completed by the children themselves [ 10 , 11 ]. The ECOHIS, as previously mentioned, is an instrument primarily used for preschool children to assess OHRQoL. It contains 13 questions that are answered by the parents and consists of two parts. The first part, focusing on the impacts of Oral Health-Related Quality of Life (OHRQoL) on the children themselves ("child section"), consists of four domains and a total of nine questions [ 11 , 12 , 13 ] : 1) Oral Symptoms (1 question), 2) Child-related Function (4 questions), 3) Child's Psychology (2 questions), and 4) Child's Self-image and Social Interaction (2 questions). The second part addresses the impacts of MLQ on the family ("family section") and includes two domains with a total of four questions: 1) Parental Distress/Suffering (2 questions) and 2) Family-related Function (2 questions). The CPQ consists of 25 items divided into four subscales [ 14 ]: 1) Oral Symptoms (5 questions), 2) Functional Limitations, 3) Emotional Well-being, and 4) Social Well-being. Additionally, there are two questions regarding general oral health and overall health, which respondents can rate as "excellent" = 4, "very good" = 3, "good" = 2, "fair" = 1, and "poor" = 0. In these questions, a high value corresponds to an exceptionally good (oral) health status, unlike the rest of the items. The data from the questionnaires were manually transferred into an Excel spreadsheet and into the statistical analysis software IBM SPSS Statistics Version 27 (IBM Corp., Armonk, NY, USA). Prior to analysis, a Pearson correlation coefficient of 0.30 and a significance level of 0.05 were set in SPSS. This was then cross-checked by a second person involved in the study planning. The diagnosis or reason for presentation of the patients was supplemented from the clinical patient records. If a patient had two relevant diagnoses, both were included in the database. Nominal measurements (e.g., gender, type of diagnosis) were summarized using frequencies and proportions, along with cross tabulations. T-tests for independent samples were calculated to compare interesting proportions between both groups. Analysis of variance (ANOVA) was conducted to assess statistical significance and subsequently examined for validity through correlation analysis. Correlation analysis was performed to analyze the effect of different factors on global oral health, overall well-being, and OHRQoL (ECOHIS scores). Results Out of a total of 103 participants, 4 were excluded due to incorrectly filled out questionnaires, resulting in only 99 children (46% female, 53% male) being included in the study. Subsequently, it was found that the overall population had not been strictly separated according to the age criteria. For organizational reasons, the ECOHIS group (n = 46) included 2 subjects who were older than 6 years, and the CPQ group (n = 53) included 29 subjects whose ages were outside the range of 8-10 years. A particular difficulty arose with the 7-year-olds (n = 11), the age group that fell between ECOHIS and CPQ subjects. Of them, 9 received the CPQ questionnaire and 2 received the ECOHIS questionnaire. Table 1 and 2 summarizing the characteristics of the study population. Table 1: Characteristics of the study population for ECOHIS and CPQ groups. Regarding the most common problems, as seen in Table 2, the response frequencies of the six most common oral problems among ECOHIS respondents are listed. Accordingly, 26.1% of respondents reported being "hardly" affected by "pain," while 28.3% reported being "never" affected. Additionally, 19.6% reported experiencing "occasional" pain, and 17.4% reported experiencing "frequent" pain. For more than two-thirds (69.6%) of respondents, "pain" was likewise "never" a problem, and the "absence from kindergarten/daycare/school" due to oral symptoms had "never" occurred in most children (73.9%) so far. "Sleeping problems" mostly also "never" (60.9%) arose. Table 2: ECOHIS – Most common problems (n = 46) In the younger age group, measured with the ECOHIS, 95.7% of parents rated the "general health status" of their child as "good," "very good," or "excellent," while 4.4% rated it as "fair" or "poor". However, only 65.2% rated the "oral health status" as "good" or better, with 34.8% rating it as "fair" or "poor." As shown in Table 3, no statistically significant association was found between the ECOHIS total score and the "general health status" (ρ = 0.035; p = 0.82 > 0.05). The correlation of the "Child Section" domain with the "general health status" was also found to be non-significant (ρ = 0.18, p = 0.24 > 0.05). In contrast, a significant association was observed between the total score of the "Family Section" domain and the total score of the "general health status" (ρ = 0.31; p = 0.03 < 0.05). However, similar to the "general health status," the association between the "oral health status" and the "Family Section" was significant (ρ = 0.33; p = 0.03 < 0.05) as seen in table 3. Table 3: ECOHIS correlation: General / Oral health status & domains or total score (n = 46) More than two-thirds (67.4%) of the children presented to the Emergency Unit at the Department of Paediatric Dentistry in Vienna due to caries-related pain. Among the 31 subjects with caries, eleven additionally suffered from swelling/fistula. Thus, 35.5% of the caries patients and 23.9% of all 46 ECOHIS subjects had a fistula as a complication of caries. Table 4 presents the ECOHIS total score as well as the domain total scores in the group of the two most common diagnoses, caries (n = 31), and anterior tooth trauma (n = 9). In the caries subpopulation, the mean ECOHIS total score was 13.77 (± 9.885; range 0-42), and the domain total score in the "Child Section" averaged 7.68 (± 7.54; range 0-30). In the "Family Section," the domain total score averaged 2.90 (± 2.88; range 0-8). Patients with the second most common diagnosis, anterior tooth trauma (n=9), had an average ECOHIS total score of 7.33 (± 3.64; range 0-13) and a domain total score of 2.33 (± 3.00; range 0-8) in the "Child Section." In the "Family Section," the average was 0.22 (± 0.67; range 0-2). Moving on to the CPQ group, the average total score when answering the CPQ was 18.36 (± 12.35; range 0-50). The occurrence of "oral symptoms" was rated on average with the highest domain sum score of 6.11 (± 4.08; range 0-15). Table 5 summarizes the response frequencies for the six most common oral health-related issues of the CPQ. 24.5% of patients reported experiencing "frequent" toothache, while 20.8% reported experiencing it "occasionally". The majority of respondents (30.0%) reported experiencing such pain "once or twice" during the specified period, and 17.0% reported having experienced it "never". Table 4: ECOHIS – Most common diagnoses & their (domain) total scores (n = 46) Table 5: CPQ - Most common oral health-related problems (n = 53) The first two parts of the CPQ capture "general health status" and "oral health status". In this study, 96.2% of respondents rated their "general health status" as "good", "very good", or "excellent", while 3.8% rated it as "fair" (none rated it as "poor"). However, only 69.8% rated their "oral health status" as "good" or better, while 30.2% rated it as "fair" or "poor". To examine the relationships between "general health status" and the CPQ sum score, as well as the individual domains, Spearman's rank correlation coefficient (ρ) was calculated analogously to the ECOHIS evaluation and tested for significance using the p-value (p) at a significance level of 0.05 (Table 6). Similarly, the "oral health status" was tested for correlations (Table 6). No significant correlation between the "general health status" and the overall CPQ sum score could be established (ρ = 0.09; p = 0.52 > 0.05) (Table 8). The relationship between the "oral health status" and the overall CPQ sum score was also found to be non-significant (ρ = 0.23; p = 0.09 > 0.05) (Table 6). Table 6: CPQ Correlation General / Oral Health Status & Domains or Sum Score (n = 53) It is noticeable that more than half (50.9%) of the patients showed caries. Of the 27 participants with caries, four simultaneously suffered from a fistula or swelling. Thus, 14.8% of the participants had caries, and 7.5% of all participants had a fistula as a complication of caries. Almost a quarter (24.5%) of the respondents had less common problems ("Others"), such as broken fillings or crowns, space maintainer fractures or pressure sores, fractures, hypersensitivity pain, tooth mobility, or teething pain. The most common diagnosis, "caries" (n = 27), is analyzed in more detail regarding the response behavior in the CPQ (Table 7). A decreasing mean value was observed from domain 1 to domain 4 (with their ascending numerical designations). In domain 1, "oral symptoms," the average sum score was the highest at 5.85 (± 4.25; range 0-15). In domain 2, "functional limitations," the average sum score was 3.41 (± 4.12; range 0-12). The scores for emotional and social well-being were lower (3.00 ± 3.44; range 0-12 and 1.04 ± 1.87; range 0-8, respectively). Table 7: CPQ - Most Common Diagnoses & Their (Domain) Sum Scores (n = 53) Discussion The study focuses on oral-health-related quality of life (OHRQoL) in children aged 0–10 during the early weeks of COVID-19 pandemic. It aimed to evaluate the impact of COVID-19 restrictions on children's OHRQoL and its correlation with health and social conditions. Results showed a decrease in OHRQoL, with the highest impact in the "oral symptoms" domain, primarily due to toothache. Significant correlations were also found between general and oral health with family background (ECOHIS) and between oral health, oral symptoms, and emotional well-being (CPQ). The ECOHIS participants showed a relatively balanced gender distribution, with females (56%) outnumbering males (43%). According to the predetermined classification, the age should be between 0 and 6 years. Two of the 11 seven-year-olds were assigned to the ECOHIS instead of the CPQ, due to difficulties in self-completing the ECOHIS. Among the CPQ respondents, there was an uneven gender distribution. Almost two-thirds of the included participants were male (62%), while slightly more than one-third were female (38%). When considering the age of the CPQ participants, it ranged from 5 to 14 years at the time of the survey. According to the protocol, participants younger than 8 years old should have answered the ECOHIS instead of the CPQ (ages 8–10), and participants older than 10 years old should have answered the CPQ (ages 11–14) (total n = 29). The average age of the CPQ participants being 8 years old, with a range of 5–14 years, confirms that most children were in the age group defined by the questionnaire, which is 8–10 years old. This is further supported by the standard deviation (± 2.1), which provided little room for variation. It can be concluded that the ECOHIS participants were predominantly older, while the CPQ participants were predominantly younger than the mean age of the age group for which the questionnaire was designed. From this, it can be inferred that only a few patients of the ECOHIS were included at the lower end and few of the CPQ at the upper end of the age range. The ECOHIS standard deviation (Σ) of 12.22 in this study was significantly higher compared to other studies conducted under normal conditions in various countries: Australia (4.20), Brazil (3.84), China (9.63), Austria (6.10), Mexico (3.20), Peru (8.74), and Thailand (4.15) [ 15 , 16 , 11 , 17 , 18 , 19 , 20 ]. Specifically, the study's ECOHIS_Σ of 12.22 was notably higher than the 6.12 measured in Austria under normal conditions, indicating a more significant restriction in OHRQoL during the pandemic. This higher deviation is attributed to the study population being from an emergency service rather than routine care. Spanemberg et al. reported that patients in pain services have an eight-fold higher likelihood of experiencing greater OHRQoL impairment compared to those in routine treatment [ 21 ]. The range of 0–42 reflected the highly variable perception of OHRQoL, and the ECOHIS_Σ of 12.22 was shifted far to the left in this range, illustrating the relatively low average OHRQoL impairment. The average poorer OHRQoL of our participants could also be attributed to the emergency situation, as observed in patients treated by the pain service compared to routine treatment. Therefore, the potentially worse OHRQoL of our participants may be justified by the emergency situation [ 21 ]. Rauch et al. also found in their survey that patients presenting with pain in German emergency dental care services, in addition to a high prevalence of dental anxiety, exhibited a high level of OHRQoL impairment [ 22 , 23 ]. These findings mitigate the potential influence of the pandemic on the OHRQoL. In other publications, it has also been demonstrated that "tooth pain" has the strongest impact on individual oral health-related quality of life (1.52 ± 1.30) [ 15 , 24 , 25 ]. The closely clustered average response values of the remaining ECOHIS questions suggest a similar influence on OHRQoL. Upon closer analysis, it is evident that the responses in the ECOHIS questionnaire differed significantly from those in the CPQ questionnaire. While the majority (54.4%) of ECOHIS respondents reported "never" or "rarely" experiencing "tooth pain" in the affected young child, the CPQ respondents mostly (45.3%) perceived pain "occasionally" or "often." The ECOHIS evaluation study by Pahel et al. found a more frequent rating of "never" or "rarely" in response to the pain question (83.1%) compared to our cohort [ 13 ]. Similarly, for other "most common problems" (such as "difficulty drinking hot/cold beverages" 63% and "difficulty eating certain foods" 50%), a majority of ECOHIS respondents in our study reported these problems as "never" occurring. This is corroborated by data from an Italian evaluation conducted in 2020 [ 26 ]. Pahel and colleagues found even more frequent positive responses such as "never" and "rarely" indicative of good OHRQoL in the populations they studied compared to our study [ 13 ]. In conclusion, the relationships between the ECOHIS domains and the "general health status" and "oral health status" should be discussed. A significant, "moderately" strong correlation was found between the "general health status" and the "family section" (ρ = 0.31; p = 0.03). Similarly, a significant correlation was found between the "oral health status" and the "family section" (ρ = 0.33; p = 0.03). Thus, poor (oral) health was associated with high response values in the family section, indicating a significant disruption in family life. No correlations were found between the "child section" and the "general sum scores" with the "general health status" and "oral health status." This could be attributed to the small sample sizes. In some of the studies conducted under normal conditions, the study populations were subdivided into subgroups based on diagnoses, enabling a comparison with our work. Abanto et al. differentiated Brazilian patients regarding their OHRQoL into "caries-affected" (16.65 ± 11.56), "with trauma" (8.60 ± 8.81), and "with anterior malocclusion" (8.19 ± 8.84) [ 16 ]. Another population studied in Mexico showed significantly lower values for these diagnoses [ 18 ]. For "caries-affected" individuals, the average ECOHIS sum scores were 3.26 (± 0.39), for "with trauma" it was 5.4 (± 1.95), and for "open bite" it was 3.1 (± 0.26). Bekes et al. collected an ECOHIS_Σ of 8.6 (± 6.7) in the Austrian normal collective for caries-affected individuals [ 11 ]. In China, an ECOHIS_Σ of 14.98 (± 6.99) was found for caries-affected individuals [ 17 ]. Comparing the caries sum scores of these studies with our work (13.77 ± 9.885), it can be observed that the results of the Brazilian (16.65 ± 11.56) and Chinese studies (14.98 ± 6.99) were closest to the values we determined [ 16 , 17 ]. An Austrian study of the CPQ found a total score of 7.5 [± 8.6] in children without caries compared to 9.1 [± 10.1] in children with caries [ 11 ]. This means that the score of those affected by caries was more than half of the one we determined (16.33 [± 12.38]). At the beginning of the pandemic, caries patients in Austria perceived their MLQ (Mean Life Quality) as significantly worse than under normal conditions. In other evaluation studies, such as those from the Arab Emirates (23.3 [± 19.0]) and Cambodia (22.4 [± 13.6]), the total scores of those affected by caries also reached a higher level than the caries total score we determined [ 27 , 28 ].However, the scores from the previously cited Turkish (13.2 [± 9.1]) and Mexican (14.87) studies were lower than our caries total score [ 29 , 30 ]. The impairment of the MLQ due to caries in our study was statistically in the mid-range compared to studies that considered this item under different conditions. The average overall sum score of CPQ participants in our study was CPQ_Σ 18.36. With a maximum possible sum score of 140 points, this average indicated a low OHRQoL impairment. However, the range of 0–50 was very large, suggesting many different response values and thus different weights of questions. This was also evident from the large standard deviation of ± 12.35. The sum score of 18.36 is shifted to the left in the range, confirming the relatively low average OHRQoL impairment. Upon closer examination of the individual questions, the significantly negative influence of the symptom "tooth pain" on OHRQoL was confirmed (1.75 ± 1.22). A Brazilian study published in 2021 also reached the same conclusion, where the negative effects of tooth pain were more strongly associated with poorer OHRQoL than dental malocclusions [ 31 ]. Four other questions stood out in our analysis with values greater than 1.0 compared to the rest of the items. One question was: "How often food got stuck in the teeth" (1.68 ± 1.36). It also belongs to the domain of oral symptoms and had nearly the same negative impact on OHRQoL as the question about "pain." The other three items that contributed most to reducing OHRQoL were: how often the child "got annoyed," experienced "pain when drinking cold beverages or eating," or had "difficulty eating or chewing foods such as apples, corn on the cob, or meat." These questions and related common answers give a clear indication on the influence of oral health on the quality of life. Most participants experienced "tooth pain" "often," making it a particularly distressing symptom. In contrast, in the domains of "pain when drinking cold beverages or eating" and "food getting stuck in the teeth," the response values were relatively evenly distributed. The frequency of response values such as "very often," "often," "occasionally," etc., varied little. Most participants reported "never" having a problem with "bad breath." This contrasted with the results of a study published in 2011, which surveyed a group of adolescents aged 11–14 years using the CPQ-G [ 32 ]. In that study, foetor ex ore was perceived as "often" or "very often." The older children, like the younger ones in the ECOHIS, answered the question about "oral health status" with more negative scores than the question about "general health status." While only 69.8% rated their "oral health status" as "good" or better, with 30.2% rating it as "fair" or "poor," the "general health status" was rated as "good" or better by 96.2% of the cohort, with none rating it as "poor." From the participants' perspective, oral health thus had little influence on general health. Analyzing the correlations of the domains with "oral health status" and "general health status," it can be observed that none of the domains, nor the overall sum score, correlated significantly with "general health status." However, there was a tendency for a relationship between oral symptoms and general health, for instance. With a larger sample size, the significance level might have been reached. Two out of the four domains correlated significantly with "oral health status." A statistically significant, "moderate" causal relationship was observed between "oral symptoms" and "emotional well-being." This demonstrates an interaction between "oral symptoms" and "emotional well-being" with "oral health status." The factors in the pandemic exerting a strongly negative influence on "oral symptoms" remain speculative. It is possible that patients, due to social restrictions and regulations, had more time to focus on their personal issues. Additionally, the population's awareness of "health changes" may have been heightened due to the confrontation with the novel, unexplored virus. Another reason for the high OHRQoL scores could have been the late presentation to emergency dental services, leading to significantly reduced oral health. Better prevention and thus avoidance of OHRQoL deterioration could be achieved in the future if patients present themselves to emergency services more promptly under pandemic restrictions. Also, regular visits to dental practices without the pressure of a crisis situation would mitigate the negative OHRQoL development. These unconfirmed speculations could serve as a research approach for further studies. This study is the first systematic analysis of OHRQoL in Austrian children during the early COVID-19 pandemic, but it has limitations. The small study group reduces statistical significance, and the results, reflecting Vienna's situation in the pandemic's early weeks, may not apply to other regions. New health strategies to combat the pandemic were implemented after the first 6 weeks of the study. Further research is needed to investigate their impact on oral health and OHRQoL. Another study limitation is not considering the respondent's gender in the toddler group (ECOHIS). Research shows fathers and mothers assess children's health differently, with mothers generally providing more reliable answers about oral health [ 33 ]. Furthermore, some participants misunderstood the questionnaires, leaving notes indicating confusion and occasionally overlooking the back page, leading to unwanted exclusions. On some days, no questionnaires were answered due to pandemic-related staff shortages, while more were completed on following days. Additionally, comparing our results with other studies was impossible due to the lack of similar research. Lastly, the outbreak of the pandemic was an unexpected event with an unpredictable course of infection. The pandemic caught both the population and dental care completely unprepared. During the observation period, new strategies had to be constantly developed to combat the disease and maintain healthcare services. At the beginning of our six-week observation, the OHRQoL may have been assessed differently than at the end, as circumstances changed rapidly. It is likely that today, over two years after the start of the pandemic, a survey would yield completely different results. Conclusion The early COVID-19 pandemic significantly impacted the OHRQoL of children aged 0–10 years old. The main reasons for impaired OHRQoL were toothaches. In the younger group (ECOHIS), oral health was influenced by family circumstances, while in CPQ, it was affected by oral symptoms and emotional well-being. Declarations Author Contributions: Conceived and designed the study: KB. Conducted the study: KB, CD. Analyzed the data: KB, CD, AA. Interpreted the data: All authors. Wrote the manuscript: AA, KB. Read, revised and agreed to be accountable for the manuscript: All authors. Compliance with Ethical Standards Conflict of interest The authors declare that they have no conflict of interest. Funding The study was funded by 3M. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent Informed consent was obtained from all individual participants included in the study. Data Availability Statement: All data supporting the reported results are available upon request from the corresponding author. References Informationen zu den Mutationen des Coronavirus | Statista. Accessed May 26 (2024) https://de.statista.com/themen/7518/corona-mutationen/ Bahramian H, Gharib B, Baghalian A (2020) COVID-19 Considerations in Pediatric Dentistry. 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Health Qual Life Outcomes 4:4. 10.1186/1477-7525-4-4 Arrow P, Brennan D, Mackean T, McPhee R, Kularatna S, Jamieson L (2021) Evaluation of the ECOHIS and the CARIES-QC among an Australian Aboriginal population. Qual Life Res 30(2):531–542. 10.1007/S11136-020-02646-8 Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP (2011) Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol 39(2):105–114. 10.1111/J.1600-0528.2010.00580.X Lee GHM, McGrath C, Yiu CKY, King NM (2009) Translation and validation of a Chinese language version of the Early Childhood Oral Health Impact Scale (ECOHIS). Int J Paediatr Dent 19(6):399–405. 10.1111/J.1365-263X.2009.01000.X Montoya ALB, Knorst JK, Uribe IMP, González RAB, Ardenghi TM, Sánchez CCA (2021) Cross-cultural adaptation and psychometric properties of the Mexican version of the Early Childhood Oral Health Impact Scale (ECOHIS). Health Qual Life Outcomes 19(1). 10.1186/S12955-021-01747-3 Ramos RPL, García Rupaya CR, Villena-Sarmiento R, Bordoni NE CROSS CULTURAL ADAPTATION AND VALIDATION OF THE EARLY CHILDHOOD HEALTH IMPACT SCALE (ECOHIS) IN PERUVIAN PRESCHOOLERS Leelataweewud P, Jirarattanasopha V, Ungchusak C, Vejvithee W (2021) Psychometric evaluation of the Thai version of the Early Childhood Oral Health Impact Scale (Th-ECOHIS): a cross sectional validation study. BMC Oral Health 21(1):1–11. 10.1186/S12903-020-01332-Y/TABLES/6 Spanemberg JC, Cardoso JA, Slob EMGB, López-López J (2019) Quality of life related to oral health and its impact in adults. J Stomatol oral Maxillofac Surg 120(3):234–239. 10.1016/J.JORMAS.2019.02.004 Rauch A, Hahnel S, Schierz O (2019) Pain, dental fear, and oral health-related quality of life-patients seeking care in an emergency dental service in Germany. J Contemp Dent Pract 20(1):3–7. 10.5005/JP-JOURNALS-10024-2467 Oliveira MMT, Colares V (2009) The relationship between dental anxiety and dental pain in children aged 18 to 59 months: a study in Recife, Pernambuco State, Brazil. Cad Saude Publica 25(4):743–750. 10.1590/S0102-311X2009000400005 Ortiz FR, Tomazoni F, Oliveira MDM, Piovesan C, Mendes F, Ardenghi TM (2014) Toothache, associated factors, and its impact on Oral Health-Related Quality of Life (OHRQoL) in preschool children. Braz Dent J 25(6):546–553. 10.1590/0103-6440201302439 Mashoto KO, Åstrøm AN, David J, Masalu JR (2009) Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study. Health Qual Life Outcomes 7. 10.1186/1477-7525-7-73 Contaldo M, della Vella F, Raimondo E et al (2020) Early Childhood Oral Health Impact Scale (ECOHIS): Literature review and Italian validation. Int J Dent Hyg 18(4):396–402. 10.1111/IDH.12451 Al-Blaihed D, El-Housseiny AA, Farsi NJ, Farsi NM (2020) Validity and reliability of the Arabic version of the child perceptions questionnaire for 8-10-year-old children. Qual Life Res 29(11):3131–3141. 10.1007/S11136-020-02545-Y Turton BJ, Thomson WM, Foster Page LA, Saub RB, Razak IA (2015) Validation of an oral health-related quality of life measure for Cambodian children. Asia-Pacific J public Heal 27(2):NP2339–NP2349. 10.1177/1010539513497786 Aydinoglu S, Arslan I, Karan NB, Dogan T (2021) Validity and reliability of the Turkish version of the Child Perceptions Questionnaire 8–10. Int J Paediatr Dent 31(5):565–575. 10.1111/IPD.12742 Aguilar-Díaz F, del Irigoyen-Camacho C (2011) Validation of the CPQ8-10ESP in Mexican school children in urban areas. Med Oral Patol Oral Cir Bucal 16(3):430–435. 10.4317/MEDORAL.16.E430 Matos AC, Drumond CL, Guimarães MO, Silva-Freire LC, Paiva SM, Vieira-Andrade RG (2022) Impact of untreated dental caries and dental pain on sadness related to oral health of Brazilian children. Eur Arch Paediatr Dent 23(2):301–308. 10.1007/S40368-021-00682-7 Bekes K, John MT, Schaller HG, Hirsch C (2011) The German version of the child perceptions questionnaire on oral health-related quality of life (CPQ-G11-14): population-based norm values. J Orofac Orthop 72(3):223–233. 10.1007/S00056-011-0027-2 Pani SC, Mubaraki SA, Ahmed YT, Alturki RY, Almahfouz SF (2013) Parental perceptions of the oral health-related quality of life of autistic children in Saudi Arabia. Spec Care Dent 33(1):8–12. 10.1111/J.1754-4505.2012.00294.X Tables Table 1 to 7 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Table5.docx Table6.docx Table7.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4905859","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343143791,"identity":"d0067db5-e51a-4173-a6af-61da8add175f","order_by":0,"name":"Ali Al Ibraheem","email":"","orcid":"","institution":"Medical University Vienna, University Clinic of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Al","lastName":"Ibraheem","suffix":""},{"id":343143792,"identity":"7eeae2e4-c7e0-44de-bd0a-7cd08fe622ff","order_by":1,"name":"Clara Dürsch","email":"","orcid":"","institution":"Medical University Vienna, University Clinic of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Clara","middleName":"","lastName":"Dürsch","suffix":""},{"id":343143794,"identity":"1f15d51c-a801-48a0-998c-b9feaafbadfb","order_by":2,"name":"Katrin Bekes","email":"data:image/png;base64,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","orcid":"","institution":"Medical University Vienna, University Clinic of 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11:09:04","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":13867,"visible":true,"origin":"","legend":"","description":"","filename":"Table7.docx","url":"https://assets-eu.researchsquare.com/files/rs-4905859/v1/fb7e438d84ee4ca79c60a965.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Oral health-related quality of life in children attending the pain service at the University Dental Clinic Vienna at the onset of the COVID-19 pandemic in 2020","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the beginning of the coronavirus, the quality of life in Austria changed significantly[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. By October 2020, surveys indicated that 69% of the population found the COVID-19 crisis 'very stressful' or 'rather stressful.' Mobility restrictions, curfews, and quarantine measurements limited oral health care and particularly dental visits. Non-necessary treatments at the University Dental Clinic in Vienna, Austria, were postponed due to high infection risks and staff shortages, allowing only emergency care for urgent dental treatments such as acute traumas or pain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Initially, dental treatments were limited to emergency services [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, adequate management and treatment of dental pain are essential in pediatric dentistry, as dental caries is one of the most common problems affecting children, with a prevalence ranging from 30\u0026ndash;90%. This condition imposes a heavy burden on patients and their families, potentially impacting their quality of life, general health, and well-being [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, the concept of oral health-related quality of life (OHRQoL) has become an essential measure for examining the impact of oral conditions on the psychosocial well-being of both children and adults [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. By including the patient\u0026rsquo;s or parent\u0026rsquo;s self-perceived oral health and needs in terms of social or psychological impacts, OHRQoL provides a comprehensive assessment of patients\u0026rsquo; oral health, complementing traditional diagnostic criteria in clinical practice. This has also led to the development of various questionnaires and evaluation methods to collect data directly from patients and ultimately helping to improve everyday practice [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the widely used instruments to measure OHRQoL is the Child Perception Questionnaire (CPQ), designed for children aged 8\u0026ndash;10.\u003c/p\u003e \u003cp\u003eFor young patients the Early Childhood Oral Health Impact Scale (ECOHIS) can be applied to investigate the relationship between parental perception of the quality of life of their preschool children and their oral health status.\u003c/p\u003e \u003cp\u003eWhile many studies have investigated quality of life (QoL) under various circumstances, there is a particular need for research on general QoL and oral health-related quality of life (OHRQoL) during COVID-19 and its global impact on both patients and practitioners.\u003c/p\u003e \u003cp\u003eTherefore, this study aims to analyze the oral health-related quality of life (OHRQoL) in children who presented at the Emergency Dental Service of the Department of Paediatric Dentistry, University Dental Clinic Vienna, Austria at the beginning of the COVID-19 pandemic from March to early May 2020.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThe present study was planned and conducted at the Department of Pediatric Dentistry at the University Dental Clinic Vienna, Medical University. A positive ethics vote was obtained (Ethics vote: 1822/2015, 2025/2015). The data collection was initially planned for the first eight weeks of the SARS-CoV-2 pandemic from March to early May 2020. However, it was delayed and conducted from April 3rd to June 2nd, 2020. All pediatric patients and their legal guardians who presented to the Emergency Unit during this period were informed about the possibility of participating in the study.\u003c/p\u003e \u003cp\u003e After obtaining written consent from the legal guardians (along with verbal consent from the children), the patients or accompanying persons were provided with the questionnaire standardized for their age. After the allocation of a patient ID (pseudonymization), an OHRQoL questionnaire had to be completed. Additionally, the diagnosis and reason for presentation were noted in the patient file.\u003c/p\u003e \u003cp\u003eFor children aged 0 to 6 years, the German version of the Early Childhood Oral Health Impact Scale was used, and for those aged 7 to 10 years, the German version of the Child Perceptions Questionnaire in version 8\u0026ndash;10 was employed. The questionnaires are included in the appendix of the study. The ECOHIS-G was filled out by the parents or legal guardians, while the CPQ was completed by the children themselves [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ECOHIS, as previously mentioned, is an instrument primarily used for preschool children to assess OHRQoL. It contains 13 questions that are answered by the parents and consists of two parts. The first part, focusing on the impacts of Oral Health-Related Quality of Life (OHRQoL) on the children themselves (\"child section\"), consists of four domains and a total of nine questions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] : 1) Oral Symptoms (1 question), 2) Child-related Function (4 questions), 3) Child's Psychology (2 questions), and 4) Child's Self-image and Social Interaction (2 questions). The second part addresses the impacts of MLQ on the family (\"family section\") and includes two domains with a total of four questions: 1) Parental Distress/Suffering (2 questions) and 2) Family-related Function (2 questions).\u003c/p\u003e \u003cp\u003eThe CPQ consists of 25 items divided into four subscales [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]: 1) Oral Symptoms (5 questions), 2) Functional Limitations, 3) Emotional Well-being, and 4) Social Well-being. Additionally, there are two questions regarding general oral health and overall health, which respondents can rate as \"excellent\" = 4, \"very good\" = 3, \"good\" = 2, \"fair\" = 1, and \"poor\" = 0. In these questions, a high value corresponds to an exceptionally good (oral) health status, unlike the rest of the items.\u003c/p\u003e \u003cp\u003eThe data from the questionnaires were manually transferred into an Excel spreadsheet and into the statistical analysis software IBM SPSS Statistics Version 27 (IBM Corp., Armonk, NY, USA). Prior to analysis, a Pearson correlation coefficient of 0.30 and a significance level of 0.05 were set in SPSS. This was then cross-checked by a second person involved in the study planning. The diagnosis or reason for presentation of the patients was supplemented from the clinical patient records. If a patient had two relevant diagnoses, both were included in the database.\u003c/p\u003e \u003cp\u003eNominal measurements (e.g., gender, type of diagnosis) were summarized using frequencies and proportions, along with cross tabulations. T-tests for independent samples were calculated to compare interesting proportions between both groups. Analysis of variance (ANOVA) was conducted to assess statistical significance and subsequently examined for validity through correlation analysis. Correlation analysis was performed to analyze the effect of different factors on global oral health, overall well-being, and OHRQoL (ECOHIS scores).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of a total of 103 participants, 4 were excluded due to incorrectly filled out questionnaires, resulting in only 99 children (46% female, 53% male) being included in the study. Subsequently, it was found that the overall population had not been strictly separated according to the age criteria. For organizational reasons, the ECOHIS group (n = 46) included 2 subjects who were older than 6 years, and the CPQ group (n = 53) included 29 subjects whose ages were outside the range of 8-10 years. A particular difficulty arose with the 7-year-olds (n = 11), the age group that fell between ECOHIS and CPQ subjects. Of them, 9 received the CPQ questionnaire and 2 received the ECOHIS questionnaire. Table 1 and 2 summarizing the characteristics of the study population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Characteristics of the study population for ECOHIS and CPQ groups.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding the most common problems, as seen in Table 2, the response frequencies of the six most common oral problems among ECOHIS respondents are listed. Accordingly, 26.1% of respondents reported being \u0026quot;hardly\u0026quot; affected by \u0026quot;pain,\u0026quot; while 28.3% reported being \u0026quot;never\u0026quot; affected. Additionally, 19.6% reported experiencing \u0026quot;occasional\u0026quot; pain, and 17.4% reported experiencing \u0026quot;frequent\u0026quot; pain. For more than two-thirds (69.6%) of respondents, \u0026quot;pain\u0026quot; was likewise \u0026quot;never\u0026quot; a problem, and the \u0026quot;absence from kindergarten/daycare/school\u0026quot; due to oral symptoms had \u0026quot;never\u0026quot; occurred in most children (73.9%) so far. \u0026quot;Sleeping problems\u0026quot; mostly also \u0026quot;never\u0026quot; (60.9%) arose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eECOHIS \u0026ndash; Most common problems (n = 46)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the younger age group, measured with the ECOHIS, 95.7% of parents rated the \u0026quot;general health status\u0026quot; of their child as \u0026quot;good,\u0026quot; \u0026quot;very good,\u0026quot; or \u0026quot;excellent,\u0026quot; while 4.4% rated it as \u0026quot;fair\u0026quot; or \u0026quot;poor\u0026quot;. However, only 65.2% rated the \u0026quot;oral health status\u0026quot; as \u0026quot;good\u0026quot; or better, with 34.8% rating it as \u0026quot;fair\u0026quot; or \u0026quot;poor.\u0026quot; As shown in Table 3, no statistically significant association was found between the ECOHIS total score and the \u0026quot;general health status\u0026quot; (\u0026rho; = 0.035; p = 0.82 \u0026gt; 0.05). The correlation of the \u0026quot;Child Section\u0026quot; domain with the \u0026quot;general health status\u0026quot; was also found to be non-significant (\u0026rho; = 0.18, p = 0.24 \u0026gt; 0.05). In contrast, a significant association was observed between the total score of the \u0026quot;Family Section\u0026quot; domain and the total score of the \u0026quot;general health status\u0026quot; (\u0026rho; = 0.31; p = 0.03 \u0026lt; 0.05). However, similar to the \u0026quot;general health status,\u0026quot; the association between the \u0026quot;oral health status\u0026quot; and the \u0026quot;Family Section\u0026quot; was significant (\u0026rho; = 0.33; p = 0.03 \u0026lt; 0.05) as seen in table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eECOHIS correlation: General / Oral health status \u0026amp; domains or total score (n = 46)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMore than two-thirds (67.4%) of the children presented to the Emergency Unit at the Department of Paediatric Dentistry in Vienna due to caries-related pain. Among the 31 subjects with caries, eleven additionally suffered from swelling/fistula. Thus, 35.5% of the caries patients and 23.9% of all 46 ECOHIS subjects had a fistula as a complication of caries. Table 4 presents the ECOHIS total score as well as the domain total scores in the group of the two most common diagnoses, caries (n = 31), and anterior tooth trauma (n = 9). In the caries subpopulation, the mean ECOHIS total score was 13.77 (\u0026plusmn; 9.885; range 0-42), and the domain total score in the \u0026quot;Child Section\u0026quot; averaged 7.68 (\u0026plusmn; 7.54; range 0-30). In the \u0026quot;Family Section,\u0026quot; the domain total score averaged 2.90 (\u0026plusmn; 2.88; range 0-8). Patients with the second most common diagnosis, anterior tooth trauma (n=9), had an average ECOHIS total score of 7.33 (\u0026plusmn; 3.64; range 0-13) and a domain total score of 2.33 (\u0026plusmn; 3.00; range 0-8) in the \u0026quot;Child Section.\u0026quot; In the \u0026quot;Family Section,\u0026quot; the average was 0.22 (\u0026plusmn; 0.67; range 0-2).\u003c/p\u003e\n\u003cp\u003eMoving on to the CPQ group, the average total score when answering the CPQ was 18.36 (\u0026plusmn; 12.35; range 0-50). The occurrence of \u0026quot;oral symptoms\u0026quot; was rated on average with the highest domain sum score of 6.11 (\u0026plusmn; 4.08; range 0-15). Table 5 summarizes the response frequencies for the six most common oral health-related issues of the CPQ. 24.5% of patients reported experiencing \u0026quot;frequent\u0026quot; toothache, while 20.8% reported experiencing it \u0026quot;occasionally\u0026quot;. The majority of respondents (30.0%) reported experiencing such pain \u0026quot;once or twice\u0026quot; during the specified period, and 17.0% reported having experienced it \u0026quot;never\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eECOHIS \u0026ndash; Most common diagnoses \u0026amp; their (domain) total scores\u0026nbsp;(n = 46)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: CPQ - Most common oral health-related problems\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(n = 53)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first two parts of the CPQ capture \u0026quot;general health status\u0026quot; and \u0026quot;oral health status\u0026quot;. In this study, 96.2% of respondents rated their \u0026quot;general health status\u0026quot; as \u0026quot;good\u0026quot;, \u0026quot;very good\u0026quot;, or \u0026quot;excellent\u0026quot;, while 3.8% rated it as \u0026quot;fair\u0026quot; (none rated it as \u0026quot;poor\u0026quot;). However, only 69.8% rated their \u0026quot;oral health status\u0026quot; as \u0026quot;good\u0026quot; or better, while 30.2% rated it as \u0026quot;fair\u0026quot; or \u0026quot;poor\u0026quot;.\u003c/p\u003e\n\u003cp\u003eTo examine the relationships between \u0026quot;general health status\u0026quot; and the CPQ sum score, as well as the individual domains, Spearman\u0026apos;s rank correlation coefficient (\u0026rho;) was calculated analogously to the ECOHIS evaluation and tested for significance using the p-value (p) at a significance level of 0.05 (Table 6). Similarly, the \u0026quot;oral health status\u0026quot; was tested for correlations (Table 6). No significant correlation between the \u0026quot;general health status\u0026quot; and the overall CPQ sum score could be established (\u0026rho; = 0.09; p = 0.52 \u0026gt; 0.05) (Table 8). The relationship between the \u0026quot;oral health status\u0026quot; and the overall CPQ sum score was also found to be non-significant (\u0026rho; = 0.23; p = 0.09 \u0026gt; 0.05) (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: CPQ Correlation General / Oral Health Status \u0026amp; Domains or Sum Score\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(n = 53)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is noticeable that more than half (50.9%) of the patients showed caries. Of the 27 participants with caries, four simultaneously suffered from a fistula or swelling. Thus, 14.8% of the participants had caries, and 7.5% of all participants had a fistula as a complication of caries. Almost a quarter (24.5%) of the respondents had less common problems (\u0026quot;Others\u0026quot;), such as broken fillings or crowns, space maintainer fractures or pressure sores, fractures, hypersensitivity pain, tooth mobility, or teething pain. The most common diagnosis, \u0026quot;caries\u0026quot; (n = 27), is analyzed in more detail regarding the response behavior in the CPQ (Table 7). A decreasing mean value was observed from domain 1 to domain 4 (with their ascending numerical designations). In domain 1, \u0026quot;oral symptoms,\u0026quot; the average sum score was the highest at 5.85 (\u0026plusmn; 4.25; range 0-15). In domain 2, \u0026quot;functional limitations,\u0026quot; the average sum score was 3.41 (\u0026plusmn; 4.12; range 0-12). The scores for emotional and social well-being were lower (3.00 \u0026plusmn; 3.44; range 0-12 and 1.04 \u0026plusmn; 1.87; range 0-8, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: CPQ - Most Common Diagnoses \u0026amp; Their (Domain) Sum Scores\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(n = 53)\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study focuses on oral-health-related quality of life (OHRQoL) in children aged 0\u0026ndash;10 during the early weeks of COVID-19 pandemic. It aimed to evaluate the impact of COVID-19 restrictions on children's OHRQoL and its correlation with health and social conditions. Results showed a decrease in OHRQoL, with the highest impact in the \"oral symptoms\" domain, primarily due to toothache. Significant correlations were also found between general and oral health with family background (ECOHIS) and between oral health, oral symptoms, and emotional well-being (CPQ).\u003c/p\u003e \u003cp\u003eThe ECOHIS participants showed a relatively balanced gender distribution, with females (56%) outnumbering males (43%). According to the predetermined classification, the age should be between 0 and 6 years. Two of the 11 seven-year-olds were assigned to the ECOHIS instead of the CPQ, due to difficulties in self-completing the ECOHIS. Among the CPQ respondents, there was an uneven gender distribution. Almost two-thirds of the included participants were male (62%), while slightly more than one-third were female (38%). When considering the age of the CPQ participants, it ranged from 5 to 14 years at the time of the survey. According to the protocol, participants younger than 8 years old should have answered the ECOHIS instead of the CPQ (ages 8\u0026ndash;10), and participants older than 10 years old should have answered the CPQ (ages 11\u0026ndash;14) (total n\u0026thinsp;=\u0026thinsp;29).\u003c/p\u003e \u003cp\u003eThe average age of the CPQ participants being 8 years old, with a range of 5\u0026ndash;14 years, confirms that most children were in the age group defined by the questionnaire, which is 8\u0026ndash;10 years old. This is further supported by the standard deviation (\u0026plusmn;\u0026thinsp;2.1), which provided little room for variation. It can be concluded that the ECOHIS participants were predominantly older, while the CPQ participants were predominantly younger than the mean age of the age group for which the questionnaire was designed. From this, it can be inferred that only a few patients of the ECOHIS were included at the lower end and few of the CPQ at the upper end of the age range.\u003c/p\u003e \u003cp\u003eThe ECOHIS standard deviation (Σ) of 12.22 in this study was significantly higher compared to other studies conducted under normal conditions in various countries: Australia (4.20), Brazil (3.84), China (9.63), Austria (6.10), Mexico (3.20), Peru (8.74), and Thailand (4.15) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Specifically, the study's ECOHIS_Σ of 12.22 was notably higher than the 6.12 measured in Austria under normal conditions, indicating a more significant restriction in OHRQoL during the pandemic. This higher deviation is attributed to the study population being from an emergency service rather than routine care. Spanemberg et al. reported that patients in pain services have an eight-fold higher likelihood of experiencing greater OHRQoL impairment compared to those in routine treatment [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The range of 0\u0026ndash;42 reflected the highly variable perception of OHRQoL, and the ECOHIS_Σ of 12.22 was shifted far to the left in this range, illustrating the relatively low average OHRQoL impairment.\u003c/p\u003e \u003cp\u003eThe average poorer OHRQoL of our participants could also be attributed to the emergency situation, as observed in patients treated by the pain service compared to routine treatment. Therefore, the potentially worse OHRQoL of our participants may be justified by the emergency situation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Rauch et al. also found in their survey that patients presenting with pain in German emergency dental care services, in addition to a high prevalence of dental anxiety, exhibited a high level of OHRQoL impairment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These findings mitigate the potential influence of the pandemic on the OHRQoL.\u003c/p\u003e \u003cp\u003eIn other publications, it has also been demonstrated that \"tooth pain\" has the strongest impact on individual oral health-related quality of life (1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The closely clustered average response values of the remaining ECOHIS questions suggest a similar influence on OHRQoL.\u003c/p\u003e \u003cp\u003eUpon closer analysis, it is evident that the responses in the ECOHIS questionnaire differed significantly from those in the CPQ questionnaire. While the majority (54.4%) of ECOHIS respondents reported \"never\" or \"rarely\" experiencing \"tooth pain\" in the affected young child, the CPQ respondents mostly (45.3%) perceived pain \"occasionally\" or \"often.\" The ECOHIS evaluation study by Pahel et al. found a more frequent rating of \"never\" or \"rarely\" in response to the pain question (83.1%) compared to our cohort [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, for other \"most common problems\" (such as \"difficulty drinking hot/cold beverages\" 63% and \"difficulty eating certain foods\" 50%), a majority of ECOHIS respondents in our study reported these problems as \"never\" occurring. This is corroborated by data from an Italian evaluation conducted in 2020 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Pahel and colleagues found even more frequent positive responses such as \"never\" and \"rarely\" indicative of good OHRQoL in the populations they studied compared to our study [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, the relationships between the ECOHIS domains and the \"general health status\" and \"oral health status\" should be discussed. A significant, \"moderately\" strong correlation was found between the \"general health status\" and the \"family section\" (ρ\u0026thinsp;=\u0026thinsp;0.31; p\u0026thinsp;=\u0026thinsp;0.03). Similarly, a significant correlation was found between the \"oral health status\" and the \"family section\" (ρ\u0026thinsp;=\u0026thinsp;0.33; p\u0026thinsp;=\u0026thinsp;0.03). Thus, poor (oral) health was associated with high response values in the family section, indicating a significant disruption in family life. No correlations were found between the \"child section\" and the \"general sum scores\" with the \"general health status\" and \"oral health status.\" This could be attributed to the small sample sizes.\u003c/p\u003e \u003cp\u003eIn some of the studies conducted under normal conditions, the study populations were subdivided into subgroups based on diagnoses, enabling a comparison with our work. Abanto et al. differentiated Brazilian patients regarding their OHRQoL into \"caries-affected\" (16.65\u0026thinsp;\u0026plusmn;\u0026thinsp;11.56), \"with trauma\" (8.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81), and \"with anterior malocclusion\" (8.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.84) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Another population studied in Mexico showed significantly lower values for these diagnoses [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor \"caries-affected\" individuals, the average ECOHIS sum scores were 3.26 (\u0026plusmn;\u0026thinsp;0.39), for \"with trauma\" it was 5.4 (\u0026plusmn;\u0026thinsp;1.95), and for \"open bite\" it was 3.1 (\u0026plusmn;\u0026thinsp;0.26). Bekes et al. collected an ECOHIS_Σ of 8.6 (\u0026plusmn;\u0026thinsp;6.7) in the Austrian normal collective for caries-affected individuals [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In China, an ECOHIS_Σ of 14.98 (\u0026plusmn;\u0026thinsp;6.99) was found for caries-affected individuals [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Comparing the caries sum scores of these studies with our work (13.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.885), it can be observed that the results of the Brazilian (16.65\u0026thinsp;\u0026plusmn;\u0026thinsp;11.56) and Chinese studies (14.98\u0026thinsp;\u0026plusmn;\u0026thinsp;6.99) were closest to the values we determined [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn Austrian study of the CPQ found a total score of 7.5 [\u0026plusmn;\u0026thinsp;8.6] in children without caries compared to 9.1 [\u0026plusmn;\u0026thinsp;10.1] in children with caries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This means that the score of those affected by caries was more than half of the one we determined (16.33 [\u0026plusmn;\u0026thinsp;12.38]). At the beginning of the pandemic, caries patients in Austria perceived their MLQ (Mean Life Quality) as significantly worse than under normal conditions.\u003c/p\u003e \u003cp\u003eIn other evaluation studies, such as those from the Arab Emirates (23.3 [\u0026plusmn;\u0026thinsp;19.0]) and Cambodia (22.4 [\u0026plusmn;\u0026thinsp;13.6]), the total scores of those affected by caries also reached a higher level than the caries total score we determined [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].However, the scores from the previously cited Turkish (13.2 [\u0026plusmn;\u0026thinsp;9.1]) and Mexican (14.87) studies were lower than our caries total score [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The impairment of the MLQ due to caries in our study was statistically in the mid-range compared to studies that considered this item under different conditions.\u003c/p\u003e \u003cp\u003eThe average overall sum score of CPQ participants in our study was CPQ_Σ 18.36. With a maximum possible sum score of 140 points, this average indicated a low OHRQoL impairment. However, the range of 0\u0026ndash;50 was very large, suggesting many different response values and thus different weights of questions. This was also evident from the large standard deviation of \u0026plusmn;\u0026thinsp;12.35. The sum score of 18.36 is shifted to the left in the range, confirming the relatively low average OHRQoL impairment. Upon closer examination of the individual questions, the significantly negative influence of the symptom \"tooth pain\" on OHRQoL was confirmed (1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22). A Brazilian study published in 2021 also reached the same conclusion, where the negative effects of tooth pain were more strongly associated with poorer OHRQoL than dental malocclusions [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Four other questions stood out in our analysis with values greater than 1.0 compared to the rest of the items. One question was: \"How often food got stuck in the teeth\" (1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36). It also belongs to the domain of oral symptoms and had nearly the same negative impact on OHRQoL as the question about \"pain.\" The other three items that contributed most to reducing OHRQoL were: how often the child \"got annoyed,\" experienced \"pain when drinking cold beverages or eating,\" or had \"difficulty eating or chewing foods such as apples, corn on the cob, or meat.\" These questions and related common answers give a clear indication on the influence of oral health on the quality of life.\u003c/p\u003e \u003cp\u003eMost participants experienced \"tooth pain\" \"often,\" making it a particularly distressing symptom. In contrast, in the domains of \"pain when drinking cold beverages or eating\" and \"food getting stuck in the teeth,\" the response values were relatively evenly distributed. The frequency of response values such as \"very often,\" \"often,\" \"occasionally,\" etc., varied little. Most participants reported \"never\" having a problem with \"bad breath.\" This contrasted with the results of a study published in 2011, which surveyed a group of adolescents aged 11\u0026ndash;14 years using the CPQ-G [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In that study, foetor ex ore was perceived as \"often\" or \"very often.\"\u003c/p\u003e \u003cp\u003eThe older children, like the younger ones in the ECOHIS, answered the question about \"oral health status\" with more negative scores than the question about \"general health status.\" While only 69.8% rated their \"oral health status\" as \"good\" or better, with 30.2% rating it as \"fair\" or \"poor,\" the \"general health status\" was rated as \"good\" or better by 96.2% of the cohort, with none rating it as \"poor.\" From the participants' perspective, oral health thus had little influence on general health.\u003c/p\u003e \u003cp\u003eAnalyzing the correlations of the domains with \"oral health status\" and \"general health status,\" it can be observed that none of the domains, nor the overall sum score, correlated significantly with \"general health status.\" However, there was a tendency for a relationship between oral symptoms and general health, for instance. With a larger sample size, the significance level might have been reached. Two out of the four domains correlated significantly with \"oral health status.\" A statistically significant, \"moderate\" causal relationship was observed between \"oral symptoms\" and \"emotional well-being.\" This demonstrates an interaction between \"oral symptoms\" and \"emotional well-being\" with \"oral health status.\" The factors in the pandemic exerting a strongly negative influence on \"oral symptoms\" remain speculative. It is possible that patients, due to social restrictions and regulations, had more time to focus on their personal issues. Additionally, the population's awareness of \"health changes\" may have been heightened due to the confrontation with the novel, unexplored virus. Another reason for the high OHRQoL scores could have been the late presentation to emergency dental services, leading to significantly reduced oral health. Better prevention and thus avoidance of OHRQoL deterioration could be achieved in the future if patients present themselves to emergency services more promptly under pandemic restrictions. Also, regular visits to dental practices without the pressure of a crisis situation would mitigate the negative OHRQoL development. These unconfirmed speculations could serve as a research approach for further studies.\u003c/p\u003e \u003cp\u003eThis study is the first systematic analysis of OHRQoL in Austrian children during the early COVID-19 pandemic, but it has limitations. The small study group reduces statistical significance, and the results, reflecting Vienna's situation in the pandemic's early weeks, may not apply to other regions.\u003c/p\u003e \u003cp\u003eNew health strategies to combat the pandemic were implemented after the first 6 weeks of the study. Further research is needed to investigate their impact on oral health and OHRQoL.\u003c/p\u003e \u003cp\u003eAnother study limitation is not considering the respondent's gender in the toddler group (ECOHIS). Research shows fathers and mothers assess children's health differently, with mothers generally providing more reliable answers about oral health [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Furthermore, some participants misunderstood the questionnaires, leaving notes indicating confusion and occasionally overlooking the back page, leading to unwanted exclusions. On some days, no questionnaires were answered due to pandemic-related staff shortages, while more were completed on following days. Additionally, comparing our results with other studies was impossible due to the lack of similar research.\u003c/p\u003e \u003cp\u003eLastly, the outbreak of the pandemic was an unexpected event with an unpredictable course of infection. The pandemic caught both the population and dental care completely unprepared. During the observation period, new strategies had to be constantly developed to combat the disease and maintain healthcare services. At the beginning of our six-week observation, the OHRQoL may have been assessed differently than at the end, as circumstances changed rapidly. It is likely that today, over two years after the start of the pandemic, a survey would yield completely different results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe early COVID-19 pandemic significantly impacted the OHRQoL of children aged 0\u0026ndash;10 years old.\u003c/p\u003e \u003cp\u003eThe main reasons for impaired OHRQoL were toothaches. In the younger group (ECOHIS), oral health was influenced by family circumstances, while in CPQ, it was affected by oral symptoms and emotional well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceived and designed the study: KB.\u003c/p\u003e\n\u003cp\u003eConducted the study: KB, CD.\u003c/p\u003e\n\u003cp\u003eAnalyzed the data: KB, CD, AA.\u003c/p\u003e\n\u003cp\u003eInterpreted the data: All authors.\u003c/p\u003e\n\u003cp\u003eWrote the manuscript: AA, KB.\u003c/p\u003e\n\u003cp\u003eRead, revised and agreed to be accountable for the manuscript: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by 3M.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003eThis article does not contain any studies with animals performed by any of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eAll data supporting the reported results are available upon request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInformationen zu den Mutationen des Coronavirus | Statista. 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Spec Care Dent 33(1):8\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/J.1754-4505.2012.00294.X\u003c/span\u003e\u003cspan address=\"10.1111/J.1754-4505.2012.00294.X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 7 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"oral health, dental pain, quality of life, Covid-19, general health","lastPublishedDoi":"10.21203/rs.3.rs-4905859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4905859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOral-health-related quality of life (OHRQoL) has become increasingly significant in dentistry. This study examines OHRQoL during the early COVID-19 pandemic in children aged 0\u0026ndash;10 who visited the Emergency Unit of the Department of Paediatric Dentistry in Vienna from March to May 2020, focusing on the impact of COVID-19 restrictions on various social and health aspects.\u003c/p\u003e \u003cp\u003e \u003cb\u003eObjectives\u003c/b\u003e: The study aimed to assess OHRQoL in children during early weeks of the COVID-19 pandemic and correlate it with other health and social conditions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMaterial \u0026amp; Methods\u003c/b\u003e: Children (up to 10 years) and their parents visiting the Emergency unit of the Department completed OHRQoL questionnaires. In children aged 0\u0026ndash;6, their parents answered the Early Childhood Oral Health Impact Scale questionnaire (ECOHIS), while 7-10-year-olds completed the Child Perception Questionnaire (CPQ) by themselves. Summary scores and associations between oral and general health subdomains were analyzed.\u003c/p\u003e \u003cp\u003e\u003cb\u003eResults\u003c/b\u003e: Both the ECOHIS and CPQ groups showed high general summary scores, indicating decreased OHRQoL (ECOHIS 12.22 [\u0026plusmn;\u0026thinsp;8.68] and CPQ 18.36 [\u0026plusmn;\u0026thinsp;12.35]). The highest scores were in the \"oral symptoms\" domain, mainly due to \"toothache.\" Significant correlations were observed between \"general health\" and \"oral health\" with the \"family section\" in the ECOHIS group, and between \"oral health\" and \"oral symptoms\" and \"emotional well-being\" in the CPQ group.\u003c/p\u003e \u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e: During the pandemic, both age groups experienced decreased OHRQoL. Family background influenced oral health (ECOHIS), while oral symptoms and emotional well-being correlated with oral health (CPQ). Further research is needed to understand pandemic-related factors affecting OHRQoL and develop preventive strategies.\u003c/p\u003e","manuscriptTitle":"Oral health-related quality of life in children attending the pain service at the University Dental Clinic Vienna at the onset of the COVID-19 pandemic in 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-10 11:08:59","doi":"10.21203/rs.3.rs-4905859/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4523f2b1-0084-4bcc-b77b-c34de83b2eca","owner":[],"postedDate":"September 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T15:23:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-10 11:08:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4905859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4905859","identity":"rs-4905859","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}