| Abstract|| |
Aim: To determine the relationship between Oral Health-related Quality of Life (OHRQoL) with Dentition Status and Treatment need among 12 year old school children of Dilsukhnagar, Hyderabad. Patients and Methods: A cross sectional study was carried out among 990 private school children aged 12 years old in Dilsukhnagar, Hyderabad city. OHRQoL was assessed by 16-item Child Perceptions Questionnaire (CPQ11-14), and Oral hygiene was evaluated using Simplified Oral Hygiene Index (OHI-S), and Dentition status and Treatment need. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. Study population proportions and mean scores were compared using Chi-square test, Student t- test, and Analysis of Variance (ANOVA). Spearman's analysis was done to determine correlation between CPQ11-14and its domain scores with OHI-S and Dentition status and Treatment Need based on gender. P < 0.05 was considered statistically significant. Results: In the present study, all domains of CPQ11-14i.e., Oral Symptoms (OS) (3.27 ± 2.5; P = 0.0001), Functional Limitation (FL) (1.48 ± 2.1; P = 0.02), Emotional Wellbeing (EW) (1.83 ± 2.5; P = 0.02) and Social Wellbeing (SW) (1.25 ± 2.02; P = 0.0002) showed significant gender difference, with males having higher mean score compared to females. The majority of the study population was caries free 789 (79.7%). In addition, the dental caries experience among males and females was around 20% (p = 0.92). When total mean DMFT and DT scores were compared based on gender, no statistically significant difference was noted though females showed higher mean score. Conclusion: The study results indicate that, there is a correlation between oral hygiene status and dentition status with quality of life.
Keywords: Dental caries, dentition status, oral health related quality of life, oral hygiene status, school children
|How to cite this article:|
Patanapu SK, Doshi D, Kulkarni S, Reddy B S, Srilatha A, Narayana D S. Correlation of oral health related quality of life with dentition status and treatment need among 12 year old school children of Dilsukhnagar, Hyderabad. Indian J Dent Res 2020;31:343-9
|How to cite this URL:|
Patanapu SK, Doshi D, Kulkarni S, Reddy B S, Srilatha A, Narayana D S. Correlation of oral health related quality of life with dentition status and treatment need among 12 year old school children of Dilsukhnagar, Hyderabad. Indian J Dent Res [serial online] 2020 [cited 2020 Sep 22];31:343-9. Available from: http://www.ijdr.in/text.asp?2020/31/3/343/291495
| Introduction|| |
Health has been considered as a fundamental human right and a world-wide social goal that is to be attained by all people. The widely accepted definition of Health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” has led to the development of a multidisciplinary approach to health.
According to the policy of the World Health Organization (WHO) program, oral health is an integral and essential part in general health of a population. Traditionally, oral health has been defined based on the presence of oral disease and disorders derived from clinical findings and dental indices. The measurement of oral health is historically derived from disease based model and oral disorders are measured with objective and quantitative indicators. Though, prevalence of oral diseases has been described in populations, less is known about how the disease and symptoms affect person's quality of life. Hence, the use of only clinical indicators for oral health status and treatment needs assessment is recognized to have serious limitations.
Quality of life is a holistic approach that not only emphasizes on individual's physical, psychological and spiritual functioning but also their interactions with environment. Conventional clinical dental methods of assessing oral health information have shortcomings because they assess only the normative aspects of oral health rather than how oral health impacts their individual cognitive behaviours., This increased acknowledgement of the existence of oral health impact has led to the emergence of Oral Health Related Quality of Life (OHRQoL) measures. These dimensions are subjective indicators and depend on information provided by individuals about their oral health status and its consequences on various aspects of their life.
Oral Health Related Quality of Life (OHRQoL) is a multidimensional construct that captures person's perception about factors that are important in their everyday lives and measures the extent to which an individual's daily living is disrupted by oral problems. Therefore, OHRQoL provides essential information when appraising the treatment needs of individuals and making clinical decisions and evaluating interventions, services and programs in a population.
Children are affected by several oral and oro-facial diseases that have the potential to limit their daily activities such as eating, sleeping, talking and enjoying the general health. Among them, dental decay remains one of the most wide-spread chronic diseases and may cause discomfort, pain and functional impairment.
Recent studies,, have reported that dental caries may have a negative impact on OHRQoL of children and those suffering from dental caries could experience more oral pain with difficulties in chewing, be worried or upset about their mouth and may have missed the school. This in turn can lead to unfavourable perceptions of health and overall poor quality of life in school children. Furthermore, Alves LS, et al. showed that school children with treated caries had an improved OHRQoL in comparison to children with untreated caries. Thereby, dental caries treatment provides a long-term positive impact on school children's OHRQoL.
Also, a significant negative correlation between dental caries status and OHRQoL score (P = 0.003) and dental caries treatment needs and OHRQoL score (P = 0.01) was reported by Geetha Priya et al. among South India Children.
With limited literature on Indian school children, retrieving knowledge about the association between oral diseases and Oral Health Related Quality of Life can help in evaluating the dental treatment needs of children. Determining the magnitude of impact of poor dentition status on children's everyday activities may put more emphasis on developing oral health promotion and care programmes. Hence, the present study aimed to correlate Oral Health Related Quality of Life with the dentition status and treatment need among 12 year old school children in Dilsukhnagar, Hyderabad, Telangana.
| Patients and Methods|| |
Ethical clearance was obtained from the Institutional Review Board of the dental college (PMVIDS & RC/IEC/PHD/DN/003915).
Sample size estimation
A pilot study was conducted to assess the feasibility, to estimate the sample size and to finalize the survey proforma. The sample size was calculated using the formula, where n = required sample size; Z = Standard normal variate value (Z- standard value = 1.96); S = Standard deviation of DMFT (0.39); d = margin of error at 5% (standard value = 0.05). With a confidence level of 95% and sampling error at 5%, the estimated sample size obtained was minimum of 575 subjects. To compensate for gender difference, a sample of 990 was taken for the present study.
Sampling methodology and study sample
The study participants were selected based on the following criteria.
- Students aged about 12 years and present on the day of examination
- Students willing for the oral examination.
- Unfilled or partially filled questionnaire
- Physically disabled and mentally challenged children
- Children with systemic disorders (e.g. Down's syndrome, Autism etc)
- Subjects with any medical condition not suitable for the study (e.g. Children on antibiotic therapy etc.).
Stratified cluster sampling was employed and permission to carry out the study was obtained from the authorities of respected schools. A written and informed consent was obtained from parent/guardian of each participant before oral examination. The survey was conducted within the working hours of the school, as per the time allotted by Principals of the respective schools. The study was conducted for a period of four months from the month of January 2017 to April 2017. The clinical examination of all the subjects was done by a single pre-trained, pre-calibrated examiner to limit intra-examiner variability.
A self-reported 16-item Child Perception Questionnaire (CPQ11-14) was used to measure school children's oral health related quality of life. The participating children were asked about the frequency of events in the previous three months in relation to the child's oral/oro-facial condition. The children who experienced oral problems were classified into four domains: Oral Symptoms (OS; 4 items), Functional Limitations (FL; 4 items), Emotional Well-being (EW; 4 items), and Social well-being (SW; 4 items). The response were scored on a 5 point Likert scale ranging from never = 0, once/twice = 1, sometimes = 2, often = 3 and everyday/almost everyday = 4. The overall and domain specific CPQ11-14 scores were computed by summing all item scores with a possible vary from 0-64 and each domain specific score ranges from 0-16. The higher the score, the worse the perceived Oral Health Related Quality of Life (OHRQoL) and greater will be the oral health and treatment need.
The oral hygiene status was assessed using Simplified Oral Hygiene Index (OHI-S) by John C Greene and Jack R Vermillion (1964) and Dentition status and Treatment Need was recorded based on the codes and criteria according to WHO proforma 1997.
| Statistical Analysis|| |
The data was analyzed using Statistical Package for Social Sciences (SPSS) package version 21.0. Analysis of Variance (ANOVA) and Student t-test was used for comparison among variables. Decayed, Missing and Filled teeth (DMFT), and its individual components were compared with variables using Student t-test. Chi-square test used to associate prevalence of dental caries of study population based on variables.
Correlation of overall mean CPQ[11-14] and its domain scores with oral hygiene status and dentition status and treatment need was done using Spearman's correlation method. P < 0.05 was considered statistically significant.
| Observations and Results|| |
A sample of 990 school children comprising of 530 (53.5%) males and 460 (46.5%) females participated in the study. Majority of the study population had no history of previous dental visits (581; 58.7%) compared to children who visited a dentist (409; 41.3%). Based on the history of previous dental visits, higher number of males visited the dentist (22.8%) compared to females (18.5%).
The total mean CPQ[11-14] score of the study population was 7.11 ± 6.6. A statistically significant gender difference was noted with males having higher mean score for total CPQ11-14(7.98 ± 6.9) than females (6.11 ± 6.1) (p = 0.0001).
Likewise, all domains of CPQ[11-14]i.e., Oral Symptoms (OS) (3.27 ± 2.5; P = 0.0001), Functional Limitation (FL) (1.48 ± 2.1; P = 0.02), Emotional Wellbeing (EW) (1.83 ± 2.5; P = 0.02) and Social Wellbeing (SW) (1.25 ± 2.02; P = 0.0002) showed significant gender difference, where in males had higher mean score compared to females (OS-2.41 ± 2.2; FL-1.19 ± 1.8; EW-1.48 ± 2.3; SW-0.79 ± 1.7, respectively). Among the domains, oral symptoms domain had highest mean score for both males and females compared to various other domains [Table 1].
|Table 1: Comparison of mean domain and total mean scores of Child Perception Questionnaire (CPQ11-14) based on gender|
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Based on oral hygiene status, the overall OHI-S, DI-S and CI-S mean score for the study population was 1.30 ± 0.6, 0.88 ± 0.3 and 0.42 ± 0.4, respectively. Though for males a higher mean scores of Debris Index-Simplified (DI-S), Calculus Index –Simplified (CI-S) and Simplified Oral Hygiene Index (OHI-S) was recorded, it was comparable with females with no significant difference (DI-S P = 0.42; CI-S P = 0.07; OHI-S P = 0.11) [Table 2].
|Table 2: Comparison of total mean Debris Index-Simplified (DI-S), Calculus Index– Simplified (CI-S) and Simplified Oral Hygiene Index (OHI-S) scores based on gender|
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The majority of the study population was caries free 789 (79.7%). In addition, the dental caries experience among males and females was around 20% (p = 0.92).
The total mean DMFT of the study population was 0.46 ± 1.1. While, individual components of DMFT was recorded as, Decayed (DT)- 0.44 ± 1.1, Missing (MT)- 0 and Filled Teeth (FT)- 0.02 ± 0.1 for the study population.
Based on gender, though females showed higher mean score DMFT and DT scores (DMFT-0.48 ± 1.2; DT-0.47 ± 1.1). This difference was not statistically significant (p value- DMFT = 0.48; DT = 0.78).
The overall number of teeth affected with dental caries was 191 (19.3%) [code 1; decayed 187 (18.9), and code 2 filled with decay 4 (0.4%)]. The second most prevalent condition was trauma (fracture) (T) of the teeth 2.7% followed by filled teeth which was 1.4% [code 3], and fissure sealant 0.3% [code 6]. Only a small percentage of study population had bridge abutment, special crown or veneer/implant [code 7; (0.1%)].
A statistically significant difference was observed based on gender for sound teeth, wherein 78.9% of females were having sound teeth (code 0) compared to males (75.8%) (p = 0.03). On the other hand, females had significantly higher percentage (19.6%) of decayed teeth (code 1) than males (18.3%) (p = 0.02). However, small percentage (0.2%) of males had bridge abutment, special crown or veneer/implant (code 7) than females (0), which was found to be statistically significant (p = 0.04). Surprisingly, none of the subjects had missing teeth due to caries or also for any other reason (code 5 and 6). Likewise, none of the female subjects had fissure sealant (code 6) [Table 3].
|Table 3: Distribution of study population based on dentition status according to gender|
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According to treatment need, around 78% of subjects did not require any treatment (code -1). However, One hundred and sixty nine study participants (17%) were in need for one surface filling (code 1); followed by pulp care and restoration (3%) (code 5), and 1.8% of subjects needed two or more surface fillings (code 2). A few subjects were in need of extraction [code 6; 6 (0.6%)], and fissure sealant [code F; 5(0.5%)]. Surprisingly, none of the subjects were in need of crown for any reason (code 3), and veneers (code 4).
With regard to gender comparison, a statistical significant difference was found with greater percentage of females (80%) not requiring any treatment (code 0) as compared to males (76.2%) (p = 0.03). On the other hand, 17.6% of females required one surface filling compared to their male counterparts (16.6%); which was statistically significant (p = 0.02). However, though more number of males needed of pulp care and restoration (4%), extraction (2%) and fissure sealants (0.7%) than females, the difference was not statistically significant (code 5,6 and F) [Table 4].
|Table 4: Distribution of study population based on Treatment need according to gender|
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A significant positive correlation was seen between OHI-S and total CPQ[11-14] and its domain scores for both males and females. Likewise, except for the domain oral symptoms, all other domains had significant positive correlation with dentition status scores.
Based on treatment need, males and females showed significant positive correlation with oral symptoms (p = 0.04; P = 0.01), emotional wellbeing (p = 0.05; P = 0.04) social well-being (p = 0.002; P = 0.03) and overall CPQ11-14(p = 0.001; P = 0.001). However, even though functional limitations domain of CPQ11-14 showed positive correlation with treatment need among both males (r = 0.697) and females (r = 0.881), the difference was not statistically significant [Table 5].
|Table 5: Correlation between total and domain scores of CPQ11-14 with OHI-S, Dentition status and Treatment needs based on gender|
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| Discussion|| |
Despite the dramatic improvements in the prevention and treatment of dental caries over the past few decades, it still is one of the most prevalent oral diseases of childhood. According to the World Health Organization, the mean Decayed Missing and Filled Teeth (DMFT) for 12-year olds is 1.67 globally with around 74% of countries having mean DMFT score of 3 or less. On the other hand, National Oral Health Survey in India has shown that prevalence of dental caries is 53.8% among 12-year-old children.
There is an increasing recognition that dental caries can have a significant impact on physical, social and psychological health, thus affecting the quality of life and health perceptions of an individual., Therefore, identifying this importance of poor oral health on well-being of an individual, an attempt was made in the present study to correlate Oral Health Related Quality of Life (OHRQoL) using Child Perceptions Questionnaire (CPQ11-14) with the oral hygiene and dentition status and treatment needs among 12-year-old school going children of Dilsukhnagar, Hyderabad.
A growing body of evidence has shown that Oral Health Related Quality of Life (OHRQoL) instruments can be an effective measure of the psychosocial impacts of oro-facial disease and are a useful adjunct to conventional clinical measurements. This importance of OHRQoL in supplementing clinical data has been recognized in the last decade, and several instruments have been developed in different populations and languages. Amongst those only few instruments are specially designed to assess oral health related quality of life in children.,,, Earlier attempts were made to measure the OHRQoL in children by using questionnaire for parents. While parents are useful as informants, their reports for children older than six years are now considered as complementary to and not substitutes for child reports.
The child perceptions questionnaire (CPQs) has been developed in Canada for measuring the OHRQoL among children aged 6-14 years., CPQ is a part of Child Oral Health Quality of Life Questionnaire (COHQoL) which consists of three age specific questionnaires for children 6-7, 8-9 and 11-14 year olds (CPQ6-7, CPQ8-10 and CPQ11-14) to measure the cognitive abilities of children at different age groups. The CPQ11-14 assesses the perception of children on how oral health impacts their physical and psychosocial problems experienced over previous three months as a result of the condition of their teeth and mouth. Moreover, it has an excellent internal consistency and test-retest reliability. In addition, Cronbach's alpha for the four domains ranged from 0.64-0.86 as validated through studies., Hence, the CPQ11-14 questionnaire was utilized in this study.
According to World Health Organization, 12 years is important as it is generally the age at which children leave primary school and therefore can be the last age at which a reliable sample may be obtained easily through the school system. Also, it is likely that at this age all permanent teeth, except third molars, will have been erupted. Thus, this age is considered as the global monitoring age and hence, 12-year old school children were included in the current study.
In this study, 41.3% of the study population had history of previous dental visits. Where as in the study by Locker D, et al. on Canadian school children a higher percentage of children (85.3%) visited the dentist at least once in a year.
In this study, majority of the subjects responded for the option 'Never' for most of the questions of CPQ11-14. This indicated that most of the study population did not experience discomfort, pain, functional impairment due to their teeth or mouth. This was in contrast to study done by Alsumait A, et al. among Kuwaiti school children of age 11-12 years old wherein around 74% of children reported at least one negative impact on their quality of life by responding with 'Often' and/or 'every day or almost every day'.
In the current study, a statistically significant gender difference was noted with males having higher mean score for total CPQ11-14(7.98 ± 6.9) and its domains. Similar findings were noted among Mexican school by Martinez AM, et al., whereas, no significant gender difference for overall CPQ11-14 and subscale scores was noted among Kuwaiti school children. The reason for the present study findings could be because females presented an improved oral health related quality of life than males and are more concern about their health and appearance.
A higher percentage of subjects in the present study perceived pain, bad breath, mouth sores and food impaction. Thus, higher mean score was observed for Oral Symptoms domain compared to other domains among both males (3.27 ± 2.5) and females (2.41 ± 2.2). Similar findings were reported by Do LG, et al., among 8-13 year old school children of South Australia.
A study by Yee R, et al. in Nepal among 12 and 13 year-old subjects showed that males and females had a comparable mean OHI-S scores (1.24 and 1.17). Also in current study, though males had higher mean OHI-S, DI-S and CI-S scores in comparison to females no significant difference was noted.
On a positive note, 79.7% of subjects were caries free. This witnessing of low caries experience could be because incipient caries are not accounted in DMFT by WHO proforma but is counted only when caries involve dentin. Further, though the dental caries experience was comparable among males (20.2%) and females (20.4%), the prevalence of dental caries was significantly higher among females (19.6%). Most of the Indian studies,, showed more caries prevalence in females than males which could be due to the changes in salivary rates and composition induced by hormonal fluctuations. However, lesser number of caries free individuals was observed among school children in Shimla (67%) and Hyderabad (70%).
When total mean DMFT and DT scores was compared based on gender, no statistically significant difference was noted, though females showed higher mean score (DMFT-0.48 ± 1.2; DT-0.47 ± 1.1) than males. However, Shailee F, et al. observed significant high mean DMFT score among female school children. These findings were in line with the findings of Moses J, et al. and Singh et al. It may be due to fact that, teeth erupt earlier in females and have been exposed to oral environment for a longer period than the males of the same age.
A note-worthy finding of the present study was that, around 77.3% of study population had sound teeth and only a small percentage had bridge abutment, special crown or veneer/implant (0.1%), and none of the subjects were having missing teeth due to caries or also for any other reason.
In the present study, 78% of subjects did not require any treatment and none of the subjects were in need of crown for any reason reflecting good oral health maintenance by the study population. However, 17% of subjects need one surface filling and only 1.8% of subjects needed two or more surface fillings. This was in agreement with the study done by Villalobos-Rodelo JJ, et al. among Mexican public school children of age 6-12, where majority of the children (81.1%) needed restoration of at least two tooth surfaces.
Furthermore, gender comparison showed high percentage of females (17.6%) required one surface filling and males required pulp care (4%) and extraction (1%). In contrast to these findings, a study done by Shailee F, et al. noted that equal percentage of males and females required treatment.
Our results revealed that, overall CPQ11-14 and most of the domains showed a significant positive correlation with OHI-S, dentition status and treatment need. Therefore, higher the scores of OHI-S, dentition status and treatment need, more is the CPQ11-14 score and poorer is the Oral Health Related Quality of Life. Similarly, Alves LS, et al. noted that, individuals with treated caries presented an improved OHRQoL and this positive impact was more related to functional limitation and emotional well-being domains.
Our study acknowledges certain limitations such as cross-sectional study design and self-reporting nature of the questionnaire, making it difficult to draw any conclusion about causal relationship. The sample comprised of children of private schools, hence further studies are needed to include various social, economical and cultural backgrounds and to determine the influence of different clinical conditions on OHRQoL measures.
| Conclusion|| |
In the current study, males had poor oral health related quality of life compared to females. Further, females had better oral hygiene status than males. Majority of the study population was caries free. In addition, dental caries experience among males and females was comparable (20%). Overall CPQ11-14 and most of the domains showed a significant positive correlation with OHI-S, dentition status and treatment need based on gender.
Considering the above results, it can be concluded that, oral hygiene status and dentition status affects Oral Health Related Quality of Life. Thus, measurement of OHRQoL should be an essential component of oral health surveys, clinical trials and studies evaluating the outcomes of preventive and therapeutic programs intended to improve oral health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Dolar Doshi
Department of Public Health Dentistry, Government Dental College and Hospital, Afzalgunj Police Station Road, Room No. 311, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]