Table of Contents
Abstract
The psychosocial impact of dental aesthetics Questionnaire (PIDAQ) is a specialized psychometric instrument designed to evaluate how an individual's dental appearance influences their psychological well-being and social functioning. Originally developed to capture the nuanced ways that dental aesthetics impact quality of life, the scale recognizes that oral health extends far beyond mere physical functioning or the absence of disease. It acknowledges that a person's smile and dental alignment can profoundly affect their self-esteem, social interactions, and overall mental health.
The Portuguese adaptation of this instrument (PIDAQ-PT) represents a rigorous cross-cultural translation aimed at providing clinicians and researchers in Portugal with a reliable tool for assessing these subjective experiences. By translating and validating this measure, psychometricians have ensured that the cultural nuances of the Portuguese population are accurately reflected in the assessment of dental aesthetics. This adaptation process involved strict adherence to international guidelines, including forward and backward translation, expert panel reviews, and pilot testing to guarantee semantic and conceptual equivalence.
In the broader landscape of health psychology and dental research, the PIDAQ-PT serves as a critical bridge between objective clinical assessments and Patient-Reported Outcomes. It allows dental professionals, particularly in Orthodontics and cosmetic dentistry, to quantify the psychosocial burden of dental anomalies and to track psychological improvements following treatment. The validation of this tool in a Portuguese cohort not only expands the global utility of the PIDAQ but also reinforces the universal importance of aesthetic oral health in shaping human psychosocial experiences.
📊 Psychometric Scorecard
23
Multidimensional
0.91
0.905
📍 Portugal
Authors
Purpose
The primary purpose of the PIDAQ-PT is to provide a standardized, patient-centered metric for evaluating the psychosocial distress or confidence associated with dental appearance. Historically, dental treatment needs were determined almost exclusively by objective clinical indices, such as the degree of malocclusion or the physical presence of decay. However, these objective measures often fail to correlate with the patient's actual lived experience or their motivation for seeking treatment.
This instrument fills a crucial gap by capturing the subjective, psychological dimension of dental aesthetics. For researchers, it offers a validated metric to study the intersection of oral health and mental well-being across different populations. For clinicians—especially those in Orthodontics, periodontics, and restorative dentistry—the scale acts as a vital baseline assessment tool. It helps practitioners understand the patient's aesthetic concerns, tailor treatment plans to address specific psychosocial impacts, and objectively measure the psychological success of cosmetic interventions over time.
Construct
The psychological construct measured by the PIDAQ-PT is the multidimensional psychosocial impact of dental aesthetics. This construct is rooted in health-related quality of life theories, which posit that physical characteristics (like a smile) interact with cognitive and emotional processes to shape an individual's self-concept and social reality. The scale operationalizes this broad construct into four distinct but interrelated dimensions.
The first dimension, dental self-confidence, captures the positive psychological states and self-assurance derived from one's dental appearance. The social impact dimension evaluates the extent to which individuals feel their dental aesthetics hinder their social interactions or cause them to worry about others' judgments. The psychological impact domain assesses internalized negative emotions, such as feeling inferior or unhappy due to one's teeth. Finally, the esthetic concern factor measures the individual's direct worry or dissatisfaction with the visual appearance of their dentition. Together, these facets provide a comprehensive profile of how dental aesthetics permeate a person's psychological landscape.
Validity
Validity evidence for the PIDAQ-PT was primarily established through rigorous construct validation techniques, specifically confirmatory factor analysis (CFA). The researchers sought to determine if the original four-factor structure developed in other cultural contexts would hold true for the Portuguese population. The CFA results demonstrated a good fit for the model, with Comparative Fit Indices (CFI) ranging from 0.905 to 0.921. In psychometric evaluation, CFI values above 0.90 generally indicate an acceptable fit, suggesting that the theoretical model adequately represents the observed data.
Additionally, the Root Mean Square Error of Approximation (RMSEA) values fell between 0.088 and 0.090. While ideal RMSEA values are typically lower (often cited as < 0.08), values up to 0.10 are frequently considered acceptable in complex, multidimensional psychological measures. These fit indices collectively provide strong evidence that the Portuguese translation successfully captures the same four distinct psychosocial domains as the original instrument, ensuring that the scale measures what it theoretically claims to measure within this specific cultural demographic.
Reliability
The reliability of the PIDAQ-PT was evaluated using both internal consistency and temporal stability metrics, yielding exceptionally strong results. The overall internal consistency of the scale was excellent, with a Cronbach's alpha of 0.91. When examining the individual subscales, the alpha coefficients were even higher, ranging from 0.93 to 0.98. These values indicate a very high degree of interrelatedness among the items within each domain, meaning that the questions are reliably tapping into the same underlying concepts without excessive redundancy.
To assess temporal stability, the researchers conducted a test-retest reliability analysis over a one-week interval with a subset of participants. The resulting Intraclass Correlation Coefficient (ICC) for the total scale was 0.84, with subscale ICCs ranging from 0.87 to 0.96. In psychometric standards, an ICC above 0.75 is considered indicative of good reliability, and values above 0.90 are excellent. This demonstrates that the PIDAQ-PT is highly stable over time, ensuring that fluctuations in scores reflect true changes in the patient's psychosocial state rather than measurement error.
Factor Analysis
The factor structure of the PIDAQ-PT was investigated using Confirmatory Factor Analysis (CFA), a robust structural equation modeling technique used to verify the hypothesized dimensional structure of an instrument. Because the PIDAQ has a well-established four-factor model from its original development and subsequent international validations, the researchers did not need to perform exploratory factor analysis. Instead, they directly tested how well the Portuguese data fit the predefined model consisting of dental self-confidence, social impact, psychological impact, and esthetic concern.
The analysis was powered by a robust sample size of 501 participants, easily exceeding the recommended threshold of 10 participants per item (which would require a minimum of 230 subjects for a 23-item scale). This large sample ensured the stability of the variance-covariance matrix during the CFA. The resulting fit indices (CFI > 0.90, RMSEA < 0.09) confirmed that the 23 items map appropriately onto their respective latent factors in the Portuguese version, maintaining the structural integrity of the original scale.
Subscales
| Subscale | Items | Description |
|---|---|---|
| Dental self-confidence | 1, 2, 3, 4, 5, 6 | Measures the positive psychological impact and self-assurance an individual derives from their dental appearance. |
| Social impact | 7, 8, 9, 10, 11, 12, 13, 14 | Assesses the degree to which an individual's dental aesthetics negatively affect their social interactions and cause concern about others' perceptions. |
| Psychological impact | 15, 16, 17, 18, 19, 20 | Evaluates internalized negative emotions, such as feelings of inferiority or unhappiness, stemming from dental appearance. |
| Esthetic concern | 21, 22, 23 | Captures the individual's direct dissatisfaction and worry regarding the visual appearance of their teeth. |
Instrument
| Test Type | Self-report questionnaire |
| Format | 23 items, 5-point Likert scale (0 = 'not at all' to 4 = 'very strongly') |
| Scoring | Items in the dental self-confidence subscale are reverse-scored to align with the other subscales. Higher total scores indicate a greater negative psychosocial impact of dental aesthetics. |
| Language | Portuguese |
| Population | Adults, Clinical patients |
| Age Group | 18-88 years |
| Administration | Face-to-face interview |
Scoring & Interpretation Guidelines
| Scoring Instructions | Reverse score items 1 through 6 (Dental self-confidence subscale) |
Sample
The validation sample consisted of 501 adult patients (mean age 48.7 years, standard deviation 18.0; range 18-88 years) seeking triage appointments at the Egas Moniz Dental Clinic in Almada, Portugal. The sample was predominantly female (52.3%). An additional pilot sample of 50 individuals was used for the initial semantic equivalence and test-retest reliability phases.
Cite This Paper
João Fidalgo, João Botelho, Luís Proença, José João Mendes, Vanessa Machado, Ana Sintra Delgado (2022). psychosocial impact of dental aesthetics Questionnaire – Portuguese Version. International journal of environmental research and public health. https://doi.org/10.3390/ijerph19169931
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Psychosocial Impact of Dental Aesthetics Questionnaire – Portuguese Version Items
Items are not yet available
The scale author has been contacted to obtain permission to share the items. This section will be updated once the items are provided.
Cite this article
Mohammed looti (2026). Psychosocial Impact of Dental Aesthetics Questionnaire – Portuguese Version. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/psychosocial-impact-of-dental-aesthetics-questionnaire-portuguese-version/
Mohammed looti. "Psychosocial Impact of Dental Aesthetics Questionnaire – Portuguese Version." PSYCHOLOGICAL SCALES, 12 Aug. 2026, https://scales.arabpsychology.com/s/psychosocial-impact-of-dental-aesthetics-questionnaire-portuguese-version/.
Mohammed looti. "Psychosocial Impact of Dental Aesthetics Questionnaire – Portuguese Version." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/psychosocial-impact-of-dental-aesthetics-questionnaire-portuguese-version/.
Mohammed looti (2026) 'Psychosocial Impact of Dental Aesthetics Questionnaire – Portuguese Version', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/psychosocial-impact-of-dental-aesthetics-questionnaire-portuguese-version/.
[1] Mohammed looti, "Psychosocial Impact of Dental Aesthetics Questionnaire – Portuguese Version," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.
Mohammed looti. Psychosocial Impact of Dental Aesthetics Questionnaire – Portuguese Version. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.