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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 1  |  Page : 23-26

Determinants Related to Oral Health-Related Quality of Life Among Subjects Attending a Dental Institute in Moradabad City − A Cross-Sectional Study


1 Department of Community and Preventive Dentistry, UCMS College of Dental Surgery, Bhairahawa, Nepal
2 Department of Public Health Dentistry, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
3 Department of Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India

Date of Web Publication14-Mar-2017

Correspondence Address:
Aasim F Shah
Department of Public Health Dentistry, Government Dental College and Hospital, Shreen Bagh, Srinagar 190010, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.201936

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  Abstract 

Introduction: It is very well documented that oral health has a noticeable influence on not only physical but also psycho-social domain of life. Quality of life (QoL) is now recognised as a valid parameter in patient assessment in nearly every area of healthcare, including oral health. Aims: To assess whether the subjects’ complaints affect their QoL and also to determine possible socio-demographic and personal habits-related determinants related to oral health QoL. Material and Methods: This cross-sectional descriptive study was performed in a dental institute in Moradabad, Uttar Pradesh, India, from January 2013 to April 2013 on 1054 subjects. Examination of subjects and recording of questionnaires wereperformed by four researchers. Two patient-centred outcome measures, the 14-item Oral Health Impact Profile (OHIP-14) and the 16-item Oral Health-related Quality of Life (OHQoL-UK) measure were used. The OHIP-14 and OHQoL-UK scores of groups were expressed as median (interquartile range). The Mann–Whitney and Kruskal–Wallis tests were used for statistical analysis. Results: OHIP-14 scores were highest and OHQoL-UK scores were lowest in subjects who came with trauma. OHIP-14 scores were lowest and OHQoL-UK scores were highest in subjects who had orthodontic or aesthetic complaint. It was seen that there was a statistically significant difference in OHQoL-UK (P < 0.001) and OHIP-14 (P < 0.001) scores of subjects according to complaints. Conclusions: OHQoL is poorer in subjects who have complaints of oral disorders.

Keywords: Life quality, oral diseases, oral habits, oral health


How to cite this article:
Batra M, Shah AF, Dany SS, Rajput P. Determinants Related to Oral Health-Related Quality of Life Among Subjects Attending a Dental Institute in Moradabad City − A Cross-Sectional Study. J Indian Assoc Public Health Dent 2017;15:23-6

How to cite this URL:
Batra M, Shah AF, Dany SS, Rajput P. Determinants Related to Oral Health-Related Quality of Life Among Subjects Attending a Dental Institute in Moradabad City − A Cross-Sectional Study. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Nov 14];15:23-6. Available from: http://www.jiaphd.org/text.asp?2017/15/1/23/201936


  Introduction Top


A patient-reported outcome can be termed as a statement about the status of a patient’s health condition that comes directly from the patient herself/himself, without interpretation of the patient’s response by a clinician or anyone else.[1] Quality of life (QoL) is one such an outcome. There is an escalating acknowledgement that oral well-being has a substantial bearing on not only physical, but also social and psychological welfare. QoL is now recognised as a valid parameter in patient assessment in nearly every area of physical and mental healthcare, including oral health. As in general medicine, experiences of dental subjects are also imperative in the appraisal of treatment need, in planning appropriate therapy and in clinical outcome.

A variety of patient-centred outcome measures termed ‘oral health-related quality of life measures’ (OHQoL) have been developed to gauge the degree to which oral health problems influence not only the physical functioning and pain, but wider paradigms such as psycho-social functioning and life satisfaction.[2] In 1996, 11 OHQoL measures were assessed in an international conference,[3] Amongst which, Oral Health Impact Profile (OHIP-14) and the UK Oral Health-related Quality of Life (OHQoL-UK©) were voted to be most consistent and effective.[4],[5] OHIP-14 and the OHQoL-UK© are centred on two theoretically distinct versions of oral health. The OHIP-14 consists of self-reported measurements of the adverse impacts of oral conditions on daily life. OHQoL-UK, recently developed in the United Kingdom, is based on the World Health Organization model of ’structure-function-ability-participation’, which incorporates both negative and positive influences on health.[6]

The purpose of this study was to determine to what degree oral health-related complaints affect their QoL and to explore the various associated socio-demographic personal habits-related factors to OHQoL.


  Material and Methods Top


This cross sectional descriptive study was performed in the Oral Diagnosis and Radiology Department, in Kothiwal Dental College and Research Centre, Moradabad, from January 2013 to April 2013. The ethical clearance was obtained from the institutional ethical committee. All the subjects who visited the Departmental Out Patient Department (OPD) within this period were taken into the study. Out of the total population, those who gave a verbal consent were selected forming a convenience sample of 1054 subjects. Subjects who were <18 years old and those who could not provide adequate data and subjects with physical handicap or debilitating systemic diseases were excluded.

Two patient-centred outcome measures, the 14 item OHIP-14[4] and the 16 item OHQoL measure (OHQoL-UK)[5] were used in this study. The questionnaires were translated into local language (Hindi) by the investigators and were pilot tested on a similar population who were not part of the study. A pilot sample of 25 subjects was used twice prior to the start of the study. Test–retest reliability was assessed and value for Pearson’s co-efficient for the reliability was found to be 0.70 which stated an acceptable reliability.

For standardisation, the researchers were trained and tools were calibrated for both intra-oral examination as well as for recording the questionnaires. Intra-examiner reliability was high (kappa co-efficient 0.81). Firstly, demographic data were recorded and subsequently clinical and radiographic examinations were performed when needed. After intra-oral examination, subjects were asked to complete patient-centred outcome measures. The responses to questionnaires were recorded in a face-to-face interview.

Scores were derived from both questionnaires by summing the responses pertaining to each of the individual questions within the measures. For the OHIP-14, each item was scored: ‘never’ − score 0, ‘hardly ever’ − score 1, ‘occasionally’ − score 2, ‘fairly often’ − score 3 and ‘very often’ − score 4. Higher scores indicate poorer OHQoL. For the OHQoL-UK, the response categories were ‘very bad effect’ − score 1, ‘bad effect’ − score 2, ‘no effect’ − score 3, ‘good effect’ − score 4 and ‘very good effect’ − score 5. Lower scores indicate poorer OHQoL. Thus, better OHQoL was indicated with lower scores in OHIP-14, and with higher scores in OHQoL-UK questionnaires.

The OHIP-14 and OHQoL-UK scores of groups are expressed as median (interquartile range). A P < 0.05 was considered statistically significant. The Mann–Whitney and Kruskal–Wallis tests were used to compare the OHQoL scores among the gender groups and identify differences in OHQoL with subjects’ complaints, education and harmful habits.


  Results Top


The results were analysed for 1054 subjects who were included in the study. These included 54.3% males and 45.6% females. The subjects of age group 28–37 years comprised the major section (35.9%) of the sample. Out of total population, 52.4% of subjects were having graduation and high school level of education. Most common recorded complaint by the subjects was that of caries and toothache (53.8%) followed with tooth loss and denture need (11.9%), periodontal complaints (9.7%) and orthodontic and aesthetic defects (7.87%) [Table 1].
Table 1: Demographic characteristics of subjects (N = 1054)

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There were statistically significant differences between the two genders for both OHIP-14 (P < 0.05) and OHQoL-UK (P < 0.01). There was a statistically significant difference in OHQoL-UK (P < 0.001) and OHIP-14 (P < 0.001) scores of subjects according to complaints (P < 0.01). OHIP-14 scores were highest, and OHQoL-UK scores were lowest in subjects who came with trauma. OHIP-14 scores were lowest, and OHQoL-UK scores were highest in subjects who had orthodontic or aesthetic complaint. There was a significant difference among different education level subjects in OHQoL-UK (P < 0.001) and OHIP-14 (P < 0.001). It was found that as the education level increased, higher OHQoL-UK scores were recorded, and similarly, OHIP-14 scores dipped with the raise in education level among subjects. There was also a significant difference reported for OHQoL among subjects with different harmful habits. Subjects who had no harmful habits had higher QHQoL-UK (P < 0.01) scores and lower OHIP-14 scores (P < 0.01) than subjects who were smokers or drinking alcohol [Table 2].
Table 2: OHIP-14 and OHQoL-UK scores according to gender, complaint, education and habits (N = 1054)

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  Discussion Top


The influence of health on the QoL has received considerable awareness in both medicine and dentistry. According to Locker and Gibson,[7] positive health has been defined as the absence of negative health states, positively worded items, positive outcomes of oral health, a set of psychological and social attributes, and positive outcomes of chronic conditions such as oro and craniofacial differences. McGrath et al.[8] asserted that positive and negative health conditions and experiences are distinctive; in that, ’the absence of a negative does not necessarily imply a positive, and a positive state can coexist with a negative state’. The QHQoL-UK endeavours to gauge both positive and negative effects of oral health, while the OHIP-14 assesses only negative effects of oral health.[7] So this is an inadequacy for OHIP-14 in encapsulating the universal perception of health and well-being.

In the present study, we made an effort to deal the issue from the patient’s standpoint, and we used patient’s chief complaint. First of all, we ascertained the nature of their complaints and then whether, if there was any correlation between these complaints and their OHQoL.

Tooth decay and toothache are the foremost complaints among subjects, with range of 53.8%. Similarly, Ng and Leung[9] found out that QoL of subjects without toothache was better than that of subjects with toothache.

There are no studies reported in the literature concerning the impact of maxillofacial trauma on OHQoL in adult subjects, although a high prevalence of traumatic injuries in childhood and adolescence has been described in the literature.[6] Cortes et al.[10] found that children with untreated dental fracture of permanent teeth had more impacts on their daily living than did children without any dental trauma. According to our results, trauma was the complaint that had the most negative effect on QoL.

There are indications that many subjects suffering from Temporo Mandibular Joint (TMJ) disorders may also show a reduced OHQoL.[11] We have also found low OHQoL-UK values and high OHIP-14 values in subjects with TMJ disorders in comparison with subjects with other complaints, representing a poorer OHQoL in TMJ subjects.

According to our results, there was a significant difference between the OHQoL-UK and OHIP-14 scores of males and females. However, Fernandes et al.[12] found no significant difference between the OHIP-14 scores of males and females. Steele et al.[13] found the OHIP-14 scores of females to be higher in the United Kingdom and Australia, in agreement with our study.Fernandes et al.[12] found that OHIP-14 scores of subjects who were smokers to be higher, similar to the results of the present study. The negative effect of smoking to OHQoL is probably due to the harmful effects of smoking on oral tissues. In the same study, Fernandes et al.[12] found OHQoL to be better in subjects who drank alcohol. We also found OHQoL of subjects who drank alcohol to be better than subjects who both drank alcohol and smoked.

In this study, we have also found OHQoL-UK values to be higher in subjects who have low OHIP-14 scores, in agreement with the literature. While low OHIP-14 values indicate good QoL, low OHQoL-UK values indicate poor QoL[2] and vice versa. This is the first study that has been performed that considers patient complaints and the effect of these complaints on their QoL in our society in Indian scenario.

The data collected for habits may have certain limitations. We assume that habits associated with smoking may have been probably under-reported. In addition, recall bias and social desirability bias could be considered with respect to smoking and alcohol consumption. Moreover, the selected population was taken from a single hospital which also could affect the outcome of the study.


  Conclusion Top


OHQoL is poorer in subjects who have complaints of oral disorders.

The current study also shows that various socio-demographic and harmful habits influence the OHQoL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
US Food and Drug Administration: Guidance for Industry Patient-reported outcome measures: Use in medical product development to support labeling claims. US: Department of Health and Human Services Food and Drug Administration; December 2009. Available from: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM193282.pdf  Back to cited text no. 1
    
2.
Hegarty AM, McGrath C, Hodgson TA, Porter SR. Patient-centred outcome measures in oral medicine: Are they valid and reliable? Int J Oral Maxillofac Surg 2002;31:670-4.  Back to cited text no. 2
    
3.
Slade GD, Strauss RP, Atchison KA, Kressin NR, Locker D, Reisine ST. Conference summary: Assessing oral health outcomes − Measuring health status and quality of life. Community Dent Health 1998;15:3-7.  Back to cited text no. 3
    
4.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.  Back to cited text no. 4
    
5.
McGrath C, Bedi R. An evaluation of a new measure of oral health related quality of life − OHQoL-UK(W). Community Dent Health 2001;18:138-43.  Back to cited text no. 5
    
6.
World Health Organization. International Classification of Functioning, Disability and Health. Geneva: World Health Organization 2001.  Back to cited text no. 6
    
7.
Locker D, Gibson B. The concept of positive health: A review and commentary on its application in oral health research. Community Dent Oral Epidemiol 2006;34:161-73.  Back to cited text no. 7
    
8.
McGrath C, Broder H, Wilson-Genderson M. Assessing the impact of oral health on the life quality of children: Implications for research and practice. Community Dent Oral Epidemiol 2004;32:81-5.  Back to cited text no. 8
    
9.
Ng SK, Leung WK. Oral health-related quality of life and periodontal status. Community Dent Oral Epidemiol 2006;34:114-22.  Back to cited text no. 9
    
10.
Cortes MI, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children. Community Dent Oral Epidemiol 2002;30:193-8.  Back to cited text no. 10
    
11.
Türp JC, Motschall E, Schindler HJ, Heydecke G. In subjects with temporomandibular disorders, do particular interventions influence oral health-related quality of life? A qualitative systematic review of the literature. Clin Oral Implants Res 2007;18:127-37.  Back to cited text no. 11
    
12.
Fernandes MJ, Ruta DA, Ogden GR, Pitts NB, Ogston SA. Assessing oral health-related quality of life in general dental practice in Scotland: Validation of the OHIP-14. Community Dent Oral Epidemiol 2006;34:53-62.  Back to cited text no. 12
    
13.
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.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2]



 

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