{'fraction_non_alphanumeric': 0.03907926874398638, 'fraction_numerical': 0.020427799570720155, 'mean_word_length': 5.059192825112108, 'pattern_counts': {'":': 0, '<': 9, '<?xml version=': 0, '>': 7, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Awareness assessment in Turkish subpopulation with chronic oral mucosal diseases

Objectives: The aim of this study was to evaluate the awareness of group Turkish patients with chronic oral mucosal diseases by chronic oral mucosal diseases questionnaires (COMDQ). Materials and Methods: Eighty patients with chronic oral mucosal diseases were participated in the study. A detailed medical history of each patient was taken, and all the COMDQ questions, which were translated from English version, were filled out. The data were analyzed with the IBM Statistical Package for Social Sciences Statistics 22.0. Results: The mean ages of patients were 48.91 ± 13.36 years. Of the total 80 cases of chronic oral mucosal diseases identified 52 (65%) were female and 28 (35%) male. The standardized mean scores for COMDQ were 1.72 ± 1.11 for “pain and functional limitation,” 1.09 ± 0.94 for “medication and treatment,” 2.31 ± 1.06 for “social and emotional,” and 2.27 ± 0.83 for “patient support,” respectively. Conclusions: The results of this study indicate that the Turkish version of the COMDQ has the profitable psychometric peculiarity and comfortable to patients with chronic oral mucosal diseases in Turkey.


INTRODUCTION
Chronic oral mucosal diseases are a group of diseases including autoimmune, inflammatory, and infectious conditions that can affect the oral mucosa. These conditions can result in substantial morbidity with the emotional and functional outcome for patients. [1] Oral diseases can change an aspect and cause to decline in interpersonal and family relationships. In addition, they have harmful impaction on speaking, mastication, and self-respect. [2][3][4] The chronic oral mucosal diseases not only affect the daily lives of patients but also can affect the patients' quality of life (QoL) with various treatment options and their side effects. These conditions critically disturb life quality in most people and can influence diverse of life such as nutrition, chewing, aspect, and social interaction. the various psychometric measurements have been used to measure oral health-related quality of life (OHQoL). [10] The QoL measurement instruments can be divided into generic, disease-specific, and discipline-specific questionnaires. [11,12] Generic QoL questionnaires cannot detect small, clinically important changes related with a specific disease, but they allow to make comparisons between different diseases. Disease-specific questionnaires accurately predict clinical changes related with a specific disease but do not let to make a comparison against diseases. [5,[11][12][13][14][15] Chronic oral mucosal diseases questionnaires (COMDQ) is a discipline-specific questionnaire developed for the area of oral medicine and radiology. [5] COMDQ has been recently developed that consists of 26 items. The items are sorted accordingly clinical decision into four domains; pain and functional limitation, medications and side effects, social and emotional, and patient support. [5,12,16] A variety of patients based outcome instruments called "OHQoL measures" have been improved. [17,18] "OHQoL" centered on the appearances of individual life affected by oral health issues and assess as a multidimensional properties, which comprises not just physical functioning and pain, but also psychosocial functioning, mental health, appearance, and life satisfaction. [2,19,20] In this study, the COMDQ have used, and it was translated into Turkish, so we evaluated the availability of the questionnaire in Turkish patients. Therefore, the aim of this study was to evaluate the awareness of group Turkish patients with chronic oral mucosal diseases by COMDQ.

Subjects
Eighty patients with chronic oral mucosal diseases attending the Department of Oral Diagnosis and Radiology of Marmara University of Faculty of Dentistry were participated in this study. Overall, 80 cases of oral mucosal diseases included burning mouth syndrome, geographic tongue, gingival pigmentation, erosive cheilitis, hemangioma, hyperkeratosis, lichen planus, lichenoid reaction, lipom, oral leukoplakia, papillamatous, pyogenic granuloma, changes related to prosthesis, pseudoxanthoma elasticum, recurrent aphthous stomatitis, squamous cell carcinoma, changes to related trauma and vesicobullous diseases. A detailed medical history of each patient was taken and prediagnosed patients were told about the content of the questionnaire. Those who want to participate in the questionnaire have included. The patient's sociodemographic information of age, gender, and work were assessed. This study was performed according to the guidelines at the declaration of Helsinki concerning ethical principles for medical research involving human subjects. Due to the retrospective nature of this study, ethical board approval was not by local laws and regulations, and the informed consent requirement was waived by the departments where the study was carried out.

The instrument
COMDQ is an OHQoL instrument containing 26 items. The items are sorted accordingly clinical decision into four domains: Pain and functional limitation (nine items), medication and treatment (six items), social and emotional (seven items), and patient support (four items). For each item, patients answered by using a Likert-type response scale coded. Responses were coded 0 = "not at all," 1 = "slightly," 2 = "moderately," 3 = "considerably," 4 = "extremely" [ Table 1].

Statistical analysis
The data were analyzed with the IBM Statistical Package for Social Sciences for Windows 22.0 (Armonk, New York: IBM Corp). Descriptive statistical methods (mean and frequency) were used for evaluation of the data. The Kruskal-Wallis test was used to evaluate comparisons between quantitative data. Statistical significance of differences among the groups was determined by Mann-Whitney U-test (for nonparametric distribution). The values of P < 0.05 were interpreted as significant.

Patient characteristics
Eighty patients (52 female and 28 male) with chronic oral mucosal diseases were enrolled in the study. The patients were aged 19-79 and the average age was 48.91 ± 13.36. Of the total 80 cases of chronic oral mucosal diseases identified 33 (41.3%) were employed, 35 (43.8%) unemployed, and 12 (15%) retired. Among these 80 patients, the most common was burning mouth syndrome (20%), lichen planus (15%), and changes to related trauma (14.6%) were followed. The standardized mean scores for COMDQ were 1.72 ± 1.11 for "pain and functional limitation," 1.09 ± 0.94 for "medication and treatment," 2.31 ± 1.06   for "social and emotional," and 2.27 ± 0.83 for "patient support," respectively. The median scores of patients' answers to COMDQ questionnaire are shown in Table 2.

Assessments related gender
The score of social and emotional in female was statistically significantly higher than male (P < 0.05) [ Table 3]. Significant differences were not observed among the genders for the other domains (P > 0.05).

Assessments related ages groups
The scores of pain and functional limitation were shown statistically significant difference (P < 0.05).
In under the age of 45, the scores were determined significantly higher than the age of 45 and older [ Table 4]. Significant age-related differences were not observed in the other domains (P > 0.05).

Assessments related employment state
The scores of pain and functional limitation were shown statistically significant difference (P < 0.05). As a result of the dual comparison, unemployed group scores were determined significantly higher than retired group (P < 0.05). There were no statistically significant differences between the other groups (P > 0.05) [ Table 5].
The scores of medication and treatment were shown statistically significant difference (P < 0.05). As a result of the dual comparison, the employed and unemployed group scores were determined significantly higher than retired group (P < 0.05). There were no statistically significant differences between the other groups (P > 0.05) [ Table 5].
The scores of social and emotional were shown statistically significant difference (P < 0.05). As a result of the dual comparison, the employed and unemployed group scores were determined significantly higher than retired group (P < 0.05). There were no statistically significant differences between the other groups (P > 0.05) [ Table 5].
According to employment state, the scores of patient support were not shown statistically significant difference (P > 0.05) [ Table 5].

Assessments related diseases
According to diseases, the groups that a number of cases below five were not evaluated. The groups that a number of cases were more than five were evaluated. The scores of "pain and functional limitation," "medication and treatment," "social and emotional,"

DISCUSSION
To our knowledge, the present study was the first study evaluating the psychometric properties of the COMDQ in Turkish patients. QoL measures are increasingly being used for evaluate the perceived impact of oral health in different patient populations. It is important to detect the character of the plaints that lead patients to look for a cure and to what degree these influence patients' life quality. [21] Therefore, there is an increasing need for use in different languages.
When reviewed the literatures, COMDQ was not used in Turkish population before but also other similar measures were used. Mumcu et al. [2] evaluated the multidimensional concept of oral health impact profile-14 (OHIP-14) in Behçet's disease and recurrent aphthous stomatitis. The study was found that OHIP-14 was easy and useful enough for clinicians and patients to use and evaluate. In the other study,   and "patient support" support were not shown statistically significant difference (P > 0.05) [ Table 6].
evaluated and compared OHQoL in patients from UK and Turkey with Behcet's disease by using OHIP-14. [22] The comparison results showed that patients from UK and Turkey had the same impairment in their oral QoL status. Furthermore, Mumcu et al. [23] investigated oral and general health related QoL in patients with Behçet's disease and assessed the yield of Turkish versions of OHIP-14, OHQoL, and short form-36 (SF-36) questionnaires. OHIP-14 and OHQoL are specific questionnaires for oral health and SF-36 is the general measure of health status. The study demonstrated that both specific and general questionnaires scores were significantly worse in patients with Behçet's disease. In the other study in Turkey, determined which complaints cause patients to come to their clinic and to what degree those complaints affect their QoL. [21] Min et al. [12] found that the Chinese version of the COMDQ has good reliability and validity can be applicable to assess the QHRoL of patients with chronic oral mucosal diseases in China. Similarly, in our study found that the Turkish version of COMDQ is applicable and can be used in evaluating in QoL of patients.
Our study demonstrated that in under the age of 45 the scores were determined significantly higher than the age of older in the domain pain and functional limitation. Likewise, Bijina et al. [5] evaluated 45 and the QoL in patients with chronic oral mucosal diseases by COMDQ, and the older patients were reported significantly lower score. Furthermore, in our study, in the domain of social and emotional scores were showed a higher in female than male. Contrary, in that study male reported significantly higher oral health related than female in pain and functional limitation.
Furthermore, Baker et al. [24] reported data on QoL measures in patients xerostomia by using OHIP-14  and oral impacts on daily performance measures, which had good psychometric features as measured in that study. Moreover, Hegarty et al. [25] studied the relevance of QoL measures, which were UK (OHQoL-UK) and OHIP-14 in oral lichen planus. The results of this study showed that both questionnaires performed well in the assessment of patients with oral lichen planus.
Locker and Allen [26] described OHQoL as the effect of oral diseases in daily life that is substantial to patients and reported that the instruments used in oral health examination supply accurate knowledge.
The generic and specific instruments have some advantages and disadvantages. In a previous study published that the comparison of dimensions of OHQoL measured by a generic health state measure and a specific oral health measure. [27] OHIP is one of the most commonly used to measure patient's sensation of the influence of oral diseases on their life. The questionnaire was used previously in many different populations. [2,6,7,[28][29][30] However, some limitations should be considered when interpreting the results. One of them, there is the inhomogeneous distribution of the gender; the majority of patients were female. Furthermore, heterogeneity in age and deficiency in the number of patients might not allow to generalize our findings to the general populations. Further longitudinal studies should be required to generalize.

CONCLUSION
Chronic oral mucosal diseases are common and the perspicuity and medicinal management of these situations can have an efficacy on the daily lives of patients. Qol measurements can play a key role by helping evaluate the dimensions of the disease and its treatment. Our findings suggest that the Turkish version of COMDQ is applicable and can be used in evaluating QoL of patients. This assessment is so important to determine the patient's QoL.