Validation of an erosive tooth wear risk factors questionnaire for adolescents

Objective To validate a questionnaire for the identification of factors associated with erosive tooth wear (ETW) in adolescents. Materials and methods Based on previous questionnaires, a 73-question instrument was designed (four domains: sociodemographics, general/oral health history, diet and oral care habits). Content validity was assessed by five external experts, and the questions' understandability was evaluated in a pilot study (10 adolescents). Three internal experts agreed on modifications. Construct validity was assessed after the resulting questionnaire was applied to 454 12- to 15-year olds from Bogota (Colombia). Statistical analyses included exploratory factor analysis (EFA), internal consistency, and confirmatory factor analysis (CFA). Results After the content validation, 52% of the questions were excluded and remaining 38 questions were adjusted. Construct validation: The EFA resulted in the regrouping of questions into the three remaining domains (KMO = 0.68; Bartlett's test: p < 0.001). Internal consistency was good (general questionnaire Cronbach's alpha = 0.67; individual factors' Cronbach's alpha = 0.30-0.69; ICC = 0.39-0.62; p < 0.001), and the model showed satisfactory fit. CFA showed good convergent and discriminatory validity suggesting the elimination of 14 additional questions (chi(2) =238.518; p > 0.086; CFI = 0.96; TLI = 0.95; RMSEA = 0.017; PRATIO = 0.76). The final validated questionnaire comprised 24 questions (general/oral health history: n = 5; dietary habits: n= 15; oral care habits: n = 4). Conclusion The validation of the ETW questionnaire for adolescents was satisfactory and resulted in a short applicable questionnaire version.