|Year : 2015 | Volume
| Issue : 4 | Page : 486-491
Gender based comparison of impact of dental pain on the quality of life among out patients of a private dental college in Tamil Nadu
Shruthi Suresh, S Soniya, Ganesh Rajendran
Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Tiruvallur, Tamil Nadu, India
|Date of Web Publication||7-Dec-2015|
No. 12, Buddhar Street, Vetri Selvi Anbalagan Nagar, Chennai - 600 082, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Dental pain is the most common reason for the patients to visit a dental office and anxious patients typically expect more pain than they experience. Dental pain has an impact on the patient's oral health and quality of life. Aims: To evaluate and compare the dental pain and anxiety levels in both male and female patients prior to dental treatment and to assess the influence of oral health on the quality of life. Materials and Methods: A cross-sectional study was conducted at a Private Dental College in Tamil Nadu which included 201 patients consisting of 101 males and 100 females. The origin of dental pain was identified and the patients were asked to indicate the level of pain experienced by them at the moment with the help of a 100 mm visual analogue scale (VAS), numerical scale (NS), verbal pain rating scale (VRS), and faces pain scale. The Modified Dental Anxiety Scale (MDAS) was used to evaluate dental anxiety before self-assessment questionnaire, Oral Health Impact Profile-14 (OHIP-14) was used to assess the impact of dental pain on the quality of life of the patients. G* Statistical software was used for statistical analysis. Results: The mean age of males was of 36.57 years and for females it was 35.50 years. The number of patients who had pulpal pain (68.66%) was greater than those who had periodontal pain (29.35%). The mean score of VAS for males (55.41 ± 20.43) was significantly lower than the females (62.51 ± 1.73). The mean score of NS was 54.46 ± 20.71 for males and 62.50 ± 21.38 for females. Severe pain was reported by 27% females and 15.8% males in VRS. It was found using the MDAS that 5% of females and only 1.5% of males had dental phobia. The mean OHIP-14 score was 19.73 ± 9.43 for females and 16.67 ± 8.72 for males. The male patients reported a lower impact on oral health than the females. Conclusions: The level of pain and anxiety experienced by female patients are greater when compared to males. Dental pain affected the quality of life and the impact being higher in case of females.
Keywords: Dental pain, modified dental anxiety scale, oral health impact profile-14, pain scale
|How to cite this article:|
Suresh S, Soniya S, Rajendran G. Gender based comparison of impact of dental pain on the quality of life among out patients of a private dental college in Tamil Nadu. J Indian Assoc Public Health Dent 2015;13:486-91
|How to cite this URL:|
Suresh S, Soniya S, Rajendran G. Gender based comparison of impact of dental pain on the quality of life among out patients of a private dental college in Tamil Nadu. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jan 26];13:486-91. Available from: http://www.jiaphd.org/text.asp?2015/13/4/486/171205
| Introduction|| |
Dental pain is the most common reason for the patients to visit a dental office. Pain is a distressing sensation and was recorded as one of the four cardinal signs of inflammation by Celsus in his book "De Medicina.", Since pain is perceived only by the patient, it can be regarded as a symptom rather than a sign. The International Association for Study of Pain defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Odontogenic pain is the most common type of orofacial pain which is associated with the teeth and/or its supporting structures.
Anxiety, according to Folayan et al., is a universal human phenomenon. Dental anxiety is the feeling of tension associated with dental treatment and is not necessarily connected to external stimuli. Anxiety before dental treatment is one of the reasons for avoiding dental treatment., It is also considered a major reason for broken appointments. Anxious patients typically expect more pain than they experience. The involvement of patient's psyche along with subjective nature makes exact measurement of pain difficult; yet pain cannot be effectively treated or relieved unless it is measured. The visual analogue scale (VAS), numeric scale and verbal rating scale (VRS) are often used in pain surveys., The Oral Health Impact Profile (OHIP) and its short form OHIP-14 are inventories to measure the oral heath related quality of life., The most commonly used self-assessment questionnaires for dental anxiety are Corah's dental anxiety scale, Modified Dental Anxiety Scale (MDAS), and dental fear survey.
This study was conducted among the patients visiting a Private Dental College in Tamil Nadu. The aims of this study were to evaluate the dental pain and anxiety levels in the patients prior to treatment, to evaluate the concordance among the different pain scales (VAS, VRS, Faces Pain Rating Scale, and numeric scale) and to assess the influence of oral health on the quality of life of those patients.
| Materials and Methods|| |
A cross-sectional study was conducted to assess the dental pain and anxiety levels and also their impact on the oral health of the patients visiting a Private Dental College in Tamil Nadu. The study was approved by the Institutional Review Board of that Dental College and an informed consent was obtained from the each patient. The sample size was estimated to be 190 based on 80% power and with an alpha error 0.05 and a total of 210 patients who were diagnosed with dental pain was included in the study, of which 100 were females and 101 were males. The patients were examined by a clinician to identify the origin of pain (pulpal, periodontal, or referred). The level of pain experienced was indicated in four types of pain scales by every individual.
The VAS consists of a 100 mm horizontal line with the words "no pain" and "worst possible pain" placed at left and right hand extremes of the line, respectively. The numerical scale (NS) consists of figures 1–100 on a 100 mm horizontal line, 0 represented "no pain" and 100 worst pain ever. The patients were asked to place a vertical mark through the scales as appropriate for them at the moment. The patients were asked to choose a word to describe their pain from "no pain," "mild pain," "moderate pain," "severe pain," "very severe pain," and "worst possible pain" in the VRS. An appropriate smiley face from the faces pain scale (FPS) index was chosen by the patients ,,,, [Figure 1].
The subjects were then asked to fill the OHIP-14 and MDAS questionnaires , which were in English. For each question of OHIP-14 there was a five point Likert scale coded never (score 0), hardly ever (score 1), occasionally (score 2), fairly often (score 3), and very often (score 4) based on the frequency of impact. The MDAS is a self-filled questionnaire which consists of 5 questions based on the possible reasons for the patients to get anxious in a dental setup. For each question of MDAS, there was a five point Likert scale coded not anxious (score 1), slightly anxious (score 2), fairly anxious (score 3), very anxious (score 4), and extremely anxious (score 5). The scores for all the questions are summed together to get the final score. The collected data were entered in Microsoft Excel Sheet 2010 and analyzed using SPSS (Statistical Package for the Social Sciences) version 19 (IBM Corporation). Descriptive statistics was only analyzed for the collected data.
| Results|| |
The sample consisted of 101 (50.25) male patients ranging from 15 to 70 years with a mean age of 36.57 years and 100 (49.75%) female patients ranging from 13 to 70 years with a mean age of 35.50. [Figure 2] shows the distribution of the origin of dental pain based on gender.
[Table 1] shows the frequency distribution of the subjects' response to each of the question on OHIP-14 based on gender.
|Table 1: Frequency distribution of the subjects’ response to each of the question on OHIP-14 based on gender (males n=101 and females n=100)|
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The total OHIP-14 score for each individual was calculated by summing up the scores for the responses of the 14 items. [Table 2] shows the mean scores of OHIP-14 questionnaire based on gender.
The level of anxiety measured by MDAS was based on the responses to the questions by the individuals. [Table 3] shows the frequency distribution of subjects' response to each of the question on MDAS based on gender.
|Table 3: Frequency distribution of subjects’ response to each of the question on MDAS based on gender (males n=101 and females n=100)|
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The total score of MDAS ranges from 5 to 23 in both males and females. The cut-off value is 19. 5% of the female patients have values ≥19 and only 1.5% of the male patients had values ≥19. [Table 4] shows the mean scores for VAS and NS based on gender.
The mean score of VAS for males (55.41 ± 20.43) was lower than the mean score of VAS for females (62.51 ± 1.73).
[Figure 3] shows the distribution of responses for VRS based on gender.
|Figure 3: Distribution of responses for verbal pain rating scale based on gender|
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The range for VRS score was between 2 and 10 for both males and females. The mean VRS score for males was 4.83 ± 2.17
[Figure 4] shows the distribution of responses for Faces Pain Rating Scale based on gender.
|Figure 4: Distribution of responses for Faces Pain Rating Scale based on gender|
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The range for FPS score was between 2 and 10 for both males and females. The mean score for males was 5.21 ± 2.08 and females it was 6.01 ± 2.27.
| Discussion|| |
In the present study, it was noted that out of 201 patients who were diagnosed with dental pain, the number of patients who had pulpal pain (68.66%) was greater than those who had periodontal pain (29.35%). The findings of a study by Nuttall et al., showed that the oral conditions can affect the people in different ways and sometimes can be sufficiently serious that their lives are affected.
The OHIP-14 questionnaire was given to the patients to assess the impact which dental pain had on their oral health. Marino et al. evaluated the impact of oral health on the quality of life by applying OHIP to a sample in southern Europe, and they found a significant association with gender. The male patients reported a lower impact on oral health than the female patients. The result of the present study is consistent with this report.
Physical pain and psychological impact of oral health conditions were the most frequently reported problems that affected the people. Females exhibited greater levels of functional limitation and psychosocial difficulties when compared to the males in this study. The mean OHIP-14 score was 19.73 ± 9.43 for females and 16.67 ± 8.72 for males. The mean scores were comparatively higher than the values found in representative samples in Australia (7.4 ± 0.13), England (5.1 ± 0.11), and in Brazilian adults (3.95 ± 4.88). According to Luo et al., orofacial pain has a substantial detrimental impact on daily life activities, psychological distress, and quality of life. The results of the present study are consistent with a study by Zheng et al. who found that patients with pain of dentoalveolar origin had a significantly higher mean OHIP score, where presence and intensity of pain influenced the quality of life.
The level of dental pain experienced by patients preoperatively was measured. Many studies consider the pain scales VAS, NS, VRS, and FPS to be reliable and suitable for clinical use.,, The mean score of VAS for males (55.41 ± 20.43) was comparatively lower than the females (62.51 ± 1.73). The mean score of VAS was consistent with the mean score of NS which was 54.46 ± 20.71 for males and 62.50 ± 21.38 for females. Some patients prefer to communicate their pain in words rather than numbers. 27% females reported that they had severe pain in VRS, which was higher than the males (15.8%). The mean scores of FPS and VRS were somewhat similar. The face for worst possible pain was chosen by 10% of females and only 3% by males.
Nowadays, human psychology and behavioral sciences play an important role in dental education and also in clinical practice. Some patients develop behavior to avoid oral health care because of their anxiety related to dental health and treatment procedures. The patients were assessed for dental anxiety preoperatively using MDAS questionnaire. The patients were said to be dental phobic if the score was ≥19. In this study, 5% of females and only 1.5% of males were assessed to have dental phobia. This study shows the level of anxiety was significantly less when compared to a study population in Nigeria (8.1% females and 2.6% males), Toronto (10.2%), Northern Ireland (19.5%), and UK (11%). It was also noted that the female patients had higher levels of anxiety during the waiting time before treatment. 15% of females were extremely anxious about having a local anesthetic injection which was significantly compared to males (3%). Good quality dental care can be given by the assessment of dental anxiety of the patient before dental treatment procedures. A positive correlation was seen between dental anxiety and pain perception. Hence, proper behavior modification methods to reduce the patient's anxiety level are necessary.
| Conclusions|| |
The findings of the present study shows that dental pain affected the quality of life of the patients and females had a higher impact than the males. The impact can be reduced if proper measures are taken to reduce the dental pain. Since anxiety can influence the pain perception, it is better to give counselling for the patient or adapt some behavior modification techniques in order to provide good dental care. If the patients have very high scores of dental anxiety or highly dental phobic, conscious sedation can be administered before the start of the treatment. Effective pain management can therefore reduce the level of pain, reduce the level of anxiety and also improve the quality of life of the patient.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Rocha e Silva M. A brief survey of the history of inflammation 1978. Agents Actions 1994;43:86-90.
Benaroyo L. How do we define inflammation? Schweiz Rundsch Med Prax 1994;83:1343-7.
Mersky H. Pain terms: A list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain 1979;6:249.
Folayan MO, Idehen EE, Ojo OO. The modulating effect of culture on the expression of dental anxiety in children: A literature review. Int J Paediatr Dent 2004;14:241-5.
Kleinknect RA, Bernstein DA. The assessment of dental fear. Behav Ther 1978;9:626-34.
Scott J, Huskisson EC. Graphic representation of pain. Pain 1976;2:175-84.
Kent G. Cognitive process in dental anxiety. Br J Clin Psych 1985;24:259-64.
Reville SI, Robinson JO, Rosen M, Hogg MI. The reliability of linear analogue scale for evaluation of pain. Anaesthesia 1977;36:186-7.
Raspe H, Kohlmann T. Disorders characterised by pain: A methodological review of population surveys. J Epidemiol Community Health 1994;48:531-7.
Lund I, Lundeberg T, Sandberg L, Budh CN, Kowalski J, Svensson E. Lack of interchangeability between visual analogue and verbal rating pain scales: A cross sectional description of pain etiology groups. BMC Med Res Methodol 2005;5:31.
Oliveira BH, Nadanovsky P. Psychometric properties of the Brazilian version of the oral health impact profile-short form. Community Dent Oral Epidemiol 2005;33:307-14.
Mariño R, Schofield M, Wright C, Calache H, Minichiello V. Self-reported and clinically determined oral health status predictors for quality of life in dentate older migrant adults. Community Dent Oral Epidemiol 2008;36:85-94.
Kleinknecht RA, Thorndike RM, McGlynn FD, Harkavy J. Factor analysis of the dental fear survey with cross-validation. J Am Dent Assoc 1984;108:59-61.
Gould D, et al
. Visual Analogue Scale (VAS) Point of Information, Blackwell Science Ltd. J Clin Nurs 2001;10:697-706.
Kremer E, Atkinson JH, Ignelzi RJ. Measurement of pain: Patient preference does not confound pain measurement. Pain 1981;10:241-8.
Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: A comparison of six methods. Pain 1986;27:117-26.
Rodriguez CS. Pain measurement in the elderly: A review. Pain Manag Nurs 2001;2:38-46.
Hockenberry MJ, Wilson D, Winkelstein ML. Wong's Essentials of Pediatric Nursing. 7th
ed. St. Louis, MO: Mosby; 2005. p. 1259.
Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: Validation and United Kingdom norms. Community Dent Health 1995;12:143-50.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.
Nuttall NM, Steele JG, Pine CM, White D, Pitts NB. The impact of oral health on people in the UK in 1998. Br Dent J 2001;190:121-6.
Steele JG, Sanders AE, Slade GD, Allen PF, Lahti S, Nuttall N, et al.
How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples. Community Dent Oral Epidemiol 2004;32:107-14.
Biazevic MG, Rissotto RR, Michel-Crosato E, Mendes LA, Mendes MO. Relationship between oral health and its impact on quality of life among adolescents. Braz Oral Res 2008;22:36-42.
Luo Y, McMillan AS, Wong MC, Zheng J, Lam CL. Orofacial pain conditions and impact on quality of life in community-dwelling elderly people in Hong Kong. J Orofac Pain 2007;21:63-71.
Zheng J, Wong MC, Lam CL. Key factors associated with oral health-related quality of life (OHRQOL) in Hong Kong Chinese adults with orofacial pain. J Dent 2011;39:564-71.
Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378-81.
Lara-Muñoz C, De Leon SP, Feinstein AR, Puente A, Wells CK. Comparison of three rating scales for measuring subjective phenomena in clinical research. I. Use of experimentally controlled auditory stimuli. Arch Med Res 2004;35:43-8.
Ponce de Leon S, Lara-Muñoz C, Feinstein AR, Wells CK. A comparison of three rating scales for measuring subjective phenomena in clinical research. II. Use of experimentally controlled visual stimuli. Arch Med Res 2004;35:157-62.
Koleoso ON, Akhigbe KO. Prevalence of dental anxiety in Nigeria. World J Dent 2014;5:53-9.
Locker D, Shapiro D, Lidell A. Who is dentally anxious? Community Dent Oral Epidemiol 1996;24:346-50.
Humphris GM, Freeman R, Campbell J, Tuutti H, D'Souza V. Further evidence for the reliability and validity of the Modified Dental Anxiety Scale. Int Dent J 2000;50:367-70.
Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health 2009;9:20.
Sanikop S, Agrawal P, Patil S. Relationship between dental anxiety and pain perception during scaling. J Oral Sci 2011;53:341-8.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]