|Year : 2014 | Volume
| Issue : 3 | Page : 204-208
Oral health impact on quality of life assessment among dental patients in Bangalore city
Y Pradeep1, K Pushpanjali2
1 Department of Public Health Dentistry, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
2 Department of Public Health Dentistry, MS Ramaih Dental College, Bengaluru, Karnataka, India
|Date of Web Publication||15-Nov-2014|
Department of Public Health Dentistry, Government Dental College and Hospital, Vijayawada, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Over the past few decades mankind has been mainly affected with chronic noncommunicable diseases, which led to compromised quality of life. Common dental diseases come under same categories that are largely social and behavioral in origin. Health-related quality of life helps us address the limitations of traditional clinical indicators of health. Aim: To measure the impact of oral health on quality of life among patients visiting dental teaching hospitals and private clinics in Bangalore city using oral health-related quality of life (OHQoL) - U.K index. Materials and Methods: A total of 1200 individuals who are above 16-year of age were selected through stratified cluster random sampling technique for this study. Data were collected using OHQoL-U.K instrument. Results: Most of the subjects (78%) perceived their oral health as impacting their quality of life. Many participants perceived their oral health had positive impact on life quality through enhancing their smile, appearance, speech. But 44.9% and 28.5% of respondents said their oral health has a negative impact on quality of life because of breath odor and finance respectively. Subjects are belonging to lower socioeconomic background, women and older adults (>45 years) perceived their oral health has a negative impact on quality of life compared to subjects from higher social class, men and young adults. Conclusion: Oral health has more impact on physical and functional aspects rather than on social and psychological domains.
Keywords: Oral health, quality of life, subjective oral health indicators
|How to cite this article:|
Pradeep Y, Pushpanjali K. Oral health impact on quality of life assessment among dental patients in Bangalore city. J Indian Assoc Public Health Dent 2014;12:204-8
|How to cite this URL:|
Pradeep Y, Pushpanjali K. Oral health impact on quality of life assessment among dental patients in Bangalore city. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2020 Feb 22];12:204-8. Available from: http://www.jiaphd.org/text.asp?2014/12/3/204/144799
| Introduction|| |
The definition of the health is ever changing that "ability to lead socially and economically productive life."  Nowhere has this statement been more apparent than in oral health. The traditional view of ill health, including dental ill health, has been of organic disease and pathological processes caused for the most part by microbes and other noxious agent, combined with individual's susceptibility. In line with this medical model of ill health, epidemiologists developed clinical indicators to measure disease and to plan treatment needs.  These clinical indicators assess and quantify the presence and extent of damage to the teeth and its supporting structures. They give no indication of the impact of the disease process on function or psycho-social wellbeing of the individual. Thus, a major shortcoming in clinical indicators is the inability to reflect the capacity of individuals to perform desired roles and activities. 
Growing recognition of the importance of patient's perceptions in assessing health outcomes had led to the development of subjective indicators. One such subjective indicator is health-related quality of life. This helps us address the limitations of traditional clinical indicators. It also addresses the values and concerns of individuals, families, public and private health care providers, researchers and decision makers. 
Quality of life is relatively new concept in the field of health and very much so with respect to oral health. Much has been said and written on the quality of life in recent years. It is a highly subjective component of wellbeing and highly difficult to define. World Health Organization (WHO) defines quality of life as, "the condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness (including comfort in the physical environment and a satisfying occupation), education, social and intellectual attainments, freedom of action, justice and freedom of expression." 
With the growing recognition of the importance of quality of life measurements in health care as a means of describing and monitoring the health of populations and individuals, a number of indicators have been developed for use in dentistry. , Few indicators like oral health impact profile (OHIP - 14) are based on previous WHO model of health: Disease - impairment - disability - handicap, focusing on the burden of disease (wholly negative).  Whereas U.K oral health-related quality of life (OHQoL) measure is based on the most recently revised WHO model of health: Structure - function - activity - participation, focusing on both disease and health states (negative and positive). This new model of health reflects social understanding that health and oral health affects people in both positive and negative ways and thus both enhances and reduces life quality. Furthermore, this questionnaire showed good psychometric properties when used among other population (Brazil and Middle East). ,
By 1980's evidence emerged of the impact of oral disorders within populations, refuting the earlier views that oral conditions were merely a private experience.  Recent research also highlighted that dental diseases are largely social and behavioral in origin. They are experienced by people in social and psychological ways and have emotional and psycho-social consequences as serious as other disorders.  Hence, the present study was undertaken to assess the oral health impact on individual's quality of life using OHQoL-UK index in Bangalore city.
| Materials and Methods|| |
Participants were the patients who reported to outpatient departments of various clinical setups in Bangalore city. Based on the pilot study results, sample size determined for the study was 1200 with 95% confidence interval and 80% power to detect the significant difference of 10% OHQoL score.
Bangalore city is divided into two zones: North and South zones by City Corporation for administrative purpose. From each zone, one dental teaching hospital and 30 private dental clinics were randomly selected. From each teaching hospital, 300 adult patients coming to outpatient departments were given a questionnaire. From each dental clinic, 10 adult patients were selected based on inclusion and exclusion criteria.
Dental patients aged 16-year and above coming to outpatient departments of selected teaching hospitals and private dental clinics.
Adult patients are coming to outpatient departments with acute conditions who require emergency care.
A questionnaire was developed for data collection that has two parts- the first part included demographic data and socioeconomic status of participants, and the second part included OHQoL-UK and its translated version (Kannada). Modified Kuppuswamy's scale  was used to assess socio economic status.
Oral health-related quality of life-UK Items included in physical, social and psychological domains. Each of the "proposed" 16 items was scored first on "effect," with responses ranging from bad to good effect on the quality of life. Then the respondents were asked to rate the "impact" of each effect on a scale ranging from none to extreme impact, in that way incorporating an individual weighting system ranging from none to extreme. Each item could thus be scored on a scale from 1 to 9. Summing up individual item responses would generate an overall OHQoL-UK score with possible scores ranging from 16 to 144.
Translation of questionnaire
Translation of United Kingdom's OHQoL measure into local language (Kannada) was done with the help of professional bilingual translators.
Pilot study was carried out to know the validity and reliability of the translated questionnaire and to know the feasibility in our population. Criteria validity of the questionnaire was assessed by correlating OHQoL-UK scores to a global self-rating of oral health status. Those who rated their oral health as "poor" had lower OHQoL-UK scores compared to those who rated their oral health as moderate or good.
The stability of translated version of United Kingdom's OHQoL measure over time was assessed by test - retest reliability. The first 10% of respondents who completed the questionnaire were contacted after 1 week and asked to complete the questionnaire. The level of agreement of overall OHQoL-UK scores is 88%.
Prior permission to conduct the study was obtained from the respective principals of the colleges and the program for data collection was scheduled accordingly. The study was reviewed by the Ethical Committee of M.S. Ramaiah Dental College and clearance was obtained prior to the study.
A total of 600 adult patients coming to outpatient departments of selected dental teaching hospitals V.S. Dental College, Bangalore and K.L.E Dental College, Bangalore were included. The questionnaire was self-administered by the investigator to patients and was collected after its completion. During the process of completing the questionnaire, patient's doubts regarding any questions is clarified.
A total of 60 dental clinics were selected proportionately from two zones of Bangalore city. Information about dental clinics address was picked from the IDA directory 2005. The dentists in each clinic were briefed about the purpose of the study and the content of the questionnaires. From each dental clinic, ten adult patients were selected randomly. Questionnaire was administered to patients who are willing to participate voluntarily in the survey. Informed consent was obtained from the participants.
Data management and analysis were conducted using SPSS 10 software (SPSS Inc, Chicago). Simple frequency distributions of responses to each item were produced to explore the prevalence of effects and their impact on life quality. Chi-square test is used to find the differences between the groups. Bivariate analysis was performed to identify disparities in the impact oral health had on life quality in relation to age, gender and social class.
| Results|| |
Of 1200 questionnaires, 109 questionnaires (9%) were discarded because of incomplete answers, where >3 of 32 ratings (16 "effect" and 16 "impact" ratings) were incomplete. In the case where 3 or fewer of responses were incomplete average scores were used for missing values. Hence, the results were presented for 1091 respondents.
Most of the subjects (49%, n = 538) are between 25 and 44 years. Males constitute 50.3% (n = 549); most of the subjects in this study (60%, n = 655) belong to middle class [Table 1]. When the question was asked about impact of impaired oral health on different domains of quality of life, components belonging to the psychological domain showed little or no impact on quality of life [Table 2]. About 67.7% of subjects from lower socioeconomic class said their oral health had an adverse effect on their finance compared to 10.5% of subjects from higher socioeconomic class [Table 3].
|Table 3: Cross tabulation of distribution of subjects by social class according impact of oral health on general health |
Click here to view
The participant's OHQoL scores ranged from 38 to 142 with a median value of 88. Majority (78%) of respondents perceived their oral health as impacting on their quality of life. Many participants perceived oral health as enhancing their life quality through enhancing their speech (61.6%), appearance (56.8%), ability to eat (54.35%) and smiling or laughing (52.1%). Few respondents perceived their oral health status in no way affected their quality of life in certain aspects. In particular, participants frequently perceived that their oral health status had no effect on their mood, ability to work and personality. Less frequently, participants perceived oral health as detracting from their life's quality, most often having a bad effect on their finances or by causing bad breath. Also, majority of respondents claimed their oral health more frequently enhanced their life quality as 58.1% of respondents had OHQoL scores above the median value. Bivariate analysis identified disparities in the impact oral health had on life quality in relation to age, gender and social class. Among all these three factors, social class has greater influence on the quality of life, followed by age and gender. 56% of subjects from lower social class had OHQoL scores below the median value compared to 39.2% of subjects from higher social class (P < 0.01). About 44.6% of females had OHQoL scores lower than the median value, compared to 39.3% of males (P < 0.05).
Younger adults had OHQoL scores greater than older adults; 58.1% of subjects above 45-year of age had OHQoL scores below the median value compared to 37.1% of subjects below 45-year of age.
| Discussion|| |
The present study was conducted to know the perceptions of patients visiting outpatient departments of selected dental teaching hospitals and private dental clinics, about how oral health affects and impacts their quality of life.
In this study, 78% of respondents perceived their oral health as impacting their quality of life. This supports earlier findings from studies done in Britain and middle east using the same OHQoL-U.K measure, in which most people do perceive that their oral health affects their life. , But when this finding was compared with that of studies done using different quality of life instruments contradictory results were observed.  In a large study utilizing the dental health index, it was reported that 54% of respondents claimed no impact from dental problems.  In another study, utilizing the OHIP, majority of respondents claimed that their oral health did not affect their daily activities, social interactions or conversation.  Perhaps the great response observed in this study reflects the fact that OHQoL - U.K instrument measures both positive and negative dimensions of OHQoL.
Across the 16 aspects of OHQoL, the group perceived more frequently that oral health had positive than negative influences on life quality and more so on the physical domain than on social and psychological domains. These findings were similar to earlier studies done in U.K, Brazil and Middle East, ,, which suggest that oral health has greater influence on physical rather than on social or psychological domains.
Out of 1091 respondents, 633 (58.1%) respondents had OHQoL scores above the median value (median value is 88), whereas 41.9% of respondents had OHQoL scores lower than the median value. Bivariate analysis identified disparities in the impact oral health had on life quality in relation to age, gender and social class. This finding is similar to study done in Britain.  Higher OHQoL scores seen in subjects from high social class may be because of their awareness about oral diseases and use of private dental care.
When OHQoL scores were compared between males and females, 44.6% of females had OHQoL scores lower than the median value, compared to 39.3% of males (P < 0.05). Lower scores observed among females in relation to physical (appearance) and social (smiling) domains may be because females are more conscious about their appearance and smile and majority of them perceived these aspects as negatively affecting their life quality leading to less OHQoL scores compared to males. But this finding is in contrary to studying done in U.K in which women had higher scores than men. 
Similarly, when OHQoL scores were compared between age groups younger adults had OHQoL scores greater than older adults. 58.1% of subjects above 45-year of age had OHQoL scores below the median value compared to 37.1% of subjects below 45-year of age. Overall it can be concluded that the majority of females, older adults (>45 years) and lower social class subjects perceived that oral health has a bad effect on their quality of life.
There are few important limitations in this study. The first limitation is the cross-sectional nature of the study, in which exposure and outcome are determined simultaneously, and the time sequence is often difficult to define. Another limitation is that the people perceptions of quality of life may change over time. In general, people remember recent events more clearly, and an information bias may exist in this type of study. Thus, in future studies it is necessary to perform longitudinal study designs, which would allow obtaining information on multiple potential causes for impaired oral health.
| Conclusion|| |
Majority of respondents perceived their oral health as impacting their quality of life, and they perceived that their oral health had greater influence on physical and functional aspects rather than on social and psychological aspects of life.
| References|| |
WHO. Available from: http://www.who.int/kobecentre/ageing/ahpvol5_glossary.pdf. [Last accessed on 2013 Aug 12].
Cushing AM, Sheiham A, Maizels J. Developing socio-dental indicators - The social impact of dental disease. Community Dent Health 1986;3:3-17.
Inglehart MR. Assessment of oral health related quality of life, historical perceptive. In: Inglehart MR, Bagramian RA, editors. Oral Health - Related Quality of Life. Illinois: Quintessence; 2002. p. 30.
McGrath C, Bedi R. Population based norming of the UK oral health related quality of life measure (OHQoL-UK). Br Dent J 2002;193:521-4.
Locker D. Measuring oral health: A conceptual framework. Community Dent Health 1988;5:3-18.
Chavers LS, Gilbert GH, Shelton BJ. Racial and socioeconomic disparities in oral disadvantage, a measure of oral health-related quality of life: 24-month incidence. J Public Health Dent 2002;62:140-7.
Lawrence HP, Thomson WM, Broadbent JM, Poulton R. Oral health-related quality of life in a birth cohort of 32-year olds. Community Dent Oral Epidemiol 2008;36:305-16.
Asgari I, Ahmady AE, Broder H, Eslamipour F, Wilson-Genderson M. Assessing the oral health-related quality of life in Iranian adolescents: Validity of the Persian version of the Child Oral Health Impact Profile (COHIP). Oral Health Prev Dent 2013;11:147-54.
SunderLal, Adarsh, Pankaj. Oreintation to community medicine, social and behavioral sciences. Text Book of Community Medicine. 3 rd
ed. New Delhi: CBS Publishers; 2013. p. 17.
McGrath C, Bedi R. Measuring the impact of oral health on quality of life in Britain using OHQoL-UK (W). J Public Health Dent 2003;63:73-7.
[Table 1], [Table 2], [Table 3]