Identifying the Unseen: Cross-Cultural Adaptation and Psychometric Properties of the Persian Dental Neglect Scale (P-Dns) to Uncover Oral Health Neglect in Iranian Seniors Publisher Pubmed



Taghian M ; Najafi H ; Molania T ; Hoshyari N ; Alizadeh Ghamsari S ; Fendereski A ; Papi S
Source: BMC Geriatrics Published:2025

Abstract

Background: Good oral health is vital for quality of life, yet many older adults neglect their oral hygiene and dental visits. As no specific tool adapted to the Iranian cultural and socioeconomic context exists to assess oral health neglect in this population, this study aimed to evaluate the psychometric properties and cross-cultural adaptation of the Persian version of the Dental Neglect Scale (P-DNS) for older adults. Methods: This methodological study used convenience sampling at Tooba Clinic in Sari, Iran, from May to July 2024. Data were collected via face-to-face interviews using the P-DNS, the Geriatric Oral Health Assessment Index (GOHAI), the Decayed, Missing, and Filled Teeth (DMFT) index, the Gingival Index (GI), and a demographic questionnaire. P-DNS translation and cultural adaptation followed Beaton et al.‘s guidelines. Psychometric properties were analyzed using SPSS v.25.0, with statistical significance set at p < 0.05. Results: The study included 200 participants (mean age: 65.5 ± 5.7 years). Mean (± SD) scores were: P-DNS 19.5 ± 5.5, GOHAI 23.5 ± 5.1, DMFT 23.2 ± 8.3, and GI 1.43 ± 0.45. Experts confirmed face, content (scale-level CVI = 0.89), and cross-cultural validity. Confirmatory factor analysis indicated a good model fit (GFI = 0.99, CFI = 1). Convergent validity was supported by a significant positive correlation between P-DNS and GOHAI (r = 0.57, p < 0.05). Divergent validity was supported by significant negative correlations between P-DNS and the DMFT (r = − 0.42, p < 0.05) and GI (r = − 0.46, p < 0.05) indices. Internal consistency (Cronbach’s α = 0.91) and test-retest reliability (ICC = 0.92) were high. Using ROC curve analysis with the GOHAI as a criterion, an optimal cut-off score of 13.5 was established (AUC = 0.82), yielding 88.1% sensitivity and 65.5% specificity. No significant floor (2%) or ceiling (2.5%) effects were observed. Higher P-DNS scores (indicating less neglect) were positively associated with higher education, better perceived economic and oral health status, having insurance, and more frequent dental visits and brushing (p < 0.05). Conclusion: The P-DNS demonstrated high validity and reliability, making it a valuable tool for assessing dental neglect among older adults in Iran. However, the findings’ generalizability may be limited due to the use of convenience sampling. © 2025 Elsevier B.V., All rights reserved.