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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 6  |  Page : 738-741
Association between oral health-related quality of life and atraumatic restorative treatment in school children: An exploratory study


Department of Community Dentistry, Division of Health Education and Health Promotion, Piracicaba Dental School, University of Campinas -UNICAMP, Piracicaba, SP, Brazil

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Date of Submission11-Apr-2011
Date of Decision01-Jun-2011
Date of Acceptance16-Feb-2012
Date of Web Publication3-May-2013
 

   Abstract 

Background: The present study's objectives were to compare the perceptions of oral health-related quality of life (OHRQoL) among school children presents dental caries with that of caries-free school children, and to evaluate the subjective impact of atraumatic restorative treatment (ART) on the OHRQoL of school children.
Design: Exploratory study.
Setting: Public school in Piracicaba, Brazil.
Materials and Methods: The sample was composed of 30 children in the age-group of 8-10 years. The children were divided into two groups: one with caries and other without caries. The information related to OHRQoL was obtained through the administration of the Child Perceptions Questionnaires (CPQ 8-10 ). To evaluate the impact of ART on the school children's OHRQoL, the CPQ 8-10 was re-administered 4 weeks after the initial treatment. For statistical analysis we used the nonparametric Wilcoxon test for two dependent variables (test and re-test groups) and the nonparametric Mann-Whitney test for independent variables (test and control groups).
Results: It was observed that children with dental caries reported larger impact of oral health conditions on the quality of life when compared with the caries-free group, especially in the emotional and social well-being domains ( P≤.05). After the school children who presented with dental caries received ART, there was improvement in the median scores of CPQ 8-10 in all of the domains, but particularly in the functional limitation domain ( P≤.05).
Conclusion: Dental caries exerts a strong influence on the OHRQoL of children. ART was shown to be a simple and painless caries management approach that could improve the OHRQoL of school children.

Keywords: Atraumatic restorative treatment, dental, oral health, quality of life

How to cite this article:
Paula J S, Tôrres L, Ambrosano G, Mialhe F L. Association between oral health-related quality of life and atraumatic restorative treatment in school children: An exploratory study. Indian J Dent Res 2012;23:738-41

How to cite this URL:
Paula J S, Tôrres L, Ambrosano G, Mialhe F L. Association between oral health-related quality of life and atraumatic restorative treatment in school children: An exploratory study. Indian J Dent Res [serial online] 2012 [cited 2020 Nov 28];23:738-41. Available from: https://www.ijdr.in/text.asp?2012/23/6/738/111249
A method that is widely used in public health dentistry to control dental caries in children and adolescents is atraumatic restorative treatment (ART). This technique is considered a feasible treatment option as it is based on the current philosophy of minimum intervention and maximum preservation of the tooth and can be applied to the entire population. [4]

ART is a simple, low-cost technique that uses only manually operated instruments for the removal of carious tissues and requires immediate restoration of the cavity with an adhesive restorative material, namely glass ionomer. [4] This material has the property of continual fluoride release, its act as a constant reservoir of fluoride in the oral cavity. Thus, glass ionomer functions as a reservoir of fluoride in the oral cavity, thereby participating in the processes of de- and remineralization and contributing to caries prevention. [5],[6] Various longitudinal studies have been conducted to verify the efficacy of ART as a preventive and restorative approach. [7],[8],[9],[10],[11]

The use of ART in a school setting is considered a practical and effective method for treating dental caries and may help to meet the demand when a large number of children are in need of dental care, especially so because only a short time is necessary to perform the procedure, unlike conventional treatment. [11],[12]

Despite the success of ART in the control of dental caries and in the maintenance of oral health, little is known about the effects of this technique on oral health-related quality of life (OHRQoL) and psychosocial factors in school children.

This exploratory study had two main goals, namely, to compare the perceptions of OHRQoL among school children with dental caries vs that in their caries-free counterparts, and to evaluate the subjective impact of ART on the OHRQoL of school children who had dental caries and were treated with this approach.


   Materials and Methods Top


This research was conducted in a public school in Piracicaba, São Paulo, Brazil. A convenience sample of 15 school children, aged 8-10 years who had dental caries and needed tooth restoration using the ART approach was selected (test group). Another 15 caries-free school children with similar characteristics as the test group was randomly selected to serve as the control group. The sample size was calculated to give a power of 0.80. Statistical significance was set at P < 0.05.

The school children were clinically examined for the presence of decayed, missing, and filled permanent or primary teeth. Examination was done in natural light outside the classroom by a calibrated examiner, using CPQ probes and mirrors according to the procedure recommended by the World Health Organization (WHO) for epidemiological studies. [13] The intraexaminer variability was found to be good (kappa = 0.92).

The Child Perceptions Questionnaires (CPQ 8-10 ) was used to evaluate OHRQoL in the two groups. The questionnaire was self-administered but the researchers initially read and explained the questions to all the children who participated. This questionnaire was developed by Jokovic et al.[1] and translated and validated for the Brazilian population by Barbosa et al.[2] The group with dental caries (test group) was treated with the ART approach in the school environment. The need for ART was based on a defined protocol. [4] Carious teeth with evident pulp involvement, inability to access the carious lesion without the use of rotary instruments, and teeth with extensive coronal destruction were reasons for exclusion from the study, and children with such lesions were instead referred to the public health dental services for treatment.

Four weeks after ART, the CPQ 8-10 questionnaire was re-administered to the test group to see whether there were alterations in their OHRQoL (re-test group).

Ethics

The project was approved by the Research Ethics Committee (No. 125/2009) of the Piracicaba Dental School, University of Campinas. Consent for the children to participate in the study was obtained in writing from the children's parents/guardians.

Statistics

For statistical analyses, the nonparametric Wilcoxon test for two dependent variables (test and re-test groups) and the nonparametric Mann-Whitney test for independent variables (test and control groups) were used. The results were compared using program BioEstat ® 5.0, with the level of significance set at 5%. [14]


   Results Top


The mean decayed, missing, and filled primary or permanent teeth (dmft and DMFT) of the 15 children with dental caries were 3.2 ± 2.0 and 0.33 ± 0.62, respectively. The overall score of CPQ 8-10 showed that the impact on OHRQoL was lower in the control group than in test group [Table 1]. There was statistically significant difference between the two groups in the emotional and social well-being domains (P≤.05).
Table 1: Sum of the responses [median (minimum value-maximum value)] of CPQ8-10 in the groups of school children according to the domains scores, overall scores, and groups evaluated

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After ART, children who previously had dental caries demonstrated a reduction in the overall and domain scores of CPQ 8-10 , but the difference from pretreatment scores was not statistically significant (P≥.05). The decrease in median score from 42.0 to 29.0 indicates an improvement in OHRQoL. The scores in the functional limitations domain demonstrated statistically significant improvement (P≤.05) after completion of ART (re-test group). The domains related to oral symptoms, emotional well-being, and social well-being also presented lower values, which indicates that there was relatively less impact on OHRQoL after ART treatment.


   Discussion Top


In this study, children who had no dental caries reported fewer problems in the social and emotional domains of CPQ 8-10 than their counterparts with caries, stressing the importance of the psychological and social components in self-perceived OHQoL. [15] Biazevic et al.[3] reported that the absence of dental caries could be correlated with the absence of limitations in daily activities.

The presence of caries lesions adversely affects OHRQoL, as demonstrated by the differences in the overall and domain scores in CPQ 8-10 between the test and control group in this study. This is in agreement with the findings of other authors, [16],[17],[18],[19],[20] who have also demonstrated the influence of dental diseases on the quality of life.

ART is recognized as a a public health approach for the control of dental caries. The technique is not dependent upon expensive and sophisticated dental equipment. Reports show that this approach can be used in the school setting to improve the oral health of large populations of underserved children. [21],[22],[23] However, in spite of the advantages of this treatment method, we could not find any study that examined the impact of ART on OHRQoL. The majority of studies have only reported the acceptability of the approach after the treatment was performed. The present study explores the impact of the approach on other subjective parameters that affect daily activities among school children.

Besides being effective in the control of dental caries, ART promoted improvement in the subjective aspects of OHRQoL when it was applied in school children in this study. This was significantly expressed in the functional limitations domain, where subjects stated that they were able to masticate, speak, and sleep better since the painful cavities were filled. The ART approach also had an impact on the oral symptoms, emotional well-being, and social well-being domains of the CPQ 8-10 , but the effect is less marked than on the functional limitations scores. In general, the ART approach improved the quality of life of the school children, and thus our findings support the study by Cunion et al.[16] where parents reported better quality of life of their children when they were treated by conventional dentistry.

Although this was not assessed in the present study, we hypothesize that the impact of the ART approach on the OHRQoL could have influenced the subjective perceptions related to self-esteem of school children. However, this hypothesis should be validated by data from other studies, using specific instruments for the purpose, because information on this association is still scarce in the literature.

This study demonstrated that CPQ 8-10 is useful for determining differences in children's self-reports with regard to their OHRQoL in a longitudinal evaluation. As pointed out by Jokovic et al., [1] evaluation of the psychometric properties of this instrument is needed in longitudinal studies.

The data of the present study should be interpreted in the light of some limitations. The study was exploratory and used a convenience sample instead of selecting patients with a randomized sampling technique. No measures of self-esteem were included to help the authors to understand the subjective aspects related to oral health of school children. Although many existing studies [4],[5],[8],[11],[24],[25] have evaluated patient satisfaction with ART, we suggest that further studies should be conducted in different populations to evaluate OHRQoL and psychosocial conditions. Longitudinal studies with larger samples and randomized sampling are needed for detailed examination of the psychometric properties of the CPQ 8-10 and the impact of ART on the OHRQoL of children.

 
   References Top

1.Jokovic A, Locker D, Tompson B, Guyatt G. Questionnaire for measuring oral health-related quality of life in eight- to ten-year-old children. Pediatr Dent 2004;26:512-8.  Back to cited text no. 1
    
2.Barbosa TS, Tureli MC, Gavião MB. Validity and reliability of the Child Perceptions Questionnaires. BMC Oral Health 2009;9:13.  Back to cited text no. 2
    
3.Biazevic MG, Rissotto RR, Michel-Crosato E, Mendes LA, Mendes MO. Relationship between oral health and its impact on quality of life among adolescents. Braz Oral Res 2008;22:36-42.  Back to cited text no. 3
    
4.Frencken JE, Pilot T, Songpaisan Y, Phantumvanit P. Atraumatic restorative treatment (ART): Rationale, technique and development. J Public Health Dent 1996;56:135-40.  Back to cited text no. 4
    
5.Frencken JE. The ART approach using glass ionomers in relation to global oral health care. Dent Mater 2010;26:1-6.  Back to cited text no. 5
    
6.Taifour D, Francken JE, Beiruti N, van't Hof MA, Truin GJ. Effectiveness of glass ionomer (ART) and amalgam restorations in the deciduous dentition: Results after 3 years. Caries Res 2002;36:437-44.  Back to cited text no. 6
    
7.Frencken JE, Makoni F, Sithole WD. ART restorations and glass ionomer sealants in Zimbabwe: Survival after 3 years. Community Dent Oral Epidemiol 1998;26:372-81.  Back to cited text no. 7
    
8.Holmgren CJ, Lo EC, Hu DY, Wan HC. ART restorations and sealants placed in Chinese schoolchildren - results after three years. Community Dent Oral Epidemiol 2000;28:314-20.  Back to cited text no. 8
    
9.Wang L, Lopes LG, Bresciani E, Lauris JR, Mondelli RF, Navarro MF. Evaluation of Class I ART restorations in Brazilian schoolchildren: Three-year results. Spec Care Dentist 2004;24:28-33.  Back to cited text no. 9
    
10.van Gemert-Schriks MC, van Amerongen WE, ten Cate JM, Aartman IH. Three-year survival of single- and two-surface ART restorations in a high-caries child population. Clin Oral Investig 2007;11:337-43.  Back to cited text no. 10
    
11.Pendrys DG. Use of The ART Technique Within the School Setting Can be A Practical and Effective Method of Treating Caries Among Large Populations of Underserved Children. J Evid Based Dent Pract 2010;10:13-5.  Back to cited text no. 11
    
12.Schriks MC, van Amerongen WE. Atraumatic perspective of ART: Psychological and physiological aspects of treatment with and without rotary instruments. Community Dent Oral Epidemiol 2003;31:15-20.  Back to cited text no. 12
    
13.Word Health Organization. Oral health surveys, basics methods. Geneva: Word Health Organization; 1997.  Back to cited text no. 13
    
14.Ayres M, Ayres M Jr, Ayres DL, Santos AS. BioEstat 5.0. Aplicações Estatísticas nas Áreas das Ciências BioMédicas. Brazil: Sociedade Civil de Mamirauá, Belém; 2007.  Back to cited text no. 14
    
15.Bernabé E, Tsakos G, Sheiham A. Intensity and extent of Oral Impacts on Daily Performances by type of self-perceived oral problems. Eur J Oral Sci 2007;115:111-6.  Back to cited text no. 15
    
16.Cunnion DT, Spiro A 3 rd , Jones JA, Rich SE, Papageorgiou CP, Tate A, et al. Pediatric oral health- related quality of life improvement after treatment of early childhood caries: A prospective multisite study. J Dent Child (Chic) 2010;77:4-11.  Back to cited text no. 16
    
17.Filstrup SL, Briskie D, Fonseca M, Lawrence L, Wandera A, Inglehart MR. Early childhood caries and quality of life: Child and parent perspectives. Pediatr Dent 2003;25:431-40.  Back to cited text no. 17
    
18.Do LG, Spencer A. Oral Health-Related Quality of Life of children by dental caries and fluorosis experience. J Public Health Dent 2007;67:132-9.  Back to cited text no. 18
    
19.Gherunpong S, Tsakos G, Sheiham A. The prevalence and severity of oral impacts on daily performances in Thai primary schoolchildren. Health Qual Life Outcomes 2004;2:57.  Back to cited text no. 19
    
20.Pahel BT, Rozier RG, Slade GD. Parental perceptions of children's oral health: The early childhood oral health impact scale (ECOHIS). Health Qual Life Outcomes 2007;5:6.  Back to cited text no. 20
    
21.Bresciani E. Clinical trials with Atraumatic restorative treatment (ART) in deciduous and permanent teeth. J Appl Oral Sci 2006;14:14-9.  Back to cited text no. 21
    
22.Lo EC, Holmgren CJ, Hu D, van Palenstein Helderman W. Six-year follow up of atraumatic restorative treatment restorations placed in Chinese school children. Community Dent Oral Epidemiol 2007;35:387-92.  Back to cited text no. 22
    
23.Mandari GJ, Frencken JE, van't Hof MA. Six-Year Success Rates of Occlusal Amalgam and Glass-Ionomer Restorations Placed Using Three Minimal Intervention Approaches. Caries Res 2003;37:246-53.  Back to cited text no. 23
    
24.Leal SC, Abreu DM, Frencken JE. Dental anxiety and pain related to ART. J Appl Oral Sci 2009;17:84-8.  Back to cited text no. 24
    
25.Farag A, Frencken JE. Acceptance and discomfort from atraumatic restorative treatment in secondary school students in Egypt. Med Princ Pract 2009;18:26-30.  Back to cited text no. 25
    

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Correspondence Address:
J S Paula
Department of Community Dentistry, Division of Health Education and Health Promotion, Piracicaba Dental School, University of Campinas -UNICAMP, Piracicaba, SP
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.111249

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