Using associations between oral diseases and oral health-related quality of life in a nationally representative sample to propose oral health goals for 12-year-old children in Thailand

Impact of oral diseases on 12- and 15-year-old children's quality of life: condition-specific oral health related quality of life analysis

BACKGROUND

Oral diseases can affect children's quality of life. The aim of the present study was to assess the Condition-Specific (CS) impacts from oral diseases in 12- and 15-year-old Thai population using data from the two consecutive national oral health-related quality of life surveys.

METHODS

The oral health-related quality of life surveys were conducted for this study as a part of 6th and 7th national oral health survey. The study sample of 1,066 12- and 815 15-year-olds from 6th national oral health survey; and 556 12- and 351 15-year-olds from 7th national oral health survey were from Bangkok and four regions of Thailand. Oral impacts were assessed by the Child-Oral Impacts on Daily Performances index for 12- and Oral Impacts on Daily Performances index for 15-year-olds. The overall impacts and CS impacts attributed to oral diseases were calculated. The detailed characteristics of the CS impacts were analyzed. Cochran's Q test and McNemar's test were used to determine the difference between the proportions of CS impacts of caries, gingival diseases, oral lesions, and malocclusion.

RESULTS

CS impacts-caries were prevalent for both age, followed by gingival disease and oral lesions. CS impacts-caries were the highest in the intensity and extent for both age groups. CS impacts-caries were significantly higher than those of gingival diseases for eating, speaking, relaxing, emotional state, and studying. CS impacts-gingival disease was significantly higher than caries for cleaning in one survey.

CONCLUSIONS

CS impacts-caries were the most prevalent and severe among adolescent. Gingival disease was infrequently related to severe impacts on daily performances.

Impact of dental fluorosis on the oral health related quality of life among 11- to 14-year-old school children in endemic fluoride areas of Haryana (India)

OBJECTIVE

This study investigates the impact of dental fluorosis on the oral health-related quality of life (OHRQoL) among 11- to 14-year-old school children in endemic fluoride areas of Haryana (India).

MATERIALS AND METHODS

A cross-sectional survey was conducted among 2,200 school children in endemic fluoride areas of Haryana. Using cluster random sampling, three districts out of 14 endemic fluoride districts were selected, and children 11-14 years of age were examined. A child perception questionnaire (CPQ_11-14 ) (Hindi version) evaluated the impact of dental fluorosis on OHRQoL. The Thylstrup-Fejerskov index (TFI) was used for assessing dental fluorosis. The data were analysed using SPSS version 18, and non-parametric tests were used to assess the significance. The regression analysis was used to determine the effect of change in CPQ scores with dental fluorosis at P < 0.05.

RESULTS

The study participants included 45.3% males and 54.7% females among which mild to moderate level of dental fluorosis was identified with mean mean TFI Scores being 3.19 ± 1.55. Children without dental fluorosis had 1.17 times more odd of percieving their oral health as excellent/good when compared to children with dental fluorosis (P < 0.05). Study subjects with dental fluorosis did not have higher mean CPQ_11-14 domain and total scores when compared with subjects without dental fluorosis.

CONCLUSION

It can be concluded that mild dental fluorosis did not affect the OHRQoL of the children in the endemic fluoride areas of Haryana in India.

Condition-Specific Oral Health Impacts in Thai Children and Adolescents: Findings From the National Oral Health-Related Quality of Life Survey

This study was a part of the 7th National Oral Health Survey of Thailand and aimed to assess overall and condition-specific oral health-related quality of life of 12 and 15 year olds. Oral impacts were assessed using the Child-Oral Impacts on Daily Performances Index for 12 year olds and the Oral Impacts on Daily Performances index for 15 year olds. Overall oral impacts and condition-specific oral impacts (CS-impacts) were calculated. Detailed characteristics of CS-impacts were analyzed. Seventy-five percent of 12 year olds and 70.1% of 15 year olds had one or more oral impacts. CS-impacts attributed to dental caries were 37.8% and 36.5% for 12 and 15 year olds, respectively, followed by CS-impacts attributed to periodontal diseases and oral lesions. Dental caries was the most important cause of oral impacts. The severe impacts on daily performances of 12 year olds were mainly caused by dental caries, while those of 15 year olds related to dental caries and oral lesions. The majority of Thai children and adolescents experienced oral impacts. CS-impacts attributed to dental caries were most prevalent and most severe.

Association between malocclusion, caries and oral hygiene in children 6 to 12 years old resident in suburban Nigeria

Background

There are conflicting opinions about the contribution of malocclusions to the development of dental caries and periodontal disease. This study’s aim was to determine the association between specific malocclusion traits, caries, oral hygiene and periodontal health for children 6 to 12 years old.

Methods

The study was a household survey. The presence of malocclusion traits was assessed in 495 participants. The caries status and severity were assessed with the decayed, missing, and filled teeth (dmft/DMFT) index and the pulpal involvement, ulceration, fistula and abscess (pufa/PUFA) index. The Simplified Oral Hygiene Index (OHI-S) and Gingival Index (GI) were used to assess periodontal health. The association between malocclusion traits, the presence of caries, poor oral hygiene, and poor gingival health were determined with chi square and logistic regression analyses. Statistical significance was inferred at p < 0.05.

Results

Seventy-four (14.9%) study participants had caries, with mean (SD) dmft/DMFT scores of 0.27 (0.82) and 0.07 (0.39), respectively, and mean (SD) pufa/PUFA index scores of 0.09 (0.43) and 0.02 (0.20), respectively. The mean (SD) OHI-S score was 1.56 (0.74) and mean (SD) GI score was 0.90 (0.43). Dental Aesthetic Index scores ranged from 13 to 48 with a mean (SD) score of 20.7 (4.57). Significantly greater proportions of participants with crowding (p = 0.026) and buccal crossbite (p = 0.009) had caries. Significantly more children with increased overjet (p = 0.003) and anterior open bite (p = 0.008) had moderate to severe gingivitis. Poor oral hygiene (OR: 1.83; CI: 1.05–3.18 p = 0.033), crowding (OR: 1.97; CI: 1.01–3.49; p = 0.021) and buccal crossbite (OR: 6.57; CI: 1.51–28.51 p = 0.012) significantly increased the odds of having caries. Poor oral hygiene (p < 0.001), increased overjet (p = 0.003), and anterior open bite (p = 0.014) were the only significant traits associated with gingivitis.

Conclusions

Crowding and buccal cross bite were associated with caries, whereas increased overjet and anterior open bite were associated with gingivitis. These findings justify the recommendation of orthodontic treatment to improve oral health.

Systematic review of factors influencing oral health-related quality of life in children in Africa

Background

Oral health-related quality of life (OHRQoL) is influenced by cultural and societal context. Existing OHRQoL children measurement tools have been conceptualised in high-income countries. Probing whether the factors influencing OHRQoL are context-reliant in the African setting is necessary and is the purpose of the current review.

Aim

To investigate if the factors influencing OHRQoL are context-reliant.

Methods

Seven databases were searched using search terms (‘oral health’; and ‘quality of life’, ‘health-related quality of life’, ‘patient-reported outcomes’, ‘well-being’; and ‘child*’, ‘adolescents’, ‘teen*’, ‘youth’; and ‘determinants’, ‘factors’, ‘predictors’; and ‘oral health quality of life tools/instruments/scales’; and ‘Africa*’). Abstracts identified were exported to a reference software manager. Three of the authors used specific selection criteria to review, firstly, 307 abstracts and, secondly, 30 full papers. Data were extracted from these papers using a pre-designed data extraction form, after which quantitative synthesis of data was performed.

Results

Key factors influencing OHRQoL followed an existing conceptual framework where environmental and individual factors in the form of socio-economic status (SES), area of residence and children psyche status, and the presence of any oral condition other than dental caries were reported among child populations in Africa.

Conclusion

There is preliminary evidence to suggest an association between individual factors such as children’s psyche and oral problems, excluding dental caries, and environmental determinants such as area of residence and SES in children’s OHRQoL in African children. The finding that dental caries was not a key factor in child-oral health is unexpected. There seemed to be a contextual viewpoint underpinning the current OHRQoL frameworks and OHRQoL was context-reliant.

Oral clinical status and oral health-related quality of life: is socioeconomic position a mediator or a moderator?

AIM

To evaluate whether socioeconomic position exerts a mediating and/or moderating effect on the association between oral clinical measures and oral health-related quality of life (OHRQoL) in adolescents.

MATERIALS AND METHODS

The study analysed data on 5,445 adolescents aged 15-19 years from the Brazilian Oral Health Survey (SBBrasil Project). The numbers of decayed and missing teeth, number of sextants with gingivitis and malocclusion were assessed through oral clinical examinations. Participant's age, sex, OHRQoL and socioeconomic position were also collected. Monthly family income was used to indicate the participant's socioeconomic position, and OHRQoL was assessed using the Oral Impacts on Daily Performance. Moderation was tested using Poisson regression models. Structural equation modelling and Sobel's test assessed the mediation effects.

RESULTS

Oral clinical measures, OHRQoL and socioeconomic position were significantly correlated (P < 0.001). The moderator effect of socioeconomic position on the association between all oral clinical measures and OHRQoL was observed. The impact of all oral clinical conditions on adolescents' OHRQoL was lower in the low-family-income groups compared with those with a better income. Socioeconomic position partially mediated the relationship between the four oral clinical measures and OHRQoL. Sobel's test confirmed these findings (P < 0.001).

CONCLUSIONS

The findings suggest the importance of socioeconomic position as a moderator and mediator factor between oral clinical measures and OHRQoL. Disadvantaged adolescents are likely to experience poor OHRQoL due to oral conditions. The reduction of the impact of oral conditions on quality of life in adolescents may be enhanced by addressing social inequalities related to oral health.

The impact of dental caries on children and young people: what they have to say?

BACKGROUND

Dental caries affects 60-90% of children across the world and is associated with a variety of negative impacts. Despite its ubiquity, there has been surprisingly little exploration of these impacts from the child's perspective.

AIM

The aim was to allow children to describe the impact of dental caries on their daily lives and to describe the terminology they used.

DESIGN

Children, aged 5-15 years, with caries experience were purposively sampled from primary and secondary care dental clinics. Focus groups (n = 5) and in-depth interviews (n = 16) were recorded and transcribed verbatim. Data analysis took a narrative approach, and themes were derived from the data using framework analysis.

RESULTS

Pain was the main theme to emerge. Within this, three subthemes were identified: impacts related to pain, strategies adopted to reduce pain, and emotional aspects resulting from pain. A second theme was also identified relating to the aesthetic aspects of caries.

CONCLUSION

Children as young as 5 years of age were able to competently discuss their experiences of dental caries. Participants reported a number of impacts affecting various aspects of their lives. These will be incorporated into the future development of a caries-specific measure of oral health-related quality of life.

Impact of school-based dental program performance on the oral health-related quality of life in children

OBJECTIVE

To assess the association between the performance of school-based dental programs (SBDPs) and oral health-related quality of life (OHRQoL) in school children, in the province of Yogyakarta, Indonesia, taking into account untreated caries and sociodemographic factors.

METHODS

A cross-sectional survey was administered with 1906 children aged 12 and participating in SBDPs. Four SBDPs were chosen to represent good and poor performance in urban and rural areas. Caries was assessed using World Health Organization (WHO) criteria, whereas the children were interviewed for the OHRQoL and sociodemographic data. The OHRQoL was assessed using the Condition-Specific Child-Oral Impact on Daily Performances (CS Child-OIDP) index related to dental caries.

RESULTS

The mean CS Child-OIDP score was 1.63 (SD ± 3.20) for good performance SBDP and 6.89 (SD ± 8.85) for poor performance SBDP. Analysis by negative binomial regression showed that being served by a poorly performing SBDP (RR = 4.45, 95% CI = 3.87-5.13), and to some extent living in a rural area and being a girl, were significantly associated with a greater risk of having a lower quality of life than were the counterparts. Untreated caries did not show an association with OHRQoL.

CONCLUSION

There are substantial indications that SBDP performance is related to children's OHRQoL.

Effects of enamel fluorosis and dental caries on quality of life

The objectives of this study were to determine the impact of enamel fluorosis and dental caries on oral health-related quality of life (OHRQoL) in North Carolina schoolchildren and their families. Students (n = 7,686) enrolled in 398 classrooms in grades K-12 were recruited for a onetime survey. Parents of students in grades K-3 and 4-12 completed the Early Childhood Oral Health Impact Scale (ECOHIS) and Family Impact Scale (FIS), respectively. Students in grades 4-12 completed the Child Perceptions Questionnaire (CPQ8-10 in grades 4-5; CPQ11-14 in grades 6-12). All students were examined for fluorosis (Dean's index) and caries experience (d2-3fs or D2-3MFS indices). OHRQoL scores (sum response codes) were analyzed for their association with fluorosis categories and sum of d2-3fs and D2-3MFS according to ordinary least squares regression with SAS procedures for multiple imputation and analysis of complex survey data. Differences in OHRQoL scores were evaluated against statistical and minimal important difference (MID) thresholds. Of 5,484 examined students, 71.8% had no fluorosis; 24.4%, questionable to very mild fluorosis; and 3.7%, mild, moderate, or severe fluorosis. Caries categories were as follows: none (43.1%), low (28.6%), and moderate to high (28.2%). No associations between fluorosis and any OHRQoL scales met statistical or MID thresholds. The difference (5.8 points) in unadjusted mean ECOHIS scores for the no-caries and moderate-to-high caries groups exceeded the MID estimate (2.7 points) for that scale. The difference in mean FIS scores (1.5 points) for the no-caries and moderate-to-high groups exceeded the MID value (1.2 points). The sum of d2-3fs and D2-3MFS scores was positively associated with CPQ11-14 (B = 0.240, p < .001), ECOHIS (B = 0.252, p ≤ .001), and FIS (B = 0.096, p ≤ .01) scores in ordinary least squares regression models. A child's caries experience negatively affects OHRQoL, while fluorosis has little impact.

Assessment of the quality of measures of child oral health-related quality of life

Background

Several measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures.

Methods

A systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group.

Results

The search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis.

Conclusion

The three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change.

Which aspects of an oral health-related quality of life measure are mainly associated with global ratings of oral health in children?

OBJECTIVES

To assess the associations of global subjective ratings of oral health with different aspects of an oral health-related quality of life measure, namely total Oral Impacts on Daily Performances (OIDP) and Child-Oral Impacts on Daily Performances (Child-OIDP) scores, extent and intensity of oral impacts, the different performance scores and oral impacts attributed to certain groups of oral conditions.

METHODS

This study was part of the Sixth Thailand National Oral Health Survey. One thousand and sixty-six 12-year-olds and 815 15-year-olds were interviewed on their OHRQoL using Child-OIDP and OIDP indices, respectively, and rated their overall oral problems on 3-point and 5-point scales, respectively. Associations of global rating of oral health with different Child-OIDP/OIDP outcome variables were estimated using Spearman's rank correlations and logistic regressions.

RESULTS

Child-OIDP/OIDP scores were significantly associated with global ratings. Intensity was associated with global ratings, whereas extent was not. Impacts of 'very little' intensity were associated with a slightly higher chance of having poorer oral health perceptions. Global ratings were associated most with oral impacts attributed to dental caries, but not with the impacts related to natural process, such as eruption. Eating, cleaning teeth, emotional stability and smiling, plus social contact in 15-year-olds were performances associated with global ratings. Fifteen-year-old girls were more likely to perceive more oral problems than boys.

CONCLUSIONS

Associations of global ratings of oral health with Child-OIDP/OIDP scores were mainly due to the intensity of impacts. Global ratings were related to multidimensional aspects of children's quality of life.