|Year : 2014 | Volume
| Issue : 2 | Page : 88-92
Child-Oral impacts on daily performances: A socio dental approach to assess prevalence and severity of oral impacts on daily performances in South Indian school children of Bangalore city: A cross-sectional survey
Neha Agrawal1, K Pushpanjali2, ND Gupta1, Amit Kumar Garg3
1 Department of Periodontics and Community Dentistry, Dr. Ziauddin Ahmad Dental College, AMU, Aligarh, Uttar Pradesh, India
2 Department of Public Health Dentistry, M. S. Ramaiah Dental College, Bengaluru, Karnataka, India
3 Department of Conservative Dentistry and Endodontics, K D Dental College, Mathura, Uttar Pradesh, India
|Date of Web Publication||6-Sep-2014|
Dr. Ziauddin Ahmad Dental College, AMU, Aligarh, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Oral disorders can have a negative impact on the functional, social and psychological well-being of children and their families. Oral health and dental treatment may have an impact on eating, speaking and appearance, thereby affecting quality of life. Thus, there has been a greater focus on the measurement of quality of life as a complement to the clinical measures. Objective: The aim was to assess the prevalence, characteristics and severity of oral impacts in south Indian school children using Child-Oral Impacts on Daily Performances (Child-OIDP) index as a measure of oral health related quality of life. Methodology: A cross-sectional study was undertaken among the six government, and six private school children aged 11-12 years, of Karnataka, South India randomly selected as cluster, and all their 563 children were invited to participate. A cross culturally adapted and validated oral health-related quality of life measure; Child-OIDP was used to assess oral impacts. Results: The common perceived oral health problems were tooth ache reported by 342 children, a sensitive tooth reported by 230 children, tooth decay - hole in the tooth reported by 226 children. Eating was the most common performance affected (68.3%). The severity of impacts was high for eating and cleaning mouth and low for the study and social contact performances. Conclusion: The study reveals that oral health impacts on quality of life of school children of Karnataka aged 11-12 years. Oral impacts were prevalent, but not severe. The impacts mainly related to difficulty eating. Toothache, a sensitive tooth, tooth decay and bleeding gums contributed largely to the incidence of oral impacts.
Keywords: Children, oral impacts, quality of life
|How to cite this article:|
Agrawal N, Pushpanjali K, Gupta N D, Garg AK. Child-Oral impacts on daily performances: A socio dental approach to assess prevalence and severity of oral impacts on daily performances in South Indian school children of Bangalore city: A cross-sectional survey. J Indian Assoc Public Health Dent 2014;12:88-92
|How to cite this URL:|
Agrawal N, Pushpanjali K, Gupta N D, Garg AK. Child-Oral impacts on daily performances: A socio dental approach to assess prevalence and severity of oral impacts on daily performances in South Indian school children of Bangalore city: A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2019 Nov 22];12:88-92. Available from: http://www.jiaphd.org/text.asp?2014/12/2/88/140258
| Introduction|| |
The concept of need is central to planning, provision and evaluation of health care services. Traditionally, need has been estimated by using professionally based measures, known as normative need. Although normative need is important, it mainly reflects the clinical aspects of illness. However, subjective measures of health are important too, because they provide insights into how people feel and how satisfied they are with their quality of life.  Health-related quality of life instruments should therefore be considered in combination with clinical measures.
Oral disorders can have a negative impact on the functional, social and psychological well-being of young children and their families.  Oral health and dental treatment may have an impact on speaking, eating and appearance, thereby affecting quality of life, which is a multidimensional concept.  Children who suffer from poor oral health are 12 times more likely to have more restricted activities, including missing school than those who do not.  More than 50 million h annually are lost from school due to oral diseases.  Premature loss of deciduous teeth may lead to mal-alignment of permanent teeth, impacting on individual's appearance. Importantly tooth loss can affect children's nutritional intake and consequently their growth and development.  These issues have stimulated current interest in pediatric research related to oral health related quality of life.
Although there has been an increase in the development and use of oral health-related quality of life measures in the past two decades, most have been developed for use in adults. This is because numerous methodological and conceptual problems are involved when developing health-related quality of life measures for children; as such measures have to take into consideration distinct changes in the growing child.  For example, children's understanding of illness and health is age-dependent due to social, language, emotional, and cognitive development.  Children undergo changes in psychosocial awareness, physical changes in dental and facial features, as well as cognitive developments. ,
The Child-Oral Impacts on Daily Performances (Child-OIDP) were developed and tested among 11-12-year-old Thai children.  The Child-OIDP allows for analysis of condition-specific impacts on daily performance, thus attributing impacts to specific oral conditions or diseases according to the respondent's perceptions.  It comprises dimensions not tapped by clinical measures, such as functional, psychological and social limitations.  The outcome of these measures can be used for planning and evaluating oral health promotion programs, to motivate patients, teachers and health professionals to seek and provide more regular dental care for children. Therefore, the present study was conducted with following aim and objectives.
Aim of the study
To assess prevalence estimates of a Kannada translated version of the Child-OIDP frequency inventory for use in 11-12-year-old schoolchildren emanating from Government and Private schools of Bangalore city.
Objectives of the study
• To validate the Kannada translated version of the Child-OIDP in pilot study
• To assess the prevalence of perceived oral health problems in 11-12-year-old children of Bangalore city using Kannada translated version of the Child-OIDP
• To assess the prevalence of Child-OIDP in 11-12-year-old children of Bangalore city using Kannada translated version of the Child-OIDP.
| Methodology|| |
A cross-sectional study was undertaken among the six government, and six private school children aged 11-12 years, of Karnataka, South India randomly selected as cluster, and all their 563 children were invited to participate. About 505 of those 563 children participated in an interview voluntarily (nonresponse rate of 10.3%); 49.3% were female, and 50.7% were male, with the mean age of 11.5 years. Ethical clearance was obtained from Institutional ethics review board. Permission was obtained from the respective authorities of selected schools. Consent forms and letters informing parents were sent to parents.
Description of the index
In the present study, Child-OIDP  instrument was used to measure the oral-health related quality of life of children. It is derived from the OIDP with wording modifications addressing children's capability in relation to their intellectual, cognitive and language development. It is based on a modified version of WHO International Classification of Impairments, Disabilities and Handicaps. The instrument consists of three parts. First part included demographic details; second part consisted of oral health problems as perceived by the children with their mouth and teeth, in past 3 months. Third part contained table, including 8 common daily performances that may get affected because of oral problems such as eating, speaking, cleaning mouth, sleeping, emotional status, smiling, studying, and social contact.
The principal investigator made preliminary contact with the targeted schools. The schools were issued with a sample of the instrument, the parent consent forms and offered the opportunity to express any concern in relation to their content. Principal investigator met key "stakeholders" in each school (including the principal, the senior management team and class teachers). Teachers were reassured and encouraged to stress "This is not a test. Children should not take it too seriously, feel free and enjoy answering it."
Data were collected through an interview for oral impacts using the Child-OIDP,  by one interviewer and oral examination by two calibrated community dentists, mainly based on the WHO guidelines.  The Simplified-Oral Hygiene Index (OHI-S)  was also used to assess oral hygiene. The methods used to translate the questions in the Child-OIDP index to Kannada and to adapt the index to the South Indian culture followed published guidelines.  All documents were translated from English to Kannada, and the validity was assessed by a back-translation method, involving blind re-translation into English. The validity of the translation was verified by experts in the use of questionnaires in both languages. This was also checked after wording modifications, in order to ensure the conceptual and functional equivalences of the questionnaires. A pilot study was carried out to validate all questionnaires before using them in the main data collection. The psychometric properties of the Child-OIDP in terms of face, content, construct and criteria validity as well as internal and test-retest reliability were excellent. The index was also practical to use with this age group. Furthermore, about 10% of the children were randomly selected and re-interviewed after 1-week to re-evaluate test-retest reliability. Weighted kappa score for the Child-OIDP was 0.93, and that of inter-examiner for oral examinations was 0.86, indicating good to excellent agreement.
For the application of the Child-OIDP, the children were initially asked to record all oral health related problems they have experienced in the past 3 months. This step aimed to focus children's attention to their oral health problems and to lead to the oral impacts assessment later. Their answers here were used only as a guide to investigate OIDP in the next step and were referred to when they were asked about the causes of oral impacts in individual interviews. Thereafter, children were individually interviewed, irrespective of their answers at the first step, to assess oral impacts on daily life in relation to 8 daily performances. In the event that a child reported an impact on their performance of these eight daily performances, the child responded to questions about the severity and frequency of the specific impact; a score from 0 to 3 is given to rate each of these characteristics. The calculation of the index involves the multiplication of the severity and frequency of each performance. A sum is made of the values obtained for the eight performances, resulting in a number from 0 to 72, which is divided by 72 and then multiplied by 100, so that the final Child-OIDP score varies from 0 to 100.
The data were analyzed using the SPSS 16. Descriptive statistics, kappa statistics and Mann-Whitney U-test were used. Test-retest reliability was tested by using the intra-class correlation coefficient (ICC).
| Results|| |
Among 505 children, 234 (46.3%) were 11-year-old and 271 (53.7%) were 12-year-old. There were total 505 children, which included 256 (50.7%) males and 249 (49.3%) females. Out of 505, 202 (40%) children belonged to 5 th standard and 303 (60%) children were from 6 th standard [Table 1]. The common perceived oral health problems were tooth ache, a sensitive tooth and tooth decay reported by 342 (67.7%), 230 (45.5%) and 226 (44.8%) children respectively. The least perceived oral health problems were deformity of mouth or face (e.g. cleft lip, cleft palate) stated by 61 (12.1%) children and missing permanent tooth 15.2% declared by 77 children [Table 2] and [Figure 1].
|Table 1: Distribution of children according to gender, class and school (n=505) |
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|Table 2: Prevalence of perceived oral health problems in 11 - 12-year-old children of Bangalore city (n=505) |
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|Figure 1: Prevalence of perceived oral health problems in 11-12-year-old children of Bangalore city (n = 505)|
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Prevalence of child-oral impacts on daily performances in 11-12-year-old children in Bangalore city
The prevalence of oral impacts was high; 77.6% of children had experienced some kind of oral impact on their daily life during the past 3 months. The prevalence of impacts on eating (68.3%) and cleaning mouth (37.8%) were relatively high. The remaining prevalence of impacts were lower, namely speaking (12.1%), sleeping and emotional state (9.9%), smiling (8.7%), social Contact with people (6.3%) and studying (5.5%) [Table 3].
|Table 3: Prevalence of OIDP (Child-OIDP) in 11-12-year-old children of Bangalore city |
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This population had a low level of dental caries: 42.5% were caries free and the decayed missing filled tooth scores ranged from 0 to 12 with a median score of 1.0 and a mean of 1.7 (±2.1). Almost all children (97.4%) had a community periodontal index score of 1 or more; 57.2% had calculus. In terms of oral hygiene status, 25.2% had good, 68.4% had moderate and 6.4% had poor oral hygiene. OHI-S scores ranged from 0.5 to 5.4 with a median of 2.4 and mean score of 2.4 (±0.7), indicating a moderate level of oral hygiene.
No difference in overall impact scores were identified between government and private school children (Mann-Whitney U-test).
The test-retest reliability of the index as measured by ICC was 0.80.
The main perceived causes of impacts on each of the 8 performances are shown in [Figure 2]. Toothache, sensitive tooth and decay in the tooth were among the main perceived causes of impacts on 6 performances. The majority of impacts on Eating and speaking were caused by toothache 43.5% and 34.8, respectively. An ulcer was one of the perceived causes of impacts on the following five performances; eating (4.3%), speaking (18.6), cleaning (11.4%), sleeping (4.9%) and study (14.5%).
| Discussion|| |
The new concern about the impact of the mouth on quality of life and the shortcomings of professionally defined needs for health care have led to the development of broader measurements of health need.
The validity of quality of life mainly relies on the subjective measurement. The rationale for this comes from the conceptual distinction between health and disease. A normative index measures only biological pathology, without considering social and psychological aspects of health. Consequently, clinical oral health indicators "tell us nothing about the functioning of either the oral cavity or the person as a whole and nothing about subjectively perceived symptoms such as pain and discomfort."  Therefore, subjective measures are better placed than clinical measures to be used for the validation of oral health-related quality of life (OHRQoL) indicators. 
The present study was carried out on the basis of the instrument designed by Gherunpong et al. This instrument has been cross culturally adapted and validated among different population. ,,, Guillemin F stated that the cross culturally adapted version can be as valid and reliable as the original and has several advantages.  It provides a common measure for the investigation of health-related quality of life within different cultural contexts, different countries and allows comparisons between them. It is less costly and time-consuming than generating a new measure. 
The present study had high response rate (90.17%). This can be attributed to the meeting the researcher had with the Principal and class teachers on the previous day of the survey. The cooperation extended by the teachers and parents led to completeness of data.
The interviewer-administered questionnaires method was used for the assessment of children's response. This method has been used in other studies. ,,,,, and resulted in high response rates, reduced respondent bias and ensured greater participation.
In the present study, as the sample size was adequate (505) and children belonged to both the government and private schools, they represented the 11-12-year-old child population of Bangalore city hence the study had good external validity.
The prevalence of impacts observed in India (77.6%) was comparable to those found in other countries where the Child-OIDP was adapted and applied: Brazil (80.7%) and France (73.2%). However, it was higher than in England (40.4%). ,, Eating was the most affected performance in all the studies using Child-OIDP in a general population. In relation to the most prevalent oral impacts, eating and cleaning mouth were the two performances mostly affected in India which were similar to France and England, while in Brazil emotional status was the second most affected performance. ,, Concerning the perceived oral problems, tooth-ache and sensitive tooth were the most commonly reported problems by the Indian children while sensitive tooth and tooth color were the most commonly reported by the Brazilian children.  In France, the problems mentioned were position of teeth and wounds. 
Test retest reliability evaluated using ICC was very good and showed that the index is a stable measure. This result is comparable to other validation studies of Child-OIDP. ,,,
This study has the limitations inherent to a cross-sectional design, especially the lack of temporality. Therefore, longitudinal studies are needed to assess how individuals perceive OHRQoL over time.
It was concluded that cross culturally adapted and validated Kannada version of Child-OIDP scale can be applied by any trained person and not only by a dentist, it can be used in public health programs as a socio-dental indicator of oral health. 
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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