|Year : 2022 | Volume
| Issue : 1 | Page : 2-6
|Tooth loss and oral health-related quality of life among adult dental patients: A cross-sectional study
Nagarani Veeraboina1, Dolar Doshi2, Suhas Kulkarni1, Shiva Kumar Patanapu3, Satya Narayana Dantala1, Adepu Srilatha1
1 Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India
2 Department of Public Health Dentistry, Government Dental College and Hospital, Hyderabad, Telangana, India
3 Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Telangana, India
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|Date of Submission||21-May-2019|
|Date of Decision||29-Jan-2020|
|Date of Acceptance||12-Jun-2020|
|Date of Web Publication||09-Aug-2022|
| Abstract|| |
Background: Oral diseases seriously impair the quality of life (QoL) in a large number of individuals and they may affect various aspects of life. Aim: To determine the relationship between tooth loss and oral health-related quality of life (OHRQoL) among adult dental patients. Study Setting and Design: A cross-sectional study was carried out among 296 adult dental patients aged 35–44 years attending Department of Oral Medicine and Radiology of Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. Materials and Methods: Oral Health Impact Profile-14 (OHIP-14) was used to assess OHRQoL. Dentition status and periodontal status according to WHO criteria 2013 and position, number of teeth lost by Batista et al. (2014) tooth loss classification were assessed. Statistical Analysis: Mann–Whitney U test and analysis of variance were used to find prevalence and severity of OHIP-14 with tooth loss and logistic regression analysis to evaluate the association between OHIP-14 prevalence and severity based on variables. Results: Except for the subjects with history of previous dental visit, variables such as gender and reason for dental visit showed significant difference (P ≤ 0.05) with tooth loss. Males subjects, who visited dentist with a history of pain, presence of periodontal disease and tooth loss up to 12 teeth (score 3) emerged as significant predictors for OHIP-14 prevalence (OR = 6.7, OR = 1.13, OR = 3.31). Conclusion: The study strongly evidenced that number and position of tooth loss had negative impacts on OHRQoL.
Keywords: Oral health-related quality of life, prevalence, severity, tooth loss
|How to cite this article:|
Veeraboina N, Doshi D, Kulkarni S, Patanapu SK, Dantala SN, Srilatha A. Tooth loss and oral health-related quality of life among adult dental patients: A cross-sectional study. Indian J Dent Res 2022;33:2-6
|How to cite this URL:|
Veeraboina N, Doshi D, Kulkarni S, Patanapu SK, Dantala SN, Srilatha A. Tooth loss and oral health-related quality of life among adult dental patients: A cross-sectional study. Indian J Dent Res [serial online] 2022 [cited 2022 Sep 29];33:2-6. Available from: https://www.ijdr.in/text.asp?2022/33/1/2/353536
| Introduction|| |
Health has evolved over the centuries as a concept from an individual concern to a worldwide social goal and encompasses the whole quality of life (QoL). Slade et al. identified the shift in the perception of health from merely absence of disease and infirmity to complete physical, mental and social well-being. Hence, clinical measures only are not sufficient to describe the health status of an individual. Therefore, the concept of QoL has evolved as a holistic approach measuring not only disease outcomes but also factors adjunct to it.
A major factor that can strongly affect the overall health-related QoL is the oral health of the individual. Consequently, oral health is integral and essential to general health, well-being and QoL of every person. Furthermore, oral diseases impinge on people's everyday lives by disrupting certain activities like eating, sleep, work and social roles. Hence, oral health-related quality of life (OHRQoL) can be used to assess the subjective evaluation of individual's oral health.
OHRQoL is a rapidly growing phenomenon, which has emerged over the past 20 years. It is a multi-dimensional patient-centred concept that focuses on the impact of oral problems on individual's physical, psychological and social well-being., Traditionally various indices have been used to describe the prevalence of diseases in the population but they gave no indication of the impact of the disease process on function or psychological well-being. Thus, the clinical indicators of oral diseases such as dental caries and periodontal diseases only are not sufficient to describe the oral health status of an individual.
Oral diseases seriously impair the QoL in a large number of individuals and they may affect various aspects of life. OHRQoL is influenced by many variables including dental diseases, tooth loss, psychological and dietary factors, out of which tooth loss is one of the prime factors. The most common oral diseases are dental caries, periodontal diseases and the final outcome of these diseases if untreated, leads to tooth loss.,
Severe tooth loss has been regarded as one of the main oral health conditions causing burden to population and adversely affecting their QoL. Studies,,,,,, have shown that the number of missing teeth as well as their relative position in the mouth is associated with impairment of OHRQoL. Tooth loss will presumably cause functional mutilation with regards to chewing and aesthetics depending on the location of tooth loss, thereby affecting QoL.
Despite a large number of OHRQoL studies, only few of them explore the impact of tooth loss in terms of number or position of teeth in the mouth on OHRQoL, but there is no measure that combines number and position of missing teeth. Hence, the present study aimed to determine the relationship between tooth loss and OHRQoL among adult dental patients.
| Materials and Methods|| |
Approval for the study was obtained from the Institutional Review Board of Panineeya Institute of Dental Sciences and Hospital (PMVIDS&RC/PHD/PR/0263-18). Upon agreement and explanation of the study procedures, subjects willing to participate signed the consent form. Anonymity and confidentiality of respondents were maintained and participation was voluntary.
The sample comprised subjects aged 35–44 years, adult dental patients attending the Department of Oral Medicine and Radiology of Panineeya Institute of Dental Sciences and Hospital. Subjects who received antibiotic treatment within last 1 month, subjects with systemic medical conditions and those not willing to participate were excluded from the study.
Demographic details like age, gender, past dental visit and reason for dental visit were recorded. A self-reported 14-item Oral Health Impact Profile-14 (OHIP-14) developed by Slade (1997) administered to assess the OHRQoL of an individual. The subjects were instructed to express their opinion on a five-point Likert-type scale with a score ranging from 0 (never) to 4 (very often). All responses for fourteen questions were summed to produce an overall OHIP score (0 to 56) with higher scores indicating worse OHRQoL.
Clinical oral examination
In the clinical oral examination, dentition status and periodontal status (Community Periodontal Index (CPI) modified) were evaluated according to World Health Organization (WHO) criteria 2013. Tooth loss was the main explanatory variable and measured based on position and number of missing teeth developed by Batista et al.
The final outcome for this study was OHRQoL, measured by OHIP severity, i.e., the total OHIP-14 score (sum of the Likert-type responses for the fourteen questions, range: 0–56), and OHIP prevalence, i.e., the relative frequency of one or more impacts “often/very often” on OHRQoL.
The clinical examination of all the subjects was done by a single pre-trained, pre-calibrated examiner. The training and calibration were done in the Department of Public Health Dentistry (Panineeya Institute of Dental Sciences and Hospital) under the guidance of a senior faculty. The recorder was also pre-trained in the department.
Statistical analysis was done utilizing Statistical Package for Social Sciences (SPSS) Software version 21.0. Mann–Whitney U test was used to find the prevalence and severity of OHIP-14 and tooth loss based on variables. Comparison of means scores of OHIP-14 and its domains with tooth loss was assessed by analysis of variance (ANOVA) based on variables. Logistic regression analysis was used to evaluate association between OHIP-14 prevalence and severity based on variables. Statistically significance was set at P < 0.05.
| Results|| |
A total of 296 adult dental patients comprising 128 (43.2%) males and 168 (56.8%) females participated in the study with a mean age of 38.7 ± 0.25 years with majority of them having dental caries (66.9%). Around 60% of the subjects visited dentist previously, among them 27.2% visited due to need. Furthermore, history of pain in the oral cavity (54.4%) was the most common reason for dental visit, whereas only 18.3% had a routine dental check-up in the past [Table 1].
Among the total population, the majority of subjects (54%) had not lost any tooth due to caries or periodontal diseases (score 0). Around 21.3% of subjects had lost up to 12 posterior teeth, excluding first molars (score 2), 14.1% lost 1–4 first molars only (score 1) and 10.5% lost up to 12 teeth, including one or more anterior teeth (score 3). Surprisingly, none of the subjects were edentulous (score 5) nor had lost more than 12 teeth (score 4). Except for the history of previous dental visit, variables such as gender (P ≤ 0.04) and reason for dental visit (P ≤ 0.01) showed significant difference with tooth loss classification.
Based on gender, a higher percentage of males had score 0 and score 3, whereas more females had scores of 1 and 2. Among the subjects who visited dentist for a routine check-up, higher percentage had score 0 and none had score 3. A majority of those visiting for pain had score 2 and need-based dental visit had score 3 [Table 2].
|Table 2: Distribution of tooth loss based on tooth loss classification among study subjects according to variables|
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Though females have shown higher prevalence for OHIP-14 compared to males, significant difference was observed only for the dimensions physical pain (P = 0.001), psychological discomfort (P = 0.004) and physical disability (P = 0.01).
Likewise, the severity of OHIP-14 as calculated by mean score was also higher among females with significant difference for the same dimensions as the prevalence [Table 3].
|Table 3: Prevalence and severity of oral health impact profile-14 (OHIP-14) based on gender among the study subjects|
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Male subjects (OR = 0.24), who visited dentist with a history of pain (OR = 6.7), presence of periodontal disease (OR = 1.13) and tooth loss up to 12 teeth (score 3) (OR = 3.31) emerged as significant predictors for OHIP-14 prevalence in this study. However, when the OHIP-14 severity was considered, subjects who visited dentist with a history of pain (OR = 1.16), presence of periodontal disease (OR = 0.23), carious teeth (OR = 3.19) and tooth loss up to 12 teeth including anterior teeth (score 3) (OR = 3.5) showed to be significant predictors [Table 4].
|Table 4: Logistic regression analysis between OHIP-14 prevalence and severity among study subjects based on variables|
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| Discussion|| |
Despite improvements in oral health conditions across all the age groups, oral diseases such as dental caries, periodontal disease and tooth loss are still prevalent. The burden of oral diseases in individuals is mostly measured as OHRQoL which considers the prevalence, severity and also the negative and positive impact.
The oral health impact profile (OHIP) is one such popular measure, which was developed based on WHO criteria such as impairment, disability and handicap. According to Slade, short version of OHIP-14 instrument can be useful for quantifying levels of impact on well-being in settings where only a limited number of questions can be administered. Hence, in the present study, OHIP-14 used to measure the impact of oral diseases on individual's QoL.
Previous works of literature,,, showed that number of lost teeth had functionally, aesthetically and psychologically negative impacts on OHRQoL, but limited studies are available about the impact of the position of the teeth on individual's well-being., Hence, in the present study, tooth loss classification developed by Barista et al. was used to examine whether the number of teeth or the position of the tooth lost or both that have greater impact on OHRQoL.
In this study, around 66.9% of the subjects had caries and 37.2% had periodontal disease and this might be one of the reasons for having higher percentage of tooth loss of up to 12 posterior teeth, excluding the permanent first molars (21.3%). Similarly, a previous study by Osunde et al. among Nigerian adults showed that mandibular first and third molar and maxillary first molar teeth were most frequently lost due to caries (65.5%) followed by periodontal disease (13.1%) and symptomatic impacted tooth (9.8%).
Studies by Fotedar et al. among dental patients in Shimla (57.9%) and Oremosu and Uti among Nigerian adults (83.1%) reported that males who visited dentist due to some episodic problems showed significantly higher tooth loss of up to 1–3 upper and lower posterior teeth. However, in the present study, females who visited the dentist previously due to pain showed significantly higher tooth loss up to 12 posterior teeth (16.8%) excluding first permanent molars. This reflects the negative attitudes of study population towards dental care as they preferred for extraction rather than conservative treatment in case of pain.
In the present study, females had higher prevalence for OHIP-14 (58.2%). Similar findings were reported by Barista et al. among Brazilian adults (48.1%), Fotedar et al. among Indian adults (36.5%) and Lawrence et al. among Dunedin adult (23.4%) population. This shows females might have better awareness about oral health, high dental self-consciousness and more critical in judging their dental appearance. In contrast, the study done by Sanadhya et al. among rural and urban population of Udaipur reported a significantly greater odds (OR) of OHIP-14 among males (OR = 1.35).
Previous studies, Barista et al., Lalic et al. and Fotedar et al. showed that physical pain, psychological discomfort and physical disability domains showed significantly higher OHIP-14 severity among females which was similar with the present study. This could be because women perceive that oral health affects QoL to a greater extent compared to men. According to Indian scenario, it might be a fact that the females are more dependent and have a family responsibility, which influences the access and utilization of dental services and that might lead to poor OHRQoL.
As evidenced,,, untreated dental caries and periodontal diseases lead to tooth loss and affect daily activities. In the present study also, logistic regression analysis revealed that subjects who visited dentist with a history of dental pain and tooth loss due to periodontal disease and dental caries showed significant predictors of OHIP-14 prevalence and severity. Similarly, the study by Batista et al. showed that Brazilian adults who presented caries and utilized dental care services due to dental pain were more likely to have higher negative oral health impacts.
Furthermore, those who had up to twelve missing teeth including anterior teeth were more likely to have high prevalence and severity on OHIP-14 than those who had twelve missing posterior teeth. This showed that missing tooth in anterior region of the mouth, significantly leads to negative aesthetic perception and psychological impairment. These findings concur with the study by Lahti et al. wherein impaired subjective oral health was more often reported among those with fewer natural teeth. These findings were in line with the study done by Srivastava et al. in which tooth loss may affect the QoL among adult dental patients in Lucknow, Uttar Pradesh, India.
The present study also acknowledges some limitations. First, a convenience sample of dental patients may influence interpretation and generalizability. In addition, the study was cross sectional and other factors like reasons for tooth loss were not considered. Hence, further studies are needed with definite populations, especially in different social and cultural environment as many factors play a role in good oral health and impact QoL.
| Conclusion|| |
The prevalence and severity of OHIP-14 were higher among subjects who visited dentist with pain, having tooth loss up to 12 teeth (including anterior) and tooth loss due to periodontal diseases and caries. Thus, the study strongly evidenced that number and position of tooth loss had negative impacts on OHRQoL.
We would like to thank the Department of Oral Medicine and Radiology staff of Panineeya Institute of Dental Sciences and Hospital for giving permission to carry out the study.
A written and informed consent was obtained from each participant. Upon agreement and explanation of the study procedures, subjects willing to participate signed the consent form.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Shiva Kumar Patanapu
Department of Public Health Dentistry, Kamineni Institute of Dental Sciences and Hospital Narketpally, Nalgonda Dist, Telangana (State)
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]
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