|Year : 2020 | Volume
| Issue : 2 | Page : 118-123
Impact of contextual school and home environmental characteristics on oral health-related quality of life among 11–14 years old children residing in Sri Ganganagar city
Thounaojam Leimaton, Simarpreet Singh, Manu Batra, Deeksha Gijwani, Sakshi Shukla, Parul Mangal
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
|Date of Submission||03-Aug-2019|
|Date of Decision||05-Feb-2020|
|Date of Acceptance||24-May-2020|
|Date of Web Publication||24-Jun-2020|
Dr. Thounaojam Leimaton
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Environment has shown a significant impact on day-to-day activities like psychological well-being, including oral health-related quality of life (OHRQoL) among children. Aim: To assess the impact of contextual school and home environmental characteristics on OHRQoL among 11–14 years old children residing in Sri Ganganagar city. Materials and Methods: A convenience sample of 345 children aged 11–14 years old were recruited. The present cross-sectional study was conducted among school-going children in Sri Ganganagar, Rajasthan, during November 2018–January 2019. Data were collected on demographic characteristics along with OHRQoL using Child-Oral Impacts on Daily Performances (C-OIDP) index. A prevalidated questionnaire used to collect data on contextual school and home environmental characteristics, oral hygiene, and dental caries were recorded using Oral Hygiene Index-Simplified (OHI-S) and Decayed, Missing, and Filled Teeth (DMFT) index, respectively. The data were analyzed with IBM SPSS Statistics Windows, Version 21.0. (Armonk, NY: IBM Corp). Mean, standard deviation, Chi-square test, t-test, and multivariable Poisson regressions models were analyzed for this study, and the level of significance was set at P < 0.05. Results: The mean C-OIDP extent was significantly higher in 11-year-old (6.11 ± 4.53) (P = 0.008), among those who were living with single parents with a less maternal level of education (<9 years). The mean DMFT score was higher among the participants who did not feel safe at school (3.94 ± 2.24) (P < 0.01) and mean OHI-S score was seen higher among those who were bullied at school (2.50 ± 0.51) (P = 0.018). Mean C-OIDP extent was statistically associated with bullying at school (P = 0.007) and lack of security (P = 0.002). Among all factors of C-OIDP, smiling factor shows a major problem for the children (10.2 ± 4.73) (P = 0.02). Conclusion: Poor school and home environmental characteristics were independently associated with poor OHRQoL in individuals. Actions toward the improvement of schools' security and implementation of anti-bullying campaigns should be components of health promotion strategies.
Keywords: Child, oral health, quality of life, schools
|How to cite this article:|
Leimaton T, Singh S, Batra M, Gijwani D, Shukla S, Mangal P. Impact of contextual school and home environmental characteristics on oral health-related quality of life among 11–14 years old children residing in Sri Ganganagar city. J Indian Assoc Public Health Dent 2020;18:118-23
|How to cite this URL:|
Leimaton T, Singh S, Batra M, Gijwani D, Shukla S, Mangal P. Impact of contextual school and home environmental characteristics on oral health-related quality of life among 11–14 years old children residing in Sri Ganganagar city. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Jul 7];18:118-23. Available from: http://www.jiaphd.org/text.asp?2020/18/2/118/287640
| Introduction|| |
Oral health has been increasingly recognized as a factor that affects the quality of life of individuals. Negative impacts on oral health adversely influence people's daily performance. Oral diseases not only cause pain but may also lead to social embarrassment and trigger processes of suffering, making the whole body suffer. The World Health Organization indicates that oral health is essential to promote general health and quality of life.
School-age is an influential stage in people's lives, a time when lifelong sustainable oral health-related behaviors, as well as beliefs and attitudes, are being developed. Children are always part of the family, and any disease or condition affecting children can affect their siblings and parents. 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. Children can have numerous oral diseases that can lead to loss of school days and high treatment costs.
The idea of “quality of life” has been recently expanded, and improving it has become an objective of good practices of health promotion and disease prevention. The concept of “Oral Health-related Quality of Life” (OHRQoL) refers to the impact that oral health or disease has on the daily activities of individuals which includes factors that fall into four categories: functional factors, psychological factors, social factors, and the existence of discomfort or pain. One of the measurements developed specifically for children is the Child-Oral Impact on Daily Performance (C-OIDP).
Evidence for the role of contextual school and home determinants in OHRQoL in adolescents is scarce. Although children health have been influenced by specific social environments, including bullying behavior and physical violence at school. The same has been observed when considering school environment factors influence OHRQoL in children socioeconomic and psychosocial factors, where individuals exposed to unfavorable characteristics such as low family income, low parental schooling, and family problems reported a worse OHRQoL.
To date, there are no OHRQoL studies of a large population-based sample of school children who are frequently the main target for dental public health services. Therefore, the aim of the study was to find out the impact of contextual school and home environmental characteristics on OHRQoL among 11–14 years old children residing in Sri Ganganagar city.
| Materials and Methods|| |
The present cross-sectional study was conducted among 11–14 year old school going children in Sri Ganganagar, Rajasthan, during the month of November 2018–January 2019. Ethical approval to conduct the study was obtained from the ethical committee of Surendera Dental College and Research Institute, Sri Ganganagar, on October 20, 2018, and the reference number was SDCRI/IEC/2018 / 015. Proxy consent was obtained from the authorities (school's principal) after explaining to them the aim and objectives of the study.
The multistage sampling method was used for sample selection. In the first stage, Sri Ganganagar city was divided into four zones that is – East, West, North, and South. In the next stage, from each zone, two schools were selected on the basis of probability proportional to enrollment size whose authorities gave permission for conducting the study.
The pilot study was conducted on 30 subjects to estimate the sample size of the study. In the pilot study prevalence of dental caries was 66%. Sample size was calculated using the formula: n = z2pq/d2 (where n = sample size, p = prevalence of dental caries among children [66%], q = free of dental caries (100-p [66%] =34%), d = allowable error [1.96], z = point on normal deviation [0.05]). On calculation “n” = 345.
The study was carried out among 345 subjects in the study and was screened using the following inclusion and exclusion criteria. Inclusion criteria were those who were present on the day of study and those who did not wish to participate in the study and those who were mentally and physically disabled were excluded from the study.
A data was collected through face-to-face interviews using questionnaire consisting of demographic variables such as age and gender. Oral impact on daily performance was recorded by using C-OIDP, in which children were initially asked about oral health-related problems they have experienced in the past 6 months.
Another item that questionnaire related to the school and home environment characteristics comprised factors such as safety at school, bullying at school, living with both the parents, maternal education level, respectively. Questionnaire related to the school environment which included in last 30 days he or she did not feel safe at school (yes/no) and if the students reported being bullied “sometimes” or “most of the time” they were categorized as victims of bullying and home environment characteristics included that students were asked whether they currently lived with both parents (Yes/No), maternal educational level was assessed through years of schooling and categorized as <9 years of schooling (incomplete primary education) or 9 years or more of schooling.
The questionnaire was piloted to find out the face validity, and few adjustments and modifications were made in the questionnaire before its application. Cronbach's alpha coefficient was found to be 0.80, which showed satisfactory internal reliability of the questionnaire. The clinical examination was conducted by a single calibrated examiner for whom kappa statistics were determined at 0.88. After the interview, clinical examination to record debris, calculus, and dental caries was done according to the Oral Hygiene Index-Simplified (OHI-S) and Decayed, Missing, and Filled Teeth (DMFT) index using type III examination.
The C-OIDP was the instrument that described the oral health and quality of life of the children, which was created by Gherunpong et al. in 2004. The C-OIDP allowed for analysis of condition-specific impacts on daily performance, thus attributing impacts to specific oral conditions or diseases according to the respondent's perceptions. The C-OIDP consists of close-ended questionnaire that measures oral impacts on eight daily performances, namely, eating, speaking, cleaning teeth, sleeping and relaxing, smiling, emotional stability, working, and social activities. The oral impact score of each performance was obtained by multiplying severity and frequency scores 0, 1, 2, 3, or 4 each in relation to that performance. It was classified into 5 levels; 0-never affected, 1 - less than once a month, 2 - once or twice a month, 3 - once or twice a week and 4 - every day. Then, the scores of the 8 performances were summed up. Finally, the overall sum score was divided by 72 and multiplied with 100 to give a percentage scores.
The data were analyzed with IBM SPSS (Statistical Package for the Social Sciences) Statistics Windows, Version 21.0. (Armonk, NY: IBM Corp). The statistical analysis was determined by the unpaired t-test, Chi-square test, multivariable Poisson regression models to find out the association of sociodemographic variables, contextual school, and home environment factors and clinical variables with C-OIDP and level of significance was set at P < 0.05.
| Results|| |
The study sample consisted of males (55.7%) and females (44.3%), respectively. Most of the male participants did not feel safe at school (47%) and <9-year maternal education level was seen higher (48.7%). Fair OHI-S score was seen higher in males (35.7%) than females (27%). Hence, the results were found to be statistically significant (P = 0.004) [Table 1].
|Table 1: Demographic, home and school environment characteristics and oral hygiene index.simplified of the participants|
Click here to view
The mean DMFT scores were seen higher among females (2.82 ± 1.84) than males (2.28 ± 1.85). Hence, the results were found to be statistically significant (P = 0.007) [Table 2].
|Table 2: Gender-wise description of decayed, missing, and filled teeth of the participants|
Click here to view
The mean ± standard deviation (SD) C-OIDP score was found higher in males (4.90 ± 4.24) among 11-year-old (6.11 ± 4.53). The mean ± SD score of participants who did not feel safe at school and most of the time bullied at school showed higher C-OIDP 6.56 ± 3.97 (P = 0.002) and 7.09 ± 6.07 (P = 0.007), respectively. Those subjects who did not feel safe at school and sometimes bullied at school showed a higher mean DMFT score. The OHI-S was higher among those participants who did not feel safe at school and bullied at school [Table 3].
|Table 3: Sample distribution of child-oral impacts on daily performances, oral clinical measures according to demographic and contextual school and home environment characteristics|
Click here to view
[Table 4] presents the description of C-OIDP in 11–14-year-old children Performances. The percentage of subjects with an impact on performances mainly related to difficulty in cleaning teeth (51.30%) and eating (37.39%) were relatively high. The mean ± SD C-OIDP of each performance with impact was high in smiling (10.2 ± 4.73) on their daily life during the past 6 months experienced, respectively, the results were found to be statistically significant (P = 0.02) [Table 4].
|Table 4: Description of child-oral impacts on daily performances in 11-14 years old children performances|
Click here to view
In Model 1, lack of security at school and bullying at school variables were associated with C-OIDP extent. The contextual measure of maternal schooling and home environment was inserted in Model 2. Lack of security at school, bullying at school, maternal schooling, age, and home environment variables were associated with a higher mean C-OIDP extent in Model 3. In the final model (Model 4), subjects studying in school with higher levels of safety at school were more likely to have a higher mean of C-OIDP extent than those living in cities with lower levels (Relative Risk [RR] =1.99, 95% confidence interval [CI] 1.01–2.82). All the factors except for age were associated with the C-OIDP extent in the final model. The C-OIDP extent was higher among participants with higher DMFT (RR =2.31, 95% CI 1.04–2.68) and poor OHI-S (RR =1.17, 95% CI 1.06–1.34) [Table 5].
|Table 5: Adjusted associations of contextual school and home environmental characteristics and individual variables with child-oral impacts on daily performances extent|
Click here to view
| Discussion|| |
Oral health is intrinsically linked to general health and quality of life. There is an increasing recognition that children are affected by numerous oral disorders, all of which can have a significant impact on physical, social, and psychological well-being. This has resulted in a greater clinical focus on improving OHRQoL as a major objective of dental care.
The information provided through a questionnaire on quality of life like C-OIDP related to oral health allows us to know the situation of children and to consider the psychosocial impact of oral diseases on general welfare.
The finding showed that low OHRQoL may not be linked only to children's dental needs but also with the place where they live, their interpersonal relationships, and the contextual school and home environment factors that influence their life. These factors can lead to psychosocial decline, affecting their self-perception and self-image. The impact of the inadequate school environment and home conditions on children's health and well-being has been highlighted. Recent studies consistently reported that higher levels of psychological distress, lower self-esteem, and depression in children were related to bullying and lack of security at school. So the research has been conducted to assess the association of contextual school and home environmental characteristics with OHRQoL (OHRQoL) among 11–14-year-old children residing in Sri Ganganagar city, Rajasthan.
In the present research, school and home environmental characteristics were found to be poor in individuals aged between 11 and 14 years. These findings were similar to the study found out by Alwadi and Vettore,which emphasized that poor school and home environmental characteristics were associated with worse OHRQoL among adolescents and young adults. According to the author, the main two reasons were students living in cities with high levels of school bullying, and adolescents peer aggression may experience more psychological distress, depression, and worse well-being, that increases the susceptibility to oral diseases and to oral impacts and secondly low social support and networks at school, which in turn may influence oral health through social isolation and contribute to the adoption of unhealthy behaviors.
The C-OIDP score was found higher in children that showed poor indicators of OHRQoL. As we have taken children as the study subjects, their psycho-social behaviors were fluctuant, and the food habits, as well as the oral health behaviors, were expected to be irregular, and this age group always poses resistance to the cultivation of regular proper oral health behaviors, and also there might be a physiological transition of dentition causing changes in periodontal structures resulting in bleeding possibly.
In the study, participants showed higher OHI-S scores among male. A similar study conducted by Shabani et al. showed similar results that the OHI-S score was seen higher in males. This may be attributed to lack of cleaning their teeth, and hence, it was unlikely to achieve good levels of oral hygiene, and their gum problems would undoubtedly remain or even get worse eventually.
In this study, the mean DMFT scores among study participants according to age indicated the highest among the age group of 11 years in females. The absence of proper oral hygiene leads to an increase in oral diseases in children. Furthermore, the normal pattern of the susceptibility of individual teeth to dental caries was exhibited. A similar study conducted by Shyam et. al. showed dissimilar results that the DMFT score was found higher in 12 years in females.
The present study shows that the mean C-OIDP of each performance is high in smiling with an impact on children's daily life during the past 6 months experienced, respectively. Due to dissatisfaction with the position of teeth that lead to psychological impacts of oral health, such as avoiding laughing, and being teased about teeth. However, studies conducted by Gherunpong et al. showed dissimilar results that eating was the most important aspect of the OHRQoL of children. Difficulty with eating due to oral problems and led to more severe oral impacts on children's quality of life than impacts on other performances.
The limitations of this study include its cross-sectional design and convenience sampling method. Although the sample of school children came from varying academic abilities, socioeconomic backgrounds and gender balance was acceptable, this study was conducted in an urban area. For the better understanding and interpretation of OHRQoL can be obtained only from longitudinal studies in future.
| Conclusion|| |
The findings support that poor school and home environmental characteristics are associated with worse OHRQoL among children. Actions towards the improvement of schools' security and the implementation of anti-bullying campaigns should be components of health promotion strategies in the schools with a strong potential to reduce oral health inequalities. Social policies aiming to improve maternal education should also be considered to improve the oral health of children. Hence, the use of OHRQoL measures among children should be promoted to gain an in-depth knowledge about oral health.
We would like to acknowledge Dr. Vikram Pal Aggarwal for helping us with the statistical analysis and providing us with his vital support without which this study was not possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sheiham A. Oral health, general health and quality of life. Bull World Health Organ 2005;83:644.
Luoto A, Lahti S, Nevanpera T, Tolvanen M, Locker D. Oral-health-related quality of life among children with and without dental fear. Int J Paediatr Dent 2009;19:115-20.
Broder HL, McGrath C, Cisneros GJ. Questionnaire development: Face validity and item impact testing of the Child Oral Health Impact Profile. Community Dent Oral Epidemiol 2007;35 Suppl 1:8-19.
Chang FC, Lee CM, Chiu CH, Hsi WY, Huang TF, Pan YC. Relationships among cyberbullying, school bullying, and mental health in Taiwanese adolescents. J Sch Health 2013;83:454-62.
Piovesan C, Batista A, Vargas F, Machado T. Oral health-related quality of life in children: Conceptual issues. Rev Odonto Cienc 2009; 24:81-5.
Centers for Disease Control and Prevention (CDC), Brener ND, Kann L, Shanklin S, Kinchen S, Eaton DK, et al
. Methodology of the youth risk behavior surveillance system–2013. MMWR Recomm Rep 2013;62:1-20.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
Knutson JW. An index of the prevalence of dental caries in school children. Public Health Rep 1944;59:253-63.
Gherunpong S, Tsakos G, Sheiham A. A sociodental approach to assessing dental needs of children: Concept and models. Int J Paediatr Dent 2006;16:81-8.
Yusof ZY, Jaafar N. A Malay version of the Child Oral Impacts on Daily Performances (Child-OIDP) index: Assessing validity and reliability. Health Qual Life Outcomes 2012;10:63.
Feu D, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA. Oral health-related quality of life and orthodontic treatment seeking. Am J Orthod Dentofacial Orthop 2010;138:152-9.
Alwadi MA, Vettore MV. Are school and home environmental characteristics associated with oral health-related quality of life in Brazilian adolescents and young adults? Community Dent Oral Epidemiol 2017;45:356-64.
Arhin DK, Oppong Asante K, Kugbey N, Oti-Boadi M. The relationship between psychological distress and bullying victimisation among school-going adolescents in Ghana: A cross-sectional study. BMC Res Notes 2019;12:264.
Athira S, Jayakumar HL, Chandra M, Gupta T, Dithi C, Anand PJ. Oral health-related quality of life of school children aged 12-17 years according to the child-oral impacts on daily performances index and the impact of oral health status on index scores. Int J Prevent Public Health Sci 2015;1:25-30.
Shabani LF, Begzati A, Dragidella F, Hoxha VH, Cakolli VH, Bruçi B
. The correlation between DMFT and OHI-S index among 10-15 years old children in Kosova. J Dent Oral Health 2015;1:1-5.
Shrestha A, Rao A, Sequeira PS, Shenoy RK. Impact of oral health on daily performance among 10-12 year-old school children in Mangalore. JNDA 2007;16:1-10.
Shyam R, Manjunath BC, Kumar A, Narang R, Goyal A, Piplani A. Assessment of dental caries spectrum among 11 to 14-year-old school going children in India. J Clin Diagn Res 2017;11:ZC78-81.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]