Longitudinal impact of clinical and socioenvironmental variables on oral health-related quality of life in adolescents

Discriminant validity of the current gingivitis classification in adolescents: a cohort study

OBJECTIVES

To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study.

MATERIALS AND METHODS

A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up.

RESULTS

Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites.

CONCLUSION

The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites.

CLINICAL RELEVANCE

The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs.

Oral health-related quality of life determinants throughout adolescence: a cohort study in Brazil

PURPOSE

Oral health-related quality of life (OHRQoL) is a complex construct that reflects the interaction among well-being, socioeconomic, oral health status, and also contextual factors. This study aimed to verify the association between poorer socioeconomic background and oral health condition on OHRQoL throughout adolescence.

METHODS

A cohort study followed a random sample of 1134 participants aged 12 years in 2012 (T1), 770 adolescents with an average age of 14 years in 2014 (T2; retention rate, 67.9%), and 768 adolescents with an average age of 17.5 years in 2018 (T3; retention rate, 67.8%). OHRQoL was collected three times using the Brazilian short version of the Childhood Perception Questionnaire 11-14 (CPQ 11-14). At baseline, the adolescents were clinically assessed by dentists, and their demographic data, socioeconomic status, use of dental services, and toothache were evaluated. The mean income of the neighborhood was used as a proxy of contextual factors. This variable was obtained from an official municipal publication. Poisson multilevel regression analyses were performed using a hierarchical approach to assess the predictors of OHRQoL over time.

RESULTS

Adolescents living in a neighborhood with low mean income, low household income, low education levels, girls, and nonwhite individuals reported poor OHRQoL. Clinical variables such as gingival bleeding and malocclusion were also associated with higher overall scores on CPQ11-14, indicating poor OHRQoL.

CONCLUSION

Our results showed that the unfavorable contextual and individual socioeconomic environment, and oral disease negatively influenced OHRQoL during adolescence.

Oral health literacy, sociodemographic, family, and clinical predictors of dental visits among Brazilian early adolescents

BACKGROUND

The prevalence of dental caries is high in adolescents worldwide, and a large percentage have never been to a dentist or have not had regular dental appointments.

AIM

To evaluate the influence of oral health literacy and sociodemographic, clinical, and family factors on dental visits among early adolescents.

DESIGN

A cross-sectional study was conducted with 740 12-year-old students in Campina Grande, Brazil. Students answered about their level of oral health literacy (BREALD-30), levels of family adaptability and cohesion (FACES III), and visits to the dentist sometime in life. Dental caries experience was evaluated using Nyvad criteria. Robust Poisson regression for complex samples was performed.

RESULTS

A higher level of oral health literacy (PR = 1.01; 95% CI: 1.01-1.03), high social class (PR = 1.28; 95% CI: 1.09-1.50), higher mother's schooling (PR = 1.58; 95% CI: 1.37-1.83), family cohesion classified as enmeshed (PR = 1.55; 95% CI: 1.19-2.02) and connected (PR = 1.22; 95% CI: 1.02-1.44), and the absence of toothache (PR = 1.18; 95% CI: 1.01-1.38) remained associated with having visited a dentist.

CONCLUSIONS

Oral health literacy and sociodemographic, family, and clinical factors were predictors of having visited a dentist among early adolescents.

Effect of dental caries and socioeconomic status on social capital throughout adolescence: a 6-year follow-up

The aim of the study was to investigate the influence of clinical and socioeconomic factors on social capital throughout adolescence. A cohort study was performed in 2012 (T1) with a random sample of 1,134 12-year-old adolescents from Santa Maria, Brazil. Questions on socioeconomic factors (maternal education, household income, household crowding) were answered by the parents. Clinicians evaluated their dental caries (decayed, missing, and filled status of permanent teeth) and gingival bleeding (using the Community Periodontal Index). Contextual variables including the mean income of the neighborhood in which the school was located were used (T1). The adolescents were revaluated in 2018 (T2) and answered questions regarding social capital (social trust, social control, empowerment, neighborhood security, and political effectiveness). A path analysis was used to test the relationship between the predictor variables (T1) and social capital (T2). A total of 768 adolescents were reevaluated at a 6-year follow-up (cohort retention rate of 67.7%). Most of the adolescents were girls, with a low household income, about 40% had caries experience (T1), and about 64% had high social capital (T2). The highest neighborhood's mean income was related to a lower household income in T1 (p < 0.01), and this was directly related to a low social capital in T2 (p = 0.04). Furthermore, caries experience at T1 was directly associated with low social capital at T2 (p = 0.03). Socioeconomic factors were also related to caries experience. Individuals who lived in neighborhoods with greater inequality such as families with a low household income and those with untreated dental caries in early adolescence, had a low social capital after follow-up.

Relationships of Dental Caries and Malocclusion with Oral Health-Related Quality of Life in Lithuanian Adolescents Aged 15 to 18 Years: A Cross-Sectional Study

There is a lack of evidence of the moderating effects of caries lesions and malocclusions on oral health-related quality of life (OHRQoL) among older adolescents. This study aimed to evaluate the relationship of dental caries and malocclusion with OHRQoL among Lithuanian adolescents aged 15 to 18 years. A survey in a representative sample of adolescents included a clinical examination to assess dental health status using the DMFT (Decayed, Missing, and Filled Permanent Teeth) index, and malocclusion using the Index of Complexity, Outcome, and Need (ICON). The Child Perceptions Questionnaire (CPQ) was used to evaluate respondents’ OHRQoL. Negative binomial regression was fitted to associate the clinical variables with the CPQ scores. A total of 600 adolescents were examined. The overall mean DMFT score was 2.7. A need for orthodontic treatment was detected among 27.7% of adolescents. Subjects with caries lesions (DMFT > 3) had higher CPQ scores in the domains of functional limitations and social wellbeing (relative risks were 1.35 (95% confidence interval: 1.09–1.67) and 1.30 (1.03–1.64), respectively), while subjects with a need for orthodontic treatment (ICON > 43) had higher CPQ scores in the domains of emotional wellbeing and social wellbeing (relative risks were 1.81 (1.40–2.22), and 1.69 (1.34–2.14), respectively). It was concluded that both dental caries and malocclusion have negative relationships with OHRQoL in adolescents above 15 years, but their effects occur differently in each OHRQoL domain.

Influence of socioeconomic inequalities on levels of dental caries in adolescents: A cohort study

BACKGROUND

Socioeconomic factors at both contextual and individual levels influence health.

AIM

Evaluate the influence of socioeconomic inequalities on the incidence of dental caries in adolescents.

DESIGN

This cohort study was conducted with a multistage random sample of 1134 12-year-old adolescents from Southern Brazil. The experience of dental caries was assessed according to the decayed, missed, or filled surfaces (DMF-S) index. The Basic Education Development Index (IDEB) was collected during baseline as a school-level variable. Individual variables included demographic, socioeconomic, behavior-related, and oral health measures. Multilevel Poisson regression analysis through a hierarchical approach was used to explore the influence of exploratory variables on the mean of decayed surfaces.

RESULTS

770 14-year-old adolescents were reevaluated (follow-up rate of 68%) after 2 years. Examiner's Kappa values for the assessment of dental caries ranged from 0.81 to 0.90. Adolescents with low household income and lower school's IDEB had higher mean of decayed surfaces. Non-white adolescents, lower frequency of dental attendance, parents' poor perception of child's oral health, and dental plaque were also associated with the incidence of dental caries.

CONCLUSION

Adolescents from a lower socioeconomic background and poor school context had higher levels of dental caries over time.

Exploring an Association of Demographic, Oral, and Systemic Health Factors Among Patients Attending a Teaching Dental Center

Background:

Updated information on oral health status could be used to monitor oral disease patterns, as widespread variations in oral health outcomes within and between different countries are reported.

Aim:

The objective was to examine the status of oral and systemic health and their association with demographic characteristics of the population attending a public dental center.

Methods:

A cross-sectional secondary analysis of the patients’ record was conducted during June 2017 attending the dental center of Madina Teaching hospital Faisalabad, Pakistan. Study variables were analyzed using the t test and the c2 test with a significance level of P ≤ .050.

Results:

The mean age of the study sample was 31.9 ± 14.5 years; 56% were females; 48% had primary or higher education; 9% were hypertensive; 5% had hepatitis; and 5% diabetes mellitus; 52% were with poor oral hygiene, 68% had dental caries, 84% had no fillings, 27% had tooth loss, and 99% functional dentition; 74% patients had calculus, 67% had gingivitis, and 5% had periodontitis. Age was the strongest risk indicator. Dental caries, tooth loss, poor oral hygiene, gingivitis, periodontitis, and tooth mobility were significantly associated with diabetes mellitus; tooth loss and tooth mobility were associated with cardiac disease; tooth loss, periodontitis, and tooth mobility were associated with hypertension, whereas tooth loss and calculus were associated with hepatitis. Higher age and lower income were positively associated with poor oral hygiene.

Conclusion:

Age and gender remain to be the strongest predictors for both oral and systemic conditions. Poor oral health and tooth loss showed a strong relationship with chronic systemic conditions.

Dental treatment improves the oral health-related quality of life of adolescents: A mixed-methods approach

AIM

To evaluate and understand the impact of dental treatment on oral health-related quality of life (OHRQoL) of adolescents.

DESIGN

A sequential explanatory mixed-methods design was performed. A sample of 182 adolescents, aged 10 and 15 years old who had finished their dental treatment at adolescent dental clinic of Federal University of Santa Maria from 2010 to 2016, were included. Participants answered the short form of Child Perceptions Questionnaire (CPQ_11-14) prior to their dental treatment and 1 month after concluding the treatment. The effect size was calculated to assess magnitude of change. In qualitative phase, semi-structured interviews took place at the end of the dental treatment. Interviews were audio-recorded and analyzed according to thematic analysis following Braun and Clarke.

RESULTS

The effect sizes ranged from 0.35 to 1.00, and the oral symptom domain presented the greatest effect. Sixteen interviews were conducted and five themes emerged: concept of quality of life, oral health influenced by oral conditions, oral health symptoms influencing seeking care behavior, personal and subjective experiences, and dental educational environment.

CONCLUSION

Dental treatment has an uncountable meaning for adolescents because it has a psychosocial meaning in this phase of life and it is able to improve their OHRQoL.

Socioeconomic inequalities in oral health-related quality of life in adolescents: a cohort study

PURPOSE

Socioeconomic inequalities are recognized as a major problem with people in low socioeconomic groups having worse subjective oral health outcomes, including oral health-related quality of life (OHRQoL). However, only a few longitudinal studies assessed the impact of contextual and individual socioeconomic determinants in adolescents' OHRQoL. We estimate the impact of socioeconomic inequalities on adolescents' OHRQoL over a 2-year period.

METHODS

This study followed up a random sample of 1134 12-year-old schoolchildren for 2 years in Brazil. OHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-year-old Children (CPQ11-14) at baseline and follow-up. Participants were clinically examined for dental caries, gingival bleeding, and malocclusion. The schoolchildren's parents answered a questionnaire regarding socioeconomic status, social capital, and adolescents' use of dental service. Socioeconomic contextual variables were collected from official city publications. Multilevel linear regression models fitted the associations between socioeconomic factors and overall CPQ11-14 scores over time.

RESULTS

A total of 747, 14-year-old adolescents were reassessed for OHRQoL (follow-up rate of 66%). Adolescents with lower mean income school's neighborhood (P < 0.05), household income (P < 0.05), and maternal schooling (P < 0.05) had higher overall CPQ11-14 scores. Female sex, attending a dentist by toothache, dental caries, and malocclusion were also associated with higher overall CPQ11-14 scores.

CONCLUSIONS

Adolescents from low socioeconomic background reported worse OHRQoL at 2-year follow-up compared to those from high socioeconomic background. Actions toward health inequalities need to address socioeconomic factors in adolescence.

Family Affluence Based Inequality in Oral Health-Related Quality of Life in a Population of Lithuanian Adolescents

Background: The social inequalities in oral health have had increasing attention in recent years. The present study aimed to explore the impact of family affluence on Oral Health-Related Quality of Life (OHRQoL) among Lithuanian adolescents aged 11–18 years. Methods: The cross-sectional, population-based study included a representative sample of 881 adolescents aged 11–18 years (mean = 15.55; SD = 1.51) randomly selected from 20 schools in Lithuania. The schoolchildren completed questionnaires to evaluate their OHRQoL using a Lithuanian version of the Child Perceptions Questionnaire (CPQ). The adolescents’ family affluence was indirectly assessed by inquiring whether they possessed various modern life items. In dental examination, the severity of malocclusion was predetermined by the Index of Complexity, Outcome, and Need (ICON). The relationship among variables was examined employing the negative binomial regression and the path analysis. Results: The sum score of CPQ as a whole and the sum scores of all four domains were significantly associated with family affluence, indicating higher OHRQoL among adolescents from more affluent families. The severity of malocclusion had a significant association with emotional and social well-being domains of OHRQoL only. Conclusion: This study evidences the family affluence based inequality in OHRQoL among Lithuanian adolescents.

Orthodontic treatment need, self-esteem, and oral health-related quality of life among 12-yr-old schoolchildren

The aim of this study was to investigate the association between orthodontic treatment need and oral health-related quality of life (OHRQoL) among 12-yr-old children. The study also assessed whether self-esteem modifies and/or moderates this relationship. Cross-sectional data on 406 schoolchildren aged 12 yr were analyzed. Data on socio-economic and demographic characteristics, dental pain, self-esteem, and OHRQoL were collected using validated questionnaires. Orthodontic treatment need was assessed, through dental examinations, using the dental aesthetic index (DAI). Multiple negative binomial regression and path analysis were used to estimate the association of orthodontic treatment need and self-esteem with OHRQoL. A modifying effect of self-esteem on the relationship between DAI and OHRQoL was observed. Self-esteem did not mediate the abovementioned relationship. Children with lower scores of self-esteem had worse OHRQoL among those with lower orthodontic treatment need (a DAI score of < 31). However, self-esteem did not influence the association between DAI and OHRQoL in children with greater orthodontic treatment need (a DAI score of ≥ 31). Self-esteem attenuated the impact of malocclusion on OHRQoL in children with minor or definite malocclusion, but not among those with severe or very severe malocclusion. Self-esteem appears to buffer the impact of malocclusion on OHRQoL in children with minor orthodontic treatment need.

The factors that influence oral health-related quality of life in young adults

Background

Young adulthood is a time when subjects transform their role from a dependent child to an independent social identity. This cross-sectional study aimed to analyze the sociodemographic and clinical factors that may influence the OHRQoL of 18-year-old young adults.

Methods

A representative sample was selected from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. The oral health impact profile (OHIP-14) was used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression.

Results

A total of 300 eligible subjects (165 females, 135 males) were recruited. Females had more severe caries than males; however, gender was not a significant factor of OHRQoL. Household income affected OHRQoL more than parents’ education did: household income had effects on physical pain, psychological discomfort, psychological disability, and the total OHIP; while parents’ education had some effects on functional limitation, physical pain and psychological discomfort. As for clinical factors, unhealthy periodontal conditions were more prevalent than caries (94.67% vs. 59.00%); however, both of them showed no effect on OHRQoL. Malocclusion had a negative effect on OHRQoL; the most affected subscales were psychological discomfort and psychological disability.

Conclusion

In this study, family ecosocial factors and malocclusion had an effect on OHRQoL. Among the family ecosocial factors, it was household income that had the most effect on OHRQoL. Malocclusion mainly affected the subscales of psychological discomfort and psychological disability. Gender, periodontal status and caries had no effect on young adults’ OHRQoL.

Relationship Between Orthodontic Treatment Need and Oral Health-Related Quality of Life among 11⁻18-Year-Old Adolescents in Lithuania

The aim was to examine the relationship between orthodontic treatment need and Oral Health-Related Quality of Life (OHRQoL) among Lithuanian adolescents aged 11–18 across gender and age groups. A representative cross-sectional study of 911 adolescents aged 11–18 (mean (M) = 15.53; Standard Deviation (SD) = 1.52) was conducted in 26 public schools. The schoolchildren completed the Child Perceptions Questionnaire to evaluate their OHRQoL. The Index of Orthodontic Treatment Need (IOTN) was used to evaluate the severity of malocclusion. The strength of association between variables was evaluated via negative binomial regression estimating the ratio of sum score means (RSSM). A worse OHRQoL score was associated with a higher grade of IOTN; however, only the Emotional and Social wellbeing domains were significantly affected by malocclusion (RSSM = 1.158; 95% Confidence Interval (CI): 1.083–1.237 and RSSM = 1.205; 95% CI: 1.114–1.304, respectively). The significant association was identified only among females (RSSM = 1.264; 95% CI: 1.176–1.359). A significant association was observed in all age groups for Emotional and Social well-being domains but only in the oldest age group for Oral Symptoms and Functional Limitations domains. Conclusions: Malocclusion has a negative impact on the OHRQoL of young people with emotional and social aspects being the most affected. Girls and older adolescents suffered from malocclusion more than boys and their younger counterparts.

The factors that influence oral health-related quality of life in 15-year-old children

Background

Several hypotheses on factors that influence oral health-related quality of life (OHRQoL) have been proposed but a consensus has not been reached. This cross-sectional study aimed to analyse the sociodemographic and clinical factors that may influence the OHRQoL of 15-year-old children.

Methods

A representative sample was selected from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. Child Perception Questionnaire (CPQ_11–14, 37 items) including four domains, namely oral symptoms (OS), functional limitations (FL), emotional well-being (EWB), and social well-being (SWB), was used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression.

Results

A total of 364 eligible subjects (186 girls, 178 boys) were recruited. The prevalence of caries was higher in girls than in boys (P = 0.013). Compared with girls, boys tended to have a better experience in the domains of EWB, SWB and the total CPQ (adjusted OR = 0.46, 0.59 and 0.61, respectively). Unhealthy periodontal conditions were more prevalent than caries (92.6% vs. 52.7%); moreover, periodontal conditions with CPI scores of 2 had a negative effect on the domain of SWB and the total CPQ (adjusted OR = 1.76 and 1.71, respectively). Only the most severe malocclusion showed an effect on the domain of FL and the total CPQ (adjusted OR = 1.55 and 2.10, respectively). Little effect of family ecosocial factors and caries was found on CPQ scores.

Conclusion

In this study, gender, periodontal status, and malocclusion showed an effect on OHRQoL after adjusting for potential confounders. Boys had less caries and better OHRQoL than girls did. Unhealthy periodontal conditions led to worse social welfares and OHRQoL. The most severe level of malocclusion caused oral functional limitations, hence worse OHRQoL.